Essential fatty acid requirements in infancy.

The infant's requirements for essential fatty acids (EFA) have been calculated by different workers from the same limited number of observations which depended on the use of butterfat, linoleic acid, and its esters as the source of EFA. The linoleic acid content of the butterfat employed was determined by a method of known not to be specific for the biologically active linoleic acid (cis cisC18:2omega6). The assay reported (3.3%) is about double that (1+01.6%) usually anticipated. If the butterfat used was actually of average linoleic acid content, then estimates of requirements are about twice the true values. In some tests, linoleic acid or its esters were used rather than fat or triglycerides. In other tests the total fat content of the diet was very low, and the tocopherol content of the diet was not controlled. All of these factors could adversely affect linoleic acid utilization and so exaggerate EFA requirements. If minimum EFA needs are as high as those suggested (1.0%) of cal), deficiency should be commoner than it in fact is. For the reasons noted above it is believed that the minimum requirements for EFA have been set far too high and are in fact less than 0.5% of cal, so that a daily allowance of 65 mg/100 cal (about 0.6% cal) should provide an ample margin of safety.


Vitamin E: a reexamination.

An attempt is made to place into proper perspective the relative values of the eight natural forms of vitamin E and the epimers of the synthetic products with regard to their biological activities. Since differences in activities reported are mostly in a function of different rates of biological turnover, feeding a non-alpha-tocopherol compound three times a day would be expected to give a different biological value than if the total were fed once a week or together with alpha-tocopherol. An analysis of data to support an increase in the current RDA for vitamin E is presented. Recent developments on the prolongation of blood clotting time by vitamin E are interpreted from the viewpoint that alpha-tocopherol is oxidized to tocopherylquinone, which is an inhibitor of vitamin K.


Detection of methionine in pernicious anemia megaloblasts and other types of erythroid precursors.

Utilizing a bacterial-agar overlay technic incorporating the methionine-requiring bacterium Leukonostoc mesenteroides, little or no bacterial growth was seen surrounding the megaloblasts and proerythroblasts of eight patients who had severe untreated pernicious anemia. Similarly, scant bacterial growth was observed in five cases of chronic erythremic myelosis (DiGuglielmo syndrome). Heavy bacterial growth, indicating ample amounts of methionine, was seen in two cases of autoimmune hemolytic anemia, and in two cases of severe untreated folate-deficiency anemia. The results are consistent with the "methyltetrahydrofolate trap" hypothesis in pernicious anemia, in which a defect in the methylcobalamin-dependent methyltransferase leads to reduced amounts of methionine. These studies also suggest that a similar methyltransferase defect does not occur in folate deficiency or autoimmune hemolytic anemia. The generation of methionine, as estimated by the present technic, may also be defective in chronic erythremic myelosis.


Mania in childhood: case studies and literature review.

Criteria for mania in children have been established on the basis of criteria for mania in adults. Mania in children is an episodic disorder characterized by marked irritability and agitation, a considerable increase in activity level, push of speech, sleep disturbances, distractability, and noticeable mood instability that persists for longer than one month. Euphoria is frequently present in children with mania and is manifested as an adamant denial of any illness or problem. Previous reports have not stressed the characteristic appearance of depressive symptoms, such as hopelessness and helplessness, crying spells, death wishes, and beliefs of persecution, all of which can occur during the manic episode in children.


Neonatal pneumopericardium.

Six cases of pneumopericardium in neonates with hyaline membrane disease were observed during a six-month period. Five babies were receiving positive inspiratory or expiratory pressure or both. All but one had other extra-alveolar air collections. In three cases, sudden decrease in PaO2 was the only recorded sign that led to diagnosis. Pericardial aspiration was performed in four babies; one died and three either survived or died later of unrelated disease. One neonate was not treated and died of other causes. Treatment was delayed in the sixth infant; the pneumopericardium disappeared spontaneously but soon reappeared and contributed to a fatal outcome, although a drainage catheter was inserted. This experience and review of other authors' observations suggest that prompt drainage by catheter and continuous suction is indicated.


Fatal disseminated BCG infection. An investigation of the immunodeficiency.

A 2-year-old boy had a fatal disseminated BCG infection. Immunologic assessment showed a normal humoral response and normal numbers of E rosettes, normal thymus weight and histological features, but an abnormal response of lymphocytes in vitro and negative skin tests. Histological examination showed the presence of Gram-negative acid-fast bacilli within the macrophages. The possible mechanisms of immunodeficiency in this patient are discussed.


Suture granulomas simulating tumors: a preventable postgastrectomy complication.

Suture granulomas can occur after gastric surgery with nonabsorbable suture material. They are usually an asymptomatic, incidental finding on post-surgical x-ray studies, but have to be recognized because their radiological appearance may mimic gastric neoplasms and therefore may lead to unnecessary reoperations. Four cases of suture granulomas are presented, their diagnostic criteria outlined, and a plea is made for the use of a new completely absorbable suture material which could eliminate the occurrence of suture granulomas as well as the other known complications related to nonabsorable sutures, such as suture-line ulcers, abscesses, and adhesions.


A new look at the protection of hemoglobin AS and AC genotypes against plasmodium falciparum infection: a census tract approach.

A total of 4,097 randomly selected children under 5 years in Accra, Ghana were investigated for Hb type, malarial parasite species, and parasite density. Even though malarial infection rates in this metropolitan population were lower as compared to holoendemic areas, the differential survival of Hb S carriers was confirmed. In addition, similar but less pronounced survival effects were seen in Hb C heterozygotes. Hb S carriers had the highest infection rates. More females than males were infected. Individuals with a moderate parasite count (less than 50,000/ml) were seen more commonly amoung AS and AC individuals as compared to AA controls. It is postulated that heterozygotes have a better immunological defense against the deleterious effects of P. falciparum infection because persistent parasitemia stimulates antibody production.


Clinical pharmacy: the past, present and future.

Clinical pharmacy is discussed in terms of its historical basis, current status and future trends. Topics covered include the origins and current scope of clinical pharmacy practice, controversial issues in clinical pharmacy practice and education, and the quest for quality in clinical pharmacy practice.


Rabies immune globulin (human) in the prevention of rabies.

The development of rabies immune globulin of human origin is discussed. Antirabies serum of equine origin when used in conjunction with rabies vaccine, enhances significantly the chances of survival after a severe bite by a rabid animal. However, those who receive the equine serum may develop serum sickness or even anaphylaxis. To circumvent this risk, while preserving the benefit, many workers have attempted to develop rabies immune globulin of human origin. Success was impeded by the difficulty in obtaining rabies immune plasma with the needed antibody level. Despite this and other obstacles, production of the human globulin on a scale sufficient to satisfy clinical needs has been finally realized. At the appropriate dosage, this globulin was demonstrated to interfere minimally, if at all, with the expression of active immunity induced by vaccination.


Pharmacist involvement as a member of a renal transplant team.

A renal transplant service is described in which the pharmacist attends daily rounds, monitors drug dosage and conducts a medication instruction program aimed at improving patient compliance. A renal transplant handbook was developed to provide the patient with pharmacy, nursing and dietary instructions. Prior to patient discharge, the pharmacist provides a final medication consultation. As an active member of a renal transplant team, the pharmacist serves as a valuable source of drug information to medical personnel and patients.


Current drug therapy--barbiturates.

The following aspects of barbiturate therapy are reviewed: chemistry and stability of the agents; mechanism of action; pharmacology; absorption, distribution. metabolism and excretion; uses; cautions; drug interactions; laboratory test interferences; acute toxicity; chronic toxicity; and dosage.


An evaluation of the teratogenicity of certain antinauseant drugs.

In a large, prospective, observational study of pregnancy and child development, the antinauseant drugs prescribed to gravides for nausea and vomiting in the first 84 days of pregnancy were evaluated for their teratogenic potential. The severe congenital anomaly rates per 100 liveborn children and ther perinatal death rates of this group did not differ from the rates of the group with untreated nausea and vomiting. There was no indication that the phenothiazine derivatives, specifically the prochlorperazine derivative, as well as meclizine, cylizine, and Bendectin were associated with teratogenicity. The trimethobenzamide drug gave a slight suggestion of an excess of severe congenital anomalies.


Beta-lactam antibiotics alone or in combination with gentamicin for therapy of gram-negative bacillary infections in neutropenic patients.

This study was initiated to determine whether antibiotic combinations are superior to single antibiotics for the treatment of gram-negative bacillary infections in neutropenic patients. Twenty-six patients with Pseudomonas and Proteus infections received either carbenicillin or carbenicillin, plus gentamicin. The cure rates were 83 and 93 per cent, respectively. Twenty-three patients with infections caused by other gram-negative bacilli received either cephalothin plus gentamicin. The cure rates were 64 and 67 per cent, respectively. Superinfection occurred in 26 per cent of the patients who received a single antibiotic compared to 15 per cent of the patients who received a combination. Four of the 26 patients who received gentamicin developed transient azotemia. Combination therapy may be superior to single antibiotic therapy, but this study demonstrated no statistically significant differences.


Proteus species isolated from human eyes.

Of 34 species of Proteus isolated from human eyes, 29 (85%) were P. mirabilis and five (15%) were P. morganii. In vitro antibiotic sensitivity studies showed that gentamicin best controlled both P. mirabilis and P. morganii of all the antibiotics tested. In vivo tests on experimental Proteus infections of rabbit coreas, treated with gentamicin and tobramycin, yielded comparable clinical results, but gentamicin was more effective in eliminating the organism from the experimental lesions.


Surgically uprighting and grafting mandibular second molars.

A two-year follow-up was made of twenty-one impacted, mesially inclined mandibular molars which were surgically uprighted and splinted with autogenous bone grafts. There were two instances of follicular cysts in the adjacent impacted third molars and two instances of supereruption of uprighted teeth. With these exceptions, all uprightings were successful according to the criteria of continued root growth, normality of pulp chambers, normal periodontium, and normal contiguous structures.


Mononuclear cell turnover in chronic inflammation: studies on tritiated thymidine-labeled cells in blood, tuberculin traps, and dermal BCG lesions of rabbits.

