[Primary epiretinal gliosis (author's transl)].

Analyzing the findings of 45 patients with primary epiretinal gliosis in 51 otherwise entirely healthy eyes, the clinical features of the disease are elaborated. The disorder is characterized by the occurance of a glial membrane covering the retina in the area of the posterior pole and leading to a distorsion of the posterior pole and leading to a distorsion of the subjacent and surrounding tissues. Most frequently, the foveal region is involved, but the foveola is often spared. With increasing distance from the center the frequency of involvement decreases. Only in very rare cases the membrane extends beyond a distance of 5,5 mm from the center of the retina. The density of the membrane varies from case to case. Average visual acuity of the eyes evaluated in this study was 0,45. In no case it was worse than 0,05. The incidence of the disease increased with both increasing myopia and hyperopia. The average age of the patients was 55 years. There was no predominance of either men or women. The glia cells which compose the membrane originate from the innermost layers of the retina, from where they extend on the retinal surface through a defect in the inner limiting membrane. The reason for the formation of the defects is not yet understood. It is also unknown if the presence of such defects is absolutely necessary for the development of this condition.


[Retinal detachment following central vein occlusion. A comparative study by means of angiography and histology (author's transl)].

The comparison of the angiographic and histologic findings following central vein occlusion in a 42-year-old male suffering from arterial hypertension leads to the conclusion that a secondary arrhegmatic serous retinal detachment may be caused by a separation of the pigment epithelium with multiple defects in this layer.


[On the operative treatment of tear opening atresia (author's transl)].

The authors describe a method of identifying and opening tear canaliculi when the openings are closed. For this purpose the common canaliculus under the medial palpebral ligament by the lateral wall of the tear sac is exposed by lamellar dissection under the microscope and opened. The roof of the tear point (where the tear opening should be) is excised over conical sounds laid retrogradely. Finally a vein catheter is placed from the upper and lower tear duct openings through the tear sac into the nasal cavity and left in situ for 12 weeks.


[Biological compatibility of soft contact lens materials (HEMA) (author's transl)].

After implanting a disc (0,25 mm thickness and 1,5 mm diameter) of soft contact lens materials ("Soflens", "Hydroflex", "Hydron") in the anterior chamber of rabbits through a lancet incision, the reactions of iris, aqueous and cornea were observed for six months at regular intervals with slit lamp photograph. At the place where the disc touched the iris one could see during half a year periodic hyperaemia iridis and foreign-substance-granuloma of the iris. The cause of these reactions is a toxin in the HEMA. The reactions are more intense than with PMMA.


[On the structure of the pigment epithelium proliferation over malignant melanoma of the choroid (author's transl)].

Proliferations fo the retinal pigment epithelium over malignant malanoms of the coroid were examined in the following regions: 1. at the posterior pole, 2. in the equator region, 3. in the ora region. The pigment epithelial cells exist in each proliferation in a differently marked pattern of mono- and double layers. Furthermore the proliferations show a varying amount and localisation of a fine fibrillar substance. The majority of the proliferated pigment epithelial cells at the posterior pole are loosely arranged to mono and double layers. Fine fibrillar substance occurs only adjacent to the mono-layers. The proliferation at the equator has a more distinct layering of the cells. The fine fibrillar substance is mainly located between the two layers of double layered cell complexes. The proloferation in the ora-region is characterised by numerous flat mono- and double layers which are embedded in fine fibrillar substance.


[Concentration dependent effect of 5-ethyl-2'-deoxyuridine on experimental and clinical herpetic keratitis (author's transl)].

Concentration dependent effect of 5-ethyl-2'-deoxyuridine (EDU) on epithelial regeneration and on herpes keratitis in rabbit has been studied. Successfull completion of the experimental studies was followed by clinical treatment of 10 otherwise therapy resistent metaherpetic cases using 2% EDU eye drops and 0,5% subconjunctival injections. With nine patients under this therapy improvement and healing of the corneal processes was achieved.


[Checking and clinical application of time gain compensation (TGC) in diagnostic ultrasonography (author's transl)].

The usefulness of TGC depends on the scanning technique. The A- and B-scan echograms of the orbit can show much more detailed information of the orbital structures, if TGC and a corresponding scanning technique are applied. The sound beam should be directed preferably through the center of the eyeball to keep the length of vitreous within the sound beam constant. The external eye muscles, orbital fat and optic nerve can much better be identified and localized. Radiolucent orbital foreign bodies (wood splinters) were experimentally examined and could also be shown much better using TGC. The TGC characteristic must be measured for reproducible adjustments. The scale readings of the apparatus are insufficient. Even in apparatus supplied with an indication of the TGC characteristic on the screen checking of the real TGC characteristic proved necessary. A simple measurement technique, easily applicable under hospital conditions is described. It is based on a test reflector made from material for soft corneal contact lenses (testreflector W 38, Poly-HEMA, 38% water content.


[Bone marrow diagnostic in hairy cell leukaemia (author's transl)].

Evaluation of the histologic changes of the bone marrow and clinical data of twelve male and two female patients with hairy cell leukamia before treatment. Mean age of the patients was 46 years, time from the onset of symptoms 5.5 months. 13 of the patients were anaemic, showing splenomegaly, 12 suffered from thrombopenia, 9 from granulocytopenia, and 8 from hepatomegaly. In all of the cases, the relative numbers of lymphocytes in the blood had been increased together with various amounts of characteristic hairy cells. All of the cases had a typical histologic picture of lymphocytic bone marrow infiltration, mostly of the diffuse type. In 50% of the cases not only the well known rod-like intracellular inclusions could be seen, but also ring-shaped figures whose significance is discussed. Decrease of the granulopoiesis, disintergration of the marrow sinusoids, and osteoporosis are the most important additional signs. The progression of the disease is marked by increasing bone marrow infiltration, by splenohepatomegaly, anaemia, thrombopenia, and increasing numbers of typical lymphocytes in the blood. The bone marrow being considered to be the origin of the disease for good reasons, the histobiopsy of this organ ranks among the diagnostic and prognostic measures to be taken at first sight.


[On the mechanism of ascorbic acid induced methemoglobin reduction of human erythrocytes (author's transl)].

Ascorbic acid and dehydroascorbic acid penetrate the human erythrocyte membrane. In vitro methemoglobin is reduced nonenzymatically by both substances in concentrations of 10(-2) M to 10(-3) M. Dehydroascorbic acid is reduced nonenzymatically to ascorbic acid by GSH, even with low GSH-content of erythrocytes. Under physiological conditions ascorbic acid induced methemoglobin reduction is far less important than reduction by the NADH dependent methemoglobin reductase system. In methemoglobinemic conditions caused by toxic effects or by congenital methemoglobin reductase deficiency treatment with ascorbic acid is possible. However, critically increased methemoglobin content of the blood higher than 30% makes therapy with methylene blue necessary.


[The enzymatic determination of maltose in blood (author's transl)].

An enzymatic method for the determination of maltose in blood is described. In this method after neutral deproteinization the assay is carried out by the hexokinase technique [6--7] after splitting of the maltose with alpha-glucosidase [8]. This time-saving procedure of high specificity and  sensitivity requires only small volumes of blood. The practicability of the method is shown by analysis of blood level during an infusion of maltose.


[Raised plasma-prolactin levels in essential hypertension: index of reduced hypothalamic dopaminergic activity (author's transl)].

Serial measurements of plasma-prolactin concentration (HPr) and plasma-renin activity (PRA) at 30-min intervals were made in 19 male patients with essential hypertension and in 8 normotensive subjects. HPr was markedly higher in the hypertensive patients than in the normotensive controls. Patients with reduced plasma-renin activity and only slightly elevated HPr-levels showed lower urinary sodium excretion, but a more pronouced 24-h natriuretic response to i.v. furosemide than patients with normal renin and very high HPr-levels. Six patients were treated with the dopaminergic agonist bromocriptine. The drug induced a significant blood pressure reduction in five patients and normalised pressure in two patients. The data do not indicate a role for prolactin in sustaining hypertension via renal salt retaining mechanisms. It is suggested that the raised HPr-levels represent an index of altered central nervous function, characterized by reduced hypothalamic activity. The blood pressure-lowering effect of the dopaminergic agonist bromocriptine fits with the hypothesis that reduced hypothalamic dopaminergic activity might be a factor in the pathogenesis of essential hypertension.


[Carbenicillin induced disturbance of platelet function: a study in patients with normal renal function (author's transl)].

After therapeutic doses of carbenicillin (3X10 g/24 h) prolongation of bleeding time, measured according to Ivy, was observed (median time prior to therapy 4 min 08 s-4 min 18 s; 24 h after therapy 15-20 min; 72 h after therapy greater than 30 min) in 5 patients with normal renal function and 2 patients with slight impairment of renal function (Ccr60-70 mlX1.73 m(2)). Prolongation of bleeding time was observed at serum concentrations between 13 and 180 microgram/carbenicillin/ml. After carbenicillin was withdrawn, prolongation of bleeding time was demonstrable for 4 days, i.v. even after the drug had been eliminated completely by urinary excretion. Higher doses of carbenicillin caused more severe disturbances of platelet function. The finding of prolonged bleeding time after carbenicillin may have clinical relevance (e.g. interaction with other anticoagulants, p.o. wound bleeding, gastro-intestinal hemorrhage, thrombopenia).


[Morphological and functional studies in a case of primary (idiopathic) thrombocythaemia in childhood (author's transl)].

Primary (idiopathic) thrombocythaemia is a rare disease in childhood. Haemorrhagic diathesis and splenomegaly are principal findings besides thrombocytosis. The cases of a nine year old girl with thrombocyte levels between 2.8 and 4.5 X 10(6) microliter is described. The examination in light and electron microscopy revealed various morphological abnormalities in thrombocytes and megakaryocytes. Platelet function was disturbed in various degrees. The impact of functional abnormalities on the haemorrhagic diathesis is discussed. The findings in this child were compared to those of the better characterized picture of primary and secondary thrombozytosis in adulthood. Possible pathogenic relations to myeloproliferative diseases are also discussed.


Functional properties of mahaim fibers.

