[Bicillin in a complex scheme for the active prophylaxis of exacerbations and the progression of chronic bronchopulmonary diseases in children].

A complex scheme of prophylaxis of exacerbation and progression of chronic bronchopulmonary diseases in children was developed. It included the use of bicillin, stimulating therapy, desensibilizing drugs, vitamins, proteolytic enzymes, physiotherapy, physical excercises, massage, sanation of the chronic infection foci and interferone administration during influenza. 466 patients were subjected to the active prophylaxis for a period of 1-3 years. No exacerbation of progressing of chronic pneumonia was observed in 81.3 per cent of the children subjected to bicillin prophylaxis for 3 years. The number of the bronchial asthma attacks in the group of the patients with the infectious allergic form of bronchial asthma decreased 3-4 times per year under the effect of complex prophylactic therapy, the attacks became shorter and their elimanation with broncholitics was easier.


[Treatment of inflammatory diseases of the brain with kanamycin].

On the basis of clinical trials with 20 patients suffering from acute inflammatory diseases of the brain recommendations for determination of indications for rational use of kanamycin were formulated. Kanamycin proved to be effective in treatment of severe forms of neuroinfections caused by gramnegative bacteria, as well as mixed and resistant staphylococcal infections. With the account of the clinical state the use of the drug should be preceded by bacteriological tests with qualitative and quantitative determination of sensitivity of the isolates to the antibiotics.


Preparation and evaluation of two microbiological media from shrimp heads and hulls.

Two peptones were extracted from raw shrimp waste after autolytic digestion. Digests were derived from shrimp heads and shrimp hulls, both of which are by-products of the shrimp processing industry. Digests were evaluated for suitability in supporting growth of microorganisms by measuring the total cell mass produced by five genera of bacteria and five genera of fungi in broths formulated from the peptones. Comparison was made to five commercially available medium preparations and a catfish peptone. A 0.5% solution of the lyophilized shrimp head digest, heated at 121 C for 15 min, resulted in a cloudy suspension. However, the digest supported excellent growth of fungi and good growth of bacteria. A heated 0.5% solution of the hull digest was clear and supported good growth of both bacteria and fungi.


Effect of starter culture on staphylococcal enterotoxin and thermonuclease production in dry sausage.

Different amounts of enterotoxin A-, B-, and C1-producing staphylococci were added to dry sausage prepared by normal processes, either alone or in conjunction with a starter culture (micrococci and lactobacilli). The sausage was examined after 0, 3, 7, 14, and 30 days for staphylococci, micrococci, and lactobacilli, and measurements were made of water activity, pH, enterotoxin, and thermostable nuclease. The results showed that in the absence of starter culture measurable amounts of enterotoxin A were formed in a 200-g sample of dry sausage in 3 days, the level of Staphylococcus aureus infection being over 10(6) cells/g. Enterotoxin B was not found, although the total number of staphylococci was over 10(8) cells/g. Enterotoxin C1 was observed when the Staphylococcus count was about 8 X 10(7) cells/g, but was no longer detectable after 7 days. The starter culture prevented the production of enterotoxin A in all cases investigated. By contrast, a very high-level inoculation of an enterotoxin C1-producing strain gave a positive result after 3 days of incubation even in the presence of a starter culture. Heat-stable nuclease was observed in all sausages to which enterotoxin-producing staphylococci were added. The cell count determined in a sample of sausage had no definite correlation with the thermonuclease activity of the sample.


Stimulatory effect of dihydroxyphenyl compounds on the aerotolerance of Spirillum volutans and Campylobacter fetus subspecies jejuni.

The aerotolerance of the microaerophilic bacterium Spirillum volutans was greatly stimulated in a defined medium by the presence of dihydroxyphenyl ferric iron-binding compounds such as nor-epinephrine at 10(-5) to 10(-6) M. Dihydroxyphenyl compounds at 2 X 10(-4) M, or iron salts (ferrous or ferric) at high concentration, greatly increased the aerotolerance of a strain of Campylobacter fetus subsp. jejuni when grown on streak plates of Brucella agar. The results suggest that the microaerophilism of these organisms might in part be caused by a failure to synthesize microbial ferric iron-binding compounds at sufficient levels to support aerobic growth.


Growth of saprophytic and pathogenic leptospira: evaluation of medium, temperature, inoculum, and cost.

Of four media tested, a tissue culture medium supplemented with a bovine serum albumin-oleic acid complex provided the best leptospiral growth and cost efficiency.


Improved procedure for production of cytochalasin E and tremorgenic mycotoxins by Aspergillus clavatus.

This report describes an improved procedure for production of cytochalasin E and tremorgens by solid substrate, agitated fermentation of Aspergillus clavatus on pearled barley.


Inhibitory effect of light on growth-supporting properties of eosin methylene blue agar.

Exposure of eosin methylene blue agar to visible light can alter the ability of that medium to support microbial growth. Proteus species were most sensitive to the photodynamic action.


Aerosol evaluations of the DeVilbiss No. 40 and Vaponefrin nebulizers.

De Vilbiss no. 40 and Vaponefrin standard nebulizers produced aerosols of small particles suitable for deep pulmonary vaccination and therapy of respiratory infections in man and animals.


Rapid determination of dipicolinic acid in the spores of Clostridium species by gas-liquid chromatography.

A gas-liquid chromatographic procedure has been developed to quantitate dipicolinic acid in bacterial spores. The culture, washed from a plate, was hydrolyzed with acid containing the internal standard, pyridine-2,4-dicarboxylate, and then extracted into methyl isobutyl ketone. The internal standard and dipicolinic acid were then extracted into a small volume of trimethylphenylammonium hydroxide. Injection of the resultant quaternary ammonium salts into a gas chromatograph yielded, via thermal decomposition, the methyl ester derivatives of the dipicolinic acid and the internal standard. The amount of dipicolinic acid in the sample was determined from a standard curve. The method was sensitive to 100 ng of dipicolinic acid per sample and was 1,000 to 5,000 times more sensitive than the commonly used methods. Preparation of the sample required less than 1.5 h and less than 15 min of the analyst's time.


Biodegradation of phthalic acid esters in river water and activated sludge.

The primary and ultimate biodegradability of phthalic acid, monobutyl phthalate, and five structurally diverse phthalic acid ester plasticizers in river water and activated sludge samples were determined via ultraviolet spectrophotometry, gas chromatography, and CO2 evolution. The compounds studied underwent rapid primary biodegradation in both unacclimated river water and acclimated activated sludge. When activated sludge acclimated to phthalic acid esters was used as the inoculum for the CO2 evolution procedure, greater than 85% of the total theoretical CO2 was evolved. These studies demonstrate that the phthalic acid ester plasticizers and intermediate degradation products readily undergo ultimate degradation in different mixed microbial systems at concentrations ranging from 1 to 83 mg/liter.


Preliminary studies on the characterization and distribution of Staphylococcus and Micrococcus species on animal skin.

A total of 221 strains of staphylococci and 98 strains of micrococci isolated from the skins of Eastern gray squirrels, Southern flying squirrels, raccoons, opossums, squirrel monkeys, swine, sheep, horses, cattle, and dogs were characterized in a preliminary attempt to resolve their natural relationships and distribution in nature. Staphylococci demonstrating the widest host range included Staphylococcus xylosus and unnamed Staphylococcus sp. 3. Unnamed Staphylococcus sp. 2 was isolated only from sheep, Staphylococcus sp. 4 only from opossums, Staphylococcus sp. 5 only from squirrel monkeys, and Staphylococcus sp. 6 only from swine. The predominant species isolated from human skin, including S. epidermidis, S. hominis, S. haemolyticus, and S. capitis, were either not isolated or only rarely isolated from animal skin. Micrococcus varians was the predominant Micrococcus species isolated from animal skin. M. luteus was only occasionally isolated. M. lylae, M. sedentarius, M. roseus, M. kristinae, and M. nishinomiyaensis, species occasionally isolated from human skin, were not isolated from animal skin.


Further studies on a mycoparasitic basidiomycete species.

An unidentified basidiomycete was found capable of parasitizing 37 of 50 isolates of fungi tested as hosts. All phytopathogenic fungi tested, as well as most of the saprophytic fungi, were susceptible to this mycoparasite. In some cases, reproductive structures as well as hyphae were infected. High glucose-yeast extract ratios in the test medium favored parasitism. The mycoparasite was able to utilize 14 of 27 compounds tested as carbon sources.


Enzymatic epoxidation: synthesis of 7,8-epoxy-1-octene, 1,2-7,8-diepoxyoctane, and 1,2-Epoxyoctane by Pseudomonas oleovorans.

The kinetics of the enzymatic formation of 7,8-epoxy-1-octene, 1,2-7,8-diepoxyoctane, and 1,2-epoxyoctane by growing and resting cell suspensions of Pseudomonas oleovorans are described. Formation of 1,2-epoxyoctane occurs concurrently with exponential growth on 1-octene, providing that 1-octene is in excess. Conversion of 1,7-octadiene to 7,8-epoxy-1-octene by cells growing on octane lags behind exponential growth and continues into the stationary phase, terminating upon cell death. Formation of 1,2-7,8-diepoxyoctane does not begin until the cells are well into the stationary phase and also continues until cell death. Results with growing and resting cell suspensions suggest that the various substrates compete for the same enzyme system; that viable cells are essential for substrate transport and epoxidation by whole cells; and that whole cells may concentrate and sequester the epoxides, rendering them unrecoverable by our current methods.


Characterization of anaerobic heterotrophic bacteria isolated from freshwater lake sediments.

Strict anaerobic culture techniques were used to quantitatively and qualitatively evaluate the anaerobic heterotrophic bacteria present at the sediment-water interface of hyperutrophic Wintergreen Lake (Augusta, Mich.). Anaerobic plate counts remained constant from March through December, 1973, ranging from 2.4 X 10(6) to 5.7 X 10(6) organisms/g (dry weight) of sediment. The isolatable bacteria represented a small percentage of the total microbial community, which was shown by direct microscopic counts to be 2.0 X 10'' organisms/g (dry weight) of sediment during June and July. Bacteria of the genus Clostridium dominated the isolates obtained, accounting for 71.8% of the 960 isolates examined. A single species, Clostridium bifermentens, comprised 47.7% of the total. Additional bacterial groups and the percentage in which they were isolated included: Streptococcus sp. (10.8%), unidentified curved rods (9.5%y, gram-positive nonsporing rods (5.6%), and motile gram-negative rods (1.9%). Temperature growth studies demonstrated the ability of all the isolates to grow at in situ sediment temperatures. Gas-liqid radiochromatography was used to determine the soluble metabolic end products from [U-14C]glucose and a U-14C-labeled amino acid mixture by representative sedimentary clostridial isolates and by natural sediment microbial communities. At in situ temperatures the natural sediment microflora produced soluble fermentative end products characteristic of those elaborated by the clostridial isolates tested. These results are considered strong presumptive evidence that clostridia are actively metabolizing in the sediments of Wintergreen Lake.