Rabbits were injected intradermally in multiple sites with BCG. Four days after the BCG injection, they were injected intravenously with a single pulse of tritiated thymidine (3H-TdR) at various times thereafter, the BCG lesions were biopsied and evaluated for 3H-TdR-labeled mononuclear cells (MN). Periodically, Old Tuberculin (OT) was injected intradermally, creating MN traps which were biopsied and evaluated 1 day after their onset. 3H-TdR-labeled cells were also evaluated in samples of blood. During the first 8 days after the 3H-TdR pulse, the labeled MNs represent short-lived cells, i.e., recently dividing monocytes and lymphocytes. During this time, the percentage of labeled MNs in the blood, in the traps, and in the BCG lesions rose and fell together. This result suggests that the majority of the MNs in the BCG lesions had a turnover rate of about a week. By 12 days and afterward, the percentage of MNs labeled by 3H-TdR in the blood was higher than that in the BCG lesions which was in turn higher than that in the traps. At this time the circulating MN population probably contained labeled long-lived lymphocytes that did not enter inflammatory sites (the traps) as readily as the short-lived lymphocytes. The labeled MNs remaining in the BCG lesions probably did not divide and dilute out their 3H-TdR label as readily as those that were trapped from the bone marrow via the blood. The percentage of MNs labeled with 3H-TdR in the traps had decreased to about one-fifteenth of its peak value by 12 days, suggesting that the bone marrow's supply of labeled MNs was depleted at this time, except for the few cells labeled as a result of 3H-TdR reutilization.


Rosette formation of human erythrocytes on canine transmissible venereal sarcoma cells.

Human erythrocytes have been shown to form spontaneous rosettes on nonlymphoid canine transmissible venereal sarcoma cells. The tumor cell would attach on glass surface, and morphologic studies by both electron microscopy and light microscopy on Giemsa-stained rosetting tumor cells showed that they could be differentiated from the rosetting T lymphocytes in the tumor.


Effects of Ritalin on underachieving children: a replication.

Effects of Ritalin upon scholastic achievement of 18 academically deficient children were studied, in an attempt to validate findings of an earlier study of similar design. Results, in keeping with the previous research, indicate that while Ritalin affects behavior, it does not enhance learning, and may in fact mask academic problems. It is urged that the drug be used sparingly and critically, and only in conjunction with other modes of intervention.


Organic factors in hyperkinesis: a critical evaluation.

The role of organic factors in childhood hyperkinesis is evaluated, with a focus on electroencephalographic, neurological, biochemical, pregnancy and birth, and genetic research. Evidence that the majority of hyperkinetic children suffer from organic dysfunction is found to be minimal. This conclusion is discussed, and guidelines for future research are offered.


Effect of methylprednisolone on myocardial preservation during coronary artery surgery.

It has been proposed that a single preoperative dose of a corticosteroid may protect the myocardium from ischemic injury during open heart surgery. To test this hypothesis, a prospective, randomized, double blind study was carried out in ninety-five patients undergoing coronary bypass surgery using intermittent ischemic arrest with systemic and local hypothermia. Half the patients received 2 gm (approximately 30 mg/kg) of methylprednisolone 2 hours prior to the initiation of cardiopulmonary bypass and the other half received a placebo. Postoperative electrocardiograms and blood levels of serum creatine phosphokinase (CPK), lactic dehydrogenase (LDH), and serum glutamic oxalacetic transaminase (SGOT) were compared in the two groups. No apparent difference was noted in the number of patients with significantly elevated levels of CPK, LDH, or SGOT or in the number with positive isoenzyme patterns of CPK and LDH. Moreover, there was no significant difference in the mean values of CPK, LDH, or SGOT between the two groups. The number of patients with electrocardiographic evidence of myocardial injury (10 per cent) was the same in both groups and no difference was noted in (1) the ease with which patients could be weaned from cardiopulmonary bypass, (2) postoperative arrhythmias, (3) postoperative bleeding, (4) postoperative respiratory insufficiency, and (5) length of hospital stay. It is concluded that a single preoperative dose of 2 gm of methylprednisolone offers no demonstrable protection to the myocardium from the effects of ischemia during coronary artery bypass surgery.


Regional program for kidney preservation and transplantation in New England.

From July 1972 to March 1975, 431 cadaver kidneys were harvested and preserved by continuous pulsatile perfusion with cryoprecipitated human plasma. Forty-eight per cent of the transplanted kidneys were considered to have immediate function, another 48 per cent demonstrated acute tubular necrosis, and 4 per cent were classified as nonfunctioning. There was no difference in the incidence of acute tubular necrosis in relation to the total preservation time. There was a significant difference in the survival of primary cadaver grafts at six months and one year between the kidneys that demonstrated immediate function and those with acute tubular necrosis.


Abdominal incision and closure. A systems approach.

The application of systems analysis and flow charting technics to abdominal incision and closure allow a complete display of objectives and alternatives. A route of alternatives has been chosen and supported by the best available principles in the surgical literature. The choices include an unconventional large bite monofilament continuous one-layer closure of the abdominal aponeurosis as well as several less commonly used principles to minimize the risk of wound infection. The process of graphic display of objectives and alternatives in a surgical procedure or disorder allows one to more sharply focus on alternatives at different steps and more rigidly support them by careful analysis of past experience or review of the literature.


Experimental fibroplasia in the rabbit vitreous. Effects of hyaluronidase and implantation of autologous dermal tissue.

Intravitreal implantation of dermal connective tissue in rabbits caused a fibroplasia resulting in vitreous retraction, retinal detachment, and traction of nervous tissue from the optic nerve into the vitreous space. Following implantation into eyes with an intact vitreous the incidence of retinal detachment was low (2 eyes of 12). When the hyaluronic acid of the vitreous was degraded by hyaluronidase prior to implantation, 9 eyes of 12 developed a progressive detachment of the retina, usually within one or two months. Intravitreal fibroplasia was found to be an important pathogenic factor causing deteachment of the retina.


The adequacy of oxygenation during cardio-pulmonary resuscitation.

A series of experiments with eight dogs was carried out to determine the efficiency of oxygenation during cardio-pulmonary resuscitation. High oxygen tensions very near to normal levels were found in most dogs, and this was attributed mainly to normal lung function previous to cardiac arrest.


[Current methods for investigation of the lymphatic system (author's transl)].

Investigation of the lymphatic system attracts an ever increasing interest not only of scientists working in the theoretical field but also of clinicians. Therefore it is no wonder that numerous methods for the study of the lymphatic system have been proposed. The present article surveys a great number of these methods, and particular emphasis is given to the work that has been and is being carried out in the Soviet Union. It is shown that a detailed knowledge of the lymphatic system is essential if a holistic view of the structure and function of a particular organ is to be obtained.


Cytologic features of bone marrow in normal and mastitic cows.

Rib bone marrow was aspirated from normal cows and from cows with experimentally induced or naturally acquired mastitis. Nucleated cell counts in marrow films were made on the basis of differentiation of 500 cells. The myeloid/erythroid ratio was less than 1.0 in normal cows and generally greater than 1.0 in mastitic cows. The marrow reserve of mature neutrophils was nearly depleted in response to experimentally induced Streptococcus agalactiae mastitis (4th postinoculation day) or in an acute flare-up of naturally acquired Str agalactiae mastitis. A dose of 0.05 mg of Escherichia coli endotoxin, introduced into a single, normal, lactating quarter produced similar results within 8 hours. Concurrently, with depletion of marrow reserves of mature neutrophils, a neutropenia with left shift developed in the blood, and immature granulocytes increased in the marrow. The intensification of granulopoiesis returned the marrow reserves to normal or above normal within a period of 4 to 5 days, thereby reestablishing homeostasis.


Bactericidal activity of bovine neonatal serums for selected coliform bacteria in relation to total protein and immunoglobulin G1 and immunoglobulin M concentrations.

Bactericidal activity for a serum-sensitive Aerobacter aerogenes strain was associated with antibodies present in immunoglobulin G1 (IgG1) and immunoglobulin M (IgM), with the greatest activity on a weight basis in IgM. Activity in immunoglobulin G2 was absent. A total of 118 serums were prepared from blood collected from neonatal calves on farms experiencing unusually high mortality from diarrhea. The serums were allotted to 4 groups on the basis of total serum protein concentrations as follows: group I=7.0 to 9.5 g/dl, group II=6.00 to 6.98 g/dl, group III=5.00 to 5.90 g/dl, and group IV=3.9 to 4.9 g/dl. Bactericidal activity for the serum-sensitive aerobacter strain was distributed approximately equally throughout the 4 groups. Activity for 3 strains of Escherichia coli was minimal to absent. Concentrations of IgG1 and IgM were determined in 82 of the serums. Concentrations of IgG1 ranged from 0 to 54.2 mg/ml, with overlapping among the 4 groups. Concentrations of IgM could not be determined in serums with concentrations greater than 1.6 mg/ml. However, bactericidal activity did not correlate with the immunoglobulin concentrations, since activity was present to the same degree in serums with small concentrations of immunoglobulins compared with serums with as much as threefold larger concentrations.


In vitro and in vivo transfer of drug resistance for Salmonella and Escherichia coli strains in turkeys.

In vitro and in vivo transfers of antibiotic drug resistance were observed when isolates of multi-resistant Salmonella saint-paul and Escherichia coli donors were mated with multi-sensitive E coli and Salmonella typhimurium recipients, respectively. For in vivo studies, day-old turkey poults were used. Drug resistances were transferred either alone or in various combinations. In vitro, transfer was more frequent from E coli to S typhimurium; in vivo, transfer was more often observed from S saint-paul to E coli. Transfer occurred in vivo within 3 or 6 days after the recipient strain was given to poults previously infected with donor bacteria. In some instances, phage typing of S typhimurium indicated a change after transfer of drug resistance from E coli to S typhimurium. The criteria for in vivo transfer of drug resistance were discussed, and the implications of a change in phage type were noted.


A fluorescent antibody technique for identification of Mycoplasma hyopneumoniae colonies.

