Post-yersinotic Reiter's disease in a physician treated with osmium tetroxide.

A case of general yersinosis in a male physician is described. Most probably the infection was acquired nosocomially in a paediatric ward. The infection affected several organs including the liver, but osmium tetroxide was nevertheless used to perform chemical synovectomy in a knee joint suffering from active arthritis. The arthritis was cured, and the already existing liver affection did not progress. The only complaint from the patient, months after the osmic acid injection, was a strong metallic taste on the tongue. More than a year after the intra-articular injection, the metallic taste disappeared. The amount of osmium in the patient's blood was then calculated to be less than 100 molecules of osmium per ml blood.


Late synovectomy of the hand in rheumatoid arthritis.

PIP joints, MCP joints and wrists of 80 patients with rheumatoid arthritis were operated on with late synovectomy. The rate of recurrence of local synovitis was about 5%, which contrasted favourably with a considerably higher rate of progression of bony erosions. The loss of range of movement was small to moderate. Pain was alleviated in most cases. The possibility of forecasting the results by preoperative parameters was limited. It was concluded that the main indication for late synovectomy of the hand was alleviation of pain. The prophylactic effect on joint destruction seemed to be both slight and unpredictable.


The significance of chemotherapy for relapses from respiratory tuberculosis.

Relapses were analysed among 1,000 patients with arrested pulmonary tuberculosis who lived in the suburban area of Copenhagen. They have been carefully followed through a period of up till 15 years. Relapses did not occur if the patients had had a full course of modern chemotherapy. Therefore, it is recommended that routine follow-up of these patients be abolished. But relapses were very frequent among patients who had received incomplete chemotherapy or no chemotherapy at all. Attempts have been made to identify the groups particularly prone to a relapse. Age, and the time interval since the previous disease were of importance. Otherwise, neither the character of the disease, the extent of X-ray lesions, the frequency of cavities, nor the conditions at time of cure seemed of significance. Therefore close attention should be paid to all previous tuberculosis patients who have not undergone adequate modern drug treatment and, in selected cases, to consider preventive chemotherapy.


The effect of voluntary hyperventilation on arterial blood gases and gas exchange in patients with chronic obstructive lung disease.

A 2 min test of voluntary hyperventilation (VHV) was performed on 19 patients with chronic obstructive lung disease (COLD) and on eight control subjects. The average decrease in PaCO2 in the patients in this test was 4.6 mmHg (11%) and the average increase in PaO2 was 12.3 mmHg (19.1%). The average decrease of PaCO2 in control subjects was 16.5 mmHg (48.6%) and the average increase in PaO2 was 38.0 mmHg (46.2%). In patients with COLD, PaCO2 changes during VHV correlated significantly with respiratory exchange ratio; the correlation with minute and alveolar ventilation and deltaVO2/deltaVE ratio during VHV was of borderline significance. PaCO2 changes during VHV did not correlate with FEV1 (percent of predicted) or FEV1/VC%. The possible mechanisms of changes in blood gas tensions during and after the end of VHV test are discussed. The VHV test seems to be useful in evaluation of patients with COLD.


Static mechanical lung properties in healthy children.

The elastic properties of the lung (elastic recoil and static compliance) have been studied in 27 children from 7 to 15 years of age by a quasi-static method. There is a significant relationship between the static expiratory compliance and the quasistatic pressures at different percentages of total lung capacity on the one hand, and height and age on the other. The specific compliance is independent of both height and age. The authors also use a sigmoid mathematical model based on the relationship between specific compliance and maximum pulmonary volume. This model fits well with the experimental data. Comparison is made with the currently used exponential model of Salazar & Knowles. The results favour the hypothesis of an increase in the number of alveoli all through childhood.


Scanning electron microscopy of the bronchial mucosa in some lung diseases using bronchoscopy specimens. A pilot study including cases of bronchial carcinoma, sarcoidosis, silicosis and tuberculosis.

In order to study the lung defence mechanisms and the mucociliary transport system scanning electron microscopy was performed on biopsy specimens obtained at bronchoscopy under local anaesthesia. There were great variations in the appearance of the cilitated epithelium from the large bronchi in 40 patients with bronchial carcinoma, sarcoidosis, silicosis, tuberculosis and other lung diseases. Areas with a low frequency of cilia were observed mainly in granulomatous disorders, and in silicosis, atypical cilia occurred abundantly. Squamous metaplasia with a complete loss of cilia was found in chronic bronchitis, bronchial carcinoma, after radiotherapy and in two of seven cases of sarcoidosis. Scanning electron microscopy seems to be an excellent method for studying the surface of the bronchial epithelium in many lung diseases, and may prove to be helpful in occupational medicine.


Acute renal failure subsequent to the administration of rifampicin. A follow-up study of cases reported earlier.

A clinical presentation is made of a 2-3 year follow-up of six cases of acute renal failure that have been reported earlier. The patients had developed transient renal failure after the intermittent administration of rifampicin. The stage of olig-anuria lasted for 1-3 weeks, and five of the patients were treated by hemodialysis. Two of the patients died due to unrelated causes during the follow-up period. The four patients re-examined were clinically cured. Pathologic findings by light microscopy and immunofluorescence at biopsy were scarce. Nothing abnormal was seen by electron microscopy in two of the cases studied. Renal function was normal. In three cases the excretion at 131I-hippuran renography was slightly slowed. Although in the acute stage the renal lesions histologically appeared toxic, evidence suggestive of an immunological mechanism cannot be excluded.


[Prognostic factors concerning the survival time of Hodgkin's disease stage III and IV, treated with cytostatic agents].

On the basis of a retrospective study of 79 well-documented cases of Hodgkin's disease it has been possible to determine the prognostic significance of several factors in regard to 3-year survival. All patients evaluated were in stage III or IV and receiving polychemotherapy. According to the survival curves, the following factors adversely affected the prognosis to a significant extent: clinical stage IV, the presence of systemic symptoms, male sex, and failure to receive maintenance therapy. Also, patients treated by polychemotherapy only on relapse following other prior treatment, had a somewhat worse prognosis, though in out patient material this was not statistically significant. Other criteria significantly affecting the probability of 3-year survival in a negative sense were: decreased activity index, anemia, lymphopenia, elevated alkaline phosphatase values, low serum albumin and high serum globulin values. Elevated sedimentation rate, leukocytosis and leukopenia had no statistically significant influence upon survival.


[HL-A system and diabetes mellitus].

In 19 families of juvenile diabetes patients intravenous glucose tolerance was tested and HLA antigens were determined. A total of 68 first degree blood relations (siblings, parents, children) was studied. Taking the age dependent variabilities of the glucose assimilation coefficient (k-value) into consideration, glucose intolerance was found in 35.5% of the blood relations. Particularly in blood relations (above all in siblings) aged under 35 and with glucose intolerance, a trend to increased frequencies of those HLA antigens (B8, BW15, CW3) associated with juvenile diabetes was found, but it is not yet clear whether this association will be of practical significance.


[Cytodiagnosis of the uterine portio vaginalis according to WHO nomenclature. I. Correlative revision of cytological and histological diagnoses as quality control of selected materials. Frequency and possible reasons for the lack of correlation of cytological and histological diagnoses].

Smears from the uterine cervix have been evaluated for neoplastic changes on the basis of descriptive terms. The material was obtained by a single gynecologist using a standardized sampling technique and the results were compared with the respective histological diagnoses. Material which was found to be unsuitable for technical reasons was excluded from this study. A 98.7% agreement between cytological and histological findings was noted. Discrepancies between cytological and histological findings were essentially due to differing dysplastic changes in the deeper layers of the surface epithelium and the cervical glands, which were not sampled by the smears on the surface layer. In a few cases the discrepancies could not be explained but they disappeared after several years of observation. The practitioner should be acquainted with the nomenclature used by cytologists. In his turn, the cytologist should be familiar with the pathological anatomy of the organ in question.


[Cytodiagnosis of the uterine portio vaginalis according to WHO nomenclature. II. Clinical implications of descriptive cytological evaluations].

The evaluation of smears of the uterine cervix on the basis of descriptive terms requires the practitioner to be acquainted with the nomenclature used by cytologists. A theoretical scheme is provided which correlates the diagnostic features encountered with their respective clinical implications.


[Malignant peritoneal mesothelioma].

A case of diffused malignant mesothelioma of the peritoneum in a 64-year-old man is presented. This mesothelioma, of the papillary type, was complicated, after a year without significant clinical symptoms, by the development of ascites and obstructive upper bowel ileus. Physiological-anatomical and clinical aspects, as well as special radiologic findings and therapeutic regimens, are discussed in the light of the literature. It is recommended that all patients with malignant mesothelioma of the peritoneum be treated by total abdominal irradiation and intreperitoneal instillation of colloid P32.


[Ayurveda].

The ancient medicine of India (ayurveda) is a broadly conceptualized anthropology embracing the whole human being without the Western body/soul dualism. A symptomatology based on careful observation leads, in conjunction with etiology, pathogenesis and pathology, with constitutional and personality features, to a differentiated nosology. This broad concept is matched by multidimensional therapy embracing pharmacologic, surgical, psychotherapeutic and "paramedical" measures. Ayurveda ("life knowledge") is a combination of religious, philosophical, anthropological, medical and psychological concepts. It is impressive how accurate the knowledge and description of psychiatric diseases already was 2,500 years ago, and how little these phenomena have changed with time. The therapeutic armamentarium (paramedical, psychotherapeutic and pharmacologic) of ayurveda psychiatry has not yet been sufficiently studied by scientific methods.


[Hormonal treatment of hirsutism].

In 44 hirsute women treated with antiandrogens, sequential administration of cyproterone acetate and ethinylestradiol produced a success rate of 87%. The mean duration of treatment was 9 months, and side effects were rare. Antiandrogens are therefore superior to conventional cosmetic methods, though prior hormonal analysis is indispensable.


[Mesosystolic click syndrome and arrhythmia].

On 24-hour ambulatory ECG, 17 patients with mitral valve prolapse displayed more frequent and serious arrhythmias than a control group of 17. Neither resting ECG, treadmill ECG, nor other external recordings were capable of predicting which of the patients were prone to development of arrhythmias.


[The benign symmetrical lipomatosis (adenolipomatosis Launois-Bensaude; Madelung's fat neck)].