Electrophysiological studies were performed in a patient with a short P-R interval and a small delta wave. The findings suggest that ventricular pre-excitation resulted from an infranodal bypass (Mahaim type). As the functional properties of the pathway were evaluated, impaired conductivity (suggested by rather long refractory periods) became apparent at frequency stress. The pathway could easily be blocked by Ajmaline. This demonstrated an unexpected early diastolic improvement in conductivity; i.e. a supernormal phase of conduction. Due to this supernormal phase, Mahaim-fiber conduction was present when block in the anterior division of the left bundle branch, or even trifascicular block occurred. Thus the effects of exclusive Mahaim-fiber conduction on ventricular activation were documented.


The diagnostical significance of antibodies against hepatitis B core antigen.

The frequency of hepatitis B was examined using three serological parameters: HBsAg, antiHBs and antiHBc. All three substances were detected qualitatively by means of sensitive radioimmunological techniques. Of 1216 patients with acute hepatitis, 55 percent were HBsAg and antiHBc positive on admission to hospital. A further 17.8 percent had no HBsAg but were antiHBc  positive and also partly antiHBs positive. These cases can be divided into 2 groups: In one group, in 8.6 percent of patients had a high antiHBc concentration during the acute phase. Similar antiHBc concentrations were seldom found (0.04 percent) in HBsAg negative blood donors. AntiHBs in the patients was at first mainly negative and then appeared during reconvalescence. These cases were considered to be acute hepatitis type B, although HBsAg was absent. In the second group, comprising 9.2 percent of the patients, antiHBc was present in low concentrations and in majority of cases antiHBs had been present from the beginning. The same antibody constellation was found in 3.6 percent of 2341 blood donors. In the group of patients it is supposed that the acute hepatitis present is not of type B and has a different aetiology. The low concentration of antibody is interpreted to be a sign of an earlier HBV-infection.


Inclusion body myositis. A "slow-virus" infection of skeletal musculature?

We report the case of a 56-years old patient with clinical symptoms of an unresolved neuromuscular disease. The light microscopic studies of a muscle biopsy from the m. triceps shows the picture of a diffuse muscular atrophy. By electron microscopy, myelin-like degeneration zones with tubular-filamentous inclusions can be shown in the cytoplasma of the atrophic muscle cells. These filamentous structures correspond morphologically to the nucleocapside of paramyxoviruses. These results lead, even without the proof of inflammatory cells, to the diagnosis of an "inclusion body" myositis also taking into account the clinical and electrophysiological findings.


Serum protein-bound carbohydrates in aging men and women.

Carbohydrate components of serum glycoproteins were analysed in 162 men and 48 women of various age groups. All components studied, namely amino-sugars, hexoses and neuraminic acid increased with age in men. In women only the hexoses level increased with age while the contents of amino-sugars and of neuraminic acid decreased with age, especially after the age of 30. The statistical analysis showed that women had a higher content of hexoses and a lower one of neuraminic acid than the men of the same age groups. The amino-sugar content was higher in women up to 30 years and lower in older women in comparison to men. It is assumed that these changes are due to changes in the steroid hormones with age.


[Action of benzbromarone on the renal excretion of allantoin in normouricemic and hyperuricemic humans (author's transl)].

Oral administration of benzbromarone at daily doses of 100 mg or 300 mg over a period of 3 or 6 days does not produce a significant change of the excretion rates of allantoin in the 24-h-urines of humans in a normouricemic or hyperuricemic state. Threrefore, the theroretically improbable assumption that benzbromarone may induce an increased elimination of uric acid by an enteral pathway cannot be accepted any longer. Failing additional direct effects upon purine metabolic pathways (Sorensen and Levinson, 1976) benzbromarone exerts its hypouricemic action solely by uricosuric properties.


Identification and genetic monitoring of mouse inbred strains using biochemical polymorphisms.

53 inbred strains and substrains of mice from 3 institutes in The Netherlands were examined at 12 chromosome loci coding body protein-polymorphism Es-1, Es-2, Es-3, Es-5, Gpi-1, Hbb, Id-1, Ldr-1, Mpi-1, Mup-1, Pgm-1, Trf). The allelic variation at 7 loci could be detected simultaneously. Within each institute most strains showed a unique combination of alleles at the 12 loci involved. Some nominally similar (sub)strains showed allelic divergence. One strain showed allelic variation at 4 loci. These findings emphasize the possibility and the necessity of monitoring the genetic purity of inbred strains of mice. A routine monitoring scheme using body protein-polymorphisms is proposed.


Inhibition of bacteria in mouse drinking water by chlorination.

Experience with the use of mouse drinking water containing chlorine is discussed. With an initial concentration of 5 p.p.m. bacteria were recovered from the bottles after 7 days and there was considerable growth in untreated bottles. Above this concentration no bacteria survived. It is recommended that 15-20 p.p.m. chlorine are used for practical purposes.


Isolation of Encephalitozoon cuniculi from urine samples.

Encephalitozoon cuniculi was isolated from the urine of infected rabbits using human and canine tissue cultures. The organism was isolated from 7 of 11 contaminated urines from seropositive animals. The advantages of urine over tissue as a source of E. cuniculi are that it is obtainable from living animals, can be examined for the presence of organisms, and is essentially free of cells likely to overgrow the tissue cultures used for isolation.


Structure of the normal rat larynx.

Recent studies have shown the rat larynx to be an important organ in the evaluation of irritancy of inhaled materials. Serial sections and scanning electron microscope observations have clarified its basic structure. In particular the cartilage pattern and the distribution of the epithelia lining the lumen have been determined. There are 2 specialised epithelia--stratified squamous (found in areas subject to wear) and ciliated pseudostratified columnar (which produces and transports mucus). Aways intervening between these is an unspecialised epithelium, the non-ciliated columnar. The marked variation in type of epithelium over a short distance within the larynx emphasises the need to take sections in the same plane when comparing different specimens.


Effect of autoclaving and physical structure of diets on their utilization by mice.

A pelleted and 2 expanded rodent diets were autoclaved at 121 degrees C for 20 minutes, and fed to DBA/1 and LACA strains of mice. Reproduction was not significantly different on any diet and autoclaving had no effect other than increasing the intervals between litters. However, apparent food consumption was greater and efficiency of food utilization (expressed as young weaned/diet consumed) was poorer in mice fed pelleted diets. Diet had no significant effect on growth, but food wastage and consequently apparent food consumption were less and food utilization more efficient when expanded diets were fed. In addition, true food consumption was lower and food conversion more efficient. Autoclaving had little effect on expanded diets but caused a significant reduction in wastage and in apparent and true consumption of the pelleted diet, perhaps because of increased hardness.


Influence of diet pellet hardness and particle size on food utilization by mice, rats and hamsters.

Increasing hardness of diet pellets reduced food wastage by each species. Also, less wastage occurred when pellets made from finely ground materials were given, an effect that was not related to hardness. The hardest diet reduced growth of the mice by reducing true food consumption and a poorer food conversion efficiency (true food consumption/growth) was obtained. Apparent food consumption increased with the softness of the diet and food utilization (apparent food consumption/growth) of the softest diets was less efficient than those of the others. Grinding of the raw materials prior to pelleting had no effect on food conversion, but food utilization was less efficient because of the greater wastage of pellets from coarsely ground materials and consequent apparent food comsumption.


Abnormal urogenital organs occurring spontaneously in inbred ACI and Kyoto-notched rats.

Spontaneous malformations of urogenital organs found in inbred rat foetuses of ACI/NHok strains were further investigated with a postnatal survey involving other inbred strains. A new type of malformation occurred in Kyoto-notched rats. The present findings suggested that the malformations have different hereditary characteristics caused by different maldevelopmental mechanisms and are probably due to recessive polygenes.


Brain and spinal cord lesions in the newborn rat.

Previous studies involving the induction of central nervous system lesions in animals have required complex, expensive equipment including sterotaxis and an operating microscope. This study describes a technique for producing telencephalic (forebrain) lesions in the developing rat by the use of copper wire. In addition, a nonvisual method of producing spinal cord transections in the young rat is discussed. Both techniques have a high succes rate and minimal mortality.


Staphylococcal kidney abscesses in rats treated with corticosteroids.

A heavy growth of Staphylococcus aureus was isolated from kidney abscesses in rats from 2 inbred strains treated with corticosteroids. The S. aureus phage types which caused the abscesses are endemic in the rat breeding colonies. One strain of rat was more sensitive to the action of the corticosteroids.


Extracorporeal circulation (ECMO) in neonatal respiratory failure.

Sixteen moribund newborn infants with respiratory failure were treated with extracorporeal membrane oxygenation (ECMO) for 1 to 8 days. Cannulation via the right jugular vein and carotid artery was used to establish venoarterial-cardiopulmonary bypass. High flow (80 percent of cardiac output) allowed decreasing FIO2 and airway pressure. Diagnoses and results were as follows: respiratory distress syndrome, four patients (two improved, one survived); meconium aspiration syndrome, eight patients (four improved, three survived); persistent fetal circulation (some with diaphragmatic hernia), four patients (three improved, two survived). Intracranial bleeding occurred in 43 percent, accounting for most of the deaths. In a parallel series of 21 infants treated with conventional ventilator therapy, the mortality rate was 90 percent and intracranial bleeding occurred in 57 percent. ECMO provided life support and gains time in newborn respiratory failure. In high mortality risk infants, the rate of survival is higher and intracranial bleeding lower with ECMO than with optimal ventilator management.


The long-term outlook for valve replacement in active endocarditis.

This study follows the clinical course of 22 patients in the active phase of infective endocarditis who inderwent valve replacement at North Carolina Memorial Hospital between March, 1966, and March, 1976. At the time of operation, there was gross valve tissue destruction in 16 patients, verrucae in nine, ruptured chordae tendineae in five, and myocardial or annular abscess formation in five. Four patients survived less than 6 months after the initial operation. One survived almost 3 years before dying of recurrent carcinoma of the lung. The remaining 17 patients have been followed an average of 4.6 years. Major postoperative complications were as follows: paravalvular problem, five patients; congestive heart failure, seven patients; complete heart block, three patients; systemic arterial emboli, four patients. These complications often were associated with the preoperative presence of annular or myocardial abscess. Thus it appears that postoperative complications often result from annular structural deficiencies rather than being directly related to active infection.


