A comprehensive screening method for detecting organic acidurias and other metabolic diseases in acutely sick infants and children.

A protocol is described for the comprehensive screening of acutely ill neonates and infants for inherited metabolic diseases, with particular reference to the organic acidurias. A group of simple initial tests provide positive pointers to metabolic disorders, leading to comprehensive screening tests for the aminoacidopathies and organic acidurias. Specimen chromatograms of urinary organic acids in the normal neonate, infant, and child, obtained using the methods described, are given and compared with that from the urine of a child with previously unreported 2-hydroxyglutaric aciduria. The place of the scheme in the management of inherited metabolic disease in the perinatal period and its relationship to other screening programmes are discussed. It is estimated that use of the protocol would allow the detection of about one-half of the known inborn errors of metabolism, including the aminoacidopathies, the organic acidurias, the hyperammonaemias, and several disorders of carbohydrate metabolism, many of which present acutely in the neonate and infant.


Problems associated with measuring sweat chloride concentration with an ion-specific electrode.

The measurement of sweat chloride concentration was investigated by using the Orion 417 skin chloride electrode. The effects of variation in pilocarpine concentration, iontophoresis period, and sweat collection period were also investigated. The results show that the sweat chloride concentration is directly related to the amount of sweat produced. When the amount of sweat collected falls below a certain level, there is an apparent increase in sweat chloride concentration. A procedure is recommended for the measurement of sweat chloride concentration which offers good precision (coefficient of variation 9.8%) and the minimum of inconvenience to the patient.


The geography of marriage in Britain, 1920-1960.

In 1959 the Population Investigation Committee at the London School of Economics instituted a nationwide survey of attitudes of marriage, contraception and family size. Questions were also asked about the birthplace of the partners and where they were living when they first met each other. These four place names provide the basis for marital mobility data whose geographical distribution is described here. A simple model of marital mobility is presented and the data are analysed according to (1) the propensity to marry outside the individual's birthplace or home town and (2) the distribution of the distan(e separating the partners when they come from different places. The data are very heterogeneous, so they are broken down for further analysis according to the population sizes of the birthplaces and home towns of each partner. The propensity to marry within the same place is strongly and positively associated with its population size. If the partners come from different places when the distance between their birthplaces, or between their home towns when they met, is associated with the population size of these places. Similar associations were found between the probability of migration from the birthplace, the distance moved, and population size. Men are more likely to move from their birthplaces than are women, and if they move they are more likely to move further. Marriage distance, as defined here, is also strongly influenced by population size. The geographical theory of central places offers a suitable framework for understanding the relation of marital mobility and population size and the results of this study are discussed in the context of geographical theories.


Sibling correlations in growth and adult morphology in a rural Colombian population.

Correlations for body measurement between members of 207 pairs of school-aged and 116 pairs of adult siblings in a mestizo farming community of the Colombian Andes are comparable to those from previous studies of well nourished urban-industrial samples, both in magnitude and pattern of heritabilities. While the genetic potential in physical growth is impeded by undernutrition and disease in childhood in samples such as the present one, hereditary influences on the variability of growth and adult size appear to be as important in such populations as they are in well nourished ones. School-aged sibs have significantly higher correlations than adult sibs and parent-offspring pairs for some measurements, suggesting environmental contributions in physical resemblance of siblings. Fatfold correlations between adult sisters are persistently higher than those of other sib pairings when socio-economic differences, age, and seasonal variation in nutrition are held constant, implying a greater genetic basis for adipose tissue in females.


Ventilatory capacity if healthy Chinese children: relation to habitual activity.

Ventilatory capacity, including forced expiratory volume (FEV 1-0) and forced vital capacity (FVC), and selected anthropometric indices have been obtained for 36 boys and 19 girls aged 5-10 years from a working class district in Kowloon. The ventilatory capacity is related to stature and is 13 per cent larger for boys than girls. After allowing for stature and sex the residual variation is significantly reduced by also allowing for the children's habitual activity. The ventilatory capacity of the more active children, including those who have lived all their lives in squatter huts on the hillsides, is on average 8 per cent larger than for the inactive children including those who have lived all their lives in tenement flats with lifts. The groups are apparently similar with respect to income, dietary pattern, intelligence and disease incidence, so that findings provide independent support for the hypothesis that the level of habitual activity during childhood contributes to the ventilatory capacity. The absolute level of ventilatory capacity resembles that of Nepalese children and differs from that of some other groups.


A study of menarcheal age in India.

A study of menarcheal age was carried out in southern India. A logit method of analysis was applied to status quo data on 1267 Tamil and Telugu speaking girls aged 9 to 18 years in 3 schools catering for different socio-economic groups. There appears to be no relationship of menarcheal age with dietary pattern classified simply as vegetarian and non-vegetarian. Differences in median age at menarche between schools correspond well with the socio-economic differences between them. The median age in the most advantaged school (12-86 years) is comparable with that in recent studies in southern and eastern Europe, and may perhaps be in advance of some recent north-west European samples.


The age at menarche in some populations of the Veneto, North Italy.

The mean age at menarche in 6252 girls from secondary schools in six areas of the Veneto (Northern Italy) in 1975-1976, was estimated by probit analysis as 12-77 +/- 0-038 years. This mean is the highest known for Italy. Sexual maturation appears late in girls from large families and early in girls from small families: mean menarcheal ages were respectively 12-81 +/- 0-057 and 12-64 +/- 0-036 years.


Sex ratio in a sample of human fetuses in Denmark, 1962-1973.

The sex ratio was determined in 791 fetuses from pregnant women in the Copenhagen area 1962-1973. All the mothers were sterilized in connection with an induced abortion. Eighty percent of the fetuses had a crown-rump length between 50 mm and 150 mm corresponding to postmenstrual age of 11-19 weeks. The sex ratio was 138. There was no association between length and sex ratio. The difference between this sex ratio and that for live births in Denmark 1962-1973 (105-9) is substantial.


The effect of varying sea salt concentration in the growth medium on the chemical composition of a purified membrane fraction from Planococcus citreus Migula.

Membrane preparations were prepared from cells of Planococcus citreus grown in the presence of three final concentrations of sea salt in a basic growth medium. The concentration of salt in the medium affects the amount of membrane in the cell. The three preparations were subjected to chemical analysis and no significant changes in chemical composition were seen as the salt concentration in the medium was increased. Values for the various components generally were within normal ranges and were similar to those of non-halophiles rather than extreme halophiles. The protein levels were slightly higher and it it cellular ion balance. Atomic absorption analysis of the major cations associated with the membranes showed that divalent ions were present in a 2:1 ratio with ...


Stimulation of human lymphocytes in vitro by purified autologous DNA.

Addition of increasing concentrations of autologous DNA, but not of allogeneic DNA, in culture media of human lymphocytes induces a parallel increase of thymidine incorporation into leucocytes and of lymphocytes transformation into blast cells. Specificity of DNA action was analysed by different DNase and RNase treatments. DNase or RNase alone neither stimulates blastic transformation of lymphocytes and incorporation of thymidine into leucocytes, nor inhibits PHA-induced stimulations of these cells. However Dnase--but almost not RNase--clearly inhibits thymidine incorporation and blast transformation induced by autologous DNA.


Electron microscopy of sporulation in Schwanniomyces alluvius.

Sporulation in Schwanniomyces alluvius appeared to be preceded by fusion of a mother and daughter cell. Meiosis probably occurred in the mother cell and one or two spores were formed in the latter. A study of thin sections showed that the spore wall developed from a prospore wall. The mature spore wall consisted of a broad light inner layer and a thinner dark outer layer including warts. An equatorial ledge was present. During germination in the ascus, a new light inner layer was formed and the old layers of the spore wall partly broke up. Ascospores in a strain of S. persoonii had a different wall structure in that the dark layer had changed into light areas separated by dark material which formed bulges at the surface.


Relationship between chemical structure and adjuvant activity of some synthetic analogues of N-acetyl-muramyl-L-alanyl-D-isoglutamine (MDP).

Synthetic N-acetyl-muramyl-L-alanyl-D-isoglutamine, hereafter referred to as muramyl dipeptide or MDP, represents the minimal structure which can replace mycobacterial cells in Freund's complete adjuvant. This synthetic adjuvant can also enhance the humoral antibody response when administered to mice with an antigen in water by various routes including the oral route. The present paper reports some new results concerning the relationship between the structure and the adjuvant activity of MDP. Synthetic analogues of MDP were tested either in a water-in-oil emulsion in guinea-pigs or in saline in mice. The chemical modifications concerned essentially the D-glutamyl residue. The results obtained confirm the importance of maintaining the intact structure of the D-Glu residue and show that adjuvant activity can be abolished by certain modifications at the level of both carboxyl functions.


In vitro measurement of specific rat IgE antibodies.

A radioimmunoassay has been developed for measuring specific rat IgE antibodies. The method used in base on the principle of the paper radio allergo sorbent technique (PRAST) as described by Wide et al. [11]. There is a good correlation between PRAST results and passive cutaneous anaphylaxis (PCA) titer. Inhibition tests with different purified monoclonal immunoglobulins show the specificity of this in vitro technique for measuring IgE antibodies. PRAST is in general somewhat more sensitive than the PCA test.


Coenzyme Q system in the classification of some ascosporogenous yeast genera in the families Saccharomycetaceae and Spermophthoraceae.

The Co-Q systems of 11 strains representing the genera Schwanniomyces, Lodderomyces, Lipomyces, Nematospora and Metschnikowia were determined. All the genera were characterized by the Q-9 system except for the genus Nematospora with needle-shaped ascospores. The only species, Nem. coryli, was found to have the Q-6 system. These results are discussed from the taxonomic point of view.


Internal standards for gas chromatographic analysis of metabolic end products from anaerobic bacteria.

2-Methylpentanoic acid and benzoic acid are suggested for use as routine internal standards for gas chromatographic analysis of microbial end products.


Technique for isolating phage for Azotobacter vinelandii.

An enrichment technique was developed whereby azotophage could readily be isolated after inoculation of soil sites with Azotobacter vinelandii.


Isolation of a cellulotytic Bacteroides sp. from human feces.

An anaerobic cellulolytic bacterium, identified as a Bacteroides sp., was present in 10(-8) g of feces from only one of five human subjects.


Characteristics of Bacteroides isolates from the cecum of conventional mice.

