Canine malignant lymphomas: comparison of morphologic and immunologic parameters.

Twenty-three canine malignant lymphomas were studied to correlate morphologic and immunologic properties of the neoplastic cells. Morphotologic characterization included histologic classification of cell type and growth pattern, anatomic distribution of lesions, and transmission electron microscopic examination. Parameters examined to indicate B- or T-cell nature of lymphoma cells included demonstration of mitogen responsiveness, cell-surface Ig, spontaneous rosette formation with human red blood cells, and scanning electron microscope (SEM) examination of cell-surface features. Results indicated that the cells from histiocytic lymphomas were lymphocytes rather than histiocytes or macrophages. Most cells from lymphomas examined possessed cell-surface ig, indicating B-cell nature. The cell types represented by the different Ig-positive lymphomas were compatible with maturation arrest at different stages in normal lymphocyte differentiation. For the two most common histiologic cell types, nitogen responsiveness and the presence of cell-surface Ig indicated that diffuse, poorly differentiated lymphocytic cases were biologically heterogenous, whereas nodular histiocytic lymphomas were biologically homogenous. Most canine lymphomas had a multicentric anatomic distribution; however, one thymic and two alimentary forms were observed. Lymphomas with a nodular pattern in lymph nodes had multifocal splenic involvement centered on small arteries, whereas lymphomas with a diffuse pattern in lymph nodes had diffuse involvement of splenic white pulp. The cells of Ig-positive and Ig-negative neoplasms examined by SEM were predominantly of the smooth-cell type.


Immunosuppression induced in vitro by cell-free extracts of Friend leukemia virusinfected splenocytes.

The immunologic responsiveness by normal BALB/c spleen lymphocytes immunized in vitro with sheep erythrocytes was markedly suppressed by calrified cell-free homogenates of Friend leukemia virus (FLV)-infected mouse spleens. Suppression was achieved with a 3,000Xg supernatant of FLV-containing homogenates freed of cellular debris but not with crude unclarified homogenates or pelleted material after centrifugation. The immunosuppressive effects of the virus were dose dependent, whether the virus was added directly to the target spleen cells or separated from them by a 0.4mu Nuclepore filter. Suppression was prevented by heating of the virus at 100 degrees C for 10 minutes or by neutralization with antiserum to FLV. Addition of the virus as late as 48 hours after in vitro immunization of splenocytes affected the immune response. However, suppression was maximum  when the clarified virus was added to the splenocytes 1 or 2 days before immunization. The agent in the FLV-infected spleen homogenates responsible for immunosuppression appeared to be the virus per se; however, virus-associated soluble factor(s) might have been involved.


Hybrid-versus-parental strain reaction. II. Comparative mortality in parental strain mice of different H-2 genotypes.

Lethally irradiated perental strain mice were inoculated with marrow from reciprocal hybrid donors. Hybrid cells could recognize the quantitatively greater antigenicity of parental strain recipients. The severity of the hybrid-versus-parental strain and parental strain-versus-hybrid reactions was compared. There was a significantly less severe reaction when DBA/2 mice were inoculated with (DBA/2female X C57BLmale)F1 arrow than with (C57BL X DBA/2)F1 marrow, which indicated a maternal influence on antigen recognition. The reaction of (DBA/2 X C57BL)F1 against DBA/2 recipients was significantly less severe than the DBA/2 reaction against (DBA/2 X C57BL)F1 recipients. All reactions involving C57BL were equally severe and more lethal than those involving DBA/2 mice. The strength of these reactions was a function of the relative tissue antigenicity and responsiveness of the parental strains of the hybrid cross. Both the expression of tissue antigens and the ability to recognize and respons to them are influenced by the maternal strain of the hybrid cross.


Identification of carcinogenic tannin isolated from Bracken fern (Pteridium aquilinum).

We attempted to isolate a carcinogenic substance from bracken fern (Pteridium aquilinum), a naturally occurring toxicant responsible for the production of chronic enzootic hematuria and urinary bladder cancer of cattle and carcinogenic for various target organs of several species. Hot methanol extracts of bracken fern were solubilized in water and extracted with chloroform followed by a mixture of n-butanol-butanone (1:1). That fraction was dried and triturated with ether-methanol (4:1), n-butanol, and finally absolute ethanol. The insoluble residue was dissolved in 10% aqueous methanol and passed through Dowex 1 OH-, Dowex 50 H+, or Dowex 1 OH- and then Dowex 50 H+ ion exchange resins. A condensed tannin, isolated from one ot the fractions, was identical to that isolated from bracken fern by the caffeine procedure used for the separation of tannins from other plant constituents. Three systems were used for bioassay; induction of bladder carcinoma by implantation of cholesterol pellets containing bracken fern fractions into the bladder lumens of mice; acute toxicity by ip injection of brachen fern fraction into mice; and growth inhibition of Escherichia coli. The following fractions induced significantly greater incidences of bladder carcinoma than  did cholesterol pellets only: tannin, Dowex 50 H+, residue, n-butanol, and methanol. Tiliroside, a component of bracken fern fractions into the bladder lumens of mice; acute genic acid, and quercetin were not carcinogenic. Tannin was the most toxic (mean lethal dose: 0.16 mg/g) and carcinogenic. None of the carcinogenic fractions inhibited growth of E. coli.


Transfer RNA and transfer RNA methylase activity in spleens of patients with Hodgkin's disease and histiocytic lymphoma.

tRNA levels, base composition, and tRNA methylase activities of normal and tumor tissue from the spleens of 24 patients (18 with Hodgkin's disease and 6 with histiocytic lymphoma) were studied. There were no significant differences in major base composition of normal and tumor tissue. Methylated guanosine was increased in tumor tissue of some patients, and tRNA methylase activities were increased in extracts from the tumors.


T-cell precursors in mice bearing the Ehrlich ascites tumors.

Mice bearing Ehrlich ascites tumors and challenged with sheep erythrocytes produced fewer plaque-forming cells than did normal mice. At the same time the immunosuppression developed, the number of T lymphocytes in the thymus and spleen were reduced significantly. In the spleen, the number of B lymphocytes remained constant during carcinogenesis, whereas that of the macrophages increased significantly, as compared to the controls. In this paper, we demonstrated that the mechanism responsible for thymus and spleen depletion of theta antigen-bearing cells had to be ascribed to fewer T-lymphocyte precursors in the bone marrow of mice with cancer. The reduction of T-lymphocyte precursors was probably caused by the same "soluble factor(s)" produced by Ehrlich ascites tumor cells, which also interfered with the proliferation of myelopoietic stem cells in the bone marrow of mice with this neoplasm, as we previously reported. By performing several reconstitution experiments of lethally X-irradiated hosts, we determined that the immunodepression by Ehrlich ascites tumor cells was readily reversible, and the alteration of the T:B lymphocyte ratio in the spleen had a minor  function, if any, in the pathogenesis of the immunosuppression.


Use of dimethylmyleran in adoptive chemoimmunotherapy of two murine leukemias.

Dimethylmyleran (DMM) is an antitumor agent that has minimal effects on immunity. In a study of its usefulness in adoptive chemoimmunotherapy, C57BL/6 mice inoculated on day 0 with C57BL/6 Friend virus-induced leukemia (FBL-3) were treated on day 5 with 12 mg DMM/kg [less than LD10 (lethal dose for 10% of mice)] plus C5BL/6 spleen cells. All untreated mice died, with a median survival time (MST) of 17 days. DMM alone or with nonimmune cells prolonged survival to day 20, and 3/53 mice survived beyond day 60. By contrast, 12/25 mice treated with DMM plus cells immune to FBL-3 were cured. Similar results were obtained in C57BL/6 mice with syngeneic Rauscher virus-induced leukemia (RBL-5). Untreated mice died, with an MST of 14 days. DMM alone or with nonimmune cells prolonged the MST to 21 and 26 days, respectively, and 3/26 and 6/28 mice were long-term survivors. However, 13/28 mice were cured by DMM plus cells immune to antigenically related FBL-3. Lethal irradiation of cells immune to FBL-3 abolished their efficacy. Finally, in contrast to the efficacy of sublethal DMM plus immune cells, an LD100 of DMM (20 mg/kg) plus hematopoietic reconstitution with nonimmune syngeneic cells was not effective against FBL-3 OR RBL-5. The results emphasized the critical role of immune cells in chemoimmunotherapy even when the drug used is nonimmunosuppressive.


Spontaneous colon tumors in rats.

Twenty-eight cases of spontaneous colon tumors were found during autopsy of approximately 3,000 male W rats in our laboratories between 1968 and 1974. Macroscopically, these tumors were multiple and localized in the proximal part of the colon. Many nodules protruded on the serosal surface; polypoid tumors protruding into the lumen were rare. Microscopically, hyperplastic and adenomatous polyps were observed in the mucous membrane of the colon. There was adenomatous downward growth into the submucosal layer, and tubular-type adenocarcinomas invaded all the coats of the colon wall. Structural atypism was frequent and slight cell atypism was also present. Invasive tumors sometimes had an inflammatory reaction, and bacterial growth was observed within the neoplastic glands in thionine-stained sections. Escherichia coli and a gram-negative, facultative anaerobic bacillus, which grew only with E. coli in vitro, were isolated. A cultured epithelial cell line was established from one colon tumor. After a primary tumor was transplanted intraperitoneally into young adult rats, a mass grew in the peritoneal cavity for 4 months. The tumor incidence seemed higher at different times in the animals examined.


Membrane markers in "histiocytic" lymphomas (reticulum cell sarcomas).

Neoplastic cells from 9 patients affected with a "histiocytic" lymphoma were studied with 5 membrane markers of B or T lymphocytes. In 2 patients a monoclonal B-cell proliferation was found; they had been affected previously with well documented B-cell proliferations: chronic lymphocytic leukemia or Waldenström's macroglobulinemia. The blast cells of 2 other patients had T-cell features; in a fifth case, the abnormal cells carried only a strong receptor for the Fc fragment of IgG, which suggested their truly monocytic origin. In 4 patients, the cells had no detectable surface markers. These findings demonstrated that this group of lymphomas is heterogenous, that the term "histiocytic" appears to be wrong in most instances, and that the cellular origin of the malignant cells frequently remains unidentified and thus prevents a satisfactory new classification.


Immunosuppression by Moloney leukemia virus: lack of correlation between virus replication and the immunosuppressive effect.

