Frontal  sinus disease. IV. Cellular response to experimentally-induced infection.

The pathogenesis of chronic frontal sinusitis is poorly understood. The canine frontal sinus model was developed to isolate experimentally the variables involved. We have recently determined that blockage of the naso-frontal duct does not, by itself, produce sinusitis or mucocele experimentally. The purpose of the present investigation is to examine the histological and ultrastructural responses of the sinus mucosa to artificially-induced infection. Bone wax was implanted in the canine frontal sinus via an osteoplastic flap, and subsequently removed three months later. Radiological, histological and ultrastructural analysis of the resultant infected mucosa was performed at periods up to one year. The sinus mucosa did not return to normal up to nine months following removal of the infection-inciting foreign body. Persistent changes included epithelial and submucosal thickening, polypoid degeneration, matting of the ciliary carpet, and "bursting" of the ciliary cell bodies. In the light of this and previous experiments, an insidious cycle of events leading to irreversible frontal sinus disease is postulated, requiring the interplay of at least three variables: the infectious insults, the response of the sinus mucosa, and the variable patency of the nasofrontal duct.


Metastasis of malignant melanoma of the nasal mucosa to the small intestine.

Malignant melanoma of the mucous membranes is rare and has a very poor prognosis. When localized in the nose, the tumor becomes apparent late in the course of the disease with nasal obstruction and epistaxis. Distant metastases are uncommon, but any organ of the body can be involved. A case of a malignant melanoma of the nasal mucosa with metastasis to the small intestine is presented, and the natural history of the metastatic disease is discussed.


A model for tracheal study.

While attempting to devise a valvular device to prevent aspiration in tracheo-esophageal anastomosis, we employed a model in the dog, which we feel would be very useful in the study of other tracheal problems. Essentially, a segment of trachea with its blood supply intact is isolated and turned through 90 degrees. One end of the segment is then anastomosed to the skin whereas the other end is either anastomosed to the gullet or covered with silastic, depending upon the required investigation. In both cases, after an interval of at least nine months, the segment continued to be lined by respiratory epithelium and no stenosis had occurred. Where silastic sheeting was employed to cover the end of the segment, the inner aspect of the silastic was covered with a thin layer of fibrous tissues lined by respiratory epithelium.


Implantation of multiple intracochlear electrodes for rehabilitation of total deafness: preliminary report.

Many instances of total deafness are due to destruction of the organ of Corti but with partial or complete preservation of the function of the cochlear nerve. In such cases, it is possible to restore some hearing by electrically stimulating the fibers of the cochlear nerve with the help of implanted electrodes. Preoperative testing with electric shocks applied to the round window have aroused sensations of noise in 45 cases of total bilateral deafness with a great variety of etiologies. The only negative results were in two cases of operated acoustic neuromas. Our operation places up to eight intracochlear electrodes, each with a separate fenestration opening into an electrically isolated compartment of the scala tympani. Stimulation of each electrode yields a different sound sensation of a pitch that depends on its location along the cochlea. Electric filters direct different frequency bands to the appropriate electrodes, with the necessary compression of dynamic range. In three experimental cases of unilateral deafness, pitch matches to the normal ear were made. In seven therapeutic operations on adult cases of acquired total bilateral deafness, speech recognition was usually relearned within a month or two. Improvement of voice quality was also dramatic. The intracochlear electrodes have been well tolerated for months, but the method of connection to the external equipment still presents difficulties.


Histiocytic medullary reticulosis with involvement of the nose.

A case of histiocytic medullary reticulosis in which nasal involvement was predominant is reported. The patient was a 33-year-old woman with a 14-month history of unilateral nasal stuffiness. The diagnosis was established by antemortem examination of films of bone marrow aspirates and by clinical features including fever, wasting, hepatosplenomegaly, anemia, and leukopenia. The histologic examination of autopsy specimens disclosed proliferation of histiocytes, which ingested nuclear debris and closed proliferation of histiocytes, which ingested nuclear debris and erythrocytes, in the necrotic lesion of the nose, sternal bone marrow, liver, spleen, thymus, uterus, ovali, and ileum. On reviewing literature on this subject, such a case of histiocytic medullary reticulosis which predominantly involves the nose is very rare.


"Practical suggestions on facial plastic surgery--how i do it". The lower blepharoplasty.

The above-described operation is the musculocutaneous ("skin-muscle") flap procedure of blepharoplasty for the lower lid. The author is pleased to state that he has been very satisfied with this technique and that he has experienced no serious complications with it. Although the scar may be somewhat low by most standards, after several weeks it is hardly discernible (Fig. 7).


Effects of exercise on coronary collateralization--angiographic studies of six patients in a supervised exercise program.

The existence of coronary collaterals in man and a positive correlation of their extent with the degree of coronary artery obstruction has been shown. The theory that functional collateralization associated with coronary occlusive disease is a response to local hypoxia is widely advocated. It was theorized here that coronary heart disease patients might enhance coronary collateralization through exercise-induced myocardial hypoxia. This pilot study was carried out to test the specificity of coronary arteriography for measuring changes in collateralization after a period of exercise training. Reports of follow-up examinations 7 years after program termination are also included. Six volunteer, male subjects--3 months to 3 years post-myocardial infarction--completed 10-12 months of medically-supervised exercise. All had an intensive cardiovascular work-up, serial treadmill exercise tests and coronary arteriography before and after training. All demonstrated the expected physical, physiological, metabolic, and psychological benefits. Two showed some definite, increased collateralization, however, in both of these the changes may have been a response to some extension of the occlusive disease and not exclusively an exercise effect. It was evident that minute changes in coronary collaterals are detectable by selective coronary arteriography, but that the specific effect of exercise on the development of collaterals could only be determined by a large-scale, controlled program with randomization of the multiple, uncontrollable variables among exercise and non-exercise populations.


Effect of training on plasma catecholamines in post myocardial infarction patients.

Exercise induced plasma catecholamine levels, of post myocardial infarct patients, were compared before and after a 27 week training program in two groups. Heavy Intensity Exercise (H.I.E.) and Light Intensity Exercise (L.I.E.). The men (age 38-54 years) were exercised on a bicycle ergometer at constant submaximal work loads (test load) and to a symptom limited maximum work load, both before and after the training program. Forearm venous samples were obtained after 30 minutes rest and within 3 minutes of completion of the test load. After training a significant increase in both maximum work load and heart rate (P less than 0.05) was observed in the H.I.E. group. At the test load these individuals had a small (6%) decrease in heart rate. No significant changes were observed in the L.I.E. group at submaximum or maximum exercise. Prior to training, exercise resulted in a significant increase in norepinephrine (NE) with no change in epinephrine (E). Training resulted in a significant reduction (P less than 0.05) in the NE response at the test load of the H.I.E. group while no change was found in the L.I.E. group. Endurance jogging reduced the sympathetic response to moderate exercise.


Physiological effects of a sports rehabilitation program on cerebral palsied and post-poliomyelitic adolescents.

Thirty-four spastic cerebral palsied (CP) post-poliomyelitic (P) adolescents (mean age--17.9 years) participated in a twice-a-week mild conditioning program, lasting 12 months. Nine CP adolescents served as a control inactive group. The post-conditioning submaximal heart rates of the CP active group were significantly lower during 75 and 150 kpm/min work loads on an arm ergometer, compared with the respective values at the beginning of the program. Peak O2 uptake values, directly measured during an all-out arm pedalling test, were improved by some 8% in the CP active group. Neither CP inactive nor P active showed any significant changes attributable to conditioning in physiological variables obtained during the submaximal or maximal tests. Adiposity level of each of the three groups remained unchanged. The mechanical efficiency of all subjects was low (16.2%) and remained so following conditioning.


Specificity of training for motor skill under physical fatigue.

The purpose of the present study was to test the specificity of training principle from exercise physiology in the context of motor skill acquisition. Thirty-six college females were randomly assigned to either an experimental or a control group and both groups received 54 practice trials on a ladder climb task over four consecutive days (3,18,18 and 15 trials/day, respectively). The control group practiced under conditions of heavy interpolated fatigue on the first 3 days with day 3 representing the heavy-fatigue criterion conditions, while the experimental group did the same except for day 2 when a vowel-cancelling task was substituted for the fatigue task. On day 4 both groups practiced under the second criterion of non-fatigue conditions. Fatigue was induced by a step-up task so that a minimum HR of 180 beats/min was attained prior to each ladder trial. The results supported the specificity hypothesis that practicing a gross motor task under conditions of heavy-fatigue would facilitate performance of that task under criterion heavy-fatigue conditions. For the second criterion of non-fatigue practice, the data appeared to support the specificity principle but the rigorous test of the differences did not reach statistical significance. The overall evidence supports the position that regards heavy physical fatigue as a variable that can cause changes in the nature of certain motor skills so that the specificity of training principle becomes applicable.


The aerobic demands of rowing in two Olympic rowers.

The relationship between rowing speed and Vo2 was determined on two Olympic oarsmen while rowing the single, double and coxless pair shells. The speeds covered ranged from 120 to approximately 300 meters/min and resulted in oxygen demands from 1.2 to 6.45 1 O2/min. First order regression equations described the speed/Vo2 relationship for each shell. Rowing at racing speed in either shell required an aerobic expenditure of 5.8-6.0 1 O2/min.


Summary of 58 cases of loss of consciousness during underwater swimming and diving.

It is well accepted that hyperventilation before breath hold swimming and diving makes it possible for a person to extend the time under water. Less well known is the fact that this maneuver can cause loss of consciousness due to hypoxia. This accident happens almost exclusively to males (56 cases). The most common age group was 16-20 years (range 12-33 years). All were known to be good swimmers or divers. Approximately 80% of the cases occurred in guarded pools. Thirty-five subjects survived the accident and of the twenty-three fatalities, there was only one good autopsy report. In this instance the findings were those associated with classical drowning preceded by hypoxia and hypercapnia. Breath holding experiments indicated that the times between loss of consciousness and death may be no longer than 2.5 minutes. The patterns associated with these cases suggest that those who are responsible for aquatic safety as supervisors or guards of pools could prevent most accidents by watching for young male swimmers who are practicing hyperventilation and underwater swimming in competition with themselves or with others.