Bacteroides isolates from the cecum of conventional mice were characterized and grouped according to their ability to ferment or hydrolyze carbohydrates and other compounds believed to be present in the intestinal ecosystem. The isolates were divided into 11 groups on the basis of the fermentation of glucose, cellobiose, gum arabic and xylan (hemicelluloses), N-acetylglucosamine, and dextrin; the hydrolysis of starch and casein (proteolysis); and the production of indole. Stock cultures of B. fragilis, B. distasonis, B. ovatus, B. vulgatus, and B. ruminicola were characterized in the same way. The strains isolated most frequently from the mouse cecum resembled B. fragilis (except that arabinose was fermented) and B. thetaiotaomicron.


Use of an axenic medium for differentiation between pathogenic and nonpathogenic Naegleria fowleri isolates.

Growth in an axenic medium composed by Chang (3rd Int. Congr. Parasitol. Munich Abstr. ICPIII 1:187-188, 1974) allowed separation of pathogenic from nonpathogenic Naegleria fowleri strains, since only the former show luxuriant growth in this medium. On the basis of these results, this medium was used in early screening for virulent Naegleria isolates. During an extensive ecological study, data were obtained on 102 Naegleria strains. Twenty of these strains grew luxuriantly in this liquid medium. Seventeen of them were tested by intranasal instillation in mice, and all proved to be highly pathogenic. Strains showing only moderate growth or no growth at all in this axenic medium were found to be nonpathogenic for mice. Moreover, it was found that using this medium in the early stage of Naegleria sampling favors isolation of pathogenic strains in mixtures of Naegleria. During these experiments, further evidence was obtained that thermal polluted waters are the main origin of N. fowleri in the environment.


Recovery of clostridia on catalase-treated plating media.

Four plating media commonly used for culturing clostridia were tested for their ability to support growth of several Clostridium species after storage of the plates for 1 to 10 days at 4 and 25 degrees C with and without subsequent addition of catalase. Liver-veal (LV) agar and brain heart infusion (BHI) agar rapidly became incapable of supporting growth after storage without added catalase, whereas Shahidi Ferguson perfringens agar base and Brewer anaerobic agar were less affected. Plate counts of vegetative cells of nine of the less fastidious Clostridium species on untreated LV and BHI agars, stored for 3 days at 4 degrees C, were 60 to 90% lower than counts on catalase-treated media. Counts on Shahidi Ferguson perfringens agar base were only 1 to 24% lower on untreated medium with the same species. Addition of 500 U of purified beef liver catalase to the surface of the 3-day-old agars before inoculation resulted in substantial restoration of the ability of the media to support colony formation from vegetative cells except with the most strictly anaerobic species (nonproteolytic C. botulinum types B, E, and F, and C. novyii types A and B). A similar response was obtained with spores of the less fastidious species on catalase-treated media. Our results suggest that inhibition of most Clostridium species on LV and BHI agars may be due to accumulation of peroxide during preparation, storage, and incubation of the media, and also suggest that the presence of glucose in these media is a major factor contributing to their inability to support growth. It is believed that the addition of exogenous catalase prevents the accumulation of peroxide(s), thus allowing colony formation from vegetative cells of the clostridia under what would otherwise be unsuitable cultural conditions.


Oxidation of linear terpenes and squalene variants by Arthrobacter sp.

Cells of Arthrobacter sp. that had been isolated from soil were used to study oxidation of some linear terpenes and squalene variants. The cells oxidized geraniol, nerol, and farnesol to the corresponding aldehydes, with partial conversion of the geometrical isomerism of the alpha,beta-double bond. The squalene variant, squalene-2,3-oxide, was cleaved to 9,10-epoxygeranylacetone and geranylacetone. Squalene-2,3-22,23-dioxide was cleaved to 9,10-epoxygeranylacetone. These products were optically active, and their stereochemistry and optical purity were determined.


Muramic acid as a measure of microbial biomass in estuarine and marine samples.

Muramic acid, a component of the muramyl peptide found only in the cell walls of bacteria and blue-green algae, furnishes a measure of detrital or sedimentary procaryotic biomass. A reproducible assay involving acid hydrolysis, preparative thin-layer chromatographic purification, and colorimetric analysis of lactate released from muramic acid by alkaline hydrolysis is described. Comparison of semitropical estuarine detritus, estuarine muds, and sediments from anaerobic Black Sea cores showed muramic acid levels of 100 to 700 microng/g (dry weight), 34 microng/g, and 1.5 to 14.9 microng/g, respectively. Enzymatic assays of lactate from muramic acid gave results 10- to 20-fold higher. Radioactive pulse-labeling studies showed that [14C]acetate is rapidly incorporated into muramic acid by the detrital microflora. Subsequent loss of 14C, accompanied by nearly constant levels of total muramic acid, indicated active metabolism in procaryotic cell walls.


Resistance of Rhizobium strains to phygon, spergon, and thiram.

Strains of Rhizobium meliloti, Rhizobium sp. nodulating cowpeas, and R. phaseoli derived from cultures susceptible to tetramethylthiuram disulfide (thiram), 2,3-dichloro-1,4-naphthoquinone (phygon), and 2,3,5,6-tetrachloro-p-benzoquinone (spergon), respectively, grew in the presence of high concentrations of the fungicides and converted them to products not toxic to the sensitive rhizobia. The results of chemical assays demonstrated that the pesticides were destroyed by the resistant bacteria but not by the susceptible parent rhizobia. Resting cells of thiram-metabolizing R. meliloti formed large quantities of dimethyldithiocarbamate, dimethylamine, and CS2 from the pesticide. The products were characterized by gas and thin-layer chromatography, colorimetric reactions, and ultraviolet spectrometry. Dimethylamine and CS2 were formed spontaneously from dimethyldithiocarbamate, but the yield was higher in the presence of R. meliloti. The phygon-resistant bacterium converted the fungicide to five metabolites and thereby rendered the chemical nontoxic to a test fungus. The resistant strain of R. phaseoli generated at least one organic product and released about one-third of the chlorine during its detoxication of spergon.


Production of [14C]patulin by Penicillium patulum.

Factors affecting the production of [14C]patulin from [1-14C]acetate by replacement cultures of Penicillium patulum have been investigated. Incorporation of [1-14C]acetate into patulin reached a maximum with 6- to 8-day-old cultures incubated at 28 degrees C for 8 h in a replacement medium containing 0.1 M glucose, inorganic salts, and undiluted [1-14C]acetate. The specific activity of [14C]patulin obtained from this method was 34 mCi/mmol when 0.5 mCi of [1-14C]acetate was supplied to the replacement medium.


Cell growth and catecholase production for Polyporus versicolor in submerged culture.

Cell growth and catecholase production for Polyporus veriscolor (ATCC 12679) were studied in mechanically agitated submerged culture, as functions of temperature. The exponential-phase growth rate exhibited a maximum at 28 degrees C. Over the range of 20 degrees C to approximately 30 degrees C, both cell mass and enzyme yield factors were constant. At higher temperatures (30 to 40 degrees C) cell mass yield factor decreased and enzyme yield factor increased. Specific respiration rate of P. versicolor was determined. Thermal deactivation of catecholase was investigated between 30 and 50 degrees C, and deactivation rates were fit to an Arrhenius rate expression.


Microbiological characteristics of Pacific shrimp (Pandalus jordani).

Microorganisms associated with Pacific shrimp (Pandalus jordani) were isolated and identified. Those on the iced raw shrimp, which yielded an average count of 1.6 x 10(6), were predominantly Moraxella, Pseudomonas, Acinetobacter, Arthrobacter, and Flavobacterium-Cytophaga spp. The blanching and peeling reduced the microbial level to 3.3 x 10(4) and also selectively eliminated Moraxella spp. The microbial flora changed after each processing sequence, and the heat sensitivity and growth characteristics of the representative microbial groups suggested that the presence of Arthrobacter and Acinetobacter spp. in peeled shrimp may indicate inadequate cleaning of raw shrimp or a shorter blanching time. The presence of Moraxella and Flavobacterium-Cytophaga spp. would indicate the degree of secondary contamination, and the presence of Pseudomonas spp. would indicate the shelf-age of the processed shrimp.


Pyrolysis gas-liquid chromatography of the genus Bacillus: effect of growth media on pyrochromatogram reproducibility.

Pyrolysis gas-liquid chromatography was performed on dried Bacillus microorganisms to evaluate the effects of growth media. Six cultures of Bacillus and six lot numbers of Trypticase soy agar (BBL) were used to test the hypothesis that a microorganism grown on various lot numbers of the same chromatogram. Also tested was the effect of three different media on chromatogram reproduction using the same six cultures. Results show little or no differences observed between the chromatograms of the individual Bacillus spp. grown on the six lot numbers of Trypticase soy agar. When chromatograms of the three different media were compared, several differences were observed, particularly in the areas most characteristic of individual species. Pryolysis gas-liquid chromatography can be a useful tool for the characterization or identification of the genus Bacillus if the chromatographic and cultural conditions are maintained.


Bioassay for homogeneous parasporal crystal of Bacillus thuringiensis using the tobacco hornworm, Manduca sexta.

A method for determining the toxicity of Bacillus thuringiensis subsp. kurstaki parasporal crystal to the tabocco hornworm, Manduca sexta, is described. The use of both mortality and weight loss data have provided a highly sensitive and reproducible bioassay that can be used to compare relative toxicities of crystals from other subspecies as well as toxic components contained therein.


N-Alkane oxidation enzymes of a pseudomonad.

A nicotinamide adenine dinucleotide (NAD)-dependent n-alkane dehydrogenase and an NAD phosphate (reduced form)-dependent alkane hydroxylase have been purified from cell-free extracts of Pseudomonas sp. strain 196Aa grown anaerobically on n-alkane. The n-alkane dehydrogenase (fraction R-3), obtained as a single peak from Bio-Gel P-60, showed an overall 135-fold purification and was demonstrated by infrared spectroscopy and gas chromatography to convert n-decane to 1-decene. The alkene hydroxylase activity in the S-3 fraction, purified 167 times from diethylaminoethyl-cellulose, was shown by the same methodology to convert decene to decanol. Commercial ferredoxin has been shown to increase the alkane dehydrogenase activity. An NAD-, flavine adenine dinucleotide-, and iron-dependent alcohol dehydrogenase was demonstrated in the R-3 fraction. A mechanism for the anaerobic conversion of n-alkane to fatty acid has been proposed.


Oxidative coupling of aromatic pesticide intermediates by a fungal phenol oxidase.