Young adult mice were infected with 10(4) plaque-forming units (PFU) or Moloney murine leukemia virus M-MuLV. Two different virus preparations were used: a) M-MuLV obtained from serial passage in mice [animal passage (AP)] and b) tissue culture (TC)-grown virus harvested after three in vitro passages of the AP M-MuLV in fibroblasts. Replication of TC and AP M-MuLV in spleen cells was determined by an infectious center (IC) assay at 1 and 2 weeks after the infection. Immune responsiveness of spleen cells was evaluated in challenge with sheep red blood cells (SRBC) and subsequent enumeration of antibody plaque-forming cells (PFC). TC M-MuLV replicated faster in the spleen than did AP M-MuLV and reached about 10- to 100-fold higher titers. However, the response of anti-SRBC PFC, suppressed to the same degree in the spleens of mice infected with TC or AP virus, was from 10 to 50% of the control response. A comparison of virus replication with the anti-SRBC response in aliquots from the same spleens showed no correlation between virus IC and antibody PFC. Both TC and AP M-MuLV induced the expression of virus-specific, cell membrane antigen on spleen cells. These findings indicated a divergence between virus replication on the one hand and the immunosuppressive effect and the cell membrane alteration on the other.


Isolated ureteral injury secondary to transperitoneal stab wound.

The patient reported suffered a transperitoneal stab wound resulting in the isolated complete transection of the left upper ureter. In spite of immediate exploratory laparotomy, the time of recognition of the injury was delayed. The treatment consisted of an ellipitcal spatulated everting uretero-ureterostomy with interrupted fine chromic catgut over a stenting ureteral catheter. The postoperative course was smooth and the final result excellent. The importance of intravenous urography in penetrating abdominal or flank trauma cannot be overemphasized. This is the first reported case of isolated ureteral injury secondary to transperitoneal stab wound.


Outpatient burns: a prospective study.

1) There is no significant difference in overall wound healing rates between non-antibacterial and antibacterial impregnated dressings used in this study. 2) The burn wound is not sterile. 3) Ease of dressing removal was similar during the first 7 days; thereafter the nitrofurazone dressings were more adherent; however, patient acceptance as subjectively evaluated at the time of dressing change and from the description of intervals between dressing changes did not vary significantly between the two dressings. 4) Pathogenic flora, both gram-positive and gram-negative, were significantly less prevalent in wounds treated with nitrofurazone dressings when the closed technique for burn treatment was utilized.


Alveolar-arterial oxygen gradient in the burn patient.

1)A presumptive diagnosis of inhalation injury by the occurrence of a "closed-space" burn and the presence of facial burns, singed nasal vibrissae, ronchi and wheezes as clinical criteria was often in error in our study group. 2) A-a O2 gradient and change in A-a gradient in our group of patients was of value in predicting the development of pulmonary dysfunction.


The management of traumatic asphyxia: case report and literature review.

Traumatic asphyxia is not as benign as has been indicated in the literature (2, 4) and may represent a life-threatening process. A thorough understanding of the involved pathophysiology coupled with aggressive cardiopulmonary management is essential for patient survival. In cases with severe pulmonary injury, the judicious employment of respirator and PEEP therapy is emphasized.


Effect of the "RNA control" locus in Escherichia coli on RNA bacteriophage R23 replication.

The effect of the rel gene of Escherichia coli on the RNA synthesis induced by phage R23 was studied. This RNA phage has the property of inhibiting ribosomal RNA formation and completely dominating the RNA synthesis of the host. Phage-specific RNA formation was found to be dependent on the allelic state of the rel gene. Determinations of RNA synthesis were made by both cumulative and short-term incorporations of uracil and adenine. Variations in labeling of nucleotide pools were compensated for by determining specific activities of ATP and UTP and using these values to obtain true, relative rates of RNA synthesis.


Bacteriophage T4-induced shut-off of host-specific translation.

To study the mechanism by which bacteriophage T4 inhibits the synthesis of inducible host enzymes we measured the formation of beta-galactosidase from preformed lac mRNA. Beta-Galactosidase was induced with isopropyl-beta-D-thiogalactopyranoside in the presence of 7-azatryptophan, a tryptophan analogue that is incorporated into proteins and renders the beta-galactosidase formed inactive. The accumulated las mRNA was measured by capacity to form active beta-galactosidase after a chase of the analogue with excess tryptophan. After T4 infection the ability to form beta-galactosidase from the preformed lac mRNA was rapidly lost even when T4 infection took place in the presence of rifampin. This restriction was dependent on the multiplicity of infection. At a multiplicity of infection of 8.6, 90% of the ability to express preformed lac mRNA was lost within 30 s. The kinetics of cessation of beta-galactosidase synthesis after T4 infection indicate that infection blocks initiation of lac mRNA translation.


Virus-like particles from killer, neutral, and sensitive strains of Saccharomyces cerevisiae.

Procedures were developed for purification of virus-like particles (VLPs) from killer, neutral, and sensitive strains of Saccharomyces cerevisiae. Morphologically similar spherical VLPs measuring 40 nm in diameter were extracted from all three phenotypes. The particles were partially purified by high-speed centrifugation through a layer of CsCl (1.26 g/cm3) and sucrose density gradient centrifugation. Gradient-purified preparations contained three centrifugal species that sedimented at approximately 43, 102, and 162S. The 43S component is considered to be an artifact. Preparations from killer strains contained three double-stranded RNA (ds-RNA) components with molecular weights of 1.19 x 10(6), 1.29 x 10(6) and 2.54 x 10(6). VLPs from neutral and sensitive strains contained only the largest ds-RNA species. VLP preparations were subsequently separated into two major density components by CsCl equilibrium gradient centrifugation. The light component banding at 1.28 to 1.30 g/cm3 was void of nucleic acid, and the heavy component banding at 1.40 g/cm3 contained only the largest ds-RNA species.


[Technique and interpretation of cystomanometry in the neurological bladder of the child (author's transl)].

One hundred and twelve cystomanometric investigations were carried out in 86 children, 67 of them were suffering from a neurological bladder. Measurement of the vesical pressure was carried out by the suprapubic route, furthermore the rectal pressure and pneumogram were recorded. This technique enables the study of vesical tonus and activity, and also permits estimation of peripheral resistance.


Identification and preliminary characterization of a mutant defective in the bacteriophage T4-induced unfolding of the Escherichia coli nucleoid.

The nucleoids of Escherichia coli S/6/5 cells are rapidly unfolded at about 3 min after infection with wild-type T4 bacteriophage or with nuclear disruption deficient, host DNA degradation-deficient multiple mutants of phage T4. Unfolding does not occur after infection with T4 phage ghosts. Experiments using chloramphenicol to inhibit protein synthesis indicate that the T4-induced unfolding of the E. coli chromosomes is dependent on the presence of one or more protein synthesized between 2 and 3 min after infection. A mutant of phage T4 has been isolated which fails to induce this early unfolding of the host nucleoids. This mutant has been termed "unfoldase deficient" (unf-) despite the fact that the function of the gene product defective in this strain is not yet known. Mapping experiments indicate that the unf- mutation is located near gene 63 between genes 31 and 63. The folded genomes of E. coli S/6/5 cells remain essentially intact (2,000-3,000S) at 5 min after infection with unfoldase-, nuclear disruption-, and host DNA degradation-deficient T4 phage. Nuclear disruption occurs normally after infection with unfoldase- and host DNA degradation-deficient but nuclear disruption-proficient (ndd+), T4 phage. The host chromosomes remain partially folded (1,200-1,800S) at 5 min after infection with the unfoldase single mutant unf39 x 5 or an unfoldase- and host DNA degradation-deficient, but nuclear disruption-proficient, T4 strain. The presence of the unfoldase mutation causes a slight delay in host DNA degradation in the presence of nuclear disruption but has no effect on the rate of host DNA degradation in the absence of nuclear disruption. Its presence in nuclear disruption- and host DNA degradation-deficient multiple mutants does not alter the shutoff to host DNA or protein synthesis.


Sonic fragility of the head-tail bond of bacteriophage P22.

The binding of tail parts to the head of phage P22 is normally irreversible, but after adsorption to host cells sonication releases many of the tail parts intact. This release is dependent on the power of sonication, but is independent of the length of sonication from 2 to 32 s. This phenomenon has been used to show that the upper limit of the number of P22 particles that can bind to a cell is no lower than 700.


Comparison of biophysical and morphological properties of occluded and extracellular nonoccluded baculovirus from in vivo and in vitro host systems.

Electron microscopic examination and buoyant density profiles of nonoccluded Rachiplusia ou and Autographa californica nuclear polyhedrosis viruses purified from both infectious insect hemolymph and cell culture medium revealed that the viruses are enveloped, single nucleocapsids. The envelopes exhibited variation in the amount and degree of fit with regard to the nucleocapsids. This was determined by: (i) electron microscopic observations of virus budding from the surface of infected cells; (ii) electron microscopic observations of negatively stained preparations of pelleted, highly purified, nonoccluded enveloped particles; and (iii) the resolution and density distributions of nonoccluded virus in sucrose gradients after centrifugation to equilibrium; all were compared with virus extracted from polyhedra. Peplomers, ovserved on the surface of enveloped nucleocapsids of nonoccluded virus, are not associated with polyhedra-derived virus. Density gradient analysis indicated that virus from insect hemolymph and culture medium exhibited similar densities of approximately 1.17 to 1.18 g/ml. This is significantly different from the buoyant density of an alkali-liberated, enveloped single nucleocapsid (1.20 g/ml). Results of this study show that the nonoccluded forms of two nuclear polyhedrosis viruses from two different sources, hemolymph and cell culture, are similar with regard to several morphological and biophysical characteristics but are quite different from the alkali-liberated, polyhedra-derived form of the virus.


Pleiotropic effects of mutants in gene A of bacteriophage phi chi 174.

It has previously been established that the functional gene A product of phi chi X 174 is required for double-stranded DNA replication and that mutants in gene A affect the lysis of the host cell. We report here other alterations of normal phenotype for a subset of gene A mutants suggesting additional functions of gene A. Mutants in the subset failed to terminate cellular DNA synthesis and were unable to efficiently inactivate the colony-forming ability of the host. Two mutants in a second group retained the ability to kill the infected cell, although only one of these mutants efficiently terminated cellular DNA synthesis. Normal termination of cellular DNA synthesis did not occur by the production of random multiple breaks in the DNA, although it may have occurred by the selective production of breaks in newly synthesized DNA. It has previously been shown that two protein products are produced from the gene A region, the smaller of which is a C-terminal fragment of the larger. The separate phenotypes reported here for the two groups of mutants in gene A are consistent with separate functions for the two gene products previously reported.