A case of benign symmetric lipomatosis is reported in conjunction with a review of the literature. The association with metabolic disorders such as gout and hyperlipemia, as reported by others, is fortuitous and not statistically significant. The etiology of this rare type of lipomatosis is unknown; its treatment is surgical and should be confined to cases with symptoms of compression or extremely disturbing appearance.


[Isolated decalcifying algodystrophy of the hip].

Transitory demineralization of the hip, a special form of reflex sympathetic dystrophy, is a rare condition. It should however be distinguished from more severe conditions such as tuberculosis or neoplastic bone disease. The typical symptoms are illustrated from 3 personally observed cases. The patients, usually men between the ages of 30 and 50 years or women in the last months of pregnancy, suffer severe mechanical pain in the hip, with limping and weakness. They usually need crutches for walking. Clinical examination of the hip reveals only slight restriction of passive movements. The erythrocyte sedimentation rate may be slightly elevated. Bone scan discloses hypercaptation, while other laboratory tests are negative. A few weeks after onset of symptoms, pelvic X-rays show extreme demineralization of the femoral head. On the other hand, the joint space and bony contours remain intact. The prognosis is excellent and the symptoms disappear after a few months or after delivery.


[Pyrithyldione excretion in the urine. Methods and results from various collectives].

A simple thinlayer chromatographic method for the detection of pyrithyldion in 5 ml of urine per analysis is described. Sensitivity (0.01 mug of pyrithyldion) and specificity (reaction still positive 5-6 days after injection of 50 mg of pyrithyldion) of the method are considered acceptable. The duration of elimination for pyrithyldion is relatively long (5-6 days). Epidemiological investigations were conducted in two different patient groups to analyze spontaneously voided urine samples. The incidence of positive urine samples in 204 ambulatory internal medicine patients was only 0.5% for pyrithyldion and N-acetyl-p-amino-phenol (the main metabolite of phenacetin). In contrast, the incidence in a specially selected group of 600 working women with regular intake of analgesics was much higher (between 17.7% and 28%) in the period 1969 to 1972.


[Long-term results of fasting. Results from 132 consecutive patients after 1-6 1/2 years].

132 consecutive patients were reexamined 1-6.5 years (m = 2.8) after total fasting in hospital. 37 patients had continued to lose weight, 20 patients had maintained their fasting result (+/-2 kg) and 7 patients had slightly regained (less than 1/3 of their weight loss during fast). These 3 groups, totalling 64 patients (48%), were considered successful. Their mean overweight was diminished from 57 to 29%, corresponding to a 60% reduction of mortality in certain age groups. On the other hand, 63 patients (48%) had regained more than 1/3 of their original weight loss. Five patients (4%) were lost to follow-up. Selection of patients and long-term follow-up appeared to have a decisive bearing on long-term results of fasting, whereas factors such as age, sex, degree of overweight, onset of overweight in childhood and sports were without significant effect. From the long-term results presented, it is concluded that under certain conditions fasting in hospital is warranted. Behaviour therapy is a possible alternative in the treatment of obesity.


[Splenic angioma with thrombocytopenia].

A case of splenectomy with thrombocytopenia but without hypersplenism is described. The etiology, proven by splenectomy, was a splenic angioma. The isotopic examinations necessary to localize the site of a vascular tumor and the relations between thrombocytopenia and hemangioma are discussed.


Reinnervation of dentate gyrus by homologous afferents following entorhinal cortical lesions in adult rats.

Granule cells of the rat dentate gyrus which are denervated by unilateral destruction of the entorhinal cortex are reinnervated in part by proliferation of surviving pathways from the contralateral entorhinal cortex. The cells of origin of these lesion-induced projections were identified by retrograde labeling with horseradish peroxidase and were the same cell type which normally project to the ipsilateral dentate gyrus


Activation of histone gene transcription by nonhistone chromosomal phosphoproteins.

Hybridization analysis of RNA transcripts from HeLa S3 cell chromatin to histone complementary DNA indicates that a chromosomal phosphoprotein fraction activates transcription of histone messenger RNA sequences in vitro with chromatin from a phase in the cell cycle when histone genes are normally silent.


5,6-Dichloro-1-Beta-D-ribofuranosylbenzimidazole inhibits initiation of nuclear heterogeneous RNA chains in HeLa cells.

The nucleoside analog 5, 6-dichloro-1-beta-d-ribofuranosylbenzimidazole (DRB) at 75 to 150 micromolar concentrations inhibits the synthesis of nuclear heterogeneous RNA (hnRNA) in HeLa cells by 60 to 70 percent. The sedimentation profile of hnRNA labeled with (3H)uridine for 45 seconds after brief treatment (45, 90, or 180 seconds) with DRB showed a progressive decrease in the labeling of shorter hnRNA molecules relative to longer molecules. Prior exposure of the cells to actinomycin D, an inhibitor of RNA chain elongation, did not alter the sedimentation profile of hnRNA. These results suggest that DRB preferentially inhibits the initiation of hnRNA chains so that after exposure to DRB for a brief period the longer nascent chains still remain to be finished and thus incorporate a greater share of the pulse label. By progressively increasing the time of exposure to DRB, and measuring the rate of increase in the average size of the labeled, nascent RNA, it was estimated that the chains were growing at rates between 50 and 100 nucleotides per second.


A model of nitrogenase active-centre and mechanism of nitrogenase catalysis.

Based upon the known reactions of nitrogenase and the principles of coordination catalysis, a model of nitrogenase active-centre is proposed. An octa-atomic cluster, Fe2S2-Mo2O2, of pseudo-cubane-type structure is supposed to form a coupled twin of trinuclear (2Mo-1Fe) active-centre, which also catalyzes the reduction of H+ to H2. With this model, mechanisms of all the known nitrogenase-catalyzed reactions are explained, together with the non-inhibition of the hydrogen-evolution reaction by CO, and the mixed character of inhibition of other nitrogenase-catalyzed reactions. Electron transport by 2-stepped ATP-driving with some electron back-flow is shown to give a reasonable explanation for the observed ATP/2e- ratio and for the reductant-independent ATP hydrolysis catalyzed by nitrogenase. The close analogy between electron transport by 2-stepped ATP-driving in nitrogenase catalysis and electron transport by 2-stepped photo-driving in photosynthesis by green plants in illustrated.


Jackrabbit ears: surface temperatures and vascular responses.

Blood flow to the ear pinnae is curtailed at ambient temperatures of between 1.4 degrees and 24 degrees C, which minimizes heat loss across the pinnae and allows the surfaces of erect pinnae to approach ambient temperature. The pinnae are warmed by steady or pulsatile vasodilation in some animals when the ambient temperature is between 1 degree and 9 degrees C below body temperature, a response favoring heat loss. When ambient temperature exceeds body temperature by 4 degrees to 5 degrees C, the pinnae are circulated with blood cooler than ambient temperature; this response favors heat influx.


Hydra hymanae: regulation of the life cycle by time and temperature.

Hydra hymanae, a hermaphroditic freshwater coelenterate, reproduces asexually at 24 degrees C and sexually at 15 degrees C. The appearance of gonads begins 12 days after transfer from 24 degrees to 15 degrees C and is complete 35 days after the temperature transition. Testes appear before eggs. Fifty percent of the mature embryos maintained at 15 degrees C hatch by day 61, but they have a low level of survival. Fifty percent of the mature embryos pretreated for from 5 to 25 days at 4 degrees C hatch by about day 45, and these have a high level of survival. Embryos maintained at 4 degrees C for longer periods (55 to 85 days) accumulate in a prehatching state and hatch with a high degree of synchrony approximately 7.5 days after return to 15 degrees C. Populations derived from newly hatched polyps are refractory to sex induction for approximately 120 days. The system is well adapted to ensure a regular alternation of reproductive modes in the natural environment.


Amianthoid change: orientation of normal collagen fibrils during aging.

High-angle x-ray diffraction provides direct evidence that amianthoid change, occurring during aging of costal cartilage, corresponds to a transformation from an isotropic to a marked anisotropic distribution of collagen fibrils. Low-angle x-ray diffraction and electron microscopy show that the fibrils have the customary 67-nanometer axial periodicity. Electron microscopy shows that wide amianthoid collagen fibrils consist of smaller parallel fibrils fused together. Similarities between amianthoid change and tendon morphogenesis are briefly discussed. Amianthoid change is remarkable in that aging is accompanied by increased order.


Extended helical conformation newly observed in protein folding.

A new secondary structure, which shows regularity within the experimental error, is noticed in alpha-chymotrypsin, and considering its extended nature, the name epsilon-helix has been suggested for the same. The average observed values of phi and psi for this conformation are -93 degrees and +146 degrees, respectively. The helical parameters turn out to be n = 2.7 and h = 3.3 angstroms.


Regulation of acetylcholine synthesis: does cytoplasmic acetylcholine control high affinity choline uptake?

When brain synaptosomes are obtained from animals that have been injected intravenously with [2H4]choline 1 minute before being killed, their high affinity [3H] choline uptake is correlated inversely with their acetylcholine content and directly with the rate at which they synthesize [2H4]acetylcholine. The control of such choline uptake by the cytoplasmic acetylcholine concentration is proposed as a mechanism regulating acetylcholine synthesis in cholinergic nerve terminals.


Tail-pinch stimulation: sufficient motivation for learning.

A paper clip applied to the tails of rats induced gnawing and eating, which decreased in latency and increased in duration with experience. With sustained pressure to the tail, rats learned a new habit in order to gain access to wood chips on which to gnaw. That these are also properties of behavior elicited by electrical brain stimulation suggests that both manipulations may act through the same mechanism. These results support the hypothesis that a nonspecific arousing stimulus can be a sufficient condition for establishing learned habits.


Sodium liquid ion exchanger microelectrode used to measure large extracellular sodium transients.

A new liquid membrane microelectrode has been developed that is easily fabricated and can measure fast sodium transients in the presence of potassium interference. It responds to a sudden change in sodium activity within 1 second. The electrode has been used to provide the first direct evidence of large sodium transients in the extracellular space of the brain of the catfish.


Stereochemical requirements for intercalation of platinum complexes into double-stranded DNA's.