Comparison of self-selected recovery methods on lactic acid removal rates.

The purpose of this study was to compare lactic acid removal rates during three modes of recovery from a standardized exercise bout. Each subject (N = 6) completed a 1 mile run (92.2 +/- 3.7% Vo2max). Thereafter, lactic acid removal rates were compared in the runners at each of three different modes of recovery: a) rest; b) a self-selected, continuous jogging pace (free-jogging); and c) completely uncontrolled recovery (free-intermittent) normally practiced by athletes. Venous blood samples were taken immediately after the mile run and every 5 min thereafter for 20 min. Data were expressed relative to the initial post-exercise blood sample (100%). Lactic acid removal was significantly faster during the free-jogging recovery than during the free-intermittent and the resting recoveries (P less than 0.001). Removal rates during the free-intermittent recovery were significantly faster than during the resting recovery (P less than 0.001). The results indicated that nearly optimal lactic acid removal rates were attained during the free-jogging recovery.


The validity of four bicycle ergometer tests.

The aim of this study was to compare the validity of four physical work and performance tests on bicycle ergometers commonly used in Sweden. The following four tests were compared: a) a work test of submaximal character designed for estimation of the maximal oxygen uptake of the individual (Vo2 max); b) a work test of maximal character designed for estimation of the highest work load an individual can sustain for 6 minutes (Wmax6min); c) the Cycling Strength and Endurance Test (CSET)-a performance test of maximal character consisting of a series of intermittently determined terminal thresholds; and d) a flexible work test of maximal character, the Individually Adapted Work Test (the IA-test): by a feedback mechanism the highest work load an individual can be expected to sustain for 4 minutes is determined. Criteria were cross-country runs (altogether 4) arranged a short time before and after the tests on the bicycle ergometer. Subjects were military conscripts, aged 17-25. When comparisons were made between the best prediction variable of each test, no significant differences were obtained. The size of the validity coefficients was .55-.70. However, the maximal work tests showed the highest validity coefficients. The investigation indicates that, when a work test is to be chosen, the problem, the practical conditions and the resources available should guide this choice.


Effects of dianabol and high-intensity sprint training on body composition of rats.

The effects on body composition and organ weights of anabolic steroid administration and of high-intensity sprint running, separately and in combination, were studied in young adult male rats. Dianabol (methandrostenolone) 1 mg/day for 8 weeks had no significant effects on muscle weight or lean body mass in either the trained or the sedentary animals. The program of sprint training resulted in a lower body weight, a lesser percentage of body fat (Runners, 8.5%, vs. sedentary, 13.5% P less than 0.01) and a greater relative lean body mass (runners, 91.5% vs. sedentry, 86.5%, P less than 0.01). We conclude from these results that (a) normal androgen levels in young, healthy male animals are sufficiently high so that the addition of a large dose of anabolic steroid does not result in stimulation of additional muscle growth, and (b) the changes in body composition induced by high-intensity, short-duration sprint training are qualitatively similar to those seen with endurance exercise training.


Factor analysis and multivariate scaling of anthropometric variables for the assessment of body composition.

This study was designed to identify the body composition factors measured by skinfold fat (S), girth (G), and diameter (D) variables and to provide multivariate scaling models that measure fat (F) and lean body weight (LBW) factors. A total of 7S, 11G, and 7D measurements were determined on 83 young women (YW) and 95 young men (YM). Body density (BD) was determined by the hydrostatic technique. All variables were factor analyzed, and F and LBW were used to validate isolated factors. The YM data showed one F factor and two LBW factors. LBW factor I measured muscle mass and bone structure; LBW factor II, bone D. The YW data isolated four factors: the same three of YM plus a second F factor specific to the pelvic girdle. Factor score models were used to develop scaling strategies to measure F and LBW factors. Full models of all 27 variables and restricted models of 14 S, G, and D variables were developed; the correlations between factor scores scaled from the full and restricted models ranged from 0.84 to 0.98. The multiple correlation between factor scores calculated from the restricted models and laboratory-determined F and LBW ranged from 0.90 to 0.94 for YM and from 0.88 to 0.89 for YW. The multivariate scaling models provide a valid field method of measuring body composition.


Asymmetry in bicycle ergometer pedalling.

The effects of changes in speed and resistance setting on the bilateral symmetry of work output on the bicycle ergometer were studied. The cranks of a Monarch bicycle ergometer were instrumented with foil strain gauges and the bridge outputs were integrated on-line and analyzed by a program running in a Hewlett Packard 2115A computer. Twenty male subjects performed three thirty-second trials at each of nine speed and resistance combinations. Indices of asymmetry from 66-178 were found using kicking dominance (n = 20) and 56-135 using a strength dominance classification (n = 13). Day to day reliability of the index of asymmetry was found to be only 0.47; within day reliability was 0.87 for day one and 0.79 for day two. No significant effects for speed or resistance changes were shown on either day for the strength dominant subjects. When kicking dominance was considered main effects were encountered on both days for speed although there was no clear directional trend. The findings of these experiments have important implications for studies where measurements are made on the lower extremity during cycle ergometer exercise, and for competitive cyclists engaged in endurance competition.


Evanescent effects of hypo- and hyperglucagonemia on blood glucose homeostasis.

Hypoglucagonemia (induced by somatostatin) and hyperglucagonemia (induced by infusion of physiologic amounts of glucagon) have only evanescent effects on blood glucose regulation. Despite on-going glucagon suppression by somatostatin, fasting hyperglycemia develops within 4-6 hr of insulin suppression, indicating that (1) basal glucagon secretion is not essential for the development of the diabetic state; and (2) insulin-deficiency (rather than altered glucagon secretion) is the dominant long-term factor determining glucose homeostasis in the diabetic. With respect to hyperglucagonemia, only a transient increase in splanchnic glucose output is observed in normal and diabetic subjects in response to physiologic increments in this hormone. The exaggerated hyperglycemic effect of glucagon observed in diabetics1 is thus a consequence of the failure to metabolize the glucose traniently released into the systemic circulation in response to the glucagon rather than a result of persistent stimulation of hepatic glucose production. These observations thus further underscore the essentiality of insulin deficiency in the diabetogenic action of glucagon.


Dominant inheritance of large molecular weight species of glucagon.

Excessive plasma levels of high molecular weight (MW) components of immunoreactive glucagon (IRG) have been found in three generations of a family in a pattern consistent with an autosomal dominant trait. Preliminary studies using gel filtration suggest the presence of two MW species of IRG greater than 3500 daltons in plasma of affected members who have normal oral glucose tolerance tests. The "hyperglucagonemia" in this pedigree is consonant with either a structural defect in biosynthetic precursors or an abnormality in enzyme-mediated cleavage of proglucagon.


The formation of sporangiospores in Phycomyces.

The multinucleate state of the vegetative spores of Phycomyces blakesleeanus arises as a consequence of cleavage of cytoplasm containing a variable number (1-6) of pre-existing nuclei. No nuclear division or incorporation of 3H-thymidine was detected during maturation of the spores.


Studies on transformation in Naegleria gruberi: effects of ions and bacterial suspensions.

The presence of electolytes inhibited the transformation of Naegleria gruberi from amoeba to flagellate, the molarity required varying with the salt used, namely 80 mM NaCl, 90 mM KCl, 50 mM CaCl2 or 60 mM MgCl2. Non-electrolytes also prevented this transformation at 250 mM for either sucrose or glucose, and this is known to be an osmotic effect. That the effect of ionic solutions was different was demonstrated by varying the time at which the environemnt was changed from distilled water to salt solution. Experiments with suspensions of either living or heat-killed bacteria in distilled water, together with the supernatants obtained when bacteria were removed by centrifugation, showed that the inhibition of transformation which occurred in bacterial suspensions was not due to any factors produced by the bacteria and present in solution. It appeared that this inhibition was brought about by the physical presence of the bacteria, either living or heat-killed, and some possible interpretations of this 'contact' phenomenon are discussed.


Development and fine structure of sclerotia and spores of the actinomycete Chainia olivacea.

Sclerotia and spores of Chainia olivacea were studied by transmission and scanning electron microscopy. Sclerotia formed by repeated branching of several hyphea. Branch tips were delimited by septa and increased in size, becoming filled with lipid-like inclusions. In mautre sclerotia, empty cells and intra-hyphal growth were observed. An electron-dense fibrillar material was deposited between hyphae and on the sclerotium surface. The similarities between these and the sclerotia of certain fungi are discussed. Spores were formed in a manner similar to that in Streptomyces species. Large inter-sporal pads were formed during ingrowth of the septa delimiting the spores.


[Growth of purple sulfur bacteria in the dark in anaerobic conditions].

Phototrophic sulphur bacteria Chromatium minutissimum 1 C, Ectothiorhodospira shaposhnikovii 1, and various strains of Thiocapsa roseopersicina grow in the dark under anaerobic conditions (hydrogen or argon) on organic media in the presence of sulphide, thiosulphate or molecular sulphur. Ect. shaposhnikovii grows also in the presence of sulphite, cysteine, methionine, glutathione, and, to a less degree, sulphates. Cultures of Ect. shaposhnikovii growing in the dark under anaerobic conditions assimilate fructose and liberate pyruvate, lactate, formiate and traces of acetate into the medium. These cultures can grow in the dark under anaerobic conditions assimilating not only fructose but also various C4-dicarboxylic acids, lactate, pyruvate, butyrate, and acetate. Thiocapsa grows on media containing malate, succinate, lactate, pyruvate, and acetate. Thiocapsa reseopersicina SL assimilates in the dark under anaerobic conditions fructose, glucose, glycerol, pyruvate, lactate, and acetate.


[Sulfite oxidation by Thiocapsa roseopersicina].

