Insulin from individual isolated islets of Langerhans 2. Effect of glucose in varying concentrations.

1. Insulin secretion of individual isolated islets of Langerhans from mice, determined at 15 second intervals, demonstrated a pulsatile pattern. Glucose stimulated increased amounts of insulin to be released from these individual islets. 2. Insulin secretion of individual isolated mouse islets of Langerhans incubated for 5-15 minute intervals showed a direct relationship to concentration. There was negligible "leakage" in the absence of glucose. 3. Serial determination of insulin release from individual islets at 15 sec. intervals also demonstrated augmented magnitude of insulin release in response to increase of glucose in the medium. More important, a pulsatile pattern of insulin release was evident, which may be related to inherent physiological periodicity of islet physiology as also reflected in the pattern of islet electrical activity.


Potassium ions and insulin release.

This article briefly reviews the effects of potassium on insulin release. Omission of extracellular potassium in vitro is followed by a delayed impairment of the release. At low concentrations of potassium, the insulinotropic effect of glucose is reduced in vivo and in vitro. In vivo, high concentrations of potassium increase insulin secretion, but, in vitro, supraphysiological concentrations of the ion first activate and then inactivate the releasing process.


Electrical characteristics of the beta-cells in pancreatic islets.

1. The electrical activity of beta-cells is characterized by a regular burst pattern. 2. The bursts occur in a potential range which is not dependent on external glucose concentration. However, there is a clear dose-response relationship between spike frequency or plateau duration and the glucose concentration. 3. There is a striking biphasic pattern of the electrical activity in response to a sudden and sustained stimulation with glucose. 4. These findings agree well with corresponding investigations on insulin release and strongly support the view that insulin release and electrical activity are directly correlated. 5. Concerning the mechanism of the electrical activity, there is evidence that an electrogenic pump plays an important role in the regulation of the burst pattern and presumably in the regulation of insulin release.


Dynamic characteristics of electrical activity in pancreatic beta-cells. I. - Effects of calcium and magnesium removal.

1. Electrical activity in beta-cells of mouse islets of Langerhans was studied using ultra-fine micro-electrodes. 11.1 mM glucose stimulated electrical activity in bursts of 12 to 24 sec duration, including an active phase, characterized by depolarization and rapid fluctuations of the potential (spikes), and a silent phase when the membrane repolarized. Analysis of the spike frequency distribution during the active phase supports the hypothesis that the spikes result from exocytosis. 2. Calcium removal, in the presence of magnesium, did not alter membrane potential. Burst activity in 11.1 mM glucose was inhibited, and spike activity appeared in some cells. The frequency of these spikes increased as the magnesium was reduced. Re-introduction of calcium induced depolarization and increased spike frequency. 3. Omission of calcium and magnesium reversibly induced depolarization. In 11.1 mM glucose, there was further depolarization, and an altered pattern of electrical activity. Bursts were reversed in polarity, the silent phase being depolarized with respect to the active phase, and duration of reversed bursts was increased while the number of spikes during the active phase was decreased. Caffeine, when added, increased the number of spikes. Re-introduction of calcium and magnesium induced a transient hyperpolarization with suppression of spike activity. 4. Simultaneous reduction of calcium and magnesium to one-half or one-tenth of the control concentration enhanced the overall spike activity in 11.1 mM glucose by shortening or blocking the silent phase between bursts. 5. Quinidine, 0.14 mM, irreversibly inhibited the silent phases of bursts and modified the biphasic electrical response to glucose.


An approach to a molecular understanding of exocytotic insulin release.

By the use of an in vitro insulin releasing system, new insights into the meechanisms underlying the insulin exocytotic process have been gained. It is proposed that insulin release is initiated by glucose interacting with a glucoreceptor on the plasma membrane. Some properties of this receptor are discussed. It is postulated that after initiation of secretion, continued insulin release is under the control of phosphorylated intermediates of glucose metabolism, i.e. glucose-6-phosphate and phosphoenol pyruvate, operating via a membrane-bound protein kinase. The initiation of insulin release by glucose, and the augmentation of this initiation by the above mentioned intermediates, is viewed as a modified cascade system. The cascade theory of insulin secretion is postulated as an alternative to the threshold distribution hypothesis of insulin secretion. The action of tolbutamide in relation to the two pool theory of insulin secretion is discussed.


Preliminary report: effects of female sex hormones on insulin secretion by the perfused rat pancreas.

The effects of progesterone and oestradiol on insulin secretion were studied with the perfused pancreas technic. 1. Progesterone did not affect-glucose induced insulin secretion directly. 2. OEstradiol increased insulin secretion directly.


Control of A and B cells in vivo by sympathetic nervous input and selective hyper or hypoglycemia in dog pancreas.

An extra-corporeal blood circuit was established between the cranial pancreatico-duodenal vein and the portal vein in the dog. Timed measurements of flow, hematocrit, insulin and glucagon concentrations in this circuit were made in order to calculate the secretion rates of insulin and glucagon. The plasma glucose concentration in the pancreatico-duodenal vein was monitored at steady state from 50 to 330 mg/100 ml for periods of 70 min by infusing a saline solution or glucose into the cranio-pancreatico-duodenal artery. No change in peripheral glucose concentrations was detected. 1. When glucose concentration in the PD vein was lowered from 100 mg/100 ml to about 50 mg/100 ml, the basal insulin secretion rate was not modified. When the glucose concentration was increased from 100 mg/100 ml to about 300 mg/100 ml, the insulin secretion rate increased linearly over the range of concentrations tested. 2. Glucagon secretion rate was unmodified throughout the range of glycemia tested. Whereas net pancreatic glucagon secretion rate was not reduced by selective pancreatic hyperglycemia, it was reduced by systemic hyperglycemia at about the same concentration. 3. In atropinized pancreas, low frequency (2 Hz) electrical stimulation of the distal end of the ligated mixed pancreatic nerve caused a mean decrease of 44% in the secretion rate of insulin, and a mean increase of 42% in the secretion rate of glucagon at all PD vein glucose concentrations studied. 4. It can be concluded, therefore, that the sympathetic nervous input at physiological frequencies controls the moment-to-moment secretory activity of the A and B cells of the pancreas independently of the concentrations of glucose.


Insulin secretion by human pancreas cultured for one year.

The pancreas of a child with intractable neonatal hypoglycemia was explanted in tissue culture on plasma clot and in monolayer culture after enzymatic dissociation. 1. Cytological and immunoenzymatic studies of pancreas before explantation showed a very altered structure, suggesting a polyendocrine tumor composed mainly of B cells. Endocrine cells were present in the epithelium of duct-like structures. Large islets were often in continuity with these structures, suggesting islet budding from ducts, and supporting the hypothesis of the persistence of embryonic characteristics. 2. In vitro, the pancreatic endocrine cells survived and proliferated; they were maintained for 362 days. During this time, they maintained their secretory capacity, as shown by radioimmunoassays of the culture media: the cells released insulin in rapidly decreasing amounts, then continued excreting low levels (5 to 60 muU/flask/day), in alternative periods of secretion and absence of secretion. 3. Cytological study by light and electron microscopy of the cells in tissue and in monolayer cultures shows that they can undergo morphological changes, and may become epithelioid, fibroblastoid or round, while retaining their secreting activity. 4. In long-term culture, the cells did not contain typical mature secretion granules. The hormone might be released into the medium by a clasmatosis mechanism. On the other hand, hormone excretion by vesicles originating from the rough endoplasmic reticulum is possible.


Five-year cephalometric study of mandibular ridge resorption with different posterior occlusal forms. Part I. Denture construction and initial comparison.

The average 5 year reduction of the occluding vertical dimension (nasion to menton) for 45 patients was 3.2mm. (2.8 mm. for the anatomic group, 3.2 mm. for the semianatomic group, and 3.6 mm. for the nonanatomic group, each constituting 15 patients). Mandibular physiologic resting face height became foreshortened on the average only one third as much as the morphologic centric occlusion face height. Tabulation of adjustments for sore spots indicated that: the fewest postinsertion appointments were required for the anatomic group of patients; three fourths of 604 denture base alterations were on lower dentures; for upper and lower denture base alterations, one third were made on the borders and two thirds, on the basal seat; one sixth of all alterations were made at routine recall examinations; the fewest upper denture base alterations were for the nonanatomic patients; and the fewest adjustments of the lower denture base on the tissue surface and on the borders were done for the anatomic group of patients. This investigation has been underway for 18 years, and several more re


Significance of the Frankfort-mandibular plane angle to prosthodontics.

Cephalometric information, specifically, vertical facial types and the Frankfort-mandibular plane angle, pertinent to prosthodontics has been discussed. The Frankfort-mandibular plane angle (FMA) is formed by the intersection of the Frankfort horizontal plane and the mandibular plane. This angle can be traced and measured by means of a diagnostic overlay. An FMA of 25 +/- 5 degrees is within normal range. A high-angle patient has an FMA of 30 degrees or more, and a low-angle patient has an FMA of 20 degrees or less. A high FMA is characterized by open-bite skeletal patterns, and a low FMA by closed-bite skeletal patterns. The clinical manifestations pertinent to prosthodontics in high- and low-angle (FMA) patients are shown in Table I. However, not all clinical characteristics are present in a given patient. The classification in Table I is a beginning. The authors consider the prosthodontic study of cephalometrics an unexploited research tool. Hopefully, in the future, it will help to bridge the gap of the biological-technical interplay that is such an integral part of prosthodontics.


Retentive properties of post and core systems.

An investigation was conducted in which different post and core systems were subjected to tensile, shear, and torque forces and their abilities to resist such forces were measured. The following conclusions can be drawn: (1) A post and core unit made of composite resin alone, without the additional retention provided by cemented posts or threaded pins, is the least retentive, and its use should be discouraged. (2) The retention of composite resin cores by four threaded pins compares favorably with other accepted techniques. (3) A round post retaining a composite resin core alone provides poor resistance to torque, but with the addition of threaded pins, its ability to resist displacement improves substantially. (4) The procedure in which composite resins are used to restore the coronal portion of pulpless teeth, with threaded pins and/or posts in the root canal, is reliable.


