Characteristics in youth indicative of adult-onset Hodgkin's disease.

From the college entrance health data of 50,000 male former students, the records of 45 who eventually died of Hodgkin's disease were compared with those of 180 surviving classmates with reference to certain indicator characteristics. Risk ratios of Hodgkin's disease tended to be lower for men who had experienced various common contagious diseases in childhood. This reduced incidence of clinical contagions may signify that: 1) Inadequate early challenge of immune mechanisms left subjects more susceptible to later Hodgkin's disease, whether or not it is of infectious origin; 2) heightened immune mechanisms that led to subclinical attacks of early contagious diseases promoted an autoimmune response that evolved as Hodgkin's disease; or 3) early childhood infections eliminated some subjects who otherwise would have attended college and ultimately developed adult-onset Hodgkin's disease. Also, Hodgkin's disease risk was higher for students who had reported early death of a parent, particularly from cancer. Moreover, the risk tended to be increased among collegians who were obese, heavy cigarette smokers, and coffee drinkers. None of these indicator characteristics was associated with 89 fatal lymphomas of other types that occurred in the same study population.


Note on comparison of small proportions in large-scale experiments.

A statistical confidence interval procedure was given for comparison of a treatment to a control where the response of each experimental unit was binary, e.g., presence or absence of a tumor. The method was appropriate when the two sample sizes were moderately large but the number of positive responses was small. The confidence interval was for the ratio of the two response rates.


Human colon adenocarcinoma cells. II. Tumorigenic and organoid expression in vivo and in vitro.

A human colon epithelial tumor cell line (LS174T) recultured in vitro following passage through hamsters displayed differences in its cell doubling time and synthesis of carcinoembryonic antigen when compared with the cells grown solely in vitro. These animal-passaged cells more closely resembled the parent tumor cell line (LS180) derived from the primary tumor than LS174T, the trypsinized variant of LS180. Analysis of lactate dehydrogenase isoenzymes indicated that the tumor cells recovered from the hamsters were free of xenogeneic host tissue. Furthermore, LS174T grafted to athymic (nude) mice grew as a mucinous adenocarcinoma microscopically resembling the original tumor. The altered growth potential of LS174T was also demonstrated on confluent feeder monolayers of normal cells and by uninhibited multiplication in vitro. These results suggest that, at least in this one case, short-term passage of long-term cultured cells into xenogeneic hosts may effect a phenotypic reversion such that the cells regain properties observed in the primary tumor and the initial in vitro explant.


Selective induction of intestinal tumors in rats by methyl(acetoxymethyl)nitrosamine, an ester of the presumed reactive metabolite of dimethylnitrosamine.

Methyl(acetoxymethyl)nitrosamine (DMN-OAc) was synthesized and tested for toxicity and carcinogenicity in rats to test the hypothesis that alpha-hydroxylation is required for metabolic activation of dimethylnitrosamine (DMN) to a reactive, proximate carcinogen. The acute median lethal doses (LD50) of DMN-OAc and DMN injected ip into 5-week-old male Sprague-Dawley (Charles River (CD) rats were determined to be 0.19 and 0.59 mmole/kg body weight or 25 mg DMN-OAc/kg and 44 mg DMN/kg body weight, respectively. Single ip injections of one-half the LD50 DMN-OAc (13 mg/kg body weight) in 5-week-old rats of both sexes resulted in a high incidence of epithelial tumors of the intestinal tract. Mean survival times for rats with intestinal tumors were 353 days for males and 433 days for females. Tumors were rarely found at other sites. DMN at equivalent toxic (one-half the LD50, 22 mg/kg) and molar (= one-sixth LD50, 7.0 mg/kg) dose levels, yielded (as expected) tumors of kidneys, lungs, and occasionally other organs, but at a much lower incidence. The finding of the potent carcinogenicity of DMN-OAc supported the postulate that alpha-hydroxylation of DMN in vivo generates a proximate carcinogen.


Pharmacokinetic prediction of tissue residues.

The applications of pharmacokinetic modeling to the prediction of tissue residues of drugs in food-producing animals are reviewed. The properties of the one-compartment open model are discussed, and the application of this model to the serum levels, urine outputs, and tissue residues of sulfamethazine and its metabolites in sheep is described. The properties of the two-compartment model are discussed, and the application of this model to the serum levels and urine outputs of dicloxacillin in humans is described. Complexities encountered with drugs such as pentobarbital, the tetracyclines, etidronate, and salicylate are discussed as examples of pharmacokinetic behavior that make both modeling and tissue residue prediction difficult.


Application of pharmacokinetic methods to the drug residue profile.

A pharmacokinetic approach to the delineation of a drug residue profile in food-producing animals has been presented. It is recognized that the determination of a drug withdrawal period is one of the costly developmental procedures in drug development for food animals; thus it is believed that in the early developmental phases, a thorough pharmacokinetic characterization of a drug in the target species would greatly facilitate the design and quality of studies conducted in the later phases of new drug development. It is suggested that drugs that are intended for use in food animals can be characterized kinetically in less costly studies, the results of which might be used to determine the feasibility of developing a drug that might cause serious residue problems. It is also suggested that the pharmacokinetic modeling of a drug in the target animal may provide an essential data base for calculating dosage rates and intervals that directly relate to the efficacy aspects of drug development.


Experiences in dealing with drug-related bound residues.

Although more than 90% of the radioactivity was excreted in the urine and feces within 10 days of oral treatment of sheep with a single dose of p [14C]toluoyl chloride phenylhydrazone (TCPH), persistent blood residues (5-6 ppm) were observed for at least 21 days. The 14C residues were largely localized in erythrocytes and covalently bound to both heme and globin. Only the phenyl group of the phenylhydrazine part of TCPH was present as 14C bound residues. An analytical procedure to measure the level of phenyl groups incorporated in heme, based on their oxidation to benzoic acid, was developed to monitor residues in treated animals. Relay metabolism in rats was studied by feeding sheep blood containing 14C residues form [14C]TCPH treatment. No retention of 14C residues in rat tissues was observed, which contrasted with the TCPH metabolism. A 90-day relay toxicity study in rats, which were fed dried blood from treated sheep containing up to 2,000 times the potential exposure to residues in the human diet, indicated no observable toxic responses. It is concluded that these data support a tolerance of 6 ppm TCPH equivalents in blood.


Methodology for the determination of bioavailability of labeled residues.

Methods are described for the determination of bioavailability of lipo- and hydro- soluble compounds in the rat. These procedures involve catheterization of the portal vein and/or intestinal lymphatics to study absorption in unanesthetized animals. Catheterization of the common bile duct prevents recycling of materials through the entero-porto-hepato-biliary circulation (EPHBC). Steady-state conditions are ensured by constant infusion of bile or a solution of bile acids into the stomach or duodenum. The techniques and physiological considerations discussed in detail here have resulted in new proposed animal preparations, of value in the accurate determination of the bioavailability of labeled residues ingested by the second species. Since intake must be adequate to permit meaningful conclusions, the concentration of radioactivity in the harvested homogenized tissue is increased by lyophilization. The lyophilized material is compressed into pellets of adequate size. The animals, kept in restraining cages to prevent coprophagy, are allowed to eat the labeled residue spontaneously, if necessary, for 48 and even 72 hr. Bile, urine, and feces are collected for a sufficient length of time to allow quantitative excretion of the labeled residue, if no absorption takes place. Collection of these excreta must be complete. It is essential to account for most-if not all-of the radioactivity administered. Data so obtained allow an accurate balance between intake and excretion of the labeled residue. The presence of radioactivity in the intestinal wall, carcass, liver, and urine is indicative of absorption. The appearance of radioactivity in the bile also indicates absorption, in addition to suggesting that the compound(s) may undergo EPHBC. The extent of recovery of the administered radioactivity in the luminal contents and feces indicates the extent to which the labeled residue is not bioavailable. Evaluation of data obtained with these new animal models should permit corresponding upward adjustments of the minimum levels of residues allowable in the tissue of animals intended for human consumption.


Covalent binding and endogenous incorporation as illustrated by nitroso carcinogens.

Serious problems of interpretation may arise when metabolic studies are carried out with radioactively labeled drugs and other foreign chemicals. Detection of free or bound radioactivity in tissues or body fluids may indicate the presence of the unchanged chemical or of various products of its decomposition. Some radioactivity may, however, represent incorporation of certain metabolites of foreign chemicals into body constituents by normal biosynthetic pathways. The interpretation of the results of such metabolic experiments from the standpoint of safety evaluation will be profoundly different if the radioactivity represents covalent binding to a cellular macromolecule than if it results from normal endogenous incorporation. These two distinct types of binding of radioactivity to body constituents are well illustrated by experimental studies with some carcinogenic nitroso compounds, such as dimethylnitrosamine and N-methylnitrosourea. Dimethylnitrosamine requires metabolic activation by microsomal enzymes and yields formaldehyde and a chemically reactive methylating intermediate, probably a methyl carbonium ion. The latter reacts with nucleophilic sites in nucleic acids and proteins, and also with water to yield methanol. N-Methylnitrosourea does not require metabolic activation but yields the same methylating intermediate spontaneously under physiologic conditions. Both formaldehyde and methanol are metabolized largely to CO2, but they also enter the one-carbon metabolic pool and became biosynthetically incorporated into nucleic acids, proteins, and other cell components. Alkylation of cellular constituents is associated with various biological effects, including cytotoxicity, carcinogensis, and mutagenesis, and the same effects are produced by the activated forms of a variety of other chemical carcinogens. It is clearly of paramount importance to distinguish between these two types of incorporation of radioactivity.


Biomedical responses of rats to chronic exposure to dietary cadmium fed in ad libitum and equalized regimes.