Extracts of the cells of Thiocapsa roseopersicina, strains BBS and SL, grown in the light in anaerobic conditions and in the dark in aerobic conditions oxidize sulphite in the presence of cytochrome c and AMP or in the absence of AMP. The rate of the oxidation, especially AMP-dependent, is higher in the cells cultivated in the dark on a mineral medium. The oxidation of sulphite, both in the absence and presence of AMP, is related to the membrane fraction and is inhibited by p-CMB while azide and atebrine inhibit mainly AMP-independent sulphite oxidation. Two enzymes are presumed to be involved in sulphite oxidation by Thiocapsa roseopersicina: APS-reductase and sulphite: cytochrome c-oxidoreductase.


[Chemistry of denitrification in sporogenous soil bacteria].

Soil sporeforming denitrifying bacteria, Bacillus filaris and Bacillus polymyxa, differ by their cultural-morphological and physiological characteristics, but are similar in the chemistry of dissimilating nitrate reduction. Two processes occur simultaneously: denitrification yielding gaseous nitrogen forms, and nitrate respiration upon which nitrates are reduced to ammonia. The ratio between the two depends on physico-chemical conditions of the environment. The chemistry of dissimilating nitrate reduction by sporeforming bacteria differs therefore from nitrate transformation by other denitrifying microorganisms: Pseudomonas, Micrococcus, Rhizobium, Achromobacter, which, according to the published evidence, are capable only of denitrification.


[Effect of nitrogen source on growth of Arthrobacter simplex and its biosynthesis of cholinesterase].

The effect of organic and inorganic forms of nitrogen on biomass accumulation and cholinesterase synthesis was studied with Arthrobacter simplex var. cholinesterasus. The culture assimilates nitrogen of ammonium compounds better than other forms of inorganic nitrogen; the best nitrogen source for biosynthesis of cholinesterase is ammonium phosphate. Nitrogen of nitrates is not assimilated. The amount of biomass is almost twice as high on the medium with peptone, casein or casein hydrolysate as on the medium with mineral nitrogen, while the activity of cholinesterase on these nitrogen sources decreases 1.5--2.0 times. Yeast extract as a nitrogen source increases biomass accumulation by a factor of 2.5 and does not supress synthesis of cholinesterase. The concentration of the enzyme synthesized per unit biomass on the medium with yeast extract is the same as on the medium containing ammonium phosphate. The effect of amino acids and amides, i.e. beta-alanine, proline, amides of aspartic and glutamic acids, and their mixtures, is similar to the action of yeast extract: they stimulate biomass accumulation and do not inhibit synthesis of the enzyme. Other amino acids supress synthesis of cholinesterase. The amount of accumulated biomass in the presence of glutamic acid is twice as high as in the case of any other amino acid, and three times as high as on the medium containing ammonium phosphate. Similar action of glutamic acid is manifested when it is used in mixtures with other amino acids. On the medium containing glutamic acid as a sole source of nitrogen, an increase in biomass production is accompanied with a decrease in biosynthesis of the enzyme by 50%. Repression of the biosynthesis is less if glutamic acid is added in mixtures with proline, beta-alanine and asparagine.


[Optimization of the nutrient medium for Actinomyces spheroides--producer of proteolytic enzymes with fibrinolytic activity].

Optimization of the medium for growing Actinomyces spheroides producing proteolytic exoenzymes with the fibrinolytic activity was performed by the method of mathematical planning. The composition of the medium is as follows (%): glucose 7.1, sodium citrate, trisubstituted, 0.48; (NH4)2SO4, 0.15; MgSO4, 0.575; KH2PO4, 0.2; ZnSO4, 0.001; FeSO4, 0.002. The fibrinolytic activity of the cultural broth on this medium is three times as high as on the initial medium (7142 units). Changes in the ratio between components of the medium lead to changes in the ratio between the fibrinolytic and caseinolytic activities. Therefore, Act. spheroides, strain 1, produces exoenzymes which differ by their substrate specificity. The ratio between the fibrinolytic and caseinolytic activities of the complex on the optimized medium is twice as high as on the initial medium.


[Synthesis of the nitrogen-fixing enzyme system in oligonitrophilic bacteria].

Oligonitrophilic bacteria were cultivated on a medium containing only 2.5--10.0 mg/litre of nitrogen compounds. They assimilated elementary nitrogen only after utilization of these nitrogen compounds during growth and formation of nitrogen-fixing enzyme system. Their cells grown on a medium containing high concentrations of bound nitrogen did not fix nitrogen during further incubation in the atmosphere of 15N; therefore, the enzymes involved in nitrogen fixation were induced. These organisms are characterized by diauxia during their growth on media containing "start" doses of nitrogen. Enzymes catalysing nitrogen fixation in azotobacter are also induced. But, contrary to oligonitrophilic bacteria, the azotobacter does not require nitrogen compounds in the medium in order to adapt to molecular nitrogen, and its growth curve is not of a biphasal character. These data and the evidence of other authors suggest that all nitrogen-fixing microorganisms are characterized by the induced, not constitutive, enzymes involved in reduction of molecular nitrogen.


[Production of chitinase by Actinomyces kurssanovii and its properties].

Actinomyces kurssanovii, a culture producing large amounts of chitinase and chitobiase, was cultivated on a medium of the following composition (%): demineralized crab shells, 3.0; K2HPO4, 0.5; peptone, 0.2; yeast extract, 0.1; MgSO4-H2O, 0.09. The maximum amount of the enzymes was synthesized after growth in a fermenter of the actinomycete during 48 hours. The highest activity of chitinase is manifested at pH 7.0 and depends on ionic composition of the buffer, being higher in veronal buffer than in phosphate or tris//HC1 buffers. The chitinase and chitobiase of the strain decompose completely colloid chitin and chitin in demineralized crab shells with the formation of N-acetyl-D-glucosamine.


[Effect of temperature on the synthesis of protein and individual amino acids by the thermotolerant yeast Candida tropicalis on media with hydrocarbons].

Synthesis of protein and amino acids by the thermotolerant yeast Candida tropicalis K-41 was studied at various temperatures of cultivation during growth on media with hydrocarbons in conditions of continuous cultivation. The content of protein in the cells decreased by 6% with an increase in growth temperature by 10 degrees C (from 29 to 39 degrees C) while excretion of free amino acids into the medium increased. The cultural broth of the cells grown at 39 degrees C contained up to 8 amino acids, with alanine, aspartic acid, serine and glycine prevailing. The content of amino acids which liberated into the medium decreased in the intracellular pool. However, the total amount of free amino acids in the system "cell--medium" remained constant at various temperatures of cultivation. Synthesis of free amino acids does not presumably limit total synthesis of protein by the yeast.


[Effect of the physiological properties of yeast strains on their formation of higher alcohols and aldehydes and on the composition of nitrogen compounds in the fermented wort].

Dynamics of formation of by-products was studied with the following yeast races: Sacch. cerevisiae, strain Odesskaya-14 (baker's yeast); Sacch. vini, strain Prikumskaya 80/9 (wine yeast). The yeast cultures were found to be very similar by the rate of biomass accumulation, ethanol production, and the fractional composition of nitrogen compounds. The concentration of accumulated higher alcohols depended on the mass of yeast cells, their growth rate, and the duration of cultivation.


[New brown chlorobacteria Prosthecochloris phaeoasteroidea nov. sp].

Two strains of new photosynthetic bacteria were isolated from salt meromictic lakes Mogilnoye and Faro. The bacteria are abligate phototrophic anaerobic cultures which utilize H2S as an electron donor by oxidizing it to elementary sulphur and sulphates. Sulphur is liberated outside the cell. The cultures contain bacteriochlorophyll e and carotenoids of the isorenierathene type. Photosynthetic structures are represented by chlorobium-vesicles. According to these properties, the cultures belong to the Chlorobiaceae family. The bacteria have no gas vacuoles. The cells form 10--20 apophyses-prosthecae which is typical of the Prostheocochloris genus. The new strains differ from Prosthecochloris aestuarii by the brown colour of the cell suspension, the composition of pigments, and ecology. They are classed as a new species Prostheocochloris phaeoasteroidea nov. sp. Diagnosis of the new species is presented.


[Age changes in cells in Streptococcus diacetilactis cultures].

The activity of metabolism changed in the cultures of Streptococcus diacetilactis, strain Bogdan, with aging. The number of viable cells decreased as well as the ability to evolve oxygen, to produce C-4 compounds, and to react to pH changes by liberating acids upon alkalifying or neutral products upon acidifying. After the culture had been grown during 72 hours, 2,3-butyleneglycol was found in the cultural broth, and the number of viable cells was low. As was revealed by electron microscopy, the cells were intact during 48 hours; they started to disintegrate by 72 hours. After 120 hours all cells were disintegrated. First, the cells produced no more mesosomes, became less electron dense; then the cell wall was decomposed and the contents of the cell poured through disruptions in the cytoplasmic membrane.


[Cell wall of pigmentless variants of Staphylococcus aureus].

Physico-chemical properties and chemical composition of the cell wall of pigmentless variants B-3 and B-6 differ from those of the parent strain of Staphylococcus aureus 209-P. As to morphology, the wall is more thick and loose. The mutants differ also by the phagotype, the ability for sorption of acridine orange, and the rate of sedimentation of cell suspensions. The properties of teichoic acids and the content of peptides in peptidoglycan change in the cell wall of the mutants.


[Comparative physiology of the replication of RNA-containing bacteriophages MS2 and Q beta].

The yield of the phage QB is always less than the yield of the phage MS2, the conditions of cultivation being similar. This is due to the fact that the yield of the phage QB from an infection centre is lower by a factor of 5--10 than the yield of the phage MS2. The yield of the phages may be increased by optimizing conditions of cultivation. The RNA-containg phages MS2 and QB were cultivated in the peptone-yeast growth medium in fermenters with the working volume of 30 and 50 litres. The yields were 2--5-10(13) particles/ml and 1--4-10(12) particles/ml for the phages MS2 and QB, respectively. The specific infectiveness of purified phage preparations was 2--4-10(12) particles/OD260 (MS2) and 2--4-10(11) particles/OD260 (QB).


[Ultrastructure of bacteriophages specific for Bacillus thuringiensis var. galleriae].