Exposure of subgingival margins by nonsurgical gingival displacement.

A procedure has been outlined in which (1) gingival displacement is accomplished prior to subgingival tooth preparation and (2) the margins thus created can be very readily registered with commonly used elastic impression materials. Although the technique involves the placement of three cords, the benefits of better visibility and not having to cope with bleeding tissues result in a saving of time during the preparation appointment. The predictability of tissue contours results in fewer remakes and more esthetic and biologically acceptable restorations.


Construction of a maxillary orthopedic prosthesis for simultaneous maxillary expansion and obturation.

An effective means of obtaining maxillary expansion and obturation was presented. By use of split palatal orthopedic prosthesis incorporating a posterior fanscrew with an obturator, two patients showed improved speech, cosmetic appearance, and oral physiology while gaining the desired alignment of the maxillary segments before further surgery.


A study of ceramic-metal restoration process.

The conventional process of ceramic-metal dental restorations has several drawbacks, produces substandard quality restorations, and may result in frequent failures. The lack of adequate development of nonprecious alloys has limited the bond strength between the coping and opaque to only 14,000 p.s.i. The procelain layer oftentimes contains cracks and gas bubbles, making it weak and hence susceptible to failures even during processing. The restorations, ranging from single-unit to full-arch, undergo severe stresses in a person's mouth, and therefore, a high degree of strength is essential. Attempts are being made to improve the present technique to obtain better restorations. Several modifications have been made to the conventional process, and a much stronger alloy-to-opaque bond and a defect-free ceramic layer have been achieved. Since the work on our technique has not been completed, the detailed description and experimental results will be the subject of a future article.


Pathogenesis and treatment of Escherichia coli infections in calves.

Two clearly defined types of E. coli infection are recognised and the factors predisposing and giving rise to pathogenicity are discussed. The mode of action of enterotoxins in the secretary mechanism is thought to be through stimulation of adenyl cyclase activity. Treatment and prevention of the disease is considered in relation to the pathogenesis of the infection.


A prescreening device for cancer of the uterus.

A prescreening device for cancer of the uterus was based on the slower sedimentation rate of cells from a vaginal aspirate in the presence of cancer than in its absence. The apparatus recorded the increase in light transmission through the test tube as the cells fell. This mechanical examination of the rate of fall of vaginal and cervical cells did not diagnose cancer, but it identified the normal specimens free of cancer or infections. The negative specimens comprised the bulk of diagnostic material. There was a small increase in false-negative rate compared with the false-negative rate in standard cytologic tests, but this was counterbalanced by the increase in the number of specimens examined.


Diethylstilbestrol metabolism in food-producing animals.

The metabolic fate of diethylstilbestrol (DES) in food-producing animals is described in this paper. Emphasis is on ruminant animals because DES is currently used in their production. Data presented from recent studies in ruminants show 14C excretion (rates and routes) and distribution after ingestion or subcutaneous implantation of 14C-labeled DES. The chemical nature of the radioactive compounds in excreta and liver is described. In addition, DES metabolism in cockerels and swine and degradation of DES in feces are discussed. The sources of data in this review are published studies, and a limited amount of unpublished data from the author's laboratory are included.


A history of sweeteners--natural and synthetic.

Sweetness for the prehistoric man was the taste sensation obtained from sweet berries and honey. Man's quest for other sweet things led to sucose, starch-derived sugars, and synthetic sweeteners. An unusual source of sweet taste is a West African berry known as miracle fruit (Synsepalum dulcificum). This fruit possesses a taste-modifying substance that causes sour foods--e.g., lemons, limes, or grapefruit--to taste sweet. The active principle was found to be a glycoprotein. Until this time, only small molecules were considered sweet-evoking substances, but now macromolecules are considered capable of participating in taste perception. The intense sweetener of the fruit of Dioscoreophyllum cumminsii, called the serendipity berry, was revealed to be a protein. The intensely sweet principle of Thaumatococcus daniellii, called katemfe, was reported in 1972 to contain two proteins having intense sweetness. Since intensely sweet protein sweeteners act directly on taste buds as a probe, a peptide linkage analogous to the aspartic acid sweeteners may be partly responsible for their sweetness.


Environmental metallic carcinogens: an overview of exposure levels.

Exposure levels of the principal carcinogenic and potential carcinogenic metal and mettalloid pollutants in the environment (e.g., arsenic, beryllium, chromium, nickel, cadmium, and lead) are primarily reviewed with emphasis on their environmental sources both natural and manmade. There is a general paucity of definitive information concerning aspects of material balance and chemical transformations of these elements in various chemical forms in the environment, primarily the atmosphere. Estimates of both exposure levels and risk to populations other than industrial workers of the above metals have been in most instances quite difficult to obtain and generally speculative. The trend for the immediate future appears to be of greater exposure to these metals not only as a result of generally increased usage patterns, but also because of prospective enhanced use of fossil fuels for space heating and electricity generation.


Thenar "H-flap" for fingertip injuries.

Many severe fingertip injuries may be successfully treated by a thenar H-flap (Fig. 3). It is recommended to cover protruding bone in younger patients. The flap must be detached in 10 to 14 days. The use of the H-flap design permits all wounds to be closed between the first and second stages of surgery and leaves a painless, esthetic donor site.


Dressing comparison in the healing of donor sites.

To determine the clinical effectiveness of commonly used impregnated gauze on the healing of donor sites, impregnated dressings (Vaseline, Scarlet Red, xeroform, and hydrophilic petrolatum) were compared to unimpregnated fine mesh gauze of identical weave and porosity. Rate and quality of healing were found to be virtually the same regardless of the dressing used. Plain fine mesh gauze continues to be the most effective, convenient, and inexpensive means of managing donor sites.


Repair of the amputated great toe.

A new method has been introduced to form a functional great toe following amputation. This method has several advantages, especially its simple one-stage operation, which uses a local plantar flap. Results are good from the esthetic and functional point of view. It may be used for traumatic and congenital defects of the great toe. Three cases are presented with illustrations.


Reduction in C3 conversion in patients with severe thermal injury.

Serum opsonic activity for E. coli 075, concentration of native C3 and C3 conversion by inulin were determined in the sera of five patients with burns involving 45% to 80% total body surface during 3 weeks postburn. In all patients, opsonic activity, C3 concentration, and C3 conversion were reduced during the first week following the injury. C3 was restored to normal or elevated levels by the end of the first week postburn and remained normal or elevated thereafter for the duration of the study. In two patients, opsonic activity and C3 conversion were markedly reduced during the entire 3-week postburn period. In the other three patients, opsonic activity was fully restored to normal within 1 week postburn and, in two of these patients, remained normal thereafter for the duration of the study. In the other patient, opsonic activity became reduced again during the third postburn week. C3 conversion in all five patients remained at a low normal or abnormal level during the entire period of study. Addition of normal human serum to the burn sera fully restored opsonic activity to normal but did not normalize C3 conversion. The results suggest that reduced opsonization is related to a deficiency of serum proteins, whereas reduced C3 conversion may be caused by a circulating inhibitor. Both abnormalities were shown to be associated with microbial infections in burned patients.


[Benign, diffuse external otitis].

A review of the literature on benign diffuse external otitis was done to throw light on the problems of pathogenesis, etiological factors, and various forms of treatment. A prospective study done on normal adult ear canals and a prospective study of 26 new cases of benign external otitis was done according to clinical criteria elaborated by Senturia to show that Coly-Mycin Otic is a drug to be recommended in the treatment of this disease.


Temperature gradients and prediction of flap viability.

This study validates a simple clinical method used to determine optimum time for flap transference. Temperature was used as an indirect measurement to determine blood flow. By means of a needle thermocouple, temperature differences in a variety of flaps were measured. Differences between the base and most distal portion from the blood supply were recorded. The method was first developed on the dog  and then applied to patients. It was found that temperature differences of 2.5 degrees C or less insured flap success. Greater temperature differences increased the chance of necrosis.


Chorionic gonadotropin in weight control. A double-blind crossover study.

Two hundred two patients participated in a double-blind random cross-over study of the effectiveness of human chorionic gonadotropin (HCG) vs placebo in a wieght reduction program. Serial measurements were made of weight, skin-fold thickness, dropout rates, reasons for dropping out, and patient subjective response. There was no statistically significant difference between those receiving HCG vs placebo during any phase of this study (P greater than .1).


Diagnosis of cryptococcal meningitis.

In a patient with progressive neurological deterioration, multiple lumbar CSF studies and extensive serological testing failed to demonstrate cryptococcal infection, while a single cisternal puncture produced viable cryptococcal organisms.


Candida precipitins as a diagnostic aid in Candida endocarditis.

We report a case of aortic valve homograft endocarditis secondary to preoperative contamination of the homograft. Candida precipitins, determined by double immunodiffusion, were an invaluable aid in diagnosis in the presence of negative venous blood cultures.


Children of home dialysis patients.

Fifteen children of six families in which one parent was undergoing home dialysis were examined by the Minnesota Multiphasic Personality Inventory, human figure drawings, and family interviews. All the children were found to be clinically depressed, and two thirds had a history of being referred by teachers to school counselors and psychiatrists for behavioral problems in school. Of these referred children, all showed disorders of psychomotor activity and reduced academic achievement. There was no clear-cut evidence that these children were depressed because of exposure to home dialysis per se. The most disturbed children seemed to be responding to depressed parents or to partial object loss. A controlled, prospective study is planned to clarify this question.


Routine blood cultures from febrile outpatients. Use in detecting bacteremia.

Of 565 febrile patients examined in the emergency room of a metropolitan hospital, 210 had blood samples cultured (37.1%). Bacteremia was present in 9 of 86 patients who were admitted to the hospital but in only one of 124 patients who were not admitted (P less than .005). Thus, approximately 5% of febrile adult outpatients had bacteremia, and these patients were usually admitted before the results of the culture were known. Since positive cultures were found so infrequently in patients not admitted and were, therefore, of little value in guiding the treatment of these patients, we conclude that use of routine blood cultures to screen for bacteremia in unnecessary for febrile adult outpatients who are not admitted to the hospital.


Renal transplantation in a Community Hospital.