Growth of Enterobacter aerogenes in a chemostat with double nutrient limitations.

The behavior of Enterobacter aerogenes during growth in chemostats limited by single and double nutrient restrictions was examined. On the assumption that different essential nutrients act to limit growth in different ways, we selected pairs of nutrients likely to affect different aspects of metabolism. Results show that macromolecular cell composition can be controlled by using more than one nutrient restriction. The polysaccharide content of the cells is readily manipulated by the ratio of carbon to nitrogen in the inlet nutrients. Also, at low dilution rates, ratios of protein to ribonucleic acid are dependent on the ratio of phosphate to nitrogen in the input nutrients. An examination of both acetic acid and metabolite production (as measured by ultraviolet absorbance of culture filtrates) showed that accumulation of these products was dependent on both dilution rate and type of nutrient limitation(s). These results were examined in terms of the problems of translation of batch to continuous culture processes and the use of selected nutrient limitations to control noncellular product formation.


Treatment of melanotic freckle with x-rays.

Sixteen patients were treated for melanotic freckle of Hutchinson (lentigo maligna) with the Miescher technique of x-ray therapy. Eleven patients had no local cutaneous recurrences of persistence following x-ray therapy. Five patients had local recurrence or persistence of their lesions. Three patients developed metastatic malignant melanoma. The first of these three patients had lentigo maligna melanoma, and the second patient had a melanotic freckle with atypical cells extending down the adnexae, including the sweat apparatus to the level of the coiled portion of one sweat gland. The third patient was considered to be in a precancerous phase at the time of irradiation. Nevertheless, metastases occurred. European colleagues indicate that they have not experienced such problems in using the Miescher technique. The procedure has been abandoned in our department, pending further clarification of the discrepancy between our results and those reported by our European colleagues.


Allergic contact sensitivity to thiuram compounds in a hemodialysis unit.

An outbreak of dermatitis among patients in a hemodialysis unit was traced to thiuram compounds, most likely coming from the hemodialysis apparatus itself. Eight of the 21 patients in the facility had allergic contact sensitivity to various thiuram compounds. Testing of patients from other hemodialysis units, in which different hemodialysis equipment was used, did not disclose sensitivity or dermatitis. In the affected patients, allergic contact sensitization of the skin probably resulted from the systemic circulation of an antigen during hemodialysis.


Benign papular acantholytic dermatosis.

Seven male patients, aged 41 to 63, had benign papular acantholytic dermatosis. The patients complained of firm, intensely pruritic, 1- to 3-mm, reddish-brown or flesh-colored papules. The lesions were usually found on the upper part of the torso or on the neck. At least five of the seven patients reported that sunlight initiated or exacerbated the condition. The mean duration of the disorder exceeded two years. Histologically, the predominant lesion in all seven cases was acantholysis. Dyskeratosis was not a characteristic finding, being absent in five of the seven cases and minimally present in two. We will compare the features of benign papular acantholytic dermatosis with those of other papular acantholytic disorders.


Vitiligo associated with regional enteritis.

Although the cause of vitiligo is unknown, there is considerable evidence to indicate that autoimmunity plays a role. Much of this evidence is based on the increased associated occurrence of vitiligo in a number of diseases also believed to be autoimmune in origin. I have observed a case of almost simultaneous onset of vitiligo and regional enteritis. A search of the literature revealed no specific case report associating these two disorders. The association of these two disorders in the same person may be more than fortuitous, since both diseases may be autoimmune in origin.


Cutaneous cartilaginous tumor.

A histologic diagnosis of cartilaginous tumor was made from solitary nodular skin lesions of two patients. Lack of information about cartilage tumors in the dermatologic literature suggests that they rarely develop as superficial lesions. Despite a high incidence of nuclear changes suggesting malignant neoplasm, the majority behave in a benign fashion and can be treated conservatively.


Linear eccrine poroma.

A 44-year-old woman had multiple papular lesions of 20 years' duration. The lesions were limited to the right lower extremity and were arranged in a linear fashion. They had the histologic appearance of eccrine poroma; however, thin intertwining strands of tumor cells extended down into the dermis in a pattern similar to that of premalignant fibroepithelioma. Also, bud-like proliferations of tumor cells were attached to the epidermis, analogous to those superficial basal cell epithelioma. A dilated cystic duct resembling that found in syringoma was present in the upper part of the dermis. To my knowledge, such a linear distribution of multiple eccrine poromas has not been reported in the dermatologic literature.


Pathogenesis of solar urticaria. Sweat droplet in testing for photosensitivity.

It was impossible to replicate solar urticaria lesions by irradiation in the laboratory, until the role of sweating was recognized. We found that the sweat droplet, acting as a lens, serves as a photointensifier. As such, sweat would appear to play a meaningful role in the pathogenesis of cutaneous photosensitivity reactions, as well as be an adjuvant in phototesting.


Acquired cutis laxa associated with multiple myeloma.

Acquired cutis laxa, or generalized elastolysis, is a rare disease. One patient was found to have not only cutis laxa but also multiple myeloma.


Crying vital capacity. Measurement of neonatal lung function.

Serial measurements of crying vital capacity (CVC), expressed as ml/cm chest circumference, were made by reverse plethysmography during the first 2 weeks of life. Clinically normal babies born at term by elective caesarean section had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies born vaginally. In contrast, no significant difference was shown between the mean CVC in term babies born vaginally and those born by urgent caesarean section. Clinically normal term babies born by caesarean section (elective and urgent) had a smaller mean percentage rise of CVC in the first 24 hours of life and a significant delayed rise of CVC from 24-48 hours compared with those born vaginally. Clinically normal preterm babies born vaginally had a smaller mean CVC in the first 2 weeks of life compared with term babies born vaginally, and were characterized by a significant rise of CVC from 5-10 days. Babies with hyaline membrane disease (HMD) had a smaller CVC in the first 2 weeks of life compared with clinically normal preterm babies. Babies of various gestational ages with transient tachypnoea (TT) had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies, but a similar mean CVC in the first 72 hours of life compared with clinically normal preterm babies. At each postnatal age the mean CVC of babies with HMD was less than the corresponding mean in babies with TT. All babies with TT had a rise in CVC from 24-48 hours, whereas CVC fell in all babies with HMD except one during this period. CVC is a simple, safe, rapid, and noninvasive test of neonatal lung function, and is a valuable aid to other methods of assessing pulmonary function in the neonate with respiratory distress.


Mucociliary transport in trachea of patients with cystic fibrosis.

Mucociliary tracheal transport rates were measured in 20 patients with cystic fibrosis, in whom these rates ranged from 0 to 12.8 mm/min. The patients were divided into 3 roughly equal groups on the basis of their transport rates. (1) Those in whom no abnormality in mucociliary transport was detected in the trachea; (2) those in whom normal transport rates were measured but in whom abnormalities such as cessation, or reversal of bolus movement were observed; (3) those in whom no normal transport rates were observed. In the first group the rates were similar to those observed in a population of healthy adults. These normal rates were observed in some patients who had a productive cough. The mean mucociliary tracheal transport rate increased with increasing maximum midexpiratory flow. Those patients with a low Shwachman score and poor arterial oxygen tension tended to fall into groups 2 and 3. In the ciliary dyskinesia assay in rabbit trachea the serum from the patients with the higher transport rates tended to initiate more rapid discharge of material from the epithelium and ciliary dyskinesia.


Growth patterns and nutrition in Nepali children.

A growth survey of four groups of Nepali children from birth to 12 years was undertaken and the growth patterns related to diet. The patterns are those of children suffering from malnutrition in the second and third year and not those of a genetically small race. Diet histories showed inadequacies of diet, mostly preventable, occurring during the same period. Privileged children within the groups showed a different pattern and a significantly better growth.


Oxygen consumption and evaporative water loss in infants with congenital heart disease.

The relation between environmental temperature, heat production, oxygen consumption, and evaporative water loss was studied in 67 infants with congenital heart disease. The majority of the cyanosed infants had a low minimum oxygen consumption, a low evaporative water loss, and a diminished metabolic response to cold stress. Minimum oxygen consumption and evaporative water loss rose in 6 of these infants after the construction of a surgical shunt. Many of the ill acyanotic infants had an abnormally high minimum oxygen consumption, and those in cardiac failure often continued to sweat in an environment below the thermoneutral temperature zone.


Defect of platelet function associated with chronic hypoglycaemia.

Two patients are described with chronic hypoglycaemia; the first having glucose-6-phosphatase deficiency (type I glycogen storage disease), and the second fructose 1:6-diphosphatase deficiency. Both cases were associated with a bleeding diathesis, a defect of platelet aggregation, and a deficiency of platelet adenine nucleotides. The effect on the platelet abnormalities of a period of normoglycaemia was studied in both patients. Correction of the platelet abnormalities occurred rapidly after stabilization of the blood glucose within the normal range. Normal function persisted for the duration of the normoglycaemia, facilitating diagnostic liver biopsy and surgical procedures. A biochemical explanation for the nucleotide deficiency is suggested.


Ketamine anaesthesia for medical procedures in children.

Ketamine hydrochloride 2 mg/kg, together with atropine 0.2 mg, has been given intravenously on 100 occasions on a general paediatric ward. No serious side effects occurred. Dreams followed in 4 children but did not reduce acceptability of the drug. In our hands it has greatly reduced the pain and distress of children undergoing many routine medical procedures, particularly the dread which builds up when these have to be repeated in the same child. It has also produced close to ideal conditions for the operator, and probably increased his efficiency by reducing the emotional strain which occurs when doing painful things to a frightened patient.