Role of the bacteriophage P22 tail in the early stages of infection.

The initial binding of phage P22 to its host, Salmonella typhimurium, is dependent in a linear fashion on the number of tail parts per phage head. (The normal head has six.) There is also a later step which depends on tail parts. This step must occur some time after hydrolysis of the O antigen has been initiated and before ejection of phage DNA from the head is complete. This step causes PFU to depend on approximately the third power of the number of tail parts per head.


Mutants of bacteriophage T4 deficient in the ability to induce nuclear disruption: shutoff of host DNA and protein synthesis gene dosage experiments, identification of a restrictive host, and possible biological significance.

The shutoff of host DNA synthesis is delayed until about 8 to 10 min after infection when Escherichia coli B/5 cells were infected with bacteriophage T4 mutants deficient in the ability to induce nuclear disruption (ndd mutants). The host DNA synthesized after infection with ndd mutants is stable in the absence of T4 endonucleases II and IV, but is unstable in the presence of these nucleases. Host protein synthesis, as indicated by the inducibility of beta-galactosidase and sodium dodecyl sulfate-polyacrylamide gel patterns of isoptopically labeled proteins synthesize after infection, is shut off normally in ndd-infected cells, even in the absence of host DNA degradation. The Cal Tech wild-type strain of E. coli CT447 was found to restrict growth of the ndd mutants. Since T4D+ also has a very low efficiency of plating on CT447, we have isolated a nitrosoguanidine-induced derivative of CT447 which yields a high T4D+ efficiency of plating while still restricting the ndd mutants. Using this derivative, CT447 T4 plq+ (for T4 plaque+), we have shown that hos DNA degradation and shutoff of host DNA synthesis occur after infection with either ndd98 X 5 (shutoff delayed) or T4D+ (shutoff normal) with approximately the same kinetics as in E. coli strain B/5. Nuclear disruption occurs after infection of CT447 with ndd+ phage, but not after infection with ndd- phage. The rate of DNA synthesis after infection of CT447 T4 plq+ with ndd98 X 5 is about 75% of the rate observed after infection with T4D+ while the burst size of ndd98 X 5 is only 3.5% of that of T4D+. The results of gene dosage experiments using the ndd restrictive host C5447 suggest that the ndd gene product is required in stoichiometric amounts. The observation by thin-section electron microscopy of two distinct pools of DNA, one apparently phage DNA and the other host DNA, in cells infected with nuclear disruption may be a compartmentalization mechanism which separates the pathways of host DNA degradation and phage DNA biosynthesis.


UV sensitivity of a nonrepressor regulatory protein of bacteriophage P22.

The product of phage P22 gene c1 has two functions: it promotes synthesis of P22 repressor and it retards expression of some lytic genes. We present evidence that this product is inactivated in UV-irradiated hosts. The conditions for inactivation of c1 product include a functional DNA recombination system involving the host recA gene.


Management of urinary fistulas after renal transplantation.

Urinary fistulas developed in 13 of 134 patients after renal transplantation. Bladder fistulas originating from the anterior suture line in 6 patients were satisfactorily managed by urethral or paravesical drainage. Fistulas arising from the donor ureter were best treated by surgical repair using the recipient's own ureter. Caliceal fistulas in 3 patients were successfully treated with nephrostomy drainage. A favorable outcome was achieved in 11 of the 13 patients, with closure of the fistula and preservation of renal function.


Management of extensively destroyed ureter: special reference to renal autotransplantation.

Renal autotransplantation has been attempted 6 times in 4 patients for the correction of extensive ureteral disease. Indications in these patients include trauma secondary to ureterolithotomy and spinal fusion, and failed supravesical diversionary procedures. Included in our report is the first case of autotransplantation associated with ureterosigmoidostomy. Renal autotransplantation is an effective method to restore or preserve renal function in patients with extensive ureteral damage or disease. However, the procedure should not be considered in poor risk patients with good contralateral renal function or in patients in whom standard reparative procedures are possible. The hazard is real of vascular spasm, poor perfusion and ultimate autograft failure in kidneys with advanced chronic pyelonephritis and/or inflammation involving the renal pedicle. Autotransplantation should be considered only as a last resort in such patients.


Changes in cell-mediated cytotoxicity during the clinical course of patients with bladder carcinoma.

The conventional cell-mediated cytotoxicity assay was modified so that more useful estimates of cell-mediated immunity to transitional cell carcimoma of the urinary tract could be obtained. With this modified assay changes in the levels of cell-mediated immunity in transitional cell carcinoma patients to transitional cell carcinoma target cells were measured during the clinical course. Initial results from a small number of patients with invasive and non-invasive tumors showed that anti-transitional cell carcinoma cell-mediated immunity increased after the tumor was removed and during administration of Bacillus Calmette-Guerin.


Reflux into the unused ureter.

Reflux occurs into unused ureters in patients with urinary diversion and renal tranplantation, and into the ipsilateral ureter in patients with renal agenesis or dysplasia. Efflux may prevent reflux in patients with normal ureterovesical anatomy. If urine begins to flow down the ureter again the reflux may cease. Thus, in patients undergoing urinary tract reconstruction, undiversion should be done before an antireflux operation is performed. Reimplantation can be done after undiversion on a normal capacity bladder if the reflux persists.


Leptospirosis in small mammals of Iran: I. Serologic tests and isolation of Leptospira hebdomadis from Apodemus sylvaticus.

Leptospires of the hebdomadis sero-group and related to sejroe serotype, were isolated from the kidney of a vole (Apodemus sylvaticus) by direct culture as well as by animal inoculation. Sera of the vole from which leptospires were isolated, and serologic specimens from 1372 other small mammals, were negative for leptospiral agglutinins.


Unfavorable effect of atropine-diphenoxylate (Lomotil) therapy in lincomycin-caused diarrhea.

In this double-blind, randomized study, 200 normal subjects received a three-day course of one of five treatment regimens: lincomycin hydrochloride monohydrate injection (sterile solution, 300 mg/ml) with two tablets of either placebo, a mixture of atropine sulfate and diphenoxylate hydrochloride (Lomotil), an aspirin-phenacetin-caffeine (APC) combination or the latter with codeine, or an injection of saline with two placebo tablets. Gastrointestinal irritation was most prominent in subjects receiving lincomycin with atropine-diphenoxylate and lincomycin with APC plus codeine (P less than .05). Decreased intestinal motility from atropine-diphenoxylate or codeine may increase the contact time between the lincomycin (or its metabolites) or some developing toxic substances and the mucosal epithelium. The use of atropine-diphenoxylate or codeine in treating lincomycin-induced diarrhea may be questionable.


Ex vivo surgical dissection. Autotransplantation in renal disease.

Ex vivo dissection, reconstruction, and autotransplantation have been performed in a total of five patients. Two had intrarenal aneurysms, and in three, this treatment was deemed best suitable. One patient has sustained normal renal function with as little as one third of his remaining kidney. There are techniques now available to provide a means of ex vivo preservation of organs adequate to sustain renal viability during bench surgery.


Cultures of blood drawn by catheters vs venipuncture.

Cultures of blood drawn through indwelling intravascular venous and arterial cannulas were compared with those of blood drawn simultaneously by percutaneous venipuncture. In 92% of 174 comparisons, the results were identical. Cultures of blood drawn through indwelling intravascular catheters are as reliable as those of percutaneously obtained samples. In addition, the speed, ease, and lack of trauma in obtaining blood for cultures in critically ill patients further recommends this technique.


Paroxysmal atrial fibrillation with asystole and syncope: report of a case of sinus node dysfunction with hypokalemia and hypertension.

A patient is presented who developed syncope due to asystole following paroxysmal atrial fibrillation. Suppression of intrinsic cardiac pacemakers during tachycardia is postulated as the mechanism for asystole. This patient might have sinus node dysfunction. The episodes of tachycardia occurred more often when the serum potassium level was low.


[Behavior of fibrinogen-split-product-E in fibrinuria following allogeneic kidney transplantation (author's transl)].

80 urine samples from 10 kidney grafted patients were immunologically analyzed for detection of fibrin degradation products by various techniques. Split product E, which was quantitatively determined by two-dimensional immunoelectrophoresis only contributes to a minor part to fibrinuria, but increases significantly during periods of severe acute rejection also during the first 2-3 weeks, when overall fibrinuria is not a useful indicator of impending rejection. Determination of split-product E therefore seems to be a valuable diagnostic procedure.


[Value and limitations of coronary blood flow measurement in man (author's transl)].

Attempts to measure coronary blood flow in man have made considerable progress during the last 25 years. The major techniques are based on the direct or indirect Fick principle; coronary flow is calculated from the arterio-coronary venous difference of inert gases or from the precordial recorded disappearance curve of radioactive gases or substances. The accuracy of the techniques depends upon the properties or the indicators used and the precision of their determination. All techniques applied hitherto are intricate and unsuitable for general use. -A lot of information is obtained about coronary circulation in health and disease by coronary flow measurements in man. Further studies in this field may influence pathophysiological and clinical concepts especially concerning coronary heart disease.


[Present state in synchronization therapy of malignant tumors and acute leukemias (author's transl)].

Chemotherapy of malignant tumors can be made more effective by synchronization of the cell cycle. Synchronization therapy consists of a synchronizing step (phase I), an interval and a cytocidal step (phase II). Some regimens till now approved in clinical treatment are presented. The results are found to be encouraging. In all schedules three effects work together namely synchronization recruitment, summation.


Pinworm infections in laboratory rodents: a review.

The important and common oxyurids which affect laboratory rodents- Syphacia spp., Aspiculuris tetraptera and Passalurus ambiguus-are discussed and reviewed. Their life histories, pathogenicity and immunity are examined, and mention is made of the influence of age, sex, strain and host status on infection. The importance of using worm-free animals in experimental work is stressed, and guidance is given on diagnosis and control.


Computer-aided speech training for the deaf.

An effort to develop a computer-based system of speech-training aids for the deaf is reported. The system is described, as are four different types of visual displays that have been programmed to date. The use of the system in a school for the deaf and an attempt to evaluate its effectiveness are described. The importance of close collaboration between researchers and teachers on efforts to develop innovative training aids is emphasized, as is the need to resolve some basic pedagogical issues.


Early removal of the eschar in upper extremity burns.

