Blood alcohol levels in injury victims at the emergency station of a rural central hospital.

Blood alcohol was determined in 182 consecutive adult injury victims at the emergency station of a rural central hospital during a fortnight in March 1974. In 30% of them alcohol was found in the blood. The percentage was 38 in males and 15 in females. No significant differences in alcohol involvement (AI) between social classes were noted. During the night 62% of the patients had ingested alcohol. The injuries on Saturdays were more often alcohol-involved (54%) than on other days of the week (26%). AI was very frequent (86%) in the victims of fights, assaults, and suicide attempts, while it was only rarely (9%) seen in industrial accidents. AI was clinically detected in 72% of the cases with positive blood alcohol concentrations. It can be concluded from the results of this and other studies referred to, that the AI rate for fresh injuries of adults at the Pinnish emergency stations was about 30-35%.


Blood alcohol levels in a series of injured patients with special reference to accident and type of injury.

Blood alcohol was determined in 1012 injury victims. It was found that the alcohol involvement (AI) rate was 37% in the total number of patients, 19% in industrial, 38% in traffic, 36% in home, 45% in other freetime accidents, and 69% in the victims of fights, assaults, and suicide attempts. The most common external cause of injury was falling (447 cases) with an AI rate of 38%, while the 172 other nontraffic true accident cases had a rate of 24%. The road and stairs were the usual places of falls while intoxicated. Head injuries had a high (47%) and upper extremity injuries a low (25%) AI rate. Tibial and ankle fractures were also very often associated with alcohol intake. Contrarily to traffic and industrial accidents the slightly injured at home and in other freetime environments had been drinking more frequently than the severely injured. The data suggest that alcohol is a powerful contributing factor in leisure-time injuries. Head and low leg are especially vulnerable in drunken persons. Not only driving but even when walking while intoxicated means taking risks.


Use of hemodialysis and forced diuresis in the treatment of poisoning.

This paper is a brief commentary of the role of forced diuresis and hemodialysis in the treatment of acute poisoning. The importance of informed conservative management is stressed. Rationale and methods of forced diuresis and urinary alkalinization are presented. Dialysis is reserved for special situations where shortening the poison-patient contact time is indicated.


Serum cholesterol esterifying activity in kwasiorkor.

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.


Fluorocarbon toxicity: aerosol deaths and anaesthetic reactions.

Twelve cases of death due to fluorocarbon inhalation have been seen in a four year period 1971-1975. The source of the material has been commercial spray cans. The postmortem examinations are nonspecific, but a history of excitement or sudden death is often elicited. Confirmation of the cause of death was made by demonstration of a halogenated hydrocarbon in the blood by gas chromatography.


Mechanism of D-alanine production by Corynebacterium fascians.

The amounts of extracellular D-alanine accumulated by Corynebacterium fascians ATCC 21950 in a medium containing glycerol as the sole carbon source is increased to almost 12 mg/ml by adding pyruvate to the medium. Cell-free extracts of C. fascians were shown to possess both L-alanine dehydrogenase and alanine racemase activities. These results indicated that a mechanism exists that allows this microorganism to synthesize D-alanine from pyruvate. A study comparing the optical purity of the intracellular alanine and the extracellular alanine suggested that the cell membrane possesses the stereospecific permeability for D-alanine. Thus, it may be concluded that L-alanine is first formed from pyruvate by L-alanine dehydrogenase and then converted to D-alanine by racemase inside the cells. Subsequently, only D-alanine leaks out stereospecifically through the cell membrane, and large amounts of D-alanine accumulate in the extracellular medium.


Acetylene reduction (nitrogen fixation) associated with corn inoculated with Spirillum.

Sorghum and corn breeding lines were grown in soil in field and greenhouse experiments with and without an inoculum of N2-fixing in Spirillum strains from Brazil. Estimated rates of N2 fixation associated with field-grown corn and sorghum plants were less than 4 g of N2/ha per day. The mean estimated N2-fixation rates determined on segments of roots from corn inoculated with Spirillum and grown in the greenhouse at 24 to 27 degrees C were 15 g of N2/ha per day (16 inbreds), 25 g of N2/ha per day (six hybrids), and 165 g of N2/ha per day for one hybird which was heavily inoculated. The corresponding mean rates determined from measurements of in situ cultures of the same series of corn plants (i.e., 16 inbreds, six hybrids, and one heavily inoculated hybrid) were 0.4, 2.3, and 1.1 g of N2/ha per day, respectively. Lower rates of C2H2 reduction were associated with control corn cultures which had been treated with autoclaved Spirillum than with cultures inoculated with live Spirillum. No C2H2 reduction was detected in plant cultures treated with ammonium nitrate. Numbers of nitrogen-fixing bacteria on excised roots of corn plants increased an average of about 30-fold during an overnight preincubation period, and as a result acetylene reduction assays of root samples after preincubation failed to serve as a valid basis for estimating N2 fixation by corn in pot cultures. Plants grown without added nitrogen either with or without inoculum exhibited severe symptoms of nitrogen deficiency and in most cases produced significantly less dry weight than those supplied with fixed nitrogen. Although substantial rates of C2H2 reduction by excised corn roots were observed after preincubation under limited oxygen, the yield and nitrogen content of inoculated plants and the C2H2-reduction rates by inoculated pot cultures of corn, in situ, provided no evidence of appreciable N2 fixation.


Disorders of granulocytes induced by toxic agents.

The effect of various toxic agents on granulocytes or their precursors is reviewed with emphasis on hypoplastic anemia, granylocytopenia (toxic, idiosyncratic and immune), leukemia and morphologic cytoplasmic and nuclear changes.


Comparative sensitivities of flame atomic absorption spectrophotometry (AAS) and molecular absorption spectrophotometry (MAS).

A sensitivity comparison was made between conventional atomic absorption spectrophotometry (AAS) and conventional molecular absorption spectrophotometry (MAS) for the serum trace metals, copper, iron, and zinc. The sensitivity aspect considered was absorbances was obtained for concentrations in the solutions analyzed using unit lightpaths of 1 cm and 10 cm for MAS and AAS, respectively. A distinction was made between procedural sensitivity and measurement sensitivity where the latter represents molar absorptivity. Some  was given to the concepts of procedural sensitization by concentration of the analyte through the use of lyophilization, extraction or ashing. The misuse of data obtained with scale expanders is described as a commonly occurring phenomenon of both AAS and MAS and a source of confusion in the understanding of measurement sensitivity.


Methionine overproduction by Saccharomycopsis lipolytica.

Six ethionine-resistant (Etr) regulatory mutants of Saccharomycopsis lipolytica Sl/1 overproducing methionine have been isolated. Five of them are also resistant to seleno-methionine. The activity of homocysteine synthase (O-acetyl-L-hormoserine-acetate lyase, adding hydrogen sulfide) is derepressed in these mutants and is not susceptible to the methionine-mediated repression. The pool of free methionine in Etr mutants is enhanced 1.5 to 18 times, and incorporation of 35S into methionine is 1.5 to 50 times higher than that in the wild strain. Neither accumulation of endogenous free methionine in Etr mutants nor the uptake of exogenous methionine is accompanied by an increase in the S-adenosylmethionine pool. This implies compartmentation of methionine metabolism in S. lipolytica.


Study of plating efficiency of bacteriophages of thermophilic lactic acid bacteria on different media.

The qualitative and quantitative abilities of phages of 13 strains of thermophilic lactic bacteria (lactobacilli and streptococci) to produce plaques on six different media were studied. The influence of the addition of calcium on the one hand, and of incubation conditions (aero-anaerobiosis), on the other hand, was also examined. For the phages of lactobacilli, the best results were obtained with the medium of de Man, Rogosa, and Sharpe (1960), whereas for the phages of streptococci the medium of Hogg and Jago (1970) appeared to be the best. Calcium and incubation conditions play a role which is variable in importance, but rarely negligible.


Adsorption of bacteria to roots as related to host specificity in the Rhizobium-clover symbiosis.

Quantitative microscope techniques were utilized to examine the adsorption of rhizobial cells to clover root hairs. Adsorption of cells of noninfective strains of Rhizobium trifolii or infective R. meliloti strains to clover root hairs was four to five times less than that of the infective R. trifolii strains. Attachment of the rod-shaped bacteria to clover root cells occurred in a polar, end-on fashion. Viable or heat-killed R. trifolii cells precoated with a clover lectin having 2-deoxyglucose specificity had increased adsorption to clover roots. Adsorption of bacteria to roots was not increased if the clover lectin was inactivated by heat or 2-deoxyglucose treatment prior to incubation with R. trifolii. Adsorption of R. trifolii to clover root hairs was inhibited by 2-deoxyglucose (30 mM) but not by 2-deoxygalactose or alpha-D-glucose. Adsorption of R. meliloti cells to alfalfa root hairs was not affected by 2-deoxyglucose at that concentration. These results suggest that expression of host specificity in the Rhizobium-clover symbiosis involves a preferential adsorption of infective cells to clover root hairs through a 2-deoxyglucose-sensitive receptor site.


Fractionation of serum cholesterol: a critique.

A procedure for fractionation of serum cholesterol is developed by employing digitonin for the precipitation of free cholesterol in isopropanol. This method is based on the ferric acetate color reaction which is unaffected by traces of digitonin. It is influenced only negligibly by the presence of stanols in serum and is shown to be equally chromogenic with respect to both free and ester forms of cholesterol. The proposed procedure shows a three-fold improvement in precision (3.1 percent coefficient of variation [CV]) compared to that of the procedure by Leffler and McDougald (10.5 percent C.V.) which is based on the ferric chloride color reaction. The proposed free cholestrol procedure showed a mean recovery of 99.5% percent (98.1 to 102.5 percent) when cholesterol in 40 to 200 mg per dl concentrations was added to serum. The analytical performance of the proposed fractionation of serum cholesterol is critically reviewed with respect to its potential application in the diagnosis of liver diseases and in basic or experimental research.


Ring hydroxylation of p-chlorophenylacetate by an arthrobacter strain.

Resting cell suspensions of a strain of Arthrobacter grown on phenylacetate converted p-chlorophenylacetate to two products. One of the products was identified as 4-chloro-3-hydroxyphenylacetate.