Forty 100 g male rats were fed, in groups of eight, either 0, 5, or 25 ppm cadmium in a purified diet for 14 wk. Three groups were fed each of the levels of cadmium on an ad libitum basis. Two other groups were fed either 0 or 5 ppm cadmium in amounts that were equalized to that consumed by the 25 ppm group fed ad libitum. Cadmium ingestion decreased daily diet consumption, weight gain, and terminal body weight. These parameters were not significantly different in rats whose diet consumption was equalized. Packed cell volume and serum iron as well as serum zinc were decreased in the rats fed 25 ppm cadmium. These effects were not related to diet intake. No major differences were observed in serum ceruloplasmin, glucose, protein, leucine aminopeptidase activity, or copper in any of the groups. Blood urea nitrogen and renal leucine aminopeptidase activity were decreased by cadmium ingestion in the rats fed ad libitum only. In contrast, serum alkaline phosphatase activity was elevated by cadmium in the equalized-intake groups only. Cadmium and zinc concentrations were elevated and the iron concentration was decreased in the kidney, liver, and intestinal mucosa of the cadmium-fed rats irrespective of level of diet consumption. The increased uptake of cadmium in these tissues was coincident with the increased content of the cadmium-binding protein, metallothionein, in the cytosol fraction. The results indicate that some parameters of chronic cadmium toxicity are associated with diet consumption whereas others are not.


Biliary excretion of cadmium in rat. II. The role of metallothionein in the hepatobiliary transport of cadmium.

Intravenous injection of 109Cd-labeled CdCl2 (1 mg/kg) to control rats and rats that had been injected with CdCl2 (0.25 mg/kg) 24 hr earlier showed that there was a decrease in the biliary excretion of 109Cd in the latter group. The 24 hr pretreatment with CdCl2 resulted in induced synthesis of metallothionein in rat liver and kidney. The binding of cadmium to liver tissue was increased and the renal accumulation of cadmium was unaltered on cadmium pretreatment. Rat liver metallothionein was isolated from rats injected repeatedly with CdCl2. Intravenous injection of cadmium-bound metallothionein gave a different distribution of cadmium in the tissues and biological fluids as compared to injection of CdCl2. A major percentage of cadmium was deposited in the kidney with urinary excretion after injection of rat cadmium-metallothionein to control rats. The biliary excretion of cadmium after cadmium-metallothionein injection was minimal. About 90% of cadmium in the kidney cortex and urine could be recovered as cadmium-thionein in sephadex gel filtration, 3 hr after cadmium-thionein injection.


Cadmium-induced enteropathy: comparative toxicity of cadmium chloride and cadmium-thionein.

In protecting the body against the noxious effects of dietary cadmium ions, cadmium is bound to metallothionein in the proximal intestine, and subsequently excreted into the lumen with desquamation of the epithelium. The purpose of this study was to determine the extent to which cadmium in the form of intestinal cadmium-thionein is absorbed from the intestinal lumen and to appraise the toxicity of cadmium-thionein on the intestinal mucosa. With open-ended duodenal perfusion, equivalent amounts of cadmium administered as CdCl2 or cadmium-thionein entered the mucosa, but significantly less cadmium from the perfusate of cadmium-thionein passed into the body. Exposure of the mucosa to CdCl2 for 1 hr led to minor abnormalities in the form of broadening of villi with pseudostratification of epithelium, and swelling of mitochondria, whereas cadmium-thionein produced extensive necrosis of absorptive cells. The results suggest that cadmium-thionein may play a paradoxical role, providing protection against the cadmium ion in the intracellular milieu, but promoting cadmium toxicity when it is present in sufficient amounts in the lumen of the intestine.


Renal trauma in children.

Recent experience with two cases of renal trauma led us to review 57 admissions to Children's Memorial Hospital, CHICAGO, DURING THE LAST 15 YEARS. It became apparent that a clearly defined approach to the management of renal trauma was lacking. A uniform investigation of such patients to include early intravenous pyelography and followed by renal scan or arteriography when pyelography is inconclusive in assessing the exact nature of the renal damage is recommended. The importance of these studies in diagnosing associated congenital anomalies and solitary kidney is also shown. Criteria for management by early surgical intervention or conservative approach are presented. The ultimate aim in management is to preserve the greatest possible amount of functioning renal tissue with the least risk and morbidity to the patient.


An effective prehospital emergency system.

An Emergency Medical Services (EMS) system with the capabilities of rapid response, patient extrication, basic life support, advanced life support, radio communication, and transportation provides appropriate care for a wide spectrum of injured and acutely ill patients. The validity of the selective dual response system in demonstrated by: 1) rapid provision of basic life support, 2) appropriate availability of advanced life support, 3) conservation of educational and fiscal resources, and 4) the enchancement of knowledge and manipulative skill expertise of relatively few, but busy, EMT-paramedics who are provided close medical supervision and support.


Lightning injuries.

The course of three patients apparently struck by lightning is reviewed. The circumstances of the injury and the power of the lightning discharge are uncontrollable variables affecting morbidity and mortality. Immediate cardiopulmonary resuscitation followed by careful clinical monitoring and aggressive treatment of involved organ systems will help most patients to complete recovery.


Fatal systemic mycotic infections in the burned child.

Two cases of systemic phycomycotic burn wound infection occurred in severely burned children. Both patients, although treated aggressively, died after systemic colonization through the burn wound by fungi. Modern burn therapy has increased survival of many severely burned children but opportunistic fungal infection remains as an ominous threat. Early recognition, wide excision or amputation, and systemic antifungal agents comprise the current clinical armamentarium against systemic fungal invasion of burn wounds.


[Hydraulic haemostasis in transurethral resection of the prostate (author's transl)].

The method described for T.U.R. of the prostate merits the name of hydraulic haemostasis. Its principle consists of placing the irrigation recipient at a height of 90 cm, using it in combination with the Iglesias continuous irrigation-suction resector with a low intravesical pressure. Per- and postoperative bleeding is minimised and the "T.U.R.", syndrome is absent, despite reports in the world literature. Two modifications to the Iglesias resector are presented: the optic protector and a new system of suction orifices.


[Simple renal cysts in the adult. Anatomical study. Aetio-pathogenic considerations, based upon 57 cases (author's transl)].

On the basis of 57 cases of simple cysts of the kidney in adults, the authors describe the histological nature of their wall. They stress the extremely common presence of smooth muscle fibres, drawing no inference that they might be of calyceal origin. The congenital or acquired nature of these cysts, as well as their origin is discussed.


[A rare association of hamartomas of the kidney, renal insufficiency, Bourneville disease and arterial hypertension (author's transl)].

On the basis of a clinical case, the authors review the principal signs of Bourneville tuberose sclerosis and show the renal manifestations which may be encountered. The most common is the presence in both kidneys of tumours which are hamartomas. In addition, this patient suffered from hypertension and renal insufficiency. Their frequency and pathogenesis are discussed in the context of this disease.


[Congenital segmental duplication of the lumbar ureter (author's transl)].

In a 23-year-old man attacks of nephritic colic led to the discovery of an obstruction on the left lumbar ureter. Segmental resection of the ureter was performed, removing 10 mm of malformed, obstructed ureter. This was an incomplete duplication, the two ureteral segments lying side-by-side, each with its own musculature, for a distance of 7mm. Above and below the anomaly, the ureter was normal. This exceptional malformation is compared with other internal obstructions of the ureter.


Bacteriophage conversion of spore-negative mutants to spore-positive in Bacillus pumilus.

A pseudolysogenic phage, PMB1, was isolated from soil on the basis of its ability to increase the sporulation frequency of the oligosporogenic Bacillus pumilus strain NRS 576 (sporulation frequency, less than 1%). Several spore-negative mutants (sporulation frequency, less than 10-8) derived from strain NRS 576, which were converted to spore positive by infection with PMB1, were subsequently identified. PMB1 repeatedly grown on a given spore-negative mutant (e.g., GW2) converted GW2 cells to spore positive. Each plaque-forming unit initiated the conversion of a spore-positive clone in semisolid agar overlays. GW2 cells remained spore positive as long as they maintained PMB1. Return of PMB1-converted cells to the orginal spore-negative phenotype correlated with loss of PMB1. In liquid media, PMB1 infection increased the sporulation frequency of mutant GW2 over 106-fold. More than half of the spore-negative mutants we isolated from strain NRS 576 were converted to spore positive by PMB1 infection. PMB1-induced spores of the spore-negative mutant GW2 were somewhat more heat sensitive than uninfected or PMB1-infected spores of the spore positive parent of GW2. PMB1-induced spores of GW2 do not differ from wild-type spores in morphology by phase-contrast microscopy, dipicolinic acid content, or rate of sedimentation through Renografin gradients.


Control of protein synthesis by a temperature-sensitive mutant of reovirus 3. I. Temperature-sensitive function of ts261-b mutant.

The ability of a temperature-sensitive (ts) mutant of reovirus, ts261-b, to synthesize virus-specific RNAs and proteins during infection at the nonpermissive temperature (37 degrees C) was investigated. The relative amounts of the mutant virus-specific single-stranded (ss) RNA's and double-stranded (ds) RNA's synthesized in cells at 37 degrees C were 20 to 25% as much as those synthesized in the wild-type virus-infected cells. The 10 segments of the mutant ds RNAs and the three size classes of the ss RNAs were synthesized in the usual proportions. The methylation of the mutant viral mRNA's (ss RNAs) was not blocked at 37 degrees C in infected cells. A striking temperature-sensitive restricted function of the ts261-b mutant was expressed in the synthesis of the viral proteins. This study, which uses an in vitro protein-synthesizing system reconstituted with an endogenous polysomal fraction and a postribosomal supernatant from reovirus-infected cells, has demonstrated that the endogenous polysomes obtained from ts261-b mutant-infected cells at 37 degrees C are not active in the synthesis of the viral polypeptides of known molecular weights, and the amounts of the mutant viral polypeptides synthesized in vitro by these polysomes are 5 to 9% of those synthesized by the corresponding fraction from wild-type-infected cells. The impaired protein-synthesizing capacity of the mutant virus-specific polysomes can be restored during maintenance of the infected cells at 30 degrees C after shift-down from 37 degrees C. The in vitro synthesis of viral polypeptides of known size by the active endogenous polysomes derived from cells infected at the permissive temperature is accelerated by the addition of the postribosomal supernatant obtained from cells infected at the permissive temperature. The postribosomal supernatant from mutant-infected cells at 37 degrees C did not have a stimulatory effect, but rather, it inhibited in vitro viral protein synthesis.