The soil fungus Rhizoctonia praticola produced an enzyme that accumulated in the growth medium and caused the polymerization of phenolic and naphtholic intermediates of various pesticides. The dialyzed crude enzyme was purified by ion-exhange column chromatography with diethylaminoethyl-cellulose, followed by gel filtration with Sephadex G-200. The enzyme, a phenol oxidase, was capable of polymerizing 2-chlorophenol, 4-chlorophenol, 2,4-dichlorophenol, and 4-bromo-2-chlorophenol. 1-Naphthol, 2-naphthol, and some of their derivatives formed oligomers or polymers when incubated with the enzyme, but 4-nitrophenol and 2,4-dinitriphenol were not oxidized. Chlorinated and brominated anilines, which are derivatives of herbicides, were not altered by the phenol oxidase from R. praticola, but 4-methoxyaniline was transformed by the enzyme to 2-amino-5-p-anisidinobenzoquinone-di-p-methoxyphenylimine. The formation of polymeric products was determined by mass spectrometric analysis.


Nitrification in histosols: a potential role for the heterotrophic nitrifier.

Insufficient populations of Nitrosomonas and Nitrobacter were found in a Pahokee muck soil (Lithic medidaprit) to account for the nitrate concentration observed. To determine if heterotrophic nitrifiers could account for some of this discrepancy, a method was developed to measure the levels of heterotrophic nitrifiers in soil. A population of 4.1 X 10(5) Arthrobacter per g of dry fallow soil, capable of producing nitrite and/or nitrate from reduced nitrogenous compounds, was observed. Amendment of the much with 0.5% (wt/wt) sodium acetate and 0.1% (wt/wt) ammonium-nitrogen as ammonium sulfate (final concentrations) not only resulted in the usual increase in autotrophic nitrifiers, but also in a fourfold increase in the heterotrophic nitrifying Arrthrobacter. Amendment of like samples with N-Serve [2-chloro-6(trichloromethyl) pyridinel] prevented the increase in Nitrosomonas, but not that in the heterotrophic nitrifiers. Nitrate production in the presence of the inhibitor was diminished but not prevented. An Arthrobacter sp., isolated from the muck, produced nitrite when inoculated at high densities into sterile soil, unamended or amended with sodium acetate and/or ammomium sulfate. These data suggest that the heterotrophic population may be responsible for some of the nitrate produced in these Histosols.


Factors affecting nitrification in situ in a heated stream.

Nitrification, previously shown to occur in the stream under study, ensued only when the stream received heated (28 degree C or above) discharges and was negligible when water temperatures were 17 degree C or lower. The most probable number os ammonium oxidizer in stream bed sediments exceeded intrite oxidizers by ratios of 43:1 to 1,113:1, and the average rate of ammonium oxidation in this stream, 0.50 mg of NH4-N/liter per h exceeded the rate of nitrite oxidation, 0.29 mg of NO2-N/liter per h, resulting in an accumulation of nitrite. Nitrification rates were influenced by the dissolved oxygen concentration, increasing during daylight hours and exhibiting maximum rates during the summer months.


Numerically dominant denitrifying bacteria from world soils.

Nineteen soils, three freshwater lake sediments, and oxidized poultry manure were examined to determine the dominant denitrifier populations. The samples, most shown or expected to support active denitrification, were from eight countries and included rice paddy, temperate agricultural, rain forest, organic, and waste-treated soils. Over 1,500 organisms that could grow anaerobically on nitrate agar were isolated. After purification, 146 denitrifiers were obtained, as verified by production of N(2) from NO(3) (-). These isolates were characterized by 52 properties appropriate for the Pseudomonas-Alcaligenes group. Numerical taxonomic procedures were used to group the isolates and compare them with nine known denitrifier species. The major group isolated was representative of Pseudonomas fluorescens biotype II. The second most prevalent group was representative of Alcaligenes. Other Pseudomonas species as well as members of the genus Flavobacterium, the latter previously not known to denitrify, also were identified. One-third of the isolates could not utilize glucose or other carbohydrates as sole carbon sources. Significantly, none of the numerically dominant denitrifiers we isolated resembled the most studied species: Pseudomonas denitrificans, Pseudomonas perfectomarinus, and Paracoccus denitrificans. Denitrification appears to be a property of a very diverse group of gram-negative, motile bacteria, as shown by the large number (22.6%) of ungrouped organisms. The diversity of denitrifiers from a given sample was usually high, with at least two groups present. Denitrifiers, nitrite accumulators, and organisms capable of anaerobic growth were present in the ratio of 0.20+/-0.23:0.81+/-0.23:1. There were few correlations between their numbers and the sample characteristics measured. However, the temperatures at which isolates could grow were significantly related to the temperatures of the environments from which they were isolated. Regression analysis revealed few relationships between physical parameters and bacterial types, save for the anaerobe numbers, in which 94% of the variance could be accounted for.


Citrate, a specific substrate for the isolation of Clostridium sphenoides.

With a medium containing citrate as the carbon and energy source, 10 clostridial strains were isolated from various mud samples. Characterization of these strains revealed that they all belonged to the same species, Clostridium sphenoides. Strains of this organism obtained from culture collections were also able to grow citrate, whereas 15 other clostridial species tested were not. Citrate was fermented by C. sphenoides to acetate, ethanol, carbon dioxide, and hydrogen. Experiments with stereospecifically 14C-labeled citrate indicated that citrate lyase was involved in citrate degradation.


Ethylene production by soil microorganisms.

Ethylene-producing strains of Penicillium cyclopium and P. crustosum were isolated from soil. These isolates produced ethylene on a variety of carbon growth substrates including phenolic acids. The quantities of ethylene produced on the various substrates varied, and the subtrate-ethylene prosuction pattern for P. cyclopium strains differed significantly from that of P. crustosum strains.


Rapid tube test for detecting fungal cellulase production.

A simple procedure is described for the detection of cellulolytic activity in fungi, utilizing dyed cellulose powder as substrate. The powder, incorporated into a basal medium containing agar, mineral salts, and growth factors, is layered onto basal medium minus cellulose. Cellulase production results in release of the dye which diffuses into the lower layer.


Production and antibacterial activity of malforming C, a toxic metabolite of Aspergillus niger.

The production of the new mycotoxin malformin C by a solid substrate fermentation is described. Malformin C is highly toxic (mean lethal dose = 0.9 mg/kg) and exerts antibacterial activity against a variety of gram-positive and gram-negative organisms.


Glucose-1-phosphate as a selective substrate for enumeration of Bacteroides species in the rumen.

When glucose-1-phosphate was used as the only added energy source in a selective roll tube medium, colony counts for rumen contents ranged from 17.8 to 84.8% of the total culturable count. Percentages were highest in rumen contents from sheep fed high-concentrate rations. From a total of 73 cultures isolated from glucose-1-phosphate roll rubes, only 15.1% were presumptively identified as Bacteroides species. Strains presumptively identified as Butyrivibrio, Selenomonas, Treponema, Streptococcus bovis, and Lachnospira also fermented glucose-1-phosphate. Thus, glucose-1-phosphate would not be useful as a selective substrate for isolation or enumeration of Bacteroides species from the rumen.


Ultrastructural studies of vitiligo, Vogt-Koyanagi syndrome, and incontinentia pigmenti achromians.

Studies of early progressive vitiligo, Vogt-Koyanagi syndrome, and incontinentia pigmenti achromians were made by electron microscopy. At the periphery of the depigmented lesion, the melanocytes had several subcellular abnormalities, ie, vacuolization of the cytoplasm, aggregation of melanosomes, autophagic vacuoles, fatty degeneration, pyknosis or homogeneous cytoplasmic degeneration, and others. Numerous nerve endings were seen in close contact with the basal lamina of the epidermis or even within the epidermis. Direct continuities between Schwann cell basal lamina of nerve endings and the basal lamina of the melanocytes were observed. Nerve endings could be associated with either normal or abnormal melanocytes.


Inflammatory linear verrucose epidermal nevus. A pathologic study.

We saw three patients with inflammatory linear verrucose epidermal nevus (ILVEN). The purpose of this study is to better delineate the histopathologic features of this type of nevus. In fact, in all three cases very particular, specific histologic lesions have been noted that permit us to better distinguish this recently outlined entity. The histologic features were depressed, cup-like areas of hyper-granulosis with overlying orthokeratotic hyperkeratosis, alternating (with sharp dermacation) with raised, level areas of agranulosis with overlying parakeratotic hyperkeratosis.


Phototoxicity occurring during the manufacture of ultraviolet-cured ink.

Four workers employed in the manufacture of ultraviolet-cured inks complained of photosensitivity characterized by an intense burning sensation during sun exposure. Three of these workers developed dermatitis on exposed areas following sun exposure. Six compounds used as photoinitiators in the ink formulations were found to absorb solar ultraviolet radiation. Two preparations of mixed isomers (ortho and para) of amyl dimethylaminobenzoate were found to be phototoxic to Ehrlich ascites cells in vitro and to produce diphasic phototoxic reactions in vivo after topical application on symptomatic workers, asymptomatic workers, or previously unexposed subjects. These responses could be prevented in two subjects by the application of a 10% sulizobenzone sunscreen prior to sun exposure. Two other photoinitiators, Michler's ketone and thioxanthone were phototoxic in vitro but not after topical application in vivo.


Vegetables responsible for contact dermatitis of the hands.

Fifty-three patients having contact dermatitis on the fingertips showed positive patch tests with several vegetables the commonest being garlic, onion, tomato, and carrot in that order of frequency. Of several preparations, made from garlic onion, tomato, and carrot, the juices used as such gave the maximum number of positive patch test reactions. Lyophilization of the juices led to false-negative patch tests in some cases. Patch tests in the controls were positive in some cases but these were probably cases of latent hypersensitivity, because some of them, like the patients, showed positive reactions even with the diluted juices. The antigens in garlic and onion were extractable in water, ether, acetone, or alcohol and were also present in the essential oils of these vegetables. Infrared spectra of the essential oils of garlic and onion were similar and showed straight chain acids, esters, and methylene groups. Clinically, there was no suggestion of cross-sensitivity between onion and garlic.


Treatment of morphea-type basal cell carcinomas with radiation therapy.