The carcinogenic effect of inhaled asbestos fibers.

Inhalation of asbestos fibers is associated with high incidence of lung cancers and pleural or peritoneal mesotheliomas in humans. All of these lesions were successfully reproduced in animal experiment, and it was shown that asbestos neoplasm may occur with or without accompanying asbestosis. Incidence of tumors from crocidolite was nearly three times as high as from chrysotile or amosite. It is possible that different carcinogenic entities are responsible for the causation of lung tumors and mesothelial tumors. Lung tumors seem to depend on the adsorptive capacity of asbestos fibers, allowing other carcinogens (heavy metals, polycyclic hydrocarbons, cigarette smoke) to attain a critical focal concentration. Mesothelial tumors, on the other hand, might arise in response to mechanical irritation by fibers which may become lodged during lymphatic spread. Tissues subject to constant respiratory movement (e.g., pleura or peritoneum) are specifically vulnerable to the latter action.


Preparation of phase 1Q fever antigen suitable for vaccine use.

Five lots of phase 1 Q fever antigen suitable for use as vaccine were prepared utilizing the Freon-brushite method of antigen purification. Antigen concentration levels were initially adjusted turbidimetrically and later confirmed by antibody response in guinea pigs. Data showed that all lots were essentially identical in purity and antigenicity.


Carbon monoxide in firemen before and after exposure to smoke.

A statistically significant difference was found between the mean baseline carboxyhemoglobin of non-smoking firemen (COHb 2.53, sd = 1.05, n = 32) and smoking firemen (COHb 5.54, sd = 2.61, n = 26). A consistent increase in mean COHb levels after exposure to smoke was seen in both non-smoking (4.41 sd = 2.95, n = 7) and smoking men (8.74, sd = 5.66, n = 11), but the mean increase in these two groups was statistically significant only at the 90 percent level (t = 1.85, df = 16, p less than 0.1).


Effect of dissolved aromatic hydrocarbons on the growth of marine bacteria in batch culture.

Dissolved aromatic hydrocarbons were found to decrease growth rate and maximum cell density of marine bacteria in batch cultures. The magnitude of the decrement was observed to be a function of concentration of the hydrocarbon and inherent toxicity. The inherent toxicity was observed to increase inversely with solubility such that naphthalene at 100 muM concentration demonstrated a toxic effect similar to benzopyrene at 0.02 muM. A partial oxidation product of naphthalene was found to be more effective in decreasing growth parameters than naphthalene at equivalent concentrations and to cause complete cessation of growth at the higher concentrations permitted by its polar structure.


Production of sterigmatocystin by Aspergillus versicolor and Bipolaris sorokiniana on semisynthetic liquid and solid media.

Higher yields of sterigmatocystin were obtained with Aspergillus versicolor than with Bipolaris sorokiniana both in liquid and on solid media. The optimum temperature for sterigmatocystin production by A. versicolor was 27 to 29 degrees C and 23 degrees C for B. sorokiniana. In liquid shake cultures, production of sterigmatocystin by B. sorokiniana was negligible, whereas maximal production by A. versicolor was 210 mg/liter. On solid substrates, the highest yields (8 g/kg) were obtained with A. versicolor on still cultures of whole corn supplemented with Soytone.


Metabolism of DDT analogues by a Pseudomonas sp.

A Pseudomonas sp. rapidly metabolized several nonchlorinated analogues of DDT, with the exception of 2,2-diphenylethanol, as the sole carbon source. Several of the mono-p-chloro-substituted diphenyl analogues were also metabolized as the sole carbon source by the bacterium. The resulting chlorinated aromatic acid metabolites were not further metabolized. The isolate was unable to metabolize p,p'-dichlorodiphenyl analogues as the sole carbon source.


Volatiles produced by microorganisms isolated from refrigerated chicken at spoilage.

Volatile components present at spoilage of refrigerated chicken breasts were identified using high-vacuum-low-temperature distillation techniques followed by analysis with combined temperature-programmed gas chromatography and mass spectrometry. A comparison was made of the compounds detected from both irradiated and non-irradiated muscle stored at 2 and 10 degrees C under both aerobic and anaerobic conditions. Isolates were randomly selected from the spoiled poultry, identified, and evaluated for their ability to produce volatile spoilage noted when grown on radiation-sterilized chicken. Several isolates that produced off-odors on sterile chicken breasts were examined. Twenty-two compounds were associated with spoilage. Some of the compounds found on both irradiated and unirradiated samples were considered to play only a minor role in the spoilage aroma or were present in low concentrations, since the aroma of spoiled irradiated chicken lacked the harsh odor notes typical of spoiled unirradiated chicken. Fifteen of the 22 compounds were considered to be unique to unirradiated, aerobically spoiled samples. Nine of these compounds, hydrogen sulfide, methyl mercaptan, dimethyl sulfide, dimethyl disulfide, methyl acetate, ethyl acetate, heptadiene, methanol, and ethanol, were found on chicken spoiled at both 2 and 10 degrees C. xylene, benzaldehyde, and 2,3-dithiahexane were detected only in samples stored at 2 degrees C and methyl thiolacetate, 2-butanone, and ethyl propionate were associated with 10 degrees C spoilage. Fifty-eight isolates randomly selected from fresh, radiation-pasteurized, and unirradiated spoiled poultry were classified taxonomically, and 10 of them, which produced spoilage odors on sterilized chicken breasts, were selected for subsequent analysis of their volatiles. Isolates identified as Pseudomonas putrefaciens and Pseudomonas species that were members of groups I and II of Shewan's classification, as well as Flavobacterium and oxidative Moraxella, produced a number of the compounds found in the aroma of spoiled chicken. A total of 17 compounds were identified. Whereas no isolate produced all of the aroma compounds found in the aroma of spoiled chicken, together they did produce the nine found in unirradiated samples spoiled at either 2 or 10 degrees C, as well as methyl thiolacetate and xylene. Six compounds were present in the volatiles produced by the isolates but were absent in the volatiles identified from spoiled chicken. These were hydrogen cyanide, methyl isopropyl sulfide, 2-propane thiol, methyl propionate, ethyl benzene, and an unidentified compound.


Effects of nutritional characteristics of Streptococcus agalactiae on inhibition of growth by lactoperoxidase-thiocyanate-hydrogen peroxide in chemically defined culture medium.

Five cultures of Streptococcus agalactiae have an absolute requirement for L-cystine to grow in a chemically defined medium. The L-cystine could be replaced with cysteine, glutathione, or the disulfide form of glutathione. Dithiothreitol could not substitute for the sulfur-containing amino acids of glutathione; hence, the growth requirement appears to be truly nutritional. Growth was maximum with 4 to 5 mug of L-cystine per ml. If the concentration of L-cystine was no greater than 4 to 5 mug/ml, complete growth inhibition could be obtained by the addition of lactoperoxidase, thiocyanate, and H2O2. The growth inhibition, however, was nullified by additions of L-cystine 10-fold or more in excess of the concentration needed for maximum growth. During the aerobic degradation of glucose by cell suspensions, H2O2 accumulation could be shown with cultures 317 and 11-13, the only cultures the growth of which was inhibited without addition of exogenous H2O2. All of the cultures had varying degrees of peroxidase activity. The balance between H2O2 generation and peroxidase activity of the culture evidently determined whether growth could be inhibited with lactoperoxidase and thiocyanate without H2O2 addition. The growth yeilds per 0.5 mol of the disulfide forms (cystine and oxidized glutathione) were 1.5 and 1.9 times greater than that per 1 mol of the sulfhydryl forms (cysteine and glutathione).


Effect of storage time and temperature and the variation among replicate tests (on different days) on the performance of spore disks and strips.

Laboratory-prepared spore disks were stored for 96 weeks at 22 degrees C with 50% relative humidity (RH) and at 4 degrees C with less than 1% RH. At the same time commercial spore strips were stored for 64 weeks at 22 degrees C with 50% RH. The spore count per unit and the heat resistance were measured at the beginning of the experiment and after 16, 32, 48, 64, 80, and 96 weeks of storage. The laboratory-prepared spore disks stored at 4 degrees C with less than 1% RH showed less change in numbers of spores per disks and decrease in the survival time than did the disks stored at 22 degrees C with 50% RH. Both the laboratory-prepared spore disks and  the commercial spore strips stored at 22 degrees C with 50% RH decreased in survival times with increased storage time. The relative change in the survival times with storage was less for the commercial spore strips than for the laboratory-prepared spore disks.


Inhibition of methanogenesis in salt marsh sediments and whole-cell suspensions of methanogenic bacteria by nitrogen oxides.

Hydrogen-dependent evolution of methane from salt marsh sediments and whole-cell suspensions of Methanobacterium thermoautotrophicum and Methanobacterium fornicicum ceased or decreased after the introduction of nitrate, nitrite, nitric oxide, or nitrous oxide. Sulfite had a similar effect on methanogenesis in the whole-cell suspensions. In salt marsh sediments, nitrous oxide was the strongest inhibitor, followed by nitric oxide, nitrite, and nitrate in decreasing order of inhibition. In whole-cell suspensions, nitric oxide was the strongest inhibitor, followed by nitrous oxide, nitrite, and nitrate. Consideration of the results from experiments using an indicator of oxidation potential, along with the reversed order of effectiveness of the nitrogen oxides in relation to their degree of reduction ,suggests that the inhibitory effect observed was not due to a redox change. Evidence is also presented that suggests that the decrease in the rate of methane production in the presence of oxides of nitrogen was not attributable to competition for methane-producing substrates.


Metabolism and growth yields in Bacteroides ruminicola strain b14.

Metabolism of D-glucose by Bacteroides ruminicola subsp. brevis, strain B14, has been examined. Growth yield studies gave molar growth yields, corrected for storage polysaccharide, of approximately 66 g (dry weight)/mol of glucose fermented. The storage polysaccharide amounted to about 14% of the total dry weight, or 55% of the total cellular carbohydrate, at full growth. After correcting glucose utilization for incorporation into cellular carbohydrate, measurement of product formation showed that 1.1 succinate, 0.8 acetate, and 0.35 formate are produced and 0.5 CO2 net is taken up during the fermentation of 1 glucose under the conditions used. The implication of these results with respect to adenosine 5'-triphosphate (ATP) molar growth yield calculations is discussed. If substrate-level phosphorylation reactions alone are responsible for ATP generation, then the ATP molar growth yield must be about 23 g (dry weight)/mol of ATP. Alternatively, if anaerobic electron transfer-linked phosphorylation also occurs, the ATP molar growth yield will be lower.