Eighty renal transplantations were performed at an urban community hospital over a ten-year period. Forty-two transplants were from living related donors and 38 from cadaver donors. The one-year rejection rate for cadaveric transplants was 35% and for transplants between parents and children, 31%, whereas only one of 21 (5%) transplants between siblings was rejected during the first year. These results compare favorably with those reported by others and appear to justify performance of kidney transplantation in the community hospital setting where large numbers of transplant surgeons and nephrologists are involved, and where the number of transplants never has exceeded 15 per year.


Cardiovascular responses of hyperactive children to methylphenidate.

Heart rate, blood pressure, and oxygen consumption were measured in 27 hyperactive children during rest, exercise, and recovery, once taking placebo and again taking methylphenidate hydrochloride. Half were measured first taking the drug and half first taking the placebo. Twenty-three matched controls were also measured twice to test for reproducibility of results. Drug and placebo ECGs were recorded on 12 of the subjects. Oxygen consumption did not change (P = .40), but heart rate (P = .001) and blood pressure (P = .003) increased significantly with methylphenidate therapy. There was a significant correlation between size of dose in milligrams per kilogram and increase in heart rate (.38, P less than .05) and blood pressure (.50, P less than .05 systolic) (.46, P less than .05 diastolic). No evidence of the development of tolerance to these drug effects was found in children who had been taking methylphenidate from two months to more than a year. No ECG changes other than tachycardia were seen.


Relationship of the P loop measurements to pulmonary artery wedge pressure and left atrial volume in pure mitral stenosis.

Frank vectorcardiographic P loops with satisfactory signal to noise ratio were obtained from 28 patients with pure mitral stenosis by using computer-averaging technique of eight successive beats. Twenty-three parameters of the P loop automatically measured were compared with the mean pulmonary artery wedge pressure (mPAW) and the maximal left atrial volume (max. LAV) calculated from biplane angiocardiogram by the area-length method. There was a significant correlation between the m PAW and four P loop measurements. The positive amplitude in lead Z (the posterior component) showed the highest correlation with the mPAW (r=0.54, p less than 0.01). In the multiple regression analysis, the predicted m PAW using eight P loop measurements and the measured m PAW showed a high significant correlation (r=0.86, p less than 0.01). There were significant correlations between the max. LAV and fourteen P loop measurements. The magnitude of spatial maximal P-vector showed the highest correlation with the max. LAV (r=0.86, P less than 0.01). In the multiple regression analysis, the predicted max. LAV using four P loop measurements out of 23 showed the best correlation with the measured max. LAV (r=0.94, P less than 0.01).


Effect of cephalothin on growth patterns of micro-organisms.

Isolates of Staphylococcus aureus, Escherichia coli. Klebsiella pneumoniae and Proteus mirabilis were incubated in the presence of inhibitory concentrations of cephalothin. After destruction of the antibiotic, there was a lag phase before S. aureus began to proliferate again. When similar experiments were conducted with E. coli, K. pneumoniae, and P. mirabilis, no lag phase was observed. This data suggests that the inhibitory activity of cephalosporins may be different for gram-positive cocci and gram-negative bacilli.


Effect of capsular polysaccharide of Klebsiella pneumoniae on Host resistance to bacterial infections. II. Effects on peritoneal leukocytes of normal mice and mice infected with virulent Salmonella enteritidis.

In normal mice, the total count of peritoneal leukocytes was markedly decreased after intraperitoneal (i.p.) injection of the capsular polysaccharide of Klebsiella pneumoniae (CPS-K) depending on the dosage injected. This decrease was mainly due to the depletion of macrophages, and a decrease in the number of lymphocytes occurred to a lesser extent. CPS-K in relatively smaller doses mobilized polymorphonuclear neutrophilic leukocytes (PMN) into the peritoneal fluid but it decreased them transiently in larger doses. In mice infected i.p. with a virulent strain of Salmonella enteritidis, there was an abundant emigration of PMN into the peritoneal fluid. When 200 mug of CPS-K was injected i.p. immediately before bacterial challenge, emigration of PMN was markedly delayed for 48 hr after infection. Associated with this suppressed emigration of PMN, the numbers of macrophages and lymphocytes in the peritoneal fluid were significantly less in mice treated with CPS-K than those in untreated control mice for 48 hr after infection. The numbers of both cell-associated and extracellular bacteria in the peritoneal fluid were markedly greater in mice treated with CPS-K than those in untreated control mice. In both in vivo and in vitro experiments, ingestion of bacteria by macrophages and PMN was not blocked by CPS-K or neutral CPS-K, the active substance responsible for the infection-promoting effect of CPS-K. It appeared that CPS-K somehow impaired the intraphagocytic bactericidal activity.


Ineffectiveness of lipopolysaccharide for preventing the tolerance induction in bone marrow-derived lymphoid cells with dinitrophenyl-poly-L-(glutamic acid, lysine).

The effect of endotoxin or lipopolysaccharide (LPS) on tolerance induction in bone marrow-derived lymphoid cells (B cells) was investigated. Dinitrophenylated amino acid copolymer-L-(glutamic acid, lysine) (DNP-GL) acts as a potent tolerogen on normal and DNP-primed B cells. LPS significantly enhanced the anti-sheep red blood cell plaque-forming cell (anti-SRBC PFC) response that occurred after the immunization with a low dose of SRBC. LPS did not induce the primary anti-DNP PFC response after the injection of DNP-GL, nor did it prevent the tolerance induction in normal and DNP-primed B cells that occured after the administration of DNP-GL.


[Microsurgical release of subretinal fluid in retinal detachment. Report on 200 cases (author's transl)].

When the incision of the sclera, suprachoroidea and choroidea is performed under the microscope step by step, the release of subretinal fluid becomes an absolutely controlled microsurgical procedure. When employing this technique, one can avoid complications related to the injury of choroidal vessels, especially if one uses transillumination with fibre-optics during the perforation of the choroid. A further useful tool for drainage is a sclerotomy retractor which allows the spreading out the edges of the sclerotomy--wound by grasping the loops and pulling them aside of a pre-placed Mendoza suture. As the retractor does not engage the sclera directly but only with the aid of the pre-placed suture, it is possible to observe the operation field without any hindrance from the instrument and to perform microsurgical incision of the chroid at any desired point.


[Corneal astigmatism after penetrating keratoplasty with direct and indirect sutures (author's transl)].

After a full thickness optic keratoplasty the corneal astigmatism of 116 eyes was checked. 72 cases had been operated on with indirect, 44 with direct sutures. Up to the sixth month after the operation the astigmatism was found to be equally distributed between 0.75 and 12 dpt and until the end of the second year between 0.75 and 8 dpt. Neither the way of suturing nor the diameter of the graft nor the kind of corneal lesion had any influence on the postoperative astigmatism. After six months, the height and the axis of the astigmatism remained approximately constant; however, in four cases of keratokonus followed up for nineteen years the astigmatism gradually increased.


[Ocular manifestation of subacute sclerosing panencephalitis (SSPE) (author's transl)].

A case history of a patient with subacute sclerosing panencephalitis (SSPE) is presented with emphasis on the initial ocular manifestation of the disease. Acute necrotising retinitis was found clinically and proved histologically. Clinical and histological findings are compared with reports in the literature.


[Observations on the treatment of glaucoma with clonidin (author's transl)].

Observations on 50 patients treated for up to 2 1/2 years with clonidin revealed very variable side-effects. A large proportion of these patients remained free from side-effects. In a second, bigger group the side-effects decreased so markedly during the treatment, that this drug could be used again. The effects of this drug on the patients are reported in each case.


[Clonidine as ointment (author's transl)].

From 15 eyes in 12 patients with chronic simple glaucoma a comparison of the IOP-diminishing effect between 1 drop 0.25% aqueous solution of Clonidine and a 2 cm long application of 0.2% Clonidine-ointment was made with special regard of local and general side effects, especially on the blood pressure. The reduction of the IOP and the blood pressure was greater and of longer duration after ointment application has a definite depôt-effect. Older patients should be fully digitalized beforehand in order to support the cardiovascular system during Clonidine application.


[Bivalent glaucoma therapy with pilocarpine and adrenaline - advantages of the combination piladren (author's transl)].

A comparative trial was performed on 56 glaucomatous eyes - piladren gave usually a better pressure-reducing effect than pilocarpine alone or pilocarpine and epinephrine/adrenaline from separate bottles. The main possibilites of medical glaucoma therapy are mentioned and subjective and objective advantages and disadvantages are communicated.


Immunologic and cytochemical cell markers in non-Hodgkin's lymphomas.

Lymph nodes were obtained from 28 patients with non-Hodgkin's lymphoma and 24 patients without hematologic malignancy. Cases of undifferentiated lymphoma, diffuse histiocytic lymphoma, diffuse and nodular mixed histiocytic-lymphocytic lymphoma, nodular poorly differentiated lymphocytic lymphoma, and diffuse well differentiated lymphocytic lymphoma were analyzed. Touch preparations were stained for nonspecific esterases, peroxidase, Sudan black B activity and with periodic acid-Schiff and Wright-Giemsa reagents. Mononuclear cell suspension from lymph nodes and, in some cases, peripheral blood were tested for spontaneous rosette formation with sheep erythrocytes and for the presence of surface immunoglobulin. The remainder of the lymph node was examined after staining with hematoxylin and eosin. Analysis of the lymphocyte surface markers indicated that 15 cases of various histologic types of lymphoma were B cell proliferations. However, three out of four cases of diffuse poorly differentiated lymphocytic lymphoma and one of seven cases of diffuse histiocytic lymphoma appeared to represent T cell neoplasia. Lymph nodes from four cases of lymphoma representing diverse histologic types were replaced by neoplastic cells devoid of discernible cell markers. In five cases, the distribution of cell surface markers in the malignant lymph node failed to differ from data obtained in the analysis of non-neoplastic lymph nodes. The study indicates that the histopathologic entities recognized in the currently employed classification of lymphoreticular malignancies are heterogeneous. Alterations in the distribution of cell surface markers in the peripheral blood from five of 12 patients indicated involvement prior to demonstrable morphologic evidence of peripheral blood involvement in four patients and bone marrow infiltration in two patients.