Long-term follow-up after isolated aortic valve replacement.

Follow-up information was obtained for 1,127 patients having had isolated aortic valve replacement between May, 1963 and April, 1976. The mean follow-up period was 4.4 years. Valves employed included Starr-Edwards Models 1000 (83 patients), 1200 (203 patients), 1260 (435 patients), and 2320 (52 patients), as well as homograft valves (103 patients) and porcine xenograft valves (251 patients). The over-all mortality rate was 7.6 percent, and the linear attrition rate thereafter was 2.7 percent per year. Long-term survival was found to be significantly related to the following preoperative variables: age, congestive heart failure, functional class, radiographic cardiac enlargement, history of acute or remote myocardial infarction, valvular lesion, left atrial mean pressure, pulmonary artery mean pressure, coronary artery disease, left ventricular angiogram, and cardiac index. From this analysis, we conclude that aortic valve replacement in asymptomatic severe aortic regurgitation, (AR) is indicated. Actuarial analysis of prosthetic valve-related death and complications suggest that the porcine xenograft valve is an excellent choice for aortic valve replacement.


Cold cardioplegia or continuous coronary perfusion? Report on preliminary clinical experience as assessed cytochemically.

Myocardial preservation by continuous coronary perfusion is compared with cold cardioplegia. The 1 L. of St. Thomas' cardioplegic protective solution used for infusion into the coronary arteries was at 4 degrees C. and had a normal electrolyte content except for raised concentrations of magnesium and potassium and the addition of procaine. Myocardial preservation was assessed by cytochemical grading of myocardial biopsy specimens and also by the requirement for significant inotropic support postoperatively. In aortic valve replacements with an aortic occlusion time of 1 1/2 hours, both techniques afforded a similar degree of preservation, except that the inner half of the myocardium was markedly better preserved by cold cardioplegia. After 2 hours in double valve replacements, a single cardioplegic infusion was not as effective as continuous coronary perfusion, but this could be corrected by a second infusion of the cardioplegic solution after an hour.


The effects of thoracotomy on coronary blood flow in the dog.

A velocity-sensitive catheter-tip flowmeter was used to measure left coronary arterial blood flow prior to, during, and following left lateral thoracotomy in the artificially ventilated dog anesthetized with sodium pentobarbital. Thoracotomy was performed with (six dogs) and without (10 dogs) the addition of an increased expiratory airway resistance. Opening the chest without the increased airway resistance had no effect on coronary blood flow, despite a fall in arterial pressure, because coronary vascular resistance decreased. This was associated with a fall in arterial PO2. Thoracotomy with the airway resistance in place caused a transient slight fall in coronary flow owing to decreased arterial pressure and increased coronary resistance. All changes disappeared by the twelfth minute. Arterial PO2 was unaffected. Under the conditions of this experiment, thoracotomy had surprisingly little effect on coronary blood flow.


Total one-stage repair of interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus.

Successful total repair in one stage was performed in a 3-year-old girl who had interrupted aortic arch associated with aortic septal defect and patent ductus arteriosus. Surface-induced deep hypothermia and interrupted perfusion were used. The results of postoperative catheterization and angiocardiographic studies are analyzed, and the literature and results of previous surgical  attempts at correction are reviewed.


Resection of aneurysm of the aortic arch without cardiopulmonary bypass.

Four cases of aneurysm of the aortic arch were encountered within 1 year at the National Taiwan University Hospital, Taipei, Taiwan, Republic of China. All four patients underwent resection of the aneurysm and graft replacement of the aortic arch without cardiopulmonary bypass or hypothermia. Temporary external shunting with Tygon tube from the ascending aorta to the femoral artery, with and without permanent bypass grafts from the ascending aorta to the carotid arteries, was used in three patients. Permanent bypass grafts with multiple anastomoses was used in one patient. The over-all operative mortality rate was 25 percent. Some adjuncts are made to perfect the safe and simple technique of temporary external shunting, which has been reported previously from the same institution.


Benign giant cell tumor of femur with bilateral multiple pulmonary metastases.

This paper presents the unusual case of a patient with a histologically benign giant cell tumor of the femur that resulted in bilateral multiple pulmonary metastases having the appearance of benign giant cell tumor. An aggressive surgical approach was used to eradicate the pulmonary metastases; 25 nodules excised from the left lung and 33 nodules from the right lung were proved histologically to be benign giant cell tumors. Three years after bilateral thoracotomies, he remains well, without evidence of recurrent disease, and his lung function is almost normal.


Intramural lymphatic cyst of bovine heterograft.

An intramural lymphatic cyst of a bovine heterograft is described. This previously unreported complication presented as a pulsatile mass in the thigh of an 84-year-old woman who had undergone vascular reconstruction 12 months previously. The clinical presentation, operative findings, and pathological findings are described, and the management of the case is discussed.


Helix-coil stability constants for the naturally occurring amino acids in water. 15 Arginine parameters from random poly(hydroxybutylglutamine-co-L-arginine).

Water-soluble copolymers containing L-arginine and N5-(4-hydroxybutyl)-L-glutamine were prepared by copolymerization of the N-carboxy-alpha-amino acid anhydrides of Ndelta-tert-butyloxycarbonyl-L-ornithine and gamma-benzyl L-glutamate, followed by aminolysis with 4-amino-1-butanol, by removal of the tert-butyloxycarbonyl protecting group, and by treatment with O-methylisourea. The copolymers were fractionated and characterized, and the thermally induced helix-coil transitions of these copolymers were studied in water at neutral pH in the presence and in the absence of KCl. The Zimm-Bragg parameters sigma and s for the helix-coil transition in poly(L-arginine) in aqueous solution were deduced from an analysis of the melting curves of the copolymers in the manner described in earlier papers. The computed values of s indicate that L-arginine is a weak helix-making residue at low temperature and a weak helix-breaking residue at high temperature in aqueous solution. The results were found to be in good agreement with those obtained earlier in conformational analyses of arginyl residues in proteins.


Helix-coil stability constants for the naturally occurring amino acids in water. 16. Aspartic acid parameters from random poly(hydroxybutylglutamine-co-L-aspartic acid).

The synthesis and characterization of water-soluble random copolymers containing L-aspartic acid with N5-(4-hydroxybutyl)-l-glutamine, and the thermally induced helix-coil transitions of these copolymers in water and in 0.1 N KCl, are described. The incorporation of L-aspartic acid was found to decrease the helix content of the polymer at both high and low pH, in water and also in 0.1 N KCl. The Zimm-Bragg parameters sigma and s for the helix-coil transition in poly(L-aspartic acid) in water and in 0.1 N KCl were deduced from an analysis of the melting curves of the copolymers in the manner described in earlier papers. Corrections were made for the presence of a small amount of racemized aspartic acid, using data from random copolymers containing D-aspartic acid as the guest residue. The computed values of s indicate that L-aspartic acid destabilizes helical sequences at all temperatures in the range of 0-70 degrees C. Titrations of the copolymers and of N-acetyl-N'-methyl-L-aspartic acid amide in 0.1 N KCl are described.


Helical structures of poly(D-L-peptides). A conformational energy analysis.

Conformational energy calculations are reported for a number of possible helical structures of poly(D-L-peptides): the alpha helix, two single-stranded piDL, and five double-stranded pipiDL helices. For a poly(D-alanine-L-alanine) sequence, the energies of the various helices are found to differ by less than 1 kcal/(mol residue). For some helices (especially the piDL ones) two structural variants are predicted. These variants, called "goniomers", are characterized by reversed sequences of conformational angles but have the same screw sense and similar helical parameters. A biological implication of these goniomers is suggested, and their usefulness as a critical test for energy calculations is considered.


13C NMR spectroscopy of alternating poly(gamma-benzyl D-L-glutamate) in alpha- and double-helical conformations.

Carbon-13 NMR spectra of alpha single-helical and pipiDL double-helical conformations of alternating poly (gamma-benzyl D-L-glutamate) are presented. In both cases, the existence of doublet for the backbone carbon atoms is consistent with D and L residues being in different conformational states when engaged in the same helix. The resonances of the Calpha atoms in both helices, which are found at identical chemical shifts, and comparison with the 1H NMR observation, favor the hypotheses that solvent molecules are located inside the helical core of the double helices.


Conformational studies of poly(alanine) in dichloroacetic acid by nuclear magnetic resonance.

Proton nuclear magnetic resonance spectra were studied for monodisperse L-alanine oligopeptides (the dimer, trimer, tetramer, and nonamer) containing an n-butylamide group at the C-terminal residue and for the random and block copolymers of D- and L-alanines having sharp molecular weight distributions in dichloroacetic acid (DCA). It was found that the NH signals of poly(L-alanine)s and some copoly(D,L-alanine)s were split into three peaks in DCA, suggesting that these NH peaks reflect the conformation of the polymers. These NH peaks were assigned to the terminal helix (helix-coil junction) and the random-coil and the inner helix, respectively, from the lowest field. On the basis of the above assignment, the microconformations of polycalanine)s in DCA were examined quantitatively. Moreover, it was concluded from the specific nature of the solvent that both the effects of the hydrophobic side chains of the polymers and the acidity of the solvent are most important for the formation of the helical conformation of poly(L-alanine).


Solid-state and solution conformation of N-tert-butyloxycarbonyl-L-prolylglycine.

The occurrence of the oxy analogue in the trans-II 4 leads to 1 intramolecularly hydrogen-bonded nonhelical peptide conformation, recently proposed for t-BOC-L-Pro-Gly-OH in the solid state on the basis of infrared absorption evidence, has been disproved by x-ray diffraction analysis. This type of folding is also absent in polar solvents. However, in solvents of low polarity the presence of this folded form cannot be excluded.


Antimicrobials commonly used for urinary tract infection: sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, nalidixic acid.

Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are excreted in the urine in high concentration and, with the exception of Pseudomonas aeruginosa and Serratia marcescens, are all active in vitro against usual aerobic gram-negative bacteria. They are useful for treatment of uncomplicated lower urinary tract infections in an outpatient setting but are probably not indicated for acute upper tract infections, especially in the hospitalized patient. Trimethoprim-sulfamethoxazole is a very effective combination agent in vitro, has appealing pharmacokinetic properties, and is usually well tolerated by patients. However, it is more expensive than the sulfonamides and is ordinarily not indicated for initial treatment. A sulfonamide is in our view still the agent of first choice, with either nitrofurantoin or nalidixic acid as an alternative if sulfonamides cannot be tolerated.


Antiviral agents.

Only a few agents with antiviral activity are available for regular clinical use. Amantadine hydrochloride is effective in the prophylaxis of influenza A2. Idoxuridine and adenine arabinoside have found application as topical agents in the treatment of herpes simplex keratitis. Adenine arabinoside is also under investigation in the treatment of disseminated infections due to herpes zoster and herpes simplex. Ribavirin, an agent with a wide spectrum of activity in vitro, has not fulfilled expectations in clinical trials. Because of the near eradication of smallpox, methisazone has become less important as a prophylactic agent in smallpox.


Antituberculosis agents: isoniazid, rifampin, streptomycin, ethambutol.

Effective antituberculosis drugs have radically improved the prognosis of the patient with active tuberculosis. Surgical therapy is rarely needed, and sanatoria have largely vanished. Initially, triple-drug therapy is indicated in cavitary pulmonary disease and severe renal disease and it is generally used in miliary tuberculosis and meningitis. Use of one of the three drugs may be discontinued after there is evidence that the bacillary population has been decreased. Two-drug therapy is indicated for other active disease. Isoniazid alone is adequate for prophylaxis. The major cause of therapeutic failure is failure of the patient to take the antituberculosis medication regularly. The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobials used. When treatment failure is apparent, careful reassessment by experienced physicians is indicated. A single drug should never be added to a failing regimen.


Hypothalamic-endocrine dysfunction in anorexia nervosa.

Multiple endocrine determinations were carried out on 101 patients with anorexia nervosa. Ninety-five percent of the patients studied were female, and in 94% of patients the anorexia nervosa began before 30 years of age. Evidence of gonadal dysfunction was the predominant manifestation, both clinically and by laboratory studies. Amenorrhea occurred before or concurrent with onset of weight loss in 65% of the women. The average weight loss was 28% of the weight before illness began. In an additional 11%, the disease began before menarche. The mean age of menarche in patients with secondary amenorrhea was 13 years. Urinary excretion of pituitary gonadotropin was undetectable in 44 of 65 patients and was below 19 rat units per 24 hours in the remaining patients. Serum luteinizing hormone level was below 8 microgram/dl in 15 of 27 patients studied and serum follicle-stimulating hormone was below 10 microgram/dl in 7 of 27 patients studied. Mean serum or urinary estrogens, or both, were low in more than 50% of the patients. Elevation of serum corticosteroids or loss or reversal of diurnal variation, or both, was noted in 50% of patients. Fasting serum growth hormone levels were elevated in 45% of the patients. Mean total and free serum thyroxine, thyroid-stimulating hormone, and triiodothyronine levels were low. These hormonal alterations in the hypothalamic-pituitary axis in patients with anorexia nervosa probably represent adaptive and protective mechanisms for chronic starvation and weight loss.


Tension myalgia of the pelvic floor.

The clinical picture in and efficacy of physical treatment for pelvic floor myalgia were reviewed. The medical records of patients having a diagnosis of pyriformis syndrome, coccygodynia, levator ani spasm syndrome, proctalgia fugax, or rectal pain who had been seen at the Mayo Clinic and treated in the Department of Physical Medicine and Rehabilitation from 1970 through 1975 were retrieved. Adequate information and follow-up were available for 94 patients. Seventy-eight patients were women and 16 were men, whose ages ranged from 26 to 72 years. All patients had tenderness of the pelvic floor muscles on rectal examination. The most common associated findings were poor posture, deconditioned abdominal muscles, and generalized muscle attachment tenderness. The most effective therapeutic regimen was a combination of rectal diathermy, Thiele's massage, and relaxation exercises. Of the 94 patients, 30 had complete resolution of their symptoms, 19 had marked improvement, 17 had moderate improvement, and 14 had mild improvement. Only 14 patients had no change and 1 patient was worse after treatment.


Intra-aortic balloon assist: initial Mayo Clinic experience and current concepts.

The initial experience with intra-aortic balloon assist (IABA) at the Mayo Clinic has been with 34 desperately ill individuals; 17 survived hospitalization. Hemodynamic improvement associated with institution of IABA can be documented. An unacceptably high complication rate (26%) has resulted in extensive modification in the technique of employing IABA. Concepts of patient selection and applications of IABA have evolved from this initial experience and from a review of the literature and have resulted in less reluctant use of this cardiac-assist modality.


Programmed ventricular stimulation in management of recurrent ventricular tachycardia.

Programmed ventricular stimulation was used effectively in the clinical management of six patients with medically refractory, chronic, recurrent ventricular tachycardia. Critically timed ventricular stimuli reliably terminated episodes of ventricular tachycardia and thus obviated repeated countershocks. Critically timed stimuli also reliably induced reentrant ventricular tachycardia. This provided a "clinical model" allowing immediate determination of optimal suppressive drug regimens. The technique has practical application in selected patients with recurrent ventricular tachycardia and can be safely performed within the intensive-care unit.


Complete occlusion of the left main coronary artery and the importance of coronary collateral circulation.

Study of four patients who survived complete occlusion of the left main coronary artery forms the basis of conclusions concerning the functional significance of coronary collateral circulation. Each of these patients had prominent collateral circulation from the right coronary artery. Global left ventricular function was maintained to the extent that congestive heart failure did not occur; the biplane ejection fraction was normal in the two patients where measurement was possible. The peak rate of systolic wall thickening by roentgen videometry in anterior left ventricular segments was normal in one patient and mild to moderately depressed in another. Experience with the patients described herein indicates that coronary collateral flow can provide critically needed circulatory support for the patient with coronary artery disease.


Vitamin K-responsive coagulopathy in Henoch-Schölein purpura.

Henoch-Schönlein purpura is classically described as a systemic vasculitis without known platelet or clotting abnormality. A 15-year-old boy with Henoch-Schönlein purpura experienced a major hemorrhagic diathesis that was responsive to parenterally administered vitamin K. We believe that the gastrointestinal vasculitis prevented the absorption of available vitamin K necessary for the synthesis of clotting factors. Early treatment with parenteral vitamin K in similar cases should be considered.


Morphological changes in aging cell lines of Paramecium aurelia. III. The effects of emetine on polysome formation.

The effect of emetine, an inhibitor of cellular protein synthesis, on young and old cell lines of Paramecium aurelia was studied. Emetine treatment resulted in the accumulation of ribosomal aggregates in the form of helices or rosettes. In treated young cells, large patches of endoplasmic reticulum with clusters of ribosomes were frequently observed. These structures were smaller in treated aging cells. Owing to the association of these ribosomal clusters with endoplasmic structures, they were called "ribosomal complexes". In young cells the polysome helices were more numerous, compared to those of old cells. The difference in the number of polysomes between the young and old cells appeared to be related to the number of ribosomes. The results suggested that in aging cells there were fewer ribosomes and less RNA. In very old cells the ribosomal particles appeared to be altered morphologically.


The clinical investigation and management of chest pain in an emergency department: quality assessment by criteria mapping.

Criteria Mapping, a recently developed chart review method, was tested for its ability to assess the quality of symptom investigation and management for the presenting complaint of chest pain in an emergency department. A criteria map, which is based on decision making logic and permits use of criteria relevant to individual patients, was used to review the records of 137 patients who were examined for chest pain and subsequently discharged from the emergency department. All 111 patients assessed as receiving adequate process had positive outcomes. Twenty-six charts (19 per cent) were determined to have inadequate process, having failed at least one relevant and critical criterion; 23 of these 26 patients had positive outcomes. Review of the unmet criteria in these 23 charts revealed their uncertain predictive validity regarding immediate risk of death. We conclude that the Criteria Mapping method--the first reported technique for evaluating care for patient problems (as opposed to diagnoses)--provides an effective and feasible means for assessing the quality of symptom investigation and management.


Thyroxine and propylthiouracil-induced changes in the activity of monoamine oxidase in the fetal rat.

The activity of monoamine oxidase (MAO) towards tryptamine has been determined in heart, brain and liver of the 21.5 day old rat fetus. The activity was compared between normal, thyroxine and propylthiouracil (PTU) treated animals. Hypothyroidism induced by PTU leads to a decrease in the activity of the three organs, while hyperthyroidism causes an increase in the enzymatic activity. These differences seem to be rather independent of the protein content of the organs. It appears thar rat fetal MAO is under a strong thyroid control.


Evaluation of a new strategy for continued stay review in hospitals.

A classification of in-patients by "reason for admission" (RFA) is described and compared with the classification by diagnosis. The RFA classification assigns length of stay on the basis of twenty-five reasons for admission for adult medical-surgical cases. Length of stay norms for the RFA method were developed and compared to diagnosis specific norms (dx norms). A group of 500 charts was subjected to simulated continued stay review using both RFA and dx norms as screening methods. Although the dx norms screened out for individual review 76% more cases than the RFA norms, the number of screened out cases in which length of stay could have been reduced without affecting the quality of care was the same. The RFA strategy may provide a more efficient method of continued stay review that is also more relevant to hospital medical care than the standard method based on diagnosis.


Aging in the nematode Caenorhabditis elegans: major biological and environmental factors influencing life span.

The free-living nematode Caenorhabditis elegans is an excellent experimental system for the study of aging. The present study identifies some of the major biological and environmental factors influencing life span as a prelude to more detailed genetic and biochemical analyses. Life span can be altered during any part of the life cycle by a change in either temperature or food concentration. Parental age and parental life span both have relatively small effects on progeny life span. The nematode accumulates fluorescent pigment resembling lipofuscin, and becomes less sensitive to ultra-violet radiation as it ages.


Computer-based audit to detect and correct overutilization of laboratory tests.