Preparation of pure microbiological samples for pyrolysis of gas-liquid chromatography studies.

Bacterial samples were prepared for pyrolysis gas-liquid chromatography using cells grown on membrane filters. Pyrochromatograms were reproducible when cells harvested from the filters were pyrolyzed without being washed.


Fractures in Paget's disease of bone.

After a short introduction dealing with the orthopaedic problems of Paget's disease, six patients are reported with pathological fractures due to this disease, which is rare in The Netherlands. Rigid fixation with osteosynthesis is the treatment of choice. In cases in which substantial bowing of the bone exists, a corrective osteotomy is advisable.


Discoid knee menisci in children.

Five children were operated for discoid menisci. One of them had, in addition, an anomalous capsular attachment and an anomalous course of the popliteus tendon. Vascularisation at the free margin was a striking feature in the four discoid menisci of the primitive type. Limited or painful extension was common in these children. In four cases the diagnosis was confirmed arthrographically. Arthrography was carried out in two patients respectively four and sixteen years old, after operation. In both cases a small regenerated meniscus was found as is seen after meniscectomy in adults.


Use of the lag screw for the surgical treatment of subcapital fractures of the femoral neck with slight displacement.

A report is given of the results of surgical treatment with a compression screw in a group of 22 patients with subcapital fractures of the femoral neck with minor displacement. The patients' average age was 63 years. Postoperatively, two patients (aged 75 and 83) died from complications not directly attributable to the operation. The remaining 20 patients were followed-up for two to eight years by means of personal interview, functional studies and radiological control. Two of the 20 patients died from unrelated causes at an early stage of the survey; however, the condition of the fractures at the time of death was satisfactory. Necrosis of the femoral head occurred in two cases. In all, a good functional result was obtained in 18 patients (90%). It is pointed out that these patients constituted a selected group, in which the prognosis was favourable in any case.


The Christiansen hip prosthesis preliminary results.

The combined endo- and total hip prosthesis of Christiansen is described. In this prosthesis an articular connection, or trunnion bearing, is introduced between the head and stem components in order to reduce friction at the acetabular joint. The stem portions of both prostheses are identical. The endoprosthesis was inserted in 50 patients, who were followed-up during one year. The results were according to the classification of Love (Surg. Clin. N. Amer., 1963, 43, p. 1217): excellent in 60%, good in 22%, and poor in 18% of cases. In addition some results from other Norwegian hospitals were presented.


Histoplasmoma of the lung.

A review of all granulomatous surgical lesions in the files of the Free University Hospital revealed four cases of histoplasmoma in which Grocott-staining procedures provided histologic confirmation of the presence of Histoplasma capsulatum bodies. The case histories have been presented briefly. A short review of the literature follows.


Isolated and atypical manifestations of Scheuermann's disease.

In addition to the typical form of Scheuermann's disease, atypical and localized manifestations also occur. Examples are paradiscal defects and the development of vertebral synostosis. These unusual manifestations are illustrated by reference to a number of patients.


Perforating rectal injuries.

The symptomatology, diagnosis and treatment of perforating rectal injuries are discussed. An analysis is presented of the data concerning 24 patients with intra- and extraperitoneal penetration of the rectum. Factors that contribute to the continuing high mortality rate of rectal perforation are its rarity, the highly infectious character of faecal contamination of the abdominal cavity or perirectal tissue, and the fact that examination often reveals little or no external trauma. The treatment of choice would appear to be an aggressive approach based on faecal diversion and drainage, supplemented with peroperative irrigation of the injured rectum.


Findings in patients with diverticulosis and diverticulitis of the colon.

During the period from 1957 up to and including December 1975, the surgical clinic of Nijmegen admitted 82 patients with the diagnoses of diverticulosis and diverticulitis of the colon: the diagnosis of diverticulosis was made in 16 cases; in 17 diverticulitis was diagnosed and these patients were treated by conservative methods. Forty-nine patients were subjected to operation for diverticulitis. Of the patients treated conservatively, none died; of those treated by operation, three (6%) died. There were nine patients with peritonitis and three with ileus who required emergency surgery. As a matter of principle these patients were treated in several stages; none of them died.


The femoro-femoral cross-over graft.

The femoro-femoral cross-over graft is a good alternative to direct reconstructive vascular surgery in high-risk cases of unilateral iliac artery occlusion. The technique is simple and can readily be performed under local anaesthesia. A series of 21 patients is discussed briefly. Blood-flow measurements in seven patients confirmed the observation of other workers that a steal syndrome from the donor leg only occurred when the outflow tract in the donor leg was worse than in the ischaemic leg. Flow in the donor iliac artery was considerable increased. Four patients died in the observation period, one graft occluded three months after operation. There was no late failures.


Some aspects of zygomaticomaxillary fractures.

Early diagnosis and treatment of zygomaticomaxillary fractures are essential. From results obtained in the treatment of 500 patients with fractures of the zygomaticomaxillary complex it was concluded that insertion of an implant on the orbital floor through an infra-orbital incision can be avoided. This procedure is seldom indicated, and has to be reserved for some old untreated fractures. However, it may also be indicated for young children with a blow-out fracture of the orbital floor (solitary or as part of a zygomaticomaxillary fracture). In these cases an approach through the maxillary sinus, as commonly used in adults, will result in injury or removal of the dental germs, which are still localized high in the maxilla. The possible cause of a blow-out fracture of the orbital floor (traumatic lesion of the infra-orbital margin) is discussed with reference to recent literature and to a number of patients, including a boy aged 7 1/2 years.


Distribution of HEOD (dieldrin) in mammals: III. Transport--transfer.

A mathematical model simulating the blood transport and tissue residue distributions of the highly toxic and highly lipid soluble pesticide dieldrin in mammals is presented. This model is a significant improvement over our previously published preliminary model for dieldrin distribution in mammals. The assumptions and working hypotheses of the model are presented and used in generating a set of differential equations based upon mass balance principles. Two simulation cases are examined. The first simply demonstrates the gross features of: 1) Transport limiting conditions; 2) equal transport-equal membrane transfer conditions, and 3) membrane transfer limit conditions. The second studies a single tissue (the blood-brain barrier case) example of the above mentioned conditions. All simulations made were conducted for a hypothetical mature male rate of the average Wistar type eating food ad lib.


Parathion persistence on South African citrus.

The fate of parathion applied to citrus was affected by rain, sun and wind, but not much by fruit variety, while the application method had an important effect. The formulation influenced the persistence of parathion on leaves and glass in the laboratory, but had no influence on the persistence on leaves or fruit in the field. The deposits of the emulsifiable concentrate and of the wettable powder and oil mixture were higher than that of the wettable powder alone, but since the rates of disappearance were the same, higher harvest-time parathion residues on and in the fruit resulted when the first two formulations were used. The time needed to reach a tolerance value increased for applications made later in the growing season.


The deleterious effects of fungicides and herbicides on Xenopus laevis embryos.

Groups of 30 Xenopus laevis embryos, at "tail-bud" stage (Nieukoop-Faber stages 22-24) were exposed to 0.1-2 ppm concentrations of various pesticides for 1 to 10 days. The pesticides used were chloranil and dichlone (both are fungicidal and herbicidal); diquat (herbicide); and nabam (fungicide). The parameters examined were mortality, gross morphology, histology, and behavior. Chloranil (1.25 to 1.75 ppm) treated embryos showed abnormalities of the otolith, optic cup, and general pigmentation. Their movement was sporadically convulsive and they were unable to maintain proper balance. Dichlone (0.1 to 0.15 ppm) disrupted the development of the cephalic end of the embryo. Many of these embryos developed a slightly retarded trunk and tail only. These headless embryos lived for a time and were relatively lethargic. Diquat (0.75 to 2.0 ppm) administration reduced body size and pigmentation, and altered body shape. When embryos were treated with both 1.0 ppm of diquat and 2.0 ppm of nabam the integrity of myomeres and myocommata of the musculature was disrupted. The histological bases of these morphological and behavioral changes are discussed.


Degradation of compounds containing carbon atoms by photooxidation in the presence of water.

It was shown that all compounds containing carbon atoms, tested in this study, were degraded by the coincident influence of light, oxygen (air), and water. By this photooxidation, saturated as well as unsaturated aliphatic and aromatic compounds, monomeric, polymeric and high polymeric compounds were degraded and the carbon atoms of these compounds as well as carbon itself in form of amorphous carbon or diamond, were converted to carbon dioxide, if dispersed in water or together with water as very small solid, liquid, or gaseous particles. As such conditions occur extensively in nature, it was concluded that this degradation of organic substances is of great importance in nature, in addition to microbial and enzymatic degradation. This photooxidation further represents a possibility for pollution control to prevent damage to environment by degrading organic substances which are either slightly soluble or practically insoluble in water, as well as compounds which will not be destroyed by microbial and enzymatic degradation.


Effects of DDT in Fundulus: studies on toxicity, fate, and reproduction.

The toxicity, absorption, distribution, metabolism, and effects on reproduction of DDT was studied using the killifish (Fundulus heteroclitus), a species of economic importance because of its widespread abundance and its presence toward the lower end of the food chain. 14C-DDT was administered by exposure from the ambient water. There was a rapid removal of the radioactive pesticide from the water accompanied by uptake of radioactivity primarily by carcass (primarily muscle tissue) and eggs of the fish. Most (greater than 92%) of the radioactivity in the carcass was shown by TLC methods to be the parent pesticide. One day after a single 24-hr exposure to 14C-DDT, approximately 70% of the administered radioactivity was found in the carcass and the levels of the tissue decayed with a t 1/2 of three days. One day after a single 24-hr exposure to 0.1 ppm of 14C-DDT, the organs that contained the highest concentration of the pesticide (ca. 5 ppm) were intestine and liver. When the pesticide was administered by two 24-hr exposures from water, the intestine, liver and ovaries contained the major concentration of radioactivity (7 to 14 ppm). Untreated Fundulus contained less than 0.2 ppm of total DDT-like compounds. A variety of doses and schedules were tested in an effort to maximize the absorption of DDT, while minimizing the mortality to the fish. An intermittent schedule of 24 hr in 0.1 ppm DDT followed by 24 hr in DDT-free sea water, repeated two times, was found to be optimal. At the levels examined, DDT delayed the rate of normal development of fertilized eggs from Fundulus, but did not appear to cause any observable alterations in the hatched fry. Fertilization of Fundulus eggs was significantly diminished when insemination was carried out in DDT-containing sea water.