[A case of fish tape-worm infection treated with paromomycin and an observation on its mode of action. II. With special reference to aminosidine (author's transl)].

A female adult suffering from fish tape-worm infection was successfully treated with a single oral administration of 4,000 mg aminosidine, a paromomycin. The drug concentration in the segments of the worm removed were as high as 600 mg/ml or more, meanwhile, serum level and urinary recovery in the patient were very low. Consequently, it was presumed that some acute effect, such as neuro-muscular toxicity, of the drug, which was well absorbed into parasite, but ill-absorbed from the gastrointestinal tract of human, is one of the mode of antihelminthic activity, in this case.


[Ototoxic effect of BB-K8 administered to pregnant guinea pigs on development of inner ear of intrauterine litters (author's transl)].

Transplacental ototoxic effects of BB-K8 on development of inner ear in intrauterine guinea pigs were evaluated by differential frequency pinna reflex test in range of 20 kHZ to 500 HZ and histopathological examination of spiral and vestibular organs in new born guinea pigs from pregnant ones given BB-K8 i.m. during gestation. Twenty-five pregnant guinea pigs of the Hartley strain and 63 new-born guinea pigs from the pregnant ones were used in the study. Following antibiotics were given i.m. daily to the 20 pregnant guinea pigs from 7th day of gestation for 56 days. BB-K8 was given at the dose level of 100 mg/kg and 200 mg/kg, respectively. Kanamycin (KM) was administered at the dose level of 100 mg/kg and 200 mg/kg, respectively. Physiological saline solution (1.0 ml/kg) was given i.m. to the pregnant guinea pigs for 56 days. The differential frequency pinna reflex test was performed in the frequency range from 20 kHZ to 500 HZ to determine an extent of frequency of pinna reflex loss. The test was carried out before the start of administration of the antibiotics and once a week during the administration. After the last injection of the antibiotics, intravital perfusion fixation was carried out in the new born animals under anesthesia with nembutal. Histopathological examination was made in celloidin serial sections of the cochlea and vestibulum of the new born animals to observe an extent or degree of hair cell damage. (1) The differential frequency pinna reflex test revealed that new born guinea pigs from the pregnant ones given BB-K8 and KM respectively at the dose level of 100 mg/kg did not show occurrence of pinna reflex loss at any frequency tested. At the dose level of 200 mg/kg, BB-K8 did not result in transplacental hearing impairment in new born guinea pigs, but KM caused transplacental pinna reflex loss in the highest frequencies from 20 k to 15 kHZ in 3 of 10 animals. (2) Histopathological examination detected that unilateral incomplete loss of outer hair cells of the spiral organ confined to the basal end of cochlea was found in 3 of 13 new born guinea pigs from the pregnant ones treated with BB-K8 (100 mg/kg). In the animals, slight damage of hair cells in the vestibular organs occurred in 100%. These hair cell damages were enhanced slightly in the new born guinea pigs from the pregnant ones treated with BB-K8 (200 mg/kg) and much more in the new born ones from the pregnant ones treated with KM (100 mg/kg, 200 mg/kg). (3) These results suggest that BB-K8 has a mild potency to cause transplacental ototoxic damage in the inner ear of intrauterine guinea pigs within the pregnant ones treated for 56 days (normal gestation period approximately 70 days).


[Clinical and bacteriological study on Flavobacterium meningosepticum (author's transl)].

The present study concerns in vitro observations on the susceptibility to antibiotics and chemotherapeutic agents of the strains of F. meningosepticum isolated from various clinical specimens at the Clinical Laboratory of Juntendo University Hospital and the assessment of their clinical significance of the patient, when they are isolated from clinical specimens. 1) Fifty-two % of the strains was isolated from sputum, 20% from urine and 8% from pus and exudate. Only 2 strains were obtained from blood and one strain from cerebro-spinal fluid. 2) The patients with F. meningosepticum from sputum had respiratory distress due to the basic disorder of central nervous system, respiratory system or cardiovascular system. An endotracheal tube or a tracheal canule was placed in most of the patients to assure a patient airway, and they received massive antibiotic therapy. Most of the patients with infected urine had functional and structural abnormality of the urinary tract, as well as a history of instrumentation, and had previously received antibiotic therapy. The bacteremia due to F. meningosepticum occurred after major operation in 2 patients, and one of them suffered from hydrocephalus associated with meningitis, moreover, in whom the organism was isolated from cerebro-spinal fluid. The route of infection with F. meningosepticum cannot be assessed certainly, but the correlation with catheterization or canulation strongly suggests that the instrumentation is required for the organism to become established. 3) In vitro test for sensitivity to 19 chemotherapeutic agents were done with the strains of F. meningosepticum isolated at the laboratory from August 1974 through July 1976. A large number of the strains were highly resistant to SB-PC, CB-PC, DKB, LCM, CL and NF, and resistant to AB-PC, CEZ and AMK. All strains were highly sensitive to MINO, DOTC and CLDM in this order, and were sensitive to EM, PA and NA. The relative sensitivity was found to TC, CP, GM and PPA.


Conversion of percutaneous transhepatic cholangiodrainage to internal drainage in obstructive jaundice.

Conversion of percutaneous transhepatic cholangiodrainage to an internal drainage is safe and effective in rerouting bile back to the intestinal tract in obstructive jaundice without major operative procedure. The method consists of insertion of a drainage tube with several side holes beyond the bile duct stricture. Usually, a single lumen tube is used. However, double lumen tube is preferred when the amount of bile discharge is excessive. This simple technique is found to be useful in the management of obstructive jaundice not only for preoperative decompression of biliary tree but also for the inoperable lesions.


Postoperative choledochofiberscopic removal of intrahepatic stones.

An  endoscopic approach for the diagnosis and treatment of intrahepatic stones is presented based on the experience of 4 cases, in which complete removal of intrahepatic stones was done by postoperative choledochoscopy. Postoperative choledochoscopy for the diagnosis and treatment of gallstone disease is not difficult to perform. The choledochofiberscope is inserted into the bile duct via choledochal fistula 3 weeks after the operation. Stones are crushed or grasped with forceps under direct vision. In some cases, the stricture in the intrahepatic biliary tree is dilated with the use of a  high frequency waves cutting knife to facilitate stone removal. In fact, over 410 stones were successfully removed in one case by 28 postoperative choledochoscopies without any complications. The details of the choledochofiberscope developed by us with the close cooperation of Machida Company of Tokyo was presented. Postoperative choledochoscopy seems to be a safe and simple procedure and is useful in the treatment of intrahepatic stones.


Value of lymphocyte reactivity induced by phytohemagglutinin in the treatment of malignant diseases.

An improved micromethod for evaluating in vitro lymphocyte blastogenetic activity, a modification of the method of Park and Good, is devised and used in 111 stomach cancer, 34 colorectal cancer, and 22 breast cancer cases. Follow-up information on the lymphocyte blastogenetic activity levels was available in 28 stomach cancer patients after the clinically complete removal of the tumor. In 16 patients with early stomach cancer the lymphocyte blastogenetic level did not differ greatly from a control values from healthy volunteers. However, in 66 advanced stomach cancer cases, statistically lower levels were encountered. After the complete removal of the tumor in 28 stomach cancer patients, the lymphocyte blastogenetic values rose postoperatively. The lymphocyte blastogenetic levels in patients with curative colorectal cancer or curative breast cancer were significantly higher than those patients with non-curative tumors.


[Risk factors in aortic valve prosthesis].

The paper is devoted to the determination of the prognostic value of preoperative and intraoperative symptoms observed in aortic valve prosthetic replacement, as well as to the development of a quantitative criterion of the severity of the patient's state for the evaluation of the risk factor of surgery. The peculiarities of the clinical pattern were analysed in 117 patients operated on for aortic valve pathology. The computerization of the assessment of individual symptoms and their combinations (36 symptoms, 114 signs pertaining to the patient's history, objective, instrumental and radio-surgical examinations) was carried out on the "Minsk-22" computer. The leading factors in the assessment of cardiovascular lesions include the systolic and diastolic pressure, the degree of heart size enlargement, the end diastolic pressure in the left ventricle. Among the independent factors, of greatest prognostic value are the degree of calcification of the aortic valve cusps, the duration of the disease, and the period after the onset of subjective symptoms. The duration of the operative procedure and of the perfusion serves as an additional valuable guideline in making the prognosis of aortic valve replacement.


[Thromboembolic complications after aortic valve prosthesis].

The presented analysis covers the results of aortic valve replacement in 155 patients followed-up for 1 to 11 years after surgery. Actuarial statistics permitted to reveal the dynamics of survival and of good results of different institutions. No anticoagulation whatsoever was given to 85 patients, while 70 others received Phenylin, 30-60 mg/day. Thromboembolism was found to be the leading complication affecting the survival rate and the stability of good results in the late postoperative period. Among the patients receiving no anticoagulants the incidence of thromboembolism proved significantly higher than among those treated with Phenylin.


[Echocardiographic diagnosis of rheumatic mitral valve insufficiency].

Echocardiography was used for the examination of 45 patients with rheumatic mitral valve insufficiency. Echocardiographic data were found to permit making the diagnosis of mitral valve disease and differentiating within the group of mitral valve disease as such. A mitral disease with prevailing insufficiency is characterized on an echocardiogramme by a unidirectional diastolic movement of thickened mitral cusps, by an increased general excursion of the mitral valve, dilatation of the left ventricular cavity, increased systolic excursion of the ventricular septum, and a significant dilatation of the left atrial cavity. "Pure" mitral insufficiency is characterized by a dilatation of the left heart, vari-directional movements of the mitral cusps during the diastole, and a marked lack of their closure during the systole.


[Prognosis for immediate results of mitral commissurotomy].