Fluorescent antibody staining of Mycoplasma hyopneumoniae colonies is difficult because the colonies wash from the agar. Airdrying of the colonies grown on solid medium-overlayed glass microscope slides fixed the colonies in place, so that fluorescent antibody stain could be readily accomplished. Apparent loss or alteration of antigenicity did not result from the air-drying process. The technique is useful for the identification of M hyopneumoniae isolates.


Computer analysis of the single-breath nitrogen washout curve.

A computerized system has been developed to analyze the parameters that can be derived from the nitrogen washout curve. Analog signals for air flow, volume, and nitrogen concentration are entered either on-line or off-line into a 24,000 mini-computer. The program calculates vital capacity, total lung capacity, and residual volume, as well as the slope of phase III, closing volume in liters, total lung capacity, residual volume, closing capacity, closing volume/vital capacity ratio, and closing capacity/total lung capacity ratio. Validation tests showed excellent correlation between hand- and computer-calculated values of closing volume(r=0.864), vital capacity (r=0.997), total lung capacity (r=0.991), and slope of phase III (R=0.926). We concluded that the computerized system for analysis of the expired nitrogen washout curve is as reliable as hand calculations and is  immeasurably faster.


Necrotizing fasciitis in narcotic addicts.

In its early stages necrotizing fasciitis may mimic an uncomplicated cellulitis, with erythema and only mild swelling and minimal pain. The combination of physical findings in a patient with a current history of drug addiction should arouse suspicion of an underlying fasciitis. An aggressive diagnostic approach including incisional biopsy, visual inspection of the underlying subcutaneous tissue, fasica and muscle, along with a Gram stain is suggested. Extensive and frequent debridement, appropriate antibiotics and physical therapy remain the essentials of treatment. A patient is discussed in whom a delay in diagnosis lead to near-fatal sepsis.


Hernioplasty using the hernial sac in repair of inguinal hernia.

Hernioplasty with use of the hernial sac appears to offer advantages over operations previously used to repair large defects in the posterior wall of the inguinal canal. This operation was performed on 66 patients without recurrence of the lesion in the 55 patients for whom follow-up data are available.


Pleural aspergillosis: a case report.

The first case of pleural aspergillosis on either American continent since 1958 is reported. The recent literature is reviewed. The pleura is infected by aspergillus through bronchopleural or pleurocutaneous communication. Surgical removal of aspergillus infected pleura is the cornerstone of therapy.


Treatment of pelvic lymphoceles after renal transplantation by intraperitoneal marsupialization.

Pelvic lymphoceles following renal transplantation occurred in five of 70 recipients and were treated by intraperitoneal marsupialization. There were no complications other than one recurrence, which was successfully managed by a second marsupialization procedure. Intraperitoneal marsupialization avoids the prolonged wound drainage of external drainage methods, and appears to be the treatment of choice for large pelvic lymphoceles.


Renal transplant arterial stenosis: amelioration of hypertension and improvement of transplant function after revascularization.

Two of 70 patients treated for a minimum of six months after renal transplantation developed main arterial stenosis to the allograft. Both underwent transplant revascularization and had follow-up at least six months to document lasting benefit. Amelioration of hypertension and improvement of transplant function proved statistically significant. Collateral vessels were not identified on pre-revascularization arteriographic studies. It is suggested that loss of the potential to develop protective collateral channels to transplanted kidneys mandates aggressive evaluation when hypertension and deteriorating renal function occur in the late follow-up period after renal transplantation. In such instances, arteriography and renin determinations may identify salvagable renal allografts, obviating necessity of subsequent retransplantation.


Bilateral tube thoracostomy to preclude fatal tension pneumothorax in patients with acute respiratory insufficiency.

Two patients with acute respiratory insufficiency requiring prolonged mechanical ventilation are described. Both patients developed fatal unilateral tension pneumothoracies after the respiratory insufficiency appeared to be improving. The pneumothorax in each patient appeared to be the result of high inspiratory pressures resulting from high tidal volumes and positive end expiratory pressure. Currently, we recommend bilateral chest tube thoracostomies for those patients with inspiratory pressures greater than 40 cm H2O as a prophylaxis against this fatal complication.


Intraoperative evaluation of the lens during penetrating keratoplasty.

The decision to extract the lens at the time of penetrating keratoplasty often depends upon the surgeon's philosophy regarding the efficacy of one-stage versus two-stage procedures, because the status of the lens in a patient with visually disabling corneal disease frequently cannot be determined before the operation. The commonly employed techniques for evaluating the clarity of the lens intraoperatively are prone to inaccuracies and often depend upon pupil size. Because a combined procedure may entail a more complicated postoperative course, some surgeons elect not to extract the lens at the time of keratoplasty. This will necessitate a second procedure which might ultimately compromise a successful corneal graft, as well as allow the possibility that some cataractous lenses may become progressively intumescent during the postoperative period and endanger the clarity of the transplant. It is, therefore, important to have a method to more accurately evaluate the status of the lens in patients with opaque corneas. The application of the coaxially-illuminated operating microscope to visualize fundus details after the corneal button has been removed permits a better estimation of the lens clarity.


Penetrating keratoplasty in acute herpetic corneal performations.

Central corneal perforations have traditionally been managed by conjunctival flaps, tissue adhesives, soft contact lenses, corneal patches and other conservative measures for the immediate preservation of the eye. An alternative method of treatment is immediate penetrating keratoplasty. We present the result of immediate keratoplasty for 25 eyes referred with acute central corneal perforations, 20 of herpetic origin and 5 with a chemical burn or dry eye syndrome. In all cases, the eye was successfully preserved. Twelve of 20 grafts (60%) for herpetic perforation went on to eventual clear grafts as opposed to 1 of 5 grafts (20%) in the dry eye or chemically burned patients. Significant complications encountered included cataract formation, secondary glaucoma and persistent epithelial defects; however, these should not preclude eventual restoration of good visual acuity. Penetrating keratoplasty in acutely inflamed and perforated eyes used to lead to angle closure and secondary glaucoma in a considerable number of cases, sometimes progressing to total disaster. We have shown that if enough corticosteroids are given immediately postoperatively, the risk for angle closure is not significant.


Human transfer factor in the treatment of guinea pig keratitis.

The local and systemic administration of human transfer factor to guinea pigs with herpetic keratitis or Candida albicans keratitis failed to alter the clinical or microbial course of the animals' disease.


Short-stay surgery (Shouldice technique) for repair of inguinal hernia.

Short-stay surgery for inguinal hernia repair using the Shouldice technique, with local anaesthesia in the great majority of cases, has achieved a recurrence rate of less than 1% in the repair of both primary and recurrent inguinal hernia. A personal series of 14 982 consecutive inguinal herniorrhaphies performed during a 21-year period with an overall recurrence rate of 0.6%, using the Shouldice technique exclusively, is documented and discussed in some detail. The results suggest that the adoption of these methods on a national scale would result in a saving to the economy of many millions of pounds.


Repair of chest wall defects after irradiation for breast cancer.

A simple technique using a contralateral deltopectoral flap is described for the immediate repair of defects of the chest wall resulting from excision of radionecrosis or persistent tumour after radiotherapy. Successful use in 3 consecutive cases has shown that the deltopectoral flap may be rotated through a full 180 degrees without compromise of blood supply and that primary healing may be obtained.


Cholesterol granuloma involving the temporal bone.

The cholesterol granuloma does not represent an independent clinical or pathological entity, rather it is a term used for the description of a tissue response of the temporal bone, to the presence of a particular foreign body, i.e., cholesterol crystals. Three factors are considered to play an important role in its development: 1) interference with drainage, 2) hemorrhage, and 3) obstruction of ventilation. The cause of the initial hemorrhage may be a hemorrhagic inflammation or diathesis, a trauma or some other form of vascular disorder. Interference with air exchange and clearance can be caused by: tubal blockage, persistent mesenchyme, polypoid changes, scar formations, tympanosclerosis, cholesteatoma, etc. The cholesterol granuloma may develop in any portion of the pneumatic system of the temporal bone and it can be associated with a variety of middle ear disorders. Its principal precursor is the chronic middle ear effusion or serous otitis media. Its clinical expression and hallmark is the "idiopathic hemototympanum," the dark bluish discoloration of the tympanic membrane. Osteitis and bone erosion are manifestations of an unusual, more advanced stage. Resorption of bone, in a rare instance, may lead to extensive destruction of the temporal bone.


Duodenoplasty with proximal gastric vagotomy.

To permit proximal gastric vagotomy without drainage in patients with gross duodenal narrowing a simple longitudinal incision, sutured transversely, has been found to be simple and safe. Early follow-up results have been satisfactory.


Middle ear effusions: definitions.

Evolution of nomenclature used in middle ear effusions for the last hundred years is researched and followed. It is concluded that in the light of present knowledge the term sero-mucous otitis media is the most appropriate for the nonpurulent effusions here under discussion.


Biological mediators of inflammation im middle ear effusions.

Four biological mediators of inflammation have been found in middle ear effusions from patients with otitis media with effusion. They are chemotactic factor(s), macrophage inhibition factor(s), activated complement and prostaglandins. The potential role of these mediators has been discussed in relation to their potential for maintaining inflammation in the middle ear cleft after Eustachian tube dysfunction.


Identification of allergic factors in middle ear effusions.

Allergic factors are important, but not the only etiologic force in middle ear effusion. Nor do bacterial and viral infections, nasopharyngeal mass lesions, neuromuscular or regional anatomic abnormalities rank as sole etiologic factors. Some children have multiple components to their problem that requires specific identification before a workable approach to management can be tailored for each of them. Identification and management of allergic factors requires special skills and a greater commitment of time. Yet the marked increase in total yield when allergic techniques are added to the armamentarium of the otolaryngologist make these factors both worthwhile and satisfying.


[Effect of prodigiozan on the course of candidiasis of the oral mucosa clinically and in an experiment].

The effect of various doses of prodigiozan on Candida infection was studied under experimental and clinical conditions. Hamsters and guinea pigs were used in the experiments. Prodigiozan was administered intramuscularly to the hamsters in doses of 100 gamma/kg of the body weight 1 hour before the infection and intracutaneously to the guinea pigs in doses of 50 gamma/kg 2 days before the infection. The results showed that the drug accelerated the recovery of the animals. In complex therapy of a group of 22 patients with candidosis of the mouth mucosa of various localization prodigiozan was administered thrice in doses of 50 gamma/kg. This provided faster elimination of the pathological process.