Uptake and loss of inorganic mercury in the eastern oyster (Crassostrea virginica).

Eastern oysters (Crassostrea virginica) were found to accumulate significant levels of mercury on exposure to relatively low concentrations of mercuric chloride. Accumulation occurred in two distinct phases which may be described as a two compartment system in which accumulation is logarithmic in the first phase and linear in the second. Mercury, during the initial phase, showed a minimum outward concentration flux of 0.025 hr-1 indicating reversibility of accumulation prior to the change in phase. However, mercury was not excreted at the end of the second phase following exposure to 10, 40, 80, and 100 mug/1 for 256 hr.


Effects of weathering and flue-curing on monocrotophos residues on tobacco.

Disappearance of monocrotophos from flue-cured tobacco was studied at three locations (Kinston, Clayton, and Reidsville, North Carolina) in 1973. Average residues on green tobacco leaves collected immediately after application were 41 and 84 ppm, respectively, for application rates of 0.56 and 1.12 kg/ha. Levels declined to about 18 and 40 ppm for the two rates three days after application, to about 9 and 23 ppm at five days, and to about three and eight ppm at nine days. Conventional curing reduced residues on flue-cured tobacco by at least 99%.


Factors relating to circulating immune complexes in rheumatoid arthirits.

Evidence has been presented suggesting that circulating immune complexes occur in over half of the sera of patients with rheumatoid arthritis. These IgG-containing complexes were small, eluting between IgG and IgM on gel filtration on Sepharose 6B and were not seen in the sera of healthy control subjects. These complexes were detected in the sera of both seronegative and seropositive patients and their quantity did not correlate with IgM rheumatoid factor titre. The quantity of complexed IgG was estimated from a ratio derived from the IgG profile obtained by gel filtration of the serum. This quantity correlated significantly with the degree of inhibition by the rheumatoid sera of cytolysis in vitro of IgG sensitized target cells by K cells from human peripheral blood. A significant inverse correlation was observed between the quantity of serum complexes and the chemotactic index of the circulating polymorphonuclear leucocytes obtained from the same rheumatoid patient. It is suggested that ingestion of these complexes may be implicated in the reduction in chemotaxis observed in patients with rheumatoid arthritis. There was no correlation between the quantity of the complexes in the sera and the clinica, haematological, and biochemical measurements.


Immunoglobulin and complement deposition in skin of rheumatoid arthritis and systemic lupus erythematosus patients.

Rheumatoid arthritis (RA) was differentiated from systemic lupus erythematosus (SLE) by direct immunofluorescent techniques on skin specimens, using monospecific antisera for IgG, IgM, C3, C1q, properdin, and fibrin. Of 30 patients with RA studied, 20 had dermal vessel deposits of immunoglobulins and complement components in unaffected skin without the characteristic dermal-epidermal junctional fluorescence of SLE. Of 24 SLE patients studied, 24 had granular deposits of immunoglobulins and complement components in unaffected skin at the dermal-epidermal junction.


Indomethacin serum concentrations in man. Effects of dosage, food, and antacid.

In the use of anti-inflammatory compounds, sustained serum levels are thought to be related to drug efficacy. This study shows that frequent clinical administration of indomethacin can result in sustained serum levels of the drug and that food and antacid may have important modifying effects on serum indomethacin concentrations. After oral ingestion by fasting subjects, indomethacin rapidly appeared in the serum, usually reaching peak concentrations in 30 to 90 minutes. Food delayed and decreased the mean peak level; antacid delayed the peak and slightly enhanced subsequent concentrations. With multiple dose schedules plateau levels were reached after 24 hours. When a total daily dose of 150 mg was given as 25 mg every 4 hours peak concentrations were the same but fluctuations were smaller and average concentrations were higher than with a dosage of 50 mg every 8 hours.


Effects of enzyme induction on metabolism of prednisolone. Clinical and laboratory study.

The addition of phenobarbitone in therapeutic dosage to the drug regimen of prednisolone-treated subjects with rheumatoid arthritis produced measurable deterioration in the clinical status of the patients associated with a more rapid clearance of prednisolone from plasma. It is considered that phenobarbitone induced the hepatic metabolism of prednisolone, effectively reducing the steady state plasma level and resulting in clinical relapse. A slight but significant improvement in the adrenocortical response to tetracosactrin (Synacthen) was noted after phenobarbitone therapy.


Clinical and radiological survey of the incidence of osteoarthrosis among obese patients.

Twenty-five grossly obese males were investigated for evidence of osteoarthrosis. A roentgenological survey of multiple joints obtained from 22 of these patients showed few significant degenerative changes. 6 patients (20%) had previously incurred traumatic rents in their menisci necessitating meniscectomy. Our results refute previous claims that obesity is a factor in the genesis of osteoarthrosis but do indicate that obese individuals are more predisposed to traumatic injury of the knee.


Eye inflammation in psoriatic arthritis.

In a study of 112 patients (49 men, 63 women) with psoriatic arthritis, ocular inflammation was noted in 35 (31.2%). Conjunctivitis was the most common lesion, being found in 19.6% (10 males, 12 females). Iritis occurred in 7.1% (5 men, 3 women), episcleritis in 1.8% (1 man, 1 woman), and keratoconjunctivitis sicca in 2.7% (3 women). 20 patients (10 men, 10 women) had radiological sacroiliitis and 11 of these (7 men, 4 women) had ankylosing spondylitis according to the New York criteria. Eye lesions were noted in 7 of the patients with sacroiliitis, 3 having iritis (15%) and 4 (20%) conjunctivitis. 2 patients with spondylitis had iritis (18%) and 1 (9%) conjunctivitis. It is concluded that inflammatory eye lesions are a frequent accompaniment to psoriatic arthritis. This is taken as further evidence for the concept of the seronegative spondyloarthritides.


Early rheumatoid disease. I. Onset.

We describe features with onset in 102 patients seen within the first year of rheumatoid disease. The male:female ratio was approximately 3:4, suggesting a near equal sex incidence at onset. The disease started more often in the colder months and was usually insodious, symmetrical, and involved the upper limbs. The patients were followed prospectively and outcome was assessed after a mean of 4.5 years. Older patients fared worse and there was a trend for a poorer prognosis to be indicated by an insidious onset and early progression to symmetrical involvement.


Early rheumatoid disease. II. Patterns of joint involvement.

Data from the first research clinic visit (Fleming and others, 1976) have been subjected to factor analysis to identify early patterns of joint involvement. Nine patterns emerged. Two patterns, if present early, were found to have prognostic significance. An eventually more severe disease was associated with a pattern of large joint involvement (shoulder, elbow, wrist, knee) and a pattern based on metatarsophalangeal joints I and III.


Radiological cervical arthritis in populations.

The prevalence of cervical rheumatoid arthritis and its relationship to rheumatoid serum factors and erosive arthritis in peripheral joints has been studied in radiographs of the cervical spine and of the hands and feet drawn from 12 population samples. The changes were graded in accordance with the Atlas of Standard Radiographs of Arthritis. Rheumatoid arthritis of the cervical spine (grades 2-4) was observed in 4.1% of males and 4.7% of females aged 15 and over. Prevalence was greatest in those born before 1900, 15% of whom were affected. There was a significant association with the sheep cell agglutination test but not with the bentonite flocculation test, though the latter correlated well with erosive arthritis in the joints of the hands and feet. Arthritis of the cervical spine showed a significant correlation with both seropositive and seronegative erosive arthritis in the peripheral joints. A significantly higher prevalence of cervical arthritis than expected was noted in two population samples, one in Germany and the other in West Africa, though in neither was there a high prevalence of peripheral arthritis. The German population had relatively high antistreptolysin titres. A low prevalence of cervical arthritis was noted in populations in Czechoslovakia and in Arizona. 'Congenital' block vertebra had a prevalence of 0.9% in persons born before 1935, but none was observed in those born since. The figures suggest that environmental influences predisposing to cervical arthritis and block vertebra have changed in the last 40 years.


Hypouricaemia and increased renal urate clearance associated with hyperparathyroidism.

A 64-year-old female was found to have hypouricaemia, with serum uric acid ranging from 0.06-0.12 mmol/l (1.1-2.0 mg/100 ml), associated with an increased urate clearance of 48.9 ml/min and hyperparathyroidism. Known causes of increased uric acid clearance were excluded. Pyrazinamide reduced urate clearance dramatically to 2.1 ml/min, suggesting that the tubular defect was either one of increased secretion or a failure of postsecretory reabsorption. No other tubular abnormality was apparent except diminished urine concentrating ability. Hypouricaemia has not been previously reported in association with hyperparathyroidism and a mechanism relating the two disorders could not be readily postulated. The tubular defect shown in this instance resembled that reported in association with Wilson's disease and Hodgkin's disease. This case and earlier reports of isolated tubular defects of uric acid handling enhance our understanding of uric acid excretion.


Raised serum immunoglobulin E in Wegener's granulomatosis.

Five patients with Wegner's granulomatosis were found to have significantly raised serum immunoglobulin E (IgE) levels. The rise in IgE was not related to the extent of clinical involvement, was not part of a generalized serum immunoglobulin rise, and was not associated with eosinophilia. Raised serum IgE may be a clue to the pathogenesis of this disease.


Improvement in lacrimal and salivary secretions after alkali therapy in Sjøgren's syndrome with renal tubular acidosis.

A patient with Sjøgren's syndrome developed renal tubular acidosis which led to systemic acidosis and potassium depletion. Treatment with Shohl's solution and potassium supplements was followed by subjective improvement in tear flow, salivary flow, and by disappearance of bronchitic symptoms. Detailed objective assessments were then made during the next year, twice on treatment and twice without. These confirmed the subjective impression of improvement.