Contribution of fibreoptic endoscopy to diagnosis and management of children with gastro-oesophageal reflux.

Endoscopic and radiological examination was performed in 53 children with gastro-oesophageal reflux. There was fair agreement between endoscopic and radiological findings. Most patients showed either a normal or an erythematous oesophageal mucosa at endoscopy and these patients became asymptomatic on conservative therapy. 7 children presented destructive changes of the oesophageal mucosa with severe pathological abnormalities. Though their symptoms improved on conservative therapy, 5 required operation because of persistence or deterioration of mucosal damage. Endoscopic and pathological changes returned to normal after operation. Retrospective examination of data led to the definition of 'high risk factors' in this condition.


Severe burns in children, 1964-1974.

580 children were admitted to the paediatric burns unit of Guy's Hospital between 1964 and 1974, of which 97 had burns exceeding 20% of the surface area, and 33 died (34% mortality). 80% of those with burns exceeding 50% of the surface area died. Young children died after less extensive burns. Respiratory failure, sepsis, and malnutrition were the most lethal complications. The prompt use and careful control of intravenous fluids had reduced the immediate complications associated with shock, and acute renal failure is now uncommon. Respiratory failure resulted in many deaths during the first week after injury. The need for intensive respiratory care involving paediatric, anaesthetic, and surgical staff is stressed. Sepsis and malnutrition remain major threats to survival. Improved methods of bacteriological control by laminar air flow units and topical antibacterial agents may help to reduce infection in the future. Reduction of energy expenditure by temporary skin coverings and a high environmental temperature, combined with a high calorie intake by oral and intravenous routes, may improve the outlook for severly burned children in the next decade.


Long-term results of surgical treatment for pulmonary valve stenosis.

109 children who survived surgical treatment for isolated pulmonary valve stenosis were followed for up to 17 years. In all the postoperative status was assessed as satisfactory. Cardiac catheterization repeated in 43 gave a resting valve gradient below 40 mmHg. The 22 children whose pulmonary valves had been excised were as healthy as the 87 who had undergone pulmonary valvotomy. Consideration was given to the desirable length of postoperative review. Except for the few children with symptoms before operation, a postoperative increase in exercise tolerance was not a feature.


Reduction of incidence and mortality of respiratory distress syndrome by adminstration of hydrocortisone to mother.

Hydrocortisone (100 mg in a single injection) was given to 120 pregnant women with threatened premature delivery. None was given to a control group of 40 mothers. Orciprenaline was also given to all the mothers to inhibit uterine activity. The administration of hydrocortisone did not accelerate delivery and in the treated group 55 babies were eventually born at term; none died or had perinatal complications. 65 babies were born prematurely, and yielded these conclusions; if the mother received hydrocortisone less than 24 hours before delivery it had little or no influence on the incidence of and mortality from the respiratory distress syndrome (RDS). If birth occurred more than 24 hours after hydrocortisone injection, the incidence and mortality from RDS were lowered. Prolonged rupture of membranes had no effect on the mortality rate from RDS. It was concluded that hydrocortisone administered to mothers with threatened delivery is an effective means of mitigating the incidence and severity of RDS in infants.


Evidence of duration and type of illness in children found unexpectedly dead.

The thymus, rib, and liver from a series of 200 children found unexpectedly dead showed that in over 90% of these children the costochondral junction indicated that a retardation in growth velocity had preceded death. In a similar proportion of children the liver showed fatty change indicating a metabolic upset, which in 5% was of severe degree. Changes in the thymus compatible with a normal reaction to infection were observed in only a little over half of the child deaths. An absence of gross thymic reaction in some children in whom there was other evidence of infection suggests that in some an abnormal immunological reaction was taking place. It is concluded that careful systematic clinical monitoring of growth in these children would have shown abnormality in nearly all.


Adverse factors affecting growth of schoolchildren in St. Helena.

More than 1000 schoolchildren on St. Helena were studied to determine factors associated with suboptimal growth. Disease was demonstrable in only a small minority, but social factors were of prime importance. In particular, family size was found to be a dominant factor, over-riding the associated effect from overcrowding. The implications of this findings are discussed, and the concept of a "threshold of coping" developed. It is suggested that failure to achieve optimal growth may be a particularly useful index of the points of stress in the child-rearing patterns of society.


Clinical experience with an oral anticoagulant in children.

Nineteen cardiac patients were given warfarin sodium to prevent thrombosis and embolism. Empirical dosage resulted in long hospital stays to obtain a stable therapeutic prothrombin time. Using a dosage of 0 therefore 5-0 therefore 7 mg/kg, therapeutic levels were achieved in a much shorter time. When prothrombin time was excessive, it was successfully reduced with vitamin K or plasma. A haematoma in one case and haematuria in another were easily controlled. Warfarin sodium appears to be appropriate and effective for children requiring anticoagulants within the above dosage limits and with meticulous follow-up.


D13 ring chromosome syndrome.

A case of ring D13 chromosome, confirmed by trypsin banding, is described. Reviewing 21 cases from published reports, the most common features of this syndrome are microcephaly and associated mental retardation, poor uterine growth, deformed auricles, hypertelorism, epicanthus, broad nasal bridge, and genital defects in males.


Phototherapy. Short and long-term complications.

Use of phototherapy for hyperbilirubinaemia in 300 consecutively treated infants has shown that minor complications are common. With a knowledge of these complications and measures taken to minimize their effects, phototherapy appears to be safe in the short term. The long-term follow-up study showed that growth, and in particular head circumference, was not affected. There was, however, a higher incidence of squints and abnormal developmental performance in those infants treated with phototherapy. This may not have been due to phototherapy usage per se. However, because of these findings, it is suggested that phototherapy should not be used indiscriminately for hyperbilirubinaemia until the results of further long-term studies are available.


Acute renal failure in early life.

Data are presented on 25 children under 2 years of age with acute renal failure treated by peritoneal dialysis. The clinical features, treatment, complications, and outcome of the illnesses are described. 22 (88%) survived, and though the incidence of serious complications during the illness was high most regained full health and normal renal function.


24-Hour urinary glucose excretion in assessment of control in juvenile diabetes mellitus.

24-Hour urinary glucose excretion was measured in 43 juvenile diabetics during treatment as outpatients. In 20 children studied twice over 1-3 months there was good correlation between glucose excretion on each occasion. Subdivision of the collections into the periods 08 therefore 00-20 therefore 00 and 20 therefore 00-08 therefore 00 hours gave slightly less consistent results with correlation coefficients of 0 therefore 83 and 0 therefore 80, respectively, between the results of the repeat tests. In 37 prepubertal children, 24-hour glucose concentration and height velocity over the previous year were compared, and a highly significant negative correlation found. 10 of the 12 children with glucose excretion greater than 40 g/d had height velocities more than 1 SD below the mean for age, while only 2 of the 25 subjects excreting less than 40 g/d had height velocities more than 1 SD below the mean. The results indicate that estimation of 24-hour urine glucose excretion can be a useful index for monitoring treatment and that subdivision of the total collection may be of value in selecting the most suitable insulin regimen for the patient.


Current practice in dietary management of diabetic children. A transatlantic comparison.

Dietary therapy practice in 18 British clinics for diabetic children is reviewed, and contrasted with Canadian and American practice. Values for dietary composition expressed as energy are presented for small groups of British and Canadian children. Fat is often the principal energy source in British diabetic children; protein intake is much higher in the Canadian. It is suggested that British practice might be improved by the adoption of a simple uniform exchange system. Reported differences in growth characteristics may reflect differences in protein intake.


Beneficial effects of transfusing a patient with nontransfusion-dependent thalassaemia major.

A case of nontransfusion-dependent thalassaemia major is presented showing growth retardation, recurrent fractures, late onset of puberty, deafness, and endocrine impairment of pancreas and adrenal gland. Regular blood transfusion to maintain mean haemoglobin at about 11 g/de improvedd all these problems. It is suggested that this improvement was related to improve tissue oxygenation.


Phalangeal microgeodic syndrome of infancy.

A case is described of chilblain-like lesions in the fingers with punched-out erosions in the phalanges on x-ray which appears to be an example of Maroteaux's phalangeal microgeodic syndrome of infancy.


Congenital varicella resulting from infection during second trimester of pregnancy.

An infant with left microphthalmia, enophthalmia, and cataract with scattered zosterform skin lesions from maternal varicella at 20 weeks' gestation is described. The mother's abnormal obstetric history is discussed and published reports on congenital and neonatal varicella reviewed.


Blue double light. Improved method of phototherapy.

In newborn infants with rhesus haemolytic disease the effect of phototherapy with blue light (28 cases) on both sides of the infant was compared with the effect of traditional white light phototherapy on one side of the infant (42 cases). The number of exchange transfusions performed after the first 12 hours of life was significantly lower in the blue double light group. It is concluded that the application of blue double light may be a superior means of applying phototherapy in rhesus haemolytic disease.


Incomplete arylamidase in psoriasis scales.

Electrophoretic and immunological studies revealed that normal and pathologically altered epidermis contains an arylamidase with the electrophoretic mobility of an x-globulin. This enzyme seems to be immunologically identical with an arylamidase secreted by the prostate gland. In psoriasis scales the arylamidase migrates with the electrophoretic mobility of a beta-globulin. Presumably, this enzyme contains fewer neuraminic acid groups than the arylamidase of normal epidermis. It may well be that in psoriasis the synthesis of arylamidase is incomplete.


[On the effectiveness of lymph-nodes as filter cells in metastasizing melanoma (author's transl)].

Even without previous ray-treatment the mechanical effectivenes of the filtration ability of lymph-nodes may be reinforced by connective tissue growth around metastatic melanoma cells. On the other hand melanoma cells can pass this filter just because of the possibility to get into the lymph stream by means of wide lymphatics even within the first series of regional lymphatic ganglia. This is true also for passing the marginal lymphatic sinus and subsequent entering the vas efferens of the lymph-node. The therapeutical inferences of these observations are discussed.


Symptoms and immunology of the Henoch-Schönlein-syndrome.

The Henoch-Schönlein-syndrome, or anaphylactoid purpura, is usually a childhood disease. The progess of this syndrome in adults was observed in 4 cases at our clinic. An elevated IgA level in the serum with a normal complement value seems to be of immunological interest. By immunohistological methods fibrin and IgA could be demonstrated in skin and kidney biopsies; in glomerulae C3c was observed, occasionally accompanied by Properdin-factor-B. These findings differentiate this disease from other allergic superficial vasculitids by the detection of IgG and complement; while at the same time some similarities are indicated to the so called "Berger Nephritis" with comparable kidney findings.