Eight patients received superficial x-ray therapy for morphea-type basal cell carcinomas. Seven lesions did not recur. One recurrence adjacent to an irradiated field was observed; it was considered to be a geographic miss and has led us to include a wider field (10 mm) of normal-appearing skin beyond the clinical perimeter of the tumor when the lesion is ill-defined. The cosmetic results after treatment were poorer than anticipated for this schedule of radiation therapy, based on our extensive experience with other types of basal cell carcinomas. To obtain the best long-term results we believe that, where technically feasible Mohs surgery and conventional surgical excision with histologic verification of free margins are the treatments of choice for morphea-type basal cell carcinomas. However, our experience indicates that morphea-type basal-cell carcinomas can be cured with radiation therapy; therefore, x-rays have a place in the armamentarium of therapeutic modalities for this tumor if surgery is not feasible or if it is refused by the patient.


Cutaneous neural proliferation in highly pruritic lesions of chronic prurigo.

Nodular lesions of chronic prurigo correspond to highly sensitive pruritic areas of neural proliferation. This has been shown by light and electron microscopic studies in four patients. Axons and Schwann cells were participating in this process. Their ultrastructure appeared mostly normal; however, some disorganization, axonal swelling, and dystrophy were also observed. At places, newly formed nervous tissue imitated neuromas, surrounded by mononuclear cells and a peculiar cell type which we called "spider cell." The noninvolved skin near the nodules showed no alterations. Occlusion with elastic bandages for four weeks betters the clinical and histological picture. According to these findings, it seems that the neural proliferation in prurigo is a secondary phenomenon due to chronic traumatization by scratching. We also feel that the extreme pruritus in chronic lesions is related to the increased number of dermal nerves.


Arcuate dermal erythema in a carrier of chronic granulomatous disease.

A female carrier of chronic granulomatous disease developed arcuate, erythematous dermal plaques on her back and face. The lesions were clinically and histopathologically suggestive of Jessner benign lymphocytic infiltration of the skin. Some women with relatively fixed arcuate or annular, erythematous, dermal plaques may be carriers of chronic granulomatous disease.


Atopic dermatitis and impaired neutrophil chemotaxis in Job's syndrome.

A 22-year-old white woman with Job's syndrome was found to have atopic dermatitis and impaired neutrophil chemotaxis in vitro. Major clinical features of Job's syndrome included large, "cold" and recurrent staphylococcal abscesses, and intermittent bacterial and yeast infections. Evidence for atopic disease included infantile eczema progressing to flexural dermatitis, a family history of atopy, positive immediate hypersensitivity skin tests, and hyperimmunoglobulinemia E. Defective erythema responses to histamine, methyl niacinate, and methacholine (Mecholyl) chloride may explain the lack of redness, heat, or pain signalling the development of abscesses (hence the term "cold"). Impaired chemotaxis was probably due to an intrinsic neutrophil defect since patient's serum generated normal amounts of chemotactic factors and did not contain an inhibitor of neutrophil chemotaxis. A delay in neutrophil exudation in vivo may explain the abscess formations and the atopic diathesis may explain the absence of clinical signs of inflammation that have been described in this and other patients with Job's syndrome.


Erythema elevatum diutinum. Response to dapsone.

A patient with a 20-year history is presented as a classic example of erythema elevatum diutinum, with a dramatic response to dapsone therapy, and with interesting features of improvement during pregnancies and occurrence of giant cell tumors of soft tissue, neither of these latter features having been previously reported.


Supernumerary areolae.

One of the more unusual forms of supernumerary breast tissue is characterized by the presence of areolar tissue only. The case presented describes a patient with three supernumerary areolae, including one located outside the embryonic milk line. There is a possibility that this finding represents an atavistic phenomenon.


Evaluation of children with ventricular arrhythmias.

Ventricular arrhythmias are rare in childhood but may be associated with syncope and sudden death. This report describes 8 children with ventricular arrhythmias, 6 of whom suffered syncopal episodes. Ventricular tachycardia was documented in 5. One boy died suddenly. Complete cardiac investigation was carried out with exercise testing, Holter monitoring, echocardiography, cardiac catheterization, angiography, and electrophysiological studies. The spectrum of abnormalities related to the arrhythmias included prolapsing mitral valve, prolonged QT syndrome, sick sinus syndrome, congenital heart disease, cardiomyopathy, and idiopathic ventricular tachycardia. Exercise testing and Holter monitoring were particularly useful in documenting the arrhythmias and monitoring response to therapy.


Prognosis of babies with neonatal hepatitis.

105 babies with neonatal hepatitis were studied carefully and followed for up to 11 1/2 years. Ascertainment was complete for those with severe and persistent jaundice, but less complete for mild or anicteric cases. Prognosis was found to be poor (40% death or cirrhosis) in babies with perisitently acholic stools, but relatively good (less than 15% death or cirrhosis) in those with jaundice which was less persistent and less obstructive. The presence of second diseases (including alpha1-antitrypsin deficiency or a family history of other affected children) seemed to play a part in determining poor prognosis. A distinctive group of babies (22 cases) presented with acute fulminant illness (with or without jaundice) in the neonatal period. Cytomegalovirus infection carried a relatively good prognosis. Guidelines for selection of patients for therapeutic trials are suggested.


Apnoea induced by airflow obstruction.

Total obstruction of the airways caused all respiratory efforts to stop on 15 occasions in 10 preterm babies. This was not seen in 60 studies on 38 term babies. These findings suggest that failure to achieve an oral airway may not be the only mechanism by which upper airway obstruction might cause the cot death syndrome.


Congenital abnormalities associated with extrahepatic portal hypertension.

Congenital abnormalities were present in 12 out of 30 (40%) children with extrahepatic portal hypertension of unknown cause, but in only 2 out of 17 (12%) children with extnahepatic portal hypertension secondary to umbilical vein catheterization or omphalitis. The most frequent abnormalities in this series and in published reports were atrial septal defect, malformation of the biliary tract, and anomalous inferior vena cava. These findings are consistent with the view that some cases with extrahepatic portal hypertension are congenital in origin.


Serotonin metabolism in cystic fibrosis.

The average blood serotonin level of 67 children with cystic fibrosis was found to be about twice that of age-matched normal children. There was no corresponding increase in the urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA). Children with cystic fibrosis were well able to metabolize serotonin taken by mouth. No significant correlations were found between the blood serotonin level and the platelet count, height, weight, skinfold thickness, and pulmonary function test, 5 out of 44 patients had raised serum IgE levels, and their mean blood serotonin was higher than in those with normal IgE levels. No explanation for this emerged. Comparable findings (raised blood serotonin normal platelet count, normal urinary 5-HIAA) have been reported only in severe mental retardation. Further study of this phenomenon is warranted because (a) a raised blood serotonin level is sufficiently characteristic of cystic fibrosis to explore its use in diagnosis, and (b) it may help to explain the pathogenesis of cystic fibrosis and (c) the metabolism and function of serotonin.


Errors arising through using the Harvard tables and percentage levels of median weight-for-age in assessing nutritional status.

A self-selected sample of 417 urban and 379 rural preschool children attending the under-5s clinics was weighed in Sierra Leone. The individual weights were related to the weight-for-age Harvard 3rd centiles and 80% levels of the Harvard medians. In this analysis there were considerable discrepancies between the sexes. Further investigation showed that the distribution of the weight-for-age Harvard centiles for girls is much wider than the distribution of the Harvard centiles for boys. These distributions appear to be unusual when compared with those from London and Hong Kong studies. Accordingly, use of the weight-for-age Harvard centiles may lead to inaccuracy in the assessment of the nutritional status of preschool children. The "percentage method" as suggested by Jelliffe (1966) and Gomez et al. (1956) does not take account of the normal range of distribution of the standards. This study has shown that the 80% levels of sex-specific median weight-for-age occupy positions as much as 600 g below the sex-specific 3rd centiles for Hong Kong Chinese children, while the 80% levels closely follow the 3rd centiles for London children in the preschool age group. Thus the Hong Kong 80% levels are not comparable with the London 80% levels. Therefore, the "percentage  method" appears to be misleading in the assessment of nutritional status using weight measurements.


Neurological abnormalities in congenital amaurosis of Leber. Review of 30 cases.

A retrospective study was made of 30 children with Leber's amaurosis (congenital retinal blindness). 24 presented with severe visual impairment, typical ophalmological findings, and absent electroretinograms. 6 other children, though presenting with marked visual loss and absent electroetinograms were later shown to be less severely affected. Some of the more severely affected children had associated neurodevelopmental or renal abnormalities.


Tinidazole in treatment of amoebic liver abscess in children.

Tinidazole as a single drug therapy given in a single dose daily for 5 or 3 days was put to rigorous test in malnourished children. Of 25 children with amoebic liver abscess, 23 were cured. The 2 remaining cases required surgical drainage followed by other amoebicides, one subsequently dying from complicating bronchopneumonia.


Congenital oesophageal stenosis.

A case of congenital oesophageal stenosis presenting shortly after birth is reported. Treatment by daily dilatation with a bead on a continuous thread loop was carried on at home over several months. This proved to be a simple, safe, and effective treatment.


Leptospirosis presenting with erythema nodosum.

An illness due to a leptospiral infection in a boy aged 12 years is described which, in addition to presenting with severe fever, malaise, and aseptic meningitis, showed the rare features of severe bradycardia and erythema nodosum.


Electron microscopic cytochemical demonstration of adenyl cyclase activity in psoriatic epidermis.

Isoproterenol and sodium fluoride stimulated adenyl cyclase activity was detected in epidermal tissue from 2 patients with untreated psoriasis by an electron microscopic cytochemical technique. Adenyl cyclase activity was present on the outer surface of the cell membranes, predominantly in the basal cells and in the 4-5 lower Malpighian cell layers, while the superficial layers, stratum granulosum and stratum corneum showed no activity. The precipitates (lead-PPi complexes) after isoproterenol stimulation were larger and fewer in number than those seen after sodium fluoride stimulation. Isoproterenol stimulation was abolished by propranolol. Neither the uninvolved epidermis from the 2 patients with psoriasis nor the normal skin from 2 volunteer individuals showed any difference from the psoriatic epidermis.


DNA content of mycosis fungoides cells.

DNA content of mycosis infiltrate cells was measured in 5 patients with the Feulgen cytophotometric method in the plaque and tumor stages. In addition, the infiltrate cells were differentiated cytochemically into histiocytes and atypical lymphoid cells with NaF-sensitive naphthol-AS-D-acetate esterase. In no case was an aneuploid stem line demonstrated. However, increasing duration of the tumor stage was associated with a larger proportion of tetraploid and octoploid cells. The DNA histograms also exhibited a local proliferation of atypical lymphoid cells. This proliferation was arrested by cytostatic therapy. Comparison with semi-thin-sections of tumor tissue showed that the mycosis fungoides cells are atypical lymphoid cells. These DNA measurements do not contradict the concept of limited aneuploidy, as reported in cytogenic studies. Thus mycosis fungoides fits in with the DNA distribution pattern in the group of lymphomas.