The rationale behind early removal of the burn is sound, but the techniques presently available to accomplish this are limited. In patients with large area burns, massive excision should be considered only in burn centers prepared to provide the enormous amount of supportive care required. Carefully selected, localized burns of the upper extremity may benefit from timely surgical excision. Final function, particularly in the hand, depends more on the depth of initial injury and involvement of deep structures than on the choice between excision and topical chemotherapy. Enzymatic débridement, though an attractive concept, is presently in the development stage and should be viewed with caution. The success of any procedure for early removal of the eschar depends on prompt and complete wound coverage with skin grafts.


Reconstruction of superior vena cava-right atrial continuity and "anatomic" repair of transposition of great arteries with ventricular septal defect.

A superior vena cava-to-right pulmonary artery anastomosis (Glenn procedure), used to palliate certain types of cyanotic congenital heart defects, has usually been left intact at the time of definitive intracardiac repair. Late failure of this shunt has prompted attempts to reestablish superior vena cava-to-right atrium and right ventricle-to-right pulmonary artery continuity. The present patient, a 10-year-old boy with transposition of the great arteries, ventricular septal defect, and mild pulmonic stenosis, had had a Glenn procedure performed at 3 years of age. Angiography demonstrated a patent superior vena cava-to-right pulmonary anastomosis. The appearance of the main left pulmonary artery and of its peripheral branches suggested the presence of pulmonary vascular obstructive disease in the left lung. Therefore, it was considered advisable to reconnect the right ventricle to the right pulmonary artery, which was "protected" by the long-standing low-pressure shunt. The operative result, the intraoperative hemodynamics, and the postoperative assessment of the pulmonary blood flow by means of lung scanning, which clearly demonstrated a preferential perfusion of the right lung, support the validity of this approach.


Sampling intestinal content with a sequestering capsule. A noninvasive technique for determining bile acid kinetics in man.

A noninvasive technique for determining bile acid kinetics by isotope dilution in man features the intravenous injection of a radiolabeled bile acid, together with daily oral administration, for several days, of capsules of dialysis membrane containing cholestyramine and colored beads for dating. The cholestyramine traps conjugated bile acids during transit of the small intestine. Capsules are recovered from stool by sieving, sequestered bile acid is eluted, conjugated bile acids are isolated chromatographically, and their specific activity is determined. The precision and validity of this sequestering capsule technique were assessed by comparing the specific activity decay curve of chenodeoxycholyl conjugates obtained from capsule samples with that obtained from duodenal samples in seven healthy volunteers in whom the bile acid pool had been labeled with [14C]chenodeoxycholic acid. Estimates of pool size by the two methods correlated well (r = 0.98), as did the daily fractional turnover rate (r = 0.96). The mean (+/-SD) percentage differences for the kinetic parameters of pool size (8.3 +/- 13.6), fractional turnover rate (-15.2 +/- 11.5), and synthesis rate (-4.3 +/- 11.4) were fairly small, indicating that the noninvasive method has validity. However, agreement between simultaneously administered capsules was only fair, especially when the amount of bile acid trapped was small, suggesting that the precision of the capsule technique may be less than that of the conventional duodenal sampling technique; the latter probably obtains a more valid sample of the bile acid pool.


Medicaid records as a valid data source: the Tennessee experience.

Health care researchers rarely employ Medicaid claim files as a data base, in part because they are designed to serve fiscal and administrative ends. Indeed, some investigators have emphasized the deficiencies in such records. In contrast, we have found Tennessee Medicaid data to be suitable for research. A statewide automated data processing system reduces the occurrence of many of the errors noted by others. Further, analysis of the July 1974 month of payment file illustrates the accuracy and internal consistency of Tennessee Medicaid data. Specimen legend drug results for ambulatory patients suggest investigations of physician prescribing patterns. Evaluation of the Medicaid claims processing system suggests other applications in health care administration and research. In a time when available resources are dwindling, the incisive use of Medicaid claims files offers an attractive alternative to expensive new systems of data collection and analysis.


Mechanical suture techniques in gastro-intestinal surgery: partial gastrectomy B I and B II.

Out of a total of 140 gastro-intestinal procedures performed with mechanical suture techniques 25 partial gastrectomies (according to Billroth I or II) are discussed. Provided the operating instructions are followed and possible complications are avoided, these mechanical techniques have proved advantageous.


Recurrent adenotonsillitis: a new concept.

An update of original data is presented. These data continue to confirm the physiological effect of adenotonsillectomy on the abnormal oropharyngeal and nasopharyngeal microflora of children with recurrent adenotonsillitis. A new concept suggesting a bacterial-viral etiology of recurrent adenotonsillitis is presented. The advantages of such a concept are reviewed.


Avoiding complications in radical neck dissection.

As reported previously, it remains our conclusion that the radical neck dissection can be performed expediently in a reasonable period of time, usually without the need of blood replacement, and is not characterized by major physiologic disability or wound complications secondary to the neck dissection alone. The presence of preoperative radiation, composite resections entering the oral cavity or pharynx, and systemic disease or debilitation, however, vastly enhance the risk of significant life threatening complications and prolong hospitalization; therefore, the use of postoperative radiation therapy in combined treatment, the use of planned fistulas and generally accepted reconstructive techniques, and a careful evaluation of the methods and technique for protection of the carotid artery are recommended.


One-stage dermal pedicle flap reconstruction of the oropharynx (an experimental and clinical study).

A single stage dermal pedicle graft method for reconstruction of oropharyngeal defects is presented. Its successful clinical use is described. The advantages of the method include large surface-to-surface anastomosis which appears to minimize breakdown secondary to hypovascularity of an irradiated recipient bed. Other advantages include its single stage feature, persistent blood supply, avoidance of external tubed pedicles and intermediate salivary fistulas. A histologic study in pigs preceded its clinical use in humans. Findings of both aspects of the study are discussed.


Tympanomastoid reconstruction: an operative procedure for anatomical and functional restoration of the radicalized ear.

A new operative procedure for the anatomical and functional restoration of both the middle ear and mastoid is described. The technique employs homograft tympanic membrane with ossicles en bloc for the middle ear reconstruction and a homograft dura form and autogenous bone pate is used to recreate the bony posterior ear canal wall. The reconstructed wall becomes hard viable bone in about one year. Results in terms of wall integrity, tympanic membrane survival and hearing are discussed. The mechanism of new bone formation is discussed with presentation of histologic findings.


[Core and surface antigen of the Dane particle in liver tissue - relation to different forms of hepatitis B (author's transl)].

The complete Dane particle consists of two serologically and morphologically different components: Core (HBc) and Surface (HBs). HBc is located almost exclusively in the liver cell nucleus and can be demonstrated by immunofluorescence and electron microscopy, but not by light microscopy. HBs is located exclusively in the cytoplasm and can be demonstrated by immunofluorescence (IF) and, if present in excess, by electron an light microscopy (as ground-glass hepatocytes). The combined analysis with IF, electron and light microscopy of biopsy specimens taken from patients with different forms of hepatitis with and without immunosuppresive therapy allows recognition of at least four different reaction patterns: 1. Immunosuppression type (= HBc-predominance type), 2. Elimination type, 3. Aggressive type (= HBc+s equivalence type, 4. Carrier type (= HBs-predominance type). The patterns of HB-Antigen components are of prognostic value as to the clinical course of hepatitis. These findings strongly suggest that immune responsiveness determins the reaction pattern, the key mechanism being immune elimination of affected cells. In addition, these findings stress the role of the immune system in regard to the variability to the clinical course of hepatitis B, and shed light on morphological correlations.


Medicolegal implications of medical records.

The problem of ownership and possession of patient's medical records has been reviewed. The apparent fallacies in the presently accepted legal doctrines regarding ownership of the patient's records by health care providers have been submitted. The legal approaches and tactics available to implement the accessibility and availability of his records to the patient have been reviewed. The problems incident to the employment of statutory enactments as a means of putting the patient's record in his possession have been considered. The various legal theories that could conceivably be utilized in establishing this right on a case-to-case basis in the courts have been presented. The medicolegal implications relating to medical records have been discussed.


The medicolegal aspects of rapid deaths initiated by hypoxia and anoxia.

In all forms of death the postmortem findings may be divided into two groups. The first group comprises those of general pathologic changes, such as visceral congestion and petechial hemorrhages. These nonspecific changes are always present in a greater or lesser degree in rapid deaths initiated by hypoxia and anoxia as well as in deaths from shock and natural causes. The second group consists of the pathologic changes which are dependent upon the type of death, eg, the local injuries to the neck in throttling and strangulation, and the color of the blood in acute carbon monoxide poisoning. Such changes are best described as special pathologic changes. In the description of postmortem findings for medicolegal purposes, a clear distinction should be drawn between nonspecific general pathologic changes and special pathologic changes which are dependent upon the type of death. All postmortem findings should be considered under the two headings: (1) special pathologic changes; and (2) nonspecific general pathologic changes.


[Experience with the clinical use of the PKS-25 and KTs-28 suturing devices].

A study of the experience gained during many years of use in the surgical practice of a stitcher PKS-25 for establishing esophageal-intestinal anastomoses and of the KTs-28 apparatus for anastomosing the colon with superjacent segments of the large intestine proved their efficient performance. Their utilization makes it possible to reduce the percentage of lethal outcomes due to inadequacy of the anastomosis sutures following operations involving gastrectomy, resection of the cardia, esophagus and segments of the large intestine.


Pleural mesotheliomas--an analysis of 18 cases and review of the literature.

Eighteen cases of mesothelioma, 7 benign and 11 malignant, were analyzed retrospectively. There were 5 females with benign tumors and 10 males with the malignant variety. The mean age was 59 years in the benign group and 55 years in those with malignant tumors. Exposure to asbestos was documented in one benign and five malignant mesotheliomas. Three patients with benign lesions were asymptomatic on presentation while all 11 with malignant tumors had symptoms, chest pain and dyspnea being the most frequent. Abnormal physical findings were rarely noted in the benign group while all the malignant tumors had abnormal findings on presentation. Signs of a pleural effusion were the most common abnormal physical findings, occurring in 8 of 11 patients. Pleural effusion was the most common roentgenologic finding in malignant mesotheliomas, while a mass lesion was the presenting finding in six of seven of the benign group. Pleural effusion was a usual accompaniment of malignant tumors and was an exudate, usually hemorrhagic with leukocyte counts up to 20,000/mm3. Thoracotomy established the diagnosis in each of the five benign and seven malignant cases in which it was attempted. Pleural biopsy was diagnostic in three of six with malignant and one of two with benign tumors. Pleural fluid cytology did not yield a diagnosis in the seven instances in which it was studied. Excisional surgery was performed in five of the benign cases and all have survived one to six years. No treatment was curative of malignant mesotheliomas. Ten of the 11 with malignant tumors died from 3 to 24 months after onset of symptoms (mean 9.9 months). The clinical features of 82 benign and 160 malignant mesotheliomas from selected series in the literature are reviewed and compared with the present series. The roentgenographic features of 51 benign and 87 malignant tumors are also presented. The clinical and diagnostic features which help differentiate mesotheliomas from bronchogenic carcinomas are discussed. A careful approach to the diagnosis of malignant mesotheliomas may help avoid an unnecessary thoracotomy.