[Studies on the pituitary-testicular axis in male patients with chronic renal failure with different glomerular filtration rate (author's transl)].

In 32 male patients with chronic renal failure (age 22-60 yrs), of which 17 showed a creatinine clearance below 20 ml/min (group I) and 15 above 20 ml/min (group II), plasma levels of total testosterone (T) and total oestradiol-17beta (E2) were measured before and after stimulation with HCG i.m. LH and FSH were evaluated before and after stimulation with LH-RH i.v. Additionally, testosterone binding capacity (TeBG), free testosterone fraction (%FT) and "absolute" free testosterone (AFT) were determined. In comparison with normal persons T was clearly reduced before and after HCG in group I, whereas in group II it was reduced only after HCG. E2 showed normal basal values in both groups, but in group I it was decreased after HCG. Except for LH values after stimulation in group II, both groups showed increased LH and FSH levels before and after LH-RH in comparison with controls. TeBG and %FT did not show any changes in either group, whereas AFT was reduced in both of them. Comparing the results of group II and I we found in the latter decreased values for T before and after HCG and for E2 after HCG as well as decreased values for AFT, whereas LH and FSH before and after LH-RH were increased. There existed no significant correlation between any of the parameters T, AFT and E2 on the one hand and LH and FSH on the other hand. Significant correlations are found between creatinine clearance and T, AFT, LH and FSH. The results indicate a primary defect of the testis which gradually depends on the degree of renal insufficiency, but with well working feed-back mechanism. The possibility of an additional central regulation defect in the sense of a relative autonomy of the hypophyseal gonadotropin secretion is discussed.


The fate of subepithelial deposits in acute poststreptococcal glomerulonephritis.

The resolution of subepithelial deposits was studied by electron microscopy in 17 biopsies from five patients (mean follow-up 2.8 years) with clinically and histologically resolving acute poststreptococcal glomerulonephritis. The electron-dense subepithelial deposits were present in biopsies obtained 45 days or less after onset. By 30 to 45 days after onset, the dense deposits had decreased in number, and there appeared electron-lucent subepithelial deposits, areas suggestive of foci where deposits had recently been resorbed, as well as lucent deposits covered by a layer of lamina densa-like material (intramembranous deposits). These developments indicate that some of the subepithelial dense deposits had been completely resolved, that some were resolving, and that some had been transformed into intramembranous deposits. The resolution appeared to take place both from a continuous loss of electron microscopically invisible components of deposited material and through a removal of larger fragments of the deposits by epithelial vesicles. The intramembranous deposits persisted in all but one patient during the entire time of follow-up. The findings indicate that membranous changes--although mild and segmental--develop regularly in acute poststreptococcal glomerulonephritis and that they constitute a normal phase in the resolution of the subepithelial deposits. The absence of progressive membranous changes in these patients can probably be attributed to the short time during which immune complexes are deposited in the glomeruli.


Innumoelectron microscopy of the human chorionic villus in search of blood group A and B antigens.

The chorionic villi of placentas, 10 to 40 weeks of gestation, were examined for A and B blood group antigens with an immunoferritin technique. No specific ferritin attachment was shown on the plasma membrane of the villous trophoblasts. Furthermore, after trophoblast cell-surface mucosubstances (perhaps the barrier of the placental antigenicity, according to some authors) were digested with several enzymes, such as neuraminidase, hyaluronidase, chondroitinase ABC, pepsin, trypsin, and pronase, no ferritin tagging was observed on the plasma membrane of the villous trophoblasts. We have concluded that our failure to detect the A and B blood group antigens was not due to the masking of antigens by mucosubstance coating the trophoblasts, but was due to the intrinsic deficit of those antigens in the plasma membrane of the human trophoblasts.


The stutterer as a character in contemporary literature: a bibliography.

This 27-item bibliography includes contemporary novels, biographies, short stories, and plays in which there are characters who stutter. Several aspects of how stutterers are depicted in these works are described.


Topography of outer membrane assembly in Salmonella.

The topography of lipopolysaccharide insertion into the outer membrane of Salmonella is discussed in context with a review of recent findings pertaining to general properties of the outer membrane, such as asymmetry and lateral mobility of surface components.


Cell shape changes and transmembrane receptor uncoupling induced by tertiary amine local anesthetic.

Tertiary amine local anesthetics (dibucaine, tetracaine, procaine, etc.) modify cell morphology, concanavalin A (Con A)-mediated agglutinability and redistribution of Con A receptors. Con A agglutination of untransformed mouse 3T3 cells was enhanced at low concentrations of local anesthetics, and the dynamics of fluorescent-Con A indicated that ligand-induced clustering was increased in the presence of the drugs. In contast, these drugs inhibited Con A-induced receptor capping on mouse spleen cells. These effects can be duplicated by combinations of vinblastine (or colchicine) and cytochalasin B suggesting that local anesthetics act on microtubule and microfilament assemblies which are involved in the trans-membrane control of cell surface receptor mobility and distribution. It is proposed that tertiary amine local anesthetics displace plasma membrane-bound Ca2+, resulting in disengagement of microfilament systems from the plasma membrane and increased cellular Ca2+ concentration to levels which disrupt microtubular organization. The possible involvement of cellular Ca2+ in cytoskeletal destruction by local anesthetics was investigated utilizing Ca2+-specific ionophores A23187 and X537A. In media containing Ca2+ and cytochalasin B these ionophores caused effects similar to tertiary amine local anesthetics.


Relationship of causative factors in spontaneous regression of cancer to immunologic factors possibly effective in cancer.

In a book written by Everson and Cole (1966) on  spontaneous regression 176 examples of the phenomenon were encountered in the medical literature from 1900 to 1964, supplemented by cases referred by friends. No common denominator of explanations were found. Various types of trauma (e.g., biopsy, incomplete excision), transfusions, infection, hormone changes, drugs, etc. were encountered as possible causative factors. Most significant of all factors was encountered in the 13 examples of spontaneous regression of the bladder; in this series regression of the tumor occurred in 10 after transplantation of the ureters out of the bladder. A consideration and discussion of various reactions in human beings associated with therapeutic regressions have been reviewed hoping to develop a correlation between the two types of regression. At the time of publication of our monograph 9 years ago we were unable to suggest any mechanisms which might explain the regressions. However, since that time so many advances have been made in immunology that it appears now that a stimulation of the immune process might explain most of the regressions. We are just beginning to learn a few methods of stimulating the immune process. Use of BCG is one of the best examples of this stimulating process; other bacterial agents, or fractions, are known to have this action. No doubt there are innumerable others unknown, some of which might explain spontaneous regressions. It would appear that hormonal changes might be responsible for many of the regressions but this author doubts it explains many. More is known at the present time about cellular immunity than humoral immunity, but greater possibilities surely lie in humoral immunity. The blocking and unblocking activities developed by the Hellströms and associates are no doubt important. Immunoglobulins exert a very important role in the immune process; antibodies may consist of immunoglobulins but much more needs to be known before this relationship can be understood. The recent report (Amery, 1975) that levamisole (given at the time of resection of the lung for carcinoma) improves patient survival is exciting. Amery believes the drug may prevent the hematogenous spread of the tumor during surgery and/or may decrease the immunosuppression caused by a major operation.


Adenosine-aminohydrolase activity in the erythrocytes, lymphocytes, and plasma of healthy subjects and kidney transplant recipients.

Adenosine-aminohydrolase activity in the red blood cells and lymphocytes of transplant patients were assayed by continuous flow analysis. This enzyme, which has been implicated in the ability of lymphocytes to mount an immune response, was evaluated in renal allografted patients immunosuppressed by azothiprine and methylprednisone. Red cell  adenosine-aminohydrolase activity was depressed in all patients when compared to nontreated health controls. Adenosine aminohydrolase activity was raised in the lymphocytes of the renal allografted patients. Renal transplant patients' in vitro lymphocyte reactivity to antigens, mitogens, or skin testing to specific antigens, confirmed the depressive effects of immunosuppression observed in vivo. We conclude from these studies that red cell adenosine-aminohydrolase activity may be a more sensitive index of the state of immunoresponsiveness than the corresponding enzyme activity in the lymphocyte.


Metastatic patterns of cancers of the lymphopoietic system in man.

Autopsy records are analyzed for 358 patients with reticulum cell sarcoma, lymphocytic lymphosarcoma, or Hodgkin's disease. These records belong to a series of 4,728 autopsy records collected by the Department of Pathology at Roswell Park Memorial Institute from 1957 through 1965. This paper analyzes the distribution of metastases at specific sites in 3 malignant lymphomas. The concept of soil specificity is discussed in connection with the excess of metastases at specific sites. Soil specificity is defined as a higher than expected occurrence of metastases due to a cancer in an organ when compared to other similar primary cancers. In some instances, however, the excess of metastases in a specific site was sometimes also related to the site of origin of a malignant lymphoma. Entire series of organs located either in the abdomen or pelvis showed metastatic patterns which were very likely related to the primary sites of origin. The metastatic patterns of lymphocytic lymphosarcoma and reticulum cell sarcoma appeared to be markedly different from those of Hodgkin's disease. Reticulum cell and lymphocytic lymphosarcomas were not only more widespread than Hodgkin's disease, but the patterns of abdominal and pelvic metastases strongly suggested either their multifocal origin or a different sequence of events in the seeding of lymph node areas, as compared to those of Hodgkin's disease. The relationship between the degree of anaplasia of certain lymphomas and blood-borne metastases is discussed.


Some factors involved in the skin flap delay phenomenon.

The use of skin flaps for reconstruction following extensive ablative surgery in the head and neck area has played a major role on the improvement of the results being attained. Using the pig as an experimental animal various factors of flap orientation, skin incisions and flap undermining were investigated. Results confirmed the ineffectiveness of incision alone as a delay maneurver and suggested that anatomical orientation of cutaneous skin flaps was not of crucial significance. The complete mechanism of the positive effects of delay remains undefined.


The use of procarbazine hydrochloride versus cyclophosphamide in donor pretreatment in cadaveric renal transplantation.