Fine structure of the phage specific for Bacillus thuringiensis var. galleriae was studied. The head of the phage is of the elongated hexagonal shape, 600 X 360 A. The tail is 400 X 40 A large and has a thickening in the basal part (70 X 120 A). A so-called "collar" structure is found at the site where the head joins the tail. This a disc-shaped plate with a diameter of 120 A and a hole in the centre; 12 fillaments are attached to it radially and terminated with tines. It is possible that the structure is necessary for adsorption of the phage on the cell.


[The treatment of giardiasis and trichomoniasis with resochin and metronidazole].

Giardia lamblia and Trichomonas intestinalis were isolated from the stools of male child of 7 with chronic diarrhea. After administration of Resochin and Metranidazole the diarrhea stopped immediately, the signs and symptoms ceased and the Parasites disappeared from the stools.


[Providencia isolated from the stools of patients with gastroenteritis].

92 providencia strains were isolated from the stools of patients with gastroenteritis. All specimens were negative for other pathogenes such as salmonella, shigella, enteropathogenic E. coli and vibrios. Viral etiology was not investigated. The distribution according to years and months is shown in the table. 17 isolations made during August, seemed rather high and gave the impression of a small epidemic.


[Biological properties of Streptococcus bovis bacteriophages isolated from lysogenic cultures and sheep rumen].

Biological characteristics of eleven phages for Streptococcus bovis were investigated; seven phage were isolated from ovine rumen and four were virulent mutants of temperate phages of lysogenic cultures. The phages had many properties in common: similar morphology of negative colonies, the identical spectrum of lytic action, related antigens, absolute or high requirement of calcium ions, thermolability, and inactivation by the content of the rumen. Their susceptibility to the inactivating action of acetic acid, urea and temperature was however different. Chloroform and phenol may be used during purification and conservation of the phages.


[Isolation and enumeration of bacteriophages against S. TYPHI, E. coli, and Shigella in the streams of Ankara].

Active bacteriophages were detected agains S. typhi Vi4, E. coli 36 and Shigella YGR in the streams of Ankara, during 27.3.1973 and 19.3.1974. 49 samples were collected from 3 chosen places. Bacteriophages in high concentrations were detected against S. typhi Vi4, E. coli 36 and Shigella Y6R even in 0.0001 ml amounts of these water samples. Besides bacteriophages, salmonella and shigella were detected as well. These studies showed that the streams in Ankara were highly contaminated with bacteria, and that the detergents and other chemicals used for cleaning in houses, which eventually mixed into the streams through sewage, did not have any bactericidal effect on bacteriophages or other pathogen organisms found in these streams.


[Australia antigen in voluntary blood donors].

35.370 blood samples, collected from woluntary blood donors by the Blood Transfusion Services of the Turkish Red Crescent Society in one year, were tested by the systematic screening CEP Method for the "Au" antigen, according to the recommendations of WHO. The number and percentage of positive "Au" antigen cases are shown in Table 1. No significant difference could be detected when the relationship of "Au" antigen to months was considered. This can be seen in Table 2.


[Oxygen consumption by suspensions of Bacillus anthracoides spores].

The respiration rate of spore suspensions of Bacillus anthracoides 96 was assayed by mass spectrometry employing a hermetically sealed reaction vessel constructed for this purpose. The rate of respiration was found to depend on the method of preparing suspensions, the duration of their storage at +4 degrees C, the physiological state of spores, and the action of a disinfectant containing chlorine on them.


[The fungal flora of Ankara air in January 1972 and 1974 and its relationship to allergic diseases].

The fungal flora of the air in Ankara was searched during first week of January 1972 and 1974. Different areas of the city were chosen for investigation. The central and outskirt areas showed different patterns of fungal flora during January 1972 and January 1974. In the central areas there was a remarkable decrease in yeast flora between the two years. However, mould flora was increased in some extent. No notable difference could be detected in outskirt areas. Penicillium and Aspergillus species were isolated most frequently. It is concluded that this flora was influenced by heavy pollution of the air in Ankara. This pollution is caused mainly by: (1) Heating systems with crude coal and oil, (2) Heavy motor traffic, (3) Geographical situation of the city, cup-shaped land with poor air draughts.


[Dinitrochlorobenzene test in patients with chronic nephritis].

Dinitrochlorobenzene (DNCB) test was applied to 22 patients with chronic nephritis. Only 22% of the patients gave positive results. This was concluded to be due to the high NPN levels. It was demonstrated that this inhibition is transitory and the normal responses appear 12 hours after the return of the NPN to normal levels. When it was considered that some patients with high NPN levels showed normal DNCB reactivity and delayed rejection time, the chronic nephritis patiens reacted to organ transplants despite their normal NPN levels. It was suggested that it is one of the components of NPN which should be responsible for the above mentioned inhibition.


[Spontaneous crystallization of antibiotic substance during submerged fermentation of Actinomyces hygroscopicus].

A rare case of spontaneous crystallization of the antibiotic substance was detected during submerged cultivation of Actinomyces hygroscopicus, strain 33x, under periodic conditions directly in the MTF 5L3 fermenter ("Marubishi"). Leaf-shaped plates of the antibiotic found in the cultural broth of the strain 33x were active against gram-positive and gram-negative microorganisms, yeasts, and fungi. The crystalline state of the structures was confirmed by the X-ray analysis. According to their UV spectrum (maximum at 233-234 nm in ethanol), the crystals belong to the group of nyphimycin A1-scopafungin, antibiotics produced by some cultures of Act. hygroscopicus.


[Salmonella essen serotype isolated from osteomyelitis of the right knee in a patient with sickle cell anemia].

E. essen serotype was isolated from the material collected from the right knee joint of a 11 years old white girl, sent to our hospital from Adana. The patient had sickle cell anemia plus osteomyelitis in the right knee. This is the first isolation of this serotype in Turkey.


[Lipid metabolism of yeasts in relation to their ecology].

Lipid metabolism of epiphyte and soil yeasts was found to be different depending on their ecology. The activity of lipase and lecithinase of epiphyte cultures is higher than that of soil cultures. The highest concentration of lipids was accumulated by soil yeasts, especially the Lipomyces genus. Lipids isolated from the yeast are hydrolysed by its lipase at a higher rate than olive oil, the common substrate for lipase. Lipid accumulation is detected during later stages of cultural growth when the activity of lipase decreases. No fatty acids with the number of carbon atoms below 14 and over 20 were found in cultures of the Candida genus. Fatty acids with a long chain (C22, C24, C26) are encountered more often in cultures belonging to the Rhodotorula genus cf. Lipomyces and Cryptococcus.


[First isolation of Salmonella haifa in Turkey].

Authors report the first isolation of Salmonella haifa serotype in Ankara from the stool culture of a patient with acute gastroenteritis.


[Fermentation equipment of the USSR Academy of Sciences Institute of Microbiology for continuous cultivation of microorganisms].

A fermentation apparatus has been constructed in the Institute of Microbiology of the USSR Academy of Sciences. The apparatus permits to cultivate microorganisms both under periodic and continuous conditions with automatic regulation of pH, Eh, temperature, measurement of pO2, etc.


[Brucellosis, tularemia and borreliosis isolated from wild animals captured in Ankara, Konya, Urfa and Nevsehir provinces in Turkey].

621 citellus, 41 Mus musculus, 35 microtus, 442 meriones, 70 Rattus rattus, 56 turtle, 89 hare, 1 hamster, 1 hedgehog and 1 sea snake, altogether 1379 wild animals were captured in Ankara, Konya, Urfa and Nevşehir. Neither Brucella or Francisella tularansis could be isolated nor borrelia could be seen. 1/40-1/80 agglutination titers obtained in 3 out of 134 sera taken from citellus, in 3 out of 264 sera taken from guinea pigs which were inoculated with spleen, liver and kidney suspensions of wild animals. 1/40-1/80 agglutination titers obtained against brucella antigen in 3 out of 125 sera taken from citellus. No significant agglutination titers could be obtained in 35 sera taken from guinea pigs which were inoculated with the organ suspensions of wild animals. In blood samples of 2 citellus few trypanosoma were detected.


[Ratio of glycan to teichoic acid in Actinomyces thermovulgaris cell wall].

The molar ratio between glycan and teichoic acid was studied in the cell wall of Actinomyces thermovulgaris. A chain of teichoic acid consisting of 13 glycerophosphate units was found to correspond to 6--7 disaccharide units of glycan. The cell wall contains 31% of the glycan of the glycopeptide and 25% of teichoic acid. The content of glycan was calculated using the concentration of muramic acid in the wall. The cell wall was found to contain 1.02% of O-acetyl groups.


[Leukocyte migration inhibition test in agarose: a method for the detection of cellular immunity in humans].

Inhibition of leucocyte migration from a capillary tube is generally regarded as an in vitro corralate of cellular immunity in many species. However, significant difficulties have been encountered in the application of this test in human subjects. An alternative to this LMIT in agarose test, in which cells migrate between the agarose layer and the glass was proposed previously. In this study the said method was used in humans and applied to purified protein derivative (PPD), streptococcus group A antigen (STA) and phytohemaglutinin (PHA) (and to several other antigens, not mentioned in this report). A good correlation was obtained between skin sensitivity and antigen induced inhibition of peripheral leucocytes for PPD in 15 healthy subjects. Inhibition of cells were noted in 19 out of 20 subjects when PHA was used. Similar findings were obtained by STA. This agarose method is technically simple and requires much fewer cells (11 x 10(6) cells per antigen) than the capillary method. It also requires very small quantities of antigen (5 microliter per 11 x 10(6) cells). Our findings suggest the suitability of LMIT in agarose gel method in the detection of cell mediated immunity in man.


[Differences in the levels of serum immunoglobulins in various cancer patients].

IgG and IgM were purified from human peripheral blood sera and IgA from human colostrum. A method is established to measure the Ig classes quantitatively which is a modification of Mancini's radialimmundiffusion technique. Three Ig clases were detected from 136 cancer patients and compared with 34 healthy controls. In sarcoma there was an increase in the 3 classes of Ig in serum. These differences were also significant in patients with bone tumors. A raised level of three classes of Ig  was seen.