Analysis of the low part of stress-strain curves in rat skin. Influence of age and desmotropic drugs.

Stress-strain behaviour of skin strips in rats at different ages or after treatment with prednisolone or D-penicillamine has been analyzed. Special attention has been paid to the lower part of the stress-strain curves. A "hump" at an extension degree of 30% of original length was noted. When rats of different ages were compared this phenomenon was observed predominantly at an age of 2 months. Futhermore, this hump was remarkable in rats treated with prednisolone. When the stress-strain curves of rats at different ages or after treatment were averaged and normalized, the most pronounced deviations were found at an age of 2 months or after prednisolone treatment. The maximum of deviation from Hooke's law occurred at a relative extension degree of 70%. Thus, the maturation process and the influence of corticosteroid affected mostly the second part of the stress-strain curve. In order to evaluate further the stress-strain curves 3 consecutive tangents of the stress-strain curves indicating modules of elasticity were evaluated. The first and second modules of elasticity showed a minimum at an age of 2 months, whereas the ultimate elasticity modules increased with maturation up to a maximum at 12 months followed by a decrease similar to that observed in tensile strength at an age of 24 months.


The ultrastructure of lymphadenosis benigna cutis (pseudolymphoma cutis).

In an ultrastructural study supplementing previous histological, cytochemical and immunocytological investigations of lymphadenosis benigna cutis, the tumor is shown to consist mainly of two cell types: Lymphocytes and macrophagocytic (reticulum?) cells. The tendency to spontaneous regression is manifested on the ultrastructural level by pronounced degenerative alterations.


Effects of alkaline on horny layer cellularity.

The microscopical changes of plantar Str. corneum after immersion in alkaline were investigated. For this purpose a test system was used in which unexcised skin of guinea pig hind feet was exposed and subsequently analysed by the FITC-staining method. The effect of KOH on the Str. corneum consisted in an immediate swelling of the outer cell layers which was followed by a further increase in cell volume. Cells became separated layer by layer after maximal swelling. There is a high and constant rate of cell loss, when treated superficial cells are repeatedly removed as compared to permanent immersion. Thus, the buffering capacity of the treated outer cell layers has a rate limiting effect upon alkaline-induced cell loss in the Str. corneum.


[Light- and electron microscopical investigation on the pathogenesis of Kaposi's sarcoma (author's transl)].

In Kaposi's sarcoma (K.S.) the regular metabolism between endothelial cell, extracellular matrix and fibrocyte is disturbed. Thereby the composition of the extracellular matrix change and via a feed-back to the CNS and hormonal system in return changes of endothelial cells and fibrocytes appear. Processing of misinformation sum up in transformation of fibrocytes to tumor cells and destruction of endothelial cells. Initial a widening of the interendothelial borders of the capillary bed seem to be of great importance for the pathogenesis of K.S., because for long time spaces lymphedemas preceed the tumor. With this immunoreactions occur which probably are accompanied by autoimmuno-processes


[The ultrastructure and acid phosphatase activity in the sweat glands with "clear, reticulated cytoplasm" (author's transl)].

Investigations were carried out on the ultrastructure and distribution of acid phosphatase in the human sweat glands with "clear, reticulated cytoplasm". It is probable that the gland cells with vacuolized cytoplasm develop from the serous gland cells through a morphologically recognizable intermediate state. An extralysosomal activity of acid phosphatase occurs in the vacuolized gland cells. The free distribution of the enzyme activity is focal. A correlation between these findings and a possible holocrine mode of secretion is discussed.


Modification of experimental UV erythema by external steroids--a reflex photometric study.

A method for reflex photometric detection of the modification of a model of inflammation (UV erythema) by external corticoids is presented. The steroids which most effectively suppress erythema formation are those which have the strongest vasoconstrictor potency also on unchanged skin. A tachyphylaxis phenomenon can also be demonstrated after several applications of a synthetic steroid to the inflammation model.


Disturbance of DNA-Synthesis in early psoriasis.

In earlier studies we have shown that there is a significant prolongation of DNA-synthesis time (ts) in the epidermal cells of fully developed psoriatic lesions. The present study shows that this prolongation is to be observed even in very early plaques. The prolongation of ts precedes the development of acanthosis. A dermal infiltrate with increased proliferative activity seems to be a stimulus, in the sense of a Koebner-phenomenon. There is no pronounced prolongation of ts in other acute or chronic inflammatory processes of the skin. The behaviour of the infiltrate in psoriasis is similar to that in allergic patch test reaction. However, the abnormal psoriatic epidermis, with disturbed DNA-synthesis, does not react to the above mentioned infiltrate with a limited hyperproliferation but with the development of a psoriatic plaque. There is obviously congenital disturbances of metabolism within the epidermal cells in psoriasis.


Dynamics of mirex and its principal photoproducts in a simulated marsh system.

Three simulated marsh systems were constructed, containing sediment, marsh plants, oysters, blue crabs, fiddler crabs, and two species of top minnows. Seawater entered each of the pools by flowing across a trough, two of which contained Mirex bait. Tidal fluctuations were simulated. Samples of water, bait, and animals were periodically analyzed. All animals concentrated Mirex. Three photoproducts accumulated on the bait particles, and both oysters and one species of fish accumulated one of the photoproducts.


Effect of tetramethyl lead on freshwater green algae.

The toxicity of tetramethyl lead (Me4Pb) towards freshwater algae was studied by bubbling biologically generated Me4Pb from one flask containing 5 mg of Pb 1-1 as Me3PbOAc into the culture medium in another flask where a test alga Scenedesmus quadricauda was grown. As Me4Pb is not soluble in water and is volatile, the exposure of an alga to this lead compound was only momentary. It was estimated that less than 0.5 mg of Pb(Me4Pb) had passed through the culture medium. The primary productivity and cell growth (determined by dry weight), however, decreased by 85% and 32% respectively, as compared with the controls without exposure to Me4Pb. Furthermore, cells exposed to Me4Pb tended to clump together and striking alterations in cell fine-structure were observed. An electron microscopic analysis by an energy dispersive spectrometer revealed that Pb ions had penetrated the cell and were deposited within concretion bodies. Similar results were obtained with the green algae Ankistrodesmus falcatus and Chlorella pyrenoidosa.


Some effects of dieldrin and mirex on Ehrlich ascites tumor cells in vivo and in vitro.

The effects of dieldrin and mirex on Ehrlich ascites tumor cells were assessed, using certain in vivo (in mice) and in vitro measurements. Mirex retarded the development of Ehrlich ascites tumor in vivo, but dieldrin did not. Effects of dieldrin on de nova RNA purine synthesis from formate in vivo were slight, while mirex inhibited the synthesis of both RNA purines. Dieldrin inhibited the in vitro incorporation if thymidine, uridine, and L-leucine into DNA, RNA, and protein, respectively, but mirex was virtually without effect.


Mucociliary transport in chickens infected with Newcastle disease virus and exposed to sulfur dioxide.

Mucociliary transport was studied in the nasal mucous membranes and sinuses of 3-week-old chickens which were either exposed to sulfur dioxide (SO2), infected intranasally with the mesogenic strain of Newcastle disease virus (NDV), or exposed to SO2 after NDV infection. A newly developed apparatus was used to follow intranasal transport rates over time in the same animal, and to follow sinus transport rates over time in a separate group of animals. Intermittent exposure to concentrations of 1.4-66.0 ppm SO2 produced peaks of increased intranasal transport time, with intervening recovery periods. This suggests a homeostatic mechanism. Transport was also decelerated in the sinus when concentrations of SO2 were above 10 ppm. NDV infection produced decelerated intranasal transport rates but did not decelerate sinus rates. Combined NDV and SO2 interacted to produced persistent deceleration of the intransal transport rate. In the sinus, the combination seemed to conteract the decelerating effect of SO2 alone, suggesting a separate mechanism of homeostasis.


Fever of undetermined etiology after cleaning of steam turbine condensers.

Two outbreaks of a febrile syndrome marked by chills, headaches, myalgia, nausea, and malaise occurred in workers who had cleaned the steam condensers of electric power turbines. Mean incubation period was 38 hours. Twenty-two of twenty-three exposed men became ill. Clinical and environmental investigation failed to reveal the etiology of the outbreaks. The circumstances and clinical syndrome have points of similarity to fever following inhalation of metal fumes and low-grade, stained cotton dust, and to Pontiac fever.


Induced rhinovirus infection under controlled exposure to sulfur dioxide.

The interaction between short-term sulfur dioxide (SO2) exposure and experimentally induced rhinovirus infection was studied in thirty-two volunteers divided into two groups balanced with respect to age, antibody levels, and nasal mucus flow rates. One group was exposed to SO2 exposure at the threshold limit value (TLV) of 5 ppm during 4 hours; the other group served as controls exposed to pollution-free air under the same conditions. The SO2 exposure caused a 50% decrease in nasal mucus flow rate in the anterior parts of the nose, but there was no difference in the number of colds which developed in the two groups. The group exposed to SO2 had fewer symptoms and a possibly shorter incubation period (P = .06), and virus shedding was at a lower level but more persistent than in the control group. No differences were found in antibody response. The rhinovirus infection in the control group caused a gradual decrease in nasal mucus flow rate starting 2 days after the virus instillation, and after 5 days the rate was less than half its initial value. For future experiments on the interaction between airborne pollutants and rhinovirus infections, a virus challenge by aerosol inhalation is recommended. Our study supports an earlier observation that growth of influenza virus in the nasal cavity of mice was inhibited by exposure to SO2 concentrations of 6 or 20 ppm.


Trypsin-inhibiting activity in sera of two strains of inbred mice.

Trypsin-inhibiting activity in sera of mice of two inbred strains, AHeJ and P/J, was determined. The mean activities in both groups were identical, namely 0.77 mg of trypsin inhibited by 1 ml of serum. This finding is at variance with an earlier report.


Aerosol inhalation and depth of deposition in the human lung. The effect of airway obstruction and tidal volume inhaled.