During a prospective study, 13 patients received renal transplants from cadaveric donors whose hearts beat up to the time of their death. These donors were pretreated with cyclophosphamide-methylprednisolone (group A) or methylprednisolone-procarbazine hydrochloride (group B). After a minimum follow-up of 12 months, all grafts in group A but only one graft in group B survived. On the basis of this small experience, the combination of cyclophosphamide and methylprednisolone seems to be superior to that of methylprednisolone and procarbazine hydrochloride in reducing allograft immunogenicity. In order to achieve longer survival of the graft in the recipient, pretreatment with procarbazine hydrochloride has been discontinued. Pretreatment of the potential cadaveric allograft donor with cyclophosphamide and methylprednisolone is being continued at our institution.


Management and prognosis of multiple myeloma.

Patients with asymptomatic or smoldering multiple myeloma should not be treated but should be observed closely for progression. For symptomatic myeloma, chemotherapy is indicated. Melphalan, the agent of choice, should be given with prednisone for 1 week of every 6 weeks, If melphalan brings no response, or response and then relapse, cyclophosphamide (Cytoxan) should be give intravenously every 4 weeks or orally every day. BCNU, CCNU, and doxorubicin (Adriamycin) have also shown activity in myeloma. Hypercalcemia occurs in one-third of patients and should be countered with hydration, corticosteroids, Neutra-Phos, or mithramycin. Long-term hemodialysis has achieved some success. The combination of sodium flouride and calcium carbonate produces new bone formation; it seems a useful adjunct in treatment for myelomatous bone disease. Radiation should be utilized only for severe, localized pain or for solitary lesions. Survival with multiple myeloma varies, mean durations being 2 to 3 years. Multivariate analysis indicates that serum creatinine and calcium levels are the most significant indicators regarding 2-year survival. We have found monoclonal proteinuria not significantly more frequent with renal insufficiency than with normal renal function, renal insufficiency not significantly more frequent with lambda than with kappa chains, and survival not significantly greater with IgG myeloma than with IgA.


[Stereotactic brain operations in intractable pain (author's transl)].

The indications for central stereotactic procedures in chronic painful states are essential neuralgia, postherpetic neuralgia, anaesthesia dolorosa, causalgia, phantom-limb pain, the thalamic syndrome and pain neoplastic diseases. Stereotactic surgery applied for these conditions consists of nucleotomy of the tractus spinalis nervi trigemini, mesencephalotomy, thalamotomy, hypophysectomy, psychosurgical interventions, and chronic stimulation with implanted electrodes. The techniques and results of the interventions are reported.


[Colonic diverticulitis: diverticulitis with complications and its treatment (author's transl)].

Complications (stenosis, intestinal obstruction, abscess or fistula formation, inflammation, etc.) of colonic diverticulitis are seen in 35% of patients affected. Multiple operative procedures involve less risk than surgery performed in a single session. The mortality in emergency surgery is reported to be up to 40%, while subsequent resection of the diseased colon involves the usual mortality of surgery on the colon, i.e. 1.5-9%. The vital factor in this illness is the earliest possible surgical treatment of the diseased diverticulum, so that the extremely problematical complications can be avoided.


[Early resection in diverticulitis (author's transl)].

The danger with diverticulitis is that the disease may progress to life threatening complications. The development of diverticulitis leads from local infiltration and fibrosclerosis to final perforation. Nonresected diverticulitis favors the development of diverticulosis proximal to the affected bowel. Conservative therapy seems to be of little use in avoiding the progression of recurring diverticulitis. Signs of irreversible diverticulitis are repeated attacks, signs of local peritonitis, fixed deformation of the wall and stenosis, revelaed by barium enema. One-stage resection was performed in 101 patients for uncomplicated diverticulitis. There was one death (myocardial infarction).


[Interaction between the systems involved in fast pain perception and in slow, persistent pain (author's transl)].

A single pinprick triggers both a pang, the "1st pain" and after a pause of 0.5 s, a spreading burning feeling, the "2nd pain". The 2nd pain is delayed because it is conducted by unmyelinated C-fibers at a rate of less than 1 m/s, 20 times slower than conduction of the 1st pain. In the spino-thalamic tract the myelinated fibers of the 1st pain conduct much faster than those of the 2nd pain, and terminate in the parvocellular ventroposterior (VP) thalamic nucleus, which projects to area 3b in the postcentral gyrus. The slow C-fibers of the 2nd pain terminate in cortex-independent thalamic nuclei like limitans, which project to the outer segment of the pallidum. This subcortical pain pathway is disinhibited after destruction of the cortical pathway of the 1st pain, so that the patients suffer from spontaneous agonizing pain feeling (thalamic pain). Unbearable pain in cases of thalamic softening, in anaesthesia dolorosa and in phantom pain can be relieved by stereotactic coagulation of the thalamic nuclei involved in the 2nd pain. Normally they are inhibited by the cortical pathway of the 1st pain.


Microscopic antrostomies in children: a review of the literature in chronic sinusitis and a plan of medical and surgical treatment.

Potential complications, morbidity, treatment failures and "nasal cripples" make one cautious about advising radical sinus surgery. Though antibiotics have greatly reduced the need for radical surgery, some patients do not respond to conservative treatment. Reviewed is pertinent literature concerning treatment of chronic, refractory sinusitis in children, particularly intranasal antrostomy. Medical treatment for chronic sinusitis precedes surgical intervention. Allergic history, nasal cytology and radiographic examination are essential. Since principles of adequate surgical drainage and ventilation have long been established, controlled antrostomy procedure is done with the aid of the operating microscope, creating a nasal mucosal flap. A new instrument is presented---a self-retaining stabilized retractor speculum which allows adequate visualization with the microscope while protecting the mucosal flap and freeing both hands for the procedure.


Alternatives in nasal reconstruction ("five flaps and a graft").

Five pedicle flaps and one auricular composite graft deserve increased use and attention in nasal reconstructive surgery. All have in common the high possibility of superior functional and esthetic results while requiring the payment of a minimum penalty of tissue sacrifice. A composite graft of conchal cartilage and adherent post-auricular skin serves well in the saddle nose deformity of childhood, creating satisfactory tissue augmentation and recreating cartilaginous support for the airway. The sublabial mucosa of the upper lip provides superior tissue for pedicle flap repair of nasal septal perforations. Tunneled through  a small oronasal fistula, the flap is elevated and transposed as a one-stage procedure. No closure of the donor site is required. Forehead flaps derived from the precise midline or the non-hair-bearing bay of forehead skin (the sickle flap), are useful, non-delayed flaps carrying considerable tissue of superior color match to nasal defects. A major advantage is the excellent camouflage possible at either donor site area. When nasal reconstruction of greater dimensions becomes necessary, the scalping flap is advantageous. Flap reliability is of a high order, and flap blood supply is unequaled.


Unusual otologic manifestation of chronic lymphocytic leukemia.

The first reported case of a patient with chronic lymphocytic leukemia, who 14 years after diagnosis developed bilateral symmetrical ear lobe swelling secondary to lymphocytic infiltrates and its management, is presented. The various otologic and specific skin manifestations of leukemia are discussed and the literature reviewed. The temporal bone findings take the form of leukemic infiltrations, inflammation, and hemorrhage. These may present as a red or thickened tympanic membrane, hemotympanum, exudates in the middle ear, acute otitis media, mastoiditis, conductive or sensori-neural hearing loss, dizziness, vertigo or facial paralysis. The specific skin manifestations take the form of nodules, papules, infiltrations, plaques, ulcerations and exfoliative erythroderma. These may present as skin lesions most commonly in the head and neck area, rarely presenting in the auricle and ear canal.


Infrabrow lift.

The infrabrow lift is presented as a specific method to correct skin redundancy between the eyebrow and upper lid. Indications are outlined which differentiate this technique from the suprabrow surgical approach. The surgical technique is discussed. Esthetic results have proven most satisfactory.


"Practical suggestions in facial plastic surgery--how i do it." "Threading" augmentation for facial wrinkles.

For hundreds of years various types of sutures and threads have been placed in the human body by surgeons. The technique of thread augmentation involves the use of colorless absorbable (Vicryl) and non-absorbable (Neurolon) suture material on a long, straight Keith needle tunneled subdermally beneath prominent facial wrinkles in an effort to make the deep grooves less severe and to augment atrophic areas about the lips and oral commissures. This may be done as an isolated procedure or as an ancillary procedure at the time of a blepharoplasty or cervicofacial rhytidectomy.


Chronic pulmonary histoplasmosis.

Chronic pulmonary histoplasmosis is best regarded as an opportunist or saprophytic infection of abnormal pulmonary spaces by a fungus of very low human pathogenicity. Tissue disease results from host immune response to dispersions of soluble antigen from these focal sources. There are two distinct types of clinical and radiological response. One is an acute or subacute illness manifested by often large segmental pneumonic lesions which tend to heal and are designated as early lesions. The other, usually developing as a complication of the first, is a chronic disease marked by persistent cavitation, low gard chronic illness, and a tendency to promote pulmonary fibrosis and often progressive pulmonary insufficiency. The early lesion is a segmental interstitial pneumonitis with central areas of infarct-like necrosis often adjacent to bullous disease and often outlining prominent emphysematous spaces which appear as radiolucencies. These radiological findings are further characterized by early clearing of the interstitial components, infarct-like contraction of the necrotic zones, obliteration of much of the contained emphysematous and bullous spaces, and healing attended by considerable loss of lung volume. Symptoms are variable but tend to be mild. Malaise, fatigability, low-grade fever, aching chest pain and mild cough lasting a few days to a few weeks are usual. Symptoms are ameliorated by rest. Rest and diminished activity are recommended as treatment. Under these circumstances, 80% of early lesions heal completely and probably most of these would heal spontaneously. Any subsequent course of the disease depends on whether or nor large air spaces, adjacent to or contained within the area of pneumonitis, become infected and persist as cavities. This occurs in 20% of early lesions. Once established, an infected cavity tends to persist and to be attended by symptoms of chronic bronchitis with chronic cough and sputum, fatigability, anorexia, and weight loss. Persisting thickwalled cavities often induce gradual development of pulmonary fibrosis, particulary in the lung bases, apparently from aspiration of antigenic material. This and the accelerated obstructive bronchopulmonary disease often lead to progressive pulmonary insufficiency. The use of amphotericin B is recommended for all persistent thick-walled cavities and in some circumstances surgical resection may be indicated.