To reveal the symptoms characterizing the relative danger of a surgical intervention the preoperative data of 417 patients subjected to isolated mitral commissurotomy were analyzed. The immediate result of mitral commissurotomy was shown to depend not only on the severity of the preoperative state of the patient, but also by additional factors. These factors appeared to vary in patients with different severity of the disease. Thus, a negative result of the operation in the group of the most severely sick patients was attributed to the presence of 4 (or more) of the following 6 signs: severe oedema (internal one including), reduced diuresis, cachexia, increased sedimentation rate (over 8mm/hour), colour index over 0.9, pulmonary artery pressure over 100 mm Hg. With 4 or more signs present the incidence of mortality comprised 0.75. Among those with 3 signs or less, the mortality rate comprised about 0.06 (t approximately 5.1). Thus, patients with similar severity of the disease could be divided into two groups sharply distinguished in their surgical prognosis.


[Intravital study of energy metabolism in the liver in mitral valve stenosis].

In 42 patients with mitral stenosis an intravital study was conducted comparing the liver energy exchange with the biochemical blood serum parameters and morpho-histochemical characteristics of the biopsy material. A correlation was established between the energy exchange and the clinical stage of the disease, the pigment function of the liver and the severity of its structural changes.


[Comparative evaluation of the ultrastructure of the left atrium before and after mitral commissurotomy].

The left atrium myocardium of patients with mitral stenosis was subjected to electron microscopy with quantitative analysis of the pictures prior to and 10-15 minutes following mitral commissurotomy. The control was served by the left atrium myocardium of a man free from mitral disease, the specimen being obtained during surgery for an anterior mediastinum lypoma. In the left atrium myocardium of patients with mitral stenosis changes were revealed that demonstrated a severe decompensation of both the energy and contractile apparatus of the cardiac myocytes. Following mitral commissurotomy the activity of the bioenergy apparatus of the cardiac cells normalizes.


[Effect of the respiratory phases on the right jugular vein pulsation curve and pulmonary hemodynamics in mitral valve stenosis].

In patients with mitral stenosis the main and early changes in the pulsation curve of the right jugular vein consist in an elevation of the y-collapse. The height of the y-collapse correlates with the degree of venous congestion in the lungs, i.e. a parallelism exists between the signs of venous congestion in the pulmonary and general circulation systems. The degree of venous congestion in the lungs of patients with mitral stenosis varies with the phases of respiration. An elevation of the v-collapse in mitral stenosis cases is observed at early stages of the disease, simultaneously with the disorders in venous circulation in the upper lobes. The mechanism of circulatory disorders in the veins of the general circulation system may be due to not only pulmonary hypertension and right ventricular insufficiency, but also to the changes in the intrathoracic pressure secondary to the changes in pulmonary parenchyma.


[Sensitivity to insulin in acute myocardial infarct].

The standard test for sensitivity of insulin was conducted in 20 patients with acute large-focal myocardial infarction, and in 9 of them it was repeated 3 weeks later. The study includes only those patients who had no diabetes mellitus symptoms prior to the admission to the clinic, and whose immediate relatives were free of this disease. The test was conducted in the morning on an empty stomach, insulin was administered intravenously by infusion of 5 U/l m2 of body surface. Blood sugar measurements were made in samples procured 10, 20, 30, 45, 60, 90 and 120 min. following insulin administration. The blood sugar level was determined by the orthotoluidine method. In patients with acute myocardial infarction less distinct and slower deceleration of the reduction of the blood sugar level was noted in response to the intravenous insulin injection than during the repeated examination on the 22nd-24th day of the disease, which indicates a decreased sensitivity of insulin during the acute period of myocardial infarction. Reduction of insulin sensitivity seems to be one of the causes of frequent carbohydrates metabolism disorders in patients with acute myocardial infarction.


[Albumin metabolism in congestive circulatory insufficiency].

The examination was conducted in 78 patients with congestive circulatory insufficiency. Albumin metabolism was studied in these patients with the aid of 1(131)--labelled albumin after Metthews. The half-life of albumin was studied, as well as the decay speed factor and the synthesis rate. The plasma albumin level was determined. Changes in the half-life duration were revealed. Patients with Stage III dystrophic circulatory insufficiency were shown to have a reduced plasma albumin level, a shortened albumin half-life, and increased synthesis rate and decay factors. Patients with Stage II-A and B circulatory insufficiency had varying changes of these parameters differing from the normal range.


Urinary prostaglandins: site of entry into renal tubular fluid.

The stop-flow technique was used in dogs to determine the site of entry of urinary prostaglandins (PG) into tubular fluid. The proximal tubule was localized by the peak (U/PPAH)/(U/PIn) and the distal tubule and collecting duct by the peak U/PIn and the minimum (U/PNa)/(U/PIn). The peak of prostaglandin E (PGE) concentration was located 4.8+/-0.8 (SEM) ml distal to the proximal tubule and 4.6+/-0.8 (SEM) ml proximal to the distal nephron. At its peak, PGE was concentrated 6.3-fold over baseline, whereas inulin was concentrated 1.4-fold at its peak. The height of the PGE peak but not its location was increased by an i.v. infusion of angiotensin II at 20 ng/kg of body wt per min. Indomethacin abolished the PG peak. In a single experiment, prostaglandin F2alpha (PGF2alpha) exhibited an excretion pattern similar to PGE. These data indicate that the site of entry of PG into tubular fluid is most likely in the loop of Henle. This is consistent with the hypothesis that PG synthesized in the medulla can be transported to the cortex via tubular fluid. Whether PG in the tubular fluid can influence renal function remains to be determined.


Effect of 1,25-dihydroxycholecalciferol on impaired calcium transport by the sarcoplasmic reticulum in experimental uremia.

In the fragmented sarcoplasmic reticulum from skeletal muscle of rabbits with experimental uremia, defective calcium ion transport is found. An impairment of all parameters is observed (initial rate of uptake, storing capacity with and without oxalate, and concentrating ability). In vivo administration of 1,25-dihydroxycholecalciferol (1,25-(OH)2-vitamin D3)(2 X 27 ng X kg of body wt-1 X day-1 and 6 X 27 ng X kg-1 X day-1, respectively) improved the kinetic parameters. The low dose improved storing capacity, and the higher dose, in addition to the storing capacity, also corrected concentrating ability and the initial rate of uptake. It is concluded that active calcium transport in the sarcoplasmic reticulum is impaired by uremia and that this defect is responsive to the administration of 1,25-(OH)2-vitamin D3.


Effect of uremia on nutritionally-induced variations in protein metabolism.

The effect of uremia on nutritionally-induced variations in protein metabolism was studied in growing rats with chronic, moderate uremia. Plasma and muscle protein synthetic activities and related values were measured from incorporation rates of 14C-leucine infused over a six-hour period. Synthetic activities were compared in the postabsorptive (2 to 14 hr after feeding) and in the fasting (18 to 24 hr after feeding) states. Differences between uremic and control rats were seen in fasting: plasma and intracellular leucine declined in control rats as fasting developed; they rose in uremic rats. In fasting uremic rats, a smaller percent of leucine efflux from extracellular fluid was used for protein synthesis. In a second study, muscle protein synthesis (Sm) and net urea nitrogen production (UNPr) were compared between control and uremic rats which were a) food-deprived but given carbohydrate for 36 hr, and b) fasted for 36 hr. Fasting, as contrasted with carbohydrate feeding, was associated with depressed muscle protein synthesis and increased UNPr in both control and uremic rats; the changes were greater in uremic rats. We conclude that food deprivation for more than 14 hr incurred greater catabolic responses of body protein in moderately uremic rats. The effect was mediated in part by greater suppression of muscle protein synthesis. In contrast, moderate uremia had little discernible effect upon protein metabolism in the postabsorptive state or food deprived state when gluconeogenesis was suppressed with glucose administration.


Effects of high dialysate calcium concentration on bone remodelling, serum biochemistry, and parathyroid hormone in patients with renal osteodystrophy.

The influence of a dialysate calcium concentration of 8.0 mg/100 ml (treatment period 2) vs. 7.0 mg/100 ml (treatment period 1) on plasma calcium, phosphorus, serum immunoreactive parathyroid hormone (iPTH), bone histology, intestinal calcium absorption, and calcium transfer across the dialysis membrane was investigated in six patients with renal osteodystrophy undergoing intermittent hemodialysis. During the periods 1 and 2, the plasma calcium changes before and after dialysis were not significantly different. A significant increase in mean postdialysis plasma calcium level was observed during both periods when compared to mean predialysis level. A significant, inverse relation was found between predialysis plasma calcium and the increase in plasma calcium during hemodialysis runs. Calcium transfer across the dialysis membrane and fractional intestinal absorption of calcium in the postdialysis state were determined in four out of the six patients. During period 2, calcium transfer was higher in all four patients but intestinal calcium absorption was moderately higher only in one and strikingly lower in the remaining three patients when compared to period 1. Although brought up to 8.0 mg/100 ml, this higher dialysate calcium significantly decreased the level of serum iPTH only in one out of the six patients; in this patient, osteoclast count, active resorption surface, and periosteocytic osteolysis decreased. In a second patient, although the level of serum iPTH seemed to decrease markedly osteoclastic and osteocytic resorption did not change. In the remaining four patients, the level of serum iPTH was unchanged and bone resorption parameters were found unchanged or aggravated. It is concluded that providing additional calcium (using a dialysate calcium concentration of 8.0 mg/100 ml), the goal of which was to decrease secondary hyperparathyroidism, proved to be successful only in one patient and failed to do so in the five others. Secondary hyperparathyroidism was even found aggravated in three of them. Thus, the use of a dialysate calcium concentration of 8.0 mg/100 ml did not result in any advantage over that of 7.0 mg/100 ml in five out of six patients studied.


[Th clinical picture of retinal thrombosis (author's transl)].

Besides the acute arterial occlusion and simple venous thrombosis, the clinical symptomatology may include signs of chronic arterial insufficiency, i.e. progressive blurring of vision, absolute visual field defects, cotton wool exudates, capillary occlusion and increased retinal circulation time. The poor visual prognosis is caused by progressive macular degeneration. In the case of acute arterial thrombosis, fragmentation of the blood column and absence of arterial pulsation are indicative of pronounced retinal ischemia. The ophthalmoscopic aspect of a visible embolus may be a hint for the prognosis of eventual recanalisation.


[Trabeculectomy: surgical technique, results, indications (author's transl)].