We developed a computer-bases system to detect inappropriate use of the clinical laboratory and tested a program of physician education to reduce overutilization. We modified the hospital laboratory's computerized reporting system to identify medical patients with three or more determinations of lactic dehydrogenase (LDH) or calcium during the preceding seven days. We audited the charts of these patients, using explicit criteria, to determine whether multiple studies were justified. During the control period 51 per cent of the charts audited for multiple determinations of LDH revealed overutilization. During the study period, when physicians were notified if overutilization was found, 65 per cent of the charts showed overutilization. This difference was not significant. A simultaneous, undisclosed audit of calcium determinations also showed no change between the two periods. Therefore, this method is effective in detecting and measuring overutilization of the laboratory. It is a method which is easily adaptable to a hospital's computerized laboratory reporting system, and it can be applied without a computer. However, our program of notification and education of physicians is not effective in reducing overutilization. More effective methods of modifying physicians' use of laboratory tests need to be developed.


Statistical methods for reliability and validity testing: an application to nominal group judgments in health care.

We discuss statistical methods to analyze data for reliability (agreement among or between raters) and validity. Such analysis are frequently required for medical care data. We also discuss the application of these statistical methods to a study of the reliability and validity of nominal group estimation procedures to identify cost-effective topics for quality assurance purposes.


Turnover of lipid components in liver microsomes, mitochondria and plasma membrane of 6-, 12- and 24-month old rats.

The turnover of lipid was examined in the livers of 6-, 12- and 24-month old rats. Heterogeneity of turnover was noted for each membrane fraction. The lipid turnover rate was highest in 12-month old rats and was the same in 6- and 24-month old rats. The higher rate of lipid turnover at 12 months was observed in both the neutral and polar lipid components of the liver membranes. In the polar lipid fractions isolated from the microsomal and mitochondrial membranes the increase in lipid turnover rate at 12 months was related to increase in the turnover of phosphatidylethanolamine.


Coordination of care and its relationship to continuity and medical records.

Introduction of a computerized printout ("mini record") containing problems and therapies, and listing visits between regularly scheduled ones to a primary care facility, resulted in improved recognition of problems and therapies. Recognition both of the occurrence of the visits which had been made elsewhere and the content of those visits was not improved, even though the mini record listed the dates and place of visit. Recognition was improved more in situations where the practitioners in the primary care clinic changed than when the practitioner remained the same individual who had seen the patient at the previous visit to the primary care clinic. Coordination of care is an essential ingredient of primary care. Recognition of all information generated by patients in a series of visits is evidence of coordination. Continuity (whether achieved by continuity of practitioner or by medical records) is one means of attaining better coordination. In a previous study we showed that continuity of practitioner improves coordination. This study shows that a technologic innovation consisting of an alteration in medical records facilitates coordination, but only with regard to certain aspects of care. Explanations for this finding are postulated.


The meaning of health: understanding functional limitations.

Results of psychometric studies of 14 questionnaire items commonly used to define chronic functional limitations due to poor health are reported. Self-administered questionnaires were used to gather data from 1,209 persons 14 years of age and older. Data were used to study: scalability of items; test-retest reliability of alternate forms of scales; validity of scales in relation to 13 health status variables and age; and precision of scales in detecting differences in health. Three scales pertaining to chronic limitations in mobility, physical activity, and social role activity functions satisfied the criteria of scalogram analysis. Four-month test-retest reliability estimates for alternate forms were very high. Strong associations (some curvilinear) were observed among functional limitation scales, and between these scales and survey measures of physical abilities, general health perceptions, health worry/concern, chronic disease conditions, and age. Measures of physical abilities and functional limitations appeared to define opposite ends of a function-dysfunction continuum. Statistical modeling of precision indicates that, due to the skewed distribution of scores, large sample sizes would be required to detect differences in functional limitations in studies using only a posttest.


Comparability of two methods of time and motion study used in a clinical setting: work sampling and continuous observation.

Two methods of time and motion study, continuous observation and work sampling, were used to measure physician behavior in a prepaid group practice. Results of the two methods were compared to determine whether differences occurred because of method. No significant differences appeared in time/unit of patient service for 82 per cent of physicians studied, nor did the presence of the continuous observed affect the number of units of patient service/half day of observation. Nonpatient activities showed a slightly larger number of differences although 74 per cent of comparisons of mean activity times still showed none. Suggested causes for noted discrepancies may be circumstantial dissimilarities in the two study periods or observed proximity. Nonetheless, overall the two methods show a high degree of similarity. Unless there is particular interest in the exact content of the physician-patient encounter, when continuous observation is required, work sampling is preferred because of time, cost, and possible observed influence on nonpatient activities.


Asthma: pathophysiology and clinical correlates.

Sufficient data has now accumulated that demonstrates that a careful analysis of the presenting signs and symptoms of a patient with acute asthma will permit clinically useful conclusions to be drawn regarding the magnitude and severity of the underlying airway obstruction and the expected response to therapy. If a patient with severe obstruction deviates from this expected course, objective measurements of mechanical function and gas exchange should be obtained. In our current state of knowledge, these measurements should then be used as the prime indices of therapeutic effectiveness and less reliance should be placed on traditional clinical approaches.


Pulmonary embolism.

It is reasonable to conclude by considering an approach to the diagnosis and treatment of pulmonary embolism. When the diagnosis is suspect, and in the absence of contraindications, or hemodynamic instability, treatment with heparin may be begun and an arterial blood gas and perfusion lung scan obtained. If the Pao2 and perfusion scan are normal, it is unlikely that significant pulmonary embolism has occurred. The presence of a perfusion scan defect and hypoxemia should suggest that a ventilation scan and/or evaluation for deep vein thrombosis is performed. A ventilation scan which shows absence of ventilation in areas where there is a perfusion defect, or failure to demonstrate deep vein disease, strongly mitigate against the diagnosis of pulmonary embolism. If the diagnosis is in doubt, pulmonary angiography should be performed. If the patient presents in shock, an angiogram should be performed, while heparin is administered and supportive measures are begun. If anticoagulants are contraindicated, or if re-embolization occurs after adequate anticoagulant therapy, consideration should be given to placement of a transcaval umbrella filter.


[Social medical aspects of patients with a permanent colostomy (author's transl)].

Problems of 39 patients with permanent colostomies/ileostomies are investigated one up to seven years after having got the anus praeternaturalis. The postoperative problems of everyday life are various and often serious, they are the more severe, the less patients had been informed preoperatively and the older the patients are. Younger and more intelligent patients integrate the colostomy easier and more quickly in their everyday life. Very useful for rehabilitation is the close contact between patient and the surgeon, respectively special colostomy-consulting hours.


[Bacterial flora and nitrite production in the stomach after gastroenterostomy. Experimental aspects of the pathogenesis of carcinoma in the operated stomach (author's transl)].

A gastroenterostomy without enteroanastomosis leads to a change in the bacterial flora of the stomach, where-by in particular the proportion of nitrite-decomposing bacteria, is enhanced. This results in an increase of nitrite concentration in the gastric fluid, which may possibly be accompanied by an augmented production of carcinogenic nitrosoamine. This latter aspect is considered with respect to the origin of carcinoma in the operated stomach. Since the reported changes will be largely prevented by a Roux-Y-gastroenterostomy, this should be taken into consideration for reconstruction of the alimentary tract after gastric surgery.


[Anomalies of the biliary tract. Review and report about two distal intrapancreatic common bile ducts (author's transl)].

A brief review about occurrence and experience of abnormalities of the biliary system is reported. The knowledge of these rare anomalies is important for the difficult diagnosis, an effective surgical therapy, and to avoide diagnostical misconstructions. 2 cases of distal intrapancreatic common bile ducts with misleading symptoms are described, which had not been yet reported in the literature.


[Dissolution of gallstones left in the common bile duct (author's transl)].

The different methods of unbloody extraction of concrements left in the bile duct after cholecystectomy are described. Results in literature are compared with own experiences. In three patients out of six concrements were dissolved by heparin infusions.


[The demonstration of pharmacological active substances in the portal vein blood of dogs after occlusion of the superior mesenteric artery (author's transl)].

The experimental occlusion of the superior mesenteric artery in dogs is followed by a significant rise of serotonin-, kinin- and katecholamin-concentrations in the portal vein blood. The rise of the prostaglandin-F2alpha-concentration occurred only immediately after the occlusion or reopening of the occluded superior mesenteric artery. Under our experimental conditions the measured concentrations of these substances in the portal vein blood are too low and ineffective for the development of peptic erosions in the stomach as observed after occlusion of the superior mesenteric artery. On the other hand a possible additiv effect of the underswelling concentrations in these different substances cannot be excluded.


[Cancer risk of the stomach resected for ulcer. The role of duodenogastric reflux (author's transl)].

The purpose of this study was to find whether the reflux of bile and pancreatic juices following stomach resection (duodenogastric reflux) enhances the incidence of carcinomas near the gastroenteric anastomosis. 72 male Wistar rats were subjected to stomach resection. The gastroenteric anastomosis (GE) was performed either as short loop anastomosis (Billroth II; n = 39), thus providing a continuous duodenogastric reflux, or as Y-shaped GE (according to Roux; n = 33). By the latter technique, bile and pancreatic juices are derived quantitatively into the jejunum without coming into contact with the remaining part of the stomach. During a period of 33 weeks, operated rats as well as intact animals were given the carcinogen N-methyl-N'-nitro-N-nitrosoguanidine (NG; 120 mg/l) in the drinking water. At autopsy, 33 to 36 weeks after daily oral administration of NG, most of the tumours were found in operated rats undergoing continuous reflux (Billroth II group). In contrast to these findings, the incidence or carcinomas was significantly lower in animals without reflex (Roux group or intact control rats).-The results of our experiments demonstrate that, in rats, the duodenogastric reflux contributes substantially to the development of carcinomas of the resected stomach.


[Statistical analysis of 1186 cases of gastric carcinoma: with special reference to advanced lesion (author's transl)].