Sudden infant death syndrome in South Australia. Measurement of serum IgE antibodies to three common allergens.

Radioallergosorbent test (RAST) studies showed that IgE antibodies to Dermatophagoides pteronyssinus (house dust mite), Aspergillus fumigatus and bovine beta-lactoglobulin were significantly elevated in the sera of infants who died as a result of the sudden death in infancy syndrome (SDIS). No significant differences were found in the levels of total IgE, IgA, IgG or IgM in the sera of SDIS victims or controls. The possible role of hypersensitivity in the aetiology of SDIS is discussed.


In vitro diagnosis of allergy. Radioallergosorbent test (RAST) studies with some allergens commonly encountered in Australia.

The radioallergosorbent test (RAST) is proving valuable for experimental work in allergy research and as an in-vitro supplement in the diagnosis of clinical allergy. A detailed description of the materials and procedures required to establish the technique as a routine laboratory method, and data obtained in setting up the method for use with a variety of allergens commonly encountered in Australia are presented.


Gynaecology  from ancient Egypt: The papyrus Kahun: A translation of the oldest treatise on gynaecology that has survived from the ancient world.

This article presents a new translation of the papyrus Kahun. Interest in the papyrus lies in its being indisputably the most ancient document on gynaecology known. The text consists of a continuum of individual "cases" which lend themselves to subdivsion into four major sections. Selected commentaries accompany the translation which consist in the main of illuminating quotations from other Egyptian papyri. The aim is to propagate some insight into the gynaecological concepts behind medical practice around 2000 B.C.


Bayesian statistics: a guided tour.

An overview of Bayesian statistical decision theory is presented in the tutorial spirit. A section on fundamental principles is followed by selected applications of the Bayesian approach to parameter estimation, pattern recognition, image processing, computer-aided medical diagnosis, optimal diagnostic test selection, and radiotherapy treatment planning.


Localization of Escherichia coli ribosomal protein S4 on the surface of the 30S ribosomal subunit by immuno electron microscopy. I. Distribution of antibody-binding sites as obtained with immunoglobulins and monovalent antibody fragments from various S4-specific antisera.

The location of the ribosomal protein S4 on the surface of the 30S subunit of E. coli ribosomes was determined by immuno electron microscopy. Immunoglobulins from six separate S4-specific antisera were investigated. In accordance with earlier findings protein S4 was shown to have an elongated conformation within the antisera. Protein S4 has therefore definitely an extended or fibrous shape in the intact ribosome (Lake et al., 1974; Stöffler and Tischendorf, 1975; Tischendorf et al., 1975). S4 specific antibodies bind at four distinct sites of 30S ribosomal subunits, designated A, B, C and D. Two antibody binding sites (A and B) are located on the "head", they were shown to be separated by 70-85 A. The distance between these sites and the two sites C and D on the "body" of the subunit amounts to at least 90-125 A; hence protein S4 should be extended to a total length of approximately 160-200 A. At least three of the four S4-specific antibody binding sites were observed with antibodies from each of the six investigated. These sites were observed independently of whether isolated S4 protein, an S4-16S rRNA complex or 30S ribosomes were used as the antigen. They could also be visualized with monovalent antibody fragments (Fab). S4-specific antibodies enriched by affinity chromatography bound at identical sites which conclusively ensures that antibody binding at these sites is specific for protein S4 and is not due to the presence of contaminating antibodies in the intact ribosome. The implications of these results with respect of the correlation of each of the sites to their respective antigenically active fragments within protein S4 are discussed.


Variation of ACTA scanner numbers with the physical properties of the scanned material.

An experiment has been carried out in which an ACTA computerized axial-transverse tomographic scanner was used in a series of scans on a polystyrene phantom. Cavities in the phantom contained distilled water and various concentrations of acetic acid or ferric nitrate in aqueous solution. It is shown that the ACTA numbers generated for the low-Z acetic acid solution are proportional to the electron density of the solution, but that such is not the case for the higher-Z ferric nitrate, where photoelectric absorption is significant. The correlation of scanner numbers with electron density rather than with mass density is discussed and, as an illustrative example, the electron densities of whole blood and blood cells are calculated and the relative value is compared with the relative mass densities of the materials.


Antibiotics and compounds affecting tanslation by eukaryotic ribosomes. Specific enhancement of aminoacyl-tRNA binding by methylaxnthines.

The mode and site of action of inhibitors of translation (initiation, elongation and termination of protein synthesis) in eukaryotic systems is reviewed. The isolation and characterization of a factor is described that binds Ac-Phe-tRNA to form a complex made up of binding factors, Ac-Phe-tRNA, and ribosome. The binding of Ac-Phe-tRNA probably occurs at the ribosomal site involved in the binding of the initiator substrate Met-tRNAF. The effect of inhibitors of the intitiation phase of protein synthesis on the nonenzymic Ac-Phe-tRNA binding to ribosomes is investigated. The two sites translocation model for translation in eukaryotic cells is presented and the effects of inhibitors on the various steps of protein synthesis are determined empirically. The site of action of inhibitors of peptide bond formation at the ribosomal peptidyl transferase center is elucidated. The action of inhibitors of translocation is sutdied in model cell-free systems from human cells. In addition, a number of methylxanthines are shown to enhance the elongation phase in polypeptide synthesis by stimulating the enzymic binding of aminoacyl-tRNA. The effect of caffeine, theophylline and its derivatives are shown to be fairly specific and dependent on the ribosome concentration. Aminophylline is shown to have a similar effect but also enhances aminoacyl-tRNA synthetase activity at low Mg++ concentrations, probably displacing the optimal concentration of Mg++ in the reaction. This second effect of aminophylline appears to be due to the ethylenediamine moiety of aminophylline since it is also observed in the presence of different polyamines but not in the presence of caffeine or theophylline.


[Characterization of fluorescent derivatives of tRNA Phe by experiments in the ribosomal system].

Yeast tRNAPhe has been modified by excising the Y base and by replacing the Y base or the dihydrouracil residue with the fluorescent dyes proflavine or ethidium bromide. The poly(U) directed ribosomal system from E. coli was used to study the activities of the tRNAPhe derivatives in the assays for ribosome binding and polyphenylalanine synthesis. It was found that the tRNAPhe derivatives modified by replacing dihydrouracil were nearly as active as unmodified tRNAPhe. While excision of the Y base led to a considerable decrease in the activities, replacement by the above mentioned dyes yielded rather active tRNAPhe derivatives. The activities decreased somewhat when the tRNAPhe derivatives with a substitution in the anticodon loop were reduced with NaBH4. The lower plateau values observed with some of the tRNAPhe derivatives are largely attributed to a decreased efficiency of tRNA binding to the ribosomes which, in turn, results in an increased susceptibility to deacylation prior to phenylalanine transfer.


[Transcription of DNA by RNA polymerases of E. coli and calf thymus].

The paper deals with the comparative investigation of initiation and in vitro RNA synthesis on DNA template by E. coli RNA polymerase and B-form of calf thymus RNA polymerase. It was shown in hybridization experiments that in the range of Cot values between 10(2) and 10(4) RNA synthesized by calf thymus RNA polymerase was hybridized with homologous DNA more effectively than RNA synthesized by E. coli RNA polymerase. No differences were observed in the case of low Cot values. RNA chains synthesized by calf thymus RNA polymerase contained in average about 300-600 nucleotides per chain as determined in the kinetic experiments with ATP-gamma-32P and GTP-gamma-32P. These values are in average 5-10 times lower than in the case of bacterial enzyme. The data presented show that calf thymus and E. coli RNA polymerases initiate the RNA synthesis at apparently different sites of calf thymus DNA. The results obtained make the possibility of specific transcription of eucaryotic DNA by bacterial RNA polymerase to be doubtful.


[Phage T4 partial diploidy obtained with the method of DNA interrupted injection. I. Analysis of the genetic structure and phage progeny reproduction process].

Phage T4 chromosome fragmentation is shown to take place when DNA injection is interrupted, a fragment length being strictly controlled by the interval from the moment of adsorbtion till the moment of an interruption. Populations of the bacteria cells infected by the phage T4 partial diploids are produced with the method of DNA interrupted injection. In the population a merodiploid involves some phage T4 amber mutant and a phage "wild" type chromosome fragment of the size controlled. To construct merodiploids the amber mutant in gene 43 and the mutant in gene 32 with the higher and the lower recombination frequency, accordingly, are used. Every merodiploid which is the heterozygote by one of these genes or which is the heterozygote by the late genes is determined to reproduce mixed phage progeny. Both the mean of the burst and the parent genotypes ratio in progeny either in the E. coli CR-63 cells or in the E. coli B depend on neither the heterozygote genetic structure nor the diploid region size. The results obtained conclude that phage genes express their function in the small fragments and the fragment recombination with the mutant partner whole chromosome follows their autonomous replication.


[Demonstration of bone lacunes and canicules].

Schmorl's thionin-dye was applied to paraffin embedded sections after decalcination in a ferrichlorid-hydrochlorid acid solution. Using this modification long-lasting treatment with Müller's solution or celloidin embedding can be avoided.


[Structure of the DNA molecule in the course of reparation process after ultraviolet irradiation of E. coli cells].

Kinetics was studied of DNA degradation, processing and synthesis in the course of post-radiation incubation (irradiation dose 0-2000 erg/mm2). It has been shown that contrary to the endonuclease splitting of DNA strands, DNA degradation requires energy. DNA degradation is not enhanced upon an increase of the irradiation up to 400 erg/mm2 and more and at the incubation duration exceeding 120 min. The degradation involves not more than 40% of the total DNA quantity. It takes place in the absence of resynthesis registered by the incorporation of [3h] thymidine and 32P and dephinylamine reaction. The number of single-strand breaks in DNA (per one E. coli chromosome strans) reaches a maximum value after 120-180 min. of incubation. This maximal value is linearily increased upon an increase of the irradiation dose from 0 to 1200 erg/mm2 and does not change when the dose increases further. The number of single-strand breaks does not exceed 35-50, this value being dependent on the presence of glucose. On the basis of the data obtained a suggestion is put forward that in the course of the reparative degradation of DNA, prolonged (10(4)-10(5) nucleotides) single-stranded regions are formed. Possible role of these 'nicks" in the appearance of mutations is discussed.