Ten patients with chronic bronchitis, whose FEV1.0 varied between 0.48 and 3.00 1, inhaled uniform 5-micronm particles tagged with technetium-99 in tidal volumes (VT) varying between 750 and 1830 ml. Their  chests were scanned after inhalation to ascertain depth of deposition of the particles, and clearance from the lungs was monitored for 5 hr by serial whole-lung gamma counting. A significant inverse relationship (P less than .05) was found between depth of deposition after inhalation (D), measured horizontally across the lung as percentage per inch, and rate of clearance of the particles (5-hr retention [%] = 100- % cleared at 5 hr=69.12-3.02D). This confirmed previous findings. The depth of deposition depended directly on the FEV1.0 and VT (5-hr retention [%] = 0.026VT + 12.67FEV1.0-4.13); this resulted in a 14%-75% range for 5-hr retention. Regression slopes for VT and FEV1.0 were independently significant (P less than .05). The findings suggest that, as commonly administered at present, the therapeutic efficiency of most drugs given be aerosol will be reduced in proportion to the degree of airway obstruction as measured by the FEV1.0. The efficiency can be enhanced by increasing the depth of inspiration of the aerosol.


Species differentiation in the genus Leishmania by morphometric studies with the electron microscope.

Morphometric comparison of some ultrastructural features of leishmanial amastigotes demonstrated species-characteristic differences. These occurred in parameters relating to size, such as diameter and microtubule number; statistical analysis resolved four groups from the seven isolates studied. The results were not inconsistent with previous measurements, mostly with the light microscope, by other workers. The unqualified assertion that Leishmania species are morphologically identical is therefore no longer valid.


Effects of ozone exposure in Canadians and Southern Californians. Evidence for adaptation?

Comparison of published reports on physiological effects of exposure to ozone (O3) suggests that Canadians are more reactive than southern Californians. Responses of subjects and experimental methods were compared in a cooperative investigation of this apparent difference in reactivity. Four Canadians and four Californians were exposed to 0.37 ppm O3 in purified air at 21 degrees C and 50% relative humidity for 2 hours with intermittent light exercise. Exposures to purified air alone served as controls. Responses of subjects were similar to those observed previously: Canadians on the average showed greater clinical and physiological reactivity to exposure than did Californians, who were no more than minimally reactive. Canadians also showed larger increases in erythrocyte fragility following exposure. No methodological differences sufficient to explain different results of previous studies were found. Although other possible explanations have not been ruled out entirely, adaptation of southern Californians to chronic ambient O3 exposure is a rational hypothesis to explain these results.


The ultrastructural changes of Leishmania tropica after treatment with pentamidine.

The effect of the antiprotozoal drug pentamidine on the ultrastructure of the amastigote stage of Leishmania tropica was studied. The most remarkable change introduced by the treatment occurred in the kinetoplast-mitochondrion complex. All mitochondria were extremely enlarged and most kinetoplasts disintegrated into a network of fine filaments. The flagellar pocket was frequently dilated and filled with various quantities of double-membrane bounded bodies ejected from the pocket wall. The multivesicular bodies and lipid droplets were enlarged. The number of ribosomal granules decreased. Many protozoa had an irregular shape and damaged internal structure. The drug-induced changes of L. tropica are discussed in relation to similar effects previously observed in trypanosomes.


The distribution and significance of hepatitis B surface antigen in a rural population in Kenya.

A rural population in Kenya was studied and a prevalence of HBsAg of 5-0% and an antibody prevalence of 50% in HBsAg in negative subjects has been found; 1-2% of the negative subjects converted to positive over a six-month period. A group of HBsAg positive subjects was compared with a matched group of HBsAg negative controls clinically in liver function tests and past medical history. No statistically significant differences were found between the two groups and neither group had experienced in the past significantly more skin scarification, injections or illness with jaundice. Both ad and ay subtypes occurred in the population. This is an unexpected and important finding, which gives scope for further detailed epidemiological studies in this population.


Schistosoma haematobium in a Gambian community. III. The prevalence of bacteriuria and of hypertension.

A field study in an area of intense infection with Schistosoma haematobium showed a 6-6% prevalence of bacteriuria in males under 25 which was significantly greater than in a non-endemic area where no cases were found. In older subjects the prevalence in both areas was less than 1%. Similarly designed studies showed a slight increase in mean blood pressure levels and in the prevalence of hypertension in the endemic area. This could not with certainty be attributed to the effects of S. haematobium and the levels recorded were unlikely to be associated with a poor prognosis. The findings suggest that bacteriuria but not hypertension, may sometimes determine the outcome of S. haematobium infection in this community.


Cysticercosis of the spine.

A former regular soldier who had served in India before the second World War was in 1953-1955 diagnosed as suffering from cysticercosis affecting the brain and spinal cord as well as the muscles. Twenty years later he was found to have sustained severe damage to the lumbar spine, eventually proved due to cysticercosis involving the bones, joints and psoas muscles. The problem of why and how the disease remained active 40 years after the initial exposure remains unexplained. A search of the literature and enquiries from appropriate specialists have failed to produce any record of a similar case.


Cytogenetic observations on translocations in species A of the Anopheles gambiae complex.

The ovarian polytene chromosomes of females of species A of the Anopheles gambiae complex, from colonies suspected of containing heterozygous translocations, were examined. In three lines, the presence of translocations was confirmed and the chromosomes involved in the interchanges identified. The usefulness of cytogenetic methods for the detection of translocations is discussed.


A new Anopheles (Dipt., Culicidae) from Nigeria together with a note on An. brohieri Edwards.

A new Anopheles species of the subgenus Cellia Theobald, named An. cristipalpis, is described from five females caught in human bait catches in Nigeria. A description is also given of three females that are apparently an atypical form of An. brohieri Edwards.


A new operation for far-advanced cystic medial necrosis of the aortic root.

Three patients with far-advanced cystic medial necrosis of the aorta, which had produced giant bulbous enlargement of the aortic root and severe aortic regurgitation, were operated on using a procedure not previously described. Measurements of the aortic valve annulus and ascending aorta were made from aortograms. A knitted polyester arterial prosthesis was sewn together to form a circle. This circular prosthesis was sewn to a 31 mm Björk-Shiley aortic valve prosthesis in the way that a tire is fitted onto a wheel. The resulting composite prosthesis, which had the same diameter as the aortic root, was used to replace the excised valve. In all cases a composite prosthesis measuring greater than 50 mm in diameter was used. In 2 of the 3 patients the ascending aorta was replaced with a tubular graft reshaped as a truncated cone. This reshaping was done by inserting multiple gussets into one end of the aortic prosthesis so that the flanged end fit precisely to the transverse aortic arch. Two patients are asymptomatic more than two years following operation. The third patient died suddenly of a ventricular arrhythmia on the twenty-third postoperative day.


The heparin-coated vascular shunt for thoracic aortic and great vessel procedures: a ten-year experience.

From 1966 to 1976 a flexible, heparin-coated shunt was used for operative procedures on the thoracic aorta and great vessels in 25 patients aged 15 to 78 years. Twenty patients had resection of aneurysms of the descending thoracic aorta. There was 1 death in 15 patients undergoing elective resection and 2 deaths (both from rupturing aneurysms) in 5 patients having emergency resection. The shunt was used in 5 patients who had procedures involving involving the great vessels. There have been no complications attributable to the shunt in either group. The advantages of this shunt include elimination of the need for systemic heparin, avoidance of hypertension during cross-clamping, and adequate perfusion of the distal cirulation without an interposed pump. Because of the ease of handling, low risk, and versatility, we consider the use of this shunt the preferred method for support in elective procedures of the thoracic aorta and great vessels.


Effects of conventional hypothermic ischemic arrest and pharmacological arrest on myocardial supply/demand balance during aortic cross-clamping.

Aortic cross-clamping may produce ischemic damage due to a discrepancy between supply and demand. Supply is determined by noncoronary collateral flow and substrate stores, and demand by electromechanical activity, wall tension, and temperature. The effects of 60 minutes of conventional hypothermic ischemic arrest were compared to those of pharmacological arrest. Noncoronary collateral blood supply was comparable in both groups during cross-clamping. With ischemic arest, mechanical activity and endocardial electrical activity persisted and wall tension fell progressively. With pharmacological arrest, electromechanical activity stopped in less than 1 minute but returned (with increased wall tension) nearly 1 hour. Thirty minutes following reperfusion, coronary flow was redistributed away from subendocardium after ischemic arrest and toward endocardium after pharmacological arrest. Myocardial performance was depressed severely after conventional arrest and only mildy after pharmacological arrest. We conclude that aortic cross-clamping is safer with pharmacological arrest than with ischemic arrest. The cardioplegic solution modifies the supply/demand balance favorably, but it is washed out by noncoronary collateral blood supply.


Thromboembolic complications with the cloth-covered Starr-Edwards aortic prosthesis in patients not receiving anticoagulants.

A comparison of the incidence of thromboembolic (TE) episodes was made in three groups of patient who underwent aortic valve replacement with the cloth-covered Starr-Edwards prostheses. Group 1 consisted of patients who received anticoagulants for either the entire period of follow-up or for a period of variable duration, after which these agents were no longer administered. When anticoagulants were stopped, 22 patients were categorized as Group 3 for study. Group 2 comprised patients who never received anticoagulants. Of the 147 patients followed in Group 1, 14 suffered one episode of TE. Six patients experienced major emboli; 3 of them died. Twenty of the 82 patients followed in Group 2 (no anticoagulants) suffered TE complications. There were 10 episodes of major emboli. Five of the 22 patients in Group 3 suffered an episode (all major) of TE. It is concluded from this study that anticoagulants should be given permanently to all patients with cloth-covered Starr-Edwards prostheses. Indeed, there is no period after operation when the incidence of TE is so low that anticoagulation may be safely discontinued.


Safety and efficacy of continuous flush systems for arterial and pulmonary artery catheters.

Air embolism and static pressure errors have been attributed to continuous infusion systems. Experiments show that the primary source of air bubbles in such a system is the drip chamber. A drip chamber that minimizes this problem was tested and is recommended. Pressure errors due to the flush system are shown to be clinically insignificant. Fast flushing through a central arterial catheter is shown to be a minimal hazard.


Gore-Tex grafts for replacement of the superior vena cava.