The complexes 1,10-phenanthrolineethylenediamineplatinum(II) and 2,2'-bipyridineethylenediamineplatinum(II) have a planar, aromatic ligand system that facilitates intercalation, as shown by their ability to unwind closed circular duplex DNA. Nonbonded steric interactions can rotate the pryidine ligands out of the coordination plane in bis(pyridine)ethylenediamineplatinum(II), thus preventing intercalation. Fiber x-ray diffraction patterns of the two metallointeracalators indicate that the binding is governed by the neighbor exclusion principle.


Sex-specific cannibalism in the rotifer Asplanchna sieboldi.

In one clone, large-morphotype females rarely exhibit tactile feeding responses to their ingestible, male clonemates but readily attack small-morphotype female clonemates and males of another, taxonomically distinct, clone. In the latter clone, cannibal females lack such selectivity, but their males are well protected from capture by very large, lateral body-wall outgrowths.


Sleep in mammals: ecological and constitutional correlates.

The interrelationships between sleep, ecological, and constitutional variables were assessed statistically for 39 mammalian species. Slow-wave sleep is negatively associated with a factor related to body size, which suggests that large amounts of this sleep phase are disadvantageous in large species. Paradoxical sleep is associated with a factor related to predatory danger, which suggests that large amounts of this sleep phase are disadvantageous in prey species.


Filaroides hirthi: experimental transmission among beagle dogs through ingestion of first-stage larvae.

Four beagle dogs were found to be infected with sexually mature Filaroides hirthi lungworms from 1 to 3 months after they ingested material containing first-stage larvae opens the theoretical possibility of autoinfection of which few nematode parasites are capable.


Antiserum to brain gangliosides produces recurrent epileptiform activity.

A single injection of 10 microliters of antiserum to total brain ganglioside onto (and into) the sensorimotor cortex of the rat resulted in recurrent spiking in the cortical electroencephalogram, lasting from 7 to 17 days. Absorption of antibody with pure monosialoganglioside (GM1) completely abosished the effect. Spiking was reactivated after 4 weeks by intramuscular injection of pentylenetetrazole.


A mallophaga, Trinoton anserinum, as a cyclodevelopmental vector for a heartworm parasite of waterfowl.

The biting louse Trinoton anserinum serves as the intermediate host in the life cycle of the filarial heartworm, Sarconema eurycerca. Microfilariae, second-, and third-stage larvae were dissected from 39 of 89 lice infesting whistling swans, Cygnus columbianus columbianus, in North America and mute swans, Cygnus olor, in the Black Sea, U.S.S.R. Infective third-stage larvae obtained from lice collected from heartworm-parasitized whistling swans were injected subcutaneously into each of two hand-reared, nonparasitized mute swan cygnets. Both of these birds developed heartworm infections, one becoming microfilaremic at 14 weeks. The results of this study provide conclusive evidence that a mallophagan serves as a natural cyclodevelopmental vector of a filarial parasite.


An animal behavior model for studying the actions of LSD and related hallucinogens.

Cats injected with LSD (d-lysergic acid diethylamide) exhibit a group of behaviors that appear to be specific to hallucinogenic drugs. Two of these behaviors, limb flick and abortive grooming, have an extremely low frequency of occurrence in normal cats, but often dominate the behavior of LSD-treated cats. The frequency of occurrence of this group of behaviors is related to the dose of LSD. The behavioral changes are long-lasting following a single injection of LSD, and exhibit tolerance following the repeated administration of LSD. They are not elicited by a variety of control drugs, but are elicited by other indole nucleus hallucinogens. Because the behavioral effects are specific, reliable, easy to score, and quantifiable, they represent an animal model that can be used in studies of the effects of LSD and related hallucinogens.


Plasma membrane vesiculation: a new technique for isolation of plasma membranes.

Monolayer cell cultures of macrophages, monocytes, myoblasts, and density-inhibited and transformed fibroblasts form and release cell surface membrane vesicles following exposure to formaldehyde, related low-molecular-weight aldehydes, and disulfide blocking agents. Vesicles have a unique composition of proteins and lipids. They show enrichment of cholesterol and sphingomyelin content and a seven-to tenfold enrichment of 5'-nucleotidase activity. Vesicles also contain intramembranous particles and show a trilamellar unit membrane and no ultrastructural evidence of contamination with other cytoplasmic organelles. The technique is proposed as a novel method for isolating plasma membrane vesicles from cells in culture.


Karyotypic analysis and evidence of tetraploidy in the North American paddlefish, Polyodon spathula.

A model chromosome number of 120 was obtained for the ancient fish. Polyodon spathula (Pisces: Chondrostei). The karyotype consists of 48 macrochromosomes and 72 microchromosomes. The microchromosomes are like those found in certain other primitive fishes as well as in reptiles and birds. The possiblity that Polyodon is a species of tetraploid origin is strongly suggested by the fact that the 120 chromosomes are easily arranged into 30 groups of four homologs each. Evolutionary comparisons are made with other primitive fish groups.


Evidence of morphological and physiological transformation of mammalian cells by strong magnetic fields.

Cultures of L-929 and WI-38 cells, frozen to 4.2 degrees K and exposed for 4 to 8 hours to 5000-oersted magnetic fields, were markedly inhibited in their growth as compared to controls. In cultures grown on cover slips, approximately 7 days after exposure, morphologically distinct cells emerged and were propagated from generation to generation; 3 weeks later, in flask cultures, contact inhibition was abolished. It is concluded that under certain experimental conditions, strong magnetic fields induce morphological and physiological transformations of target cells.


Thermal stability of human DNA and chimpanzee DNA heteroduplexes.

The base pairing fidelity of heteroduplexes formed from human DNA and chimpanzee DNA has been studied by the criterion of thermal stability to test the evolutionary conservation of repeated DNA base sequences.


Calcinogenic factor in Solanum malacoxylon: evidence that it is 1,25-dihydroxyvitamin D3-glycoside.

After glycosidic cleavage of the water-soluble vitamin D-like principle of the calcinogenic plant Solanum malacoxylon, the active lipophilic portion was purified by column chromatography and analyzed by combined gas chromatography and mass spectrometry. It was identified as 1,25-dihydroxyvitamin D3, the active form of vitamin D. Thus this active metabolite of vitamin D exists in the plant world, and its presence probably accounts for pathologic calcification in grazing animals ingesting Solanum malacoxylon.


Radioimmunoassay for creatine kinase isoenzymes.

Creatine kinase has three isoenzymes designated MM, MB, and BB, with BB being the grain form and MM the muscle form. Antibodies to BB creatine kinase were obtained by immunization of rabbits with human BB creatine kinase. The antibodies demonstrated specificity for BB and MB creatine kinase (myocardial isoenzyme) but no cross-reactivity with MM creatine kinase. With the use of this antibody, a highly sensitive radioimmunoassay capable of measuring picomolar amounts of MB creatine kinase has been developed. Clinical application of this method should provide a sensitive and specific test for the diagnosis of myocardial infarction.


Early eye removal produces excessive bilateral branching in the rat: application of cobalt filling method.

When one eye of a rat is removed at birth, axons from the remaining eye form an excess of branches which are directed to both sides of the brain. This finding, which is based on a novel application of cobalt tracing methods, provides an explanation for previous reports of expanded uncrossed projections after early eye removal.


Risk of communicable disease infection associated with wastewater irrigation in agricultural settlements.

The incidence of enteric communicable diseases in 77 kibbutzim (agricultural communal settlements) practicing wastewater spray irrigation with partially treated nondisinfected oxidation pond effluent is compared with that in 130 kibbutzim practicing no form of wastewater irrigation. The incidence of shigellosis, salmonellosis, typhoid fever, and infectious hepatitis is two to four times higher in communities practicing wastewater irrigation. No significant differences are found for the incidence of streptococcal infections, tuberculosis, and laboratory-confirmed cases of influenza. Nor are differences found for enteric disease rates during the winter nonirrigation season. Strong wastewater treatment measures, including effective bacterial and viral inactivation through disinfection, are recommended for all cases of sewage irrigation or land disposal near residential areas in light of the potential public health risks involved.


Relaxin: a product of the human corpus luteum of pregnancy.

Plasma samples from peripheral and ovarian veins were obtains from women at cesarean section. A peptide that immunologically cross-reacts with a specific antiserum to porcine relaxin is present in all samples. Its concentration is four times higher in the ovarian vein draining the ovary, which contains the corpus luteum of pregnancy, than in either the peripheral vein or the contralateral ovarian vein. Secretion of ovarian relaxin correlates with secretion of ovarian progesterone, thus providing another index of luteal function.


Bacillus thuringiensis enzyme-digested delta endotoxin: effect on cultured insect cells.

Cells from three insect cell lines responded to the enzyme-digested delta endotoxin of Bacillus thuringiensis with swelling, lysis, and vesicle formation. Sufficient toxin was taken up in 1 minute to cause half-maximal cell damage. Cytoxic activity was neutralized by specific antiserum to the endotoxin.


Prenatal experience and avian development: brief auditory stimulation accelerates the hatching of Japanese quail.

A single 2-hour exposure to auditory stimulation at any point during the final 3 days of incubation accelerates the hatching of Japanese quail. The 3-day sensitive period includes both prenatal and perinatal stages of incubation. So far as is known these results provide the first unequivocal evidence that short-term prenatal sensory stimulation can affect the development of an avian embryo.


Trail marking by larvae of the eastern tent caterpillar.

Eastern tent caterpillars that are successful foragers deposit trails as they return to the tent that are more attractive than the exploratory trails of the unfed larvae. The trails of these fed returning larvae attract unfed tentmates to food finds anre chemical factors account for the attractiveness of these trails.


A blind fish can school.

Vision is not required in order for fish to school. Five individual saithe, Pollachius virens, were able to join schools of 25 normal saithe swimming in an annular tank, while blinded with opaque eye covers. Test fish maintained position within the school indefinitely and responded to short-term movements of individuals within the school, although quantitative differences in reaction time and schooling behavior were noted. Five fish with lateral lines cut at the opercula were unable to school when wearing opaque eye covers. Although it is unlikely that blind saithe could school in the wild, the constraints of the apparatus permitted a demonstration of a role of the lateral line organ in schooling.


Cannabinoid induced behavioral convulsions in rabbits.