Host-parasite relations in cotton rat filariasis. I: The quantitative transmission and subsequent development of Litomosoides carinii infections in cotton rats and other laboratory animals.

This paper introduces the long-term and continuing studies of the authors and their colleagues on several aspects of the host-parasite relations in cotton rat filariasis. Five methods are described for the calculation of the number of infective larvae of Litomosoides carinii transmitted to cotton rats and other laboratory animals by groups of Liponyssus bacoti mites. The relation between the calculated transmission intensities and the number of worms recovered from individual infected animals has been determined by each of the five methods. The accuracy and relevance of each method is discussed and one (method B) has been found to give a better correlation with worm recovery than the others. Some effects of infection with filariasis on the mites are described. The role of heavily infected mites in transmission is questioned and their influence on the calculation of transmission is discussed.


Host-parasite relations in cotton rat filariasis. II: The quantitative transmission of Litomosoides carinii to Delhi and Carworth strains of white rats, including the effect of age.

Delhi and Carworth strains of white rats were exposed quantitatively to infection with Litomosoides carinii and their susceptibility compared. Liponyssus bacoti (= Ornithonyssus bacoti) mites of known (calculated) intensities of infection were used for transmission. The relation between the calculated exposure (= transmission intensity) and the number of adult worms recovered from each rat was established. Adults of both strains of white rat were much "poorer" hosts than cotton rats. All 24 Carworth white rats (100%) and 21/24 of Delhi white rats (87-5%) of differing ages and both sexes became infected. Carworth white rats were generally more susceptible. The susceptibility of newly born Carworth white rats was greatest and was similar to that of cotton rats. Young rats of the Delhi strain were more susceptible than older rats. This strongly suggests "age resistance". The degree of resistance may, however, differ in different species and strains of white rats and in individual rats of the same strain.


The intervals between the blood-meals of man-biting Simulium damnosum (Diptera: Simuliidae).

Six marking-recapture experiments were carried out with Simulium damnosum in the Cameroon Republic, five in the rain-forest and one in the Sudan-savanna zone. Adult flies were marked by applying a small spot of oil paint to the mesonotum while they were engorging with blood on the legs of volunteers infected with Onchocerca volvulus microfilariae. Catches of wild flies were carried out for 12-13 days after the first day of marking, and all marked flies recaptured were examined. Some of the flies recaptured on days 0, 1 and 2 were nulliparous and had probably been disturbed by the application of the paint before they had completed their blood-meal. The frequency distribution of recaptured marked parous flies returning for their "second" blood-meal rose to a peak early on day 4, but more flies returned earlier,three days after taking a blood-meal, than later on day 5. After day 5, the numbers of recaptured flies were too low to demonstrate any peaks corresponding to "third" and later blood-meals. The longest surviving fly was recaptured 10 days after marking. Twenty-six percent of the flies recaptured on days 3 and 4 contained developing O. volvulus larvae three-five days old, which had presumably been ingested as microfilariae during the blood-meal taken on day 0. Infective larvae first appeared in flies returning late on day 6, and the highest percentage of infective flies occurred on day 7. Infective larvae were found in recaptured flies until day 10, the last day on which marked flies were recovered. Of 929 flies marked on the Sudan-savanna experiment, three (0-32%) flies were recaptured. Two returned on day 4 and one on day 6.


Studies on the flight range and dispersal of Simulium damnosum (Diptera: Simuliidae) in the rain-forest of Cameroon.

Five marking/recapture experiments were carried out on Simulium damnosum in the rain-forest of the United Republic of Cameroon, in order to determine the regression in biting density at increasing distances from the marking point. Flies were captured unfed, marked with fluorescent dust, and then released on the bank of a large river. Recaptures were made over the six-seven days after marking, at seven stations situated from 200 m to 79 km along a large river, from the marking site. Marked flies, which showed fluorescent pigment when examined under an ultraviolet lamp, were recovered at all seven sites. The ratios of the number of recaptures per man-hour at each distant site to the recaptures per man-hour at the marking point were calculated to obtain values for the proportional biting density (Z). The value of Z declined in a logarithmic manner with increasing distance from the marking site, such that it fell to 0-1 at distances of 34-1 km on a large river, 5-5 km on a small river, and 1-5 km on a road leading away from a large river. The peak number of flies recaptured at the farthest sites along a large river (56 km and 79 km) occurred one day later than at the station nearest the marking point. The dispersal of marked flies which had fed on volunteers carrying Onchocerca volvulus microfilariae, was studied along a large river. Of three flies recaptured 24 km upstream from the marking point, one contained 10 infective larvae of O. volvulus.


Effects of larval treatment with the insect development inhibitor PH60:40 on the vectorial capacity of Aedes aegypti (L.) for Brugia pahangi (Buckley and Edeson).

The effects of PH60:40, an insect development inhibitor, on fourth instar larvae of Aedes aegypti were investigated. Apart from delayed lethal action, possible effects on the vectorial capacity of Brugia pahangi were investigated. Two strains of A. aegypti were used, one DDT-susceptible and a good filarial vector and the other DDT-resistant and a refractory vector. A baseline exposure was found which caused only low mortalities in both strains. The treatments did not have any appreciable effect on the vectorial capacity of the good vector strain, but modified the refractory nature of the poor vector strain. It was considered possible that this could be due to a generalized harmful stress of the treatment rather than to a specific action of the chemical. Larvae were therefore subjected to heat treatments, as an example of stress, and these produced similar mortalities as with PH60:40. They did not. however, alter the vectorial capacity of survivors of either strain, so that the effects described do not seem to be due to simple stress.


Electrocardiogram in Hyperkalemia: electrocardiographic pattern of anteroseptal myocardial infarction mimicked by hyperkalemia-induced disturbance of impulse conduction.

In a patient with renal failure and shortness of breath, Q waves transiently appeared in the right precordial leads of the electrocardiogram (ECG) during episodes of hyperkalemia, without a substantial change in mean electrical axis. With restoration of the plasma potassium level to normal, R waves reappeared in these leads. It is concluded that the transient development of Q waves in the right precordial leads during hyperkalemia resulted from a hyperkalemia-induced conduction disturbance. Hyperkalemia, by affecting conduction in Purkinje fibers of ventricular muscle, or both, disturbed the normal sequence of septal and anterior wall depolarization and resulted in an ECG pattern that mimicked that of anteroseptal myocardial infarction. Clinically, hyperkalemia-induced conduction disturbances of this type must be included in the differential diagnosis of the ECG that suggests an anteroseptal myocardial infarction.


Renal trauma and hypertension: the role of renin.

Three patients developed hypertension following renal trauma. Trauma produced perinephric hematoma in two and renal artery thrombosis in one. Renal vein plasma renin activity (PRA) from the traumatized kidney was three to eight times greater than renal vein PRA from the untraumatized (contralateral) kidney. Peripheral PRA was elevated in all. A surgical operation lowered peripheral PRA to normal in all, but corrected hypertension in only two of three. Preoperative medical treatment with renin-suppressing pharmacologic agents correctly predicted this response to surgery. Postoperative renal vein PRA in the remaining hypertensive patient demonstrated that surgery successfully alleviated the abnormality in renin secretion. These studies suggest that excessive renin secretion initiate but other unidentified factors may contribute to the hypertension observed after renal trauma.


A headache protocol for nurses: effectiveness and efficiency.

To test the effectiveness and efficiency of a nurse-administered protocol for headache in the primary care setting, we conducted a prospective controlled trial. Two hundred three randomly allocated patients were evaluated by nurses using the protocol who managed independently 55.2% of the patients and received physician consultation on the others. A total of 193 patients were randomly allocated to the physician-control group. Nurse-protocol group patients experienced equivalent symptomatic relief and expressed significantly greater satisfaction with the care they had received than did patients in the physician-control group. A retrospective study of the presenting findings in patients with serious diseases of the CNS provided evidence supporting the safety of the protocol logic. We conclude that nurse-protocol management of headache in this primary care practice was effective and efficient.


Staphylococcal sepsis in patients on chronic hemodialysis regimens: intravenous treatment with vancomycin given once weekly.

Five patients on chronic hemodialysis regimens were hospitalized with six episodes of Staphylococcus aureus septicemia. Three of the patents acquired the infection during home dialysis, and it was related to the hemodialysis circulatory-access site in four. Initial therapy was methicillin sodium. Vanomycin hydrochloride was given in a 1-gm, single, weekly dose as the sole antibiotic after a short interval (mean, three days). Five of the six episodes were treated successfully. Staphylococcus epidermidis grew in blood cultures obtained during one of the treatments. The advantages of this regimen included a more prompt ambulation and the discontuation of constant infusions in patients with no peripheral veins available.


Exchange transfusion in hepatorenal syndrome with liver disease.

Ten patients with severe liver disease and the hepatorenal syndrome underwent exchange transfusions with 9 to 16 units of fresh heparinized blood to improve renal function by either removing a vasoconstrictive substance or adding a vasodilatory substance. One patient recovered from renal failure within ten days without showing natriuresis. The renal function of one patient improved somewhat, but he died 35 days after the transfusion. The other eight aptients died from 1 to 35 days after exchange transfusion, without any appreciable improvement in renal function. In six patients, renin substrate levels increased after the transfusion, but renal function remained unchanged. The results of this study failed to support a humoral concept of pathogenesis of the hepatorenal syndrome.


Idiopathic pulmonary hemosiderosis: ultrastructural studies and responses to azathioprine.

Two boys are presented who fulfilled criteria for a diagnosis of idiopathic pulmonary hemosiderosis. A lung biopsy specimen from the first patient showed alveolar-capillary basement membrane abnormalities, together with abnormalities of capillary endothelial cells and hemosiderin-laden macrophages. A lung biopsy specimen from the second patient showed mainly capillary endothelial abnnormalities and interestitial fibrosis. Both patients had a noticeable improvement in symptoms and relative stabilization of their roentgenographic and pulmonary function abnormalities following azathioprine therapy.


Tuberculosis of the skull.

Because tuberculosis of the skull is relatively unusual occurrence, it may not be immediately recognized. It responds readily to chemotherapy and should be suspected in disseminated tuberculosis or in any draining lesion of the skull that is sterile or fails to respond to conventional antibiotic therapy.