Effect of immunization on the RNA polymerase activity of guinea-pig macrophage nuclei.

Macrophages from peritoneal exudate contain three types of DNA dependent RNA polymerase. The activity of RNA polymerases in macrophages derived from normal animals is very low. Guinea-pigs were immunized by sheep red blood cells. The immunization enhanced the activity of the RNA polymerase of macrophages derived from peritoneal exudate. The RNA polymerase activity was tested after the solubilization and chromatographic resolution of the three types of polymerases with exogenous template. The results obtained indicated that the immunization enhances the levels of polymerase I and III 10 fold while the level of polymerase II increased 5 fold.


Enzyme inhibition in human skin homogenates by hydrocortisone, hydrocortisone acetate and hydrotisone butyrate.

In fresh human skin homogenates, the activities of four enzymes, lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G-6-PDH), "acid" phosphatase (AcP), and "leucine aminopeptidase" (LAP) were assayed following an incubation with hydrocortisone, hydrocotisone acetate, or hydrocortisone-17-butyrate, respectively. Concentration of the three compounds measured 2.75 mMol/l. Hydrocortison butyrate inhibited LDH-G-6-PDH-, and AcP-activities. Hydrocortisone and hydrocortisone acetate exerted a significant inhibitory action only in the case of G-6-PDH-activity.--On pure G-6-PDH from yeast, the inhibition exerted by hydrocortisone butyrate was significantly stronger than the inhibition exerted by the two other steroids. Time/action diagrams revealed the fact that hydrocortisone butyrate is superior to the other two compounds from the beginning of the incubation period.--The date sustain the assumption that hydrocortisone butyrate exerts biochemical-pharmacological actions of its own and that it may not be considered just as an esterified transport form of hydrocortisone.


Ultrastructure of inborm errors of keratinization. VII. Porokeratosis Mibelli and disseminated superficial actinic porokeratosis.

The cornoid lamella and the underlying epidermis were studied by electron microscopy on specimens biopsied from 2 patients with porokeratosis Mibelli and 1 patient with actinic porokeratosis. Findings on the two types of porokeratoses are essentially the same. The cornoid lamella was composed chiefly of extremely irregular dark cells and a few numbers of dyskeratotic cells. Both cells retained a nuclear remnant and many other degraded organelles. The epidermal cells just beneath the cornoid lamella simultaneously demonstrated productive and degenerative signs. Some of these epidermal cells underwent dyskeratosis and appeared as corps ronds-like bodies in the granular layer. Two contradictory phenomena should be attributed to the pathogenesis of cornoid lamella. In the cornoid lamella above the sweat pore microvilli-structures were found.


Ultrastructural studies in epidermolysis bullosa hereditaria. II. Dominant dystrophic type of Cockayne and Touraine.

Ultrastructural examination was performed in 9 biopsy specimens from 4 patients with the Cockayne-Touraine type of epidermolysis bullosa dystrophica dominans. The specimens were taken from: 1. clinically normal skin from the blister-nonpredilected sites (trunk) as well as 2. atrophic, 3. intact, and 4. experimentally frictioned skin regions from the blister-predilected sites (extremities). In the frictioned skin a dermolytic blister formations was observed. Development of anchoring fibrils showed a marked regional difference, the counts of fibrils being significantly lower (40%) in the predilection sites than in the nonpredilection sites. In addition the anchoring fibrils showed a variable degree of abnormal structure. The low frequency of often abnormally structured anchoring fibrils in the blister-preferred sites provides a good explanation for the clinical features. More studies are needed to see if regional differences in fibril frequency is a feature also of normal skin, in which case the dominant epidermolysis gene may represent a mutated structural anchoring fibril gene.


[Cytokinetics of epidermal and dermal cells in allergic contact dermatitis and atopic dermatitis (author's transl)].

The cytokinetics of epidermal and dermal cells was examined in 16 patients with subacute or chronic allergic contact dermatitis and 11 with atopic dermatitis. In allergic contact dermatitis a H3-thymidine-labelling index (H3-1) of 4.55 +/- 2.4% was found in the epidermis and of 0.7 +/- 0.44% in the dermal infiltrate. In comparsion, in atopic dermatitis the values were 5.5 +/- 2.31% in the epidermis and 0.93 +/- 0.72% in the dermis. The DNA-synthesis-time (ts) was lengthened slightly with 11.4 +/- 2.4 h in allergic contact dermatitis and 11.75 +/- 3.68 h in atopic dermatitis. In comparsion with normal skin, the cell-cycle-time (tc) was slightly shortened in allergic contact dermatitis (244 +/- 110 h) and in atopic dermatitis (233 +/- 83 h). There was no significant difference between both types of dermatitis regarding cytokinetics.


[Electron microscopic investigation of the leishmaniasis cutanea. I. Leishmania tropica in the tissue (author's transl)].

On two patients suffering from Leishmaniasis cutanea from the old world florid and later a residual lesion could be removed for electron-mircroscopic examination, and the following was found: 1. A pseudocarcinomatous follicular epidermal proliferation in the florid lesion. 2. Macrophages with one to three Leishmania cells can be proved in histiocytes nests. The parasites are not always clearly surrounded by host cell membrane. 3. The endocellular Leishmania cells have a ciliary system which is open on the outside. It is, therefore, correct to speak of a cryptomastigotic shape of the flagellum. The kinetoplast shows direct transition to mitochondria. The number of periplast fibrillae or tubuli amounted to 95-97 which is less than in other types of Leishmania. Yet no further morphological distinctive feature between Leishmania tropica and the other types is discernible when a comparison with the pertinent literature is made. 4. No parasites to be considered virulent were found now in the late residual focus of previously secured cutaneous Leishmaniasis. The macrophages, on the other hand, contained big vacuoles with lamellar residual substances. These are regarded as rests of the parasites.


[Letter: Porphyria cutanea tarda: normalization of porphyrin-excretion following treatment with p-amino-benzoic acid (Potaba) (author's transl)].

Two patients with porphyria cutanea tarda were treated with p-amino-benzoic acid (Potaba) (3x4g/day). Normalization of porphyrin-excretion was observed after three respectively 45 days of treatment. Furthermore no influence of the excretion of porphyrin precursors (porphobilinogen or delta-amino-levulinic acid) were noticed. Also, no side effects of this treatment were found.


Studies of respiratory morbidity in rubber workers. Part IV. Respiratory morbidity in talc workers.

Pulmonary function tests, chest x-rays, and respiratory questionnaires were administered to eighty talc workers and 189 non-exposed rubber workers from three rubber tire manufacturing plants. The talc workers, who were exposed to talc at levels below the current threshold limit value (TLV) of 20 mppcf for nonfibrous talc, had a statistically significantly greater prevalence of productive cough and of positive criteria for chronic obstructive lung disease (COLD) than did the control workers. The talc workers with more than 10 years of exposure had significantly decreased residual FEV 1.0. Multiple regression analysis of FEV 1.0 in the talc workers estimated that each year of exposure to talc dust reduced the FEV 1.0 by 26 ml. Talc workers had a clear increase in respiratory morbidity, despite the absence of chest roentgenographic changes. Based on this study, a safe exposure level for talc appears to be 25 mg/m3 as a time-weighted average.


Post-mortem study of the hip joint. II. Histological basis for limited and progressive cartilage alterations.

This histological study is based on a macroscopical study of post-mortem hip joints (Byers, Contepomi, and Farkas, 1970) in which two categories of articular cartilage alterations, in addition to osteophytes, were described. One category consisted of 'limited' alterations which occurred frequently, had several subcategories, and rarely led to joint deformity. The other consisted of progressive alterations which caused bone exposure and joint deformity. Histological sections from both groups, including all the subcategories of the first, were studied. Initially the mechanisms that destroy cartilage were determined, and then their prevalence was assessed. Six mechanisms were found, all occurring in the group of limited alterations with varying prevalence and in varying combinations. Only one, fibrillation, occurred in the progressive group.


Autoxidation of polyunsaturated fatty acids. Part I. Effect of ozone on the autoxidation of neat methyl linoleate and methyl linolenate.

Neat samples of polyunsaturated fatty acids were exposed to ozone in air in a flow system, and the formation of peroxides, conjugated dienes and thiobarbituric acid (TBA)-reactive material was followed as a function of time. The effect of ozone is to shorten the induction period normally observed in autoxidation studies, but the ozone, at the concentrations used here (0-1.5 ppm), appears to have no effect on the rates of product formation after the induction period. During the induction period, increasing ozone concentrations give rise to substantially increased rates of peroxide (or materials which titrate like peroxide) formation, a slightly increased rate of conjugated diene formation, and no significant increase in the rate of production of TBA-reactive material. Vitamin E lengthens the induction period but appears to have no other effect. Some of these data are in conflict with earlier reports of Menzel et al.


Post-mortem study of the hip joint. III. Correlations between observations.

Correlations between alterations in hip joints, described in a post-mortem study, have established the independence of limited and progressive alterations, and in addition have shown that there is a weak association between limited alterations and osteophytes and a strong one between progressive alterations and osteophytes. Nevertheless limited alterations may rarely undergo progressive damage. Cysts relate strongly to osteophytes but only moderately with progressive alterations. Limited alterations of both head and acetabulum can be subdivided. Some implications of these findings are discussed.


delta-aminolevulinic acid dehydratase in low level lead exposure.

No statistically significant correlation was observed between log delta-aminolevulinic acid dehydratase (ALAD) activity and blood lead levels (Pb-B) in rural or urban habitants (p greater than .5 and P greater than .1, respectively) in whom no occupational source of lead was known. However, when the values the the two groups were pooled, there was a fairly good negative correlation (r = 0.509, P less than .01). Stepwise correlation coefficient analysis indicated the existance of a threshold value of Pb-B (around 15 mug/100 ml) below which ALAD activity had nor orderly relationship with the Pb-B. In contrast with married couples, parents and their children showed a remarkably high interrelationship in values of ALAD. It is concluded that in low level lead exposure primarily genetic factors influence the activity of ALAD and, thus ALAD is useful for the evaluation of lead exposure only when the lead level is higher than the threshold.


Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine.

The distribution of end-plate lesions (Schmorl's nodes) and their relationship to bone density and disc degeneration have been studied in 50 post-mortem spines below D9 in subjects aged 13-96 years. Lesions were present in 76% of cases with a predominance in males. They were found more frequently in the lower than in the upper vertebral end-plate. They were also more common and more severe in the dorsolumbar (D10-L1) region than in the lower lumbar (L2-L5 region). In adults they were unrelated to age and bone density. Lesions were significantly related to disc degeneration in the D10-L1 region but not in the L2-L5 region. It is suggested that end-plate lesions arising in adolescence (or before) may predispose the dorsolumbar spine to disc degeneration in later life.


Antagonistic effect in vivo of zinc on inhibition of delta-aminolevulinic acid dehydratase by lead.

Delta-aminolevulinic acid dehydratase (ALAD) is an enzyme involved in the biosynthesis of heme, in which it catalyzes the condensation of two molecules of delta-aminolevulinic acid to one molecule of porphobilinogen. It is a sulfhydryl enzyme, which means, among other things, that its activity is inhibited by many heavy metals. In the present investigation rabbits were given either zinc or lead or both. Zinc had a strong activating effect on ALAD in vivo, and the inhibitory effect of lead was almost completely eliminated. A close positive correlation was found between ALAD in the red blood cells and zinc in the plasma, but there was no correlation between ALAD and zinc in the red blood cells. These observations are of particular interest in the light of recent findings, suggesting that zinc is an essential metal for ALAD.


Thrombocytosis in rheumatoid arthritis.

Of 75 patients with rheumatoid arthritis, 39 had a thrombocytosis and 36 normal platelet count. A highly significant relationship existed between the platelet count and disease severity and an inverse correlation with level of haemoglobin. An association appeared to exist between thrombocytosis and extra-articular manifestations of rheumatoid disease. By 75Selenomethionine labelling platelet and fibrinogen survival and turnover were determined. In 3 rheumatoid patients with thrombocytosis platelet survival was decreased and turnover increased. In these and a further rheumatoid patient with a normal platelet count there was reduced fibrinogen survival and increased fibrinogen turnover, and in addition excess fibrin degradation products were detected. The results suggest that thrombocytosis accompanies the more severe cases of rheumatoid disease and is due to a compensatory increase in platelet production associated with active intravascular coagulation.


Delayed appearance of tracer lead in facial hair.

Three adult men were fed 204 Pb - a rare, stable isotope of lead - daily for about 100 days. Simultaneous blood and facial hair measurements of this tracer and of total lead concentrations were made by mass spectrometric isotope dilution analysis. Although the blood showed an immediate response to the intake of the tracer, the facial hair showed a more gradual response and a delay of approximately 35 days. Since the pattern of appearance of lead in hair does not appear to represent a simple time delay of blood lead concentration, the existence of a physiological pool of lead fed by the blood and giving rise to the content in hair is suggested. Hair lead values should, therefore, be interpreted as the integral of the blood lead values over the mean life of this intermediate pool - about 100 days.


Absence of chromosome damage in human lymphocytes exposed to allopurinol and oxipurinol.

The biochemical evidence against incorporation of the purine analogues, allopurinol and oxipurinol, into nucleic acids is reviewed. Cytological experiments have been carried out to investigate the possibility that chromosomal damage might result from exposure of human lymphocytes to these drugs. Lymphocytes from 19 patients receiving allopurinol and one receiving oxipurinol were examined for the presence of chromatid aberrations during metaphase, and lymphocytes from untreated subjects were similarly studied during in vitro exposure to the drugs. The low frequency of aberrations observed was well within normal limits, and it is concluded that allopurinol and oxipurinol have no deleterious effects on chromosome structure.


Immunological reactivity in ankylosing spondylitis. Circulating immunoblasts, autoantibodies, and immunoglobulins.

Circulating immunoblasts were studied in 39 cases of ankylosing spondylitis. The results were compared with 20 normal subjects and a group of 39 patients with rheumatoid arthritis, Immunoblasts were found to be increased in 11 patients with ankylosing spondylitis and in 22 patients with rheumatoid arthritis in contrast to the controls who were found to have a normal lymphoid cell population in the peripheral blood. Fifteen patients showed raised levels of one or more class of immunoglobulin. Autoantibodies, including antinuclear factors, were negative in all cases. There was a correlation between raised immunoblasts and plasma viscosity but not with clinical assessment of activity. The increase of immunoblasts in the peripheral blood, together with the raised immunoglobulins supports the suggestion of an immunological basis for ankylosing spondylitis.


Circulating immunoblasts in polymyalgia rheumatica.

The percentage of immunoblasts circulating in the peripheral blood has been examined in a group of 29 patients with polymyalgia rheumatica (PMR). Less than 0.5% of immunoblasts were found in healthy young controls, but 18 of 29 unselected patients with PMR were positive when first tested, a similar proportion to that found in rheumatoid arthritis. Raised immunoblasts were found in only one of 12 elderly controls. The presence of circulating immunoblasts correlated with the activity of polymyalgia both as assessed by the erythrocyte sedimentation rate (ESR) and as assessed by an independent clinical observer. This was true in the group overall and in those patients where serial studies were made. Patients studied from the time of disease presentation showed a concurrent fall in ESR and in immunoblasts on starting steroid therapy. Detection of circulating immunoblasts can be a useful additional test in the assessment of disease activity in PMR, especially in cases with a low ESR. The presence of circulating immunoblasts supports the concept of an immunological aetiology for PMR. This is strengthened by the finding that raised immunoglobulins were more common in patients with circulating immunoblasts.


Assessment of rheumatoid activity based on clinical features and blood and synovial fluid analysis.

Joint inflammation in rheumatoid arthritis has been assessed, and the most useful guides to disease activity were determined by analysis of synovial fluid and blood together with the history of joint disability. The patient's own evaluation of the amount of pain suffered was the most useful clinical assessment. Differential cell count and glucose estimations were the most helpful guides in the synovial fluid, while C-reactive protein in the serum most accurately reflected disease activity. The effects of systemic steroids on these indices were studied, and the differences between seronegative and seropositive patients noted.


Radiographic stereoplotting. A new technique and its application to the study of the spine.

Radiographic stereoplotting is a method for taking three-dimensional measurements from a pair of x-ray films. The x-ray technique is described, as is the stereoplotter. Using this machine it is possible to locate any point within the patient and measure the distance between that point and any other point. From this information it is possible to compute areas, volumes, and angles with great accuracy, which hitherto has been impossible using noninvasive techniques. It is planned to take measurements of the spinal canal in normal backs and in patients with nonspecific back pain, in order to try to define some of these syndromes on a structural basis. It is likely that stereoplotting has some useful application in most branches of clinical medicine, since the x-ray technology is available in any diagnostic x-ray department.


Serum pyridoxal in patients with rheumatoid arthritis.

Abnormalities of tryptophan metabolism have been reported in patients with rheumatoid arthritis (RA) and it has been suggested that these abnormalities are the result of disordered vitamin B6 metabolism. Fasting serum pyridoxal, assayed by an automated microbiological system, was found to be below normal in 35 out of 42 patients with RA while a similar abnormality was found in 8 out of 35 patients with osteoarthrosis (OA). Within the RA group the abnormality could not be related to the age, sex, or drug therapy of individuals but of the 8 patients with OA and a low serum pyridoxal, 7 were receiving indomethacin either alone or in conjunction with aspirin.


Clinicopathological study of a patient with procainamide-induced systemic lupus erythematosus.

A patient who developed a multisystem involvement of systemic lupus erythematosus (SLE) after 9 years of procainamide therapy, during which time he ingested enormous amounts of the drug, is described. The patient first suffered from recurrent episodes of pleuritis and arthritis, after which he developed a characteristic SLE nephritis associated with a high level of antinative DNA antibodies and a low level of complement. He finally died from a complication of a nonbacterial endocarditis. Autopsy showed polyserositis and typical deposits of electron-dense material on the glomerular basement membrane, and confirmed the clinical diagnosis of Libman-Sacks endocarditis. The possibility that procainamide-induced SLE might have all the clinical, immunological, and pathological features of spontaneous SLE, especially in patients exposed to large doses of the drug for many years, is discussed.


Experimental arthritis of rabbits caused by intra-articular injection of autologous Fab2 produced by digestion of IgG with cathepsin D.

Intra-articularly injected autologous Fab2 produced from IgG by homologous cathepsin D induces in animals not given prior  immunization acute synovitis after 1 and 3 injections, acute synovitis after 6 injections, and chronic synovitis after 12 injections. Histologically, the chronic synovitis is similar to synovitis in rheumatoid arthritis (RA). In the joint, cathepsin D Fab2 appears to act as a fairly strong antigen. Evidence for this is provided by the infiltration of large numbers of polymorphonuclear leucocytes, the marked phagocytic activity of the exudate leucocytes and tissue phagocytes, and the stimulation of the synthesis of specific antibodies (homoreactants) in the synovial plasma cells. The immediate action of injected Fab2 suggests that it forms biologically active immune complexes with homoreactants already present. These complexes are phagocytosed, the homoreactants being demonstrable immunohistochemically in inclusions of the exudate and tissue phagocytes. In addition, the local synthesis of antigammaglobulins of rheumatoid factor type is also induced. These react with heat-aggregated homologous as well as human IgG and are likewise found in inclusions in the exudate and tissue phagocytes. In the serum of the animals the titre of rheumatoid factor-like antigammaglobulins increases to an extent depending on the number of injections given. These histochemical and serological findings show striking parallels with the findings in human RA.


Cyclic condensed metaphosphates and linear polyphosphates in brown and red algae.