A population of New Zealand White rabbits has been found to exhibit behavioral convulsions when given low intravenous doses of psychoactive cannabinoids of marijuana. The behavioral convulsions decrease in severity and then disappear after the long-term administration of delta9-tetrahydrocannabinol. The extreme sensitivity of these rabbits to the stimulant action of cannabinoids suggests that the population might serve as a model in studies of the stimulant action of cannabinoids.


Nitrous oxide "analgesia": resemblance to opiate action.

Nitrous oxide produced a dose-related "analgesia" in mice (median effective dose, 55 percent). The analgesia was evaluated by means of a phenylquinone writhing test. Narcotic antagonists or chronic morphinization reduced nitrous oxide analgesia. Either nitrous oxide releases an endogenous analgesic or narcotic antagonists have analgesic antagonist properties heretofore unappreciated.


Effect of charcoal-broiled beef on phenacetin metabolism in man.

When charcoal-broiled beef was fed to human volunteers, who were then given phenacetin orally, the concentration of phenacetin in the plasma was lowered, but its half-life in the plasma was not changed. The data suggest that feeding charcoal-broiled beef enhances the metabolism of orally administered phenacetin in the intestine or during its first pass through the liver, or both.


Impurities in labeled diethylstilbestrol: identification of pseudodiethylstilbestrol.

Radioactive impurities known to exist in labeled diethylstilbestrol used in tissue residue studies in cattle include at least five different compounds, one of which is identified as pseudodiethylstilbestrol.


Interindividual variation in binding of benzo[a]pyrene to DNA in cultured human bronchi.

The binding of benzo[a]pyrene to DNA in cultured human bronchus was measured in specimens from 37 patients. The binding values ranged from 2 to 151 picomoles of benzo[a]pyrene per milligram of DNA with an overall mean +/- standard error of 34.2 +/- 5.2. This 75-fold interindividual variation in the binding of benzo[a]pyrene to DNA is similar in magnitude to that found in pharmacogenetic studies of drug metabolism. Aryl hydrocarbon hydroxylase is also inducible by benz[a]anthracene in the bronchial mucosa.


25-hydroxyvitamin D: autoradiographic evidence of sites of action in epiphyseal cartilage and bone.

Tritiated 25-hydroxyvitamin D3 was administered to growing rats to morphologically documents its sites of action. Highly selective incorporation occurred in epiphyseal hypertrophic cells, epiphyseal matrix, osteoid, osteoblasts, and osteocytes of metaphyseal bone spicules. The labeled metabolite appeared in chondrocytic lacunar matrix coincident with hypertrophic cell death as evidenced by histological examination. The tritiated 25-hydroxyvitamin D3 became localized only in areas of active mineralization.


Rod outer segment disk shedding in rat retina: relationship to cyclic lighting.

When albino rats are reared in cyclic light, a burst of rod outer segment disk shedding occurs in the retina soon after the onset of light. The number of large packets of outer segment disks (phagosomes) in the pigment epithelium at this time is 2.5 to 5 times greater than at any other time of day or night. The subsequent degradation of large phagosomes to smaller structures within pigment epithelial cells proceeds rapidly. The burst of disk shedding follows a circadian rhythm for at least 3 days, since it occurs in continuous darkness at the same time without the onset of light.


Time-dependent disruption of morphine tolerance by electroconvulsive shock and frontal cortical stimulation.

Electroconvulsive shock or frontal cortex stimulation administered to rats at 5 but not at 180 minutes after an initial administration of morphine sulfate disrupted the development of one-trial tolerance to the analgesic effects of morphine sulfate. It is suggested that development of tolerance may be mediated by cellular mechanisms and memory processes similar to those thought to underlie conventional learning.


Perceptual analysis of moving patterns.

Configurations of moving points are often perceptually analyzed into relative and common vectors that are different from the actual motions. If a movement configuration is abruptly replaced by a test point whose objective velocity continues the apparent (but illusory) course of one of the original points, observers perceive that course as uninterrupted and colinear. This finding provides a quantitative measure of the vector extraction phenomenon and was used to show that neither of the two current models adequately fits that phenomenon.


Experimental models for evaluation of radioactive tumor-localizing agents.

Although subject to limitations, there is a need for carefully controlled laboratory studies using animal tumor models in research on tumor-localizing agents. This paper reviews the literature relating to the more important transplantable tumor systems, spontaneous or induced, as to origin, host, site, and radioactive agent used. The historical background of animal tumor models is discussed, including such technical aspects as source of tumor, techniques of transplantation, transplantation sites, and maintenance of transplants. Also, considered are the use of animal tumor models as predictive systems, expression of experimental results of quantitative studies of tissue uptake and comparative radionuclide tumor and distributional studies, and suggestions for future studies, such as the need of more intensive study of existing tumor models for a better understanding of the relationship between animal and human tumors, the need for the development of new tumor model systems, and for standardization of experimental protocols and procedures. A total of 48 t,mor models (26 in mice, 11 in rats, 7 in hamsters, 2 in rabbits, and 2 in dogs) are presented in seven tables dividing the models into tumors of epithelial tissue, connective tissue, hematopoietic tissues, melanin-forming tissue, neural tissues, undetermined site of origin or undifferentiated histologic pattern, and miscellaneous background. The use of animal tumor models in cancer research, which utilizes radionuclides, permits the investigator to do many things not permissible with human beings, but the extrapolation of animal results to human beings must be approached with caution, Although malignant disease, whether in animals or man, must be individualized, certain trends in animal studies can be observed. It is the goal of the laboratory investigator to be able to indicate to the clinician those trends or phenomena that, when repeatedly observed in animal model systems, may be applicable to an understanding of malignant disease in man.


Mechanisms for localization of radiopharmaceuticals in neoplasms.

Localization of a radiopharmaceutical agent in a "tumor" is best conceptualized in terms of the altered regional physiology attendant to the presence of the "tumor". Such localization should be expected to occur in association with other disease states characterized by similar altered regional physiology. Neoplasms, areas of inflammation, and certain phases of infarct development are characterized by increased permeability of their capillary beds to macromolecules. This is largely due to neovascularization and the large intercapillary pores associated with new growth of capillary beds in these circumstances. Often, total perfusion to such lesions is increased in comparison to surrounding normal tissue. Thus, in all three clinical conditions, the entry of macro-molecules into the interstitial fluid space from the intravascular space is increased above that seen in normal tissue. Moreover, with neoplasms and inflammatory processes, there may be a delay in new lymphatic vessel growth adding to the residence time of the macromolecules in the interstitial fluid space. In all three conditions, the increased macrophage activity associated with tissue necrosis may result in ingestion of the labeled macromolecule by the macrophage. Pinocytosis may result in ingestion of the labeled macromolecule by other cells in the lesion, or there may be specific receptor sites on the cell membrane for the macromolecule, which may lead to fixation of the labeled macromolecule on the cell surface and possible intracellular translocation of the label itself. Radiolabeled macromolecules such as albumin, fibrinogen, or gamma globulins, and radionuclides that bind to macromolecules such as radiogallium, radioindium, and other radioelements, exhibit localizing behavior in tumors, inflammatory lesions, and during certain stages of infarcts. In the case of radiogallium and radioindium, the binding macromolecule is transferrin, and it is known that some cells have specific receptor sites for transferrin-bound iron on the cell membrane. It is possible that certain cells within these lesions have cell membrane receptor sites for radiogallium- and radioindium-labeled transferrin, and the cell erroneously accepts these radioelements from the transferrin in lieu of iron in attempting to engage in heme enzyme synthesis. Another mechanism that may be operative in the localization of agents in neoplasms, infarcts, and inflammatory lesions may be the altered cell permeability found in many cells of such lesions. It is known that many agents, such as supravital dyes, are excluded from entering normal cells by the selective permeability of normal cell membranes. When cell membrane permeability is altered, such as can be seen in traumatized, dying, or dead cells, the normally excluded agent may penetrate the abnormal cell membrane and bind, and consequently accumulate in intracellular constituents.


The relationship of head and neck irradiation to the subsequent development of thyroid neoplasms.

Individuals who have received head and neck radiation for benign conditions have a markedly increased risk of developing thyroid, salivary, and perhaps breast cancer as compared to the general population. Although the relative risk is very high, the absolute risk that any one individual who has had head or neck irradiation will develop a subsequent malignancy is low. Identification of these patients through some type of screening procedure may be beneficial in terms of prevention of subsequent morbidity and perhaps mortality from cancer, especially thyroid and salivary cancer. The risks of any detection or prophylaxis program must be carefully weighed against the probable, but unproved benefits of early detection. A major unresolved question is the natural history of microscopic thyroid carcinoma in the 25 yr-40 yr old radiation exposed population.


Tobacco and tobacco smoke.

Epidemiologic studies have demonstrated a causal relation between smoking of cigarettes and cancer of the lung in man. Women smokers, cigar, and pipe smokers also face an increased risk for lung cancer. Prospective and retrospective studies have found a correlation between smoking of cigarettes, cigars, and pipes and cancer of the oral cavity, larynx, and esophagus and for cigarette smokers increased risks to develop cancer of the pancreas, kidney, and urinary bladder. Dose responses have been established between number of cigarettes smoked and cancer of the respiratory and upper digestive tract. Tobacco chewers face an increased risk for cancer of the mouth and esophagus. Tobacco smoke has induced tumors of the lung in the dogs and of the larynx of hamsters. The particulate matter of the smoke is carcinogenic to the skin of mice and rabbits, and the bronchi and connective tissue of rats. In tobacco smoke were identified tumor initiators, tumor promoters, cocarcinogens and organ specific carcinogens. Chewing tobacco is a tumor promoting agent and contains traces of tobacco specific and carcinogenic nitrosamines. Ten to 15 yr after giving up smoking the ex-smoker faces the same low risk to develop cancer of the upper digestive tract, the lung, the pancreas, and the urinary tract as the nonsmoker. It should be our goal, therefore, to prevent young people from starting the smoking habit and to convince the smoker to quit smoking. So far, we can report no success in terms of decreasing smoking habits among younger people. On the other hand, we can take satisfaction from the fact that antismoking propaganda has had an effect on college educated males, that among the population as a whole, there is a considerable number of exsmokers; that smoking cessation clinics do prove cost effective and if they were to become part of every health care center, they could help a large number of heavy smokers who cannot seem to stop smoking on their own. We can also report that there has been a significant reduction in the tar yield of American cigarettes, a reduction which we hope will continue; that the tumorigenic activity of tobacco as measured in animal studies, has decreased; and that as a consequence of the above, the risk of lung cancer and other tobacco-related cancers among smokers of these cigarettes is lower than in years past. It is unlikely that man will ever be able to inhale smoke components as harmless as unpolluted air, but as long as we have a society which accepts this habit and as long as people find satisfaction in smoking, we must work towards the day when tobacco-related cancers and other diseases will be reduced to a minimum. With the world wide coperation of the scientific community, the Departments of Agriculture, and the tobacco industry, it is our hope that this goal will be achieved.