Prolactin-secreting pituitary tumor in early adolescence: hormonal and electron microscopical studies.

A 13-year-old boy was evaluated for an enlarged sella. There were no consistent visual field defects, and carotid arteriograms and pneumoencephalograms showed no extrasellar abnormality. The endocrine workup demonstrated a subnormal growth hormone reserve. The only other, but most striking abnormality, was an excessively high serum prolactin level, which was partially suppressed with levodopa. A chromophobe pituitary tumor was removed that had histological features suggestive of malignant neoplasm. Characteristics of a prolactin-secreting tumor were confirmed by electron microscopy. The serum prolactin levels decreased substantially  after surgery and further after a course of pituitary irradiation; however, they continue to be elevated above normal. Prolactin determinations play in integral part in the evaluation for a possible pituitary tumor-not only for diagnostic purposes, but also to provide a parameter of future tumor activity in an established case. Electron microscopical studies are helpful in identifying the tumor as source of the excessive prolactin secretion.


Bone-marrow imaging in pure red blood cell aplasia.

Bone-marrow scintigraphy with indium chloride in 111 was performed on a patient with pure red blood cell aplasia before and after successful treatment with immunosuppressive drugs. The return of erythroid precursors to the bone marrow was accompanied by a substantial increase in the marrow uptake of 111In. The distribution of 111In in the posttreatment scan was indistinguishable from that of 52Fe. These results indicate that indium chloride in 111 is a useful agent for the delineation of erythroid cellularity within bone marrow.


Hyporeninemic hypoaldosteronism after chronic sodium bicarbonate abuse.

We describe a 52-year-old man who, following the discontinuation of massive intake of sodium bicarbonate, in the absence of renal insufficiency, developed progressive hyperkalemia and hyponatremia in association with hyporeninemic hypoaldosteronism. The mechanism of this syndrome is not known, but may involve suppression of the renin-angiotensin-aldosterone axis by chronic volume expansion.


Surgical correction of cardiogenic shock.

Cardiogenic shock as a result of myocardial infarction demands an aggressive diagnostic and therapeutic approach to improve survival. First, the patient likely to develop shock should be identified early in his course so that interventions to reduce or contain infarct progression and thus prevent shock can be instituted. If the patient's condition deteriorates, prompt precise diagnosis of the cause of the hemodyanamic impairment must be made at the bedside with Swan-Ganz right heart catheterization and echocardiography, and, if potentially surgically correctable disease is present, left heart catheterization with coronary angiography in the catheterization laboratory should be done. Surgical repair of anatomic disruptions of the heart ventricular septal defect, or mitral valve rupture is frequently life-saving. At present, operative intervention for shock secondary to massive myocardial infarction alone remains a challenge.


A study of "atypical schizophrenia". Comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history.

Eighty-five cases of atypical schizophrenia were compared with 200 of schizophrenia, 100 of bipolar (mania), and 225 of unipolar (depression) affective disorder. Comparisons were made on the basis of sex, age at admission, precipitating factors, outcome, and a family history of schizophrenia or of affective disorder. The atypical schizophrenia differed remarkably from the schizophrenia and most closely resembled the bipolar affective disorder when allowance was made for a younger age at onset and a higher frequency of precipitants. An analysis of symptoms verified the predominance of schizophrenic features in the atypical schizophrenia, but also showed a high percentage (80%) of patients who had one or more manic symptoms at index admission. It is concluded that great care should be taken in diagnosing schizophrenia in a patient who also has manic symptoms.


Etiological factors in manic-depressive psychoses.

Fifty consecutive patients with bipolar affective psychosis are reviewed, and the genetic and electroencephalographic findings set against extant hypotheses about inheritance of the disorder and the etiological homogeneity of the syndrome. Inheritance in this sample appears usually not to be X-linked. The syndrome seems etiologically heterogeneous in that some patients have an early onset and prominent genetic determinants, while in others without apparent hereditary predisposition, the illness start later and show electroencephalographic evidence of cerebral dysfunction.


5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor?

The incidence of suicidal acts was studied in 68 depressed patients and related to the level of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid. The distribution of 5-HIAA levels was bimodal. Patients in the low 5-HIAA mode (below 15 ng/ml) attempted suicide significantly more often than those in the high mode, and they used more violent means. Two of the 20 patients in the low mode, and none of the 48 patients in the high mode died from suicide.


Glucose-6-phosphate dehydrogenase deficiency with psychosis.

Several authors have attempted to establish a correlation between glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and chronic schizophrenia, and the results were contradictory. We propose that the correlation between G-6-PD deficiency and schizophrenia is to be found in the form of an acute delirium.


Effects of isometric exercise on serum creatine phosphokinase activity.

The effect of isometric exercise on serum creatinine phosphokinase (CPK) activity in 14 psychotic patients in remission and ten normal controls was studied. The increases in serum CPK activity at 18 and 42 hours after exercise were no significantly different in patients and controls. The postexercise serum CPK activities in the patients were significantly less than the peak serum CPK levels when they were psychotic. There were no significant correlations between postexercise serum CPK activity and preexercise or peak serum CPK activity in the patient group. It is unlikely that increased isometric muscle tension is a major causative factor in the increased serum CPK levels frequently found in psychotic patients.


Comparative effects of methylphenidate and thioridazine in hyperkinetic children. I. Clinical results.

The effects of three pharmacological treatments, methylphenidate hydrochloride, thioridazine hydrochloride, a methylphenidate/thioridazine combination, and placebo were studied in outpatient hyperkinetic children rated hyperactive both in school and at home or clinic. Active treatment lasted 12 weeks; placebo lasted four weeks. Significant clinical improvement was obtained in a variety of settings--all treatments were superior to placebo on ratings filled out by parents, teachers, and clinic staff. Though initially the combination of methylphenidate and thioridazine tended to produce greater clinical improvement, it was not superior to methylphenidate alone after 12 weeks of treatment. Methylphenidate alone and the methylphenidate/thioridazine combination were more effective than thioridazine alone. The salient side effects with methylphenidate treatment were decrease in appetite, difficulty in falling asleep, and increased mood sensitivity. In contrast, thioridazine administration was associated with appetite increase and enuresis.


Hospital psychiatry in transition. From the therapeutic community toward a rational eclecticism.

Concepts derived from the paradigm of the therapeutic community have provided the main organizing principles for general inpatient psychiatry in the past 20 years. Increasingly, however, scientific studies have thrown doubt on the efficacy of current hospital practices. Changes in the broader social milieu have occurred as well since the therapeutic community was originally conceptualized, which raise questions about the "fit" between milieu therapy principles and current psychiatric needs. No current therapeutic paradigm is sufficient to encompass current inpatient psychiatric practice. There is a need for flexibility in utilizing various organizing principles for various aspects of the problems at hand. The paradigm of "problem-solving," derived from the research findings comparing group vs individual problem-solving, is an example of one way of examining and organizing data that could be applied to certain aspects of hospital care.


Two occult causes of insomnia and their therapeutic problems.

Insomnia may be associated with a sleep-induced apnea syndrome in nonobese patients who snore. The "central" type of apnea appears to be predominant in this population, in opposition to Pickwickian and nonobese hypersomniacs. An abnormal "swallowing reflex syndrome," also induced by sleep, may be a differential diagnosis. Sleeping pills that are central nervous system depressants should be cautiously prescribed for patients with such syndromes.


Cognitive performance in conversion hysteria.

In order to test some neurobiologically based assumptions pertaining to attention and memory dysfunction in conversion hysteria, a series of tasks was given to 17 hospitalized patients with hysterical conversion reaction and to a control group of nonpsychotic patients under conditions of nonstress and stress. The results indicated significant differences in performance between hysteria and control subjects. The former group, in comparison to controls, had heightened suggestibility, greater field dependency, and greater impairment of recent memory and vigilance-attention. A discriminant analysis indicated the feasibility of using such tests as objective diagnostic criteria for hysteria.


Hypnotizability and phobic behavior.

Hypnotizability ratings of 24 phobic patients interested in the therapeutic use of hypnosis were compared with those of an equal number of smokers keen to quit smoking through hypnosis. The mean Stanford Hypnotic Susceptibility Scale score of phobics was 8.08 on a 12-point scale. The mean of smokers was 6.08. The difference was significant beyond the .01 level (two-tailed). Thirty percent of smokers were essentially nonresponsive. No phobics were nonresponsive. Those with multiple phobias scored more highly than those with a single phobia. These findings are in accord with the view that among psychiatric patients whose hypnotizability is assessed in a treatment context, hysterics are most responsive.  The implications both for theory and for a specific treatment strategy are discussed.


A thrice-told tale of therapy.

A case history twice discussed previously in the literature is reexamined. The patient probably suffered a manic-depressive illness, and remission, therefore, is not specifically attributable to psychotherapy. The significance of psychotherapy in the patient's treatment is argued, but for its supportive, not its curative, effects.


Regression in the service of residency education.

Regression as a potentially adaptive psychological response is used as a conceptual model to understand a variety of behaviors seen in beginning psychiatric residents on an inpatient service. The behaviors, discussed and illustrated with brief examples, are (1) competition and identification, (2) sexuality, (3) aggression, (4) depression and despair, (5) dependency, and (6) fusion with patients. Factors on an inpatient service that foster regressive behavior in new residents are discussed, and some of the potential resolutions of the behavoirs are proposed. Regression is seen as an adaptive experience for most residents; with appropriate supervisory intervention, it can foster cognitive development.


Psychiatric consultation education--1976.

The teaching of consultation liaison (CL) psychiatry to psychiatric residents, medical students, and other trainees is reported from 92 medical schools, representing 81% of those surveyed with a one-page questionnaire. Psychiatric residency programs devote approximately 10% of their time to CL training, a slight increase over the percentage ten years ago.  Approximately 35% of medical students in programs from which we received responses have some consultation CL education, although this varies from a few seminars to an eight-week full-time rotation. Other trainees receiving CL experience include nonpsychiatric residents and interns (22 programs), psychologists (18), nurses (12), and social workers (5). Program directors report an approximately 90% "favorable" reaction to such training by all trainees. Consultation liaison training for residents still represents a small portion of their entire experience. A surprisingly large percentage of medical students are exposed to CL education, but with tremendous variation in that exposure. Other trainees are not heavily involved in CL programs, indicating a possible future expansion of integrated psychosomatic teaching. The data presented should serve as a comparative baseline for future program design.