In this teaching-course special emphasis is given on surgical techniques and postoperative care of trabeculectomy. The follow-up of 114 eyes of 103 patients is reported. High tension in the early postoperative phase allowed no prediction of the later results. After 3 months 11%, and after one year 39% of the operated eyes with simple glaucoma had a tension higher than 22 mm Hg, even if drugs were given. Different sites of the excision in regard to the trabecular meshwork and Schlemm's canal gave no statistically different results. The filtering blebs have the tendency to develop in two directions, either scarring or becoming cystic. The cystic filtering blebs give better functional results. The development of the filtering bleb was inversely proportional to the height of the tension but went parallel to the facility of outflow. The visual acuity diminished in 35%, mostly due to cataract-formation and improved in 3%. Different complications happened in 6%. The authors consider the trabeculectomy to be the operation of choice for almost all forms of glaucoma.


[Some aspects of congenital glaucoma (author's transl)].

The following paper on certain aspects of congenital glaucoma was read at a meeting for advanced medical education. Particular emphasis was placed on a review of the theories and concepts dealing with pathogenetic factors of congenital glaucoma. Two main concepts appeared to be most prominent in past and current literature: 1. The concept of a membrane obstructing the chamber angle, 2. underdevelopment or malformation of all or some structure of the chamber angle region. In order to clarify the above mentioned concepts, three stages of development of normal human chamber angles were demonstrated by light and electronmicroscopy. Aspects of surgical treatment of congenital glaucoma were discussed. Light and electronmicroscopic findings in some trabeculectomy specimens were shown. In eyes which underwent repeated surgery, marked scar tissue was seen in the area of trabecular meshwork, thus obliterating aqueous pathways. In those cases, an excision of trabecular tissue (trabeculectomy) was recommended rather than destruction of remaining trabecular tissue (trabeculotomy).


[Approaches in medical treatment in glaucoma (author's transl)].

The developments concern methods of application and therapeutic agents. Regarding drug aplication Ocusert has to be mentioned: inserted in the cul de sac of the eye once a week it releases a low concentration of a substance continuously and with a constant rate. For acetazolamid (Diamox) it has been shown, that in long term treatment much lower concentrations than usual are effective. Efforts regarding new local agents reducing intraocular pressure are stimulating as well as inhibiting the sympathetic tone. The practically most important discovery so far is Clonidine, whose pressure lowering mechanism is not quite clarified yet and which, due to other problems, demands a very critical indication. Beta-receptor-blocking agents, such as Propranolol could become somewhat important, as well as for some special indications the chemical sympathectomy by 6-Hydroxydopamine. The sympatholytic agent Guanethidine proves to be very valuable in special cases. Besides the pressure reducing treatment medicamentally achieved increase of the blood supply to the optic nerve becomes more important. It becomes more and more evident that the elevation of the stroke volume--thus heart output--by cardiac therapy is important what demands collaboration with colleagues of other disciplines.


[Neuroradiology and the chiasmatic angle syndrom (author's transl)].

Many diagnostic procedures are available. The main methods are briefly reviewed. Standard X-rays of the skull are always needed. In doubtful cases polytomography is essential. Bone scintigraphy reveals early signs of changes in the bony macrostructures. Brain scintigraphy is still very useful in observing 1. the blood-flow in both intracranial and intraorbital regions, and 2. the cranio-orbital distribution of the radiotracer. Brain scintigraphy is particularly important in detecting meningiomas and vascular lesions. The dynamic study and the comprehensive survey it gives are still not replaced by computer tomography (CT) scanning, which however represents the most powerful advance in this field. The most suitable methods for exploring precise details of vascularisation and structural delineation remain the classical carotid and vertebral angiographies, the orbital and cavernous sinus phlebographies and also the cerebral pneumography. During the last years the accuracy of these methods has greatly increased through technological advance. In many cases they have become indispensable.


[Chiasmatic syndrome--clinical value of the visual evoked responses (VER) to the diagnosis (author's transl)].

The VER is compared with that of other neuroophthalmological examinations in 25 patients presenting lesions of the anterior optic pathways (of which 18 were of an expansive nature). The authors believe that visual field plotting and VER are indispensable complementary examinations, giving results which orientate subsequent investigations towards a chiasmatic or prechiasmatic syndrome. In 15 cases of chiasmatic syndrome of tumoral origin (thus in 30 optic nerves), visual fields and VER showed early pathological changes. In originally unilateral forms, VER changes are usually bilateral even when visual field changes are still unilateral. This draws attention to the fact that some process may be injuring either both optic nerves, or the optic chiasma. In cases where the patients are too young, or collaboration is insufficient, to enable visual fields to be plotted, evolution may be studied by VER. In post-surgical follow-up, or during therapy (eg. irradiation), VER recuperation carries a good prognosis. If no VER improvement occurs the expansive process has caused irreparable optic nerve atrophy. Nevertheless, frequent visual field study remains the best diagnostic method of chiasmatic syndromes and their evolution. An earlier diagnosis may be made in the majority of cases by the dual study of visual fields and VER.


[Neurosurgery of chiasma syndromes (author's transl)].

The conditions for the success of surgical interventions within the chiasmal region are careful preparation of the patient, ideal general anesthesia, precise surgical technique especially improved by the use of the microscope and bipolar coagulation. The surgical results also depend on the age of the patient, on his general condition, on the volume of the tumoral lesion and on the extent and kind of implication of the vascular and nervous structures of this region. The lesions are classified into extraparenchymatous lesions, intraparenchymatous lesions, giant aneurysms and inflammatory lesions. The extensive extraparenchymatous lesions represent the most important group: they comprise the pituitary adenomas, the cranio-pharyngiomas, the meningiomas and finally rarer tumors like the chordomas, or other tumors of the sphenoid. In these regions the choice of access is extremely important: transphenoidal, subfrontal intracranial or mixed. Among the intraparenchymatous lesions one has to mention first of all the gliomas of the chiasm and then the ectopic pinealomas. The giant aneurysm in older persons is improved the symptomatology by ligation of the internal carotid. The inflammatory arachnoidal lesions of the chiasm (specific or nonspecific) generally profit from an intervention aiming to disconnect the adhesions. X-ray therapy represents very often an indispensable component of the surgical treatment of the tumoral lesions. Apart from death the complications are postoperative infection, aggravation of the neuro-ophthalmological symptoms, the neuro-psychological consequences and the endocrinological and hypothalamic complications. Early diagnosis represents the best means to diminish the importance of the complications. An alternative complication is the tumor recurrence.


[Advantages and disadvantages of general anesthesia in eye surgery, seen by the ophthalmosurgeon (author's transl)].

General anesthesia in eye surgery necessitates additional investments in equipment, instruments, rooms and employees. It therefore increases the cost of operation. An anaesthesist, not familiar with the specialties of ophthalmic surgery, is a real risk. The advantages of general anesthesia outweigh by far the disadvantages: optimal observation survey and, if necessary supplementary care of the intubationned patient is guaranteed. The surgical treatment can be performed on the completely immobilized patient without any hurry, eventually additionally in controlled hypotension. Special emphasis has to be put on the postoperative care, especially on an immediate, rigorous mobilization of the patient. Under these conditions, the three-years-statistic clearly demonstrates, that the postoperative complications are as rare as those after operations performed in local anesthesia.


[Pediatric anesthesia (author's transl)].

The progress of understanding the special physiology and pathology of the small child, as well as the perfection of the technical equipment for pediatric anesthesia are responsible for the fact that today practically every child even during very difficult surgical interventions can be kept with security in general anesthesia. A survey of the problems occuring in pediatric anesthesia includes the following items: preoperative examination, preparation for anesthesia and surgical intervention, techniques of anesthesia, special dangers for the newborn and small children (fluid ratio, decrease of body temperature, hypoglycemia) and postoperative treatment. The author comes to the conclusion that the best conditions for general anesthesia of the small child are only present in a children's hospital where the necessary infrastructure is available. The pediatric anesthesist strongly wish therefore that also the specialists like the ophthalmologist make use of the specialised children's hospital for operative purposes.


Evaluation of mouse lines for maternal performance and growth of offspring.

Crossfostering sets of mice each containing four dams representative of three selected lines (M, W, and B) and one control (C) were prepared in each of two populations (P and Q) to compare nursing ability of the mother and the intrinsic growth potential of the offspring among lines within populations. The descending order of line performance for the nursing ability, as measured by mean 12-day weight of eight offspring within a nursed litter, was M (8.48 g),W (8,47 g), B (7.88 g) and C (7.22 g) in population P; and W (10.16 g), M(9.83 g), B (9.56 g), and C (9.01 g) in population Q. Dams from line W had the heaviest body weight after parturition and consumed 176.7 g of feed in population P and 191.7 g in population Q during 12 days of lactation. The order of lines for growth potential measured by 42-day weight was W (30.83 g), B (24.60 g), M (24.36 g), and C (22.61 g) in population P; and W (40.19 g), B (31.35 g), M (29.98 g), and C (27.81 g) in population Q. These results were compared with those from a conventional line comparison where mothers reared their own offspring. Between the two comparisons, line order differed for nursing ability in population P but not in population Q, and did not differ for 42-day weight.


Susceptibility of laboratory animals to infection by spotted fever group rickettsiae.

An attempt was made to find a suitable animal model for studies of spotted fever group rickettsiae. Inbred and outbred mice, the guinea pig, ferret, gerbil, hamster, wild rabbit, cotton rat, sheep, and miniature swine were tested. Of these, only certain strains of the mouse [Mai:(S) and BALB/cJ] and the guinea pig [Hla:(HA)] exhibited, overtly, the desired characteristics of disease. Other laboratory animals (such as sheep or rabbits) can be used for the production of antiserum against the spotted fever group of rickettsiae; however, these rickettsiae apparently have little or no effect on several other animal species. The lack of overt disease might explain the role of these animals or related genera as reservoirs for the tick-borne spotted fever rickettsiae.


Adynamic ileus in the rat induced by chloral hydrate.