High school football injuries: prevention of injury to the central nervous system.

Injuries to the head, neck, and spinal cord of high school athletes account for over 90% of the fatalities directly related to football. Preseasonal and seasonal guidelines that have proven to be helpful in the prevention of these injuries are presented.


Harrington instrumentation in fractures and dislocations of the thoracic and lumbar spine.

Harrington instrumentation was used to treat 23 injuries of the thoracic and lumbar spine accompanied by neural damage encountered during an 8 1/2-year period. The indication for the use of Harrington instrumentation is instability of the thoracic or lumbar spine due to trauma, laminectomy, or both. Of the 13 patients with incomplete neural lesions in the series, 12 improved. One of these was a cauda equina lesion. No patient in the series was neurologically worse after operation, in contrast to other reported series in which laminectomy alone was done. It is concluded that Harrington instrumentation is the strongest available system of internal fixation, and the only one that permits reduction of nearly all traumatic spinal deformities at the time of operation.


Usefulness of serial carcinoembryonic antigen (CEA) determinations in monitoring chemotherapy.

Serial carcinoembryonic antigen (CEA) levels were measured during chemotherapy for metastatic cancer in 94 patients. Criteria for chemotherapy responses were those used by the Central Oncology Group. Patients were classified according to changes in CEA levels and response to chemotherapy. Four categories represented a positive correlation: (1) increasing abnormal CEA with progressing disease, (2) decreasing abnormal CEA with disease regression, (3) unchanged abnormal CEA with stable disease, (4) change from normal to abnormal CEA with progressive disease. Positive correlation of serial CEA levels with clinical responses occurred in 71% of patients with GI cancer, 51% with breast cancer, 42% with sarcoma, 50% with respiratory cancer, and 25% with melanoma. These data indicate that serial CEA determinations may be of value as an additional parameter of response to chemotherapy in gastrointestinal cancer.


Current management of pelvic fractures: a combined surgical-angiographic approach to hemorrhage.

Pelvic retroperitoneal hemorrhage after pelvic fracture accounts for the high mortality and morbidity associated with this injury, a concept confirmed by analysis of 357 patients with pelvic fractures at the University of Kentucky Medical Center. The overall mortality of 9.8% was almost exclusively limited to patients with unstable fractures or crush injuries. The reliability of diagnostic peritoneal lavage in excluding associated intraperitoneal injury and the recognized utility of angiographic methods in identifying the site of bleeding constitute a major advance in management. Prompt angiographic definition of injury to major arterial trunks can lead to early operative intervention for direct vascular control. Bleeding from branches of the hypogastric artery can be managed effectively by clot embolization technic, avoiding operation. Venous bleeding is best treated by tamponade in most cases.


Practical uses of a quantitative renal scintillation camera study.

A quantitative renal scintillation camera study has been described for the evaluation of total renal function and the split function of the two kidneys by a noninvasive technic. It requires no patient preparation, is not affected by bowel gas, and no allergic reactions have been reported. Six cases are reported to illustrate its usefulness with renal tumors, neurogenic bladders, pyelonephritis, nephrolithiasis, congenital anomalies, and renal insufficiency.


Anesthesia for EMI scanning in infants and small children.

Computerized transverse axial scanning is a new, noninvasive method of diagnosing intracranial and orbital lesions. It is mandatory that the patient's head be motionless throughout the scanning procedure. This requirement creates problems in managing infants and small children for the scanning process. Ketamine hydrochloride was given intramuscularly to produce the desired motionless stated in 47 consecutive infants and small children. Satisfactory scans were obtained in all except two cases. Contraindications and precautions to be observed using this technic are discussed. It is believed that intramuscularly administered ketamine is a safe, effective means of providing immobilization for EMI scanning in infants and small children who are normotensive and show no evidence of definitely increased intracranial pressure.


The Ocusert pilocarpine system: advantages and disadvantages.

Thirty-four patients with glaucoma were treated with the Ocusert pilocarpine system, a unique method of providing round-the-clock delivery of pilocarpine in the eye for seven-day periods. Advantages of the device include therapeutic effectiveness and continuous release rate, less effect on accommodation, less miosis, convenience for the patient, and reliability in patients who must rely on others for treatment (eg, children and the elderly). Some disadvantages encountered were need for instruction and encouragement of patients; retention difficulties, with some patients unaware when the device was lost; occasional side effects of a cutting sensation (as when the Ocusert sometimes doubles over), movement in the eye, and transient blurring of vision and miosis; and high cost. Overall, when compared to pilocarpine eyedrops, the Ocusert pilocarpine system presents many definite advantages and is a highly desirable method of therapy in selected cases of glaucoma.


Gallbladder disease in patients 20 years of age and under.

Cholecystitis is uncommon in individuals under 21 years of age and, when present, usually is associated with pregnancy, sepsis, metabolic defects, hemolytic anemia, or hereditary disorders. Over the past 4 1/2 years, 92 patients 20 years of age and younger have been admitted to our institution with gallbadder disease. Of these patients, 88 were female and 76 were of Mexican-American origin. Only two of these individuals had associated hemolytic anemia. Seventy-six of these females had been pregnant at least once, and 57 were more than 10 pound overweight. Cholecystectomy was done on 88 of these patients, and cholelithiasis was found in 86. There were 28 explorations of the common bile duct, 18 of which were positive. This series represents an earlier onset of cholelithiasis in this population.


Lens surgery with the vitreous infusion suction cutter.

The vitreous infusion suction cutter was used in the removal of congenital and adult cataracts or lens remnants. The instrument may be used through a standard corneoscleral incision or through the pars plana. When a hard nucleus cannot be dispersed, ultrasonic phacofragmentation may be of help. Several brief case illustrations demonstrate the effectiveness of this instrument in lens surgery.


An antacid tasting: the relative palatability of 19 liquid antacids.

The taste of liquid antacids is proposed as a major factor in patient compliance in taking such medication when prescribed. A study was made of the relative palatability of 19 antacids. The antacids can be divided into three groups of varying palatability (p less than 0.05).


Five-year retrospective study of hospitalization and treatment of patients with sickle cell anemia.

Examination of computerized hospital records of 463 admissions of 255 patients with sickle cell anemia was made. Patients ranged in age from infancy to 65, with a mean age of 17-7 years. Only 119 of the 255 patients were male, but 54% of the admissions were for males. Most patients were admitted to pediatrics and internal medicine services. Fluids and blood derivatives were given in over 60% of cases and anti-infection drugs in 40%. Mean hospital stay was 14.75 days, twice the mean for other patients. Thirty-six percent of the patients were admitted more than once. Mortality was 1.3% for the 463 admissions. Blue Cross or Medicaid accounted for payment in 51% of admissions. This information can be helpful to health planners providing comprehensive services for sickle cell patients.


Fantasy and self-esteem of renal dialysis patients and their spouses.

The fantasy life and self-esteem of 22 male and 13 female renal dialysis patients and their spouses were examined using a Self-Esteem Evaluation Scale, Empathic Fantasy Scale, and eight portions of the Imaginal Process Inventory reflecting eight types of fantasy use. For the patient group as a whole, a high degree of fantasy behavior was associated with low self-esteem, but the sex of the patient made a difference. Frequency of fantasy was shown to be indicative of poor adjustment for female dialysis patients, but not for male dialysis patients. Results also indicated that patients, without regard to sex, were more prone toward guilt fantasies in which they were punished for some wrongdoing such as feelings of anger toward people involved in their treatment or envy of others who do not suffer their same disability.


The cost of auditing outpatient records.

When patient records are to be auditied in a program designed to assess the quality of medical care rendered, careful consideration must be given to the cost of the system implemented. Structured data collection and a defined treatment plan are advantageous in facilitating the use of nonphysicians for the majority of the audit. A system using checklists to ensure adequate recording of subjective and objective data and a defined treatment plan for a common symptom complex were implemented by physicians and physician's assistants with a patient load averaging more than 1,000 patient contacts per week in a general medical clinic at Duke University Medical Center. Audit was subsequently accomplished at a cost of 96 cents per record. To reduce this cost, more efficient methods of selecting records for audit should be developed.


Treatment of cystic hygroma.

To determine ideal treatment, 58 patients with cystic hygroma of the neck were studied. Approximately equal distribution of the lesion among sexes and sides of the neck was noted, but frequency was less than expected among blacks. Complete excision, the treatment of choice, gave an 81% cure rate. Partial excision was curative in only 12% of cases, but it decreased the tumor mass enough to eliminate the need for further treatment in 62% of cases. Aspiration of the cysts may be of value in diagnosis and management of acute respiratory problems but not for definitive therapy. Sclerosing agents and radiation therapy was not effective treatment of cystic hygromas. Of the clinical recurrences, 76% occurred within a year after therapy.


Association of tuberculosis with alcoholism.

To define the extent of the association between tuberculosis and alcoholism, all cases of tuberculosis reported in 1972 to the Fulton County Health Department (Georgia) were reviewed. Alcoholics accountered for 49% of all adult cases. Because of this high association, alcoholics should be screened regularly for possible tuberculosis.


Obscure distal femoral epiphyseal injury.

Undisplaced type I epiphyseal fracture of the distal femur in the adolescent athlete may mimic injury to a ligament. Roentgenographic examination with the knee under stress will reveal the diagnosis, thereby avoiding unnecessary arthrotomy and dictating appropriate treatment and follow-up.


Vaginal candidiasis: its diagnosis and relation to urinary infection.

