Antifactor Xa activity in thrombophilia. Studies in a family with Ar-III deficiency.

Antithrombin III (At-III) concentration and amidolytic assays reflecting functions of the At-III molecule were studied in members of a family with a strong tendency to thrombosis. Antifactor Xa and heparin cofactor activity closely parallel at At-III concentration. In all individuals with a history of thrombosis At-III concentration was about 50% of normal. The clinical features and causes of death are briefly reviewed. Mean age in deceased family members with a tendency to thrombosis was 55 years, in members with no history of thrombosis it was 65 years.


Immunologic similarities of thrombopoietin from different sources.

Thrombopoietin (TSF) has been detected in kidney cell culture media and human urine fractions by both a bioassay and an immunoassay using antisera raised against TSF-rich kidney cell culture medium and human urinary thrombopoietin. Both antisera cross-reacted with the 2 sources of TSF and gave essentially the same results in the HAI assay, a finding that suggests similarities in immunologic determinants of these 2 thrombopoietin preparations.


Detection of anti-red blood cell antibodies by treatment of the cells with neuraminidase.

Neuraminidase treated RBC were used to detect incomplete unbound anti RBC antibodies in the plasma of patients with immune diseases. 80% (48 out of 60) of the examined patients gave positive results with this method while all the 50 normal controls were negative. The indirect antiglobulin test was negative in all the patients. In the direct antiglobulin test only two RBC samples, whether treated with neuraminidase or not, gave positive results. The present study indicates that the assay of plasma on neuraminidase treated RBC may serve as a sensitive method for the detection of the presence of anti RBC antibodies in various immunological diseases.


Serum immunoglobulin levels in the course of bacterial meningitis in children.

Serum levels of 5 immunoglobulins (IgG, IgA, IgM, IgD and IgE) were determined at frequent intervals in the course of bacterial meningitis in children. 59 patients were examined; 27 with Haemophilus influenzae meningitis, 23 with meningococcal and 9 with pneumococcal meningitis. All 5 immunoglobulins increased during the 2-week course of bacterial meningitis. IgM was the immunoglobulin class responding most rapidly, regularly and intensively. IgG increased moderately. However, practically no rise of the IgG level was observed in children with H. influenzae meningitis. The elevation of the IgA and IgE levels possibly suggests that meningitis may also cause synthesis of IgA and IgE antibodies. The results of the study indicate that antibodies of all the 5 immunoglobulin classes are probably involved in the defense against the causative microbes in bacterial meningitis.


Penicillinase production in community strains of staphylococcus aureus.

A survey of penicillinase production in 406 strains of Staphylococcus aureus isolated from wounds in the County of Uppsala in 1975 showed that 76% of strains from inpatients produced penicillinase compared to 69% of the outpatient strains. The frequency of penicillinase production in Staph. aureus strains from surgical staff was 59%. 51% of strains from school children and 38% of strains from healthy adults produced penicillinase. The conclusions are that ordinary penicillinase-sensitive penicillin should not be used for treating infections in outpatients unless the isolated aureus strain has been shown to be penicillinase-negative.


Antimicrobial in vitro susceptibility of actinomyces israelii and arachnia propionica.

46 reference strains and clinical isolated of Actinomyces israelli and 8 strains of Arachnia propionica--the causative microorganisms of actinomycosis in man--were tested for their in vitro susceptibility to penicillin, sulfaisodimidine, erythromycin, tetracycline, lincomycin, clindamycin, metronidazole and tinidazole by the agar dilution method. All strains were susceptible to benzylpenicillin (minimum inhibitory concentrations, MICs of less than or equal to 0.064 mug/ml). Many strains were resistant in vitro to sulfaisodimidine (MICs 4.0-32.0 mug/ml). Erythromycin, tetracycline, clindiamycin and lincomycin possessed in vitro activity at concentrations readily attainable in serum. Due to adverse side-effects associated with clindamycin and lincomycin therapy, erythromycin and tetracycline may be the best alternative drugs to penicillin in the treatment of actinomycosis. In contrast, in vitro resistance (MICs greater than or equal to 4.0 mug/ml) of the pathogenic actinomycetes to metronidazole and tinidazole implies that these drugs may not be valuable in the therapy of human actinomycosis.


Use of electrophoresis in the identification and quantitation of antibiotics administered in combinations.

The investigation presents a method of electrophoretic separation of antibacterial drugs which are used in combinations in clinical medicine. Subsequent to electrophoresis in agarose gel, a microbiological assay was performed. This technique permitted the determination of the concentrations of beta-lactam antibiotics, rifampicin, and clindamycin in the presence of aminoglycosides. In therapeutic combinations of fusidic acid and clindamycin, the concentrations of each drug could be determined.


The NBT (Nitroblue Tetrazolium) activity of neutrophil granulocytes in patients with influenza A infection.

The NBT activity of granulocytes from 11 influenza patients was determined during the acute stage of the disease and 6-8 weeks after recovery. The NBT activity was generally higher during influenza than after recovery. In the presence as well as in the absence of the patient's serum the differences were significant both without and with Escherichia coli stimulation.


Candida meningoencephalitis treated with 5-fluorocytosine.

The successful treatment of Candida albicans meningoencephalitis with 5-fluorocytosine (5-FC) is reported. After abdominal surgery with many complications, a 60-year-old man developed severe headache, lumbar pain, mental change. The significance of this was not realized for months. The cerebrospinal fluid (CSF) showed pleocytosis, high protein and low glucose concentration. One CSF culture out of 6 revealed growth of Candida albicans. Serologic tests are also indicated candida infection. After a month of treatment with 5-FC, the severe pain decreased and he improved mentally. After 4 months, the CSF was normal and the 5-FC treatment ended. For the past year, the patient has not shown any signs of relapse.


Changes in arterial oxygen saturation in patients with hyperreactive airways during a histamine inhalation test.

The arterial oxygen saturation (SaO2) of 55 adult patients with hyperreactive airways was monitored with an eight-wavelength ear oximeter during a histamine inhalation test. The post-challenge fall (mean +/- s.d.) in peak expiratory flow was 38 +/- 15% of the baseline value; it was accompanied by a fall in SaO2 of 1.1 +/- 1.8 per cent, from 96.6 +/- 1.8 to 95.5 +/- 2.3%. It is concluded that, in the histamine inhalation test used in this study, even the development of marked bronchoconstriction usually causes only slight changes in SaO2.


Sarcoidosis with large nodular lesions simulating pulmonary metastases. An analysis of 126 cases of intrathoracic sarcoidosis.

Multiple, large metastasis-like, nodular lesions (LNL) are a rare manifestation of acute/subacute pulmonary sarcoidosis. It has previously only been described in American series and all patients but one have been Negroes. In order to estimate the frequency of LNL in a Danish series, 126 consecutive patients with intrathoracic sarcoidosis were examined with regular follow-up for 1/2-5 1/2 years. LNL simulating pulmonary metastases was found in two cases, a frequency corresponding to the American figures. In both cases pulmonary infiltrations disappeared with 3/4 and 1 1/4 years, respectively. In one case a normal chest roentgenogram was obtained 6 weeks before the onset of LNL. The importance of biopsy is emphasized. Sarcoidosis with LNL appears to have a favourable prognosis in many cases.


Regional pulmonary function in sarcoidosis.

In 26 subjects with a confirmed histological diagnosis of thoracic sarcoidosis regional lung function was studied with Xenon 133. All subjects also underwent overall lung function studies including CO steady state (TCO SS) and single breath (TCO SB) diffusing capacity. Regional ventilation (Vr) was on the average increased in stages I (isolated hilar adenopathies) and II (pulmonary infiltration) and appeared normal in stage III (pulmonary fibrosis). Regional perfusion (Qr) was on the average normal in stages I and II and decreased in stage III. There were no appreciable differences between average values in stages I and II. Abnormalities of Vr and Qr were frequently found in individual cases. A distinction was made between the total number of abnormalities and deficiency abnormalities. The total number of abnormalties was high in all three stages. Deficiency abnormalities were relatively rare in stages I and II, and frequent in stage III. The correlation between radiological and regional functional abnormalities was low. TCO SB/VA was found significantly lower (P less than 0.005) in subjects with regional deficiency abnormalities (mostly perfusion abnormalities). These data probably indicate that a lowered diffusing capacity may be due to the loss of pulmonary capillaries and not only to ventilation - perfusion disparities.


Attempts to boost tuberculin skin reactions by serum or blood transfer in BCG-vaccinated guinea-pigs.

In persons with waning sensitivity to mycobacterial antigens, skin reactivity to tuberculin may be maintained or enhanced as a result of tuberculin testing. Similar phenomena have been observed in guinea-pigs. As tuberculin testing may lead to antibody formation, the "booster" effect might be due to circulating antibody. However, a series of nine pilot experiments including blood and serum transfer from boosted to unboosted BCG-vaccinated guinea-pigs gave no support to this hypothesis.


Serum immunoglobulin A in chronic bronchial inflammation.

Serum IgA was determined by the single radial immunodiffusion method in specimens collected during 1 year from 178 patients suffering from chronic bronchitis syndrome. The IgA level was permanently, significantly higher in the group of patients than in the group of healthy controls. The difference between the patients and controls increased until middle age. This phenomenon was parallel with an aggrevation of the average functional severity of the pulmonary disease. Despite the continued aggravation, the difference lessened after the age of 49. Three cases of severe quantitative IgA abnormality were detected among the patients: one case of IgA myeloma and two cases of almost total IgA deficiency. One of the latter also showed IgE deficiency.


Nitrofurantoin-induced acute, subacute and chronic pulmonary reactions.