During neurophysiologic studies in the rat [Crl:COBS CD(SD)BR], chloral hydrate was given intraperitoneally to produce anesthesia for brain electrode implantation. The incidental occurrence of adynamic ileus in six of these rats, 5-16 days after surgery, prompted further investigation. Pathological evaluations and transmission experiments using ingesta and viscera from affected rats failed to reveal an infectious agent. Subsequently chloral hydrate-induced adynamic ileus leading to morbidity or death was experimentally produced in 14 of 27 rats, 3--36 days after intraperitoneal administration of the anesthetic at a dose of 400 mg/kg body weight and concentrations of 125--275 mg/ml. The experimentally produced condition was characterized by lethargy, anorexia, abdominal distension, ruffled hair coat, inactivity, drowsy expression, constipation, and death. Gross pathologic findings included gaseous distension and atony of the cecum and segments of the small intestine. Small intestine contents varied from liquid to solid. The colon and rectum contained only a few dry hard fecal pellets. A few animals showed excess abdominal fluid. Microscopic findings were limited to focal chronic serositis and serosal fibrosis affecting the visceral peritoneum. On the basis of the experimental studies, it was concluded that the condition described was not an infectious disease but was an abnormal physiologic condition produced by the irritating or pharmacologic action of chloral hydrate given at high concentrations in the abdominal cavity.


Pregnancy diagnosis in the guinea pig.

A method for diagnosing pregnancy in the guinea pig by manual palpation was developed. Using this technique, pregnancy was detected between the 15th and 30th day of gestation with 98% accuracy. The 2% error consisted of animals that were pregnant but diagnosed as nonpregnant. Common mistakes that led to diagnosing nonpregnant animals as pregnant were: (1) palpation of fecal pellets; (2) palpation of left kidney; and (3) palpation of the sartorius muscle. Common errors that led to diagnosing pregnant animals as nonpregnant were: (1) failure to search the entire abdomen; (2) too close apposition of thumb and forefingers while searching the abdomen; and (3) failure to deprive animals of feed before palpation.


Bronchopulmonary lavage of small laboratory animals.

A procedure was developed for performing multiple-wash, saline, bronchopulmonary lavages in living small animals. Animals were anesthetized with halothane in oxygen, intubated with tracheal catheters made from intravenous cannulas, and maintained on a flow-through anesthetic system which allowed positive pressure ventilation and fluid instillation. Wash volumes were calculated from lung pressure-volume measurements of individual animals, and lavages were accomplished by instillation and withdrawal of four washes of warmed saline. Wash volume for the mouse, gerbil, hamster, rat, guinea pig, and rabbit ranged from 0.7 ml for the mouse to 31 ml for the rabbit. The percent of wash fluid recovered ranged from 73% for the rabbit to 90% for the rat. Cell recovery data for the hamster, rat, guinea pig, and rabbit were related to body size with the hamster having the lowest count and the rabbit the highest count. The mouse, hamster, and rabbit tolerated the procedure well, but evidence of lung damage was found in the rat, guinea pig, and gerbil. Cell recovery was similar to that reported for lavages of excised lungs.


An autoclavable isolator for operating on the adult gnotobiotic dog.

An isolator, in which complex operations can be performed on a large gnotobiotic dog, was designed and fabricated of lightweight stainless steel. This "T" shaped chamber is 20-40 inches wide, 96 inches long, and 38-58 inches high. It has two 18-inch diameter entry ports and a pair of gloves mounted beneath each of four plate glass windows. The isolator rests on a 12-inch high stainless steel pallet and is moved about the laboratory by a portable hydraulic platform lift. It is readily sterilized in an autoclave at temperatures up to 285 degrees F (140 degrees C) and can be cleaned and resterilized in less than 8 hours. Although the isolator is more expensive than one made of flexible plastic film, it has the advantages of not being readily punctured and it requires less labor to clean and sterilize between uses. Thus, it is more secure and, in the long run, more economical.


Hematologic, biochemical, and physiologic indices of the sacred baboon (Papio hamadryas).

Hematologic, biochemical, and physiologic indices for a recently imported group of sacred baboons, Papio hamadryas, were studied over a 6-week period. Hematologic values were in agreement with results recorded for other species of baboons. Blood biochemical data were consistent with findings previously reported for other baboons and for man except that alkaline phosphatase levels were higher than previously for other baboons but similar to those reported for man; lactic dehydrogenase levels were higher than for man but lower than for other baboons; cholesterol levels were within the range for baboons but lower than for man; and creatinine and uric acid levels were lower and amylase levels were higher than those for man. Temperature and respiration and pulse rates were in agreement with those reported for other baboons.


Aspects of British general practitioners' prescribing.

Some criteria for the rational prescribing of pharmaceuticals were considered in relationship to the prescribing of a sample of British general practitioners. In particular, interest was focused on the criteria of effectiveness and safety in what is prescribed. Actual prescriptions were examined for one complete given month and the physicians writing these were judged on the criteria, using carefully specified definitions. Next the professional, educational, and demographic characteristics of the selected physicians were examined and an attempt was made to account for the manner in which physicians were judged on the two rationality criteria in terms of these characteristics. Ninety characteristics were originally considered. In the event it was shown that a reasonable discrimination of physicians' prescribing could be made on the basis of five such characteristics.


Prepaid group practice under universal health insurance in Canada.

This paper describes the experience of the two prepaid group practice plans in Ontario before and after universal health insurance. Both plans were capitalized, before national health insurance, by member contributions and both have had persistent problems with enrollment constraints and professional opposition. The Sault Ste. Marie Plan began in 1963, six years before Canadian medicare. The plan was paid a capitation fee for medical services but did not share in savings from its reduced hospital use. After universal insurance sharing in decreased hospital use was offset by regulations which allowed plan members to use non-plan physicians at Plan expense. Payments to non-plan physicians now take up 20 per cent of Plan income. Active enrollment of members has been replaced by a Ministry of Health registration system which is based on overall utilization. The St. Catharine's Plan began at the same time as universal insurance in 1969. Its out-of-plan use averaged about 40 per cent of total income. Most recently this program has shifted from capitation to cost-reimbursement payment. In Canada present trends include cost containment, financing by general tax revenues rather than premiums and increased categorical benefits. Under Canadian universal health insurance prepaid group practice has an uncertain future.


Statistical mechanical treatment of protein conformation. 6. Elimination of empirical rules for prediction by use of a high-order probability. Correlation between the amino acid sequences and conformations for homologous neurotoxin proteins.

One-dimensional short-range interaction models for specific-sequence copolymers of amino acids have been developed in this series of papers. In this paper, a general method for predicting protein conformation (that is based on a one-dimensional short-range interaction model, and eliminates the need for the empirical rules introduced in papers III and IV) is described. The present method involves the use of conformational (or conformational-sequence) probabilities of higher order than the first- or second-order probabilities used in papers IV and V, i.e., it treats a sequence of any number of residues; it thus alters the predictive methods that involved empirical rules in papers III and IV, and low-order (first- or second-order) probabilities in papers IV and V. The general method is applied here to the prediction of the backbone conformations of proteins, using the three-state model [helical (h), extended (epilson), and other coil (c) states] proposed in the theoretical formulation of paper II. The statistical weights in the three-state model are evaluated from the atomic coordinates of the x-ray structures of 26 proteins. The conformational-sequence probabilities (taken for three consecutive residues for numerical computation in this paper) are calculated for all possible triads (i.e., for all possible combinations of the three states, h, epilson, and c for each residue) for bovine pancreatic trypsin inhibitor and clostridial flavodoxin, in order to select the most probable conformations of these proteins. The predicted results for these proteins are compared to those predicted in paper III and to those observed experimentally. The method is applied further to the prediction of the backbone structures of homologous neurotoxin proteins whose amino acid sequences are known but whose x-ray structures are not. The effects of variation in the amino acid sequence on the conformations of the backbones are discussed from the point of view of the homologies in the amino acid sequences of 19 neurotoxins. Application of the present general predictive method to a four- and a multistate model is also described.


Alternative regression approaches to the analysis of medical care survey data.

In a multivariate analysis of ambulatory care utilization of a subsample of the 1970 National Health Interview Survey (NHIS) data the dependent variables representing utilization, acute conditions and chronic conditions were found to have discrete variable properties violating normality assumptions of standard regression analysis. Focusing on the utilization variable, alternative multivariate approaches were compared with results obtained from standard least squares analysis. These were Poisson-based multivariate regression, logit analysis, and discriminant analysis. While the fixed interval measure of utlization had an L-shaped frequency distribution with considerable departure from normality, it was found that more theoretically appropriate alternatives provided only marginal gains over the standard least squares techniques.


Monte Carlo calculations on polypeptide chains. 10. A study of the kinetics of the helix--coli transition.

A stochastic model of the kinetics of the helix--coil transition based on the equilibrium statistical mechanical theory of Lifson and Roig is presented. A Monte Carlo simulation of the kinetics based on the stochastic model was used to study the kinetics of the helix--coil transition. Kinetics simulations were conducted from several initial values of the fractional hydrogen bonding parameter theta to each equilibrium value of theta. A spectrum of relaxation times and characteristic weighting constants is reported for each kinetics simulation. The chain lengths used in this study were 15, 34, and 85 residues. It was found that at each chain length the relaxation times depend only on the equilibrium value of 0 while the characteristic weighting constants depend on both the initial and equilibrium values of theta. The mean relaxation time was calculated for several relaxations at chain lengths 15, 34, and 85. It was found that the mean relaxation time does not reflect the correct order of magnitude of the slowest relaxation process. In addition, it was found that pure random coil species do not survive long enough to be measured by nmr spectroscopy and therefore values of t greater than or equal to 10(-1)s do not reflect a relaxation time of the helix--coil transition.


FP/MIS: a management information system for a community family planning clinic.

The management information system (FP/MIS) used by the Howard University Center for Family Planning Services, which operates community family planning clinics in Washington, D.C. is described. The system was developed to satisfy program objectives in patient management, program planning and evaluation, resource management, federal reporting systems and clinical, epidemiological and health services research. The data collection forms used in the system and the output from the four data display groups--patient profile, resource management, quality of care and epidemiology-are described along with examples of their use.