[Characteristics of the interaction of the A-factor with mutant 1439 of Act. streptomycini in the biosynthesis of streptomycin].

Some peculiar properties of A-factor using by mutant 1439 of Act. streptomycini were studied. It was found that A-factor was most intensively used for biosynthesis of streptomycin when it was added during inoculation. When A-factor was added to a I- or 2-day culture it was required in 10 times higher amounts and its high non-specific adsorption by the mycelium was observed. Interaction of A-factor with the mycelium providing restoration of the biosynthetic process was very rapid on a short-term contat of the I-day culture with A-factor. Transformations occurring under the effect of A-factor and leading to formation of streptomycin took place mainly inside the cells. Changes in the life cycle induced by A-factor developed under different conditions as compared to those promoting streptomycin biosynthesis.


[Effect of certain factors on the determination of the biological activity of amphotericin B].

Sensitivity of the test-microbe to amphotericin B was studied. It was shown that composition of the nutrient medium, the innoculum amount and preincubation may significantly change the conditions of determination of the test-microbe sensitivity to amphotericin B and affect the accuracy of the microbiological method of determination of the antibiotic activity. The size of the inhibition growth zones of the test-microbe at amphotericin B concentrations within 0.06 to 1000 gamma/ml were measured. The angle of the dose response curve was the least at amphotericin B concentrations within 0.06 to 1.0 gamma/ml. Therefore, they were most suitable for plotting the standard curves. The population growth character of a number of test-cultures was investigated. A new test-culture, i.e., C. scotti Tul-I was proposed as one being most sensitive to amphotericin B, having prolong lag-phase of the population growth, forming even growth and clear inhibition zones.


[Suppresion of the R-factor transduction transmission of antibiotic resistance markers in E. coli by distamycin A].

Some mechanisms of inhibition by distamycin A of transduction of antibiotic resistance markers of R-factors (RI drd and R222) with the moderate phage PI kc in E. coli were studied. The kinetics of the transduction of the R-factor markers was investigated in comparison with the stages of interaction of PI kc phage particles with bacterial cells of E. coli K-12 carrying the R-factors such as RI and R222 -- phage PI kc -- E. coli C6000. Later the effect of distamycin A on transduction of the above R-factors was studied using the same system. It was shown that distamycin A in concentrations of 75 gamma/ml suppressed the transduction of the R-markers when added to the transduction mixture simultaneously with the phage. The transduction rate decreased 15 times if the drug was added 5 minutes after beginning of the phage contact with the recipient culture. Addition of distamycin A at the 20th minute of the experiment induced no inhibition of the transduction of the R-factor markers. Preliminary 18-hour exposure to distamycin A of the recipient culture and phagolysates possessing transduction capacity resulted in decreased rates of the transduction of the antibiotic resistance markers 35 to 40 times. No inhibitory effect of distamycin A on the process of phenotypic manifestation of the antibiotic resistance markers of the R-factors was noted. The experiments showed that distamycin A affected the early stages of interaction of the transducing particles with the recipient culture, possibly the process of penetration of the transducing DNA of the R-factors into the cells of the recipient culture.


[Resistance to nalidixic acid in tetracycline-resistant mutants of E. coli].

The studies on the effect of nalidixic acid (negram) on the synthesis of DNA and determination of its minimal inhibitory concentrations revealed a regular decrease in the sensitivity levels to negram of the tetracycline resistant mutants selected on media with tetracycline. Heterogene ty of the tetracycline resistant mutants to EDTA showed that one of the causes of insensitivity of the mutants to negram was a change in the surface structures of the microbial cell.


[Biochemical processes in the leukocytes which phagocytize antibiotic--sensitive and antibiotic-resistant bacteria].

Biochemical activity of the guinea pig leucocytes phagocyting live antibiotic sensitive and resistant bacteria was studied in vitro. The results of the study showed that the leucocytes which had absorbed live Staph. aureus and E. coli sensitive and resistant to be benzylpenicillin and levomycetin respectively differed in increased contents of nucleic acids. The increase was due to higher contents of RNA. The activity of dehydrogenases, acid and alkaline phosphatases was markedly inhibited. The use of oxygen and lipase activity did not differ from the control in the experiments with phagocytosis of both Staph. aureus and E. coli. The activity of peroxidase and catalase in the experiments with phagocytosis of E. coli did not differ from the control, while in the experiments with phagocytosis of Staph. aureus it increased. The data testified to the fact that the enzymatic activity of the phagocytes changed when they absorbed the objects of phagocytosis, the changes in the biochemical activity being dependent on the nature of the antigen and its state.


[Microflora of the pus of lactation mastitis patients and its sensitivity to a series of antibiotics].

The etiological picture of lactation mastitis and sensitivity of its causative agent to some antibiotics were studied. Mostly microbial associations were isolated from the patients. Pathogenic staphylococci typed mainly by the phages of group I predominated among the isolates. In addition the strains of Proteus, Pseudomonas, E. coli and others were isolated from the pus of the mastitis cases. Sensitivity of the microflora to some antibiotics was studied. It was found that most of the causative agents of the postnatal mastitis possessed multiple resistance. They were mainly resistant to benzylpenicillin, streptomycin, tetracycline, chloramphenicol, oleandomycin and sensitive to oxacillin, methicillin, kanamycin and rifampicin. It was shown that during the patients stay under tha stationary conditions the postoperative wound were infected for the second time with hospital microbial strains.


Transduction of various R factors by Plkc phage.

Transduction of R-factors with phage Rlkc was studied. Six of the R-factors controlled resistance to single antibacterial drugs, such as tetracycline, levomycetin, ampicillin, neomycin, streptomycin and nitrofurans. When the donor strains produced bacteriocins, treatment of the transducing lysates with trypsine increased the yield of the R+-transductants. Transduction of the resistance determinants was not in most cases accompanied with lysogenization of the recipient cells. It was confirmed that transduction with phage Rlkc provided division of the R-factors into 2 groups, i. e. those with the resistance determinants possessing transferability after transduction and those with the determinants possessing no such ability. It was supposed that one of the causes of the R+-transductant inability to transferance of the resistance determinants on conjugation was their intergration into the recipient chromosomes on transduction.


[Isolation of new species of the genus Actinomadura on selective media with rubomycin].

In the screening programme of organisms producing new antibiotics on selective media with rubomycin (5, 10, 20 gamma/ml) 4 unusual actinomyceteus cultures forming short, straight, hook-like and monospiral spore chains on the aerial mycelium were isolated. The study of the composition of the cell walls showed that they contained meso-diaminopimelic acid and madurose, a differentiating sugar. On the basis of the morphological structure and composition of the cell walls the isolates were classified as belonging to Actinomadura. Comparison of the isolates with the species of Actinomadura described in the literature showed that the isolates were new species of the genera, i.e. Am. roseola sp. nov., Am, aurantiaca sp. nov., Am. vinacea sp. nov. and Am. livida sp. nov.


[Variability in Act. circulatus var. monomycini induced by N-5-nitroso-N-methylbiuret].

The effect of N-5-nitrozo-N-methylbiuret (NMB) on various features of Act. circulatus var. monomycini, an organism producing monomycin was studied. It was found that the lethal effect of NMB depended on the exposure time, prolongation of which resulted in increased numbers of the plus variants, morphological and auxotrophic mutations and reverses into the populations of the monomycin-producing organism. An increase in the temperature of the treatment had an effect on the frequency of morphological and auxotrophic mutations inducing an increase in the number of the first and some decrease in the number of the second. The fact of specificity in formation of the vitamin B6-deficient auxotrophic mutants of the same type was of special interest. This was probably associated with genetic peculiar properties of the culture. It was supposed that the genes controlling biosynthesis of vitamin B6 were localized on the actinomycete plasmids, elimination of which under the effect of NMB resulted in blocking of vitamin B6 synthesis which in its turn impaired the reactions of transaminations participating in formation of monomycin.


[Observations on the sensitivity to antibiotics of the Shigella isolated from patients in 1966-1973].

Sensitivity to levomycetin, streptomycin, chlortetracycline, oxytetracycline, monomycin, neomycin and erythromycin of 3766 strains of Shigella isolated from dysentery patients within 1966-1973 was determined with the method of standard discs. The strains proved to be resistant to tetracycline (94.3-99.4 per cent), streptomycin (85.1-94.9 per cent) and levomycetin (69-93.1 percent). By present the dysentery bacilli have preserved their sensitivity to monomycin (88.2 per cent) and neomycin (98.2 per cent). Cultures insensitive or slightly sensitive to erythromycin predominated. Strains with multiple resistance amounted to 79 per cent, including 82.5 per cent of Shigella Sonne, 51.8 per cent of Shigella Flexneri and 35.9 percent of Newcastle bacteria.


[Change in the immunoreactivity of white rats immunized with a Candida albicans vaccine during the use of antibiotics].

The experiment was carried out with 252 albino rats of Wistar line immunized with Candida albicans vaccine under conditions of treatment with tetracycline, streptomycin and penicillin in doses of 40000-50000 Units/kg body weight. In the first part of the experiment the animals were immunized with a single dose of dead carpuscular vaccine and treated with the antibiotics for 10 days. In the second part of the experiment the animals were immunized 3 times, and 2nd and 3rd immunizations being with live cultures of C. albicans and the antibiotics were used for 20 days. The results of the experimental showed that repeated administrations of the antibiotics to the albino rats during immunization decreased the animal immune reactivity and aggravated the experimental candidosis: the rate of semination with the fungus increased and excretion of the fungus from the organism decreased.


[Method of isolating spontaneous variants of actinomycete cultures, producers of antibiotics].