Infective endocarditis and access site infections in patients on hemodialysis.

Infective endocarditis has been a subtle and very often lethal complication of hemodialysis. Thirty-five episodes have been described to date. Antecedent infections, particularly those involving the access site, access manipulation, and dental work appear to predispose to IE. Once IE is acquired, factors associated with mortality are involvement of two or more valves, infection caused by enterococci, antecedent infection, steroid therapy, infection in the first year post-access insertion and patient age over 46. The incidence of access infection with the arteriovenous fistula is significantly less than that associated with the arteriovenous cannula. Staphylococci are the most common organisms in access infections and in IE. Gram-negative bacilli and particularly Pseudomonas aeruginosa are a frequent cause of access infection but an unusual cause of IE. Access removal may be madatory in the successful management of IE in patients on hemodialysis.


Candida meningitis. Report of seven cases and review of the english literature.

Seven patients with Candida meningitis are reported. These 7, plus 21 previously cited cases, were reviewed. This infection arose by two distinct mechanisms: hematogenous dissemination and direct inoculation. Recent antibiotic therapy, corticosteroid administration and severe underlying diseases were important predisposing factors. Fever, meningismus, elevated CSF pressures and localizing neurologic signs were commonly noted. Organisms were seen on gram-stain of CSF in only 43% of cases. Mortality rate in patients receiving inadequate or no antifungal therapy was high (greater than 90%), while those patients given appropriate antifungal drugs, especially intravenous amphotericin B, had a significantly lower mortality rate (38%). Several factors associated with poor prognosis were delineated in this study: diagnostic interval after symptomatic onset longer than two weeks, CSF glucose levels below 35 mg/100 ml and presence of intracranial hypertension and focal neurologic deficits.


Cadmium and zinc sensitivity and tolerance in Klebsiella (Aerobacter) aerogenes.

The resistance of strains of K. aerogenes NCIB 418 'trained' to Cd2+ or Zn2+ in liquid medium is graded to the training concentration. Training to Cd2+ increased the sensitivity to Zn2+ but training to Zn2+ reduced the sensitivity to Cd2+. The trained organisms, particularly those trained to Cd2+, grow slowly in medium containing the metals and the growth rates after 20 and 200 subcultures were not significantly different. The survival of untrained organisms on Cd2+-agar decreased progressively as the Cd2+ concentration was increased, but a threshold concentration of Zn2+ was necessary before any decrease set in. Very low concentrations of Zn2+ potentiated the lethal action of Cd2+ and vice versa, whereas chelating the metal ions with citrate, aspartate or gluconate eliminated it. Nutrient-limitation, as might occur in natural environments, also had a profound effect. Mg2+-limited organisms were particularly resistant to both metals whereas glucose-, NH+4 and PO3-4-limited organisms were very sensitive to Cd2+, and glucose- and K+-limited organisms to Zn2+.


The butanol-soluble proteins of Klebsiella aerogenes.

Membranes of Klebsiella aerogenes were extracted with acid butanol at pH 4.2 and the solubilized proteins were fractionated by precipitation at 0 degrees C and -20 degrees C. The -20 degrees C precipitate was examined by polyacrylamide gel electrophoresis in sodium dodecyl sulphate. Several enzyme activities associated with polysaccharide biosynthesis have been identified in the crude -20 degrees C precipitate and an attempt was made to separate the enzymes from other protein. The role of certain of these enzymes in a control mechanism for polysaccharide synthesis in K. aerogenes has been postulated.


Double-blind cross-over evaluation of mazindol in the treatment of obese hypertensive patients.

The effect of mazindol (AN 448) on weight and blood pressure was evaluated in a double-blind cross-over trial in 28 obese hypertensive patients, whose blood pressure was under stable control with one or more of the common antihypertensive agents--diuretics, beta-blocking drugs and methyldopa. There was a statistically significant decrease in weight, but no significant change in blood pressure (systolic and diastolic) or pulse rate during active treatment. It was considered that the drug might be of benefit to some patients, provided that they were properly motivated to adhere to the dietary regime.


The role of delayed primary wound closure in the prevention of wound sepsis after appendicetomy.

In a personal series of 100 consecutive appendicectomies, not a single case of postoperative wound sepsis occurred. It is believed that the use of delayed primary wound closure in those patients (22%) in whom the risk of such infection was high was the main reason for this result. The technique of delayed primary wound closure is described.


Inhalation of fenoterol (Berotec) by asthmatic children: A clinical comparison with salbutamol, orciprenaline and isoprenaline.

Fenoterol (Berotec) has been administered by inhalation, via a Bennett nebulizer, to symptom-free asthmatic children aged 6 to 14 years. The effects of treatment on the results of respiratory function tests, pulse rate and blood pressure were followed. The effects of fenoterol have been compared with those of placebo, salbutamol, orciprenaline and isoprenaline. Inhalation of 1 mg of fenoterol produced effective bronchodilatation, which was more than a placebo effect and was comparable with the responses achieved with other known effective bronchodilators given by inhalation. It produced only a minor increase in heart rate at this dose level.


Problems associated with the use of drugs administered by intermittent positive pressure ventilation.

There has been an increase in the use of drugs administered by intermittent positive pressure ventilation over recent years. There are a number of problems association with this type of therapy including variable and inadequate absorption of drugs and the possibility of nosocomial infections. A number of precautionary measures are suggested to minimize these problems.


Complications of intravenous therapy.

A survey of 130 patients receiving intravenous therapy was undertaken. There were no instances of speticaemia over this period, despite a positive bacterial culture rate for cannulae of 48%. The incidence of phlebitis was 31%, and was associated with usual physicochemical factors. These included a cannulation time of greater than two days, an intravenous potassium supplement and antibiotics. Normal saline solutions given alone were associated with a lower incidence of phlebitis and continuous intravenous heparin administration may prolong the period of cannulation before phlebitis occurs. The institution of intravenous therapy teams should help to minimize the complications.


[The definition of heart failure with the product of minimal transit time and heart frequency (author's transl)].

The product of minimal transit time (MTT) and heart frequency (HF) defines the number of heart beats which are necessary to transport the blood in a determined region of the circulatory system. According to own studies in physiological (stress) and pharmacological conditions this product is constant, independent from body size, length, age etc. In proportion to the degree of heart failure the MTT X HF increases. Measuring appropriate regions of the circulatory system, right and left heart failure can easily be determined. The method has the advantage of a noninvasive procedure and gives exact quantitive accessment of the pump performance of the heart. In view of the increasing use of radio-nuclides this procedure can be recommended because of its good reliability causing little or no discomfort to the patient, and making it applicable, even under extreme conditions, for instance in a CCU.


[Clinical experience with Encephabol (author's transl)].

The author reports on a clinical study with the neuro-dynamic agent Encephabol (pyritinol, pyrithioxine) in a total of 317 patients with organic psychosyndrome of various genesis. The therapeutic effect obtained is related by the author to the mode of administration used (oral, parenteral and combined), to the dosage, and duration of treatment, and is discussed.


Reading devices for blind people.

An account is given of the social, economic, and technical factors surrounding the development of reading aids or devices for blind people. It is shown that these factors interact in such a way as to seriously constrain the approaches that can be made to device design. The progress being made in the research, development, and deployment of several types of reading devices is described to illustrate how the various constraints have affected the design goals and methods of deployment. Emphasis is laid on the development of reading machines with voice output because, ultimately, they are the most likely types of devices to be widely accepted by the blind. Looking ahead to full deployment of such devices before the end of this decade, the paper concludes with a summary of the research, development, and organizational needs that must be met.


Biomaterials and biocompatibility.

This review attempts to assess the present status of biomaterials, especially in relation to their interaction with tissue. The terms biomaterial and biocompatibility are defined and both the present areas of clinical application and the requirements of biomaterials for these applications discussed. The types of biomaterials in clinical use and those under development are briefly described. Problems associated with implant functionality are covered, dealing with fatigue, wear and membrane permeability. Of more importance are the problems relating to biocompatibility and metallic corrosion, polymer and ceramic degradation, local tissue changes, systemic effects, infection, implant loosening, blood compatibility and the assessment of biocompatibility.


International standard (C.C.I.T.T.) for transmitting biomedical analogue and digital data on the public telephone network.

Analogue transmission of biomedical signals over the public telephone network has advantages from the economic point of view over digitalized transmission. This paper deals with the special problems encountered with the transmission of biomedical signals. Furthermore, the new international transmission standard C.C.I.T.T. recommendation V. 16 is introduced. This standard has recently been adopted by the relevant study group and has been presented to the Plenary Assembly of the C.C.I.T.T. for final approval. This standard is compatible with the existing public telephone networks. The technical specifications of this standard allow the transmission of the three-channel ECG for diagnostic purposes, e.g., remote processing and computer-assisted evaluation, as well as the transmission of the one-channel ECG with acoustic coupling, e.g., in emergency cases and for pace maker monitoring.


Medical applications of analogue and digital telephone data links.

The increasing use of digital computer techniques for the analysis of signals such as the EEG, ECG, plethysmograms and cardiac output curves has led to the use of multichannel analogue frequency modulation telephone data links in the forward direction from the patient to the computer and digital links in the return direction. Single-channel analogue links are also being used for the surveillance of cardiac pacemaker patients and the television Viewphone offers the possibility of a visual contact between two centers. Examples will be given of the use of these various forms of telephone link.


Host genes involved in the replication of single-stranded DNA phage phiK.

Using various replication mutants of E. coli, the host genes that participate in the replication of some K12-specific single-stranded DNA phages have been determined. Functional products of dnaE, -F, -G and -Z genes are required for the multiplication of phiK, whereas dnaA, -B, -C(D), H, -I and -P are dispensable for viral replication. In contrast with polB, recA, B, C, or xth functions, host rep activity is essential for phiK. At the restrictive temperature, the yield of phiK was markedly reduced in the ligts7 mutant and partially decreased in a polAts strain. The phage phiK is thus less dependent on the host cells than phiX174 and phiA which require additionally the dnaB, -C(D) and -H functions. Replication of phage St-1 depends on dnaG and -Z gene products, but not on dnaP function. Although not much affected in polAts host, growth of St-1 was significantly diminished in dnaF or ligts7 mutants.