In an effort to evaluate polytetrafluoroethylene (Gore-Tex) as a replacement for large veins, tubular grafts of the material were substituted for the precava in 33 mongrel dogs weighing 15 to 30 kg. Thirteen dogs had grafts 10 cm long by 12 mm wide with a 15-to 30 micron pore size; 15 dogs had grafts of the same length and width from 90-micron pore size material; and 5 dogs had grafts 5 cm long by 12 mm wide, of 90-micron pore size Gore-Tex. The effect of Gore-Tex tubes with and without spiral support and the differences in anatomical positions of the grafts were evaluated in terms of patency. Dogs were killed if a venogram showed occlusion of the graft. Twelve dogs survived 90 days; the longest survivor was killed at eleven months. At postmortem examination, the graft was patent but extremely narrow at the atrial end. Modification in the fabrication of Gore-Tex may eliminate factors contributing to graft failure; experiments longer than 90 days are necessary to evaluate Gore-Tex as a large vein replacement material. The 90-micron pore size material used in this experiment was unsuitable as a canine venous substitute.


Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade.

The technique, indications, and results of subxiphoid pericardial window in penetrating chest wounds with suspected traumatic pericardial tamponade are reported. The classic signs of pericardial tamponade (elevated central venous pressure, muffled heart sounds, and paradoxical pulse) are unreliable in an emergency situation. Chest roentgenograms and electrocardiograms are of little diagnostic value. Pericardicentesis was either falsely positive or negative in 50% of our patients. Therefore, unexplained high central venous pressure and hypotension were considered to be pericardial tamponade until disproved by the results of a subxiphoid pericardial window. There were 4 negative and 46 positive findings of tamponade in 50 consecutive patients with suspected traumatic pericardial tamponade who underwent creation of a subxiphoid pericardial window. There were no deaths or complications from the procedures. The early use of subxiphoid pericardial window has been a major factor in reducing our mortality rate from penetrating heart wounds to 12% overall, and 8% in the past three years.


The natural history of long-term cardiac pacing.

During the past ten years, 504 patients have received one or more pacemakers for complete heart block or other arrhythmia. Of these patients, 306 (61%) are alive. Actuarial analysis shows a steady attrition of 9.4% per year for the first five years, decreasing to 7% per year for the second five years. The overall survival was decreased for patients with congestive heart failure and advanced age and was not affected by the history of Stokes-Adams attacks, initial pulse rate below 50 per minute, or a QRS duration greater than 0.12 second prior to pacing. Cardiac problems were the primary cause of death in 71% of the patients. The natural history of patients with permanent pacemakers depends, more than any other factor, on the function of the left ventricle.


Myocardial revascularization and carotid endarterectomy: a combined approach.

The approach to the patient with combined carotid and coronary artery occlusive disease has been evolving since corornary bypass procedures became feasible. When neurological and cardiac symptoms are remote, sequential procedures are adequate. Neurological symptoms or severe carotid stenoses (or both) appearing simultaneously with symptoms of myocardial ischemia present a more difficult problem. Simultaneous operation has been performed in 16 patients with 1 early death (low output) and 2 cerebral complications (1 patient with residual hand weakness and 1 without neurological risidua). The morbidity and mortality seemed unrelated to the fact that procedures were done at one operation. Therapy, however, must be tailored to the individual patient.


Ligation of the patent ductus arteriousus in the newborn intensive care unit.

During a two-year period, 21 premature infants (weight at birth, 680 to 2,340 gm) had operative closure of patent ductus arteriosus (PDA). The first 6 infants had ligation performed in the operating room (OR); the subsequent 15 had ligation in the Newborn Intensive Care Unit. There were no immediate postoperative deaths. Two infants died from problems presnet preoperatively within 30 days postoperatively. There were no infections. Technique in the unit utilizes an open warmer with local anesthesia and a paralyzing agent. By eliminating transportation to the OR one avoids problems with thermoregulation, loss of lines, malfunction of monitors, poorly controlled ventilation, and fluid overload. Additional advantages to ligation in the unit are that the infant is already monitored, intubated, and on a respirator, and that venous and usually umbilical arterial lines are in place. At the conclusion of operation, management is returned to the neonatologists for optimal continuity of care.


Predictable correction of tricuspid insufficiency by semicircular annuloplasty.

During surgical correction of multivalvular lesions, acquired tricuspid insufficiency is best treated by a semicircular annuloplasty technique. In order to achieve an individualized and accurate correction, the tricuspid annuloplasty suture is tied around an obturator, the dimensions of which are based upon Carpentier's tricuspid ring.


Repair of left ventricular-aortic discontinuity complicating endocarditis from an aortic valve prosthesis.

A case of bacterial endocarditis from an aortic valve prosthesis is described in which subannular pseudoaneurysm caused discontinuity of the aorta and left ventricle. Successful repair was accomplished using compound sponge-felt to bolster the left ventricular outflow tract and to obliterate the aneurysm.


Amyloid pseudotumor treated by tracheal resection.

Primary amyloidosis is a rare disease, and even more so when it appears as a tumorlike formation in the lung or tracheobronchial tree. On rare occasions it has been treated by pulmonary resection but never before by tracheal or bronchial sleeve resection. A case of tracheal sleeve resection for tumorlike amyloidosis is reported. If the lesion is well circumscribed to a relatively short tracheal or bronchial segment, sleeve resection appears to be a satisfactory and economical solution. However, the problem of a mucosa undermined by amyloid deposits above and below the tumorlike lesion entails the risk of anastomotic stenosis. For this reason in future cases, particularly those with extensive involvement, piecemeal endoscopic removal should be considered as the method offering the best prognosis and least risk.


Tandem coarctations of thoracic and abdominal aorta with intervening hypoplastic thoracic aorta: treatment with unilateral axillofemoral graft.

Tandem coarctations of the thoracic and abdominal aorta with an intervening segment of hypoplastic thoracic aorta were discovered unexpectedly in a 14-year-old boy brought to the emergency room for a displaced fracture of the radius. After the fracture healed, the boy's potentially dangerous anomalies were treated successfully with a unilateral axillofemoral prosthetic graft. This has remained patent for 42 months, and the boy has done well.


An infant intracardiac suction instrument.

An infant intracardiac suction instrument that neither sticks against the heart wall nor obscures the operative field is described.


Effects of adrenaline, angiotensin, potassium and calcium on lanthanum treated portal veins.

Lanthanum (La) [3 X 10(-4M] suppressed spontaneous phasic contractions of the islated rat portal vein. Removal of La from the bath solution did not restore this effect. La treated quiescent veins developed dose-dependent contractures after cumulative exposure to adrenaline, angiotensin or K. It then became possible to obtain S-shaped curves relating K concentration to tension development. This relationship was shifted to the left by increasing Ca or decreasing Na concentrations of the incubation medium. Ca dose-response curves were obtained out on previously Ca-depleted La treated veins after stimulation by K, adrenaline or angiotensin. Curves from veins exposed to adrenaline were placed to the left compared with those exposed to depolarizing solutions. This observation supports the view that drugs such as adrenaline may act by increasing Ca inward movement through the plasma membrane beyong that elicited by mere depolarization. Angiotensin evoked small contractile responses, thus showing that La treatment exerts differential blocking effects on the responses to vasoactive compounds.


Hemodynamic profile of a new cerebral vasodilator, vincamine and of one of its derivatives, apovincaminic acid ethylester (RGH-4405).

The hemodynamic modifications induced by vincamine and by one of its derivatives, apovincaminic acid ethylester (RGH-4405), have been studied in anesthetized and conscious dogs. The two alkaloids induced peripheral vasodilatation in all the experimental models, but their action on systemic blood pressure and heart rate was clearly influenced by anesthesia and was different according to the anesthetic used. In the conscious animals an increase of both heart rate and systemic blood pressure was observed, concomitantly with an increase in femoral and vertebral blood flow and a decrease in renal blood flow. In the renal vascular bed a subsequent decrease in resistance was shown, when all the other measured hemodynamic parameters had returned to control values. The greater increase of vertebral blood flow than of femoral blood flow for the same increment of cardiac output was taken as an indirect demonstration of the selectivity of the two drugs for the cerebral circulation.


Hypotensive effects of pentobarbital and diuretics on sympathectomized spontaneously hypertensive rats.

The upper abdominal sympathetic chain with the splanchnic nerve was removed bilaterally in spontaneously hypertensive rats(Okamoto-Aoki). After recovery from the operation, the sympathectomized spontaneously hypertensive rats were as hypertensive as intact or sham operated ones. However, anesthesia with pentobarbital or administration of diuretics induced a significantly greater fall of pressure in the sympathectomized hypertensive rats. The hypotensive effect of either drug was insignificant or considerably small, if present at all, in sympathectomized normotensive control rats. It seems that, in intact spontaneously hypertensive rats, the hypotensive effects of pentrobarvital and diuretics are compensated for by a reflex activation of the abdominal sympathetic nerves.


Effect of indomethacin and cyproheptadine on onset of labour in rats.

An attempt was made to postpone term in 59 pregnant rats by s.c. injections of indomethacin or cyproheptadine, or a combination of both. The cyproheptadine group gave birth to their litters on days 20-22, yet indomethacin postponed labour to the 23rd day, both when given alone or in combination with cyproheptadine. As the fourth saline group went into labour on the 20--23rd day the indomethacin postponement cannot be considered significant. Indomethacin being a prostaglandin antagonist and cyproheptadine a serotinin antagonist, it may be concluded that neither prostaglandin nor serotonin are decisive for the intricate process which triggers parturition. Other factors, such as decrease of progesterone, increase of oestrogen and perhaps foetal oxytocin, as well as placental ACTH, seem to concur in inducing labour, their effect being fortified by serotonin and prostaglandins during parturition.


Electrocorticographic effects of topically applied ouabain, epinephrine and bicuculline.

The effects of topically applied ouabain, epinephrine and bicuculline on the electrocorticographic activity were studied in unanesthetized cats with high cervical transection. Ouabain in a concentration of 25 X 10(-6) induced single intermittent spikes or paroxysms lasting for about 4-10 min. A 5% solution of bicuculline also induced paroxyms which lasted for many hours and were suppressed by topical epinephrine. Ouabain paroxysms became more vigorous when applied after epinephrine and bicuculline. Topical epinephrine dimished the ouabain discharges and the click evoked cortical responses. It is suggested that the epileptogenic activity of ouabain and bicuculline and its antagonization by epinephrine can be accounted for by the antagonistic effects of these agents on the electrogenic ion pumps such as inhibition and stimulation of the (Na + K) ATPase activity, respectively.


Inhibition of glucosamine synthesis by salicylates, hydrocortisone and two non-ulcerogenic drugs.