The clinical histories of 81 patients with hypersensitivity reactions to nitrofurantoin, 66 of whom had pulmonary reactions, were studied. Of all patients, 94% were women and of these, 43% were between 40 and 59 years of age. The nitrofurantoin preparation that contained vitamin c caused significantly fewer hypersensitivity reactions than the others. Acute pulmonary reactions appeared a mean of 8.7 days after the start of nitrofurantoin treatment. Typical for these were high fever, dyspnoea, cough, blood eosinophilia, bilateral pneumonic or pleuro-pneumonic infiltrations, a reduced transfer factor of the lung and, as revealed in pulmonary biopsy specimens, vasculitis, interstitial inflammation and alveolar exudation. Symptoms of subacute and chronic pulmonary reactions developed after at least 1 and 6 months of treatment, respectively. Findings of interest were anti-nuclear antibodies in serum, capillary sclerosis, interstitial fibrosis and inflammation in pulmonary tissue. Most patients with an acute pulmonary reaction recovered within 15 days, but in more than half of those with chronic reactions slight signs of pulmonary fibrosis persisted on follow-up. The findings suggest that the interstitial pulmonary changes caused by nitrofurantoin are largely the result of an Arthus-type immune complex-mediated reaction.


Sarcoidosis of the nose. Including a report on a patient with large sarcoid polypi of the nasal mucosa.

A report is presented on 11 patients with histologically confirmed nasal sarcoidosis, including one case with very large nasal polypi. The most frequent symptom was obstruction of the nose followed by dryness and crusting. Thickening of the nasal mucosa was the most frequent finding. Yellowish dots were observed in four patients, and polypi in two. In one patient, a granulomatous maxillary sinusitis was diagnosed. Cutaneous sarcoidosis was found in only one patient. Nine of the patients had noted their nasal symptoms during the early phase of the disease. The response to treatment with corticosteroids is discussed. It seems that an enquiry about nasal symptoms and examination of the nasal cavity are valuable even in patients with early sarcoidosis.


Lead in drinking water in soft water areas--health hazards.

Studies have been made of the uptake of lead into drinking water and the association of that with the blood lead of persons resident in houses supplied with such water. Significant regressions were found between water lead and blood lead concentrations. Very high concentrations were found in houses with lead plumbing. There were in addition increased lead concentrations found in houses using copper piping joined with lead soldered joints. These studies have suggested that some health hazards might be expected to be associated with the increased environmental uptake of lead in these situations.


Evaluation of the toxic effect of Cd2+ and Cd(CN)2-4 ions on the growth of mixed microbial population of activated sludges.

The effect has been studied of Cd2+ and Cd(CN)2-4 ions on the growth and enzymatic activity of mixed microflora from activated sludges. Both ions tested significantly inhibited the growth of microorganisms, estimated by means of the optical density, and the inhibitory effect of Cd2+ was significantly greater than that of Cd(CN)2-4 at the same mass and molar concentrations. There was also inhibition of the maximum uptake rate of glucose, but in this case there were no statistically significant differences between the inhibitory effect of the corresponding mass and molar concentrations of Cd2+ and Cd(CN)2-4.


Metallobiochemistry of heavy metal pollution: nuclear and radiochemical techniques for long term--low level exposure (LLE) experiments.

The chronic exposure of man to increasing amounts of heavy metals as a consequence of environmental pollution, requires accurate knowledge of how much the homeostatic control of trace elements can stand increased exposure to abnormal amounts of metal pollutants without alteration of the biochemical functions. This topic includes the study of the accumulation of metal pollutants in the body with the identification of metal biocomplexes under long term-low level exposure (LLE) conditions. Extremely sensitive analytical techniques are required for experimentation at the heavy metal levels which are typical of a polluted environment in order to assess the limits of physiological homeostatic controls. The possiblity of applying nuclear and radiochemical techniques, such as neutron activation analysis, multiple tracing, high resolution gamma-ray spectrometry and Cerenkov counting, coupled with biochemical techniques, such as gel filtration, ion-exchange chromatography, polyacrylamide gel electrophoresis and differential centrifugation, has been demonstrated in various typical applications in metallobiochemistry. The subject of the first part of this paper is the development and improvement of the techniques, dealing with potential metal binding components, such as metalloenzymes and nucleic acids chosen as models. The developments refer to: preparation of labelled metal pollutants with very high specific activity to label in vivo nanogram or subnanogram amounts of pollutant metals; neutron activation analysis of enzymes and nucleic acids with the aim of analyzing concentrations of many metal pollutants in the identified metal binding components of the microsamples; radiochemical methods including radiobiochemical techniques for multielement tracer experiments and for studying the interaction of heavy metas and metal binding components; development of complementary counting techniques. The in vivo applications are centered on biochemical studies on cadmium, in particular on the long term-low exposure experiment, which is under investigation at present, with the identification of both critical organs of accumulation and of the cadmium binding components. Results are given for biochemical mechanisms involving cadmium such as the stimulation of the "de novo" biosynthesis of rat liver and intestine cadmium binding proteins (CdBP) and on the systematic study of the interaction of metal pollutants and rat liver cadmium binding proteins itself. Preliminary data are also given for short term experiments dealing with the identification of cellular metal binding components for V, Se, Cd and Pb.


Comparison of three instrumental methods to monitor nitrogen dioxide.

Three commercially available automated NO2-monitors, based on amperometry, chemiluminescence and coulometry respectively, were compared under simulated field conditions over a period of 45 days of continuous operation. The main purpose of this programme was the study of the reliability of the overall system, sampling line-monitors-data acquisition and handling system (PDP-8/E), the correlation between the individual half-hour averages given by the three monitors in the range 0--700 mug NO2/m3 and the comparison of the global statistics for the same NO2-pollution simultaneously seen by the three different monitors over a period of 45 days. Based on more than 1200 valid half-hour averages, a highly significant correlation between the different monitors was obtained, while the statistics of the simulated NO2-pollution were in good agreement.


Ozone in drinking water treatment: a review.

The paper reviews the application of ozone for the treatment of potable water. The period covered by the review is 1937--1975. A complete bibliography is available from the authors upon request.


Norepinephrine-dopamine interactions and behavior.

The proposed hypothesis is directed toward explaining a number of disparate findings in terms of a stress-related interaction between the NE- and DA-containing systems in the brain. The deleterious behavioral effects of decreased DA activity, for example, may be counterbalanced by a similar decrease occurring in NE activity, such compensation being most likely to occur under conditions of stress. This hypothesis may have application to the understanding of neurological and mental disorders such as Parkinson's disease and schizophrenia.


Melatonin: daily cycle in plasma and cerebrospinal fluid of calves.

Melatonin was measured by radioimmunoassay in jugular vein plasma and lateral ventricle cerebrospinal fluid collected from calves at 12 times of the day and night. Melatonin in cerebrospinal fluid increased 17-fold from an average (+/- standard error) of 38 +/- 8 picograms per milliliter during the day to an average of 637 +/- 133 picograms per milliliter during the night (P less than .001). Plasma concentrations of melatonin increased sixfold from an average, per milliliter, of 19 +/- 4 picograms during the day to 121 +/- 24 picograms during the night (P less than .001).


Does "blastocyst estrogen" initiate implantation?

Fertilized eggs were incubated for 2 hours in a medium containing estradiol-17beta and then transferred into the uteri of day 5 pseudopregnant rats. These eggs, but not estrogen-free control eggs, induced a local increase in capillary permeability. We suggest that the blastocyst factor which induces the local increase in capillary permeability during early pregnancy is estrogen synthesized by the blastocyst.


Acute systemic effects of cocaine in man: a controlled study by intranasal and intravenous routes.

Nineteen healthy volunteer subjects who regularly administered cocaine to themselves were given placebo and 10 and 25 milligrams of cocaine hydrochloride intravenously and intranasally. A dose of 100 milligrams of cocaine was administered only by the intranasal route. By this route 10 milligrams of cocaine produced no changes different from placebo, and 25 milligrams of cocaine produced physiologic changes only in systolic blood pressure. The 100-milligram dose given intranasally and all of the doses given intravenously produced significant dose-related physiologic and subjective responses.


Rod photoreceptors detect rapid flicker.

It is widely believed that human rods cannot detect rapid flicker. With rod-isolation techniques, however, light-adapted rods detect flicker frequencies as high as 28 hertz, and the function relating rod critical flicker frequency to stimulus intensity contains two distinct branches. Human rod vision may, therefore, depend on two independent mechanisms.


Avian muscular dystrophy: functional and biochemical improvement with diphenylhydantoin.

Chicks affected with hereditary muscular dystrophy were injected twice daily with 20 milligrams of diphenylhydantoin per kilogram of body weight on days 1 to 40 after hatching. The righting ability of dystrophic chicks treated with diphenylhydantoin was improved compared to that of untreated dystrophic chicks, and acetylcholinesterase activity was reduced to normal levels in the posterior latissimus dorsi muscles.


Effect of delta-9-tetrahydrocannabinol on uterine and vaginal cytology of ovariectomized rats.

The estrogen-like activity of delta-9-tetrahydrocannabinol (delta9-THC), an active component of marihuana, as measured by uterine weight gain and vaginal smear techniques in ovariectomized rats, is reflected in histological examination of uterine and vaginal tissues. Doses of 1, 2.5, and 10 milligrams of delta9-THC per kilogram elicit hypertrophy and hyperplasia of the uterus; the dose of 2.5 milligrams per kilogram is most effective. There is an increase in stratification of vaginal epithelium with doses of 2.5 and 10 milligrams per kilogram; cornifying cells are seen with 2.5 milligrams per kilogram.


Endothermy during terrestrial activity in large beetles.

The large tropical American beetles Strategus aloeus (Scarabaeidae) and Stenodontes molarium (Cerambycidae) can endogenously maintain metathoracic temperatures 5 degrees to 7 degrees C or more above ambient temperature for many hours. During such periods, their activity is exclusively terrestrial and their oxygen consumption equals that of active mammals of the same size. Before and during flight they elevate metathoracic temperatures by an additional 8 degrees to 10 degrees C.


Chemosensory tracking of scent trails by the planktonic shrimp Acetes sibogae australis.

In the laboratory, planktonic shrimps (Acetes sibogae) precisely follow scent trails of food or paper soaked in meat extract, L-alanine, L-leucine, and L-methionine. In the ocean, Acetes may be able to follow scent trails as far as 20 meters to catch falling food. This demonstrates precise trail-following by pelagic animals.


Pathogenic mycoplasmas: cultivation and vertebrate pathogenicity of a new spiroplasma.