[Identification of mycobacteria strains isolated in our laboratory 1972-1975].

111 (3,34%) acid-fast bacteria were found by direct, and 128 (3.86%) acid-fast bacteria by homogenisation methods, in 3315 specimens sent to the tuberculosis laboratory of our institute from various clinics of Gülhane Military Medical Academy, between October 11, 1972 and December 31, 1975. It was found that there was no great difference between the direct and the homogenisation methods, provided that these tests are carried out with great care. After the isolation of 128 mycobacteria from 3315 specimens by culturing in Löwenstein-Jensen medium they were typed by niacin, nitrate reduction, catalase, and peroxydase reactions. It was found that 124 out of 128 strains were M. tuberculosis var. bovis, atypical and saprophytic mycobacteria (3.125%).


[Animal and plant cancers produced by viruses and bacteria].

In this review the animal and plant cancers produced by viruses : (onkeorna, adeno, herpes, papova, pox, reovirus, Fig 1-6), bacteria : (Agrobacterium tumefaciens, Fig. 7), fungi : (Plasmodiophora brassicae, and nematode : (meloidgyne) are discussed.


British medical undergraduates in 1975: a student survey in 1975 compared with 1966.

Undergraduate medical education in Britain has been in a state of change since before the introduction of the National Health Service. Since then the changes in the General Medical Councils's recommendations concerning the medical curriculum (1947, 1957, 1967) have accompanied attention to curricular content, and the manpower requirements of the Health Service have drawn attention to the career preferences of students. Martin & Boddy (1962) reported a survey of medical students throughout the United Kingdom which was carried out under the auspices of the Association for the Study of Medical Education (ASME). A questionnaire was used which covered such areas as reactions to the medical school and curriculum, professional expectations and attitudes, and career preferences. Then in 1966 a similar survey was carried out by ASME and the National Foundation for Educational Research, providing data for the Royal Commission on Medical Education and published as Appendix 19 of the Todd Report (1968). The survey in 1966 used a questionnaire which investigated the background of the students, the course and students' reaction to it, and career aims, considering first preclinical and final year students only.


The careers of men graduates from the Royal Free Hospital School of Medicine, London.

The survey records the data supplied by the 290 respondents to a questionnaire sent out to the first 390 male graduates of the Royal Free Hospital School of Medicine who qualified during the 20 year period after the school became co-educational in 1948. As might have been expected, there was a preponderance of students from homes in Greater London and South East England. Whilst an equal entry of male and female students was felt desirable the achievement of this objective was slow, since selection was based on merit and the male applicants in the first few years seemed less well qualified for the medical training. During the period of the survey half of the entry was at the premedical stage and the average age for starting preclinical studies was 20-0 years--a little higher than that (18-9) recorded in the ASME survey for the 1966 entry to medical schools. A slightly higher number of Royal Free men took higher degrees and diplomas than did the women. On the number available it appeared that a higher percentage of Royal Free men took MRCP as compared with women or Birmingham graduates. The DA and DCH qualifications were more favoured by women than men. Three times as many men worked in, and twice as many lived in London as in South East England, a situation that was the reverse of that for Royal Free women. There was no evidence to show that the men preferred to do career training in London and then move out.


Projected needs of health manpower in Saudi Arabia, 1974-90.

Although our projections are not completely accurate, due to inadequate data and crude methods of approximation, three conclusions are inescapable: 1. The nation should give priority to planning new schools for health administrators and rural health workers, and to generally expanding present schools for paramedicals. 2. Plans should proceed rapidly for the two new medical schools. 3. A Health Manpower plan based on census information and special studies should be developed over the next 2 years. This plan should have input from all concerned ministries. (The Ministry of Health has regarded a proposal from University Associate "a group of Harvard, Johns Hopkins and A.U.B. professors" for technical cooperation in health services planning.)


The organization of an integrated basic medical science curriculum at a new medical school, Nottingham.

The detailed organization of an integrated medical sciences curriculum from its initial planning to the final stage of "automatic" administration are described. Although some reduction in departmental autonomy results, this is outweighed by the advantages of a timetable and curriculum prepared, planned and carried out in a cooperative manner. Flexibility and scope for controlled change and experiment are retained.


A departmental approach for improving lecture skills of medical teachers.

The programme described here concentrated on improving the lecture skills of medical teaching staff in a single department. The training format for this programme included videotaping faculty lectures, providing written feedback, and formal training sessions. As a result of participating in this programme members of teaching staff felt that their lecture skills had improved and wanted additional training in other areas of education. The significance of the programme rests not only with its impact on the staff of this specific department but in its being a pilot of an approach to teacher development utilizing an exclusively self-instructional format.


Attitudes towards the content of general practice teaching.

In a study of attitudes towards the content of general practice teaching, it was found that there was good agreement between fifth year medical students and their general practitioner tutors. The social aspects of illness were considered the most important by students and both groups emphasized the value of seeing patients in their homes with time for discussion of cases. These findings are discussed in the context of the development of teaching in general practice at Glasgow University.


Evaluation of a sex education workshop.

Thirty-two first year medical students who attended a 1 day sex education workshop and seven of their classmates who did not attend the workshop were given the Sex Knowledge and Attitude Test (SKAT) both 1 month before and 3 months after the workshop. The workshop group on retest had scores significantly higher than their pretest scores in the areas of sexual knowledge, autoeroticism and sexual myths. The scores of the no-workshop group did not change significantly on any of the parameters.Evidently, knowledge can be increased and attitudes liberalized by means of an intensive day-long workshop and such changes may persist beyong the immediate period of the workshop.


A comparison of student performances in answering essay-type and multiple-choice questions.

Assessment has been made of student performances in answering exam questions of different types. Three groups of students were tested on the same material in three different forms of examination: essay-type question, essay-type question modified by providing cues, and multiple choice question. The students performed better in multiple-choice and in cued essay questions than in uncued essay questions. An important difference between essay questions and multiple-choice questions is the provision of cues in the latter.


Linear study of medical undergraduate performance.

The examination performance of a cohort of clinical undergraduates has been scrutinized. The cohort was notable for a high failure rate at the university preclinical examination, but this failure rate did not reappear consistently in all four final clinical subjects. The assaying examinations were not only valid for their objectives, but also measured a range of other attributes. Multiple choice question papers scores detect both quantitative and qualitative differences in knowledge between the high and low fail risk candidates. The effect of A-level grade is variable but is carried up to the final qualifying examinations. High performers tend to have good A-levels. The contribution of the preclinical course to the clinical qualifying examination was small, varied between the preclinical subjects and also between the clinical subjects and two streams of students. It is shown that lack of an adequate standard in science subjects before entry to university is associated with subsequent disadvantage in clinical training. Such disadvantage could be reduced by an introductory premedical course. The contributions made by the differing educational experiences within the cohort could be detected in many of the examinations; in particular, poor performance at the end of first clinical year pathology multiple choice questions paper examination was associated with poor performance at finals. Failure in the first part of finals indicated a likelihood of furhter failure, factors such as sex and motivation are shown to affect multiple choice question performance whilst others such as work overload do not. The high risk fail candidates can be detected 2 years before finals and might be given special educational treatment designed to improve their chance of first time success as there is no efficient way of identifying them before acceptance into the medical school.


Medical student assessment of videotape for teaching in diagnostic radiology.

A series of six videotape recordings, prepared jointly by the Department of Radiodiagnosis and the Television Service, University of Leeds, described some aspects of the radiology of the chest, using only radiographs. A small group of final year medical students viewed these videotapes over the space of few days. Their scores for factual questions immediately afterwards were compared with their attitudes to the learning experience, expressed anonymously without knowledge of these scores. Students who scored the highest marks were most consistently critical of the videotapes; those with lower marks tended to record favourable attitudes when they performed best and unfavourable attitudes at other times. Scales set up by the students themselves to evaluate the experience produced a wide range of detailed and constructive suggestions. In general, students commented very favourably on the capacity of videotape to present fine radiographic details and we conclude that it is an appropriate medium for this purpose.


Paediatric candidates' attitudes to computerized patient management problems in a certifying examination.

In September 1974 candidates who had taken a computerized patient managment problem examination (CPMP), as part of the certification process in paediatrics required by the Royal College of Physicians and Surgeons of Canada, completed a questionnaire designed to elicit their reactions to CPMPs. The results indicated that respondents were favourable to CPMPs, that there was little distraction caused by the equipment, logic or semantics of the problems, and that CPMPs were an acceptable examination technique. It was recommended that, in the future, CPMP examinees be allowed practice time to familiarize themselves with the equipment, that pre-examination instructions should be clarified, and that problems judged inadequate by candidates be revised.


Hydatid disease at Royal Prince Alfred Hospital, 1964 to 1974.

A survey of hydatid disease has been carried out at the Royal Prince Alfred Hospital over a ten-year period from 1964 to 1974. It would appear that there has been no change in incidence in hydatid disease in the last 25 years. Fifty per cent of the hydatid cysts dealt with in this series occurred in the liver, and 30% were in the lung. Forty per cent of patients with lung hydatid disease were found to harbour hydatid cysts in the liver as well, while 24% of those with hydatid disease in the liver were found to have co-existent lung cysts. Twenty per cent of patients with pulmonary hydatid cysts presented with urgent complications, while only 7% of those with liver hydatid cysts presented in this way. Twenty-four per cent of the patients in this series were born outside Australia, most of the rest having been born and having lived in New South Wales. In this State, the distribution of hydatid disease remains the same as it was in 1925. Of the serological tests, the Casoni intradermal reaction was positive in 67% of cases, while the complement-fixation reaction was positive in only 52%. Seventy-eight per cent of these patients came to operation; 50% were found to have viable cysts at operation. Morbidity was high from chest infection, prolonged drainage from the site of the cyst and subphrenic abscess. Since few viable cysts were found in patients over the age of 60 years, there is a strong case for conservatism in the treatment of elderly patient with an asymptomatic calcified hydatid cyst. The hydatid-dependent mortality rate in this series was 1-8%. Over a mean follow-up period of five years, in 5% of these patients, there was a proven recurrence of hydatid disease requiring further operation.