The occurrence of linear condensed polyphosphates and cyclic condensed metaphosphates was studied by means of pulse-labeling with 32P-orthophosphate (3--5h) in a number of Phaeophyceae species: Pylaiella litoralis, Ilea fascia, Ectocarpus siliculosus and also Rhodophyceae species: Ceramiumdeslongchampsii, C. rubrum, Rhodomela confervoides, Porphyridium purpureum and P. aerugineum. Two-dimensional cellulose thin layer chromatography revealed that in all species studied 32P-radioactivity was generally present in all oligopolyphosphates containing 2 to 7 phosphate residues, in cyclic metaphosphates (tri-, tetra-, penta- and hexametaphosphates) and in high-molecular-weight condensed phosphates which remained at the starting point. Among the low-molecular-weight condensed inorganic phosphates the trimetaphosphate had a significantly higher specific activity than the other oligophosphates which were separated on the chromatography plates as measured by the direct scanning with a Geiger-Muller counter. The phosphate uptake strongly depends on the internal pool of reserve phosphates of the algae cells. The 32P-orthophosphate incorporation of the cells is low and sluggish when growning in a synthetic medium or in sea water. Accordingly 32P appeared preferentially in the low-molecular-weight fractions of condensed phosphates since the storage phosphates were not yet used. After previous incubation in a P-free culture medium of the algae the 32P was rather rapidly incorporated and was found mostly in the high-molecular-weight condensed phosphates. During MAK-chromatography the high-molecular-weight fractions were eluted together with the nucleic acids (tRNA and DNA) while most of the low-molecular-weight fractions left the column immediately on elution.


The capacity of phototrophic sulfur bacterium Thiocapsa roseopersicina for chemosynthesis.

Purple sulfur bacterium Thiocapsa roseopersicina strain BBS requiring vitamin B12 may grow in the dark in media containing no other organic compounds. Under such conditions the cells oxidize sulfide and thiosulfate with the use of O2 and assimilate carbon dioxide. After 10--30s assimilation of NaH14CO3 about 60% of radioactivity is found in phosphorylated compounds characteristic for the reductive pentose phosphate cycle. The possibility of the function of this cycle in the dark in the presence of O2 is confirmed by the capacity of cells grown under such conditions to synthesize ribulose-1,5-diphosphate carboxylase. All this evidence suggests the ability of T. roseopersicina to change from phototrophy to aerobic chemolithoautotrophy.


Thermodynamic conpensation in microbial thermal death. Studies with yeasts.

Sixty eight Arrhenius plots of thermal death in six mesophilic yeast species, tested at various concentrations of NaC1, lacked an isokinetic temperature. Nevertheless the deltaHnot equal to/deltaSnot equal to plot was apparently linear with a slope corresponding to 314degrees K. It was concluded the linear thermodynamic compensation of thermal death is non-existent in heterogeneous groups of yeasts and is unlikely to occur in hetero-geneous groups of other organisms and that deltaHnot equal to/deltaSnot equal to plots lack sensitivity for the detection of non-linearity over narrow temperature ranges. However, the deltaHnot equal to and deltaSnot equal to parameters of thermal death displayed non-linear compensation in such a way that the extrapolated Arrhenius plots of death attained nearly identical values near the respective maximum temperatures for growth. Linear thermodynamic compensation occurred in each of the six strains, when stationary populations of the same strain were tested at various NaC1 concentrations. On the other hand, exponential populations of each of the strains, tested in the same way, lacked an isokinetic temperature of thermal death. The significance of linear and non-linear thermodynamic compensation in biological rate processes is discussed.


Growth of nitrobacter in the presence of organic matter. II. Chemoorganotrophic growth of Nitrobacter agilis.

1. After a resting period of up to 6 months cells of Nitrobacter agilis grow with acetate, formate, and pyruvate as carbon and energy source. Yeast extract and peptone were added to supply the organism with nitrogen and to meet possible vitamin requirements. 2. The length of the growth period depends on the substrate; it increases according to the following sequence: pyruvate, formate, acetate. The highest growth yield is observed with pyruvate, the lowest with formate. 3. O2 consumption is increased in the presence of substrates as compared to endogenous respiration. With pyruvate and acetate twice as much O2 is consumed, with formate 7 times, with yeast extractpeptone 10 times as much. 4. The ability of nitrite oxidation is largely preserved, except in cells grown with acetate or pyruvate in the presence of 0.015% yeast extract and peptone. Such cells have nearly no cytochrome a1. Accordingly. the cytochrome spectra of nitrite oxidizers grown under chemoorganotrophic and lithoautotrophic conditions coincide qualitatively. 5. The nitrite oxidizing system is inducible. It is induced by nitrite but also by substances present in yeast extract and peptone. Cells grown on acetate and yeast extract and peptone (0.015%) require 3--4 weeks before they regain the ability to grow with nitrite. Cells grown chemoorganotrophically with the same substrates and yeast extract and peptone (0.15%) start growing and nitrite as energy source without a lag. 6. Cell size and form, distribution of storage materials, order and fine structure of double membranes are correlated with growth conditions.


[On the essential oil of green algae. II. The oils of the genera Ankistrodesmus and Scendesmus].

The essential oil and its main components (i.e., proazulenes) are useful taxonomic characters also in the genera Ankistrodesmus and Scenedesmus. The amounts of oil in these genera are similar to that of the genus Chlorella. A few strains of Ankistrodesmus, which are unable to synthesize proazulenes, seem to belong to other genera.


Personal needs, values, and technical preferences in the psychiatric hospital. A replicated study.

This study tests the hypothesis that staff and patients try to make their involvement in psychiatric hospitals personally gratifying by fashioning preferences for those specific therapeutic techniques that match or satisfy their personal values and needs. Results of questionnaire data, collected from a total of 397 staff and patients at two psychiatric hospitals at two different times, show two distinctly different combinations of needs, values, and technical preferences. In one, a preference for psychotherapy and somatotherapy correlates highly with a preference or need for structured, cautious, and rule-governed relationships. Underlying these preferences seems to be a common dimension emphasizing a technical attitude towards the psychiatric hospital with true healing provided only by a professional, scientific elite. A second combination shows high correlations between a preference for social therapy and a need for unstructured, open, and trusting relationships. A common dimension underlying these preferences seems to be a moral attitude that stresses the healing power of all human relationships. Treating institutions may be categorized according to whether the technical or moral attitude predominates.


Histocompatibility antigens and manic-depressive disorders.

Forty-seven unrelated Danish patients considered to be manic-depressive, according to strict diagnostic, symptomatic, and course criteria, were typed for histocompatibility (HLA) antigens. Significantly more manic-depressive patients than controls were found to have HLA-A3, HLA-B7, and HLA-Bw16, while significantly fewer manic depressives than controls had HLA-B8. All eight of the patients with HLA-Bw16 were bipolar patients, and none were unipolar depressive patients. We emphasize the need to consider the results with caution in view of the large number of antigens considered and the relatively small number of patients involved. When statistical corrections are made for the large number of antigens investigated, only the difference between bipolar patients and controls remains significant. The best way to determine if our findings are really significant is to attempt to confirm them in other series of patients. The importance of utilizing strict symptomatic and course criteria for the selection and polarization of proband is stressed.


Combining tricyclic and monoamine oxidase inhibitor antidepressants.

The charts of 150 inpatients and 51 outpatients treated with a monoamine oxidase inhibitor (MAOI)-tricyclic antidepressant combination were reviewed. The incidence and severity of side effects among the patients on the combined regimen were essentially the same as those seen in the control groups. There were no deaths or strokes resulting from use of this regimen. The most frequent troublesome side effect was orthostatic hypotension. We conclude that the use of a MAOI-tricyclic combination in oral therapeutic doses is safe. However, the efficacy of this combination has not yet been proved, and it may be particularly toxic if taken in an overdose.


Classification of suicidal behaviors. II. Dimensions of suicidal intent.

A factor analysis of a scale to assess suicidal intent showed four major dimensions: expectancies and attitudes, premeditation, precautions against intervention, and oral communication. Certain types of actions associated with attempted suicide such as seeking help or social isolation appear to be revealing of particular behavioral patterns or motives. Dealing with intent only as a global concept is an oversimplification. Suicidal ideation and suicidal acts are seen as complex patterns of behavior requiring increasingly thorough analyses for better understanding, prediction, and prevention.


Suicide--the other side. The factor of reality among suicidal motivations.

A prevalent feature of many investigations of suicide is a degree of recoil from true empathic closeness to a suicidal person. The motives for this lie within the investigator's own dynamics--they are anxiety over one's own suicide proneness, together with guilt, shame, contempt, and the avoidance of medicolegal involvement. These motives are not altogether unrelated to the suicidal motives themselves, and they hamper the capacity of objective, neutral assessment. With a recognition of these resistances, the seldomly mentioned realistic determinant of suicide becomes discernible, the act sometimes being a clever, courageous choice of death, and not, as usually diagnosed, a pathologically generated escape from life. All suicidal motives should be evaluated according to several concomitant ratings simultaneously, while emphasizing the realistic rating. A neutral, unbiased approach to suicide should reduce the dangerous false glory sometimes attributed to the act, thus contributing to the discrimination of sickness, therapy, and health.


Neurologic soft signs in schizophrenia and character disorders. Organicity in schizophrenia with premorbid asociality and emotionally unstable character disorders.

Previous studies indicated that for two subgroups of patients, schizophrenics with premorbid asociality (SPA) and individuals with emotionally unstable character disorders (EUCD), central nervous system damage may have etiologic significance. It was hypothesized that these two patient groups would also have an increased number of neurologic soft signs. The relationship of neurologic examination, tests of auditory-visual integration, and intelligence quotient, and diagnoses was studied for 350 patients. Tests of reliability and persistence for all observed signs were performed. The EUCD and SPA groups had increased evidence of neurologic soft signs. Differences in patterns of IQ scores also suggest that different forms of brain damage may be present in these two groups. When the two groups were removed from the larger patient sample, those patients with other types of schizophrenia and character disorder did not exhibit evidence of neurologic impairment. This study of neurologic soft signs adds to the validity of considering SPA and EUCD as separate diagnostic entities.


Clinical implications of a simulation model of paranoid processes.

A shame-humiliation theory of paranoid processes embodied in a successful computer simulation model has clinical implications for the understanding, treatment, management, and prevention of paranoid disorders. The multiplicity and variety of these implications indicate that the theoretical model is more than ad hoc, since it potentially contributes new empirical content to existing knowledge about paranoid disorders. Among rival theories, a more acceptable one is that with a large consequence class, members of which turn out to be true, and that which most effectively serves multiple purposes.


A test of the psychedelic model of altered states of consciousness. The role of introspective sensitization in eliciting unusual subjective reports.