750 cases of advanced gastric carcinoma were macroscopically and microscopically studied in relation with the 10 year survival rate. Most of the patients, 59.3% in female and 68.8% in male, belonged to the 5th and 6th decades. Macroscopically 44.1% of the cases were grouped in Borrmann III type, and secondly Early-Cancer Like Lesion, 26,6%. Histologically, in 510 cases out of 750 (68.0%) serosa was definitely broken by carcinoma cell nests and in 500 cases (66.7%) lymphnode metastasis was observed. The most frequent histological type was diffuse type, 44.9%, and secondly papillotubular type, 21.2%. 10 year survival rate of 516 cases, in which no residual cancer tissue was ascertained and the favorite prognosis could be expected was studied on various factors: Early-Cancer-Like-Lesion and Borrmann I & II types carcinoma, those cases in which the muscularis propria or serosa was preserved, those cases without lymphnode metastasis, and papillotubular or medullary tubular carcinomas showed a favorite prognosis in comparison with other types.


[Closure of instrumental perforation of the stenotic esophagus by means of endo-esophageal tube. On the way from solitary success to clinical principle? (author's transl)].

Instrumental perforation, consequential to esophagoscopic diagnostic or therapeutic procedures, ranges among the inherent and life threatening complications of such manoeuvres. Emergency operations in this situation are dangerous and bedeviled with a prohibitive percentage of mortality. Further spillage into the mediastinum was successfully prevented by introducing an endoesophageal tube of the Celestin-type. Antibiotic protection proved to be the only necessary additional measure.


Verrucous carcinoma of the larynx.

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow-growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.


Conservation laryngeal surgery in the elderly patient.

In the 100 years since Bilroth first undertook a total laryngectomy, general improvements in the prevention and management of childhood and adult disease have led to continuing increase in life expectancy to the point that, in many developed countries, 25% or more of the population is over the age of 65. Although many of these individuals are in otherwise reasonable health, major head and neck procedures are often not performed in favor of radiation therapy for cure, even for lesions that would otherwise be considered amenable to surgery in younger patients, on the grounds that the patient is too old to tolerate the necessary procedure. The same argument has been employed in favoring total laryngectomy over subtotal procedures in the older patient. Review of the author's experience (27 cases) with conservation laryngeal surgery in patients over the age of 65 at the time treatment was undertaken reveals that such procedures are well tolerated in this age group. There were no mortalities and an overall complication rate of 11.1% resulted. These findings compare favorably with complication rates reported for similar patients and surgery in the under 65 age group and strongly suggest that chronologic age alone need not be a contraindication to such surgery.


Malignant melanoma of conjunctiva metastatic to parotid gland. Reports of cases and discussion of surgical management.

Invasive malignant melanoma of the conjunctiva is a rare neoplasm fatal in 40% of cases. Accepted techniques of surgical management include wide local excision, conjunctivectomy, and exenteration. Recently lymphatic dissections have been proposed, but not described, for invasive conjunctival melanoma. We present five cases of invasive conjunctival melanoma, including two with intraglandular parotid metastases. The surgical management of these patients is presented, and a proposal is made for radical bloc dissection of the orbital contents and regional lymphatics. The histology of conjunctival melanoma is discussed, and a classification proposed to assist the head and neck surgical team in the management of this disease.


Audiograms derived from the brain stem response.

Nineteen normal and 22 hearing impaired subjects were used in this study. Thresholds were determined by the following methods: 1. behavioral continuous tone, 2. behavioral tone burst, and 3. the brain stem electric response (BER) with tone bursts. A comparison of the BER thresholds with the behavioral thresholds are made for each subject. The difference between these three measures of threshold suggests that audiograms can be derived from the brain stem response threshold. The derived audiogram compares favorably with conventional audiograms. However, it must be remembered that the brain stem response is not hearing.


Transnasal microsurgical correction of choanal atresia.

Experience with the transnasal microsurgical correction of bilateral congenital choanal atresia is presented. Four case reports are presented to illustrate the advantages of this surgical approach utilizing standard otosurgical instruments and supplemental fiberoptic nasopharyngeal visualization.


An endoscopically-introducible T-tube for tracheal stenosis.

Five cases of tracheal stenosis are presented, and aspects of etiology and pathophysiology of the disease are discussed. A new soft, flexible T-tube is described along with a method of endoscopic introduction. Although many patients with tracheal stenosis will eventually need tracheal reconstruction, stenting may be definitive in selected cases.


Sarcoidosis of the head and neck.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, occasionally presenting with signs or symptoms that occur within the head and neck. The diagnosis may be made by a combination of histological evaluation of involved tissue, the presence of a relative cutaneous anergy, a positive Kveim test, and certain abnormal laboratory or radiographic findings. Although pulmonary sarcoidosis is by far the most common manifestation of the disease, an occasional patient will present with involvement of the nose, tonsils, larynx, or parotid gland. The otolaryngologist should include this entity in his differential diagnosis of lesions which occur in these areas.


Surgical obliteration and silastic arthroplasty of the canine cricoarytenoid joint.

The effects of surgical trauma on the cricoarytenoid joint were analyzed using canine models. The cricoarytenoid joints of seven dogs were surgically disrupted. In four of the dogs an arthroplasty with silastic implantation was simultaneously performed. The histologic findings and the unsuccessful functional results are presented and discussed.


Postinflammatory osteogenic fixation of the stapes.

Stapes fixation existing with chronic otitis media has been attributed usually to either tympanosclerosis or concomitant otosclerosis. A different type of stapes fixation has been encountered which the author has termed "post-inflammatory osteogenic stapes fixation." One thousand five hundred and two surgical procedures for chronic otitis media were reviewed with 112 rigid stapes fixations found of which 19 were classified as post-inflammatory osteogenic stapes fixation. Surgical techniques were discussed, case histories were presented, and photomicrographs were shown illustrating two varieties of post-inflammatory osteogenic stapes fixations classified according to the side of the fixing lesion. The etiology and pathogenesis of this condition were felt to have a direct relationship to infection and prior surgery. Post-inflammatory osteogenic stapes fixation probably occurs more frequently than realized. Further research is needed to evaluate this type of stapes fixation.


Audiological and vestibular function tests in hypothyroidism.

A battery of audiological and vestibular function tests have been performed in 72 cases of confirmed hypothyroidism. The severity of hypothyroidism was graded as mild, moderate or severe depending upon serum protein-bound iodine estimation. The incidence of hearing impairment, tinnitus and vertigo was correlated with the severity of the disease process. The site of lesion causing sensorineural hearing impairment in 25 cases was pinpointed audiologically.


Head and neck cancer developing in patients with pre-existing reticuloendothelial malignancies.

Second primary tumors develop in up to 20% of patients with reticuloendothelial malignancies (REM). At the M. D. Anderson Hospital between 1944 and 1975, there were 29 patients with pre-existing reticuloendothelial malignancies who developed second primary tumors of the head and neck. The presence of pre-existing REM complicated staging of the head and neck lesion in 14 of 29 cases (48%). In patients with clinically palpable nodes the status of involvement was correctly assessed in only 4 of 14 instances (28%). Though only 3 of 29 patients (10%) survived for 5 or more years, the average survival from diagnosis of head and neck cancer to last follow-up or death was 31 months. Patients with REM in conjunction with head and neck melanoma or with squamous carcinoma of the facial skin or lip had an average survival of 20.7, 40.3, and 51.3 months respectively. Patients with REM in conjunction with second primaries involving the oral cavity, nasal, or oral pharynx, hypopharynx, or larynx did poorly with an average survival of only 8.5 months.


Glomus intravagale.

Glomus intravagale (paraganglioma of the nodose ganglion and/or vagus nerve) is an unusual tumor. There are approximately 45 cases reported in the literature; the authors report four more cases. This tumor may ba associated with other paragangliomas of the head and neck, such as carotid body tumors, and may metastasize to regional lymph nodes, although the histology always appears benign.


Facial plexiform neurofibroma.

Facial plexiform neurofibroma is a relatively rare manifestation of Von Recklinghausen's neurofibromatosis. Two patients with extensive facial tumor involvement are presented, each having undergone wide local resection after multiple previous local excisions had failed to control the tumor and its locally deforming and destructive effects. A discussion of the problem, its etiology, pathogenesis, natural history, prognosis and suggested treatment is presented.


"Practical suggestions on facial plastic surgery--how I do it". Parotid duct transfer in xerophthalmia.

Xerophthalmia, or dry eye, is an old human affliction. Among the many causes are trachoma, surgical or traumatic destruction of the lacrimal gland, and paralysis of the greater superficial petrosal nerve after Bell's palsy or from the presence or removal of an intracranial posterior fossa tumor. The technique of parotid duct transfer is a well established effective means to rehabilitate the dry eye. A method of parotid duct transfer is described.


[Prevision of the hazard of acute carbon monoxide poisoning. A nomogram for calculating blood HbCO on the basis of the carbon monoxide concentration in air, the length of exposure and the lung ventilation (author's transl)].

The kinetics of carbon monoxide absorption was studied by the authors. An equation is proposed which enables to define the percentage of blood HbCO on the basis of the CO concentration in the air, the length of exposure, and the lung ventilation. The results proved to be satisfactory and were found to be comparable to the experimental data reported in the literature. A set of nomograms is reported which enables to define the blood HbCO saturation on the basis of the parameters which it depends on, therefore appearing to be very profitable to the physician in order to foresee and then prevent the hazard of acute carbon monoxide poisoning.


[Chromium exposure biological indices and clinical findings in chromium plating industry (author's transl)].

According to the investigations carried out on workers of two chromium plating plants, the authors believe that chromium urinary excretion allows to determine the degree of its acute absorption. Moreover, the renal clearance of diffusible chromium allows the evaluation of chromium body burden and is related to the duration as well as to the severity of exposure. This interpretation is supported by the relation between the exposure biological indexes and the clinical and instrumental investigations which make possible the evaluation of lesions caused by chromium exposure, mostly concerning the respiratory system.


[Bed rest, diet and working capability in liver disease (author's transl)].

General views concerning bed rest, diet and working capability in liver disease have changed during the last years. Rigorous bed rest in acute viral hepatitis is necessary only for short periods of time; it is necessary in chronic liver disease only in rare cases and during the terminal stage, respectively. A liver diet does not exist. Normal palatable nutrition is completely adequate in liver disease. Restriction of protein and sodium chloride intake is indicated only in cases with incumbent coma or with ascites. Patients suffering from acute viral hepatitis are incapable of working; however, they can go back to work a few weeks after the acute stage. Estimation of disability to work in patients with chronic liver disease may be difficult; no general rules can be given; in chronic active hepatitis disability is proportional to the activity of the disease and may range from 20-100%. Fatty liver without inflammatory changes does not influence working capability.