A spiroplasma recovered from allantoic fluids of chick embryos infected with the tick-derived suckling mouse cataract agent was grown in continuous passage on a new artificial culture medium. The cultured organisms induced typical ocular and other disease symptoms in susceptible animals, and were reisolated from involved host tissues. Although spiroplasmas have been previously recognized as plant and insect pathogens, this is the first spiroplasma shown to multiply at 37 degrees C and to be pathogenic for vertebrates.


Vision in insects: pathways possibly underlying neural adaptation and lateral inhibition.

Like horizontal cells in vertebrate retinas, horizontal amacrine cells beneath the insect eye intervene between receptors and interneurons at the first level of synapses. Synaptic arrangements between amacrines and interneurons that give rise to regular networks of axon collaterals may explain recent electrophysiological observations of lateral inhibition beneath the insect retina. Neural adaptation mechanisms acting on single retinotopic channels or assemblies of channels can also be referred to reciprocal relationships between receptors and first-order interneurons as well as to centrifugal cells from levels of so-called photopic receptor endings.


Surface molecules of hematopoietic stem cells: requirement for sialic acid in spleen colony formation.

Enzymatic treatment was used to test the function of some surface peptides and carbohydrates in hematopoietic spleen colony formation. Proteases and most glycosidases had no effect on spleen colony formation, whereas treatment with Vibrio cholerae neuraminidase reduced colonies by one-half. Intact sialic acid (residues appear to play an important role in colony formation.


Membrane potential of mitochondrial measured with microelectrodes.

The membrane potentials of giant mitochondria from cuprizone-fed mice were found to be independent of metabolic state. Experiments are described in which the presence of the microelectrodes in the inner mitochondrial space, and the metabolic viability of the impaled mitochonidra, are validated.


Weaver ants: social establishment and maintenance of territory.

Workers of the African weaver ant Oecophylla longinoda recruit nestmates to previously unoccupied space by means of odor trails laid from the rectal gland, a hitherto unrecognized musculated organ located at the rear of the rectal sac. When enemy ants and other intruders are encountered on the territory, the Oecophylla assemble nestmates into small resting clusters by dispensing an attractant-arrestant pheromone from the sternal gland, a second newly discovered organ located on the last abdominal sternite. Under prolonged stress, additional forces are recruited to the combat area with the aid of the rectal-gland trail substance.


Conditioned narcotic withdrawal in humans.

Subjective and physiological manifestations of the narcotic withdrawal syndrome were produced as a conditioned response. Withdrawal reactions precipitated by the narcotic antagonist naloxone in methadone-dependent volunteers were the unconditioned response. These data support clinical anecdotes of withdrawal symptoms occurring in former addicts when they return to their drug-related environment.


Species identification in the North American cowbird: appropriate responses to abnormal song.

Female cowbirds raised in auditory isolated from males responded to the songs of male cowbirds with copulatory postures. The songs of males reared in isolated were more effective in eliciting the posture than the songs of normally reared males. The females did not respond to the songs of other species. These results indicate one mechanism of species identification for this parasitic species.


Ecdysis: neural orchestration of a complex behavioral performance.

Cricket ecdysis (molting) requires continuously changing output in hundreds of motoneurons over a period of several hours, and exhibits considerable plasticity. Despite this complexity, analysis of identified motor units reveals a highly organized three-layered infrastructure, and indicates that the "small system" paradigm currently applied to simple invertebrate motor programs can be extended to much more sophisticated behavioral performances.


Reduced warfarin binding of albumin variants.

Binding studies of albumins A/A and A/Me from human plasma and isolated albumin revealed small, but statistically significant, reductions in warfarin binding of albumin A/Me compared to albumin A/A. Such differences in binding in vitro could result in altered pharmacological responses to warfarin administered to individuals possessing albumin A/Me. To determine if clinically significant differences in warfarin distribution exist, observations should be made in vivo on patients of different albumin phenotype who are receiving warfarin therapeutically.


25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol: conversion impaired by systemic metabolic acidosis.

An acute systemic acidosis in vitamin D depleted rats that was induced by ammonium chlroide feeding resulted in defective biological hydroxylation of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol. Impaired enzymatic hydroxylation occurred despite the presence of either hypophosphatemia or hypocalcemia. The data suggest that acidosis interfers with the adaptive enzymatic control of 25-hydroxycholecalciferol metabolism in the vitamin D depleted state.


Aequorin luminescence: relation of light emission to calcium concentration--a calcium-independent component.

Light emission from the calcium-sensitive bioluminescent protein aequorin was measured at calcium ion concentrations of 10(-9) to 10(-2) molar. At very low Ca2+ concentations, light emission is independent of calcium ion concentration. The maximum slope of the log-log plot of light as a function of calcium ion concentration is about 2.5. The complete relation is well described by a two-state model involving three calcium-binding sites.


Kinetic resonance Raman spectroscopy: dynamics of deprotonation of the Schiff base of bacteriorhodopsin.

We have developed a kinetic technique, combining resonance Raman spectroscopy and variable-speed continuous flow methods, to study molecular dynamics of isolated sites in macromolecules. Kinetic resonance Raman spectra of the retinylidence chromophore of bacteriorhodopsin have been obtained and the dynamics of the deprotonation of the Schiff base linkage is discussed.


Environmental degradation of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD).

Herbicide formulations containing known amounts of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and exposed to natural sunlight on leaves, soil, or glass plates lost most or all of the TCDD during a single day, due principally to photochemical dechlorination. Despite the known persistence of pure TCDD, it is not stable as a contaminant in thin herbicide films exposed to outdoor light.


Enzyme polymorphisms as genetic signatures in human cell cultures.

The electrophoretic resolution of seven relatively polymorphic human gene-enzyme systems expressed in tissue culture cells can be used as a sensitive genetic monitor for intraspecific cell contamination. An identical genotype at each of the same allozyme loci provides a 95% (or greater) confindence estimate of the identity of two cultured lines, on the basis of the allelic frequencies of the seven enzyme loci in natural populations and in populations of independently derived cultured cells. Of 27 commonly used human cell lines examined, only one of 351 pairwise comparisons proved genetically indistinguishable.


Reconstitution of chromatin subunits.

The recovery of the subunit structure of chromatin after dissociation and reconstitution is markedly affected by the procedure used. Some procedures give complete regeneration of subunits, but the procedure most commonly used for reconstitution gives poor yields of subunit-containing chromatin.


Fat-containing uterine smooth muscle cells in "toxemia": possible relevance to atherosclerosis?

Uterine smooth muscle cells in "toxemia of pregnancy" contain varying amounts of fat--a feature to date believed to characterize only the arterial smooth muscle cells in atherosclerotic lesions. Thus, the smooth muscle cells at these two sites do not differ essentially in their reactivity to certain forms of injury: hypoxia may represent an injurious factor common to both "toxemia" and atherosclerosis. These observations imply that the view that the arterial smooth muscle cells are biologically different than are those elsewhere may no longer be tenable.


Visual pigment changes in rainbow trout in response to temperature.

Lower water temperature (6 degrees C in comparison  to 16 degrees C) favors a higher proportion of porphyropsin in the retina of rainbow trout (Salmo gairdneri), regardless of the light conditions (constant darkness or 12 hours of light and 12 of darkness). This response to temperature does not follow a Q10 relation, namely an increase in the rate of a reaction produced by raising the temperature 10 degrees C.


Identification of retinoyl complexes as the autofluorescent component of the neuronal storage material in Batten disease.

Cytosomes filled with intensely fluorescent material in the form of curvilinear bodies were isolated by density gradient centrifugation followed by pronase digestion from the cerebral cortex of a child who had died at age 7 from the late infantile form of Batten disease. Forty-three percent of the dry weight of the storage material was extracted by a mixture of chloroform and methanol, leaving a waterinsoluble amorphous fluorescent residue. Infrared spectroscopy, proton magnetic resonance spectrscopy, and mass spectrometry of this residue strongly suggested the presence of retinoyl polyenes linked to a small peptide. Base hydrolysis and methanolysis yielded retinoic acid and methyl retinoate, respectively. Ozonolysis yielded a product derived from the substituted cyclohexenyl ring of vitamin A. The results indicate that the fluorescent component of the neuronal storage material is a retinoyl complex and is not derived from peroxidized polyunsatured fatty acids as previously thought.


The distrust of nuclear power.

Society seems content to strike a more moderate or uncertain balance with other technologies than with nuclear power. This attitude is traced to the social history of nuclear power, the genuine uncertainty and complexity of safety issues, underestimation of the regulatory task, and the rancorous nature of the debate. Nuclear power is not just another problem of technology, of environment, or of health. It is unique in our time. To be more demanding of nuclear safety may be to apply a double standard, but not necessarily an irrational one. Our best course appears to be to keep the nuclear option open, work toward the rapid resolution of problems such as waste disposal, but postpone recycling and the breeder reactor. Time is needed to resolve immediate problems such as transport and disposal of nuclear wastes; to come to terms with trans-scientific issues such as plutonium toxicity, sabotage, and weapons proliferation; and to evaluate long-term energy alternatives.


Morphologies of cells from 1-day chick embryos.

Cells disaggregatedfrom 1-day chick embryos show three morphologies,two reminiscent of mammalian erythrocytes and one epithelial. The presence of intermediate forms suggests that the three morphologies are interconvertible.


Characterization of a new human diploid cell strain, IMR-90.

A new human diploid fibroblast-like cell line has been established from lung tissue of a female fetus. This has been frozen away in large quantity and characterized for use in research and related purposes. This is the first of a planned series of human cell lines to be established, characterized, and banked in large quantity in support of the National Institute on Aging research and general cell biology.


Babesia rodhaini: requirement of complement for penetration of human erythrocytes.

A system has been developed in vitro in which human red cells, in the presence of fresh human (or rat) serum, are parasitized by the hemosporidian protozoan Babesia rodhaini. The ability of B. rodhaini to penetrate red cells depends on factors of the alternative complement pathway (properdin and factor B) as well as ionic magnesium and the third (C3) and the fifth (C5) components of complement. These data indicate a novel mechanism by which a parasite is able to utilize the complement system. The data are in accord with and further amplify earlier observations that demonstrated a requirement for complement in the development of babesial infection in rats.