Mutagen testing using TRP+ reversion in Escherichia coli.

Escherichia coli strain WP2 and its repair-deficient derivatives are suitable strains for mutagen screening. In these strains, agents which cause base substitution mutations can be shown to increase the frequency of Trp+ revertants. In addition, agents causing many types of DNA damage can be detected through increased killing of the repair deficient derivatives. Four ways of performing tests are described: (a) Spot tests in which a small amount of the agent under test is placed directly on a selective agar plate. Trp+ revertants are counted and increased sensitivity of repair-deficient strains determined from the size of the zone of inhibition of cell growth. (b) Treat and plate tests, where a strain is treated with the agent under test and subsequently plated to determine survival or frequency of Trp+ revertants. (c) A simplified fluctuation test which shows exceptional sensitivity in measuring mutation with low levels of mutagens. (d) Use of a liver microsomal fraction in conjunction with treat and plate tests to detect metabolically activated mutagens. The merits and defects of these systems are discussed. Common pitfalls in evaluating tests and procedures for avoiding them are described.


Use of a simplified fluctuation test to detect low levels of mutagens.

As a mutagen screening procedure we have used a modification of the Luria and Delbrück fluctuation test in which the individual tubes are scored by eye for the presence or absence of a mutation. The test is simple and extremely sensitive, detecting concentrations of mutagens up to 100-fold lower than conventional tests. Measuring mutation to tryptophan independence in Escherichia coli strain WP2 we have found that methyl methanesulphonate (0.5 mug/ml), mitomycin C (0.0015 mug/ml), dichlorvos (5 mug/ml, and K2CrO4 (0.5 mug/ml) are all positively mutagenic in the test, whereas NiCl2 is negative. Chronic exposure to low levels of mutagens using this method appears to induce more mutations than might be predicted by extrapolation from short exposure experiments at higher doses. The procedure is applicable to any system which involves mutation to prototrophy from a non-leaky auxotrophic requirement and should prove valuable in detecting and investigating the effects of low doses and chronic exposures.


The induction of mutation in yeast by hydrogen peroxide.

The inactivation and mutation to respiratory deficiency of yeast cells by H2O2 are shown to vary progressively with the phase of cell growth, with a sharp transition occurring as the cells complete logarithmic growth. Respiratory deficient mutants isolated from the wild-type population are of two types, one of which is much more sensitive to H2O2 but forms only a small fraction of the mutant sub-population. Based upon the response of the more resistant type, mutation frequency increases appear to result from selection of pre-existing mutants in log phase populations, while induction occurs in stationary phase cells. The induced mutation frequency fits a (dose)2 relationship, but the frequency is depressed when the dose is high (or number of cells treated is low). All the induced mutants are extranuclear and of the resistant type, and show a wide range of suppressiveness in crosses to respiratory competent cells. This may indicate mitochondrial DNA is altered to different extents by H2O2; by the same criterion, the spontaneously occurring H2O2 -sensitive mutants retain a large amount of mitochondrial DNA information, in agreement with their colonial morphology. A small increase in forward mutation of nuclear genes was also found after H2O2 treatment. Parallels are drawn between the response of yeast cells to ionising radiation and to H2O2, and it is suggested that radical action may be involved in inactivation and mitochondrial genome mutation induced by both agents.


Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection.

We investigated the role of maternal antibody in neonatal Group B streptococcal infection with a radioactive antigen-binding assay employing a purified polysaccharide antigen with both Type III and Group B determinants. Serums from seven women who gave birth to infants who had invasive Group B streptococcal infection with Type III strains were all deficient in antibody. In contrast, serums from 22 of 29 pregnant Type III vaginal carriers whose infants were healthy contained antibody with a prevalence significantly different from that in women delivering infants with Type III disease (P less than 0.01). Three healthy neonates born to women with antibody in serums had demonstrable antibody in umbilical-cord serum. These data suggest that transplacental transfer of maternal antibody protects infants from invasive Group B streptococcal infection with Type III strains.


Immune complexes in hepatocytic nuclei of HB ag-positive chronic hepatitis.

To localize immune complexes in viral hepatitis Type B and to assess their pathogenic role, we examined by the direct fluorescent-antibody technic 21 liver specimens with hepatitis B core antigen (HBc Ag) in hepatocytic nuclei from 10 patients with HBs Ag-seropositive acute viral hepatitis and from 11 patients with HBs Ag-seropositive chronic active hepatitis. IgG with in vitro fixation of complement was demonstrated in HBc Ag-containing hepatocytic nuclei of all patients with chronic active, but not in those with acute viral hepatitis. All patients except for one had antibody to HBc Ag in the serum as determined by indirect immunofluorescence. The evidence suggests that intranuclear IgG in chronic active hepatitis has anti-HBc specificity and forms immune complexes with HBc Ag. The binding of IgG to intranuclear HBc Ag might have pathogenic importance in chronic active hepatitis.


Physician fee patterns under medicare: a descriptive analysis.

To describe physician fee patterns under a national program, we analyzed physician reimbursement rates for 39 medical procedures for 292 local Medicare reimbursement areas. The results indicate that the maximum prevailing charge for each procedure generally ranged from three to 10 times the minimum charge. Prevailing charges, however, clustered around the mean (coefficient of variation less than 0.50) in 37 of the 39 fee distributions for general practitioners and specialists. Although differences (P less than 0.05) existed between mean general practitioner and specialist charges for 27 of the 39 procedures, these differences were generally less than 10%.


Bacterial cloning of plasmids carrying copies of rabbit globin messenger RNA.

DNA copies of rabbit globin mRNA have been inserted into the plasmid mini-ColEl. After addition of poly(dT) tails, the plasmid was used to prime the copying of mRNA by reverse transcriptase. Mini-ColEl carrying globin sequences were denatured and annealed with mini-ColEl tailed with poly(dA). Functional plasmids containing the synthesised globin sequences were isolated by transfection in E. coli.


Mechanism localisation and control of restriction cleavage of phage T4 and lambda chromosomes in vivo.

The primary action of restriction endonuclease, cleaving infecting DNA, has been demonstrated in vivo. This primary cleavage is followed rapidly by hydrolysis of the cleaved DNA at its newly exposed termini. Infecting viruses can inactivate cytoplasmic and membrane restriction endonucleases to prevent cleavage of unmodified DNA replicas.


[Kyphotic paraplegia treated by antero-lateral transthoracic decompression and double autograft].

The authors describe a case of malformative kyphosis with paraplegia, treated by transthoracic antero-lateral decompression and anterior spinal fusion by posterior spinal fusion six weeks later. The result of the surgical treatment has been excellent with complete functional recovery. The spinal fusion seems to be the main element of the treatment, by contrast it is impossible to assess the role played by the antero-lateral decompression.


[Brain scanning of the posterior fossa tumors (author's transl)].

It has been generally accepted that the scanning of the posterior fossa yield less accuracy in comparison with that of the supratentorial region. It seems that the difficulties are primarily attributable to the parotid gland, the overlying venous sinuses, and the heavy investment of the muscles with their rich vascular supply at the posterior fossa. These problems are compounded by poor patient positioning in the posterior view. We believe that the brain scanning of the posterior fossa is, however, nearly as successful as that of the supratentorial region, when the following procedures are carried out. We performed 99mTc-pertechnetate brain scanning 41 times and 169 Yb-DTPA cisternography 7 times on 25 posterior fossa tumors, from August 1970 to September, 1974. The diagnosis of these cases were confirmed by operation or autopsy. These include six neurinomas, six astrocytomas, three medulloblastomas, three hemangioblastomas, three metastatic tumors, one meningioma, one arteriovenous malformation, one osteochondroma and one microglioma.


[Atlanto-axial dislocation--instability index and indications for surgery (author's transl)].

Thirty cases of atlanto-axial dislocation were investigated and the results are reported. The may be divided into 2 groups; (a) 15 cases of abnormalities of the odontoid process, i. e. 7 cases of os odontoideum, 7 cases of fractured odontoid, 1 cases of deformed odontoid, and (b) 15 cases with no abnormalities of the odontoid process. Neurological signs were noted in 14 cases which may be divided into the following three types, i.e. acute, recurrent, and chronic-progressive. The spinal canal diameter at the atlanto-axial level was measured in the position of flexion and extension using cervical tomography. The degree of motility thus obtained was expressed in terms of "Instability Index" (I. I.) devised in our clinic. In the group with neurological signs, the acute type showed an I. I. of 39 percent which was the highest value, and followed by 33 percent in the recurrent type. In the chronic-progressive type, the I. I. value was as low as 3.75 percent with a mean maximal diameter of 11.0  mm. Operation was performed in 16 cases. In 12 cases, posterior fusion was performed from the occipital bone to C3 or in some cases C4. In 3 cases, posterior decompression and fusion from the occipital bone to C3 were conducted. In one case, anterior decompression and fusion was performed by the transoral approach. The outcome was generally satisfactory. As a new method of posterior fusion, we have used "single bone-flap" method since 1972, that could fix the occipital bone and the cervical spines more tightly. In conclusion, the operation is indicated in the following cases; (1) when neurological signs are evident, (2) even in the abcence of neurological signs, (a) when the I. I. is high (over 20 percent), (b) even when the I. I. is low, when the maximal diameter of the canal is under 14.0 mm.


Neural control of LH release in anterior periventriculo-median eminence-pituitary system.

Separate regions of the anterior periventricular area (PVA), median eminence (ME) and frontal cortex from brains of hypophysectomized female and intact male rats were extracted and homogenized. The LH-RH content of these homogenates was determined by a specific double antibody radioimmunoassay. LH-RH was found in the PVA as well as in the ME of both hypophysectomized female and intact male rats; it was not detected in the frontal cortex. Extracellular recordings were made from neurons in the PVA and 55 neurons were activated antidromically by stimulating the ME. This suggests that PVA neurons exist with axons terminating in the ME. It is assumed that these axons are unmyelinated since their conduction velocity was approximately 0.3-0.8 m/sec. In addition to the antidromically-activated neurons, 26 neurons with characteristics of transsynaptic activation were recorded in the PVA following stimulation of the ME. Some of the units recorded from the ME-arcuate (ARC) region were also activated either antidromically or transsynaptically by stimulating the PVA. The effect of PVA stimulation on LH release was tested in ovariectomized, estrogen-treated rats with or without anterior deafferentation of the hypothalamus. Increased LH concentration in serum was elicited by PVA stimulation of rats in which deafferentation was either not performed or not completed; no increase in serum LH level was observed following PVA stimulation in rats with complete deafferentation. These data suggest that PVA neurons synthesize LH-RH, which is released at the ME.