Of candidal vaginal cultures performed on 100 women who gave a history of a specific symptom complex, 85% were positive. In contrast, only 3% were positive in 100 women who did not have this history. The data indicate a definite relationship between the symptom complex and vaginal candidiasis. An additional 110 women had vaginal cultures on MacConkey's agar to determine the presence of gram-negative pathogens. The results suggest that a relationship may exist between the presence of vaginal candidiasis and an increased incidence of vaginal gram-negative organisms which could have important urologic significance.


A review of tibial lengthening procedures.

Eight patients had tibial lengthening procedures according to Anderson's method. The necessity of early determination of callus formation and bone grafting, if necessary, is emphasized. The potential morbidity in this procedure is great and the parents must be made fully aware of them. As Anderson states, it is a procedure that should be reserved for the child between 8 and 12 years old with a predictable discrepancy between 4 and 15 cm. We believe it is a useful procedure in problems of unequal length of the lower limbs but should not be used whem simpler procedures such as femoral shortening or epiphyseal arrest are indicated.


Agranulocytosis secondary to methimazole therapy: report of two cases.

Seventy-three cases of thyrotoxicosis were treated at Lloyd Noland Hospital with methimazole, propylthiouracil or both. Two cases of agranulocytosis occurred (2.7%) secondary to methimazole. Both responded to hospitalization, reverse isolation, and antibiotic coverage with complete recovery of the peripheral blood picture. The toxicity of methimazole is noted. The need for careful monitoring of blood counts during therapy and immediate discontinuance of the drug at the first clinical sign of granulocytopenia is stressed.


Placental transport of nutrients.

The fetus is dependent upon the placenta for transport to it of all nutrients for energy and growth. The primary nutrients crossing the placenta are glucose, lactic acid, free amino acids, free fatty acids, and ketone bodies. Under normal circumstances, it appears that glucose is the primary energy source. In abnormal conditions there is the possibility that energy requirements may be met also by protein-amino acid oxidation and ketone body metabolism. The fetal brain may be quite adept in the use of ketone bodies. In all transport phenomena, the placenta intervenes by diverting nutrients into its own intermediary metabolism. For a more extensive consideration of these factors, several in-depth reviews are recommended. To better understand abnormalities of intrauterine growth, we need much more specific information about the mechanisms of placental transport and the intermediary metabolism of the placenta and fetus. When these are adequately in states of normal and abnormal intrauterine growth, we can then consider methods of metabolic intervention which will correct intrauterine growth failure and, hopefully, eliminate its hazards to the fetus and child.


A comparison of modern methods of reduction mammaplasty.

There are many technics available today for reducing the oversize female breast. The most commonly used operations may be divided into two catergories, depending on treatment of the nipple-areolar complex: (1) free graft or (2) transposition on underlying tissue. According to this division, various methods are outlined and discussed.


Polymyositis: response to vitamin E.

A 70-year-old woman with polymyositis was treated with three different immunosuppressive drugs. Her condition deteriorated over a three-month period until she became totally helpness. She then made a dramatic improvement when large doses of vitamin E (d, alpha-tocopheryl acetate) were administered. Current knowledge regarding the nature of polymyositis and the rationale for using vitamin E to treat it are discussed.


The localization of multiple intra-abdominal abscesses by gallium scanning.

A septic course suggestive of intra-abdominal abscess followed surgery in a small child with a perforated appendix. Usual diagnostic studies, fluoroscopy, and rectal and wound exploration failed to localized an abscess. The use of gallium 67 scanning accurately localized multiple abscesses which were successfully drained.


Isolation procedures for thyroglobulin: effects of phenylmethanesulfonyl fluoride and freezing.

The presence of fast-migrating, low-molecular weight components in normal rat thyroglobulin, iodine-poor rat thyroglobulin and normal bovine thyroglobulin was investigated by polyacrylamide gel electrophoresis in sodium dodecyl sulfate. When normal and iodine-poor rat thyroglobulin were extracted in the presence of phenylmethanesulfonyl fluoride, a serine protease inhibitor, very few components migrating faster than the 12S half-molecule were found. In normal bovine thyroglobulin no effect of the protease inhibitor on the formation of fast-moving components was found; however, prior freezing of the glands greatly influenced the presence of these components. Thyroglobulin obtained from bovine glands without any prior freezing, contained no noncovalently-bound band migrating faster than 12S.


Monitoring aminopentamide urinary excretion by means of multiple 'microphase' extraction - a rapid method for the extraction and concentration of small amounts of lipophilic drugs from large volumes of biological fluids without distillation.

It has been demonstrated that low concentrations of basic lipophilic drugs in biological fluids may be extracted and concentrated 10(4)-10(6) times by a series of extraction procedures in which the ratio of the extracting solvent to that of the solution to be extracted is of the order of 1:100 (microphase extraction procedure). Typically, basic drugs (atropine, aminopentamide, hyoscine, chloroquine, pyrimethamine) were extracted and concentrated sufficiently for direct GC analysis from 24-hour urine samples by a procedure involving three simple consecutive extraction steps. Using this procedure, it was demonstrated that after administration of aminopentamide (300 micrograms) to patients in the form of anti-diarrhoeal tablets, measurable quantities of the free, unchanged drug can be demonstrated in 24-hour urine samples. The main advantages of the method are simplicity, rapidity and sensitivity due to the low background interference in the GC separations. The principle involved can be extended to the analysis of acidic drugs with suitable solubility properties.


Inhibition of the uptake of [13h] thymidine into hamster embryo cells by cytosine arabinoside.

1-beta-D Arabinofuranosylcytosine (ara-C) has been shown to strongly inhibit the uptake of [13h] thymidine into hamster embryo fibroblasts and transformed hamster embryo cells.


An experimental study on the onset of endolymphatic secretion in chick embryos.

Extirpation of the endolymphatic anlage of the ear vesicle or that part of the ear placode which develops into the endolymphatic anlage in chick embryos, resulted in the absence of the endolymphatic system. In specimens of which the endolymphatic anlage was removed on the fourth day, healing of the wound was completed soon after the fifth day of incubation. Most of these experimental animals developed endolymphatic hydrops at a later stage. However, where healing was delayed after the fifth day, the open wound acted as an escape route for the endolymph (thus preventing further closure) which at that stage (or soon after) reached an appreciable volume.


Endoscopic retrograde cholangiopancreatography in the evaluation of pancreatic disease.

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 98 patients with unexplained abdominal pain or known pancreatitis with recurrent pain. Patients with jaundice were excluded from the study. In 38 patients with a clinical diagnosis of pancreatitis, the radiological findings on ERCP were graded according to the criteria of Kasugai et al. Advanced pancreatitis was found in 20 patients (52,5%), moderate changes in 7 (18,4%) and minimal-change pancreatitis in 6 (15,8%). ERCP had normal pancreatic function tests. In 35 patients investigated for unexplained abdominal pain, changes consistent with pancreatitis were found in 7, pancreatic carcinoma in 5, a duodenal ulcer in 2, gallstones in 1 and a duodenal tumour in 1. ERCP was normal in 19 patients. A comparison of the findings on ERCP and the standard secretin-cholecystokinin pancreatic function test was available in 52 patients. There was a good agreement between the two tests in the patients with advanced or moderate pancreatitis as revealed by ERCP, but less agreement in the patients with minimal-change pancreatitis. A few patients with clinical pancreatitis and abnormal ERCP had normal pancreatic function tests. ERCP increases the diagnostic yield in patients suspected of having pancreatitis and is at present the only reliable method of diagnosing pancreatic carcinoma which is not evident by other non-operative techniques. ERCP is also of value in the assessment of the severity of pancreatitis and is a necessary investigation before pancreatic surgery to confirm or exclude cyst formation or the site of duct obstruction. The finding of an unsuspected cyst at ERCP necessitates early operation because of the danger of introducing infection during the procedure.


[Ebstein's anomaly of the tricuspid valve: a case report].

A case of Ebstein's malformation of the tricuspid valve with a complicating ventricular septal defect in a 3-year-old Black child is presented. A pre-operative diagnosis of an atrioventricular canal was made, and only at operation was it discovered to be an Ebstein's anomaly of the tricuspid valve. The clinical picture and diagnoses are reviewed, and the problem of a correct pre-operative diagnosis is discussed. The operative treatment and postoperative result in our patient is described.


Biological assessment of protein quality. Optimal essential: non-essential amino acid ratios for maintenance of certain states of nitrogen balance in young rats.

Male weanling rats were used to assess the effect of replacing essential amino acid (EAA) mixtures with non-essential amino acid (NEAA) mixtures on nitrogen balance. Each of 4 essential amino acid mixtures, fed in quantities sufficient to maintain specific states of nitrogen balance, was replaced with a non-essential amino acid mixture on an isonitrogenous basis. The results indicate the following: 1. Within limits, replacement with NEAA mixture caused an increase in the efficiency of utilisation of the amino acid mixture when the nitrogen balance state investigated was + 100, +200 or +300 mg/100 g body mass/8 days, but not when nitrogen balance was zero. 2. In the maintenance of nitrogen balance = 0, the EAA mixture could be replaced with NEAA mixture to a greater extent (83%) than was possible in the maintenance of balance states of + 100, +200 or +300 mg (about 70%). The results support the view that (a) EAAs are converted to NEAAs at the cost of metabolically available nitrogen: and (b) with a decrease in the state of nitrogen balance maintained by the animal, the amino acid requirement is shifted partially from EAAs to NEAAs. The implications of the above findings are discussed with reference to dietary protein evaluation and related questions.


Delayed onset of respiratory obstruction during endotracheal anaesthesia.

Two patients in whom respiratory obstruction with an insidious onset occurred during the use of a Lapro endotracheal tube are described. In one patient, the valvular nature of the obstruction produced bilateral tension pneumothoraces.


The prenatal diagnosis of Tay-Sachs disease.

Tay-Sachs disease was diagnosed prenatally on the basis of enzyme assays and the electrophoretic pattern of extracts made from cultured amniotic fluid cells. Electrophoresis revealed the presence of hexosaminidase B but no hexosaminidase A, the iso-enzyme which is deficient in Tay-Sachs disease. Estimations of the percentage of hexosaminidase A present in cultured amniotic cell extracts by means of thermal fractionation revealed the presence of only small amounts of this isozyme. Results obtained on amniotic fluid alone were found to be unreliable and were disregarded when making the diagnosis. Following termination of the pregnancy, the diagnosis was confirmed by electrophoresis and the thermal inactivation method as well as by electron microscopy. A slight lower temperature for the thermal inactivation has been found to give better discrimination than the temperature used in previously described techniques.