The in vitro inhibition of the glucosamine synthetase activity of rat gastric mucosal homogenates by sodium salicylate and phenylbutazone has been previously reported and has been adduced as a possible mechanism for the ulcerogenic effect of these drugs. This inhibition has been confirmed in human gastric and colonic mucosal homogenates and it is also shown by acetylsalicylic acid and by hydrocortisone hemisuccinate. However, paracetamol and gentamicin, neither of which is known to be ulcerogenic, also inhibited the enzyme to a similar degree to the ulcergenic drugs. This refutes glucosamine synthetase inhibition as the mechanism of the ulcerogenic action of anti-inflammatory drugs.


Mediation of enhanced reflex vagal bradycardia by L-dopa via central dopamine formation in dogs.

L-Dopa (5 mg/kg i.v.) decreased blood pressure and heart rate after extracerebral decarboxylase inhibition with MK-486 (25 mg/kg i.v.) in anesthetize MAO-inhibited dogs. In addition, reflex bradycardia caused by injected norepinephrine was significantly enhanced by L-dopa, DL-Threo-dihydroxyphenylserine had no effect on blood pressure, heart rate or reflex responses to norepinephrine. FLA-63, a dopamine-beta-oxidase inhibitor, did not have any effect on the hypotension, bradycardia or reflex-enhancing effect of L-dopa. Pimozide did not affect the actions of L-dopa on blood pressure and heart rate but completely blocked the enhancement of reflexes. Removal of the carotid sinuses caused an elevation blood pressure and heart rate and abolished the negative chronotropic effect of norepinephrine. However, L-dopa restored the bradycardia caused by norepinephrine in addition to decreasing blood pressure and heart rate. 5-HTP (5 mg/kg i.v.) decreased blood pressure and heart rate and decreased the reflex bradycardia to norepinephrine. It is concluded that L-dopa enhances reflex bradycardia through central alpha-receptor stimulation. Furthermore, the effects are mediated through dopamine rather than norepinephrine and do not require the carotid sinus baroreceptors.


Acute glomerulonephritis complicating diabetic nephropathy.

Diabetes mellitus is a systemic disorder that affects many organs in the body. Diabetic nephropathy occurs a number of years after the onset of the disease, and it is usually manifested by the development of the nephrotic syndrome. However, the sudden onset of massive proteinuria or the rapid deterioration of renal function in the stable diabetic patient should suggest that an additional pathologic condition is affecting the kidneys. We report three cases of diabetic nephropathy complicated by other superimposed renal diseases.


Diagnostic value of bone marrow iron deposits in idiopathic hemochromatosis.

The stainable iron content of the bone marrow of four patients with documented idiopathic hemochromatosis were reviewed. There was a moderate increase in hemosiderin deposits in each case, but the striking difference in the morphologic appearance of these deposits was more important. These consisted of small, uniform, closely packed granules that may be readily distinguished from the bone marrow iron found in normal persons and in persons with other disorders. This should serve as an additional simple diagnostic aid in patients with idiopathic hemochromatosis.


Pancreatolithiasis and pancreatic carcinoma. Evaluation of pancreatic excretion test with 5,5-dimethyl-2,4-oxazolidinedione.

The pancreatic excretion test with a weak acid of 5, 5-dimethyl-2,4-oxazolidinedione (DMO) was performed concomitantly with the pancreozymin-secretin test in 28 patients with pancreatolithiasis, 14 patients with pancreatic carcinoma, and 67 healthy subjects. The DMO concentration and total output of duodenal content after secretin stimulation, when corrected to the simultaneously determined plasma DMO concentration, were significantly reduced in the patients. While the pancreozymin-secretin test was abnormal in 96% of patients with pancreatolithiasis and in 86% of those with pancreatic carcinoma, the pancreatic DMO excretion test gave abnormal results in 100% of the patients. This suggests that the new test may well become effective in detecting early stages of pancreatic disease including carcinoma and chronic pancreatitis.


Aspergillus pneumonia in hematologic malignancy. Improvements in diagnosis and therapy.

Pulmonary aspergillosis in patients with leukemia or lymphoma is usually a fatal infection. However, difficulty in obtaining a premortem diagnosis has often prevented an adequate trial of anti-fungal chemotherapy. In this report, nine cases of aspergillus pneumonia in patients with hematologic malignancy were diagnosed during a one-year period. Five of nine patients had a premortem diagnosis (56%) and eight of nine (89%) received a premortem trial of amphotericin B. Two of nine patients survived infection, including one patient with prolonged neutropenia. Better diagnostic methods and wider use of antifungal chemotherapy may improve prognosis for aspergillus infection in patients with hematologic malignancy.


Essential hypertension. Pathophysiological mechanisms and therapy.

It is now possible, with the variety of available antihypertensive drugs, to treat patients with essential hypertension according to which physiologic mechanism seems to be participating most in elevating arterial pressure. This mechanistic concept of hypertension is not new. Page described it in his Mosaic Theory, and thereby suggested that hypertension may be considered a disease of disregulation. This concept is extremely valuable to the physician in understanding the altered function in his patient caused by disease, and in understanding how judicious selection of antihypertensive therapy will reverse the dire consequences.


Treatment of sickle cell disease.

The treatment of sickle cell disease requires familiarity with the medical manifestations of the vaso-occlusive and hematologic crises and their complications. This discussion deals with treatment of the sickle cell crises and major clinical manifestations of the disease. At present, treatment is primarily symptomatic despite intensive efforts during the past decade to provide more definitive therapy.


Pheochromocytoma and autonomic dysfunction.

Patients with hypertension due to the release of large amounts of NE from a pheochromocytoma and patients with PAD and postural hypotension due to diminished NE release from adrenergic axon terminals represent the extremes of the spectrum of adrenergic pathophysiolgic findings. It is reasonable to suspect that some more common disorders lie between these extremes and to anticipate that potential roles of the adrenergic nervous system in the pathogenesis of these disorders will be extensively studied with the availability of sensitive isotope-derivative methods for the measurement of catecholamine levels in plasma and in tissue.


Vegetative bacterial endocarditis on the prolapsing mitral valve. Echocardiographic evaluation.

Vegetative endocarditis on the prolapsing mitral valve can be diagnosed with an echocardiogram and the response to therapy can be followed with this technique. A dense mass of fuzzy echoes was noted on the prolapsing posterior leaflet of an echocardiogram from a patient with endocarditis. Three months after the initiation of antibiotic therapy, the mass of echoes had disappeared and was replaced by a dense linear echo, suggesting fibrosis of the part of the mitral valve that had been infected previously. Persistence of the echocardiographic evidence of endocarditis, despite negative blood cultures, may indicate persistence of the risk of peripheral embolization.


Hepatic necrobacillosis. Report of a case resembling metastatic tumor.

A 47-year-old man had multiple pyogenic liver abscesses from which the anaerobic bacteria Fusobacterium nucleatum and Peptostreptococcus were isolated. The clinical course, diagnostic evaluation, and appearance of the lesions at surgery suggested metastatic tumor. Histologically, the lesions consisted of necrotic liver tissue surrounded by zones of acute and chronic inflammation and fibrous connective tissue closely resembling the lesions of hepatic necrobacillosis attributable to F necrophorum. Treatment with high doses of penicillin was curative.


Growth hormone levels in acromegaly after external radiotherapy.

A 56-year-old acromegalic patient was treated with conventional radiotherapy. One year after treatment, the patient's growth hormone level was normal and remained so for a full year. Subsequently, the growth hormone level returned to the pretreatment, acromegalic range. The attainment of a normal growth hormone level after treatment of acromegaly is no assurance that the level will remain normal. Repeated growth hormone level determinations are necessary before cure can be considered permanent.


[Adrenal cysts in the newborn. Apropos of 2 cases].

Cysts of the adrenal gland are very rare in the neonatal period and are always diagnosed either at surgery or at autopsy. Two patients are reported. One is an infant born at term in whom a mass in the left loin was discovered on the 3rd day of life. At surgery a suprarenal tumour was discovered and a polycystic adrenal was removed: recovery was uneventful. Histology showed a cystic haemangioma in the adrenocortical tissue. The diagnosis made was that of a cystic haemangioma. The other patient is an infant born at 38 weeks gestation who became jaundiced and developed a haemolytic streptococcal septicaemia. A mass was found in the right lumbar region on the 3rd day. The calcified egg-shell appearance, renal arteriography and an intravenous pyelogram demonstrated the cystic appearance of the adrenal. The cystic mass and the adrenal gland were removed and the patient recovered. Histological examination suggested that a pseudocyst had arisen secondary to a haemorrhagic infarct caused by a septic embolus. Adrenal cysts are classified as true cysts and pseudocysts (which must be distinguished from unilateral haematomas). The histological appearances are reviewed. These patients may be added to the 11 neonatal case reports in the literature (9 haemorrhagic pseudocysts, only 2 true cysts). To our knowledge cystic haemangioma has not previously been reported.


Hypotension due to chlorpromazine. Relation to cigarette smoking, blood pressure, and dosage.

The frequency of hypotension attributed to orally administered chlorpromazine hydrochloride was compared among 187 nonsmokers, 223 "light" smokers, 87 "intermediate" smokers, and 18 "heavy" smokers. Hypotension attributed to the drug occurred in10%, 8%, 5% and 0%, respectively. Other factors found to be independently related to hypotension were high diastolic blood pressure on admission and high dosage of chlorpromazine. The results suggest that smoking status, dosage, and blood pressure must be evaluated in order to estimate the likelihood that a patient may become hypotensive after receiving chlorpromazine.


A comparison of voluntary and committed psychiatric patients.

This study compares a set of voluntary and committed patients. At the time of hospitalization, the committed patients had fewer social and economic resources and more serious impairments. In general, the type of hospitalization appeared to be primarily a consequence of the nature and severity of the patient's disorder. In the hospital the two sets of patients received fairly comparable treatment and the differences that did occur would appear to be attributable to a difference in the patients' disorders. Both types of patients experienced some improvement following hospitalization in their instrumental roles, and a very discernible improvement in their interpersonal roles. As the very slight differences between the two types of patients tended to favor the committed patients it seems quite clear that the commitment process did not have long detrimental effects.


An assessment of hostility in a population of adolescents.

In the course of an epidemiological survey of adolescents, the Hostility and Direction of Hostility Questionnaire was administered to 6,709 persons aged 13 to 18 years, representing 89% of secondary school students in Hobart, Tasmania. Extrapunitiveness was found to decrease substantially between the ages of 15 and 17 years in both sexes. Intropunitiveness also decreased, although to a lesser extent. Girls were less extrapunitive and more intropunitive than boys over the whole age range. These findings are discussed in relation to their clinical relevance and to the understanding of psychiatric disorder in adolescents.