Hydrodynamic properties and unperturbed dimensions of poly(gamma-hydroxy-L-proline) in aqueous solution.

Intrinsic viscosities and sedimentation coefficients have been measured as a function of molecular weight for poly(gamma-hydroxy-L-proline) in water. The molecular weight range covered is 9,000-35,000. High molecular weight poly(gamma-hydroxy-L-proline) in water has the hydrodynamic behavior of a random coil immersed in a good solvent, as judged by d ln [eta]/d ln M, d ln so/d ln M, dbeta/dM, and the size of beta[= nu rho (-1)]/1/3etaM-2/3(1 - nurho)-1]. The characteristic ratio, ((r2)o/nplp2) infinity, is found to be 15.9 +/- 1.6, which is not significantly different from the result of 13.7 +/- 0.9 obtained for poly(L-proline) by Mattice and Mandelkern under the same conditions. This observation casts doubt on the importance of intrachain hydrogen bonded bridges from the hydroxyl group to a carbonyl oxygen via a water molecule. The characteristic ratios and the effects of calcium chloride on the hydroynamic properties suggest that poly(L-proline) and poly(gamma-hydroxy-L-proline) possess a similar source of flexibility which is often overlooked. Two possibilities for this flexibility are a second energy minimum about the Calpha-C' bond and cis-trans isomerization about the peptide bond.


An approach to reducing the adverse effects of broken appointments in primary care systems: development of a decision rule based on estimated conditional probabilities.

A method is presented for adjusting the scheduling of appointments in ambulatory health care centers to reduce the deleterious effects of broken appointments. The essence of the methodology calls for scheduling and "expected number" of patients for a given clinic session. This "expected number" is calculated from estimated probabilities of appointment breaking, conditioned on patient characteristics which are deemed to be related to appointment-breaking rates, and on which number appointment within a specified time period is being made for the patient. The two ill effects of appointment breaking that are considered here are the diminution of efficiency of operation and interference with continuity of patient care. Ways of using this methodology to ameliorate each of these effects are outlined, with one of these way serving to alleviate both effects. This method is meant to be of quite general applicability, although its development was motivated by the problems of a localized particular situation.


Preferential and absolute adsorption to poly[N5-(3-hydroxypropyl)-L-glutamine] in water/2-chloroethanol solvent mixtures.

Preferential adsorption to poly[N5-(3-hydroxypropyl)-L-glutamine] (PHPG) in water/2-chloroethanol solvent mixtures has been determined by measuring density increments at constant concentration and at constant chemical potential. At low alcohol concentrations, decreasing preferential adsorption of 2-chloroethanol is observed. When the organic solvent content is increased, an inversion of preferential adsorption occurs, water being preferentially adsorbed. The inversion zone parallels the conformational transition curve. As an explanation it is proposed that a competition occurs between noninteracting helicogenic 2-chloroethanol, which stabilizes hydrophobic interactions, and the hydrophilic interactions of water with  PHPG. The former retains a helical structure, whereas the latter induces a helix-to-coil transition.


Differential effects of a phone reminder on appointment keeping for patients with long and short between-visit intervals.

In the Harborview Medical Center pediatrics clinic, we were interested in testing whether a phone call would increase appointment-keeping behavior and whether the call would have a differential effect depending on the interval between appointments. Ninety-eight patients were studied who had scheduled appointments 3 to 264 days in advance and still had these appointments 3 days prior to appointment time. Patients who were randomly placed in an experimental condition received a reminder call. Control patients received no call. The results indicate some difference between compliance rates of the experimental and control conditions in the expected direction (X2=3.715, df=1, p less than .05). Patients whose visits were scheduled more than 14 days prior to the appointment time ("long-interval" patients) were separated from patients whose appointments were scheduled more recently. A significant difference in appointment-keeping rates between the experimental and control groups was found (X2=4.908, df=1, p less than .025), but only for the "long-interval" patients. Therefore, the use of a phone cue is particularly recommended for these patients.


Sociocultural barriers to medical care among Mexican Americans in Texas: a summary report of research conducted by the Southwest Medical Sociology Ad Hoc Committee.

This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.


Borderline hypertension. An overview.

Borderline hypertension is widespread. Though the increased blood pressure appears to be innocent, and upon rest frequently returns to the normal range, signs of complex and profound alteration of the physiologic control of the circulation can already be found. The pathophysiology of borderline hypertension is of particular interest since it may reveal clues about the processes which initiate the hypertension rather than the consequences of the primary blood pressure elevation. Patients with borderline hypertension are at a higher risk of developing future sustained hypertension and its consequences. The risk, however, is not sufficient to justify treatment in all cases. Patients must be followed to observe blood pressure trends and treatment attempted in the selected minority which has the highest risk. The determination of risk is based on repeated measurements of blood pressure and on the assessment of risk factors for atherosclerosis and for future hypertension.


Hypertension in the elderly.

The available data indicate that classical hypertension, defined here as a diastolic blood pressure greater than or equal to 95 mm Hg, is a widely prevalent and as important a risk factor for the cardiovascular diseases in those aged 65 and over as it is in those under 65. The limited available data also indicate that pure systolic hypertension, defined here as a systolic blood pressure exceeding 160 mm Hg with a diastolic pressure under 95 mm Hg, also very common at age 65 and over, is also related to excess cardiovascular morbidity and mortality in the elderly. However, it is not clear whether this latter relationship is indicative of cause and effect, or merely reflects the fact that in the elderly pure systolic hypertension is a sign of extensive sclerosis of large arteries. The results of Veterans Administration studies on antihypertensive therapy indicate that the elderly patient with classical hypertension is amenable to effective treatment, and that the benefits of such treatment significantly outweigh the risks. Great care is needed in the use of drugs for the management of hypertension in elderly patients, especially to minimize risk of hypotensive episodes and their possible harmful consequences; but with judicious and careful therapy, hypertension of this type can be controlled with reduction in excess risk of morbidity and mortality, at least for those with average diastolic pressures greater than or equal to 105 mm Hg. The lack of data on the benefits of treatment for those with pure systolic hypertension precludes any recommendations in regard to pharmacologic treatment of this condition.


Surgical management of renovascular hypertension in older patients.

In hypertensive patients over 50 years of age, the high prevalence of renovascular hypertension (31 per cent), the low operative risk for its correction (1 to 2 per cent), and the frequency of benefit from operation (80 to 87 per cent) support an aggressive attitude toward screening and management. Diastolic hypertension  greater than 105 mm Hg in the older patient warrants investigation. If such a patient has advanced atherosclerosis with evidence of significant cardiac disease or cerebrovascular disease, the indications for operative management of renovascular hypertension correlated with the severity of hypertension, difficulty of control, and imminence of renal function deterioration. If complicating risk factors are not severe, any patient with diastolic hypertension greater than 105 mm Hg is considered an appropriate operative candidate. In contrast, when risk factors are severe, operative management is undertaken only when hypertension is difficult to control or deterioration of renal function is thought to be secondary to the renal artery stenosis. In these patients the risk of operation is obviously greater and the long term benefits are more limited. Nevertheless, based on our experience, we feel the risk of poorly controlled hypertension or impending renal failure is even higher and justifies operative intervention. Hypertension accelerates the progress of atherosclerosis, and halting or slowing the unrelenting course of atherosclerosis is worthwhile objective if this can be done without unnecessary risk.


[Diverticulitis of the colon, indications and results of surgery (author's transl)].

155 operations performed on patients with diverticulitis of the colon at the Department of Surgery, University of Mainz Medical School, were analyzed retrospectively. Mortality was 5.4% in elective surgical interventions. Primary resection was possible only in a few of the emergency cases. In cases with ileus apalliative colostomy was performed mostly as a first step of surgical therapy: if perforation had occurred into the abdominal cavity simple closure, drainage and colostomy, or eventration of the perforated region were the first steps of surgical therapy. Mortality in the emergency patients was 45.5% due to the bad general condition after longstanding ileus or due to continuing smouldering fecal peritonitis after perforation. This bad prognosis does support our view, that colectomy should be done early in patients with chronic recurrent diverticulitis.


[Surgical therapy of carcinoma of the colon and rectum (author's transl)].

Carcinoma of the colon and rectum have a much better prognosis and a higher 5 years survival rate than other tumors of the gastro-intestinal tract. In spite of this, further improvements in therapy seem to be possible; cure rates could be improved by early diagnosis, and by a combination of 3 forms of therapy: preoperative X-ray therapy, radical surgery involving colon or rectum plus regional lymph-nodes, and adequate chemotherapy. A special problem is iso- and metachronic multiplicity. Recurrent disease may be diagnosed early enough by careful postoperative controls especially during the first postoperative year and can be managed surgically with good results.


Diet-induced changes in the fatty acid composition of mouse hepatocyte plasma membranes.

Hepatocyte plasma membranes were isolated from the livers of mice fed either a low fat diet or high fat diets containing polyunsaturated or saturated fat. The combined rate and isopycnic ultracentrifugation technique which was used produced highly purified hepatocyte plasma membrane fractions. The efficacy of the procedure was checked by electron microscopy and the assay to marker enzymes for the different subcellular organelles. Mice were maintained on a low fat diet until 60-70 days of age, when they were fed high fat diets containing polyunsaturated fat. The hepatocyte plasma membrane lipids of mice fed the polyunsaturated fat diet for 4 wk contained increased proportions of the major dietary unsaturated fatty acid, linoleic acid, and increased proportions of arachidonic acid. The proportion of linoleic and arachidonic acids decreased with continued feeding of the polyunsaturated fat diet. The hepatocyte plasma membrane lipids of mice fed the saturated fat diet contained increased proportions of oleic acid.


Fatty acids of cerebrosides in different regions of the developing foetal brain.