The use of transfer factors in the treatment of multiple sclerosis: a case report.

A 23-year-old woman suffering from multiple sclerosis (MS) was given a course of 6 injections (0.5 U) of mumps transfer factor (TF) at 2-weekly intervals. The patient's symptoms improved dramatically and during the 10 months since treatment was instituted, no exacerbations have occurred. The possible aetiological role of paramyxoviruses in MS and the use of TF in the treatment of the disease are discussed. MS is however, a disease of exacerbations and spontaneous remissions, and despite our promising findings in this patient we wish to refrain from hailing mumps TF as a possible cure for this notorious disease.


Amylase: creatinine clearance ratio and urinary excretion of lysozyme in acute pancreatitis and acute duodenal perforation.

The amylase:creatinine clearance ratio in patients suffering from acute pancreatitis or acute duodenal perforation was higher than normal in both groups of patients. These findings cast doubt on the value of this parameter as a specific index of acute pancreatitis. The mechanism or mechanisms underlying the increased amylase excretion have not been determined. However, the markedly elevated urinary excretion of lysozyme observed in some patients suggests, by analogy, that diminished tubular reabsorption of amylase may contribute towards the elevated amylase:creatinine ratio.


Biochemical parameters in athletes before and after having run 160 kilometres.

A number of biochemical and haematological parameters, including plasma electrolytes, parameters of hepatic and renal function, plasma enzymes and free fatty acids were measured in 13 athletes before and after a 160-km 24-hour race. The runners were divided into 2 groups: group A, who competed the 160 km within 24 hours and group B, who either ran for 24 hours, or who retired before completing the distance. Minimal changes were found in the plasma electrolyte patterns in either group, whereas blood urea and creatinine levels increased during the race. The plasma enzymes increased to varying extents, the greatest increases being in lactic dehydrogenase, aspartate aminotransferase and the skeletal muscle specific MM isoenzyme of creatinine phosphokinase. Total bilirubin also increased, but no conclusive evidence of hepatic decompensation was found. Plasma free fatty acids levels were very markedly raised in 12 of the runners, the highest increases occurring in group A. All runners ingested carbohydrate during the race and this probably explains why the blood glucose levels increased slightly but remained within normal limits in all the athletes at the end of the race.


Differential effect of right and left vagal stimulation on right and left circumflex coronary arteries.

In anasthetised, closed-chest dogs in complete heart block that were paced at a ventricular rate of 100 beats/min, vagal stimulation increased right coronary (RC) flow by 46% and conductance by 59%, but these increases were less than those measured in the left circumflex coronary (LCC) flow (66%) and conductance (80%). Both the right and left vagus nerves affected RC and LCC flow, the left vagus having the greater effect. The response to vagal stimulation is not limited at higher ventricular rates.


Constrictive pericarditis due to methysergide therapy.

A 39-year-old woman who suffered from migraine is described. She developed analgesic nephropathy due to phenacetin, and constrictive pericarditis, probably due to methysergide treatment.


Modification of mild proteinuria by postural and other mechanisms affecting haemodynamics.

Changes in urinary protein excretion induced by standing or by the application of venous tourniquets to the thighs while the patient is in the supine position were studied in patients with mild proteinuria and compared with the changes that occur in severe proteinuria (greater than 1 mg/min). Protein excretion decreased in the majority of patients. Irrespective of the initial degree of proteinuria. The increased rate of protein excretion that occurred in a minority of patients when standing may represent a phenomenon analogous to orthostatic proteinuria.


Severe measles-associated pneumonia treated with assisted ventilation.

Measles-associated pneumonia, which was severe enough to require mechanical ventilation, caused a mortality of 64%. The main indications for special respiratory care were severe infection and hypoxaemia. Complications of the disease occurred in 78% of the patients. The commonest were anaemia, enteritis and cardiac failure, and they contributed to the grave prognosis. Viral pneumonia was present in most of the patients who died; superinfection was rare. The characteristics of measles virus was present in 30% and of adenovirus in no less that 40%.


Cryptococcal meningitis: our experience in 24 black patients.

The records of 24 patients with cryptococcal meningitis, admitted to King Edward VIII Hospital in Durban, were reviewed. There were 21 adults and 3 children over periods of 10 and 18 years, respectively. Slightly more males were affected. The age distribution was fairly even. The common clinical presentations were headache, neck stiffness, mental changes, cranial nerve palsies and papilloedema. The diagnosis was proved by the presense of Cryptococcus neoformans in the cerebrospinal fluid (CSF) in 21 of the patients, and in pathological tissue in the remaining 3 patients. A significant percentage of patients presented with an initial polymorphonuclear leucocyte predominance in the CSF. The other CSF findings were elevated protein and low sugar levels. Tuberculosis was the common coexisting disease. We found the mortality rate of 58% to be very high and a significant number of patients died even after adequate treatment with amphotericin B either singly or in combination with 5-fluorocytosine.


Schistosomiasis and carcinoma of the bladder in Zambia.

Carcinoma of the bladder is the third most important malignancy seen in Zambia, accounting for nearly 9% of all malignancies seen in the Department of Pathology at the University of Zambia. A review of 217 cases of carcinoma of the bladder seen in the department over a 5-year period revealed a preponderance of well-differentiated squamous cell carcinoma (75%). Of the 217 cases, 65% had concomitant schistosomiasis. These tumours tended to occur in a younger age group than that reported from England and North America. The pattern of pathology conforms with that reported from other parts of Africa with hyperendemic and endemic schistosomiasis. The aetiological role of schistosomiasis in bladder cancer is critically examined.


Treatment of the ruptured uterus.

Three hundred and thirty-five patients with ruptured uterus were reviewed. The incidence of this condition is increasing, probably owing to poor antenatal care and lack of facilities. The most common site of rupture in the previously unscarred uterus was found to be longitudinal on the lateral aspects of the lower and upper segments. When the ruptures were in these areas, total hysterectomy proved to be best. Repair of the rupture should only be considered when the tear is simple, transverse in the lower segment, and in the absence of infection.


Oxygen transport during extracorporeal oxygenation for the treatment of adult respiratory distress syndrome.

An inventory of hemodynamic and respiratory measurements was obtained in two patients with acute respiratory failure syndrome prior to and during venoarterial extracorporeal membrane oxygenation for study of oxygen transport. As the inspired oxygen concentration fraction was reduced from 1.0 to 0.5 and paO2 was increased from less than 50 to physiologic ranges during extracorporeal membrane oxygenation, tachycardia and pulmonary hypertension were reversed. Total oxygen transport was reduced rather than increased. Oxygen consumption and oxygen extraction were not altered during extracorporeal membrane oxygenation. However, a striking reduction was observed in cardiac output. After reversal of anoxemia, the total of the cardiac output of the patient and the extracorporeal membrane oxygenation flow were less than the cardiac output of the patient prior to extracorporeal membrane oxygenation. These observations provide evidence that the beneficial effects of extracorporeal membrane oxygenation stem, at least in part, from a reduction of the work load on the heart. Since high cardiac output failure is observed during progression of adult respiratory distress syndrome, mechanical support of circulation during extracorporeal membrane oxygenation may be of primary therapeutic benefit.


Primary malignant tumors of the small intestine.

Primary malignant tumors of the small intestine are uncommon. This infrequency and possible lack of awareness can result in a late diagnosis and a poor survival time. In a period of 34 years, only 55 patients were seen at our cancer institute. The average age of the patients was 56 years, with a male predominance ratio of 2.6:1.0. Twenty-one patients had adenocarcinomas, 19 had sarcomas and 15 had carcinoids. The most common signs and symptoms were abdominal pain and obstruction of the intestine. Preoperative diagnosis was established in 12 of these patients only by roentgenologic barium examination of the small intestine. At the time of diagnosis, 34 of the patients had metastasis to regional lymph nodes or distant organs. The median and five year survival times were one year and 19 per cent, respectively. Patients with carcinoids had better survival rates than those with adenocarcinomas or sarcomas. Palliative resection did not improve survival time. However, if other therapeutic modalities also were used, it might prove beneficial. Patients with palpable abdominal masses or intestinal bleeding, or both, had a worse prognosis than did those presenting with obstruction of the intestine because these are late presenting symptoms. Therefore, recurrent abdominal pain should increase clinical suspicion, and early diagnosis by careful examination of the small intestine with barium contrast material could improve the survival time. Finally, it seemed that these tumors had a high incidence of coexisting malignant conditions, as nine of the patients in our series had a second malignant tumor.


Impaired glucose flow in burned patients with gram-negative sepsis.

Fifteen thermally injured patients with positive blood stream cultures for gram-negative organisms demonstrated a decreased mass flow of glucose through the glucose space when compared with 17 patients without sepsis studied at a comparable time after injury. Amino acid concentrations determined in ten burned patients with sepsis and nine burned patients without sepsis revealed an increase in the gluconeogenic precursors alanine, glycine, methionine and phenylalanine in those patients with sepsis. The administration of alanine consistently increased serum glucose in seven patients without sepsis but exerted no effect on glucose concentrations in six person with sepsis. These data, taken together, indicate that gram-negative sepsis in burned patients impairs the increased rate of glucose production and flow to peripheral tissue which characteristically occurs after thermal injury.


Pulmonary insufficiency produced by isoproterenol.

Twelve healthy, anesthetized, mechanically ventilated dogs received an infusion of isoproterenol hydrochloride, 0.1 microgram per kilogram for two hours. There was a rapid and statistically significant increase in the pulmonary shunt, cardiac output and mean pulmonary artery pressure; a significant decrease in the pulmonary vascular resistance, and no significant change in the pulmonary artery wedge pressure. These findings support those of previous studies which demonstrated the beta adrenergic stimulation is important in the pathogenesis of pulmonary insufficiency. The shunt results from ventilation-perfusion inequalities produced by the increased pulmonary blood flow and pulmonary vasodilatation. Because of the production of pulmonary insufficiency, isoproterenol or other beta adrenergic agonists should be used with caution in the critically ill, who often have or may develop the respiratory distress syndrome.