Isolation of lambda prophage mutants defective in structural genes: their use for the study of bacteriophage morphogenesis.

Mutants of coliphage lambda defective in structural genes were isolated and characterized. The isolation method consisted in lysogenizing bacteria with mutagenized phage and testing for inability to form plaques after heat induction. The mutants were propagated as prophages in the lysogens. Mutants in the region of the tail-genes U, V, G and H were enriched for by a selection method based on recombination and complementation with known mutants, and they were mapped by deletion mapping with newly isolated lambdadg's. The lysates of all the mutants were examined by electron microscopy. Some of the mutants showed phenotypes different from those of known amber mutants in the same genes. They are interpreted as producing partially active, altered gene products and might be useful for the studies of morphogenesis and of the mechanism of infection.


Isolation and genetic mapping of Escherichia coli aminopeptidase mutants.

Many mutant strains devoid of aminopeptidase activity have been isolated in Escherichia coli. All of them produce cross-reacting material when tested against specific antiaminopeptidase antibody. The map position of the locus specifying this enzyme has been determined by three conjugations and two P1 mediated transduction experiments. By analogy with Salmonella typhimurium this locus has been called pepN (Miller, 1975). Mutations in pepN are jointly transduced with fabA and pyrD at high frequency. These data and conjugation results suggest a location between 20.5 and 22.5 minutes on E. coli genetic map.


Effect of auxotrophic starvation of mitochondrial marker transmission in the cdc8 mutant of Saccharomyces cerevisiae.

Crosses were made using strains of S. cerevisiae which carried mitochondrial markers conferring resistance to erythromycin and chloramphenicol. The effect of auxotrophic starvation of one parent prior to mating on the transmission of its mitochondrial markers was studied in different crosses relative to the presence of the cdc8 nuclear mutation (a temperature-sensitive DNA replication). In crosses between two cdc8 mutant strains, auxotrophic starvation of one of the haploid parental stains prior to mating caused a marked decrease of its mitochondrial marker transmission to the diploid progeny of the cross. The transmission decreased as a function of the time of starvation. This effect was not observed in the cross between two wild type strains and in crosses of starved cdc8 phenotypic revertants with cdc8 mutant strains. Only a small, if any, effect of starvation on mitochondrial marker transmission was observed when starved cdc8 mutant strains were crossed either with their phenotypic revertants or with the wild-type strains. In one of the haploid parental strains the starvation increased the frequency of petites as a function of starvation time, while in the other this effect was not observed. In the progeny of cdc8 X cdc8 crosses (both in starvation experiments and in control crosses) an increased frequency of diploid petite cells accompanied by a decreased frequency of recombination between mitochondrial markers was noticed. The influence of the cdc8 mutation on the transmission of mitochondrial markers is discussed in terms of high frequency of p- molecule formation in cdc8 strains.


Isolation and characterization of phi80dgal transducing phages that carry gal operator-promoter insertion mutations.

phi80dgal transducing bacteriophages have been isolated by the F-fusion technique of Press et al. (1971) and gal-operator-promoter insertion mutations have been introduced by homogenate formation. Five different phi80dgal isolates have been studied in more detail. One of the phi80 phages transduces the gal operon and gene aroG as well as at least part of the trp-operon; the gal operon of another phi80dgal transducing phage is inverted with respect to the phi80dgal sequences. Heteroduplex DNA mapping indicates that one of the phi80dgal isolates in addition to the gal operon and a portion of the adjacent chromosomal region carries an IS2-element which is derived from the F'gal episome. The isolated phi80dgal phages may be utilized for preparing pure gal mRNA and insertion-RNA as well as pure gal operon DNA.


A transducing bacteriophage lambda carrying the structural gene for elongation factor Ts.

A specialized transducing bacteriophage lambdadpolCdap D-9 has been isolated that carries the structural gene for EF-Ts1 (tsf). The presence of EF-Ts among the proteins synthesized under the direction of this phage in UVL-inactivated cells has been detected by two-dimensional gel electrophoresis and has been verified by antibody precipitation. In an induced lysogen of this phage the relative rate of synthesis of EF-Ts is increased 4-fold. Evidence is presented which suggest that the structural genes for ribosomal protein S2 (rpsB) and RNA polymerase sigma factor (sit) also lies on lambdadpolCdap D-9.


Catabolite translational effects on the lac messenger RNA of Escherichia coli K12.

The transcriptional and translational events occurring during the induction of the lac operon, were separated by blocking the translational step, either by aminoacid starvation or by addition of chloramphenicol. It was found that the carbon source used during the subsequent translation, affected the rate of beta-galactosidase synthesis. A decoordination effect on the production of enzymes of the lac system was also observed in high catabolite repression media, as well as in nitrogen limiting conditions. These findings suggested a similarity with the polarity phenomenon. In order to test this similarity, polarity suppressors of a Z- polar mutant were isolated. In one of these mutants, probably suA like, no carbon source effect was observed during the translational step. The induction kinetics in different media, after distinct pregrowth conditions, supported the idea that this mutant could be considered catabolite repression resistant only in certain restrictive conditions.


Treatment of hereditary angioedema with danazol. Reversal of clinical and biochemical abnormalities.

Danazol, an androgen derivative, was evaluated for its effectiveness in preventing attacks of hereditary angioedema in a double-blind study with nine patients. Of 47 placebo courses, 44 ended with attacks, but during 46 danazol courses only one attack occurred. Side effects were minimal, and virilization was not observed in the women studied. C1 esterase inhibitor levels increased three to four times, and levels of the fourth component of complement (C4) increased 15 times. These changes began during the first day of therapy and were maximal by one to two weeks. After therapy was stopped, C1 esterase inhibitor and C4 levels rapidly decreased. Danazol effectively prevents attacks in hereditary angioedema and acts to correct the underlying biochemical abnormality.


[Comparative enzymatic study of two strains of Aspergillus fumigatus and of A. fischeri of sapropytic origin or isolated from human or animal lesions: practical diagnostic applications].

14 enzymatic activities (3 dehydrogenases and 11 hydrolases) were systematically investigated in the extracts of 2 strains of Aspergillus fischeri and 14 strains of A. fumigatus (8 isolated from human or animal lesions named 'pathogenic' strains and 6 strains of saprophytic origin). The enzymic composition of A. fumigatus appeared to be very different from one strain to another but no relationships could be established between enzymic differences and origin of the strains. In addition, the immunoelectrophoretic analysis of these antigenic extracts using rabbits immunsera and sera of patients with pulmonary asperigllosis was performed. The type II chymotrypsic activity, corresponding to C arc, was shown more frequently and gave stronger reaction when antigenic extracts from pathogenic strains were allowed to react with sera of patients. Moreover, when sera of patients revealed a same enzymic activity in a saprophytic strain and a pathogenic strain, the number of precipitin lines was significantly larger with the latter one. Accordingly, antigenic extracts used for precipitin tests had to be preferably prepared from pathogenic strains and tested, for value, against sera of patients with pulmonary aspergillosis.


Transposable genetic elements and plasmid evolution.

Transposable elements of DNA that are structurally defined and genetically discrete units seem to have an important role in the evolution of bacterial plasmids. Recombination occurring at the termini of such elements can result in the joining together of unrelated DNA segments that lack extensive nucleotide sequence homology. In addition, transposable elements serve as novel biological switches capable of turning on and off the expression of nearby genes as a consequence of their insertion into or excision from plasmid genomes.


Cloned synthetic lac operator DNA is biologically active.

A chemically synthesised duplex DNA fragment containing the sequence of the lac operator was cloned in E. coli using the vehicle pMB9. Clones containing lac-pMB9 hybrid DNA produced beta-galactosidase constitutively and the hybrid DNA bound the lac repressor specifically.


[Results of the automatic analysis of a group of 2,250 electrocardiograms examined with the HP4 system and supplied by 13 hospitals associated with a single computer center].

The reliability of the HP4 programme for automatic ECG reading has been studied. 13 Lombardy Hospitals together with the Italian Diagnostic Centre took part in the experiments. In each hospital, 170 ECG's were simultaneously recorded on paper and magnetic tape, a total of 2.252 examinations. The tapes were sent to the Italian Diagnostic Centre for processing. The ECG's were also examined by hospital cardiologists using their own criteria and by a cardiologist of the I.D.C. according to the HP4 programme criteria. The evaluation criteria were of two types: 1) according to a final synthetic judgment (normal, atypical, at the limit of the normal, abnormal); 2) according to the type of pathology (arrythmia, left ventricular hypertrophy, infarction, repolarization alterations, intraventricular conduction disturbances). The data obtained in this study showed the reliability of the HP4 programme for screening the population, for use in Cardiology Departments (hospital or out-clinics) and in Social Cardiology centres. Its practical use is excluded (as are most of the programmes on the market) where a specific diagnosis in particular types of pathology is required (e.g. coronary units, cardiology division, etc.) The cardiologist is irreplaceable although this equipment provides him with a considerable aid for the performance of his work.


[Automatic clinical electrocardiography laboratory of the Udine regional hospital. Considerations on 50,000 tracings automatically analyzed with computers].

Automatic ECG processing has now passed beyond the experimental stage into the realm of clinical practice. It offers the most advanced solution to the organisation problems faced by ECG laboratories, particularly in large hospitals. A centralised laboratory for this work was first set up in Italy in 1973 at the Udine Regional Hospital. Its instrumentation and organisation are described and a consecutive sample of 1000 ECGs culled from the 50,000 computerised since its inception are discussed.


[Visual processing of 12,000 electrocardiograms according to the USPHS code and comparison of visual and automatic processing of about 6,000 electrocardiograms in accordance with the USPHS code].