Ovulation in PMS-treated rats with gonadotropin releasing hormone after pentobarbital and melatonin block.

The immature rat that has been induced to ovulate with pregnant mare serum (PMS) has proven to be a valuable model for the study of antiovulatory compounds. This paper describes an extension of this model in order to attempt to study the site of action of substances such as pentobarbital and a pineal compound, melatonin. A first experiment was designed to define a specific time for injecting pentobarbital in order to inhibit ovulation. In this study immature female rats were given injections with 25 IU PMS; pentobarbital was given at various times after PMS treatment. This study showed that sodium pentobarbital (35 mg/kg, i.p.) inhibits LH release and ovulation when rats have been anesthetized between 2 and 6 p.m. on day 2 after PMS treatment. In a second experiment ovulation was blocked with pentobarbital (35 mg/kg, i.p., beginning at 12 noon and at 2 p.m. on day 2 after PMS treatment) and completely restored to normal with the s.c. injection of 2 mug GnRH at 2 and 4 p.m. on day 2 after PMS treatment. In the third experiment, varying doses of GnRH were studied for their capacity to overcome the pentobarbital block. This study showed that 2 mug, 1 mug, 500 ng, and 250 ng of GnRH at 2 and 4 p.m. on day 2 after PMS treatment were equipotent in causing ovulation. In a fourth experiment ovulation was blocked with melatonin and this block was overcome with exogenous GnRH. In the last study exogenous GnRH was shown to restore ovulation after being blocked by both melatonin and pentobarbital. This evidence suggests that pentobarbital and melatonin inhibit ovulation by inhibiting the secretion of endogenous GnRH.


[Effect of Coretal Polfa (Oxprenolol) on parkinsonian tremor and benign essential tremor].

Coretal -- an agent blocking the beta-adrenergic receptors -- was given to 12 patients with Parkinson's syndrome with evident tremor and to 4 patients with benign essential tremor. In the group of Parkinson's syndrome the effectiveness of this treatment was evaluated by the blind method. The whole period of observation was 6 weeks, during 3 weeks the patients received Coretal 60-120 mg daily, during the next 3 weeks they were given placebo. The intensity of tremor was assessed by means of a scoring system. Improvement was achieved in 7 patients with Parkinson's syndrome and in 3 out of 4 cases of idiopathic tremor. Complete disappearance of tremor was never observed. Transient side effects were observed in 2 causes. The authors think that Coretal may be used with good result in treatment of parkinsonian tremor and benign essential tremor.


Automation of a patient medical profile from insurance claims data: a possible first step in automating ambulatory medical records on a national scale.

This report describes how a detailed patient medical profile can be produced by the systematic collection and linkage of claims data in a state-wide Medicaid program. Extension of this system nationally could provide automated medical profiles for more than 20,000,000 people at a small increment in cost. The possibility that this cost could be offset by reduction of duplicated services currently provided deserves serious consideration by health care planners and administrators. The ability of the profile to portray a patient's clinical status accurately hinges on both the determination of health care administrators to adopt sensitive and precise diagnostic codes and on the adoption of improved data acquisition techniques. The deficiencies of the database are described, and methods of overcoming these problems are suggested.


[Preliminary observations on changes in pancreatic blood flow studied with the use of rubidium (Rb86) in acute experimental pancreatitis].

Initial results of research into pancreatic blood flow by the use of a gammaemitting radioisotope, Rubidium86 (Rb86) are reported. The experiments were carried out on normal dogs and on dogs with acute pancreatitis that had been brought on by various techniques. Some of the physiopathological aspects of the role of microcirculatory changes within the pancreas in the genesis of acute necrotico-haemorrhagic pancreatitis are discussed.


[Dorsal intestinal cyst (split-notochord syndrome) in a newborn girl].

A dorsal formation in a newborn girl proved to have been caused by an intestinal cyst, thus forming part of the rare classification of split notochord malformations.


[Cholesteric liquid crystal plaque thermography. New diagnostic aid in plastic surgery (preliminary note)].

A new type of examination for assessing the vitality of flat and tubular flaps by means of patch-mounted cholesteric liquid crystals is presented. The thermographic method employed is discussed with reference to two clinical cases.


Pulsatile gonadotropin output and response to luteinizing hormone releasing hormone (LRH) in primary amenorrhea.

The pulsatile gonadotropin output and resonse to luteinizing hormone releasing hormone (LRH) administration was evaluated in 23 patients with primary amenorrhea. Pulsatile LH output and associated FSH pulses were readily observed in patients with hypergonadotropism. Responses in patients with congenital adrenal hyperplasia varied with the adequacy of the prior therapeutic management, which in turn apparently determined the maturational status of the individual. A patient with Kallmann's syndrome had both FSH and LH pulsatile activity. Patients thought to have simple delayed puberty had normal baseline gonadotropin values, and regular LH pulsations, but no correlation of FSH and LH pulsatile activity. Correlated analysis of LRH response and pulsatile gonadotropin activity may allow differentiation of individuals showing a normal progression of maturation from those with maturational dysfunction.


Cephacetrile in the treatment of female pelvic inflammatory disease.

The efficacy and tolerability of cephacetrile administered by the intravenous or intramuscular route was evaluated in an open-label study of 55 hospitalized females diagnosed as having mild to severe pelvic inflammatory disease. Rapid improvement was observed in most patients. All patients were classified as clinically cured or significantly improved. Pain was absent or mild in 86% of the patients who received cephacetrile by intramuscular injection. Seventy-two percent of the patients given the drug intravenously experienced no localized pain. Phlebitis occurred in 6 of the 53 patients (11%) who received intravenous cephacetrile and thrombosis was present in 3 (6%). Rash and puritus was reported in 1 patient. Results of this study suggest that cephacetrile is an important and useful drug in the treatment of pelvic inflammatory disease.


Obstetric observations in eleven cases of neonatal sepsis due to the group B beta hemolytic streptococcus.

Neonatal sepsis due to Group B streptococcus is reported to be increasing, but the reasons are unclear. Eleven cases from a single hospital were reviewed for common obstetric factors. Frequent observations associated with 8 surviving infants were maternal infection, early evaluation and treatment of the newborn, and 4+ or 5+ growth on maternal cultures. In contrast, mothers of the 3 infants who died had no clinical signs of infection, and cultures were not obtained. All 11 infants had direct monitoring during labor but the frequency of infection, 1/1600 live births, was lower than usually reported. Three surviving infants and 3 nonsurvivors were premature. Semiquantitative culture technics suggest that the predominance of Group B streptococcus in the vagina may be a more important etiologic factor than the frequency of its presence.


Phase I study of L-asparaginase (NSC 109229).

22 patients received intravenously infused L-asparaginase (Escherichia coli) on a protocol for 5 weekly doses. 13 patients received 100 U/kg, 1 patient 500 U/kg, and 8 patients 1,500 U/kg. Only 3 of the 9 patients receiving 500 U/kg or more were able to complete the 5-week protocol. 11 of the 13 patients receiving 100 U/kg were able to complete the 5-week protocol. Significant tumor responses were not seen. CNS toxicity and allergic reactions were observed at high- and low-dose levels. There was no difference as to the degree of protein changes, BUN elevation, or liver function abnormalities at the different dose levels.


Nitrosourea combination chemotherapy: 1-(2-chloroethyl)-3-(4-methyl cyclohexyl)-1-nitrosourea (methyl-CCNU) and cyclophosphamide.

MCCNU and cyclophosphamide are synergistic in animal tumor systems and have different chronology patterns for dose-limiting myelosuppression. The combination was employed in 49 patients with metastatic cancer with each drug administered on successive days and repeated at 6-week intervals. A total of 108 courses of therapy were monitored, and leukopenia (WBC less than 3,000 cells/mm3) and thrombocytopenia (platelets less than 150,000/mm3) were observed in 47 and 30%, respectively, at nadir days 15 and 22. No clinically beneficial effects were observed in 40 patients with measurable disease. Combination chemotherapy employing nitrosoureas have not, as in this study, generally demonstrated synergistic therapeutic effects possibly related to the low level of antitumor activity of nitrosoureas in solid tumors and the use of suboptimal doses for one of more agents in the combination.


Lymphocytes and cells in malignant transformation: similarities and possible relationship between the two cell types.

This paper points out some similarities between the behaviour and characteristics of lymphocytes and their transformation to lymphoblasts on one hand and malignant cells on the other. The areas of similarity are (1) anomalous communicating junction formation; (2) recruitment of neighbouring cells; (3) random antigen expression; (4) Fc synthesis; (5) stimulation by immune attack; (6) relation to a plasminogen activator, and (7) inhibition of stimulation by trypsin inhibitors. It is argued that, considering the anomalous membrane characteristics shown by lymphocytes and malignant cells and the list of similarities, carcinogenesis could represent a normal cell line infected with lymphocytic information. Two incidental ideas are presented based on the main idea. These concern lymphocytes but are related to malignant cells and their characteristics too. They are (1) a mechanism whereby generation of randomness in the variable region of Ig molecules could take place, and (2) a mechanism whereby the lymphocyte, in order to kill its target, could use the normal cell's propensity to form communicating intercellular junctions.


[Lactate dehydrogenase isoenzymes during early embryonic development in rats].

Using the Coon's immunohistochemical method, antisera against LDH-1 and LDH-5 and electrophoresis in polyacrylamide gel, the polypeptides A and B, i.e. the products of both the LDH genes, were shown to be present both in mature eggs and at the early stages of their development. The spectrum of LDH isozymes in the nature egg is represented, mainly, by LDH-1 and LDH-5. The electrophoretic pattern of the egg LDH depends on the method of extraction since LDH-5 appears to be in the bound form. It has also been shown that the content of LDH-2 and, especially, LDH-3 and LDH-4 in the mature egg is low.


[Heart muscle regeneration].