The incidence of solitary pulmonary metastasis from carcinoma of the large intestine.

Two hundred and two consecutive patients who underwent resection of an adenocarcinoma of the colon or rectum from January 1958 to December 1972 were evaluated for the development of a metastatic tumor in the lungs. In the 185 patients who survived the 30 day postoperative period, 30 malignant pulmonary lesions were subsequently recognized. Six of these were a solitary lesion and 24 were multiple lesions. Three of these malignant lesions were proved to be other than metastatic disease. Metastatic adenocarcinoma from the colon or rectum was proved to be present in 27 patients, an incidence of 14.5 per cent. Only four of these lesions were solitary, 14.8 per cent of the metastatic pulmonary lesions. The solitary metastatic tumors represented an incidence of 2.1 per cent in this patient population, but long term tumor-free survival was possible with appropriate pulmonary resection of the metastatic disease. It is suggested that periodic roentgenographic examination of the chest, every four to six months, be an integral part of the postoperative follow-up study carried out on these patients.


Intravascular coagulation in surgical procedures on the abdominal aorta.

A prospective study was performed on 32 consecutive patients undergoing elective operations on the abdominal aorta. Dacron prosthetic grafts were used to replace resected abdominal aortic aneurysms or to bypass aorta-iliac occlusive disease. Complete coagulation studies were performed preoperatively, immediately postoperatively and 24 hours postoperatively. Twenty to 30 per cent of the patients had significant postoperative alterations in prothrombin time, partial thromboplastin time and platelet count. Fibrin monomer, fibrin split products and plasminogen were abnormal in 40 to 80 per cent of the patients postoperatively. Results of preoperative studies showed no significant abnormalities. One of the 32 patients had mild clinical evidence of disseminated intravascular coagulation postoperatively, which was treated with 5 units of heparin per kilogram per hour. Results of the study indicate that aortic grafting procedures frequently produce intravascular coagulation, either local or disseminated. In most patients, this is offset by activation of the fibrinolytic system. However, clinically significant sequelae may result, requiring prompt recognition and treatment.


Operative cholangiography and special technical consideration in the management of severe injury of the liver.

The majority of hepatic injuries can be adequately managed by control of bleeding locally at the site, debridement and ample drainage. In some instances, severe blunt trauma and high velocity missile wounds may result in the disruption of intrahepatic structures and significant devitalization of the parenchyma of the liver, necessitating hepatic resection. Operative cholangiography was found to be useful in the evaluation and management of this type of severe injury to the liver. It is simple, practical method to recognize and localize a major disruption of the parenchyma of the liver and bile ducts; to help decide whether or not segmental, sublobar or labor hepatectomy should be performed, and to detect bile leaks from the divided bile ducts after resection of the liver. A modified technique for performing hepatic resection during an emergency situation was suggested to be more suitable than the classic technique. This is based on finger dissection along the line of injury and individual ligation of bile ducts and vessels as they are exposed within the parenchyma of the liver instead of isolation and ligation of the main inflow vessels and of the major ducts at the hilus and retrohepatic ligation of the hepatic veins.


Effect of norepinephrine on gastric wound healing.

Lavage of the stomach with norepinephrine has been suggested as a temporary means of controlling upper gastrointestinal tract bleeding. The effect of norepinephrine on the healing of a standard gastric incision in the rat was studied using irrigation topically. When compared with those rats in the control study that were irrigated with a saline solution alone, no significant difference was found in the tensile strength, local inflammatory response or synthesis of new collagen, as determined by the hydroxyproline-proline ratio. There would appear to be no adverse effect on gastric wound healing as a result of preliminary irrigation of the gastric mucosa with norepinephrine given topically in a concentration of 16 milligrams per liter.


Status of the contralateral ovary in encapsulated low grade malignant tumors of the ovary.

The incidence of bilateral involvement in carcinoma of the ovary is shown to be relatively high. This is true for the different histologic type of malignant lesions and even when the ovary is grossly normal in appearance and on palpation. Only when carcinoma of the ovary is low grade, intracystic, unruptured and nonadherent and is in a young woman desirous of childbirth can it be managed conservatively.


Surgical management of colon atresia.

Colon atresia is a rare cause of intestinal obstruction in the neonate and requires early diagnosis and prompt surgical treatment. It is impossible in the neonate to differentiate colon atresia from other forms of obstruction at the time of initial presentation. The diagnosis is confirmed roentgenographically, including views of the abdomen and contrast barium enema series. Lesions proximal to the splenic flexure are treated with initial resection of the atretic segment and a primary anastomosis. Those lesions distal to the splentic flexure are managed initally with a diverting loop colostomy with subsequent staged resection and anastomosis.


Side-effects of high pressure irrigation.

This study was undertaken to identify side-effects of high pressure irrigation. Standardized surgical wounds made in Yorkshire pigs were subjected to high pressure syringe and pulsatile irrigation. As a result of these treatments, fluids were disseminated into the adjacent tissue of the wound, predominantly in a lateral direction. Bacteria did not accompany this disseminated fluid and apparently were filtered out by the surface tissues. This treatment results in a tissue injury which impairs its defenses, making the wound more susceptible to infection. However, the remarkable cleansing capacity of high pressure irrigation appears to outweigh this side-effect, since heavily contaminated wounds subjected to this treatment heal per primum without infection.


Vascular permeability induced by pancreatic exudate formed during acute pancreatitis in dogs.

Acute pancreatitis was produced in five dogs by injecting bile into the pancreatic duct. The capillary permeability effects of the exudate formed within the peritoneal cavity were studied by injecting the exudate intradermally into puppies. The amount of radioactively labeled albumin escaping from the circulation and appearing at the intradermal injection site was used as a measure of capillary permeability. It was observed that the peritoneal exudate, especially that produced in the early stage of bile induced pancreatitis, contains one or more substances which result in an increased capillary permeability when injected intradermally into puppies.


Diagnosis of gastrinoma by the secretin suppression test.

In contrast to normal physiologic feedback suppression of serum gastrin by secretin, a paradoxic rise in the serum gastrin level has been observed in patients with gastrinoma after the administration of exogenous secretin. Exploitation of this phenomenon in the differential diagnosis of gastrinoma has been restricted by limited individual experience. Serial serum specimens for gastrin radioimmunoassay were collected from 13 patients with histologically proved gastrinoma both before and after the administration of Boot's secretin, 3 units per kilogram. Thirty-nine others with histologically proved gastrinoma who had been studied with exogenous secretin were identified in the literature. Both the peak gastrin and the integrated gastrin responses were increased after secretin administration in each of the patients in this combined series, although the magnitude of the increase was small in four patients. The absence of physiologic suppression by secretin implies neoplastic autonomy of gastrin releasing sites. While an augmented gastrin response to secretin is commonly seen in patients with gastrinoma, from a physiologic standpoint, a lack of suppression constitutes a positive secretin suppression test. Accumulated experience is consistent and suggests that this test is an important adjunt in the differential diagnosis of hypergastrinemia.


Safety and efficacy of the antiseptic chlorhexidine gluconate.

Chlorhexidine gluconate, an antiseptic for the skin, has recently been investigated in a series of clinical studies on its safety and efficacy. By using standard methods, Hibiclens, Hibitane tinted tincture and 0.5 per cent aqueous chlorhexidine gluconate were shown to have an extremely low potential for the production of irritation, allergic contact sensitization, photoallergic contact sensitization and phototoxicity. In the glove fluid test for efficacy against resident flora of the hand, Hibiclens produced log10 reductions over the control of 1.9398, 2.5371 and 2.6885 for test days 1, 2 and 5, respectively. Corresponding reductions for Hibitane tinted tincture were 3.6903, 4.0984 and 4.1253 and for the aqueous formulation, 1.5003, 1.5721 and 1.8692. In a transient flora skin contamination study, Serratia marcescens was applied at an average level of 6.8363 log10 organisms per milliliter to persons' hands, after which a 15 second Hibiclens hand wash was performed. Following five of these contaminations and hand washes, there was an over-all log10 reduction in recoverable Serratia of 3.8500. Counts were further determined after ten, 15, 20 and 25 contaminations and hand washes, resulting in corresponding reductions of 4.2649, 4.6661, 4.8501 and 5.1725, respectively. Chlorhexidine gluconate offers an alternative to available antiseptics for the skin. It has been shown to be a fast acting, broad spectrum antimicrobial agent, with an extremely low potential for eliciting dermal reactions.


A technique for preparation of saphenous vein grafts.

Late stenoses in vein grafts can result from trauma to the adventitia and the endothelium and to drying of the vein graft during preparation. Since vein grafts are sensitive to trauma, it is best to minimize nonphysiologic factors, that is, to avoid excessive hydrostatic pressure and excessive handling with instruments. With this method, the vein is prepared for distal anastomosis by distention at arterial pressure using blood as the physiologic solution. It avoids drying or prolonged storage under deleterious conditions while preparing for the anastomosis and shortens total operating time. Potential damage which can impair the efficiency of the vein as a conduit for blood is minimized.


Eye infections with herpes simplex viruses in neonates.

A newborn with severe ocular herpes simplex virus (HSV) type 2 infection acquired in utero is presented to exemplify problems in diagnosis and management. A review of 297 newborns with HSV type 1 or type 2 infection reveals that about one-fifth demonstrate ocular involvement including one or more of the following: microphatalmia, conjunctivitis, keratitis, chorioretinitis, optic neuritis and cataracts.


Type 2 herpes simplex virus infections.

The problems related to herpes simplex virus (HSV) type 2 infections include: (1) the clinical diseases produced primarily at urogenital sites, but also in extragenital areas, and the frequent recurrences of such infections; (2) the severity of the diseases produced in immunocompromised hosts and in newborns, including a varity of ocular manifestations; and (3) the possible role of the virus in human cancers. The usually sexually transmitted mode of spread of this virus has increased current medical concern with this virus. Although laboratory diagnosis of HSV-2 infection is currently available, we still lack effective preventive or therapeutic means for most clinical forms of the infection. However, the great progress made over the past decade in the molecular, virological, immunological and clinicoepidemiological aspects of HSV are providing the necessary tools to attain this goal.