N-Nitrosodiethanolamine in synthetic cutting fluids: a part-per-hundred impurity.

N-nitrosodiethanolamine has been found to be present at a concentration of 0.02 to 3 percent in several brands of synthetic cutting fluids. Its identity was confirmed by three independent techniques: (i) by measuring the retention times on two different high-performance liquid-chromatography columns, (ii) by dehydration to N-nitrosomorpholine, and (iii) by preparation of the O-methyl ether derivative.


Perception of impossible limb positions induced by tendon vibration.

When the wrist flexor muscle is vibrated and the wrist is passively extended to a position close to its anatomical limit, the hand is felt to be bent to a position about 29 degrees beyond its maximum operating range. The mechanism of position sense must in this case be operating on the basis of extrapolation. Ambiguity of sensed position can occur in this situation. Some subjects, when opposing the vibration-induced contraction of bicepts, report experiencing multiple forearms.


Cortical potentials associated with the detection of visual events.

A positive-going potential, which reaches a maximum at the vertex and midline parietal scalp electrodes, occurs in the human being when an infrequent, significant event occurs in a continuously observed visual display. It is not time locked to eye movements or operant response and appears to be generated when the observer recognizes an event that he has been instructed to detect.


Reading disability: an information-processing analysis.

In a task designed to separate perceptual processes from memory, 12-year-old children with reading disabilities showed no perceptual deficits as compared to their peers. However, they exhibited major deficiencies in memory skills for both labelable and nonlabelable visual information. Reading-disabled children in this age group appear to suffer from a basic information-processing deficiency.


Homeostasis during hypoglycemia: central control of adrenal secretion and peripheral control of feeding.

Intravenous infusions of manose or B-hydroxybutyrate, metabolic fuels which can be oxidized by brain, abolished adrenal discharge of epinephrine in rats during insulin-induced hypoglycemia, whereas infusion of fructose, a sugar which does not cross the blood-brain barrier, did not. In contrast, increased feeding behavior during hypoglycemia was prevented both by the sugars and by B-hydroxybutyrate. Thus, while the sympathetic response during marked hypoglycemia may have been initiated by alterations in cerebal metabolism, the feeding response evidently was not, and a decrease in the utilization of glucose per se does not appear to be the critical stimulus in either case.


Mechanisms and prevention of cancer dissemination: an overview.

Synthesizing data from many experimental and clinical courses, a current working model for tumor dissemination has been constructed. Several aspects of this model are being exploited to therapeutic advantage for the patient with cancer. Surgeons should continue to exercise the principles of en bloc tumor resection and employ maneuvers to minimize iatrogenic tumor dissemination .


Pathways of metastatic spread of malignant tumors.

In order to produce viable metastases,  the neoplastic cells must first be able to survive in the fluid system that they attain and that transport them. An important circumstance that has escaped the attention of most observers is the fact that the establishment of metastatic colonies is favored by the sluggish transportation of the detached neoplastic cells. Such leisurely transport is provided by lymphatic channels and peritoneal fluid; in the peritoneal cavity, the favorable circumstance aids the spread of relatively benign tumors such as pseudomyxoma peritonei and ovarian adenomas. In the blood, the slow transport is assured only by the venous access to the vertebral vein system; this avenue to blood-borne spread is particularly favorable to well differentiated tumors with a slow rate of growth and explains the widespread bone metastases from tumors with a low degree of malignancy, such as well differentiated adenocarcinomas of the thyroid and prostate. In contrast, neoplastic cells that enter the swift arterial circulation from the left heart are not often successfully implanted, in spite of their high degree of malignancy, and more often perish. Otherwide, we should observe a greater number of metastases in the small bones of the wrists and hands and of the ankles and feet, where the arterial circulation would bring them.


Metastatic and histologic presentations in unknown primary cancer.

The patient with metastatic adeno- or undifferentiated carcinoma who presents with a cryptic primary is subjected to an extensive diagnostic search. These efforts apparently stem from the following assumptions: 1). The ultimately proven primary sites in such patients will occur with the same frequency as the most commonly occurring carcinomas (i.e., lung, breast, colon, prostate, etc.); and 2). Metastatic patterns and histologies seen at diagnosis are the same as for patients presenting with these more common tumors. Our data contradict these assumptions. For example, the most commonly occurring unknown primary was pancreas. Rarely occurring primaries included breast and prostate. Lung cancer was observed frequently, but the presentation was atypical because of the large proportion of female patients. In addition, the metastatic patterns at diagnosis were unusual for many of the ultimately proven primary sites. In an attempt to deal with these contradictions, a method to search for new relationships between primary site and metastatic-histologic presentations was employed. This method succeeded in placing the location of the primary cancer to above or below the diaphragm in 80% of the patients studied retrospectively. Tested prospectively in a small group of patients, the method appears to be clincally useful. Finally, in this study we have made the diagnosis, antemortem, of the primary cancer site (PCS) in only 30 of 264 patients. The failure to find the primary site, dispite extensive radiologic work-up, was disappointing to the authors, and emphasizes the difficulty of finding PCS antemortem. In our study pancreas and lung appear to be most common cryptic primary sites.


Unusual sites of metastases.

Unusual metastases occur in a significant percentage of patients with malignant disease. In large measure, they represent a preterminal event. This is not always the case, however. In patients who have metastases to the skin, the event is generally preterminal particularly when the primary is the lung. In that instance the time between appearance of the metastasis and death is between 1.5 and 2.6 mo. Metastases to the skin occurring in patients with carcinoma of the cervix also represents a preterminal event with a time from diagnosis to death of 3 mo. In patients with carcinoma of the esophagus, the time from diagnosis to death is 4.3 mo, on the average. On the other hand, metastases to the skin from primary malignant tumors involving the colon, bladder, kidney, and ovary do not represent preterminal events. The time form diagnosis to death varies from 7.3 mo in carcinoma of the ovary to 12.7 mo in carcinomas of the kidney. Therefore, it is important when a patient presents with metastases to the skin to establish the primary source, the extent of the metastatic lesions and devise treatment programs that are appropriate to the pattern of the metastasis and the primary diagnosis...


Multiple giant cell tumors.

A case of multiple giant cell tumors is reported. Neither of the lesions was malignant. The clinical, pathologic, and radiographic features of giant cell tumors are discussed.


Amphetamine-induced angiitis leading to renal failure.

A patient is presented who developed angiitis associated with intravenous usage of amphetamine. Her disease exacerbated after further amphetamine usage and progressed, over a two-year period, to terminal renal failure. Various etiologic possibilities are discussed, and it is suggested that amphetamine-induced angiitis is a distinct clinical entity that is potentially lethal.


Thioridazine-hydrochloride-associated agranulocytosis.

A patient with thioridazine-hydrochloride-associated agranulocytosis is described and eight previously reported cases are reviewed. This complication is most likely due to a direct toxic effect on the bone marrow. As in our case, markers for an immunologically mediated mechanism have not been found. Thioridazine-hydrochloride-associated agranulocytosis usually occurs between the fifth and 11th week of therapy and is not related to the total dose of drug received. Three of the nine patients with thioridazine-hydrochloride-associated agranulocytosis have died from infectious complications. Thus, careful monitoring for infection and prompt therapy are indicated.


Intrathoracic splenosis.

Intrathoracic splenosis is a rare complication of combined diaphragmatic and splenic injury. This is the 79th reported case of splenosis and the seventh case of intrathoracic splenosis. That intrathoracic splenosis can mimic carcinoma of the lung on chest roentgenogram is exemplified by the similarity between the patient's chest film and that of his brother who died of lung cancer during the patient's hospital stay.


Infection of disk space secondary to fistula from pelvic abscess.

Disk space sepsis is a recognized complication of spinal surgery, but infection by a penetrating fistula from a retroperitoneal or pelvic abscess is rare. The lack of localizing symptoms, the insidious disease process, and the clinical and myelographic findings simulating a herniated disk syndrome obscure the true diagnosis and make identification of the primary infection difficult. A good result was obtained in this case by laminectomy and drainage of the lumbosacral disk space, followed by a diagnostic fistulogram and evacuation of a large pelvic abscess.


Phencyclidine ingestion: therapy review.

The case of a 2 1/2-year-old comatose white boy successfully treated for acute phencyclidine poisoning has been reported with a brief review of symptoms and therapy. Supportive treatment consisted of maintaining intravascular volume; giving diuretics as needed to insure an adequate urinary output; controlling excessive secretions and seizure activity; and providing respiratory support. The patient recovered over a ten-day period of treatment without neurologic or psychologic sequelae.


Pediatric pesticide poisonings in North Carolina: epidemiologic observations.

In four years, 218 pesticide exposures were reported among North Carolina children. Epidemiologic follow-up revealed 50 symptomatic cases with nine fatalities. Mean age of exposed children was 27 months; boys were involved twice as frequently as girls. Agents most often implicated were anticoagulant rodenticides (17%) and organophosphate insecticides (16%). Sixty-eight percent of exposures were to products intended for household use. Special characteristics of pesticides that contribute to morbidity include exceptional toxicity, dermal penetration, and frequent application as food baits. Exposure histories indicate that high petroleum distillate content often adds to product toxicity.


Tick paralysis: electrophysiologic measurements.

Electrophysiologic measurements in a 9-year-old girl with tick paralysis demonstrated a prolonged distal latency and a decremental response to 30 Hz stimulation. The nerve conduction determinations became normal after clinical recovery. The pathophysiologic process of this disease seems to be within the peripheral nerve although a central site of action of tick toxin cannot be completely excluded. Tick paralysis should be considered in the individual who develops ascending paralysis.


Cervical teratoma in infants and children.

Teratoma of the neck in infants and children, though uncommon, should be included in the differential diagnosis of neck masses in this age group. Radiographic examination should be an integral part of the patient's evaluation and may allow a definitive diagnosis. The clinical and radiologic aspects of this tumor are discussed. The finding of a soft tissue mass indenting the trachea and containing calcification should indicate the diagnosis of teratoma.