The term "psychedelic" applied to "altered states of consciousness" would imply that such subjective anomalies are direct expressions of normal psychological functioning. The anomaly in such experience would depend in the first instance on sensitization to qualities of immediate subjective state. Such sensitization should in itself be considered nonadaptive, cutting off the "intentionality" of psychic functioning at a microgenetically primitive level. This hypothesis was experimentally confirmed, in a setting involving isolation and inactivity for a period of ten minutes, by the striking incidence of anomalous subjective reports in groups provided instructions involving direct sensitization to immediate subjective state compared with nonsensitization groups. In addition, as would be predicted from a "psychedelic" model of altered states, a study of the experimental protocols of the early introspectionists revealed subjective anomalies similar to those found in drug and meditational states.


Postresectional anemia. A preventable complication of total gastrectomy.

The incidence of anemia after total gastrectomy has not received sufficient clinical emphasis. During a follow-up period averaging 32 months, postresectional anemia developed in seven of ten patients without evidence of malignant neoplasm; all but one of these patients had received parenterally administered cyanocobalamin. Despite low levels of circulating erythrocytes and proportionately increased erythropoietin levels, reticulocytosis was not evident. This observation suggests an uncharacterized failure of marrow erythyroid precursors. Multiple deficits in intake of constituents necessary for the production of erythrocytes were demonstrated. With the possible exception of iron, malabsorption of these constituents is not an important factor in the production of anemia. Postresectional anemia is multicausal, but is primarily nutritional. As total gastrectomy becomes more commonly employed in the treatment of nonmalignant conditions, recognition of the frequency and causes of postresectional anemia should assist both diagnostic anticipation and therapy.


Effects of selective gastric vagotomy and pyloroplasty on oral and intravenous glucose tolerance and insulin secretion.

In peripheral and portal venous blood, the immunoreactive insulin (IRI) and glucose levels in response to orally and intravenously administered glucose were measured in 14 patients with selective gastric vagotomy and pyloroplasty (SGV+P) and in 17 control subjects with other abdominal surgery. After intravenously administered glucose, the insulin and the glucose levels were nearly identical in both groups. After orally administered glucose, there were remarkable differences. Despite their early postoperative situations, and in contrast to the control patients, the SGV+P subjects showed no hyperglycemia. The measurements of IRI in the portal vein suggested that in SGV+P patients, the response of the islet cells is accelerated. In patients with SGV+P, the release of an insulinotropic intestinal factor and the preserved vagal innervation of the pancreas may be responsible for the accelerated insulin response of the undisturbed glucose tolerance.


Gastroduodenal Crohn disease.

Symptomatic involvement of the stomach and duodenum is an uncommon manifestation of Crohn disease. Our experience with three young women who had upper gastrointestinal tract symptoms indicates the seriousness of the condition. All three patients required operation for relief of symptoms. Two operations were performed for gastric outlet obstruction and one for massive hemorrhage (a rare complication of gastric involvement). All patients had roentgenographic or gastroscopic evidence suggestive of Crohn disease, and in each the diagnosis was confirmed by histopathologic means. The operative procedures consisted of distal gastrectomy in two cases and gastrojejunostomy in the third. All three patients have or have had evidence of Crohn disease of the small intestine and none of them responded to medical management. (In the most recent case, medical management included intravenous hyperalimentation.) In our experience, symptomatic involvement of the stomach in Crohn disease will not respond to medical treatment and will require surgical measures for relief.


Gunshot wounds of the abdomen. A review of 277 cases.

During a five-year period from July 1968 throuhgh June 1973, 277 abdominal gunshot wounds (GSWs) occurred, the overall fatality of which was 10%. Abdominal exploration was done in all patients. No intra-abdominal injury was found in 40 patients (14%) and no death occurred in this group. There were 28 fatalities (12%) in 237 patients (86%) who had intra-abdominal injuries. Morbidity and mortality were related not only to the number of organs injured, but also to specific organs injured. The leading cause of early death was hypovolemia due to major vessel injuries. Septicemia was the most common cause of death if the patient survived the first 24 hours of hospitalization. Penetrating abdominal stab wounds and gunshot wounds must be considered separately, and mandatory routine abdominal exploration for all penetrating gunshot wounds is advised. In stab wounds to the abdomen, conservative management may be preferable.


Intussusception in chronic renal failure.

Spontaneous intussusception in adults is rare. Recently, we managed two patients with chronic uremia in whom intussusception developed. Histologic examination of the resected segments showed intestinal intramural hemorrhage. We postulate that the coagulopathy associated with uremia may allow for intestinal intramural hemorrhage, thus forming a nidus from which intussusception may be initiated.


Metastatic carcinoma of the ureter.

Three patients had carcinoma of the stomach, rectum, and lung, respectively, metastatic to the ureter in the absence of other known metastasis. Two of the three patients had abdominal pain, while the other patient had no upper urinary tract symptoms. All patients had excretory urograms that showed delayed or no excretion of contrast medium on the side of obstruction. Obstruction was confirmed with retrograde pyelography in each case. Two of three patients were treated with nephrectomy. Metastatic carcinoma of the ureter should be considered in patients with malignant disease with initial symptoms consistent with ureteral obstruction. The diagnosis may be suggested by pyelographic demonstration of an obstructed ureter. Symptomatic patients may require nephrectomy.


Disturbances in hepatic blood flow during anesthesia and surgery.

A study of 88 patients showed a reduction in the estimated hepatic blood flow (EHBF), as measured by a colloidal gold technique, to 88% and 84% of its initial value during ether and halothane anesthesia, respectively. During the operative procedure itself, there was a further fall in the EHBF. In patients undergoing herniorrhaphy or excision of a breast tumor, the EHBF decreased to 82% and 76%, while in patients undergoing partial gastrectomy or cholecystectomy, the EHBF fell to 48% and 42% of its initial value during operations under ether and halothane anesthesia, respectively. The surgical trauma itself would appear to be the main determinant of the alteration in the liver circulation during the operation.


Sweat gland carcinoma. Current concepts of surgical management.

In three new cases of sweat gland carcinoma that we observed within recent years, the sites were the axilla, back, and arm. Axillary lymph node dissections were performed in two of the patients and the nodes were normal. Preoperative diagnoses were hydroadenitis, squamous cell carcinoma of the skin, and pyogenic granuloma. In one patient who was followed up for four years, there has been no recurrence; the follow-up period for the other two has been short. Sweat gland carcinoma is an uncommon neoplasm that occurs mostly in the older age groups. It may be very slow growing and is extremely difficult to diagnose preoperatively. Lymph node metastases are frequent and overall survival is poor. Prognosis is related to histologic cell type and presence or absence of lymph node metastases. Treatment by wide local excision of the lesion and primary regional node dissection is recommended.


Concomitant pneumococcal appendicitis, peritonitis, and meningitis.

A 9-year-old boy developed pneumococcal meningitis and peritonitis following appendectomy. Subsequent pathologic examination showed Gram-positive diplococci in the appendix. Cultures of the peritoneal fluid, blood, and spinal fluid showed Diplococcus pneumoniae. The experience illustrates the danger of assuming that all pneumococcus peritonitis is the primary variety and the advisability of routine Gram stain of the peritoneal fluid at operation in order to select the appropriate antibiotic.


Reversed ileal segment for treatment of ileostomy dysfunction. Clinical application.

Persistent, profuse ileostomy diarrhea developed gradually in a patient over a 12-hour period after proctocolectomy for ulcerative colitis. There was no evidence of ileostomy stenosis or dilation of the ileum proximal to the stoma. He was successfully treated with a reverse ileal segment of 10 cm, and gained 14 to 18 kg. ileostomy output became semisolid and decreased from 1,000 to 2,000 ml/day to 600 ml/day. The transit time changed from 12 minutes to 2 1/2 hours. Antiperistaltic segments of intestine prolong transit time and allow for greater absorption. While most patients with ileostomies are not troubled by severe diarrhea, the small proportion who are may be candidates for a reversed ileal segment.


Subclavian artery to external carotid artery bypass graft. Improvement of cerebral blood supply.

External carotid flow may contribute a substantial amount of cerebral flow via collaterals in cases of internal carotid artery occlusion. When common and internal carotid arteries are occluded, the distal portion of the external carotid artery is kept open by collateral flow. Revascularization of the external carotid by means of a bypass graft from the subclavian artery will improve the blood flow through collateral vessels connecting the external and internal carotid territories, and thus increase the cerebral blood supply from the branches of the external carotid artery.


Subcutaneous nodules as a manifestation of onchocerciasis. A rare condition in the United States.

Although infection with tissue nematodes is a significant health problem in many parts of the world, such cases are unusual in the continental United States. This report describes a case of Onchocerca volvulus infection, acquired by a 38-year-old female missionary in northern Brazil, that manifested as subcutaneous nodules in the groin and flank two years after the patient's return to the United States. A year previously, a wrong diagnosis of Wuchereria bancrofti was made at biopsy. At that time, treatment with diethylcarbamazine citrate had to be discontinued because of intense pruritus. Examination of a wet saline impression smear of a new biopsy specimen showed the adult worms to have regularly arranged outer annular ridges, which, together with the pruritus after treatment with diethylcarbamazine (a positive Mazzotti test), led to the diagnosis of onchocerciasis. Retreatment with diethylcarbamazine again caused pruritus, but this was tolerated as were subsequent treatments.


A parasacral approach to rectal prolapse.

A posterior parasacral approach is introduced for management of third-degree rectal prolapse. Anterior approximation of the levator musculature and posterior fixation of the rectum are accomplished readily through the York Mason approach.


Parotidectomy with the aid of local vasoconstriction.

Local vasoconstriction produced by infiltration of a dilute solution of epinephrine during parotidectomy allows a more rapid and accurate dissection.


Lysosomal enzyme beta-glucuronidase. Release from regenerating liver after partial hepatectomy.

In 12 dogs, 70% hepatectomy was performed to investigate the changes in serum lysosomal enzyme beta-glucuronidase activities, and to compare them with other liver functions and with the restoration of liver mass. Three dogs died within 24 hours without recovering consciousness from anesthesia, and one died on the fourth postoperative day because of hepatic insufficiency. The other eight dogs were killed at various postoperative times up to eight weeks. Regeneration of the remaining liver occurred rapidly after operation. The peak elevation of serum glutamic oxaloacetic transaminase activity was found on the first postoperative day, with a steady return to normal within two or three weeks. To the contrary, the serum activity of beta-glucuronidase decreased during the first three days, but increased substantially between the seventh and 14th postoperative day, when regeneration was considered to be maximum. The results seem to indicate that serial determinations of lysosomal enzyme activities in the blood can be a beneficial biochemical index for detection of progressing liver regeneration following partial hepatectomy.