The necessity of taking into account the specific characteristics of the colony differentiation for isolation of spontaneous variants of the initial culture with the method of monospore plating was shown on the examples of the geliomycin-producing culture Actinomyces chromogenes var. trienicus 141-18. It was found that the population density of the colonies had a significant effect on the differentiation rate during the subsequent stages and completeness of the culture development. The less was the population density, the longer was the period of the colony complete development. Definite levels of the colony organization (fractionation of morphogenesis) corresponded to different dilutions of the monospore suspension providing definite population densities of the colonies on the plates. On the basis of the data on the colony differentiation compared with the data on the population density effect upon differentiation it was possible to determine without mistake stable variants on the plates at any dilution of the monospore culture, i.e. with any population density of the colony.


[Effect of proteolytic enzymes on the antimicrobial activity of antibiotics].

The results of the studies on the effect of chemotripsin on the antimicrobial activity of monomycin against laboratory cultures, such as Staph. aureus 209 P, E. coli M38 and Streptococcus zymogenes and 20 clinical strains isolated from patients with purulent peritonitis are presented. The studies were performed with the method of two-fold serial dilutions. It was found that chemotripsin decreased 3.2.10-2.6.10(5) times the MIC (minimum inhibitory concentration) and the bactericidal concentration of monomycin. The presence of fibrin in the medium inhibited 4-128 times the antibacterial effect of monomycin. The potentiating effect of chemotripsin on monomycin could be explained by both a better "contact" of the antibiotic with the microbes and an direct increase in the antibiotic sensitivity of the microbial cells. Combination of monomycin with chemotripsin provided the use of decreased doses of the antibiotic. It is an effective means of overcoming the antibiotic resistance in pathogenic microbes.


Inhibition of peptidoglycan cross-linking in growing cells of Escherichia coli by penicillins and cephalosporins, and its prevention by R factor-mediated beta-lactamase.

The degree of peptidoglycan cross-linking has been studied in growing cells of a Dap(-) Lys(-) auxotroph of Escherichia coli K-12 by following the incorporation of [(3)H]diaminopimelic acid into the lysozyme digestion products of crude, isolated peptidoglycan. The percentage of inhibition of cross-linking increases with increasing concentrations of penicillin G, cephaloridine, and cefuroxime. When the R factor R1drd 19 was introduced into the strain by conjugation, it was found that the type IIIa, beta-lactamase specified by the plasmid was able to protect the cross-linking target against inhibition by penicillin G but not against cephaloridine, even though the beta-lactamase hydrolyzes this substrate 50% faster than penicillin G. Cefuroxime, which is completely resistant to hydrolysis by the type IIIa beta-lactamase, inhibited the peptidoglycan cross-linking target in both the R(+) and R(-) variants of the assay strain. A mutant plasmid, R1drd19amp2, which specified no type IIIa beta-lactamase synthesis, could not provide protection of the cross-linking target against penicillin G. The significance of these results, in relation to the ability of the antibiotics to pass the permeability barrier of the bacterial envelope, is discussed.


Evaluation of antibiotic efficacy using electron microscopy: morphological effects of guanylureido cephalosporin, BL-P1654, and carbenicillin on Escherichia coli.

Early response of Escherichia coli to minimal inhibitory concentrations of 112883, BL-P1654, and carbenicillin was determined by [(14)C]leucine uptake and scanning electron microscopy morphology studies. [(14)C]leucine uptake was inhibited later by carbenicillin than by BL-P1654 or 112883. Cellular swelling at 30 min, septal region swelling, and lysis were the progressive morphological changes with BL-P1654 and 112883. Carbenicillin-treated cells showed septal region swelling, beaded chains, and lysis.


Synergy in the antimicrobial action of penicillin and beta-chloro-D-alanine in vitro.

beta-Chloro-d-alanine and penicillin G acted on early and late steps, respectively, in the biosynthesis of the bacterial cell wall. In combination these compounds showed a synergistic effect on the growth of Salmonella typhimurium and of Escherichia coli in vitro.


Killing of Torulopsis glabrata by Saccharomyces cerevisiae killer factor.

The Saccharomyces cerevisiae killer factor glycoproteins killed the pathogen Torulopsis glabrata by a mechanism involving membrane damage. Some other yeast species were unaffected by these glycoprotein toxins.


Mode of action of the polyene antibiotic candicidin: binding factors in the wall of Candida albicans.

The polyene antibiotic candicidin produces a rapid efflux of K(+) ions from a suspension of Candida albicans. Onset of K(+) leakage depends on the culture age, stationary-phase yeasts leaking K(+) more slowly than exponential-phase yeasts. The time taken for potassium leakage to begin represents the time taken by the antibiotic to cross the cell wall and produce membrane damage. It was shown that there were factors in the cell wall of C. albicans that increased their total binding capacity and their affinity for candicidin during growth. An attempt was made to relate changes in the lipid content of the yeast cell with the increased time taken to produce membrane damage.


Nystatin-induced potassium efflux from Saccharomyces cerevisiae measured by flame photometry: a potential bioassay approach.

A potential bioassay method for nystatin has been developed based on the ability of this antibiotic to bring out dose-related potassium ion efflux from susceptible cells of Saccharomyces cerevisiae, such extracellular potassium ion concentration being measured by flame photometry.


Bactericidal action of dapsone against Mycobacterium leprae in mice.

Dapsone (4,4'-diaminodiphenylsulfone), incorporated into the mouse chow in a concentration of 0.1 g/100 g of diet, was administered for 1 week to mice in which Mycobacterium leprae had multiplied to the level of 10(6) organisms/footpad. M. leprae were harvested from these and also from control mice, diluted serially, and inoculated into additional mice. The organisms recovered from untreated mice multiplied in passage with a mean doubling time of 12.2 days, and 35% or more of the inoculated organisms were viable, i.e., capable of infecting mice. Growth curves of M. leprae recovered from dapsone-treated animals lagged behind those of organisms from control animals by an average of 78 days, equivalent to 98.8% killing. Foot-by-foot harvests showed that only 0.2% of the M. leprae recovered from treated mice were viable, suggesting that treatment of mice with dapsone had been accompanied by killing of 99.4% of the viable M. leprae.


Safety of the bolus administration of gentamicin.

A study was done to assess the safety of gentamicin administration by a bolus method. A total of 63 patients were randomly treated with intravenous gentamicin by bolus administration (3 to 5 min) and by slow infusion (2 h). Serum gentamicin levels were measured. Renal and audiovestibular function were monitored. Pure-tone audiometry was performed at the beginning, on day 3, and at the end of therapy. The study revealed that the bolus administration was safe and nontoxic.


Sensitization of colicin K-treated bacteria by sodium dodecyl sulfate: presence of free colicin in colicin K-treated cultures of Escherichia coli.

A method of assaying colicin K is described. It makes use of two properties of sodium dodecyl sulfate to protect bacteria against colicin action and to dissolve those bacteria on which colicin K had started its action. By this method, the kinetics of bacterial killing by colicin K have been measured directly in the treated culture without intervening dilution. The kinetics are exponential with time and are a function of the colicin multiplicity, as described previously, but do not reach a final plateau. At any time during colicin treatment, free colicin is found in the medium. Procedures that eliminate or destroy this free colicin, such as centrifugation and resuspension of the treated bacteria in a fresh medium, or addition of trypsin or sodium dodecyl sulfate to the treated culture stop bacterial killing.


Penicillin-induced lysis of Escherichia coli in medium that does not support sustained growth.

Exponentially growing cells of an Escherichia coli auxotroph that are washed and resuspended in buffer containing a carbon source undergo sufficient growth to render them susceptible to penicillin-induced lysis, even in the absence of the required metabolite. This lysis is probably responsible for the reduction in intracellular enzyme activity previously attributed to a direct effect of penicillin upon the enzyme.


Substitute for agar in solid media for common usages in microbiology.

The potassium salt of carrageenan was found to be an adequate replacement for agar in solid bacteriological media. The common microbial genetic techniques, such as purifying colonies by streaking, replication tests, and titration of cultures, were carried out sucessfully with a number of mutant strains of Escherichia coli.


Evaluation of an automated fluorescent antibody procedure for detection of Salmonella in foods and feeds.

A prototype automated system using fluorescent antibody (FA) was evaluated for rapid detection of salmonellae in foods. Samples were enriched in selenite cystine and tetrathionate broths. After incubation, both were transferred into fresh selenite cystine for a 4-h "post-enrichment" to dilute possible background fluorescence from product. These cultures were then analyzed automatically, and results were compared with those obtained by the methods of the Association of Official Analytical Chemists (AOAC). Initially, 167 samples of milk powder, dried yeast, and imported frog legs were examined. The AOAC and automated FA methods correlated well with all samples but frog legs. Difficulty with the latter was caused by procedural and mechanical problems coupled with high numbers of competing microorganisms in post-enrichment cultures. Modification of procedure and partial redesign of equipment corrected these difficulties, and excellent correlation was obtained with another 116 frog leg samples. All 89 AOAC-confirmed positives were also detected by the automated FA method, and there were only 4% false FA positives. The system shows potential for screening products for salmonellae; however, all positives should be confirmed by manual biochemical and serological methods.


Toxicity and mutagenicity of 2,4,-6-trinitrotoluene and its microbial metabolites.

TNT (2,4,6-trinitrotoluene) of explosive grade is highly toxic to marine forms that included fresh water unicellular green algae (Selenastrum capricornutum), tidepool copepods (Tigriopus californicus), and oyster larvae (Crassostrea gigas), and mutagenic to Salmonella typhimurium. On the basis of mutagenic assays carried out with a set of histidine-requiring strains of the bacterium, TNT was detected as a frameshift mutagen that significantly accelerates the reversion rate of a frameshift tester, TA-98. In contrast, the major microbial metabolites of TNT appeared to be nontoxic and nonmutagenic.


Continuously variable amplitude contrast microscopy for the detection and study of microorganisms in soil.

A new type of phase microscope was used to detect and observe the microflora in soil and to differentiate cells and spores from soil debris. This microscope provides a continuous variation in the amplitude ratios between undeviated and deviated beams of light, and the microbial cells, spores, and debris in soil change in appearance to a differing degree in response to the changes in amplitude ratio.


Selective isolation of Neisseria sicca from the human oral cavity on eosin methylene blue agar.