Difficulties in diagnosing unusual spread of cervical carcinoma.

A case involving unusual spread of cervical carcinoma in a 66-year-old white woman who remained relatively asymptomatic for 26 years after radiation therapy for stage III or IV squamous cell carcinoma is presented. Despite an extensive clinical work-up, diagnosis was not made until a large retroperitoneal tumor mass was discovered at necropsy. The subtle clues of occult malignancy are discussed and a mechanism for the unusual spread of the cervical carcinoma is presented.


Cryosurgery of the anus.

To further study the effectiveness of cryosurgery of the anus, cryolesions were produced in the rectum of pigs and healing was followed by microangiography and histologic study. In addition, cryosurgery was used on 105 patients (35 as outpatients) with anal pathologic lesions. Results demonstrated that cryosurgery is an effective method of curing most anal lesions. Since the method produced partial anesthesia, postoperative pain was decreased. The cryolesions healed rapidly and well, without major complications. The experimental work demonstrated destruction of the submucosal veins without distortion of muscles or excessive scarring. The mucosa sloughed but healed within two weeks. Cryosurgery makes office hemorrhoidectomy a reality.


Obstructive hydrocephalus as a cause of hypopituitarism.

Two patients in whom the signs and symptoms of intracranial hypertension resolved after surgical correction of hydrocephalus are described. In both instances skull roentgenograms showed an abnormal sella turcica, and an arteriogram and sir study were necessary to prevent misdiagnosis as "pseudotumor cerebri." Evidence of clinical endocrine dysfunction is an early sign of pituitary tumors, but hypopituitarism may also occur in patients with extrasellar processes, including hydrocephalus and intracranial hypertension.


The value of multiple-plane angiography in the assessment of aortoiliac disease.

Aortography, regarded as a definite diagnostic study in evaluating pateints with peripheral vascular occlusive disease, is usually done in the anteroposterior projection only. Occasionally, a significantly diseased area may not be identified on this projection, and an oblique view of the aortoiliac region may clarify the presence and severity of arteriosclerosis. At present, our indications for obtaining oblique views of the aortoiliac region are (1) when symptoms correlate poorly with the arteriographic findings in the anteroposterior projection, or (2) when the severity of the lesion is in doubt. These projections also are used to evaluate patients who have had previous aortoiliac bypass grafts and in whom ischemic symptoms recur. Patients with unilateral limb ischemia who are being considered for femorofemoral bypass graft procedures or iliac endarterectomy are also appropriate candidates, especially when radiopaque material overlies the vessels. Arteriograms in oblique projections also are recommended for more precise evaluation of the origin of the profunda femoris artery.


Pulsus alternans: its therapeutic implications.

Pulsus alternans is a pulse pattern in which the beats occur at constant intervals but with the regular alternation of the peak of the pressure pulse. Pulsus alternans frequently indicates heart failure due to disease of the left ventricle and will be seen with increasing frequency as more patients are invasively monitored. This report describes four patients who had pulsus alternans and the interventions that resulted in its disappearance. These cases would seem to support previous findings in experimental animals that the appearance of pulsus alternans may be related to myocardial ischemia. A review of the current concepts on the pathophysiology of pulsus alternans is included.


Disseminated histoplasmosis diagnosed from peripheral blood film.

Demonstration of Histoplasma capsulatum in conventional films of peripheral blood establishes the diagnosis of disseminated histoplasmosis. We describe two new examples of this pnenomenon and tabulate relevant data from 11 similar cases.


Silicone sling for ptosis.

The history of using brow suspension to correct blepharoptosis is reviewed. The disadvantages of earlier materials are discussed. The use of a silicone band, 0.8 mm in diameter, as the material for brow suspension is proposed. Five stab incisions are used, and the band is passed with the aid of a cerclage needle. A Watzke tube is used for fixation. Results in 12 patients have been very satisfactory.


Endometriosis involving the femoral vein.

The first case of endometriosis of the femoral vein presenting as a femoral hernia is reported. Histogenesis and sites of extragenital endometriosis are briefly reviewed.


Combination flap closure of facial defects.

In the past, combining local flaps to close skin defects has emphasized the shape of the defect. Combining local flaps on the basis of facial features and available donor skin has clear-cut advantages over single flap and regional flap closures in selected cases. Facial features may be more readily preserved and incision lines more easily disguised. A successful functional and cosmetic result is dependent on flap selection and design, as well as meticulous handling of skin and closure technics.


Trabeculectomy.

During a one-year period, 31 trabeculectomies were done in 25 patients. Of these procedures, 27 (87%) were done for chronic open angle glaucoma, three (10%) for congenital glaucoma, and one for chronic open angle glaucoma in an aphakic patient. Our overall success rate was 87%. Complications were few: only two of 31 flat anterior chambers persisted postoperatively. Visual acuity dropped significantly (two lines on the Snellen visual acuity chart) in only one patient.


Osteotomy of the metatarsals for pes cavus.

Described is a surgical procedure for pes cavus which includes multiple osteotomies of the metatarsals, usually combined with Steindler fasciotomy and extensor tenotomy. This method permits the correction of the cavus deformity and preserves the length of the foot without disturbing any joint. A total of 11 patients with 14 procedures have been followed up for an average of more than three years. Results of 12 of the 14 operations were favorable according the the criteria used.


Posterior fracture dislocation of the hip.

We have reviewed 46 posterior fracture dislocations of the hip treated at the University of Alabama in Birmingham Hospitals and the Birmingham Veterans Administration Hospital from 1963 to 1973. Of the 13 injuries which were followed up for at least one year, there were two good, five fair, and six poor clinical results. One instance of aseptic necrosis was documented. There was no obvious correlation between fracture type or treatment and clinical result in this preliminary series.


Congenital heart disease in de Lange's syndrome.

Seven (29%) of 24 patients with de Lange's syndrome were found to have congenital heart disease. Right-sided obstructive lesions were most commonly encountered. Approximately one in five of all patients with the de Lange syndrome exhibit congenital heart disease, usually ventricular septal defect or pulmonic stenosis.


Significance of the pecten band in anorectal surgery.

Constricting fibrous tissue in the subepithelial tissue of the terminal anus found at operation should be partially resected. Postoperative anal stenosis is prevented thereby, and superior functional and anatomic end results are attained.


Use of a crisis committee in a therapeutic community.

Described is the use of a patient crisis committee in an adult therapeutic community. The crisis committee is a function of the patient government and is called into action in situations formerly handled by physicians or nurses. This method appears to be highly successful in the therapeutic community described.


Clinical correlates of bone marrow plasmacytosis.

In light of the variable clinical expression and bone marrow plasmacytosis of multiple myeloma, we studied prospectively the prevalence and clinical correlates of bone marrow plasmacytosis in 133 anemic medical inpatients. Seventeen patients (13%) had 5% or more, and four patients (3%) had 10% or more marrow plasma cells. Only two patients (with plasmacytosis of 7.4% and 46.2%, respectively) had multiple myeloma. Lung infections (pneumonia, tuberculosis, abscess) accounted for 41% of the cases of plasmacytosis. We found that plasmacytosis correlated with the severity of pneumonia and that active pulmonary tuberculosis was usually associated with notable plasmac. ytosis. Cancer and liver disease were not important causes of plasmacytosis in this study. There was a correlation between plasmacytosis and serum hyperglobulinemia. A correlation between advancing age of the patients and increasing prevalence of plasmacytosis was attributed in part to an increasing prevalence of serious illness with age. However, some elderly patients with apparently benign disorders had unexplained plasmacytosis.


Urinary estriol for assessment of fetoplacental function.

A total of 1,607 urinary estriol determinations were performed in 447 patients with normal and complicated pregnancies. In general, the test provided reliable information concerning fetal status, particularly in pregnancies complicated by toxemia, diabetes, and postmaturity. When measured consecutively, a drop of 50% or more in estriol level usually should be considered a significant index of fetal distress. Limitations of the test and several compensatory measures aimed at minimizing inaccuracy are discussed.


Foreign bodies in the hand in children.

Foreign bodies in the hand in children are best managed when the surgeon has a well-organized approach to the total problem. The procedure of restraining a child, infiltrating the wound with local anesthetic, and probing the wound deep in the hand on the day of injury to remove the foreign body is discouraged. A detailed examination of the hand for cut tendons and nerves should be done. The initial treatment should be thorough cleaning of the skin, application of compresses wet with Bunnell's hand solution, systemic antibiotics, and tetanus prophylaxis. The foreign body is removed, as an elective surgical procedure, only if there is evidence of infection or persistent pain or both. Six weeks after all evidence of infection has cleared appropriate reconstructive procedures can be done.


Leptospirosis: a neglected cause of nonbacterial meningoencephalitis.

Two cases of leptospirosis with different clinical presentations are presented. The importance of recognizing mild, nonicteric and meningoencephalitic forms in order to identify vectors and contaminated areas and prevent further infections is emphasized. Cerebrospinal fluid (CSF) findings in reported cases of leptospirosis are reviewed and possible prognostic implications of CSF xanthrochromia, hypoglycorrhachia, persistent polymorphonuclear leukocytosis, and increased intracranial pressure are discussed.


Close monitoring is essential during isoniazid prophylaxis.

A three-year prospective study during the entire course of preventive therapy with isoniazid (INH) for recently infected hospital employees was undertaken to evaluate the risk of developing INH-related hepatic injury. Results of clinical and laboratory tests at 1, 2, 6, and 12 months were correlated to ascertain the significance and value of monitoring procedures. Thirty-two (32%) of 100 employees developed elevated SGOT levels: one (1%) patient developed clinical hepatitis in the first month of therapy; four (4%) subjects with SGOT elevations (82-378 units) became clinically symptomatic at one to four months and INH was discontinued; one (1%) individual with minimal increases in serum bilirubin and SGOT levels was symptomatic at eight months and the drug was stopped. Twenty-four (24%) otherwise asymptomatic subjects who developed SGOT elevations (70-480 units) were followed at closer intervals to complete INH therapy without further progression of liver function abnormality. The intervals between the beginning of treatment and the elevation of SGOT levels varied widely, with elevations occurring throughout the 12-month course of isoniazid therapy.