[Experimental heart tumours in rats (author's transl)].

In continuation of previous own investigations 68 heart tumours including 46 early stages were found in the heart of 590 BD IX rats systematically examined after treatment with methylnitrosourea (MNU) or ethylnitrosourea (ENU). The tumour incidence was about 40% in animals treated by repeated intravenous or intraperitoneal injections of 20 mg per kg body weight MNU. These experiments are suitable for the study of early stages and the histogenetic origin of heart tumours. At present MNU in addition to triazenes (table 5) belongs to the most powerful carcinogens which affect the heart in rats.


[Elimination of a paramyxo-type virus from oncornavirus-producing human cell lines (author's transl)].

A virus of the paramyxo-type was eliminated from cell-free material of human oncornavirus-producing cell lines (PMF). After transmission of this paramyxovirus-free inoculum to a human permanent cell strain (Tu 197/Tr 1) oncornaviruses were permanently formed and no paramyxoviruses could be detected. The paramyxovirus-free, oncornavirus-producing PMF-39 cell line could be established after inoculation of the TU 197/Tr 1 line with cell-free material containing both oncorna- and paramyxovirus diluted 1 to 1000. A second way of elimination of the paramyxovirus was the treatment of cell-free material containing both viruses with antisera against paramyxovirus. In the Tu 197/Tr 1 line inoculated with such material only oncornaviruses were formed. The second paramyxovirus-free oncornavirus-producing cell line was designated PMF 50.


[Evaluation of Brdicka's reaction in tumor diagnostic (author's transl)].

We have investigated the polarographic behaviour of sera from patients of an ORL-department by means of Brdicka reaction. It could be shown, that patients with cancer or acute inflammation had significantly increased values. But the arithmetic mean of this groups is enclosed by the scattering of the normal collective, therefore is no practically use for diagnostic purposes possible.


[The characterisation of malignant ovarian tumors by impulse cytophotometry (author's transl)].

31 malignant adnexal tumors were investigated by impulse cytophotometry. From the DNS distribution curves we interpreted the positions and the height of the peaks in order to get informations about ploidy and proliferation pattern. 45.2% were classified into the diploid, 29.0% into the polyploid and 12.9% into the tetraploid group. 12.9% were aneuploid. Comparing our results with chromosome analyses in the literature we found more tetraploid tumors in our material. For our polyploid curves we assume, that many of the cells in the 8c-peak remain in the corresponding G2'-Phase, not undergoing mitosis.


[Thoughts about the present state of tumour chemotherapy (author's transl)].

There are some impacts in tumour chemotherapy being worth-while to be discussed. Considering the information received during the Ninth International Congress of Chemotherapy, held in 1975, the author tries to evaluate the present state of clinical tumour chemotherapy from clinical point of view. The modern oncological clinician (oncologist) has to be faced with a lot of new facts, e.g. use of quantitative differences between normal and tumour cells for individualization of therapy, timing of cancer drug administration, new drugs for cancer treatment, mutual inhibition or potentiation of drug's effects, immunotherapy and possible adverse effects of clinically available drugs.


Inhibition of subcutaneous Ehrlich carcinoma by antihuman-somatotropic hormone serum of the horse as determined by the tumour-tetanus assay of the mouse.

Utilizing a quantitative tumour tetanus assay of the mouse it could be shown that antisomatotropic hormone serum of the horse exerts protective effects against solid Ehrlich carcinoma of the subcutaneous tissue and concomitantly, against tetanus mortality rates as an indicator of tumour growth. The positive correlation of the inhibitory action of antisomatotropic hormone serum against both transplantable tumour cells and subcutaneous regenerative tissue as a control lends further support to the assumption that a selective mechanism interrelates proliferative mammalian cell populations and multiplying toxinogenic clostridia, thus stimulating a new field of application of antisomatotropic hormone serum.


Mixed organ culture as a tool for considering cellular tumor-host relationships in tumor patients.

A method is reported for considering tumour-host relationships, which consists in cultivation of human tumours jointly with autologous lymphocytes in an organ culture system and determining separately tumour and lymphocyte DNA synthesis before and after mixed culture. Some experiments explore variables of the new system. For mixed organ cultures the best conditions are: 4-day incubation, lymphocyte DNA ratio to tumour cell DNA less than 9:1 (2-10(6) lymphocytes/ml) and autologous serum. So far 41 tumours (20 mammary, 17 gastric, and 4 bronchial carcinomas) have been examined. 22 tumours showed satisfactory in vitro maintenance. In 50% of the mixed organ cultures, lymphocyte DNA synthesis proved to be higher than in lymphocyte control cultures. Blast counts in the cell smears are in good accord with results obtained by biochemical determination of DNA synthesis. 7 of the tumours studied have shown a pronounced reduction of DNA synthesis in the presence of lymphocytes. The present results underline the individuality of tumour-host relationships and suggest the necessity of determinations of the immune reactivity in cancer patients. Advantages and disadvantages of the method are discussed.


[Cellelectrophoretic studies of the effect of methylglyoxal-bis-guanylhydrazone on blood cells of tumour patients (author's transl)].

The effect of methylglyoxal-bis-guanylhydrazone has been studied on the electrophoretic mobility of blood cells of 10 unselected and untreated patients with preferably solid malignant diseases. Prior to the incubation with CH3-G the electrophoretic mobility of lymphocytes and erythrocytes showed increased and of platelets showed decreased rates which extend over a larger range than usual and for which reasons cannot be given till now. The incubation with CH3-G caused a concentration-dependent reduction of the electrophoretic mobility of all three tested types of blood cells. This can be estimated as an impairment of a function of surface membrane and confirms recently obtained results of activity of CH3-G on platelets' surface membrane.


[Splenectomy in Hodgkin's disease--indication and results (author's transl)].

The spleen is involved in 20-30 percent of patients with Hodgkin's disease. Involvement of the spleen cannot be excluded with reliability by radiological procedures or clinical chemistry. Therefore laparotomy and splenectomy are recommended as staging and therapeutic measures. In the authors's material, splenectomy showed splenic lesions in 9 out of 21 patients, mostly unexpected. Splenectomy is always indicated in stage II and should be taken into consideration in individual cases of stages I and III, too.


[Basal cell carcinoma (basalioma solidum) on a tubed pedicle flap in the oral cavity (author's transl)].

A report is given on the formation of a basal cell carcinoma (Basalioma solidum) on a tubed pedicle flap of acromiopectoral transplanted into the oral cavity. This plastic successfully covered a vast perforation of the palate after a severe wounding by shell splinters 33 years ago. The histologically proofed basal cell carcinoma (Basalioma solidum) was entirely brought to disappearance by 6000 R tumor-dose telecobalt. After 1 1/2 years the patient was without any complaint and recurrence. Etiology and pathogenesis of basal cell carcinoma (Basalioma solidum) are discussed in the light of the literature.


[Changes in the exocrine secretion of the pancreas after thyroidectomy. Experimental research].

Reduction of protein and bicarbonate flow and concentration after experimental thyroidectomy was observed in the rat. Clinical applications of the reduction of thyroid activity in the treatment of acute pancreatitis are proposed.


Subclavian steal syndrome. A 12-year experience.

Over a 12-year period, 43 operations were performed on 40 patients for correction of the subclavian steal syndrome. Eleven of these patients also underwent endarterectomy for coexisting carotid artery disease. There were 16 transthoracic procedures and 27 transcervical procedures. Graft failure in two patients was corrected by a second operation. There was one early death and one late death. The remaining 38 patients have been carefully studied for up to 12 years, with an average follow-up period of 60 months. These 38 patients have remained asymptomatic and their revascularization procedures have remained functional, as determined by blood pressure determinations in the involved extremity and, in some cases, by arteriography.


Leiomyosarcoma of the inferior vena cava. Diagnosis and surgical management.

Leiomyosarcoma of vascular origin are rare tumors arising most frequently from the inferior vena cava (IVC). We report on three patients one of whom underwent definitive resection. These tumors most commonly involve the upper segment of the IVC, and appear with manifestations of the Budd-Chiari syndrome. Lesions at this level are not amenable to surgical therapy. Tumors of the middle and lower segments of the IVC usually cause right-sided pain. Diagnosis is difficult, but is best approached preoperatively by angiography and vena cavography. Optimal therapy of lesions at these levels is surgical resection. Resection of the IVC below the hepatic veins is possible with renal function preserved by collateral drainage of the left renal vein.


[Flowmeter changes induced by glucagon in hepato-portal hemodynamics in the course of hemorrhagic shock in dogs].

Anoxic lesion in haemorrhagic shock may result in exclusion of the capillary circulation to the point of stagnant hypoxia. Under normal conditions, glucagon regulates hepatoportal haemodynamics. Its experimentation in the correction of haemorrhagic shock in the dog showed that it increased hepatoportal flow towards normality by reducing local resistance. The consequences with respect to intestinal tissue metabolism make this finding of particular interest.


Postoperative acute acalculous cholecystitis.

Two patients with acute acalculous cholecystitis after major surgical operations (cystectomy ad modum Bricker because of carcinoma of the urinary bladder, and proctocolectomy because of ulcerative colitis) are described. Various possible causes of acalculous cholecystitis after operation or after trauma are discussed. Postoperative acute acalculous cholecystitis has a more fulminant course than ordinary calculous cholecystitis. Treatment consists of immediate cholecystectomy.


[Toxicological and pharmacological studies of glycerol].

The toxicological effects of 10% glycerol were investigated in the mouse and rat. This product displayed very low acute toxicity on i.v. and intraperitoneal administration while no toxic effects were noted in the rat as a result of repeated administration over 3 months. Teratogenic effects were not observed after daily i.v. administration in the rabbit. Changes in arterial pressure and globular osmotic resistance did not appear during or after continuous infusion. The relevant literature is also examined. Glycerol has been found active in experimental various models of cerebral oedema. It also has a useful effect on cerebral metabolism.


Gallstone pancreatitis. Exploration of the biliary system in acute and recurrent pancreatitis.