Strains of Neisseria sicca and N. mucosa, but not N. perflava, N. subflava, N. flava, or N. flavescens were found to grow on eosin methylene blue agar. The distribution of N. sicca on the tongue dorsum, the gingival crevice area, and the coronal surfaces of teeth of humans was determined using this medium. N. sicca averaged about 5% of the total cultivable organisms of the tongues of 14 subjects examined, but it was present in only trace quantities in dental plaque on the coronal surfaces of teeth or in the gingival crevice area.


Gluconate zinc in acrodermatitis enteropathica.

Two children with characteristic findings of acrodermatitis enteropathica were found to have low serum zinc levels prior to therapy. Treatment with zinc gluconate in low dosages resulted in an increase in serum zinc levels and clinical improvement. All family members studied had low serum zinc levels. In addition, we noted a change of hair color to red and excessive drooling just prior to exacerbations in these two patients. The hair color returned to normal with remission.


Immunologic response to A and B erythrocytic antigen.

Immunologic response to A and B erythrocytic antigen stimulation was studied in patients with pemphigus, in patients with systemic lupus erythematosus (SLE), and in normal subjects. Patients with pemphigus and normal subjects demonstrated a similar specific response (isohemagglutinins). A comparison between patients with pemphigus and SLE showed higher titers in the latter. Intercellular antibody titers increased after stimulation; corresponding titers were unaffected by isohemagglutinin absorption. Direct immunofluorescent studies showed IgG deposits in the intercellular spaces of the skin of the patients with pemphigus. However, C3 was found in the same sites in only three cases of pemphigus erythematosus. Immunofluorescent studies for IgG at the basal membrane were positive in only two cases of pemphigus erythematosus. Immunologic response of patients with pemphigus was similar to that of controls; however, it differed from that of patients with SLE.


The natural history of the perforated duodenal ulcer treated by suture plication.

This retrospective study of 174 patients with proven duodenal ulcer perforation was undertaken to delineate the natural history of those patients primarily managed by suture plication. During this 25-year period, 122 patients (70%) were treated with suture plication and 52 (30%) underwent a definitive procedure. There were 13 deaths in the overall group (7.4%) of which the mortality was 6.5% in the plicated group and 9.6% in the definitive group. Of the 122 patients treated with suture plication, 48% either 1) died of ulcer complications later, 2) required reoperation for ulcer disease, or 3) were under active treatment for ulcer symptoms. The reperforation rate in the entire series was 9% and the reoperation rate 32%. Suture plication is a time-honored, life-saving procedure, however, definitive surgery is a superior form of long-term management of the perforated duodenal ulcer patient.


Comparative studies on the laboratory diagnosis of experimental Trypanosoma congolense infection in sheep.

Comparative studies on the laboratory diagnosis of sheep experimentally infected with T. congolense were carried out by parasitological and serological methods during a period of 53 weeks. Trypanosomes were most numerous in the first weeks after inoculation, when they were detectable by all three parasitological tests: the wet mount preparation, the haematocrit centrifuge technique, and the mouse inoculation test. In the later stages of the infection, trypanosomes were observed intermittently by the HCT until 34 weeks, and were detected by the mouse inoculation throughout the experimental period. The immunolysis test andthe complement fixation test showed positive reactions starting from two weeks up to 30-35 weeks and 40-45 weeks respectively, while the titres of the indirect fluorescent antibody test and the non-specific immunoconglutination tests persisted at a high level throughout the infection. The effect of a trypanocidal drug was best detected by the IK test.


Residual right-to-left shunt following repair of atrial septal defect.

Information about 5 patients with residual right-to-left shunts following repair of an atrial septal defect is presented. In each patient the defect was located low in the atrial septum adjacent to the inferior vena cava. During operation, either the eustachian valve of the inferior vena cava had been mistaken for the lower margin of the defect or the lower portion of the defect was not closed; blood flow was then diverted from the inferior vena cava into the left atrium. To prevent this occurrence, the inferior margin of the atrial septal defect should be closed first.


Technique for using soft, flexible catheter stents in aortocoronary vein bypass operations.

A technique using soft, flexible catheter stents in performing coronary vein bypass surgery is presented which makes small vessel anastomoses easy and assures accuracy of suture placement with clear identification of the vessel lumen and an anastomosis without stenosis. It provides an essentially bloodless field without having to cross-clamp the aorta. The technique has been used to our complete satisfaction in all patients since we first started vein bypass operations in 1970. A review of the last 205 elective aortocoronary bypass grafts in 100 consecutive patients using this technique reveals a mortality of only 1% and an operative and postoperative myocardial infarction rate of 5%. About half the patients had left ventricular dysfunction with elevated end-distolic pressures, and 68% had had previous myocardial infarctions. Seventy percent of the patients are at present asymptomatic, 24% are improved, and only 4% show no improvement over their preoperative status during follow-up of one to three and one-half years.


Bullet emboli to the pulmonary artery: a report of 2 patients and review of the literature.

Bullet embolization to the pulmonary artery is a rare event. The purpose of this study is to report our experience with 2 patients and to review the 15 patients reported in the literature, with special emphasis on a rather peculiar complication that has occurred in 4 of the 9 patients who underwent bullet embolectomy: dislodgment of the missile during the surgical procedure and migration to the down-side lung, for which a second thoracotomy was required in 3 of those patients. The usual untoward effects of foreign bodies in the vascular system were seen in this series: embolization with thrombosis, sepsis, erosion and hemorrhage, and vascular occlusion with infarction. This review suggests that operative removal of a bullet in the pulmonary artery is necessary. The operation is safe and uncomplicated if precautions are taken to prevent the missile from migrating during manipulation of the lung.


Cinemicroscopy of hyperacute pulmonary rejection.

Rejection processes were studied in xenografts and allotransplants of cat or dog lungs to dogs. Cinemicroscopy of the microcirculation in untreated animals showed almost immediate sludging, cellular aggregation, reduced vascular caliber, diminished blood flow, and rapid development of perivascular edema. The principal mechanisms of the extremely rapid xenograft rejection include capillary and arteriolar obstruction due to cellular aggregation. Pretreatment with heparin was virtually valueless, while methylprednisolone offered temporary protection.


The application of a semiautomated postoperative care program in a community hospital: early results.

The clinical involvement of computer technology in medical center environment has been successfully utilized in the postoperative care of patients following open intracardiac operations. This report describes the initial experience in a community hospital with the adaptation and evaluation of such a system in the postoperative care of critically ill patients. The early experience with this noncomputerized system suggests the clinical usefulness of the approach, the potential increase in manpower utilization, and the greater utilization of the nursing staff in true patient care. The early results of the study do not indicate that this approach to patient care is necessarily economically feasible or technically applicable in all community hospitals.


Total rupture of the left main bronchus successfully repaired nine years after injury.

A patient who sustained a traumatic rupture of the left main bronchus that was successfully repaired nine years later is presented, and reference is made to reports of similar instances in which operation has been performed more than five years after injury. Pulmonary function following operation improved progressively and proved the delayed repair to have been a reasonable decision.


Immunology and thoracic surgery.

This report reviews the current status of three types of diseases in which knowledge of immunology is changing the practice of thoracic surgery. Evidence is presented for myasthenia gravis being an autoimmune disease. Thymectomy is widely considered to be the therapy of choice for patients with generalized myasthenia regardless of age or sex. Opportunistic pulmonary infections of unusual types are being encountered frequently in patients receiving immunosuppressive drugs for organ transplantation or malignancy. The important role of bronchial brushing and open lung biopsy is stressed. Immunotherapy of several types is currently being investigated experimentally and clinically and promises to change therapy for bronchogenic and esophageal neoplasms.


[Hyaline membrane disease. Results of treatment using continuous positive pressure of the airways, with or without ventilatory assistance].

Eighty cases of hyaline membrane disease were treated with continuous positive pressure at the respiratory tract level. In 35 cases, the method of the bag was used. Failure occurring in 33% of the cases required assisted respiration. In 45 cases, patients were intubated and in 43 of these mechanical ventilation was used. In spite of the severity of these clinical types, the survival rate was around 90%. It is concluded that there is evidence for early continuous positive pressure.


Macrophage electrophoretic mobility (MEM) test in malignant gynaecological diseases.

All patients examined [52] with malignant disease of the female genital tract showed lymphocyte reactions to encephalitogenic factor (EF) of more than 10% as measured by the macrophage electrophoretic mobility (MEM) test and its modification (MOD-MEM). Whilst 13 patients with non-malignant disease of the genital tract and 30 normals showed lymphocyte reaction to EF of less than 6%, 4 patients with nonmalignant gynaecological disease gave values above the 10% limit. The lymphocyte reactions of this latter group of patients were discussed with respect to their previous clinical histories. Some of the malignant cases were carcinoma of the cervix in situ so that the MEM test would appear to be of value in the early diagnosis of cancer. The need for caution in the interpretation of results is discussed as well as further possible applications of the technique.


Feto-maternal relationship in normal pregnancy in mixed lymphocyte cultures.

In eight wife-husband pairs during the whole pregnancy the reactivity of lymphocytes to PHA, to lymphocytes of unrelated donor and to lymphocytes of husband was studied. No statistically significant differences were found in reactivity of wife's and husband's lymphocytes. In eleven women at delivery a statistically significant decline of MLC reaction to lymphocytes of own and unrelated newborn was found, while the reactivity to PHA and to lymphocytes of unrelated adult donor remained unchanged. Similarly, the lymphocytes of eleven newborn infants reacted statistical significantly less to lymphocytes of own mother and unrelated mother, while the reaction to PHA and to lymphocytes of unrelated donor was well expressed.


Pott and the path to prevention.