Hypertension, blood pressure variability, and juvenile delinquency.

Although the possible role of hypertension and/or blood pressure variability in the causation of juvenile delinquency has not been directly investigated hitherto, there is evidence to suggest (a) that an excess prevalence of blood pressure variability rather than hypertension is the aspect of cardiovascular functioning which characterizes adolescents, and some indirect evidence suggests (b) that increased blood pressure variability rather than hypertension is associated with juvenile delinquency. Official criminal statistics reveal a marked increase in the rate of convictions of males in their early and middle teens--the time of puberty and the adolescent growth spurt. It is hypothesized that increased blood pressure variability is one aspect of the general change in growth rate and metabolism occurring at puberty. These physiologic changes, together with the simultaneous addition of various social stresses, may lower the threshold for aggression and impulsivity, thus placing the individual at greater risk of involvement in the wide spectrum of behaviors collectively termed "delinquent".


Adoption in evolution: recent influences on adoption in Virginia.

Adoption is a relatively new and evolving institution. The characteristics of children available for adoption are changing. Some hard-to-place children will be helped by subsidized adoption. The concept of children as property of biologic parents continues to shadow efforts to terminate parental rights. Virginia law allows adoption against parental consent if such consent is withheld contrary to the child's welfare, but decisions continue to be based upon whether or not parental behavior has been sufficiently extreme to justify a finding of unfitness. New legislation is required to put the child's interests on a par with those of parents.


Dislocation of the elbow: a retrospective study of 115 patients.

Of the 115 elbow dislocations treated at two New Orleans hospitals between 1959 and 1969, 78% were posterior. Sixty-one percent of the patients were 21 years of age or younger, and the male-female ratio was 1.7:1.0. The most common associated injuries were fractures of the medial condyle or epicondyle. All uncomplicated dislocations were treated by closed reduction and plaster immobilization. Of the 35 cases complicated by medial condylar or epicondylar fractures, 29 required open reduction and internal fixation. Results were excellent or good in 91% of the cases. The three patients (2.6%) with poor results all had mental impairment. This study suggests a generally favorable prognosis for these injuries.


Acetabular labrum tears: a cause of hip pain and degenerative arthritis.

A torn acetabular labrum causing disabling hip pain has been noted in two patients. One patient had obvious erosion of the articular surfaces of the femoral head and acetabulum corresponding to the location of the displaced torn labrum. Excision of the torn labrum fragments afforded relief of the symptoms. In addition, a torn labrum was found in two surgical procedures for degenerative arthritis of the hip. A torn labrum could be a cause of degenerative hip disease where no preexisting condition is present, ie, slipped epiphysis or infection.


Ascariasis--its complications, unusual presentations and surgical approaches.

Serious complications of ascariasis are varied and occur at all stages of worm development. The acute condition within the abdomen heralds the presence of intestinal, pancreatic, or biliary tract obstruction secondary to the physical presence of the adult parasites. Larvae may be responsible for acute respiratory disease, either as a direct allergic phenomenon or as a pneumonic infiltrative process secondary to fellow traveler bacteria. Deposition of ova in the liver allows for intrahepatic and pericholangitic abscesses with resultant parenchymal destruction and scarring. Though primary therapy is medical, specific indications for surgical intervention are discussed. These unusual but life-threatening sequelae are typified in the case presentation of a critically ill child.


Intraoperative ureteral catheterization in pelvic and abdominal operations.

Ureteral catheters are often inserted as a preliminary procedure before pelvic operations. We recommend insertion of ureteral catheters only if they are needed and during the operative procedure through a cystotomy or ureterotomy. Assessment of the need for catheterization is best made intraoperatively rather than preoperatively.


Synovectomies in moderately to severely involved rheumatoid knees: an alternative to implant arthroplasty.

A retrospective study of 19 synovectomies revealed significant relief of pain for two to ten years in selected patients with moderate to severe rheumatoid arthritis of the knee diagnosed roentgenographically. The usual indications for this procedure may be extended to include well-motivated patients when synovectomy is combined with good medical and physical therapy. Need for further operation was considered a failure of synovectomy.


Advocacy and compliance factors in a voluntary selective screening program.

To evaluate factors responsible for compliance with a voluntary selective screening program, we surveyed 495 participants and 212 nonparticipants in a screening program for Tay-Sachs disease. Knowledge about the program and motivation are the most important factors in compliance. The primary incentive for participation was to avoid having abnormal children in future generations.


Cholecystostomy--an old dog with new tricks.

A large minority of patients having cholecystostomy show cystic duct or common duct stones on postoperative tube cholangiograms. The use of mechanical (Dormia stone basket) and chemical (heparin and sodium cholate) means to remove gallstones via the cholecystostomy fistula reduces the need for additional surgery (ie, cholecystectomy), which is particularly important in poor-risk elderly patients.


A comparative review of cylindrical inlay facet fusions for scoliosis.

Results in three series of spinal fusions with Harrington instrumentation for scoliosis were compared. Patient ages ranged from 9 to 22 years, and follow-up from 12 to 105 months. Cylindrical inlay facet grafting was done in all cases. Supplemental heterologous bone was used in the first series of 51 cases, autologous bone in the second series of 67 cases, and no supplemental bone in the third series of 68 cases. Only one infection and no paralysis or death occurred in the 186 patients. The pseudarthrosis rate was the same in each series. Similarity of results led to the conclusion that supplemental bone is not necessary with this technic. The advantages of not using supplemental bone were reduced operative time, less blood loss, and absence of donor site scar.


Cardiovascular malformations associated with choanal atresia.

In this study, cardiovascular malformations were present in 11 of 63 (17.5%) patients with choanal atresia. The most frequently encountered cardiac lesions were ventricular septal defect and patent ductus arteriosus, while cyanotic heart disease was uncommon.


Gastrocolic fistula secondary to benign gastric ulcer not operated upon: case report and review of literature.

A case report and review of the literature of benign gastric ulcer complicated by gastrocolic fistula are presented. Twenty-seven percent of patients were found to be receiving ulcerogenic medications. Only 15% of patients had previous histories of ulcer disease. Parameters most suggestive of a neoplastic process included palpable abdominal mass and unexplained anemia. Diagnosis is established by barium enema. Endoscopic biopsy and cytologic studies are useful in differentiating benign from malignant processes. Surgical management of benign ulcers complicated by fistula results in more than 90% survival.


Preoperative localization of occult breast lesions: a new technic.

Percutaneous needle placement before biopsy is a simple method of localizing occult breast lesions found by mammography. A biopsy of the exact area within the breast is done. Specimen radiography assures that the correct area is included for histologic study.


Mammary tuberculosis: a rare modern disease.

Tuberculosis of the breast has become a rare disease since the advent of antituberculous chemotherapy. The incidence of tuberculous mastitis at Vanderbilt Hospital for the last two decades was 0.025% of surgically treated breast disease. This probably reflects its prevalence in economically developed parts of the world. The pathologic diagnosis of mammary tuberculosis may be difficult. The only diagnostic proof is the demonstration of tubercle bacilli by microscopic smear of culture. Numerous cases have been incorrectly reported as mammary tuberculosis because of nonadherence to this criterion. Definite guidelines for treating breast tuberculosis are not available and may never become so because of its rarity. Drug therapy has been successful and should be tried in all cases. Adequate surgical removal is inevitably corrective of the local disease. Surgically treated patients should receive antituberculous drugs before and after their operations.


Social effects of leg ulceration in sickle cell anemia.

The relationship between chronic leg ulceration and the education, employment, and familial relationships of adults with homozygous sickle cell disease was studied. There was a significant correlation between the age of onset of leg ulceration and educational attainment. Patients in the leg ulcer group demonstrated lower educational attainment, had greater difficulty in obtaining and retaining employment, and were less likely to form stable marital relationships.


An educational program for the rational use of antimicrobial agents.

A rational approach to the proper use of antibiotics must include knowledge of microbial sensitivities to various agents, proper alternative choices, pharmacologic considerations, and the cost to patient and hospital of drugs prescribed. A logical program for analysis of use of antibiotics and proper administration is presented. Since the largest misuse of antibiotics is for no infection or for prophylaxis before surgery, situations in which prophylactic use of antibiotics is of value have been reviewed. Such an educational program designed to improve the physician's use of antimicrobial agents must be a continuing effort in improving patient care.


Venous aneurysms.

Primary venous aneurysms are rare lesions, but they can sometimes lead to serious complications. A report of a venous aneurysm in an unusual location is presented, with a review of the literature.


Preparation of figures for medical articles: guidelines for physician-authors.

Just as literary conventions and styles evolve, so even do "styles" (acceptable form) in medical writing. The guidelines suggested in this paper for the preparation of various types of figures are based on current standards in scientific and, particularly, medical writing. However, since at any given time there may exist two or more equally acceptable variations of "standard" practice, it is to a physician-author's advantage to examine the particular stylistic preferences and format of the journal to which he will submit his manuscript. Hopefully he can thereby avoid later editorial requests to revise or even completely redesign figures in which he has already invested much time.


Rumination in a 7-year-old child.

Regurgitation of food by rumination has rarely been reported in latency-age children. A 7-year-old boy had symptoms of rumination, gagging, bruxism, and enuresis. During the oppositional stage of development many unresolved conflicts had developed between the patient and his parents. Short-term psychotherapy which focused on resolution of the power struggles produced rapid remission of the symptoms. A two-year follow-up showed no recurrence of difficulty.


American mucocutaneous leishmaniasis.

Presented is a well-documented, autochthonous case of mucocutaneous leishmaniasis, a protozoan disease endemic to Asia, Africa, Southern Europe, South America, and Central America, which until recently was not found in North America. Diagnosis is made by positive culture on NNN media, positive serodiagnosis, positive Montenegro skin test, the presence of Leishman-Donovan bodies on Giemsa stain with light microscopy, and the presence of the kinetoplast within the organism on electron microscopy. The recommended treatment is sodium antimony gluconate given intramuscularly, 600 mg daily for seven to ten days.