Penetrating eye injuries associated with motor vehicle accidents.

A 2 1/2-year review of penetrating eye injuries resulting from motor vehicle accidents and treated at the Princess Alexandra Hospital, Brisbane, is presented. The series dates from January 1, 1972, when legislation requiring the compulsory wearing of seat belts was introduced. The review shows a downward trend in injuries compared with the previous 6 1/2 years. Almost all the patients failed to wear a lap-and-sash seat belt or, if one was worn, it was not secured properly.


Deterioration in renal function in association with co-trimoxazole therapy.

Deterioration in renal function has been observed in four patients who were taking co-trimoxazole. Three patients had stable chronic renal failure, and in two of these there was a further permanent impairment of renal function. The remaining patient received co-trimoxazole while recovering from a short episode of acute oliguric renal failure. It is suggested that co-trimoxazole be withheld, or used with caution in patients with impaired renal function.


Skin-prick test reactions to inhalant allergens in asthmatic patients.

Skin-prick tests with extracts of a large number of inhalant allergens were carried out on 489 asthmatic patients attending the thoracic outpatient clinics at two Sydney hospitals. Positive reactions, which had been previously found to be invariably accompanied by bronchial immediate allergic reactivity, occurred in 98% of patients who had had symptoms of asthma since the first decade of life, and in 28% of those whose symptoms did not begin until after the age of 60 years. Prick-test reactions were most commonly produced by house dust and house dust mite (70%), followed by grass pollens (50%), moulds (30%), weed pollens (35%) and tree pollens (22%). The patients commonly gave positive reactions to two or more of the extracts from within each of those allergen groups.


Severe obstructive jaundice due to amoebic liver abscess.

A case of amoebic liver abscess is reported in which it is clearly indicated that severe obstructive jaundice can be a predominant clinical feature of the condition. Other clinical manifestations of interest are discussed.


Home treatment of basal cell carcinoma.

The sap of the plant Euphorbia peplus is not uncommonly used as a home treatment for warts and basal cell carcinomas. This report documents its successful use on a biopsy-proven basal cell carcinoma.


Plasma carcinoembryonic antigen in an Australian hospital population.

Plasma carcinoembryonic antigen (CEA) levels have been determined by the zirconyl phosphate gel (Z-gel) method, using materials provided by Hoffman-LaRoche Inc., on 512 samples from 425 hospital patients, and on single samples from 124 normal controls (98 blood donors and 26 healthy staff members). Of the controls, 98% had CEA levels less than 5 ng/ml. Forty-six hospital patients had CEA levels above 20 ng/ml; 45 (98%) had known present or past cancer. Nineteen patients had levels between 10 and 20 ng/ml; 11 (58%) had present or past cancer. Sixty-seven patients had levels between 5 and 10 ng/ml, and most of these had non-malignant diseases; only 34% had present or past cancer. Cigarette smoking was associated with elevated CEA levels among patients with non-neoplastic diseases, notably those with cirrhosis of the liver and chronic renal disease. There was a gradation of increasing specificity for cancer with increasing levels of CEA from 5 to over 20 ng/ml; but, on the other hand, higher levels were associated with more disseminated cancer, which would be less amenable to cure.


Prolonged antibiotic peritoneal lavage in the management of gross generalized peritonitis.

Since there is a high mortality and morbidity with conventional therapy in generalized peritonitis, a treatment regime of prolonged continuous peritoneal lavage (two to 10 days) with the lavage solution containing kanamycin (40 mug/ml) and cephalothin (100 mug/ml) was undertaken in 14 cases of gross, well established, diffuse peritonitis. Antibiotics were also given systemically. In 11 cases, in which the causative lesion was definitively repaired, no intraperitoneal complications developed and convalescence was rapid. Three patients, in whom causative lesion was not definitively repaired at operation, subsequently died. Prolonged antibiotic peritoneal lavage appears to be beneficial for patients with gross and diffuse peritoneal soiling, after the causative lesion has been repaired.


Cosmetic caliper for use with flail leg.

A new type of long leg brace made of polypropylene with an internal shoe foot piece seems to offer distinct advantages over the older, conventional type of calipers.


Value of metiamide in the preoperative management of the Zollinger-El.

Two cases of Zollinger-Ellison syndrome are reported in which metiamide produced marked reduction in gastric acid secretion and control of symptoms, so that elective gastrectomy was performed without mortality or morbidity.


New fibreglass casting system in orthopaedic practice.

The composition, manufacture and application of a new fibreglass casting system for use in orthopaedic practice are described. The performance of the first 51 fibreglass casts used in routine fracture work is reviewed. The advantages (the cast is waterprof, extremely light and strong) and the disadvantages (an ultraviolet light source is required to cure the cast and the fiberglass tape is rather expensive) are evaluated.


Microsurgical repair of Fallopian tubes.

Of three patients who underwent microsurgical repair of Fallopian tubes after tubal sterilization, two achieved intrauterine pregnancies.


Do polyunsaturated fats predispose to malignant melonoma?

The consumption of polyunsaturated fats of patients with malignant melanoma and of a control group of patients with benign naevi has been compared in order to determine whether polyunsaturated fats predispose to the development of malignant melanoma. Patients with malignant melanoma had not consumed excessive quantities of polyunsaturated fats. Thus, there was no evidence to indicate that ingestion of polyunsaturated fats is associated with an increase in incidence of melanoma.


The use of anabolic steroids by athletes to increase body weight and strength.

Over the past 20 years the taking of anabolic steroids by healthy athletes for the purpose of increasing body weight and strength has become very widespread. The ability of these agents to cause potentially serious side effects is discussed. In a series of 20 subjects studied over 18 months, no side effects of significance were recorded, and marked increases in strength and body weight were achieved.


Surgical management in atypical pulmonary tuberculosis (MAIS complex).

Forty-four patients with Mycobacterium avium-intracellulare-scrofulaceum (MAIS) complex pulmonary infection who had a surgical procedure for management of their disease are reviewed. Relapse occurred in three cases and two patients died as a late result of their surgery. This gave a satisfactory treatment result in 89% of cases. The follow-up period was from nine months to 14 years after surgery. It is suggested that, despite the advent of modern antituberculosis drugs, resection of lung tissue is still the treatment of choic in suitable cases.


Lower limb amputation in a general hospital: a comparative review.

This paper presents the results of a recent review of lower limb amputations carried out in a general hospital, and compares them with those of previous study of similar amputations. Particular attention is paid to the type of amputation-below-knee, through-knee or above-knee--and the associated morbidity, mortality and rehabilitation prospects. There is a need for an active approach to the problems of amputation with emphasis on preoperative preparation of the patient, the operation itself and rehabilitation follow-up in an amputation clinic.


Spermatocytic seminoma.

A case of spermatocytic seminoma is described. The lesion illustrates the characteristic macroscopic and microscopic pathology of this relatively rare tumour, and is the largest recorded example. The long history of 15 years draws attention to the slow growth pattern and excellent prognosis. Chromosomal analysis, hitherto undescribed for spermatocytic seminoma, reveals moderate aneuploidy of tumour cells.


Bilateral renal calculi in patients receiving methyldopa.

Two patients with bilateral kidney stones had been taking methyldopa for 8 years and 10 years respectively. Their urine contained a brown pigment which darkened and precipitated on standing. This substance was identified as methlydopa. No other cause for stone formation was found, so it is suggested that the methyldopa, because of its poor solubility, provided a nidus for stone formation.


Thalassaemia--a preventive approach.

Thalassaemia is a significant public health problem in Australia. There is a need for improved patient education about the disease in order to prevent unnecessary anxieties. The recent advent of methods for antenatal diagnosis has given emphasis to a preventive approach. A screening and counselling service established at Queen Victoria Memorial Hospital, Melbourne, is described, and some of the problems encountered are discussed. Psychological problems are common, and these need to be managed carefully.


Sequential multidrug chemotherapy and radiotherapy with possible surgery for locally advanced cancer.

A preliminary report describes the use of both a single and a combined chemotherapeutic drug regime before radiotherapy for locally advanced and radioresistant cancers. Some tumours have been rendered operable with safety by this sequence. This method is suggested to replace the current practice of following surgery with radiotherapy and finally chemotherapy. In our experience, chemotherapy before radiotherapy is assisting in the effective control of locally advanced and hitherto radioresistant cancers of many types, and in converting inoperable cancers into cancers that can be resected sometimes with safety. Also, when chemotherapeutic drugs are given before radiotherapy, damage to normal adjacent tissue is less than that seen after radiotherapy alone.


Detection of hepatitis B surface antigen in the saliva of patients with acute hepatitis B, and of chronic carriers.

Hepatitis B surface antigen was detected by radioimmunoassay in the saliva of 11 of 25 patients with hepatitis B, for periods of up to 23 days after the onset of illness. It was also detected in the saliva of three of five chronic carriers. The presence of this antigen in the saliva may be an important factor in non-parenteral transmission of hepatitis B.


Henbane chewing.

A case is presented of deliberate chewing of the flowers of henbane (Hyoscyamus niger) in the hope of producing euphoria, and an account is given of the poisoning so produced. The case indicates a more widespread use of this plant among the drug-taking community of Australia, and discussion of the case includes a description of the plant and an outline of treatment for the acute stage of the poisoning.


Psychotropic drug use in the elderly. Public ignorance or indifference?

Figures on prescription volume and cost for pensioners' consumption of psychotropic drugs are given, showing that their consumption is grossly overproportionate to their representation within the population. Pensioners comprise about 9% of the population and are prescribed 45% (range: 32% for minor tranquillizers to 58% for barbiturates) of all psychotropic drugs issued under the National Health Scheme. The data given are seen to be very conservative estimates of total national consumption, as they do not include prescriptions issued to repatriation and private patients, or drugs administered in hospitals. Community stereotypes about drugs and drug use are discussed. The community's knowledge of psychotropic drug use by the elderly is seen to be minimal and its attitude toward it indifferent.


The doctor's wife.