[Is there a therapeutic effect of cures undergone by patients with chronic liver disease? (authors transl)].

"Cures" embrace by definition a broad spectrum starting from taking waters in health resorts to hospital treatment in modern rehabilitation centers. The effectiveness of traditional cure procedures is discussed. Effectiveness of drinking cures, baths and mud packs in liver disease has not yet been proven. Controlled trials are necessary. Clinical treatment is indicated in alcoholic liver damage, viral hepatitis with a protracted course, chronic aggressive hepatitis and compensated cirrhosis of the liver; such treatment, however, is questionable in fatty liver and in chronic persistent hepatitis. Data concerning the effectiveness of treatment of chronic liver diseases are given. The following conclusions are drawn: patients with liver disease ought to be hospitalized when undergoing cures, indications have to be precised, collaboration of patients has to be stimulated, hospital discipline has to be tight, therapy of alcoholism has to include several psychosocial aspects, treatment after leaving hospital has to be improved.


[Therapy of chronic hepatitis (author's transl)].

Therapy of chronic hepatitis as practized today is discussed, including general therapeutic procedures, the so-called "liver-protective substances", and drug therapy of chronic aggressive hepatitis and of liver cirrhosis. A causal treatment of chronic hepatitis is unknown; prognosis however can be improved by treatment with glucocorticoids as demonstrated by controlled clinical trials. A combination with azathioprin does have similarly good results with a decreased frequency of the unwanted side effects of the 2 drugs. The effects of other immunosuppressive drugs and of D-penicillamin cannot yet be evaluated sufficiently at present.


[Results of two double-blind studies on the effect of silymarine in chronic hepatitis (author's transl)].

In two double-blind studies with 24 and 12 patients, respectively, the effect of silymarine on chronic hepatitis was studied. The treatment lasted three months to one year. In the laboratory tests investigated no remarkable difference between silymarine and placebo therapy was seen. Some histological changes, however, were improved under silymarine, one of them significantly. A control of these findings will be necessary. The question arises if silymarine occupies receptors on the liver cell membrane and therefore causes a partial blocking of immunologic reactions. The difficulties of prospective studies in chronic liver disease are emphasized.


[Cholelithiasis--indications for cholecystectomy, papillotomy and gallstone dissolution (author's transl)].

Patients under 50 years without risk factors carrying gallstones should be operated upon for the following reasons: (1) These patients will have complications in up to 40% of cases with increasing age; (2) only 18% of patients are without complaints after a duration of this disease of twenty years; (3) mortality of surgery is 1,06% in patients with no other risk factors. Patients at risk for other reasons, with a functional gallbladder and carrying calcium-free stones should be treated with chenodesoxycholic acid. Patients at risk for other reasons carrying residual stones after cholecystectomy, or suffering from stenosis of the papilla, or harboring stones in the choledochus after choledochoduodenostomy should be subjected to endoscopic papillotomy. Patients at risk for other reasons suffering from cholecystolithiasis or choledocholithiasis should be subjected at first to endoscopic papillotomy, and only thereafter to cholecystectomy. This will decrease the risk of surgery.


[Measurement of fecal chymotrypsin. Clinical and methodological aspects (author's transl)].

Fecal chymotrypsin activity was measured in 128 samples from 93 persons; the titrimetric procedure (Haverback) was used. Distribution of values in 67 normal persons was slanted positively and was approximatively logarithmical. The lower limit of normal was 120 microgram/g stool. Falsely normal results were obtained in 23% of 45 stool samples from 26 patients with pancreatic insufficiency. Falsely pathological results were found in 3,6% of cases. When chymotrypsin was measured photometrically (Imondi) and when the normal limit was assumed to be 50 microgram/g stool according to the literature, a diagnosis of pancreatic insufficiency was confirmed only in 30% of all patients, and 44% of the results were falsely pathological. Chymotrypsin was measured with both methods in 66 samples; correlation of results was unsatisfactory and definitely lower results were obtained with the photometrical procedure. No correlation could be found as well when chymotrypsin activities were measured in stool homogenates on the one hand, and in the supernatant of stools after centrifugation on the other hand, by the titrimetrical or by the photometrical method. Results obtained titrimetrically as well as photometrically after activation of chymotrypsin in pancreatic juice correlated well; the same was true for 2 photometric procedures tested (Imondi, Nagel). Stimulation of the exocrine pancreas with one Lundh meal did not result in any significant increase of fecal chymotrypsin activity in 12 persons tested.


[Ultrasonic examination of localized pancreatic lesions (author's transl)].

The technique of ultrasound examination of pancreatic lesions using real-time and compound scanning complementarily is described. Cases with localized lesions, e.g. pseudocysts, carcinoma, insulinoma and circumscribed inflammatory processes are demonstrated. A lesion not reflecting ultrasound in A and B mode is suggestive of a pseudocyst. Localized lesions reflecting ultrasonic waves cannot be differentiated; cytological or histological examinations have to be done in these cases.


Effects of ethionine and phenobarbital on the phosphatidylcholines of rat liver.

The diglyceride species of phosphatidylcholines from livers of male rats after treatment of the animals with ethionine (1 mg/g divided among 4 doses 2 hr apart), phenobarbital (80 mg/kg each day for 3 days), or a combination of the two drugs were determined using gas chromatography. Ethionine treatment greatly elevated the diene species (significant at the 0.005 level for 34:2 and 0.001 level for 36:2). Phenobarbital treatment had no significant effect on the quantity of 34:2 but slightly increased that of 36:2 (significant at the 0.05 level). Both drugs caused relative decreases in the quantities of 38:4 (significant at the 0.001 level for ethionine and at the 0.01 level for phenobarbital). Ethionine decreased the content of 36:4 (significant at the 0.01 level) while phenobarbital treatment did not produce a significant effect on this fraction. Thus, while ethionine produced marked effects on the quantities of the various molecular species, the effects of phenobarbital were less dramatic. Combined treatment with both drugs generally produced levels of species similar to those produced by ethionine alone.


Hydrocarbon gases produced during in vitro peroxidation of polyunsaturated fatty acids and decomposition of preformed hydroperoxides.

Hydrocarbon gases have been used previously as an index of lipid peroxidation in vivo and in vitro. In vitro experiments are reported on the formation of hydrocarbon gases from peroxidizing omega-3 and omega-6 fatty acids. Hydrocarbon gases were not released during a 20-hr peroxidation phase but were released following the decomposition of hydroperoxides by addition of excess ascorbic acid. The major hydrocarbon gas products in iron, copper, or hematin catalyzed peroxidation systems were ethane or ethylene from linolenic acid, and pentane from linoleic acid and arachidonic acid. Calculations of the ratios of hydrocarbon gases formed were based on fatty acid decrease and/or change in diene conjugation and peroxide values. Depending on the fatty acid, catalyst, and calculation basis used, pentane formation was as high as 1.3 mol %, ethane 4.3 mol %, and ethylene 10.6 mol %.


Analysis of autoxidized fats by gas chromatography-mass spectrometry: I. Methyl oleate.

A structural investigation of autoxidation products of methyl oleate was carried out by gas chromatography-mass spectrometry (GC-MS) of trimethylsilyl (TMS) ether derivatives. GC-MS using computer plots of selected masses afforded structural assignments of GC peaks due to incompletely resolved mixtures. This method provided evidence of epoxy and keto esters which are not completely separated from the main components consisting of the TMS derivatives of the allylic hydroxy esters. Use of an MS-computer system also showed that the hydroxyoctadecanoate TMS ethers were partially separated by GC. The use of synthetic hydroxyoctadecanoates for the first time enabled us to demonstrate the quantitative reliability of a GC-MS computer summation approach to analyze the isomeric composition of oleate hydroperoxides (as the saturated TMS ether derivatives). Consistently higher concentrations were found of the 8- and 11-hydroperoxides than of the 9- and 10-hydroperoxides. Minor products of autoxidation identified by GC-MS include allylic enones, isomeric epoxyoctadecanoates, dihydroxyoctadecenoates, and dihydroxyoctadecanoates.


Triterpenes from the button cactus, Epithelantha micromeris.

Ethanolic extracts of the title plant were toxic to mice. Acid hydrolysis of the toxic extracts permitted the isolation of six crystalline compounds. The known triterpenes oleanolic acid and methyl machaerinate and the common plant sterol, beta-sitosterol, were identified. The structures of two other isolated compounds, named epithelanthic acid and methyl epithelanthate, were postulated to be new delta9(11)-12-oxooleanenes, and another trace compound was incompletely categorized as a triterpene lactone.


Analysis of autoxidized fats by gas chromatography-mass spectrometry: II. Methyl linoleate.

The gas chromatography-mass spectrometry (GC-MS) approach developed in the preceding paper was applied for qualitative and quantitative investigations of autoxidation products of methyl linoleate. A GC-MS computer summation method was standardized with synthetic 9- and 13-hydroxyoctadecanoate. Equal amounts of 9- and 13-hydroperoxides were found in all samples of linoleate autoxidized at different temperatures and peroxide levels. The results are consistent with the classical free radical mechanism of autoxidation involving a pentadiene intermediate having equivalent sites for oxygen attack at carbon-9 and carbon-13. Minor oxygenated products of autoxidation indicated by GC-MS include keto dienes, epoxyhydroxymonoenes, di- and tri-hydroxy monoenes. These hydroxy compounds are presumed to be present in the form of hydroperoxides. The quantitative GC-MS method was found suitable for the analysis of autoxidized mixtures of oleate and linoleate. By this method, it is possible to determine the origin of the hydroperoxides formed in mixtures of these fatty esters.


Determination of lipid conjugated dienes with tetracyanoethylene-14C: significance for study of the pathology of lipid peroxidation.