Two hundred years ago, Percival Pott, a London surgeon, recognized that chimney sweeps were particulary liable to develop scrotal cancer and attributed the disease to exposure to soot. By so doing, he described the first environmental cause of cancer and started the chain of events that led to the first experimental production of cancer, the first synthesis of a carcinogen, and the first isolation of a carcinogen from a natural substance. Following these laboratory successes, the main object of cancer research has been to discover the fundamental characteristics of the cancer cell and the mechanism of the cancer cell and the mechanism of its production and relativly few investigations have studied the conditions under which cancer is produced in man. Recently, however, it has been recognized that we can often prevent cancer by modifying the conditions of life without detailed knowledge of the mechanism of carcinogenesis. All but a few rare cancers vary in incidence with place or time or with both and nearly all this variation can be shown to be environmental in origin. We already know enough to prevent most cancers of the mouth, oesophagus, larynx, lung, bladder, and skin in W. Europe and N. America, most cancers of the mouth in Asia, and most liver cancers in Africa. We have clues to the causation of cancer of the cervix uteri, breast, and colon and we should learn how to prevent all these cancers before long. Many new hazards could be prevented by controlling the introduction of new carcinogenic chemicals into the environment while others could be detected quickly by improved methods of epidemiological enquiry. But even so, acute clinical observers, like Pott, will continue to be needed for many years.


[Detection of immuno-stimulation in mice by a new low molecular substance (author's transl)].

With Jerne's plaque technique it was possible to verify that a new compound, termed BA 1, features pronounced immuno-stimulating properties. After single-shot i. v. application of 150 mg/kg body weight this immuno-stimulating action can be demonstrated by way of a significant increase of the plaque numbers compared to untreated controls in healthy mice and, in a somewhat diminished form, also in mice bearing Ehrlich ascites carcinoma. Furthermore, it has been shown that the plaque test proves to be suitable as parameter to describe the defense status in tumor-bearing animals as, in the case of Ehrlich carcinomas, there is a distinct negative correlation between plaque numbers and age or mass of the tumor.


Jejunoileal bypass and nutritional liver injury.

Jejunoileal bypass operation may be an experimental model of nutritional liver injury in man. The similarity of the bypass-induced hepatic histopathologic features to those of alchoholic liver disease raises the question of a common pathway in alcoholic and in postoperative (bypass) liver diseases.


Immunoglobulin E. Current status and clinical laboratory applications.

Reaginic antibodies belong to IgE, which represents a distinct immunoglobulin class. Human IgE binds with basophil granulocytes and mast cells through the Fc portion of the molecules and mediates the release of chemical mediators that cause allergic symptoms. The initial step of the reaginic hypersensitivity reaction is probably the bridging of cell-bound IgE antibody by antigen. The reaction appears to initiate enzymatic sequences that lead to the release of chemical mediators. Measurement by radioimmunoassay of IgE and IgG antibodies in ragweed-sensitive hay fever patients has revealed immunologic effects of hyposensitization treatment. Experimental models for the immunotherapy in inbred mice strongly suggest that the major immunological effect would be depression of helper function of antigen-specific T cells. The results suggest logical approaches to improve the effect of the treatment.


Group rehabilitation of vascular surgery patients.

This paper describes a continuing weekly therapy group for vascular surgery amputees. Group goals include (1) assisting amputees with feeling of helplessness, isolation, and depression; (2) facilitating staff awareness of psychosocial factors in each patients' rehabilitation; (3) integrating ward management with physiatric treatment; (4) mobilizing patient's coping skills; and (5) motivating patients to participate in rehabilitation of other amputees. Group meetings emphasize ventilative, mutual-support approaches, rarely including conventional psychotherapeutic techniques. Members exchange technical information concerning prostheses, operations and amputee life, as well as coping techniques in a general hospital social system. Patient choices as to what to discuss are described.


[Isolation of immune serums against antigens of the aorta for immunomorphological study of experimental atherosclerosis].

A possibility is shown of obtaining sufficiently pure antigens (collagen, elastin, structural grycoproteids), with the help of a preparative chemical method, from the wall of aortas of rabbits, both healthy and "diseased", i.e. with atherosclerosis. Immunomorphological analysis showed that the immune sera obtained against antigens indicated above reacted only with structures of the affected vessels, no interaction with the wall of normal aortas being noted.


[Electrolytic decalcificator of bone tissue].

The elctrolytic method considerably reduces the time of decalcification of the bone tissue and adds to the improvement of the quality of histological preparations. The use of plastics facilitates the solution of technological problems associated with manufacturing of electrolytic plants.


[Spontaneous ruptures of allotransplants of human cadaveric kidneys].

On the basis of morphological data it was established that spontaneous ruptures of allotransplanted kidneys of man were connected mainly with juxtamedullar shunting of their blood flow; Impairment of the blood flow was apparently caused both by immune and nonimmune endogenous humoral factors. The pathomorphological picture in spontaneous ruptures of transplants differed from structural changes observed in traumatic damage of the kidney.


Reconstruction after mandibulectomy for cancer.

Reconstruction after mandbulectomy for cancer presents a major problem in head and neck surgery. This study reports the experiences with a planned staged method of reconstruction that aims at both cosmetic and functional rehabilitation and that is based on a close cooperation between surgeon and prosthodontist. Stabilization of the remaining mandibular fragments by means of intermaxillary fixation at the time the tumor is resected, delayed bone grafting, and preprosthetic surgery to allow the use of a functional denture are the high points of the method. The results in 58 patients are discussed.


Early bone conduction hearing aid devices.

The concept of bone conduction hearing is old. By the 16th century the conduction of sound by a rod or the staff of a spear was reported by a number of writers; however, these writers considered these phenomena as a curiosity rather than having practical value. In the 17th century, John Bulwer and George Sibscota, both interested in the deaf and their education, applied the bone conduction phenomenon as an aid to defective hearing. Soon, independent reports from Germany, France, and Italy also described bone conduction rod devices as aids to impaired hearing. In 1879, the Audiphone, a hearing fan that operated by bone conduction, was patented. The invention of the Audiphone triggered the development and sale of a number of similar devices that had considerable popularity until the invention of the carbon-electric hearing aid in the early 1900s.


[Surgery of the tongue and floor of the mouth (author's transl)].

Most carcinomas of the oral tongue and floor of the mouth are presently treated surgically, often combined with pre- or postopervative irradiation. The treatment plan is mainly determined by the primary site and the local and regional extension, desirable are general rules on the basis of the TNM classification. The indications and principles of the most important operative procedures are discussed: Local excision, partial glossectomy, excision of the floor of the mouth with marginal mandibulectomy, composite resection. Operations for removal of the primary and radical neck dissection with preservation of the mandible (e.g. the pull-through procedure) are rarely advised. A radical neck dissection is indicated in each carcinoma of the oral tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection is advised in view of the high frequency of clinically occult lymph node metastases (between 23 and 43%). Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining a motility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible.


Mutants of Salmonella typhimurium deficient in DNA polymerase I: further characterization and genetic analysis.

Tests with a plasmid-borne ochre suppressor (sup-812) and a chromosomal amber suppressor (supD501) revealed that one of three mutants of S. typhimurium deficient in DNA polymerase I was an amber mutant. Assays performed on crude extracts established that derivatives of this mutant (designated polA3) carrying ochre and amber suppressors had about 13 to 20% respectively of the enzyme activity found in the wild-type parent. The unsuppressed mutant showed less than 1% of the wild-type level of activity. Other properties of the polA3 mutant that were also partially or in some cases completely reversed by the sup-812 and supD501 suppressors included: u.v. sensitivity, methyl methanesulphonate (MMS) sensitivity, reduced ability to effect host-cell reactivation of u.v.-irradiated or MMS-treated bacteriophages, inability to maintain the (Col El) plasmid, and reduced ability to plate the phage mutant P22 c2 hpi-308. Mapping by P1-mediated transduction showed that all three polA mutations lie between metE and rha on the S. typhimurium chromosome, and that the polA mutation is cotransduced with metE at a frequency of 20% and with rha at a frequency of 8%.


A history of the events which culminated in the first faculty of Veterinary Science in Australia.

A few years ago the University did not cater for properly training the men who would have to conduct the industries of the country. During the past 7 years, however, it had established Schools of Agriculture, Education, Mining Engineering, and had made proper provision for the training of chemists and dentists. The last, and in some respects the greatest step, was the establishment of a School of Veterinary Medicine in connection with the University.


Left-handedness in twins: incidence and patterns of performance in an adolescent sample.

Data on handedness and cognitive performance in an adolescent sample of same-sex twins were collected, and questions about incidence of left-handedness in twins and the relation between handedness and cognitive performance were considered. Same-sex twins have been found to have a higher incidence of left-handedness than that usually reported in the general population. There is a high incidence of handedness discordance (one twin right-handed and his cotwin left-handed) in both monozygotic and dizygotic twin pairs. In this sample, males and Blacks had particularly high rates of left-handedness. Among the monozygotic and dizygotic discordant pairs, quite different patterns of cognitive performance were found. On the Raven Progressive Matrices, the Columbia Test of Mental Maturity, and the Peabody Picture Vocabulary Test, the left-handers did better than their right-handed cotwins in the monozygotic pairs and the right-handers did better than their left-handed cotwins in the dizygotic pairs. Within subjects, no signficant differences were found for superiority of spatial or verbal abilities for either right-handers or left-handers. No general statements can be made about the performance of left-handed twins, since performance differs according to zygosity and handedness of cotwin configurations.


Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal.

Propranolol and practolol were tested in patients with repeated daily occurrence of spontaneous angina. Twenty-one showed ST segment depression (type I) and 15 ST segment elevation (type II) during angina. The efficacy of the treatment was evaluated in subjective (number of reported episodes of pain) and objective terms (number of episodes of electrocardiographic abnormalities documented during periods of continuous recording): practolol was fully effective in 42 per cent and propranolol in 38 per cent of type I cases; in type II angina 73 per cent of the cases fully responded to propranolol, none of the patients in this group given practolol improved. The study also showed that: (a) the effects on angina are strictly dose-dependent, and optimal results are achieved at individualized doses; (b) within the same subject the response may be preferential to one beta-blocker as opposed to the other; (c) propranolol is more effective in type II angina; (d) the occurrence of heart failure is uncommon even with high doses of beta blockers;(e) the relief of angina is due to prevention of ischaemia and not to a placebo or anaesthetic effect; (f) the prevention of ischaemia is not adequately explained by reduction of the mechanical effort and the oxygen need of the myocardium; (g) the antianginal effect is possibly dissociated from the beta blockade of the heart. The hypothesis that beta-blocking agents influence the conronary vasomotion is discussed.