A sociological survey of 52 doctors' wives was performed. The majority had attended private school, 19% had reached a tertiary level of education and 58% had been employed in the health profession before marriage, 42% in the nursing profession. At the time of the survey only 10% were in full-time external employment, but the majority assisted their husbands in their professional work. A minority acknowledged some loss of personal identity in being a doctor's wife.


The Feingold dietary treatment of the hyperkinetic syndrome.

A satisfactory explanation of the hyperkinetic syndrome in children has been lacking. Feingold has advanced the hypothesis that naturally occurring salicylates and artificial food additives may cuase this syndrome in certain children , who have a genetically determined predisposition. Following Feingold's dietary prescription, an elimination diet relevant to the foods available in Sydney was developed. The treatment regime is described, and the results of its application to 15 hyperkinetic children are presented. The parents of 10 children are "quite certain" and those of three others "fairly certain" that their children's behaviour not only improved substantially with the diet, but also relapsed promptly when significant dietary infringements occurred. A possible ecological implication of these findings is briefly discussed.


Spontaneous osteonecrosis of the medial femoral condyle.

Six patients with osteonecrosis of the medial femoral condyle were seen during a 3 1/2-year period in a rheumatology unit. This condition, which may not be rare, is characterized by the sudden onset of pain in the knee of elderly people (usually women) without significant trauma. Physical signs include effusion and tenderness at the medial margin of the knee joint. Radiographic changes may not be evident for weeks or even months. The later appearances are characteristic and the site of the lesion is remarkably constant.


Lincomycin-clindamycin-associated psuedomembranous colitis.

Five cases of lincomycin-clindamycin-associated acute pseudomembranous colitis, demonstrating a spectrum of clinical, histological and radiological severity, were encountered over a five-months period. All patients presented with watery diarrhoea without the passage of macroscopic blood or pus. Two patients were seriously ill with fulminant colitis, but responded rapidly to corticosteroids given parenterally and supportive therapy. The diagnosis of acute colitis should be considered in all patients developing diarrhoea during or up to three weeks after beginning therapy with lincomycin or clindamycin and can be confirmed by sigmoidoscopic examination. Withdrawal of the antibiotic and symptomatic treatment is appropriate for mild cases of colitis, but our experience suggests that corticosteroid therapy is safe and effective in severe cases. Indiscriminate use of these antibiotics should be avoided.


Spleno-hepatic tuberculosis due to Mycobacterium kansasii.

A case of tuberculosis of the spleen and liver is described. The organism involved was Mycobacterium kansasii, one of the atypical mycobacteria. The lack of evidence in the literature of primary splenic or hepatic involvement by this organism suggests that it is rare. In this instance it complicated a case of myeloproliferative disease, megakaryocytic myelosis with extra-medullary haemopoiesis, and was not diagnosed until autopsy.


The use of an indwelling peritoneal catheter in the treatment of chronic renal failure.

Thirty-seven patients with end-stage renal failure were treated by dialysis by the peritoneal route, with a Tenckoff catheter. The basic regime was 30 2-litre exchanges twice a week. Two patients died while receiving peritoneal therapy, and 7 patients were transferred to haemodialysis because of catheter failure. Four patients received transplants directly from peritoneal dialysis, 22 were transferred electively to haemodialysis, and 2 are still being treated by peritoneal dialysis. Fourteen (1-2%) of the 1,161 dialyses were complicated by peritoneal infection. This was controlled in 13 instances by the addition of gentamicin to the dialysate, but removal of the catheter was required in one case. The mean duration of peritoneal dialysis was 14-4 weeks; 4 patients underwent this type of therapy for 78, 63, 41 and 40 weeks respectively.


Surgery for duodenal ulcer: selection of the most suitable operation for the patient.

The results of 70 consecutive operations for duodenal ulcer are presented to illustrate an approach which attempts to make the best use of the range of available operations. The object is to select patients according to criteria which minimize mortality and recurrent ulcer rate by adapting the operation to the circumstances. Functional results have been extremely satisfactory; operative mortality was 1-4% and, although the follow-up period is not sufficiently long to allow a final rate to be determined, proven recurrent ulcer rate is 2-8%. These results indicate that his approach is worth further consideration.


Blood alcohol and road trauma survey.

Since April 8, 1974, Victorian legislation has required that blood samples be taken from all persons aged 15 years or over after a road traffic crash. A survey was carried out of 474 such persons from June 10 until September 12, 1974. Of these, blood was taken from 350, and estimates of blood alcohol concentration were obtained from 271 samples. Sixty-five samples of the 271 (24%) gave positive results for alcohol and in about two-thirds of these the levels were higher than the legal limit of 0-05 g/100 ml. Over half of the subjects with positive results for blood alcohol concentration were under 30 years of age, 80% were males, and half were car drivers. This contrasted with the "alcohol-negative" subjects, who were older, and about half of whom were males. About 60% of both groups received minor injuries, and about 20% were admitted to hsopital. Research is continuing to define drinking habits and other social characteristics of these groups.


Necropsy as a control of death certification: some unexpected findings.

A comparison of death certificates and necropsy findings in a group of premenopausal women suggests that a number of diseases are either underdiagnosed in life. Atypical cases of intracerebral haemorrhage are frequently misdiagnosed. These occur in the frontal, temporal or parietal lobes in non-hypertensive women and may be suitable for surgical treatment. Their aetiology remains obscure. Pulmonary embolus is habitually underdiagnosed in premenopausal women and myocardial infarcts appear to be overdiagnosed. The study reemphasizes that death certificates are inaccurate and that low necropsy rates render accurate statistics of diseases in the community difficult ot obtain.


Unusual complication of endoscopic retrograde cholangiopancreatography.

A case is reported of extravasation of radio-opaque contrast medium into the duodenal wall surrounding the papilla of Vater during endoscopic retrograde cholangiopancreatography (ERCP). This is a particularly uncommon complication of this relatively new technique in gastrointestinal investigation. The uneventful and complete recovery in the case reported here is in line with the clinical progress of the few previously reported patients who developed this complication.


The interaction of ethanol and delta9-tetrahydrocannabinol in man: effects on perceptual, cognitive and motor functions.

Twelve paid student volunteers (8 male, 4 female) were used in a double-blind crossover experiment to investigate the effects of delta9-tetrahydrocannabinol (THC) alone, and in combination with ethanol, on human perceptual, cognitive and motor functions. Both THC (10 mg/70 kg) and ethanol (0-5 g/kg) had little effect when administered alone. The combination of drugs, however, induced a significnat decrement in performance in some of the tests and this interaction was considered to be at least additive. The peak blood ethanol concentration was higher (P = 0-05) when subjects received both ethanol and THC than when they received ethanol alone.


Aspiration cytology in Perth: experience of 673 cases.

The experience gained from the investigation of 673 patients by aspiration cytology is reviewed. The diagnostic accuracy of the technique is not satisfactorily demonstrated in this series owing to incomplete follow-up information. However, the almost unlimited application of aspiration cytology as a preliminary diagnostic test in focal lesions of most organs and tissues is emphasized. The chief merit of the technique is it simplicity which shoudl put it into the very front line of diagnostic procedures in suspected neoplastic disease.


Spironolactone and acute mountain sickness.

Thirteen adults trekking in Nepal in 1974 to altitudes between 4,300 m and 5,500 m remained free from acute mountain sickness while taking spironolactone as a prophylactic measure. Two years previously five of these adults trekking at similar altitudes, but without treatment, had suffered from acute mountain sickness. The regime used was spironolactone in a dosage of 25 mg three times a day for two days preceding and during the periods spent at altitudes above 3,000 m.


How many endoscopic biopsy specimens?

In cases in which the endoscopist considers it necessary to attempt to confirm or exclude a diagnosis of carcinoma of the stomach or oesophagus by biopsy and histopathological examination, we find that a minimum of four fragments should be taken. Taking more than eight biopsy specimens appears to do little more than prolong the time taken for a highly skilled team to complete the operation.


Medullary carcinoma of the thyroid, multiple phaeochromocytomas, mucosal neuromas, marfanoid habitus and other abnormalities (Sipple's syndrome).

A case of Sipple's syndrome is reported, in which the full phenotype was expressed. The patient had the typical marfanoid habitus, with thickened lips and alae nasi, neuromas on lips and tongue, medullary carcinoma of the thyroid gland, phaeochromocytomas, and medullated corneal nerve fibres. The plasma calcitonin level was initially elevated, rose on calcium infusion before thyroidectomy, and was undetectably after thyroidectomy. The urinary catecholamine excretion was elevated. The plasma parathyroid hormone, adrenocorticotrophin and growth hormone levels and the serum calcium level were normal.


The evaluation of clinical competence.

This review examined new approaches to the definition and evaluation of clinical competence. Competence may be defined in terms of the components of the process of clinical performance or in terms of the outcomes of clinical performance. No single test method is capable of providing a valid and reliable evaluation of all defined aspects of clinical competence. Both in this country and overseas, new test methods and examinations are being developed and the implications which they will have for Australian medical schools are discussed.


Rheumatoid arthritis treated with chlorambucil: a five-year follow-up.

The results of a five-year study of chlorambucil in patients suffering from rheumatoid arthritis are presented. The effect of treatment was to allow a reduction in corticosteroid dosage and a sustained remission of disease activity in patients. Three patients of the series of 22 developed neoplastic disease, and the signficance of this is discussed.


Prevalence of cardiovascular risk factors including fasting serum triglyceride levels in the Cunderdin health survey of 1971.

In a mass health examination conducted in the Shires of Cunderdin and Tammin, 83% of subjects on the electoral rolls attended for screening of cardiovascular risk factors including fasting blood lipid measurements. Fasting serum triglyceride levels are presented. Other factors measured showed quite close similarities to those in the Busselton 1972 Health Survey. On conventional criteria of percentage of desirable weight, fasting serum cholesterol level and fasting serum triglyceride level, a very large proportion of the survey population was found to be eligible for preventive dietary advice--for example, 50% of males and females aged 40 to 59 years. The effective education and after-care of subjects found to be at risk requires further development of resources.


Domiciliary follow-up of the patient with acute myocardial infarction and myocardial ischaemia.