The fatty acid composition of cerebrosides of developing foetal human brain and regional variations, if any, during intrauterine life were studied. While palmitic and stearic acids were the predominant normal fatty acids throughout intrauterine life, long chain fatty acids, like lignoceric and nervonic acids, which were low at early gestational ages, rapidly accumulated at term. Regional differences were observed in the concentrations of long chain normal fatty acids especially at term. Medulla oblongata showed a greater accumulation of long chain fatty acids as compared to the cerebellum and cerebrum. The distribution of 2-hydroxy fatty acids in different regions showed a pattern predominantly that of long chain carbon units, even at 34 wk of foetal life. A higher ratio of lignoeric to stearic acid in the case of normal fatty acids, probably indicative of chain elongation, was also evident in the case of medulla oblongata and cerebellum as compared to the cerebrum. The significance of these qualitative alterations in relation to rapid growth of brain prior to term and the process of myelination has been discussed.


Relative utilization of fatty acids for synthesis of ketone bodies and complex lipids in the liver of developing rats.

The regulation of hepatic ketogenesis, as related to the metabolism of fatty acids through oxidative and synthetic pathways, was studied in developing rats. [1-14C] palmitate was used as a substrate to determine the proportions of free fatty acids utilized for the production of ketone bodies, CO2 and complex lipids. Similar developmental patterns of hepatic ketogenesis were obtained by measuring the production of either [14C] acetoacetate from exogenous [1-14C] palmitate or the sum of unlabeled acetoacetate and beta-hydroxybutyrate from endogenous fatty acids. The production of total ketone bodies was low during the late fetal stage and at birth, but increased rapidly to a miximum value within 24 hr after brith. The maximal ketogenic capacity appeared to be maintained for the first 10 days of life. 14CO2 production from [1-14C] palmitate increased by two- to fourfold during the suckling period, from its initial low rate seen at birth. The capacity for synthesis of total complex lipids was low at birth and had increased by day 3 to a maximal value, which was comparable to that of adult fed rats. The high lipogenic capacity lasted throughout the remaining suckling period. When ketogenesis was inhibited by 4-pentenoic acid, the rate of synthesis of complex lipids did not increase despite an increase in unutilized fatty acids. During the mid-suckling period, approximately equal amounts of [1-14C] palmitate were utilized for the synthesis of ketone plus CO2 and for complex lipid synthesis. By contrast, in adult fed rats, the incorporation of fatty acids into complex lipids was four times higher than that of ketone plus CO2. These observations suggest that stimulated hepatic ketogenesis in suckling rats results from the rapid oxidation of fatty acids and consequent increased production of acetyl CoA, but not from impaired capacity for synthesis of complex lipids.


Erucic acid and phospholipids of newborn rat heart cells in culture.

Erucic acid (delta 13-docosenoic acid), labeled with 14C in the 1- or 14-position, was incorporated into fetal calf serum and fed to beating, neonatal rat myocardial cell in culture. Uptake of the docosenoic acid during the first 6 hr of incubation was 41 nM/hr/mg protein in 7-day old cells and 29 nM/hr/mg protein in 14-day old cells. Fifty-seven percent of the 14C-activity was taken up from the medium in 24 hr, of which 77% was in the cells and 23% was unaccounted for. Of the 14C-activity taken up, 26% was in extractable lipid, with two-thirds in neutral lipid and one-third in phospholipid. Within the neutral lipid fraction, 88% of the 14C-activity was present in triglycerides; while in phospholipids, 66% of the 14C-activity was in phosphatidylcholine (PC); 14% in phosphatidylethanolamine (PE); 6% in sphinogomyelin (SPH) and 1% or less in cardiolipin (DPG). PC had the highest specific activity, followed by SPH and PE. The specific activity of PE was one-half that of SPH when the 14C-erucic acid substrate was labeled at the carboxyl position, but increased to equal that of SPH when the substrate was labeled at the double bond. The fatty acids of PC, PE, and SPH were influenced by erucic acid in the growth medium, but the amounts of each phospholipid were not affected. It is proposed that the altered fatty acid composition associated with incorporation of erucic acid or its metabolites into PC, PE, and SPH may affect integrity and function of heart cell membranes.


Influence of fasting-refeeding and dietary linoleate on liver glucose-6-phosphate dehydrogenase and phospholipid fatty acid composition in rats adapted to a purified diet.

Responses to refeeding after fasting were studied in male rats fed a purified casein-sucrose diet containing 5% safflower oil. After a 48 hr fast, the rats were fed either the same diet or the same diet minus oil (fat-free diet). These experiments were designed to distinguish changes due to fasting and refeeding alone without a change of diet from those changes caused by refeeding a diet of different composition. In the first experiment, rats were refed for 3 or 7 days. In rats refed either diet, liver glucose-6-phosphate dehydrogenase (G6PD) activity was elevated above refasting levels, but after 7 days, activity in rats refed the 5% safflower oil diet was significantly lower than in those refed the fat-free diet. The amount of liver arachidonate in rats refed the safflower oil diet was the same during refeeding as before fasting. In the second experiment, rats were refed the fat-free diet for 1, 2, 3, or 7 days. Liver G6PD and fatty acid synthetase were measured, as well as fatty acids in liver total lipids and phospholipids. G6PD activity increased above prefasting levels after one day refeeding and continued to increase for 7 days. Fatty acid synthetase activity increased for the first 3 days of refeeding, with no additional increase after 7 days. In all rats refed the fat-free diet, the proportions of arachidonate and linoleate in liver phospholipids diminished with time, and eicosatrienoate appeared. These results show that (a) maintenance of liver phospholipid arachidonate did not prevent increased G6PD activity in early refeeding, but the elevated G6PD activity later declined when phospholipid arachidonate was maintained by feeding a source of linoleate; (b) the metabolic state of fasted-refed rats had not returned to prefasting conditions even after 7 days of refeeding a linoleate-rich diet to which the rats were adapted before fasting.


Identification of the trans isomers of octadecenoic acid in human milk.

The presence of trans octadecenoic acid isomers was detected and analyzed in 24 hr pooled samples of human milk. Amounts of the trans isomers of the C18 monoenes ranged from 2% to 4% of the total fatty acids. For purposes of comparison, three commonly used brands of infant formula were also analyzed and found to contain 0.1% to 1.3% of trans monoene isomers. Data indicate that breast-fed and bottle-fed infants are receiving minimal levels of trans fatty acids via milk.


[A case of toxoplasmosis detected by the Sabin-Feldman test].

A case of abortion in a mother who suffered a two month abortion was diagnosed and the course of the infection was followed up by before and during the therapy, using the Sabin - Feldman test.


[The antigenic relationship between Syringospora albicans, Candida rhagii and the salmonella C1 group O antigen].

The immune sera for Syringospora albicans and Candida rhagii agglutinated Salmonella cholerae suis (0 6,7). The immune serum for S. cholerae suis agglutinated Syringospora albicans and Candida rhagii. Absorption and agglutination cross test demonstrated common antigenic factors in the tested fungus species and in S. cholerae suis (0 6,7).


[Immunological reactions related to drugs].

Drugs, when bound with proteins invivo, become immunogenic. The immunogenic response is usually unnoticed, but occasionally it may be the cause of reactions which induce tissue damages. The immunologic mechanisms which induce tissue damages are classified in four types: 1) anaphylactic, 2) cytolytic, reactions mediated by immune complex, 4) delayed type hypersensitivity reactions. Besides these reactions certain drugs induce autoantibodies which give lupus signs. In the diagnosis of drug-induced reactions the history after drug intake is considered important. The prophylaxis and treatment of these reactions are discussed briefly.


[Methods for the preparation of a pure soluble antigen from Toxoplasma gondii].

In this study we report 4 methods for separating leucocytes from toxoplasma found in peritoneal exudate of infected mice. a) Passage through No: 26 needle, b) glass adherence, c) passage through glass wool, d) sonic vibration. Experiment showed that sonic vibration at 60 watt; 60 seconds was the best way to destroy selectively almost all leucocytes present in the preparation. In order to prepare a soluble antigen  from clean toxoplasmas sonic vibration at 70 watt, 60 second was found sufficient to destroy all parasites present in the suspension. We suggest that this pure T. gondii antigen, may give more reliable results in passive hemagglutination, precipitation and complement fixation tests.


[West Nile arbovirus antibodies with hemagglutination inhibition (HI) in residents of Southeast Anatolia].

937 sera collected from different persons in Southeast Anatolia were studied for antibodies against West Nile - Virus by HI test. 763 out of 937 sera were from the research area, 42 from the neighboring districts and 21 from soldiers recently come to the research area, the features of the remaining 111 sera, except the ages of 4 could not be recorded. In the sera from the research area the West Nile antibodies were positive in 41.80%. The positive ratios were 40.49% in Diyarbakir, 47.83% in Mardin, 44.82% in Siirt, 38.09% in Urfa and 41.17% in Elâziğ. In 916 sera, the positive ratio was 40.06%. The ratio increased with the age, 5 out of 21 sera from soldiers were positive. It seems that in research area an active West Nile virus or a closely related one is found. We think that in neighboring areas some active foci of West Nile wirus are found.


[The mycological and bacteriological flora of cigarettes and its relation to human throat culture and inhalation air].

In our research we studied the mycological and bacteriological flora of both filtered and non-filtered Turkish cigarettes. We also studied by bacteriologic and mycologic methods, the specimens taken from throath of healthy people of varied ages who smoke and who do not smoke, and the flora of inhalation air from different area.


[Evaluation of new media for the isolation of salmonella and shigella].

Two hundred stool specimens were studied by using direct and indirect methods on XLD, HE, EMB and SS culture media. The results were consistent with the previous studies. As the media currently used in Turkey seem inadequate in the bacteriological diagnosis of salmonella and shigella infections, the introduction of the more satisfactory media such as XLD and HE is suggested for routine use.


[A case of pulmonary moniliasis following the misuse of antibiotics].

Our patient is a 30 year old, married female, with one daughter. She has been coughing about 200-250 cc purulent, blood stained sputum per day for the last three years. In the microscopic examination of sputum, abundant leukocytes, a small quantity of red blood cells and epithelia were found. Elastic fibres were absent. In cultures C. albicans and beta hemolytic streptococci were isolated. Coughing, sputum, and scattered moist rales at the bases (see the chest x-rays) were found clinically. Other systems were normal. An amelioration began on the third day of mycostatin treatment. There was complete healing by the tenth day of the treatment.