Ameloblastoma of the maxilla.

Ameloblastomas of the maxilla are uncommon tumors of dental origin that slowly invade and destroy local tissues. A patient with extensive ameloblastoma of the maxilla presenting as a nasal mass is reported, and the clinical features, histopathology, and current treatment of this lesion are discussed. With involvement of the maxillary alveolar ridge and sinus, only radical en bloc resection can be considered appropriate treatment.


Diabetic visceral neuropathy: treatment with bethanechol chloride.

An 86-year-old diabetic man developed nausea, emesis, abdominal distention, and decreased gastrointestinal motility. A Hollander test confirmed incomplete vagal dysfunction. Treatment with bethanechol chloride resulted in marked improvement which was reproducible after withdrawal and reinstitution of therapy. We believe that treatment with bethanechol chloride deserves further investigation in selected patients with diabetic visceral neuropathy.


Elevated triiodothyronine and dextrothyroxine levels: a potential cause of iatrogenic hyperthyroidism.

A woman in whom the use of dextrothyroxine was associated with clinical hyperthyroidism is described. She had a markedly elevated T3 level while receiving the drug, apparently resulting from conversion of the dextrothyroxine to triiodothyronine. The T3 levels fell to normal after withdrawal. Patients receiving dextrothyroxine should be examined for possible elevation of T4 and T3 thyrotoxicosis.


Bilateral simultaneous Warthin's tumor in a woman.

The incidence, histology, and proposed origin of Warthin's tumor are discussed in conjunction with an extremely rare occurrence of simultaneous bilateral tumors in a woman, the second such reported case. It is hoped that presentation of this case emphasizes the need to consider the possibility of bilateral occurrences when evaluating masses in the parotid region.


Maternal mortality. A survey of 118 maternal deaths and the avoidable factors involved.

From January 1973 to December 1975, 26 018 women were delivered at Edendale Hospital. During the same period, 4 478 patients aborted there. Maternal deaths during this period numbered 118, a mortality of 4,5/1 000 total births. Avoidable factors influencing the mortality may have been present in 28 (2387%).


Arthropathy associated with familial cold urticaria.

This is a clinical description of an unusual arthropathy in 2 members of a family with familial cold urticaria. Relevant investigations, X-ray illustrations and the family pedigree are presented. The nature of the arthropathy and its possible relationship to other arthropathies is discussed.


Hepatic and renal failure after misuse of hycanthone.

Two patients who developed hepatorenal failure after the misuse of hycanthone are described. In both patients there were predisposing factors which potentiated the adverse reactions.


Serum cholesterol and dietary data in middle-aged white males.

The mean daily dietary intake of normocholesterolaemic subjects (serum cholesterol less than 250 mg/100 ml) was compared with that of hypercholesterolaemic subjects (250 mg/100 ml or higher). Apart from a higher polyunsaturated fatty acid (PUFA) intake in the hypercholesterolaemic group, no other significant differences could be demonstrated between the two groups. Simple linear correlation coefficients (r) were calculated for the total sample, and the positive correlation (r = 0,29) between the serum cholesterol and the percentage of kilojoules derived from PUFA, was the only dietary variable to reach a statistically significant value (P less than 0,05). A stepwise regression analysis was used to calculate a multiple regression relationship (R2) between the dependent variable and the dietary variables. The results showed PUFA, total protein and saturated fatty acids (SFA) to have the highest cumulative influence on the serum cholesterol concentration. Only 29% of the variation in the serum cholesterol could be explained by the first 6 of 30 dietary variables tested in this survey. It was concluded that the small differences in the nutritional status among individuals from homogenous sample populations as well as the fact that non-linear relationships would not be reflected in the correlation coefficient, make it difficult to establish significant relationships between the dietary data and serum cholesterol concentration.


Tay-Sachs disease screening and prevention in South Africa.

Tay-Sachs disease is potentially preventable in Ashkenazi Jewish communities. About 1 out of 25 individuals is a carrier of the gene and can be accurately identified by means of a simple, inexpensive blood test. 'At risk' couples, i.e. couples of whom both partners are carriers, can be enabled, by means of prenatal diagnosis and selective abortion, to have only unaffected children. Mass screening programmes have been successfully carried out in the USA, Canada and Israel. A discussion of South African Jewish deomgraphy, attitudes to health, and priorities for public health projects, provide the background to a consideration of Tay-Sachs disease prevention in South Africa.


Viral hepatitis.

The natural history of and biochemical changes in 27 patients with viral hepatitis are outlined. Analysis is made of the symptomatology and physical signs at the time of presentation as well as a comparison between hepatitis B surface antigen-positive and negative patients. In general, hepatitis B surface antigen-positive patients have a more severe clinical illness as well as greater biochemical derangement and a longer duration of disease.


Clinical trials, children and the law.

Clinical trials are necessary for the advancement of medical science. The law is reasonably tolerant as far as experiments on adults are concerned. The legal limits within which experiments on children, especially children of tender years, may take place are, however, far more strict. The medical researcher who goes beyond these limits is liable to be attacked for legal indecorum. This article deals with these legal limits and with guidelines for the researcher.


Treatment of threatened and habitual abortion with human chorionic gonadotrophin. The role of serum human placental lactogen determination.

Treatment of habitual and threatened abortion with human chorionic gonadotrophin (HCG) is discussed. Two problems are encountered: the selection of patients for treatment; and the correct dosage of HCG. Determination of human placental lactogen (HPL) in the serum was used to select patients for treatment. The dosage of HCG was varied according to the response of the patient and as indicated by the levels of HPL in her serum.


North American blastomycosis in South Africa: a case report.

Blastomycosis dermatiditis, or North American blastomycosis, is rarely encountered in the Republic of South Africa. In view of the increasing number of reports of this disease from other parts of Africa and the rest of the world, one wonders whether North American blastomycosis is not a misnomer. It should perhaps be included in the differential diagnosis, particularly in cases of refractory skin ulceration.


The hazards of combined chemotherapy and radiotherapy in rhabdomyosarcoma of the mediastinum: a case report.

A total tumour irradiation dose of 2900 rad and a dose of 2500 rad to  a metastasis, as well as the administration of 330 mg/m2 adriamycin, successfully eradicated all traces of malignant disease after partial surgical excision in a 12-year-old Black boy with a rhabdomyosarcoma of the mediastinum. The treatment, however, damaged the heart and caused the death of the patient.


Laboratory studies and clinical features in a case of boomslang envenomation.

A case of boomslang (Dispholidus typus) envenomation is reported. Coagulation studies carried out within 2 hours of the patient's being bitten showed unrecordable prothrombin and activated partial thromboplastin times. The fibrinogen and factors V and VIII were severely depleted. Abnormal liver function tests were also documented. These abnormalities were corrected by treatment with specific antivenom. A haemolytic-uraemic syndrome was not observed.


Polymyositis as a cause of malabsorption. A case report.

We report on a patient with polymyositis which caused a malabsorption syndrome. The radiological findings included marked dilatation of the oesophagus and small intestine. The malabsorption syndrome appears to arise from bacterial overgrowth associated with intestinal stasis. The literature is reviewed. Polymyositis or dermatomyositis, like scleroderma, may involve the small bowel and cause the malabsorption syndrome.


Multiple organ failure.

Forty-two postoperative patients, each with demonstrable failure of two or more vital organ systems, have been studied as they define a syndrome of multiple organ failure. They typify the emerging clinical entity of patients kept alive solely by reason of specific mechanical and pharmacologic support. Trauma initiated hospitalization in 40 per cent and major bleeding, in 11 per cent. Sepsis was judged to be of etiologic significance in 69 per cent. Complications in clinical management were, in retrospect, thought to be of contributory etiologic significance in 57 per cent. Twenty-nine of 42 patients died; a mortality of 69 per cent. Mean duration of multiple organ failure was 30.5 days. Hospital cost, omitting the physician's fees, was conservatively estimated at $700 per day. Scientific, social, moral, ethical and legal factors emphasize the need to establish a statistically valid large data base concerning this new man-made syndrome which has both important scientific and social implications. This study is a first step in this direction.


A clinicopathologic study of prognostic factors in cutaneous malignant melanoma.

Sex, size of the primary lesion, level of invasion at the primary site, clinical status of the regional lymph nodes at the time of diagnosis and whether or not the lymphatic or the blood vessels at the primary site were invaded by tumor cells are the prognostic factors found to influence the survival of patients with a cutaneous malignant melanoma. The last two factors were found to correlate with the level of invasion. Because of the high incidence of local recurrences after a small local excision, wide excision at the primary site of skin, subcutaneous tissue and fascia with skin graft should be the treatment of choice. The role of elective regional lymphadenectomy has to be questioned, as 51 per cent of the patients never required lymphadenectomy during the course of the disease, The higher incidence of satellitosis after such a procedure, elective lymph node dissection did not improve the survival. Therefore, it appears that regional lymph node dissection has a prognostic, rather than a therapeutic, role. From the time of the recurrence, it is clear that patients with systemic metastasis have the poorest prognosis. On the other hand, patients in whom satellitosis developed lived longer, but this was not statistically significant when compared with the survival of patients with a local recurrence or with regional lymph node metastasis; Early diagnosis should be emphasized because the two main factors that seem to influence survival are the depth of invasion and the size of the primary lesion. Finally, because the level of invasion and the status of the lymphatics and blood vessels seem to carry a high prognostic significance, each primary lesion should be examined pathologically with regard to these factors.


Barium enema as a diagnostic aid in children with abdominal pain.

Diagnostic barium enema is not a substitution for well executed physical examination, and its use should be reserved only for obscure situations. An abnormal roentgenogram provides valuable information, since the fear of missing acute appendicitis in these children is minimized. When normal, this diagnostic test may bring to early operation those with minimal symptoms or unusual presentations, thus avoiding the possibility of prolonged observation and perforation. In children with known associated severe medical maladies, diagnostic barium enema can serve to reaffirm the diagnosis prior to the hazardous operative intervention. It may also eliminate the need for operation in those conditions which mimic acute appendicitis. The use of diagnostic barium enema in the past three and a half years significantly improved our diagnostic capabilities in children with abdominal pain. There was a corresponding reduction in the number of normal appendixes removed. The efficancy and, above all, the safety of this procedure make it a valuable diagnostic aid in the care of children.