For 134 patients suffering acute myocardial infarction and/or ischaemic heart disease, a cardiac programme was commenced during hospitalization and followed up in the home environment. The workings of the programme are discussed and conclusions as to its effectiveness are drawn.


Gastric ulceration within hiatus hernia.

A retrospective analysis has been made of 19 persons with gastric ulceration in hiatus hernias. Eleven patients presented with acute upper gastrointestinal haemorrhage and three with chronic anaemia. Seventeen had experienced previous abdominal discomfort or heartburn. Diagnosis of ulceration was achieved by endoscopy in 16 instances and by radiography in six instances. A chronic ulcer was found in 10 patients, a discrete acute ulcer in three and multiple erosions in six. Twelve of the hernias were sliding in type and irreducible, in contrast to previous reports that gastric ulceration is most frequent in paracoesophageal hernias. Conservative management resulted in complete healing of the ulcer in the majority of patients. Continued bleeding or failure of the ulcer to heal necessitated surgical intervention in six patients.


Volvulus of the transverse colon in an Australian aboriginal.

A case of volvulus of the transverse colon in an elderly female Australian Aboriginal is reported. The rarity of the condition is stressed and the radiological features are discussed. Reference is also made to the geographical distribution of all types of volulus of the colon, and to the apparently high incidence of the condition in Aboriginal patients admitted to the Darwin Hospital.


Fatal respiratory obstruction due to round worm.

Respiratory obstruction caused by a round worm is rate. A fatal case of the complication in a three-year-old child was encountered at the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India.


Hospital staffing and hospital costs.

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.


[Statistics and comparative pharmacokinetics (author's transl)].

An example stresses the point of well established routines, which are usual in comparative pharmacokinetics today. It seems to be necessary to analyse the problem carefully, before starting any pharmacokinetical trial.


[Renal thrombotic microangiopathy with benign hypertension and uremia secondary to oral contraceptives (author's transl)].

A 34-year-old woman developed uremia secondary to severe renal thrombotic microangiopathy after 3 years intake of oral contraceptives. In this particular case manifestation of end stage renal failure was preceded by an unusually long lasting period of nine months with benign hypertension. Even during the final stage (3-4 weeks) prior to complete development of uremia only once hemolysis but no malignant hypertension was observed. Only close long term follow up including renal biopsy and subtile functional tests may provide information whether and/or when hypertension due to oral contraceptives turns to become--at least in part--renal hypertension and also becomes persistent. This observation does not give evidence that benign hypertension causes renovascular damage and thus renal failure. Plasma renin activity was found to be basically elevated and furthermore stimulated e.g. by dialyses. However, this single observation does not permit any conclusion about a pathogenetic role of renin in creating hypertension by e.g. renal vasoconstriction or--despite hypertension--collapse of the capillary network.


[Psychological and physiological effects of a 5-week ergometer training in healthy young men (author's transl)].

40 healthy male students were randomly assigned to either the exercise or control group. The latter was asked not to alter their common physical activity while the exercise group trained three times weekly on the bicycle ergometer for 15 minutes with a constant heart rate of 140bpm. At the beginning and after five weeks physiological data comprising cardiovascular and pulmonary responses at rest and under submaximal ergometric exercise were assessed. Additional data included psychological achievement tests, self reports of personality dimensions and frequency of physical complaints. Results indicated a marked increase in physical fitness for the training group improving the work load from 158 watt to 197 watt at constant heart rate. At rest and especially at submaximal work load there was an improvement of the economy of the cardiovascular and respiratory system. Contrary to these findings there were no changes or impairment in the psychological achievement tests, measuring concentration. Compared with the control group self reports of personality dimensions did not change except for a tendency to more extrovert behavior in the exercise group. Unexpectedly, the frequency of physical complaints did not decrease. The reason for this discrepancy is discussed.


[Coincidence of two carcinomata with excessive high level of serumestrogen (author's transl)].

A case of an unusual combination of a metastasing bronchus cancer, a non-metastasing cancer of prostata and an excessive high level of serum-estrogen is described. This casuistic gives rise to some more general discussion of the pathogenesis and differential diagnosis of paraneoplastic endocrinopathies.


[Malignant tumors of the colon: statistical and clinical aspects (author's transl)].

Between 1961 and 1974 at the University Hospital Surgical Clinic at Innsbruck, 991 cases of malignant tumors of the colon have been treated. Statistically a significant increase is proved in the number of these patients above the age of fifty in the Tyrolean population during this period. On the other hand the percentage of colon-tumors is decreasing with the age in patients younger than fifty. 412 out of these 991 cases could be analysed very carefully. The malignant tumors have been studied, among other respects, in relation to the localisation in the particular part of the colon, the frequency in the different ages and sexes. Specially the symptoms due to the particular localisation of the tumor are stressed. It is also noticed that the long case history, mainly because of the patients' own negligence, plays a decisive part in the unsatisfactoring number of cured. Some measures are mentioned, which with the so far got knowledge and science can improve the final therapeutic results.


[Acute leukemia as terminal stage of Hodgkin's disease (author's transl)].

In a 61 year-old female patient with Hodgkin's disease treated with cytotoxic drugs and radiation therapy acute undifferentiated leukemia developed 10 years later. The possibility of a carcinogenic effect of the cytotoxic and actinic therapy is discussed. Leukemia complicating the course of Hodgkin's disease must be considered an independent disease and not a iatrogenic transformation of a preexisting lesion.


[Etiology of shock lung: case report (author's transl)].

In a woman, 29, two times resection and anastomosis of the small intestine because of extended infarction was performed. Following peritonitis and septic shock a progressive respiratory insufficiency developed and patient died 48 hours later despite intensive ventilatory treatment. Autopsy findings were manifold vascular damage (aorta) and thromboembolisms in mesenteric vessels and iliac veins too. Patient received oral contraceptives over several years, changed the preparation previously and contraceptive therapy was continued with another one. Thromboembolic complications may understood as undesirable side effects of the contraceptives. By microscopy of lung thrombosis in capillaries was seen and in small arteries too, as embolism carried by the blood stream. In pathogenesis of shock lung macrothrombosis as an aetiologic factor is to be discussed.


[Sjögren's syndrome with pulmonary fibrosis. A case report (author's transl)].

The case is pointing to two remarkable facts: 1. Sjögren's syndrome may also be proceeding--without demonstrating any inflammatory rheumatic symptoms--with an isolated pulmonary fibrosis, as it had been evident in another case mentioned. 2. In certain circumstances, it may be considerably difficult to differentiate, with reliable certainty, the morphological changes in the salivary gland from those of a malignant lymphoma. Besides, also in literature there are reports concerning malignant degeneration turning into malignant lymphomata [1,8] in cases of Sjögren's syndrome.


[Quantitative tracer examination about the deposition of inhaled aerosols (author's transl)].

The topical distribution of inhaled aerosols produced by customary jet nebulizers has been measured scintigraphically. Corrections for absorption and stray effects with experimentally determined factors allowed to evaluate the quantities of deposited aerosol for the head, chest and abdominal regions. Highest aerosol intakes were found with slow inhalation through the mouth. The deposition decreased at higher respiration rates with a further diminution when inhalation takes place through the nose. The individuals had characteristic patterns of aerosol distribution resulting in more pronounced deposition differences than those caused by the mode of inhalation.


Relevance of dimethylamine to mechanism studies of DIC (DTIC, NSC 45388).

Monolayer cultures of Chinese hamster ovary (CHO) cells take up the photo-decomposition products of DIC more readily than DIC itself. Dimethylamine, an immediate product of this degradative pathway, can ultimately become associated with the DNA, RNA, and protein of the cells as demonstrated by selective enzymatic degradation of macromolecules and isopycnic centrifugation. The relevance of these observations to mechanism studies of DIC is discussed.


A study of intermittent alternating drug program reinduction therapy on the frequency and duration of response in adult acute leukemia.

Of 41 adults with a diagnosis of acute leukemia that were randomized for induction therapy in combination with methotrexate, 6-MP, vincristine and prednisone (POMP) versus a combination of cytosine arabinoside, cytoxan, vincristine and prednisone (COAP), 23 (56%) patients achieved a complete remission. During remission, patients received consolidation therapy with the three courses of remission induction regimen that they had not received initially. They then received daunomycin (three courses) and L-asparaginase and were then maintained for two years with their induction therapy. The median duration of survival for all patients was 40 weeks; the median duration of survival of those patients that responded to chemotherapy was 80 weeks. There was no significant difference between the two induction regimens with regard to complete remission more than four and one half years from diagnosis and two and one half years from discontinuation of all therapy.


Psychological evaluation and management of pediatric oncology patients in protected environments.

Specific aspects of psychological investigation and management of pediatric patients with widely disseminated solid tumors treated in semiportable, laminar airflow patient isolators are discussed. Information was obtained prospectively from a psychosocial study c-ordinated with a medical investigation of the use of protected environments (PE) employing barrier isolation as an adjunct to intensive anticancer therapy. Included are description of the development of psychological criteria for patient eligibility, psychometric evaluation, longitudinal behavioral observation, pre-entry and predischarge orientation techniques, as well as approaches to the ongoing management of patients and families. No debilitating psychological disturbance has been observed in these patients, and no patients have had to be removed for psychological reasons. Specific transitory psychological changes are noted as are the problems encountered by staff members functioning in such a setting. The adoption of a well-coordinated psychosocial program of investigation and clinical intervention has proved useful in maximizing patient adjustment to prolonged treatment in protected environments.


Liquid xenon scintillators for imaging of positron emitters.

The current understanding of xenon scintillation physics is summarized and keyed to the use of xenon as a gamma-ray detector in medical radioisotope imaging systems. Liquid xenon has a short scintillation pulse (approximately 10(8) sec) and high gamma-ray absorption and scintillation efficiencies. The fast pulse may facilitate imaging in vivo distributions of hot positron sources and allow recovery of additional spatial information by time-of-flight techniques. We begin by describing our own study of the feasibility of making a practical positron scanning system, and consider the problems of scintillation decay time, linearity, efficiency, purity, and electricfield amplifcation. The prospects for a practical instrument are considered.