Correlation between regional cerebral blood flow and oxidative metabolism. In vivo studies in man.

To test the hypothesis that regional cerebral blood flow (rCBF) is normally regulated by regional metabolic activity, rCBF and the regional cerebral metabolic rate for oxygen (rCMRO2) were compared in selected human subjects. In normal subjects and patients with chronic, stable diseases of brain, rCBF correlated well with rCMRO2. In one individual with mild dementia, rCBF and rCMRO2 were measured before and during exercise of the hand and forearm contralateral to the hemisphere studied. Appropriate parallel changes occurred in both rCBF and rCMRO2 during hand exercise. In patients with acute diseases affecting the hemisphere studied, however, the correlation between rCBF and rCMRO2 was unpredictable.


Metabolic anatomy of focal motor seizures.

Contralateral focal seizures occurred in rats following the intracortical injection of penicillin into the anterior motor cortex. The anatomic dimensions of the metabolic response in the focus as well as the spread of increased activity through the brain were studied by autoradiography following intravenous injection of carbon 14-labeled 2-deoxyglucose. Injections of 25 to 200 units of penicillin resulted in mild to severe contralateral motor jerks coincident with repetitive single spike discharges on the electroencephalogram. Concurrent autoradiography revealed a 1.3- to 2.5-fold increase in metabolic activity in discrete areas in ipsilateral cortex, basal ganglia, thalamus, and contralateral cerebellum. Intracortical injections of over 300 units resulted in the development of recurrent contralateral tonic-clonic seizures, with 20% becoming bilateral. In brains of these animals there was activation of bilateral medial frontal cortex, bilateral extrapyramidal system, thalamus, cerebellum, and limbic structures.


Astereognosis. Tactile discrimination after localized hemispheric lesions in man.

The specific object of this study was to determine which cortical areas have to be damaged or disconnected to cause an impairment of somatosensory discrimination (astereognosis). Ninety-three patients with verified unilateral and circumscribed lesions took part in a somatosensory two-alternative forced-choice discrimination of size and shape. The results failed to support earlier views of astereognosis. Only direct damage to or an undercutting of the anterior part of the middle third of the postcentral gyrus caused impairment of size and shape discrimination (astereognosis) contralateral to the lesion. When the hand is used for stereognostic discrimination, the integration of somatosensory impulse patterns into spatial information about the objects is believed to take place in the contralateral somatosensory hand area.


Focal increase of cerebral blood flow during stereognostic testing in man.

An attempt was made to study the regional cerebral blood flow (rCBF) pattern during stereognostic discrimination in man. The rCBF was measured in 18 subjects who had no major neurological defects. The clearance from the hemisphere of xenon 133 injected (133Xe) into the carotid artery was measured with a 254-channel dynamic gamma camera. During stereognostic discrimination with hand, mouth, or foot, the rCBF increased focally in the corresponding contralateral sensory-motor region and increased focally in the premotor part of the frontal lobe. The increase in the sensory region was attributed to the work of neurons extracting spatial features from the received input, while the increase in the motor region was ascribed to the formulation of motor strategies and motor commands. The physiological significance of the increase in the frontal region was unclear, tentatively, it was suggested to reflect the intention, selective attention, and decision of the subject.


Pyogenic cervical osteomyelitis. Chondro-osteomyelitis of the cervical spine frequently associated with parenteral drug use.

Pyogenic osteomyelitis of the cervical spine was successfully treated without bone grafting in 11 of 12 patients. Staphylococcus aureus was the most common organism. Four of the patients were heroin addicts, and six others had received parenteral injections under medical supervision. The patients were immobilized promptly, and after diagnostic procedures, cultures, and drainage when appropriate, they were treated with antibiotics, which led to spontaneous fusion in the 11 who survived. In the preantibiotic era, these infections frequently evolved into "epidural abscess", with resultant cord compression leading to permanent paralysis or death. Therefore, early differential diagnosis from tuberculosis or cancer is necessary. Today, with early diagnosis, immobilization, an anterior surgical approach when necessary, and the appropirate antibiotic, cure without neurological deficit should be the rule.


Myotonia congenita with painful muscle contractions.

We present a family with dominantly inherited myotonia congenita and painful, electrically silent muscle contractions after exertion. In two family members, painful muscle contractions occurred coincident with hypothyroidism, and improved after thyroid replacement therapy. It is probable that this family represents a disease that is similar to but distinct from the dominant form of myotonia congenita.


Localized myokymia caused by peripheral nerve injury.

One year after a gunshot wound in the popliteal fossa, a 30-year-old man began to experience cramps and myokymia in the left gastrocnemius muscle. Myokymia was characterized by vermicular fibrillary movements localized to the gastrocnemius muscle and accompanied by plantarflexion and dorsiflexion of the toes. Neurologic examination, nerve conduction velocities, electromyograms, and muscle biopsy findings showed affection of left common peroneal and posterior tibial nerves. The myokymia disappeared during sleep, spinal anesthesia, and treatment with carbamazepine.


Triangular flap for atypical cleft lip. A modification in design.

Standardized steps or criteria for designing a triangular flap do not always fit for all types of cleft lip repair. Some compromise among the criteria is required, especially for atypical cases, such as those with a long vertical height on the noncleft side and a short lateral lip element. In order to secure symmetry in the horizontal length of vermilion, or in the distance from the peak of the cupid's bow to the mouth corner, E' should be located as high as allowable. The ratio of the length of the vertical incision to that of the triangular base affects the final shape of the repaired lip in many ways. Since the bottom of the cupid's bow is generally gradual, slight horizontal asymmetry in the cupid's bow is usually acceptable, as compared with that of the other components.


Cross-face grafting in facial paralysis.

I report the two-year follow-up results obtained by cross-face grafting in seven patients. The advantages of the method, ie, reduction of innervation of the healthy side of the face and restoration of emotional movements of the paralyzed side, are counterbalanced by the long delay in reinnervation and the limited number of motor fibers available for matched contralateral diversion. For this reason, cross-face grafting should still be considered as an experimental stage and should not be used in an indiscriminate way to achieve symmetry of emotional movements in irreversible unilateral facial palsy.


External auditory canal stenosis.

Stenosis of the external auditory canal may occur from a variety of causes. The numerous surgical techniques illustrate that repair may be difficult. The problems were resolved in two cases with the use of a silicone-rubber insert that is made at the time of the surgical procedure and is used throughout the postoperative period.


Audiometric, impedance, and otoscopic findings in children with cleft palates.

We examined the prevalence of hearing loss and/or middle ear disease among 34 children with cleft palates, using pure-tone audiometry, acoustic impedance, and pneumatic otoscopy. The overall incidence of hearing loss and otitic complications varied from 57% to 68%, depending on the procedure used. Of the three clinical procedures used in this study, pure-tone audiometry exhibited the poorest diagnostic efficiency. Close predictive agreement was found between impedance and otoscopy.


Blink nystagmus.

A pattern of eye movement similar to vestibular nystagmus associated with blink is characterized. This artifact can be seen in asymptomatic, otologically normal subjects and is considered to have different meaning than lateral conjugate deviation of the eyes on forced closure of the lids (Cogan sign). Since this nystagmus artifact is most evident during electronystagmographic testing for spontaneous and semispontaneous nystagmus, its importance can be overestimated. Simultaneous monitoring of horizontal and vertical eye movement presently provides a definitive means of identification.


Homograft tympanic membrane myringoplasty.

During a six-year period, homograft tympanic membranes have been used successfully for myringoplasty or tympanoplasty in 85% of 175 cases. This percentage is not as high as might be expected with fascia, and the homografts have not been as dependable in the wet, draining ear. However, the results do show that the homograft is an acceptable grafting material. The eardrums are not suggested as substitutes for fascia, but should be available for difficult cases. Their use is indicated in large or total defects to restore the natural anatomical conical shape of the eardrum, particularly in congenital atresia. The prime indication for their use is a missing malleus, and the malleus handle can be included within the transplant. The eardrum's rigid properties and the possibility of inclusion of ossicles make the homografts valuable in reconstruction of the old mastoid cavity.


Electrocochleography in children. A retrospective study.

A follow-up study of 35 children subjected to electrocochleography (Ecog) was conducted to determine (1) agreement of Ecog results with other audiometric measures obtained subsequently, and (2) accuracy of recommendations for patient management made on the basis of Ecog results. The latter was determined by parental experience, educational placement and achievement, and information from medical and paramedical personnel currently managing the children. These data indicate that Ecog test results are valuable in helping select between possible management alternatives in children who are not testable by behavioral means. However, discussion of two "problem" cases points to possible errors of management that could be made if Ecog results were the only available diagnostic information.


Estimating speech threshold from the PI-PB function.

Speech thresholds were determined from the performance intensity function for phonetically balanced (PB) words in 2,117 patients with varying types and degrees of hearing loss. Comparison of this threshold for PB words (PBT) with both pure-tone sensitivity (PTA) and the conventional threshold for spondee words (ST) shows that PBT not only provides a cross-check on pure-tone level, but also conveys additional information about audiometric contour.


An orbital roof fracture causing diplopia.

Fractures of the orbital floor are frequently accompanied by diplopia. There are other bony injuries that may produce similar symptoms; however, these are rare. We will describe a case in which a fracture of the roof of the orbit, essentially involving the anterior cranial fossa, produced entrapment with diplopia. A six-month follow-up demonstrated excellent surgical and functional results.


Blindness and total ophthalmoplegia. A complication of transantral ligation of the internal maxillary artery for epistaxis.

Unilateral blindness and total ophthalmoplegia developed on the same side on which transantral ligation of the internal maxillary artery was performed for persistent posterior epistaxis. Evaluation with arteriograms and phlebograms showed no compromise of retinal vessels or cavernous sinus thrombosis. At reexploration of the maxillary antrum, marked swelling of previously placed oxidized cellulose gauze was found. An experimental model, using the rabbit, was designed to determine if implantation of oxidized cellulose gauze adjacent to the optic nerve would produce blindness and ophthalmoplegia.