A review of literature on the possibility of regeneration of muscle fibers under the artificial myocardium trauma in frogs, newts, lizards, newborn kittens, rats and guinea pigs, in very small foci of trauma in adult dogs and rabbits, under the stimulation of regeneration in adult rats, rabbits and dogs. The data are given about growth and secondary differentiation of muscle fibers in the myocardium of chick, mammal and human embryos, as well as of adult cocks and rabbits under the definite conditions of explantation. It was noted that the sources and mechanism of formation of muscle fibers remained as yet unclear, as well as the causes preventing the myocardium regeneration in adult mammals under routine conditions of traumatization. It is stressed that the problem of myocardium regeneration is as yet not solved and, being one of the most important biological problems, needs further studies.


Clinical and experimental experience in reconstruction of the anterior cruciate ligament.

Various methods for reconstruction of the anterior cruciate ligament have been described in the literature. In 1968 Broström et al. described a reconstruction using the medial third of the patellar ligament as a substitute for the cruciate ligament. (The operative procedure is described elsewhere in this book by Eriksson and has also been described by Alm and Gillquist.) The aim of the present investigation was to study the long term clinical results after reconstruction of the anterior cruciate ligament using the medial third of the patellar ligament. The clinical and morphological findings were correlated at various intervals after reconstruction of the ligament. The influence of the rotatory movement of the tibia on the tensile strength and on the elongation of the anterior cruciate ligament was studied experimentally. To clarify the vascular anatomy and morphology of the cruciate ligaments and to study the vascularization and fate of the transposed part of the patellar ligament, experimental surgery was performed in dogs.


Repair of the ligaments about the knee.

The evolution of techniques used to repair torn ligaments about the knee is described. A combination of repairs of the anterior cruciate ligament, medial collateral ligament, and posterior joint capsule along with transfer of the medial half of the semimembranosus tendon and transfer of the pes anserinus is described. The surgical procedures have been evolved over a three year period in an orthopedic practice in a skiing and resort community. These combinations of surgical techniques can insure stable knees for active persons without the need to resort to more formal and more extensive surgical procedures. It is also thought that repair of both fresh and old ligament tears in the manner described gives the athletic individual a better chance for continuing in recreational and competitive sports, as well as reducing the possibility of lateral degenerative joint changes.


Closed treatment of Achilles tendon ruptures.

A method of closed treatment of ruptures of the Achilles tendon is advocated. This system provides for a period of casting for ten weeks, eight of which are with the foot immobilized in gravity equinus. The use of a long leg cast for the first six weeks is justified to allow relaxation of the gastrocnemius muscle. Clinical evaluation and experience in treating eight patients reveal a consistently good result with a minimum of complications. The inherent risks of anesthesia and surgery are avoided. The postoperative problems associated with surgery on the Achilles tendon are not present.


Varicella gangrenosa due to group A beta-hemolytic Streptococcus.

Varicella is usually a well-tolerated disease in normal children. Pyogenic infections involving the skin are the commonest complications and their potential severity is emphasized by our recent experience with two children who suffered from gangrene as a result of cutaneous superinfection with group A beta-hemolytic streptococci. We present the recognition and management of these patients in an effort to reacquaint physicians with this potentially fatal infection.


The vulnerability of the medical student: posthumous presentation of L.L. Stephens' ideas.

L.L. Stephens described several critical issues in medical professionalization. The encounter with morbidity and mortality heightens the student's feelings of vulnerability. If he over-identifies with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing patients, humane treatment suffers. Students have surreal perceptions of their responsibility for patients. Recognition of unconscious motivation may be troubling to students. Finally, there are emotional barriers to the recognition of psychosocial elements in disease. To optimize students' personal and professional functioning, medical training should deal with these concerns. Support can be provided by small continuing learning groups for students and clinical faculty, in which these issues, illustrated by videotapes of patient-student encounters and other clinical examples, are discussed in the context of providing comprehensive medical care. Support should continue during internship.


The role of artificial ventilation, oxygen, and CPAP in the pathogenesis of lung damage in neonates: assessment by serial measurements of lung function.

Lung volume, airway resistance, and compliance have been measured in 19 infants, 18 of whom suffered from the respiratory distress syndrome (RDS) at birth, while the remaining infant was ventilated for persistent apnea and a pneumothorax. Prior to discharge from the neonatal unit, and after recovery from RDS, most infants were found to have essentially normal lung function. When retested between 4 and 11 months of age, every infant who had received artificial ventilation during the acute illness was found to have developed a raised airway resistance, whereas the remaining infants, who had been treated with continuous positive airway pressure and/or oxygen were all entirely normal. The implications of these results for the management of RDS are discussed.


Preliminary study of effects of "in vivo" emotive imagery on dental discomfort.

To examine the effects of "in vivo" emotive imagery on dental discomfort (as measured by pulse rate and self-report) 27 female subjects undergoing tooth prophylaxis were exposed to three tape-recorded treatment conditions (relaxation imagery, neutral imagery, and a blank tape) in counterbalanced order. Promising findings of a pilot study were not confirmed on heart rate; however, on self-reported discomfort, positive differences appeared between the relaxation imagery and each of the control conditions.


Comparison of scoring methods for tests of attention, including an error index for use with schizophrenic patients.

A resume is given of various doubts raised concerning the application of signal-detection theory to discrimination tasks involving 'supra-threshold' stimuli, as in tests of vigilance and selective attention. The validity of this theory in pathological conditions, such as schizophrenia, is also questioned. The continuing need for a unitary index combining errors or omission and commission is emphasized and the various indices so far proposed are compared using experimental data. A new Error Index is offered as a more satisfactory resolution.


SAM Complex Coordinator and Multidimensional Pursuit Test: annotated bibliographies.

A brief description of the SAM Complex Coordinator (Mashburn Apparatus) and the SAM Multidimensional Pursuit Test (MDP or MPT) and annotated bibliographies including 144 and 51 citations respectively are presented. All references are annotated as to subject matter within six categories; Factor Analytic-Task Taxonomy, Aircrew Selection-Classification, Learning Phenomena, Stress Effects, History and Development, General Reviews.


[Adriamycin, VM 26, cyclophosphamide and prednisone (AVmCP) combination in the therapy of disseminated lymphoreticulosarcoma (Stages or topographical forms III and IV].

This work presents the results obtained on 24 patients with disseminated lymphosarcoma and reticulosarcoma (stage III and IV) with a cyclic combination chemotherapy which combines adriamycin, epipodophyllotoxin (VM 26), cyclophosphamide and prednisone. The complete remission rate is 58 p.cent of the patients who entered the trial, the response rate is 75 p.cent. Tolerance of the regimen is good in general from the hematological point of view.


[Pharmacokinetics of acebutolol].

Pharmacodynamic data correlating beta-adrenoceptor blockade with plasma level of drug were obtained in healthy male volunteers (3). Direct comparison of the inhibition of isoprenaline induced tachycardia was achieved in each volunteer after the administration of single doses of either acebutolol (300 mg), practolol (400 mg) or propranolol (40 mg). These drugs were approximately equipotent at these doses, at the times of maximum beta-adrenoceptor blockade. Pharmacokinetic data were obtained in hypertensive male patients (4) after treatment with 14C-radioactively labelled acebutolol hydrochloride. Both 'total-14C' levels and specific '14C-acebutol' levels were determined in plasma, urine and faeces. It was shown, by calculation from the renal clearance, that the late biological half-life for the decline of 14C-acebutolol in plasma was 9.4 h and 13.2 h, respectively, in two of these patients treated with a single oral dose (200 mg) of 14C-acebutolol hydrochloride. In one of the patients treated by intravenous infusion (20 mg/10 mn), the late biological half-life plasma was calculated to be 7.5 h. Renal clearance of acebutolol was shown to be close to a mean of 83 ml plasma/mn for each of three patients (two oral and one intravenous) in spite of the fact that one of the orally treated patients had an elevated level of urea in his plasma (47 mg/100 ml) indicative of some impairment of kidney function. The recovery of 14C-radioactivity in the urine (29 p. cent) and faeces (64 p. cent) was 93 p.cent of the dose of labelled acebutolol in one of the orally treated patients. The overall proportion of the dose excreted as unchanged 14C-acebutolol was 62 p.cent. The major metabolite was the product formed by shortening of the butyramido-group of acebutolol to form an acetamido-group. This metabolite was also readily excreted in both urine and faeces and was also detected in an extract of the 4 h plasma from an orally treated patient. It was identified by co-chromatography as the acetyl analogue (M & B 16 942) of acebutolol. It would be detected by the colorimetric assay of acebutolol in plasma because the same aromatic amino-compound (M & B 17 127) would be formed during the acid hydrolysis procedure. A small quantity of an other unidentified metabolite was detected in an extract of freeze-dried urine after autoradiography of a two dimensional thin layer silica-gel chromatogram.


[Hemodynamic effects and effects on plasma renin activity of injectable acebutolol in arterial hypertension].

The purpose of the study was to determine the early haemodynamic effects of injectable acebutolol and to study in parallel the changes in plasma renin activity (P.R.A.) in 11 patients, most of whom were affected with labile arterial hypertension. The haemodynamic measurements and P.R.A. determinations were carried out before and 5 and 15 mn after very slow intravenous injection of 10 mg acebutolol. The results obtained under these conditions were as follows: 1) Decrease in cardiac index (I.C.). It was particularly significant after 5 mn, since the I.C. decreased from 4.43 to 3.75 1/mm (p less than .01). It was essentially due to a decrease in heart rate, that fell from 90.45 to 77 beats/mn (p less than .001), while stroke volume changed virtually not. 2) Decrease in blood pressure, more marked on systolic blood pressure (110 mm Hg after 15 mn as against 154 mm Hg before injection; p less than .001), associated with a decrease in left ventricular work (4.7 kgm/mn/m2 after 5 mn as against 6.2 kgm/mn/m2 before injection; p less than .001), without significant changes in total systemic arterial resistances. 3) Increase in diastolic pulmonary arterial pressure (10.4 mm Hg after 5 mn against 8.09 mm Hg before injection; p less than .001), testifying to a slight left ventricular myocardial depression. 4) Decrease in supine P.R.A. level (0.72 nanogram/1/mn after 5 mn as against 1.15 nanogram/1/min before injection; p less than .01). A significant correlation was found between this decrease in P.R.A. and that in I.C., testifying to a close parallelism between the inhibition of cardiac beta-1 receptors and that of the receptors involved in renine secretion. 5) The tolerance of injectable acebutolol appeared to us to be excellent.