Multistage screening in Hesse (W. Germany) and the visual processing of about 12,000 ECG's in accordance with the USPHS (Riedel programme) are reported. A good fit was found with data obtained from a similar study in another part of the country. Comparison is then made with the visual and computerised processing of about 6,000 ECG's in accordance with the same code, using four classes: "normal", "conditionally within the limits of normal", "suspect" and "definitely pathological". The encouraging result on comparison between "normal" and "pathological" in the 6.3% consisting of false negatives (only 2.1% definitely pathological) suggests that "normal" and "conditionally normal" ratings by the computer can be accepted, whereas considerable possibilities for cardiological diagnosis would remain in the case of pathological traces, which would always be accepted, where as considerable possibilities recognised standards set down by the USPHS code are considered reliable. They can be used under hospital or screening conditions. On the other hand, the "scale of values" programme offered as a model requires further checking. Notes on future development are also offered.


[Effect od amygdalectomy on memory and learning in patients treated surgically for epilepsy].

The results of neuropsychological investigations of 40 patients with severe epilepsy and behaviour disturbances treated by stereotactic methods are presented. In all cases memory disturbances were found before the operation, in 45% of the cases mental sluggishness was present. After amygdalotomy, together with a reduction of emotional tension and psychomotor agitation, the range of direct memory extended and difficulties in learning verbal material decreased. In some patients a tendency was observed also for a rise in intelligence quotient.


[Graphic analysis of electrocardiograms with the exercise test].

The effort ECG is one of the most useful and most commonly employed methods for the early diagnosis of coronary disease in patients with a normal ECG at rest. Perfection of a computerised method for this purpose is reported. An effort test is run on the cyclergometer and the ECG is read for 2 min at rest, during the test, and for 3 min afterwards. The chest bipolar leads are used. The diagnostic possibilities are greatly improved by computerisation and interpretation of the effort ECG.


[On-line analysis of the exercise electrocardiogram].

A programme of on-line automated analysis of ECG exercise graphs relative to the CB5 derivation is described. The various operations may be subdivided into the following phases: 1) performance; 2) mean complex; 3) identification; 4) calculation and print-out of parameters; 5) filing. Automatic analysis of exercise ECG's eliminating artifacts present in graphs and obtaining parameters that are not respectively assessable, facilitates the development of rigorously objective diagnostic guidelines. The filing of indices on magnetic tape opens the way to subsequent statistical analysis of extreme usefulness in testing extensive populations.


[Differentiation of infarct patterns in the computerized ECG and confirmation with clinical and coronarographic findings and cardiac catherization].

With a view to assessing the validity of ECG criteria for a personal computerization programme, definite external features have been introduced as controls to provide objective data on the patient's disease apart from the ECG picture. To analyse the reliability of this programme, the ECG infarction component of the following groups of patients was considered. 1) 84 ECGs of patients who have suffered myocardial infarction in the more or less distant past and the diagnosis of which was confirmed at the time by chemical and laboratory data. These patients were also submitted to angiocardiography. 2) 120 ECGs of patients who have suffered myocardial infarction in the comparatively recent past and diagnosis of which was confirmed by chemical and laboratory data. These patients were not submitted to angiocardiography. 3) 85 ECGs of definitely not coronaropathic patients in whom angiocardiography was performed. In these clinically well documented cases, computer diagnoses were well correlated with those of treating physicians. It should however be pointed out that in 18% of patients with myocardial infarction, the ECG did not confirm the lesion. In the control group also, ECG alterations were recorded in 18% cases. This is a high percentage because in numerous patients the presence of rheumatic or shunt valvulopathies or myocardiopathies was encountered.


[A program of combined ECG and VCG automatic diagnosis. Note I. The atriogram].

In this paper a new computer aided ECG and VCG data handling is analized. It is based on an optimum estimation of dipole moment, which is used as the main diagnosis parameter. Already known diagnostical methods (available in present literature) are compared with this new technique. The available diagnostical range has been increased widely. The sensitivity of such a program is being analyzed both for normal and abnormal cases.


[Plan for installation of an automatic system of analysis of electrocardiograms for a group of hospitals and a regional cardiological record office].

In view of the present state of the Central ECG Department serving the "San Giovanni" group of hospitals in Turin and in consideration of the ever growing number of ECG's required daily, a reorganization of the department has become necessary. Such a reorganization must be based on the latest facilities offered by electronic engineering, namely by means of automating the entire system. Various manufacturers offer proven equipment and the only problem is one of choosing that most suitable for requirements. Personally, the on line system is considered to be best although many are opposed to it, because it is the only system that makes it possible to answer urgent demands in real time. The material collected by this Centre and by others that must of necessity arise in the Region of Piedmont, should not be dispersed but filed so that it can be employed for further controls and for statistical and epidermiological research. It therefore becomes necessary to set up a large central file at Regional level capable of storing ECG findings and all historical, clinical and laboratory data pertaining to patients who come into contact with the System. On request, it must also be capable of processing stored data and furnishing print-outs of data through video terminals for the purposes of subsequent examinations and continuations of treatment, as well as for clinical or statistical research reasons. Such a file would represent a veritable cardiological register for Piedmont and the first step on the way to the impellent creation of a Sanitary Register of the whole population.


[Clinical testing of the Sicard system for automatic evaluation of electrocardiograms].

Appraisal of the Sicard (Siemens) system for the automated evaluation of ECG's is reported. 528 ECG's were simultaneously recorded on paper and magnetic tape and examined by a group of specialists and the 404/3 computer forming part of the system, followed by a check on an IBM computer. A very high percentage of fits was noted and a favourable judgment is passed on the system.


[Automatic analysis of electrocardiogram with the Sicard system].

An assessment was made of the accuracy and practicability of the Sicard system (Siemens). This employs the Minnesota and USPHS codes. A series of 64 ECG's was examined. Results obtained automatically were compared with those given by a cardiologist and a second processing on the computer. The only differences of importance consisted of classification discrepancies, particularly in the case of arrhythmia and atypical pictures during the ventilogram recovery stage. While further improvement of the system is to be hoped for, it nevertheless makes valuable work of long-term significance possible.


[Data on experience with automated diagnostic systems].

This study highlights the various parameters considered for experimenting automatic equipment correctly. By applying such parameters to experiments with the "Sicard" system (Siemens) for automatic ECG reading, the usefulness of the system for its declared purpose, i.e. mass screening and epidemiological research, has been demonstrated.


[Results of mass ECG studies with the use of the Sicard automatic system].

The purpose of the present research is to assess the reliability of the Sicard (Siemens) system in mass screening. Experiments showed it is suitable for this use, although reservations are expressed regarding a few types of diagnosis.


[Controlled clinical trial of parsalmide].

A double-blind, between-patients comparison between parsalmide (a new drug) and phenylbutazone in 55 patients with postraumatic joint and muscle pain showed that the two compounds possessed about the same anti-inflammatory and analgesic activity, though parsalmide gave greater relief of pain and local swelling. Tolerance was excellent for both drugs. Slight gastric disturbances noted in 2 subjects with both compounds were easily corrected by symptomatic management.


[Controlled clinical trial of parsalmide in patients with subacute and chronic arthro-neuro-mypathies].

Controlled experiments were carried out to compare the anti-inflammatory, analgesic, muscle-relaxing and anxiolytic-tranquillizing activities of a new compound, parsalmide, and indomethacin. The study was conducted on 40 patients of both sexes suffering from syndromes involving neuromotor deficiency of various origin and the double blind between patient, technique was used. Overall evaluation of the activities of the two drugs did not reveal statistically significant differences although parsalmide was more effective with "pain", "tumefaction" and "anxiety" symptoms. This latter finding is particularly interesting owing to the frequent association of neuroanxiety disturbances in such patients. General and local tolerance was good with both drugs.


[Controlled clinical trial of parsalmide, a drug with analgesic and anti-inflammatory activity].

A controlled clinical trial of the anti-inflammatory, analgesic, muscle-relaxing and anxiolytic activity of a new compound (parsalmide) was compared with that of phenybutazone in 40 patients with acute or exacerbated inflammatory or degenerative processes randomly distributed into two treatment groups. Parsalmide was more effective in the relief of joint swelling and anxiety and gave better motility. On an overall evaluation, however, it was on a par with phenylbutazone. Treatment had to be suspended in two cases treated with phenylbutasone, whereas tolerance was good with parsalmide and no suspensions were required.


[Report of a controlled clinical trial of a new synthetic drug, parsalmide, in rheumatic arthropathies (inflammatory and degenerative)].

The anti-inflammatory, analgesic and tranquillizing activity of a synthetic compound called parsalmide was investigated in patients suffering from inflammatory and degenerative rheumatic arthropathies. The study was carried out in 30 subjects using the controlled experiment technique according to the "between patient" pattern, attributing parsalmide and indomethacin at random to two groups. Both preparations were found to possess good anti-inflammatory and analgesic action, comparable clinically and statistically. Tolerance was very good, particularly at gastroenteric level (no side and/or undesired effects were observed) and at the level of haemopoietic, renal and hepatic function.


[Controlled clinical trial of a new synthetic preparation (parsalmide) in the treatment of inflammatory and degenerative arthro-myopathies].

A double-blind, between-patients trial of a new drug (parsalmide) against indomethacin in the relief of inflammation and pain in 68 patients with exacerbated inflammatory and-or degenerative arthromyopathy resulted in 76% of successful results with both drugs. Tolerance was good, though side-effects, albeit slight, were more common with indomethacin.


[Parsalmide, a new synthetic substance, in inflammatory and arthrosic arthropathies. Double-blind controlled clinical trial].

The double-blind, between-patient experimental technique was employed to investigate the anti-inflammatory, antalgic and myorelaxant activity of a new synthetic compound, parsalmide. 30 patients suffering from arthrosic and inflammatory arthropathies in various sites and in newly acute phase, were treated with the substance which was assigned at random to 2 experimental groups; phenylbutazone was adopted for comparison purposes. Both substances under study proved to have good anti-inflammatory and antalgic action, although in the case of certain parameters, parsalmide was definitely superior to the control drug. The antalgic and myorelaxant activities of parsalmide were statistically superior to those of phenylbutazone. Tolerance was "very good" in 93% of cases treated with parsalmide "very good" or "good" in 86.6% of the cases treated with phenylbutazone.