During a five-year period, 82 patients were treated for acute pancreatitis, 63 of whom were proved to have associated biliary tract disease. In 18 of the 63, the accepted preoperative diagnostic measures failed to demonstrate pathologic findings in the biliary system. In 16 of the 18 patients, stones were discovered at the time of operation, although in five they were so small as to be demonstrable only filtering the aspirated bile through gauze. In the two of the 18 without stones, cholecystitis was present. In 14 patients the ducts choledochus and the pancreatic duct had a common path. All patients had no further pancreatitis two to eight years cholecystectomy. In Israel, where alcoholism is rare, three fourths of the cases of acute pancreatitis are associated with gallbladder disease.


[Accidental inhalation of a foreign body. Presentation of 2 cases with atypical symptoms].

Problems related to the inhalation of foreign bodies by children are discussed and two cases with unusual symptom pictures are presented. It is shown that some instances of acute respiratory or cardiorespiratory insufficiency of unknown origin in infancy may in fact be attributable to a foreign body in the respiratory system.


[Role of respiratory physiokinetic therapy in general surgery].

The applications of respiratory physiokinesitherapy in general surgery are considered. Emphasis is placed on its importance in the prevention and management of complications venous thrombosis and embolia, in the conservation of muscle strength, and as routine pre- and postoperative management.


Congenital choledochal cysts.

Cystic dilation of the common bile duct is a rare congenital anomaly. The cases of two patients, 2 1/2 and 18 years old, respectively, illustrate the difficulty in preoperative diagnosis, as well as the value of long-term postoperative follow-up. Ascending cholangitis developed in one of the patients after a Roux-en-Y cystojejunostomy nine years after operation. A follow-up of three years after cystoduodenostomy and 14 years after a hepaticojejunostomy is reported. In infants and small children, a cystoduodenostomy is usually done; otherwise, cystojejunostomy should be the preferred initial operation. Excision may be attempted if the cyst is very small, and in selected cases.


Central venous pressure and pulmonary wedge pressure. A comparative study in anesthetized surgical patients.

To determine the reliability of central venous pressure (CVP) as a guide to fluid therapy during an operation, repeated and simultaneous CVP and pulmonary wedge pressure (PWP) measurements were made with a Swan-Ganz catheter in 13 relatively elderly patients without obvious cardiac or respiratory disease- Overall correlation between CVP and PWP was highly significant (P less than .001); there was, however, an important variation of the correlation for each patient. For values of CVP greater than or equal to 8 mm Hg, the correlation was not significant. The disparity between right and left ventricular filling pressures was confirmed by the relationship between serial changes in CVP and PWP. These data strongly suggest that in relatively elderly patients undergoing surgery without evidence of cardiac or respiratory disease, CVP may be misleading index for appreciating PWP.


Hemicorporectomy for intractable decubitus ulcers.

A hemicorporectomy was successfully employed for control of intractable decubitus ulcers, osteomyelitis, and low-grade epidermoid cancer in a 55-year-old man marked reduction in pulmonary functions. Strict attention to postoperative fluid balance was associated with a smooth convalescence. The operation may be more applicable to paraplegic patients with intractable pelvic decubiti than to those with advanced pelvic tumors. In view of the increased number of paraplegics who may be at risk for developing this problem, more frequent consideration of the procedure seems warranted.


Percutaneous adrenal suppression with topically applied corticosteroids.

Synthetic fluorinated derivatives of cortisone, when topically applied, are absorbed readily and may suppress adrenal function. In the case presented here, large quantities of topically applied triamcinolone acetonide were used in the treatment of atopic dermatitis. This caused a noticeable decrease in the plasma cortisol level. That this was the result of adrenal suppression rather than insufficiency was indicated by a satisfactory response of the plasma cortisol levels to a cosyntropin injection test. In patients with a history of recent and extensive use of topically applied corticosteroids, appropriate diagnostic and therapeutic measures are indicated to avoid postoperative adrenal insufficiency.


[Studies on methionine metabolism. 1. Studies on general metabolism and body composition].

19-day trials were carried out with diets containing varying amounts of methionine (0.3%), 0.8%, 1.3%, 2.0%, 2.8%, 5.3%). Diets containing 0.8% methionine were found to have the most favourable effect. Increasing methionine supplementation gradually decreased the food consumption, the daily weight gains and the efficiency of food utilization of the animals. Data on weight gains and food utilization in the "pair-fed" groups were more favourable.  A stepwise decline was observed with regard to the absolute quantity of nitrogen retained (mg) as well as with regard to the quotient (%) of the amount of N retained to the amount of N utilized. Studies on the body composition of the animals showed that all those animals consuming large quantities of methionine did not synthesize protein while the process of protein synthesis in "pair fed" animals was found to be reduced, but still positive. These results suggest the occurrence of disorders in the protein metabolism arising in the organism of the animals in response to the uptake of large amounts of methionine. The relatively low fat content of the bodies of animals receiving excessive amounts of methionine, the increasing losses of fat during the trial as well as decreases in the RQ values indicated an increased rate of fat utilization in these animals. The relative water content of the body of animals receiving excessive quantities of methionine was higher, but, nevertheless, the massive weight decreases were, in the first instance, due to losses of water. Loss of water and fat as well as relative hydratation are characteristic symptoms of malnutrition. These were, to some extent, also observed in "pair fed" animals.


[35S excretion in rats after injection of 35S methionine in relation to protein and amino acid nutrition].

Experimental rats received purified or semisynthetic diets containing 10% or 6% crude protein (Soya protein). These were supplemented with 0.1% or 0.2% L-, D- or DL methionine. After a 5-day feeding period the animals were injected 35S-DL-methionine. For 48 hrs after 35S administration the pattern of urinary 35S excretion was traced. Neither the level of protein does not the configuration of the methionine supplemented nor the level of methionine supplementation were found to influence urinary 35S excretion in any way. Amino acid imbalance as induced by supplementation of 5% DL threonine produced a highly significant increase in the rate of 35S excretion on the 1st day of experiment. The results obtained suggest the conclusion that any determination of methionine requirements based on metabolic data should leave out from consideration values on the level of urinary 35S excretion obtained on the first day of experiment, as these are dependent on amino acid transport rather than on protein metabolism.


[Cu concentration in the milk of rats receiving diets with varying Cu content].

2 trials were conducted with female rats to investigate in which way the level of dietary Cu influenced the level of Cu concentrations in rat milk. The trials were made to establish whether data on the Cu content of milk might be used as indication of the level and state of Cu supply to the animal. In the period of colostrum formation the Cu content of the milk was shown to be clearly dependent on the level of dietary Cu. In later periods of lactation Cu concentrations in the milk (from 2 mg of Cu per kg of diet) were found to be unaffected by the Cu content of the diet. Constant Cu concentrations of between 2.5 to 3.0 mg per kg of milk were noted in this period. It was only in cases of extreme Cu deficiency (0.5 mg/kg of diet) that soon after parturition the Cu values decreased to and remained at a very low level of 1 mg per kg of milk. Generally, colostrum contained 4-6 times more Cu than ordinary milk (in all groups).


[Determination of phosphonic acids in ruminal fluid].

A technique has been worked out for determining amino alkyl phosphonic acids in ruminal fluid by using methods of hydrolysis, partition of the phosphonic acid on a cation exchange column and ashing of the eluate. After evaporation to total dryness the phosphonic acids were determined as phosphates. The amounts of acid found in the ruminal fluid of goats varied between 0.4 and 1.1 muMol/ml. In view of the fact that these acids are microbial compounds it will appear that any change in the amount of compounds produced in the rumen would indicate changes in the concentration of the microbial mass in the rumen.


[Influence of milk-fat substitute feeding on the metabolism in calves].

Investigations were made to study the effect of milk fat substitutes ("Laktin", "TZS-60") on the metabolism of 3 and 5-weeks-old calves. "Laktin" is prepared from lard and hydrogenated soya and fish oil; additionally, it contains lecithin, monoglycerides, antioxidants, vitamins and antibiotics. "TSZ-60" is a preparation containing starch and colloidal silicic acid as carrier material mixed with 60% of coarsely powdered fat (particle sizes ranging from 50 to 200 mum), which in turn, is supplemented with vitamins and antibiotics. The kinds of "Laktin" used in the present trial contained 95%, 58%-98% or 90% of fat while "TSZ-60" contained 59.4%. Both the 3-weeks-old and the 5-weeks-old calves digested the "Laktin" fat more efficiently than the kind of fat contained in "TSZ-60" ("Laktin": 94.3% to 97.3% of fat; "TSZ-60" 71.8% to 90.5%). As a consequence of this, the "Laktin"-fed calves exhibited a higher rate of nitrogen utilization and nitrogen retention. According to the results obtained in the present trial "Laktin" should be given in daily doses of 219 g (an amount corresponding to 7 litres of milk with a milk fat content of 3.13%) while "TSZ-60" should be fed in daily amounts of 245 g (corresponding to 7 litres of milk with a milk fat content of 2.1%). Higher doses ("Laktin": 323 g/day: "TSZ-60" 335 g/day) would have a detrimental effect on the metabolism of the calves. Apart from this, it was not found that higher doses would help to reduce the protein consumption of the animals.


[Substitution of protein feed through lysine-supplemented high-protein wheat during the rearing and laying period of hens. 2. Effect of graded lysine doses on food consumption and the rate of weight gain in young hens].

In a feeding trial 1920 young hens received rations consisting mainly of high-protein wheat with or without additions of lysine or methionine (table 1) and a control ration. The five rations contained 0.77%, 0,59%, 0,61%, 0,54% of 0,46% lysine. In the period between the 9th and 20th week of experiment the hens receiving less lysine consumed less food in the beginning but more food towards the end of this experimental period (12th to 16th week of experiment). The lower energy content of the control diet produced a higher rate of food consumption. Variations in the lysine supply in general produced only slight differences in feed consumption and weight gain in the rearing period of the hens, whereas a compensatory effect was observed with regard to the growth rate of the birds. Despite the balanced crude protein consumption of the birds a positive linear regression of crude protein utilization was calculated for the percantege crude protein retention (y) as depending upon the lysine content of the ration (x) (y = 11.34 + 19,61x; B = 0.93). The wheat protein could be improved by lysine supplements.