Importance of spicules on clinical staging of carcinoma of the breast.

Spiculated outgrowths around carcinomas of the breast were measured and assessed, both on roentgenograms and on microscopic slides in 104 spiculated carcinomas of the breast. On the basis of macroscopic and microscopic findings, the clinical stage of each tumor was corrected retrospectively. In the sense of an overestimation, 27.9 per cent, or an underestimation, 8.6 per cent, the clinical error reached 36.5 per cent of the true extent of the tumors. The relation of the histopathologic substrate of spicules of carcinoma of the breast upon metastases of axillary lymph nodes and clinical staging is significant.


Effect of burn injury on glucose turnover in guinea pigs.

Using our guinea pig model, we found the rate of appearance of glucose was elevated during the three phases following burn injury: the burn shock phase, the hypermetabolic phase and the septic phase. The rate of disappearance of glucose initially was not elevated, resulting in hyperglycemia during burn shock, but eventually, the rate of disappearance of glucose increased to the same extent as the rate of appearance of glucose. During the hypermetabolic and septic phases, the glucose turnover rate was elevated, but the plasma glucose concentration was normal. Glucose turnover was poorly correlated with total body oxygen consumption, suggesting that not all of the increased turnover of glucose was due to increased glucose oxidation.


Intestinal infarction complicating low cardiac output states.

Nonocclusive mesenteric ischemia, leading into intestinal infarction, frequently complicates and causes the fatal outcome in otherwise treatable instances of low cardiac output states. Once intestinal necrosis occurs in these patients, the mortality is almost 100 per cent. A high risk group of patients in whom intestinal infarction occurs because of low cardiac output can be readily identified. A high index of suspicion for the occurrence of intestinal ischemia in these patients should facilitate recognition of the disease during its early stages. The disastrous results experienced by us and others warrant the use of more aggressive methods for the diagnosis and treatment of patients with this condition. A high index of suspicion in a recognizable group of patients observed by selective mesenteric arteriography affords a method for confirmation of the diagnosis of mesenteric vasoconstriction. Once the diagnosis is established, a patient management protocol program should be followed. Sustained infusion of papaverine into the mesenteric artery is useful in reversing mesenteric vasoconstriction. Additionally, the judicious use of celiotomy and intestinal resection, preceded and followed by the sustained infusion of papaverine into the superior mesenteric artery, offers hope for the survival of some of these patients and warrants further use.


Ultrasound diagnosis of pelvic and wound abscess after an appendectomy.

Intra-abdominal abscess formation is a common complication of ruptured and gangrenous appendicitis. The signs and symptoms associated with abscess formation are generally nonspecific and may be seen without a collection, which is amenable to surgical drainage. Because such patients are quite fragile, it is essential to use a diagnostic test which is noninvasive and highly accurate prior to further operation. B-scan ultrasound fulfills these requirements and is particularly valuable in assessing the recurrence of abscesses and in detecting wound abscesses.


Segmental gastric antral resection in experimental peptic ulceration.

In using the technique of histamine in beeswax peptic ulceration in dogs, these experimental preparations were studied as to their efficacy to protect against ulceration: laparotomy controls; bilateral truncal vagotomy and pyloroplasty; a 50 per cent gastrectomy and vagotomy plus a Billroth II gastrojejeunostomy; a 50 per cent segmental resection of the gastric antrum and corplus plus bilateral truncal vagotomy and pyloroplasty; a 75 per cent gastrectomy and Billroth II gastrojejeunostomy, and a 75 per cent segmental resection of the gastric antrum and corpus and bilateral truncal vagotomy and pyloroplasty. Only a 75 per cent gastrectomy Billroth II and a 75 per cent segmental resection of the antrum and corpus plus vagotomy and pyloroplasty consistently protected against histamine in beeswax induced ulceration.


The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.


A technique for radical dissection of the neck.

Modifications in the technique for the performance of standard radical neck dissection have been used for the past 12 years at this institute. The use of transverse skin incisions, removal of the platysma muscle and proceedings from a posterior to anterior direction are stressed in this procedure. Primary healing, reconstruction and cosmesis have been quite good, and local recurrences have been minimal. The five year survival rates for each type of cancer of the head and neck are comparable with those obtained at other cancer referral centers.


Pancreatic duct obstruction with an acrylate glue: a new method for producing pancreatic exocrine atrophy.

Ten dogs have been used in a study which demonstrates the feasibility of producing total pancreatic duct obstruction with alkyl-alpha-cyanoacrylate glue. Low pressure injection of glue into the pancreatic duct has led to a reproducible pancreatic atrophy with preservation of the islets. A sharp rise in serum amylase was noted in each dog, but at autopsy examination at monthly intervals after the operation, no evidence of chronic pancreatitis was observed. None of the dogs was rendered diabetic. The success of the experimental technique raises the possibility that such a technique might be useful in the management of human chronic pancreatitis as an alternative to pancreatic resection, and the operation has been performed on three patients so far.


The clinical significance of retroperitoneal fibrosis.

A total of 481 cases of retroperitoneal fibrosis (RPF) presented in the literature have been reviewed. Ten additional cases from this hospital have been added. One etiological factor, methysergide, has been implicated in 12.4 percent of cases, but the majority remain unexplained. Characteristically, the patient will be male (2:1 ratio), in his 50's (30.9 percent), with vague lower back pain (34.2 percent) or possibly flank pain (34.0 percent). Physical examination usually will be unrevealing. The patient's serum chemistry probably will show some degree of azotemia (55.4 percent) and perhaps anemia (13.6 percent). The intravenous pyelogram characteristically shows bilateral hydroureteronephrosis (67.6 percent) or unilateral hydroureteronephrosis (20.3 percent) associated with medial deviation of the ureter due apparently to external compression of the ureter. Methysergide should be discontinued if implicated. Laparotomy for ureteral compression characteristically will reveal a dense, rubbery plaque in the retroperitoneum. Generous frozen section biopsies show fibrosis, usually with some chronic inflammation, suggestive of RPF. Careful inspection of retroperitoneal nodes and liver may reveal the presence of malignancy in 7.9 percent of patients. In the absence of malignancy, the ureters should lyse fairly freely and peristasis may return. If no malignancy is present on permanent sections of biopsy material, the patient can be given a fairly optimistic prognosis (cumulative mortality rate, 9 percent). Suboptimal improvement probably is an indication for steroid therapy and surgical re-exploration may become indicated. In these cases further search for malignancy should be undertaken.


The effect of surgical operation on venous plasma free amino acids.

The effects of abdominal operation on the antecubital vein plasma amino acid concentration were examined. With four groups, each containing ten patients, factors such as severity of surgical operation, anesthesia, and postoperative nutrition were examined. Immediately after operation there is a fall in the plasma concentrations of most amino acids; the nonessential amino acids (glutamate, proline, glycine, alanine, histidine, and arginine) continue to fall during the 2 postoperative days, whereas the essential amino acids (isoleucine, leucine, phenylalanine, and lysine, with tyrosine) are at higher concentration at 48 hours than immediately after operation. Comparison of a group of patients undergoing an operation of moderate severity (vagotomy and pyloroplasty or cholecystectomy) with those having the more severe procedure of resection of aortic aneurysm with Dacron graft replacement suggests that these general changes in amino acid concentrations do not appear to be due to the severity of the operation, although cystine levels were lower, and phenylalanine levels were higher, in the graft-replacement group. The changes did not appear to be the result of anesthesia. Increasing the postoperative glucose intake was associated with higher plasma alanine and lower methionine levels. It is suggested that, in surgical patients, cystine and tyrosine may become essential amino acids and rises in phenylalanine and methionine indicate transient liver dysfunction. The data give support to the view that a high calorie intake after operation has a beneficial effect.


Myocardial revascularization prior to subsequent major surgery in patients with coronary artery disease.

Of our series of patients undergoing direct myocardial revascularization, we selected 60 patients who had subsequent major surgical and cardiovascular operative procedures. Thirteen of these patients had a second subsequent operative procedure, and four of the original 60 patients had a third subsequent operation. None of the patients died during the subsequent operation and none sustained a myocardial infarction. During the 77 subsequent procedures, there were eight different episodes of cardiac complications: seven patients had supraventricular arrhythmias and one patient had acute pulmonary edema. All patients responded to medical therapy. These results are suggestive that myocardial revascularization should be performed prior to other major indicated operative procedures in patients with documented coronary artery disease.


Protein-losing enteropathy complicating the Mustard procedure.

Protein-losing enteropathy is a reported complication of several cardiac diseases. Recently we encountered a patient with protein-losing enteropathy acquired as a late surgical complication of the Mustard procedure. An obstructed superior vena caval conduit was repaired surgically and the enteropathy was resolved.


Remote organ failure: a valid sign of occult intra-abdominal infection.

Remote or local infection appears to be causally associated with major organ failure in some surgical patients. Experience with the patients described suggests that the converse relationship may be clinically useful: organ failure may indicate the presence of otherwise occult intra-abdominal infection in postoperative patients and trauma victims. Support of organ function without definitive correction of underlying infection is only pallative.


Protection of nuclear function by various agents during organ storage.

Allopurinol, Collins' solution, and spermidine were tested for their ability to preserve nuclear function during kidney storage. Spermidine increased nuclear ribonucleic acid (RNA) polymerase activity 25 to 43 percent after 60 minutes of warm ischemia. Collins' solution was less effective and allopurinol did not protect RNA polymerase activity. Spermidine offered little additional protection over Collins' during cold storage of RNA polymerase activity. Only spermidine prevented the decrease in the molecular weight of RNA transcribed following kidney storage. Only Collins' solution prevented the breakdown of rapidly labeled heterogenous high molecular weight RNA and ribosomal precursor RNA.