A method for quantitative analysis of conjugated diene unsaturation has been developed utilizing tetracyanoethylene-14C (TCNE-14C) in a Diels-Alder condensation. The amount of C14 found in the Diels-Alder adduct has been shown to be a measure of conjugated diene content. The method has proven successful in analysis of a variety of triglycerides, phospholipids, and peroxidized tissue lipids. In the course of this work, a method for removing the fatty acid substituents from phospholipids using lithium aluminum hydride was developed. TCNE-14C analysis for conjugated dienes in rat liver microsomal lipids after dosing with CCl4 or BrCCl3 has provided conclusive evidence that the increase in ultraviolet absorption at 233 nm of these lipids is due to conjugated dienes.


Structure elucidation of norlaureline and puterine, new noraporphine alkaloids from Guatteria elata.

The structures of norlaureline (1) and puterine (4), new noraporphine alkaloids isolated from Guatteria elata (Annonaceae), were established by interpretation of the optical rotation, uv, ir, pmr, and mass spectral data of their N-acetyl derivatives. Proposed structures were confirmed by transformation of 1 and 4 to laureline (3) and pukateine methyl ether (6), respectively.


Substrate metabolism in the perfused lung: response to changes in circulating glucose and palmitate levels.

The effects of circulating levels of glucose and palmitate in the isolated perfused rat lung were investigated. Rat lungs were perfused for 1.5 hr with washed bovine erythrocytes (15% hematocrit) in Krebs-Henseleit bicarbonate buffer containing 5 g% bovine serum albumin. Glucose uptake in the perfused lung varied directly with circulating glucose concentration. Lactate production was affected proportionately more by high glucose levels than by low concentrations. Pyruvate production was decreased by both low glucose and palmitate concentration in the circulating medium. Oxidation of glucose to CO2 was depressed by low glucose and by high palmitate concentrations. Glucose incorporation into lung lipids was more strongly influenced by glucose concentration than by circulating palmitate levels. These data indicate acute changes in circulating levels of glucose and palmitate alone can act to either inhibit or stimulate glycolysis, glucose oxidation, and lipid synthesis in the perfused lung.


Influence of trichloroacetic acid-phosphotungstic acid on the thin layer chromatographic mobility of gangliosides.

Trichloroacetic acid (TCA)-phosphotungstic acid (PTA) precipitation has been used as a faster procedure than dialysis for the isolation of gangliosides, but the TCA-PTA treatment causes striking abnormalities in the thin layer chromatographic mobilities of the gangliosides. However, a normal chromatographic pattern can be restored by treating the precipitated gangliosides with the tetrasodium salt of ethylenediamine tetraacetic acid followed by dialysis. Hence, TCA-PTA treatment does not appear to cause artifacts or hydrolysis of the gangliosides.


Effect of increased serum urate levels on virgin rats with no arteriosclerosis versus breeder rats with preexistent arteriosclerosis.

Healthy virgin and breeder rats (Sprague-Dawley) with naturally occurring hypertension and arteriosclerosis were fed 5% oxonic acid and 1% uric acid added to their regular diet for 30 days. Although rats are able to convert uric acid into excretable allantoin, abnormal urinary and serum urate levels appeared. Males and females, virgins and breeders, differed in the severity of their increased urate levels. Animals with elevated urate levels developed hypertension, hyperglycemia, and hypertriglyceridemia, with only slight changes in cholesterol and free fatty acids. The kidneys were greatly enlarged and manifested medullary streaking indicative of urate deposits but were free of significant damage; BUN levels in these animals were abnormally high. Adrenal glands were reduced in size and depleted of lipid, circulating corticosterone levels were subnormal, and thymi were involuted. Serum enzymes CPK and LDH were greatly increased, whereas SGOT and SGPT levels were not elevated. The abnormal urate levels did not induce de novo arterial disease in the formerly healthy virgin rats and did not cause exacerbation of the pre-existing, naturally occurring arteriosclerosis characteristic of repeatedly bred rats. It is suggested that Sprague-Dawley rats are endowed with an especially efficient hepatic and renal capacity to metabolize uric acid. Increased urate levels in rats may have some direct metabolic relationship to the production of hypertension, hyperglycemia, and hypertriglyceridemia.


[Possibilities and limits of electron microscopy (author's transl)].

This review evaluates the electron microscopical imaging techniques used today. Reviewed are transmission method, indirect imaging of surfaces by replica and surface decoration, and direct imaging of surfaces by means of scanning, emission, and mirror electron microscopy. For each method the respective limit of resolution and the possibilities of application are described. Especially, the methods of high-resolution and of high-voltage electron microscopical techniques will be pointed out as being actual means of investigation stressing electron microscopy up to the limits given by physics and technique.


[Step height measurement in the micrometer range by two-ray interferometry with adjustable light wavelength (author's transl)].

The interferometric measurement of abrupt surface steps in the micrometer range requires additional means to give unique results. It will be shown, that advantageous interpretation of the interferometric fringes are possible by combining a two-ray interferometer with a monochromator.


Practical aspects of quantitative microphotometer system.

The parameters, characteristics and modifications of standard equipment, also operational methods, are discussed in the context of reading errors. The principal errors are identified: photocell and lamp filament temperatures--internally scattered light--sample position and orientation. The application of the instrument to a specific problem (corrosion of dental amalgam) is illustrated.


Gelation of Limulus lysate by synthetic dextran derivatives.

The Limulus test has been considered specific for the presence of bacterial endotoxins. To synthesize a simple model of endotoxin, palmitoyldextran phosphate was prepared by modification of dextran by palmitoylation and phosphorylation. The present studies indicated that a variety of polysaccharide derivatives, such as palmitoyldextran phosphate, palmitoyldextran, and dextran phosphate, give a positive Limulus test and show pyrogenic activity, except for low molecular dextran derivatives. On the other hand, polysaccharides, such as dextran, starch (soluble-, chitosan, xylan, and lentinan, were negative in these assays. The gelation reaction of Limulus lysate by modified dextran derivatives may depend on the molecular weight or modification of polysaccharides by palmitoylation and/or phosphorylation to a great extent.


Immunochemical isolation of gamma-globulin mRNA and estimation of immunoglobulin gene reiteration.

The polyribosomes synthesizing gamma-globulin have been isolated by the achievement of specific precipitation using bentonite-treated anti-IgG antibody. The RNA extracted from the immunochemically precipitated polysomes was tested for its ability to direct the synthesis of proteins in a cell-free system. The specific gamma-globulin-synthesizing activity (cpm of gamma-globulin synthesized/microgram RNA) of this RNA was 10-fold greater than that from total polysomes. gamma-globulin mRNA (messenger RNA) isolated by immunoprecipitation was more than 89% pure with respect to contamination by other species of mRNA. The products synthesized by the cell-free system were also analyzed by sodium dodecyl sulphate(SDS)-polyacrylamide gel electrophoresis. This RNA has been hybridized with mouse myeloma DNA. The estimation of immunoglobulin gene reiteration was carried out using hybridization kinetics with consideration given to the DNA/RNA ratio since the estimation from the "half Cot value" is not accurate. The results suggest that in the mouse there are about 20 copies per subgroup of genes coding for the variable region of the H and L chains.


[Indoor and outdoor fungal flora of Ankara].

The variation of atmospheic fungal flora of Ankara were studied. Beside this the fungal floras of indoor and outdoor air were compared. In outdoor air Penicillium was detected most, followed by Cladosporium, Alternaria, Helminthosporium, Aspergillus, Rhizopus and Mucor. In the indoor air the same fungi were detected. However,  Penicillium and Aspergillus were found more compared with outdoor findings. Since in many parts of Ankara (Yenişehir, Cebeci, Küçükesat, Bahçelievler, Aydinlikevler), different fungi are found in indoor and outdoor air and many of them are the etiologic agents of allegic diseases, doctors have to make fungal cultures from the indoor and outdoor air of living and working buildings in order to find the source of allergic diseases.


[Study of hepatitis B surface antigen by 2 different serological methods].

This investigation was carried out in order to determine the sensitivity of Discontinous-Counter-Immunoelectrophoresis (DCIE) and passive erythrocyte hemagglutination (RPHA) teste in screening the presence of HBsAg in normal population and blood donors. 1321 sera from apparently normal individuals and 156 sera from blood donors were tested. Among, normal individuals, the carriers were 22 (1.66%) with DCIE test and 122 (9.22%) with RPHA test; and among blood donors, 6 (3.84%) with DCIE test and 36 (23.0%) with RPHA test.


The clinical features of tick bite.

The clinical features of bites by the Australian scrub tick, Ixodes holocyclus, are reviewed. Eight cases of tick bite are summarized, including six new cases of tick paralysis in children. In almost all cases neuroparalysis became worse transiently, after the tick had been removed. One child with life-threatening respiratory and bulbar palsy received canine antitick antivenene, with rapid reversal of clinical signs. The differential diagnosis of tick bite includes all acute childhood diseases which can affect the motor units; the importance of including the possibility of tick envenomation in the differential diagnosis of acute weakness or paralysis in children is illustrated. The clinical features of neuromuscular paralysis are described, together with a review of the tick's local effects at the bite site.


Accident litigants with neurotic symptoms.

Experience gained from an examination of 750 consecutive accident litigants leads to the conclusion that the aetiology of neurotic symptoms after accidents is so complex that diagnostic labels implying single causation give a false and oversimplified picture. Terms such as "compensation neurosis", "traumatic neurosis", "Mediterranean back", "postconcussion syndrome" and many others illustrate preconceived ideas of causation which are in most cases not warranted, and it is recommended that this group of patients be considered under the general label of sufferers from "accident neurosis". The many symptoms which occur are discussed, and it is found that they present in such endless variety, and in varying severity from mild to completely disabling; they do not cluster in any consistent way to justify the delineating of discrete syndromes which are artificial and misleading; their existence confuses rather than clarifies our understanding of these unfortunate people.


Drug-induced depression and attempted suicide.

Sixty-eight patients who had attempted suicide were matched with non-suicidal patients with similar diagnoses to assess the extent to which excessive drug ingestion by the suicidal group might have contributed to their behaviour. It was found that the suicidal patients were consuming more drugs, particularly those of a potentially depressing kind. The implications of this finding are discussed.