Comparative efficacy of short-acting and long-acting quinidine for maintenance of sinus rhythm after electrical conversion of atrial fibrillation.

Forty patients with chronic atrial fibrillation, apparently unrelated to any overt heart disease, were randomly allocated to two groups after restoration of sinus rhythm by direct current shock. The patients in group A were given 4 daily doses of quinidine polygalacturonate, while those in group B were given 2 daily doses of a long-acting quinidine preparation, quinidine arabogalactan sulphate. The percentage of early relapses (within the first month following DC shock) was not significantly different in the two groups: 44-4% in group A and 35% in group B (P greater than 0-50). On the other hand, there were fewer late relapses with long-acting quinidine. After 18 months of treatment, 27-8% of patient in group A remained in sinus rhythm, compared with 61% in group B (P less than 0-05). The average amount of quinidine actually ingested by the patients in group A was smaller than that in group B. However, this could not entirely account for the difference observed in the incidence of relapse since with short-acting quinidine the proportion of patients remaining in sinu rhythm was similar whether the dose was decreased or not. The incidence of gastrointestinal side-effects was the same in the two groups and there were no seriou complications that could be attributed to treatment. It is concluded that long-acting quinidine preparations are more effective than conventional quinidine in preventing late relapses of atrial fibrillation.


A critique of the evidence for active host defence against cancer, based on personal studies of 27 murine tumours of spontaneous origin.

Extensive experience with isotransplants of 27 different tumours (leukaemias, sarcomata, carcinomata), all of strictly spontaneous origin in laboratory bred mice of low cancer strains CBA/Ht and WHT/Ht, has revealed no evidence of tumour immunogenicity. Of approximately 20,000 maintenance transplants, none failed and none regressed; of almost 10,000 carefully observed tumours arising from small or minimal inocula of tumour cells, none spontaneously regressed. The number of injected viable tumour cells required to give a 50% probability of successful transplantation (the TD50) ranged from approximately 1 cell to greater than 10,000 cells among the 27 tumours; high TD50 values, which were dramatically reduced by various procedures having no immunological significance, did not signify active "resistance" of the hosts. In the case of all of 7 randomly selected tumours, prior "immunization" of recipients with homologous lethally irradiated cells increased their tumour receptivity. Several experiments using various tumours failed to give evidence that immunity could be non-specifically induced or that a massive preponderance of lymphocytes from specifically sensitized mice could inhibit tumour transplantation or growth in vivo; no trace of "resistance" to tumour was adopted by isogeneic recipients of lymphocytes from regional nodes of tumour bearers. A limited review of the recent literature on tumour immunity shows that practically all the animal data presented in support of a general theory of tumour immunogenicity or to provide a basis for active clinical immunotherapy have been obtained from transplanted tumour systems which entail artefactual immunity associated with viral or chemical induction of the tumours or their allogeneic transplantation. It is suggested that isotransplants of spontaneously arising tumours are the only appropriate models of human cancer and that any genuine rapport between the animal laboratory and the clinic requires their exclusive use.


Cellular localization of immunoglobulin within human maglignant melanomata.

The presence of antibody in patients with malignant melanoma is well established if one examines the serum. In this report we have attempted to identify antibody within solid tumours showing that they are rarely present in any appreciable quantity on the surface of tumour cells but can be seen frequently on a number of different types of host cell within the tumours. This is discussed in the light of the role of antibody in the circulation and the possibility of antibody behaving as a blocking factor in vivo.


Characterization of cytotoxic spleen cells and effects of serum factors in a syngeneic rat tumour system.

Splenocytes from inbred Wistar rats bearing a syngeneic squamous cell carcinoma (Spl) were fractionated by several techniques to characterize the lymphoid cells cytotoxic to the tumour in vitro. The anti-tumour cytotoxicity is presumably mediated primarily by T lymphocytes because it was greatly reduced by removal of T lymphocytes with heterologous anti-T serum plus complement but not by removal of other cell types. Cytotoxicity could be blocked at the tumour cell but not at the effector cell by sera taken late in tumour growth. Sera taken earlier in tumour growth could induce cytolysis of tumour cells by normal splenocytes but only if the tumour cells were treated with serum and washed before addition of the effector cells. Although splenocytes from normal and tumour-bearing rats were equally effective at lysing antibody-coated target cells it is unlikely that this mechanism is important in vivo as sera from early in tumour growth onwards contained factors (immune complexes?) which inhibited antibody-induced lymphocytolysis.


Anti-streptococcal antibodies reacting with brain tissue. I. Immunofluourescent studies.

Serum JD from a 14-year old girl with Sydenhams chorea contained antibodies which gave immunofluorescent staining of the limiting membrane of the brain, ependymal tissue and fibrous astrocytes. These antibodies could be completely absorbed by Str. pyogenes type 24 (NCTC 8305) but only partially if at all by type 6 matt (NCTC 8302) or type 6 glossy (NCTC 8709). In contrast, staining by the same serum of the choroid plexus, the periphery of hepatocytes, the periphery of the cells of the gastric mucosa, and tubules in the kidney could be absorbed out by the type 6 matt and type 24 strains (but not by the type 6 glossy or Staph. aureus NCTC 6571). A rabbit anti-streptococcal serum (3/74) raised against disintegrated washed cells of Str. pyogenes type 24 stained and the same structures in the brain to high titre, but not the choroid plexus and not the other structures stained by serum JD. These staining reactions of 3/74 could be absorbed out by Str. pyogenes type 24 but not by Str. pyogenes type 6 matt or type 6 glossy. None of these staining patterns given by serum JD or by 3/74 could be absorbed by human uterine smooth muscle. Serum 3/74 stained heart muscle but this reaction could be absorbed without affecting the brain staining reactions. Sera from 4 other patients with Sydenham's chorea were found to give staining of the ependyma and the limiting membrane, 2 only very weakly.


Luminal surface of distended arteries by scanning electron microscopy: eliminating configurational and technical artefacts.

Perfusion fixation at physiological pressures, careful tissue handling, adequate drying and reduced beam exposure time eliminated many of the intimal surface projections, ridges and bridges which have been taken for normal structures on scanning electron microscopy. In the normal distended vessel, ovoid endothelial nuclei bulged into the lumen with their major axes aligned in the direction of flow: adjacent cell margins overlapped consistently in the direction of flow, with each cell overlapping the edge of its downstream neighbour. Regular longitudinal furrows associated with undulations of the internal elastin lamina were entirely eliminated from elastic arteries when distending pressures exceeded diastolic levels during fixation.


The prelymphatic pathways of the brain as revealed by cervical lymphatic obstruction and the passage of particles.

Light and electron microscopy was used to examine portions of the brain, the circle of Willis, and the internal carotid arteries of normal cats and rabbits, of sham-operated ones, and of those whose cervical lymphatics had been ligated. Carbon was injected into the cerebral cortex of some lymphoedematous animals. It was found that lymphatic ligation produced oedema of the brain, and a dilatation of the prelymphatic spaces around the vessels. Carbon was traced in these from the injection site, around the minor and major vessels, in the adventitia of the internal carotid artery, entering lymphatics adjacent to it, and finally in the draining lymph nodes. The oedema and dilated spaces were not present in the control animals. This was taken to indicate that there is a continuous system of non-endothelialized spaces and potential spaces-the prelymphatics-draining the brain into the cervical lymphatics. The protein in these spaces appeared to be increased if the lymph-oedema had lasted three weeks as compared to 24 hours, indicating that one of the major roles of this system is the removal of protein.


Evidence for the multiplication of hepatitis B virus in  "oval cell" culture originated from human embryonic liver.

Growth conditions fof human oval cells (immature hepatocytes),evidence of hepatitis B (HB) antigen synthesis in oval cells as revealed by immunofluorescent staining and successful passage of such an agent in the culture fluid up to the 4th passage are described. The results have been proved to be readily reproducible with different inocula. The oval cells used in these experiments were defined as small round cells, with scant cytoplasm, vesicular nuclei and small nucleoli, vitally stained with indocyanine green and synthesizing alpha-foetoprotein but no albumin.


The action of iron on local Klebsiella infection of the skin of the guinea-pig and its relation to the decisive period in primary infective lesions.

The infectivity of 16 strains of Klebsiella spp. and its modification by systemic and local ferric iron were tested in the skin of the guinea-pig. The in vivo proliferation of 11 strains was enhanced in varying degrees by Fe+++ (E + strains); 5 strains (Eo) were not enhanceable even by large doses of Fe+++. Of 10 strains examined in detail, 6 were E + and 4 were E0. Guinea-pig and human sera were consistently bacteriostatic for E + strains and bactericidal for Eo strains. Both Fe+++ and microbial iron-chelators abolished the bacteriostasis of E + strains but did not affect the lethal effect on Eo strains. Both effects were diminished by heating the sera to 56 degrees for 30 min and by the anticomplementary substance Liquoid; neither appeared to be due to specific antibody. Virulence, as measured in the skin and by intravenous injection, was roughly associated with degree of enhanceability by iron, the EO strains being among the least virulent. The volume of plasma exudate entering the skin during the first 5 h was sufficient to kill a large proportion of the infecting doses of Eo strains and to inhibit the growth of infecting doses of E + strains. Enhancement of the latter by Fe+++ is predominantly the result of inhibition of the non-specific bacteriostasis exerted by the extravascular plasma. Lesions by E + strains aged 4 h or more are insusceptible to systemic Fe+++ and only moderately susceptible to large doses of local Fe+++. The insusceptibility appears to be due to segregation of the infecting bacilli within exudate leucocytes. Klebsiella infections accordingly provide another example of an initial decisive period of action of the antibacterial defences-in this case non-specific and humoral-which cease to be locally effective after the first few hours. Besides enhancing lesions due to E + strains, systemic Fe+++ has an opposite, apparently anti-inflammatory action on klebsiella lesions, slightly decreasing their size. It was evident with all the strains tested, whether dead or alive, but not in E + lesions in circumstances when they were susceptible to enhancement by the Fe+++.