On the regularities of distribution of Hypoderma bovis De Geer larvae parasitizing cattle herds in different parts of the range of this warble fly.

The type and parameters of the distribution of the second and third instar larvae of Hypoderma bovis in cattle herds in Czechoslovakia (54 herds, 7233 head), Mongolia (20 herds, 1809 head) and the USSR (48 herds, 4978 head) were studied. A statistical analysis showed a) that in the majority of cases negative binomial distribution serves as a model of the distribution of larvae with sufficient reliability; b) that the regularity of dependence of the distribution exponent k of the negative binomial distribution on the incidence of infestation remains constant in different parts of the range of this warble fly. The latter fact indicates that the regulatory systems limiting the population numbers of this warble fly are associated with host-parasite relationships and do not depend on a complex of conditions specific for various natural zones. In order to understand the regulatory processes in parasite populations it is necessary to study equally the regulatory mechanisms operating primarily on  the level of specimens as well as the regulatory systems operating on the level of populations.


A biofeedback study of postural sway.

An experiment was performed to control postural sway under auditory and visual feedback signals using a new apparatus. The subjects of 52 healthy high school girls were divided into 13 small groups. Each small group had four subjects who were assigned to one of the following four groups; 1) visual feedback group, 2) auditory feedback group, 3) auditory and visual feedback group, and 4) control group. Comparisons were made as to the duration of the green lamp being on, which indicated sway stayed around the initial central gravity. The results showed that auditory and visual feedback groups had a significant increase in the duration as compared to other three groups. With regard to the changes in the areas of postural sway, the largest increase was seen in the auditory and visual group. While the three feedback groups showed downward curves, the control group showed an upward one. Thus it is suggested that postural sway can be voluntarily controlled by a combination of an auditury feedback procedure and a visual feedback procedure, but not be either of them independently.


Effects of electrical stimulation of the substantia nigra on responses of lateral geniculate body neurons to light.

Effects of electrical stimulation of substantia nigra on responses of the lateral geniculate neurons to light were studied. Responses of the neurons to flash were enhanced or inhibited by conditioning stimulation of the substantia nigra. Enhancement of firing by nigral stimulation more often occurred in neurons excited primarily by flash, but inhibition was more commonly observed in those which showed a primary neuronal silence after light.


Accountability: a critical dimension in health care.

The intent of this paper has been to present the notion that the public's demands for accountability present health professionals with unprecedented opportunities. Good health is the bedrock upon which social progress, personal attainment, and individual happiness are built. If health professionals are personally accountable and if they work cooperatively, they can transform the energy now expended in lamenting about crises of confidence, crises of control, and crises of performance into positive action directed toward improving the nation's health. Their rewards will indeed be great.


Health care from a behavioral-ecological viewpoint.

While the intended thrust of this paper has been to elicidate the tremendous potential of the behavioral-ecological perspective for health care research and application, the intent has not been to underplay the important role of the biological sciences in the same venture. However, it is my contention that a behavioral-ecological approach to the study of health care has been widely neglected in health care functions and research. In terms of conventional research designs and terminology, the behavioral-ecological research implications can be summarized as follows: a behavioral-ecological perspective of health care research suggests research that is experimental rather than correlational-descriptive; that focuses, because of its naturalistic thrust, on external validity more than internal validity; that incorporates as independent design variables the environmental context in which health behaviors occur; and that allows single-subject as well as multiple-group designs as research strategy. Finally, in terms of dependent variables, the research design requires a clear identification of the observable characteristics of the target health behaviors under consideration. In summary, health research geared toward professional goals appears to profit significantly from an ecological-behavioral approach which provides a model of high explication, specificity, and objectivity for knowledge generation and immediate application.


Predictive nursing: the baby and parents.

Predictive nursing as a health care strategy is not entirely new. What is new and emerging are means of sharpening our assessments of the events and conditions that support health, as well as specific models engaging the individual in assessing and altering or maintaining his position on the health continuum. This study has been shared with the readers to provide an encouraging direction toward new modes of health care delivery. We believe it is the most encouraging strategy for assisting families in promoting optimal health of infants from a very early point in the infant's life. The assessment techniques discussed in this paper relate to methods of identifying individual behavior patterns of newborn infants, behavioral interaction patterns of parents and infants during the early months and years of life, and the parents' perception of the infant. All of these measures are now being tested by the Nursing Child Assessment Project staff and will result in a systematic format of screening and assessing infants and families "at risk". With current knowledge, astoundingly correct predictions about cognitive development and achievement at school age of groups of children can be made with information about the mother's levels of education and the events of the perinatal periods. The measures discussed in this article concerning the infants' behavior, parent-child interaction, and the parents' perception of the child are factors which will go beyond our present ability to identify potential problems early. Predictive nursing of the infant and young child is our eventual goal. This means going a step beyond the current level of practice by beginning to systematically identify the proneness of individuals to good or bad health outcomes--specifically, the proneness of children to have developmental delays or problems--and to then provide a meaningful type of intervention before the developmental problem occurs.


Observations of a health and healing system in a Papago community.

The Papago people in the Tohono village have a repertoire of culturally stylized patterns of behavior to help them maintain their health. The use of foods and ceremonies for preventing illness and maintaning health are emphasized in the styles of the people as well as the concept of taking care of self and others. Comfort and discomfort, fatigue, aches, thirst, hunger, and sadness are daily experiences of the people. Laughter, crying, "taking care of self and others", walking slowly, eating beans and tortillas, maintaining calm thoughts, and so on, are all culturally defined patterns for coping with alterations in feeling. When professional healers are needed, they will be consulted according to how helpful people perceive these healers to be by their sensitive attitudes and actions. The medicine man, nurses, medicine ladies, the ladies-who-pray, physicians, and St. Francis are perceived to be members of the health care team for the Papago people. The meaningful patterning of culturally defined behavior must be understood within the context of the Papago cultural system. As illustrated by the Tohono, "taking care of self and others" is highly valued, but it is only meaningful as we understand the rules of the Papago society, particularly the religious and kinship systems. These systems tell us that family members are important in taking care of themselves and others. Thus, the description in this paper of culturally patterned health practices with their rituals, ceremonies, and ways to help maintain health and heal the sick help the reader to understand the importance of health and healing behaviors within a designated cultural context. In this study, it is the Papago community and their specialty life ways of maintaining health and preventing illnesses.


Oestradiol receptors in non-neoplastic gynaecomastic tissue of phenotypic males.

Cytoplasmic oestradiol receptors have been reported in breast tumor tissue but not in the uninvolved tissue from the same patients. Since gynaecomastic tissue is highly predisposed to neoplastic transformation, such receptors were looked for in this tissue from 13 phenotypic males of whom 6 had Klinefelter's syndrome. High affinity saturable binding (Kd approximately 10(-10) M) of 3H-oestradiol-17 beta was found in the breast tissue from 12 of these patients by gel elution and dextran-coated charcoal techniques. The concentration of binding sites were found to range from 16 to 359 fmol/mg cytosol protein. Previous studies by the present authors showing steroid aromatising capacity and the present finding of specific oestradiol receptors in a 'high-risk tissue' in the absence of any histologically detectable neoplasms might be relevant in elucidating the natural history of breast cancer in such individuals.


Radioimmunoassay for non-suppressible insulin-like activity.

By immunizing rabbits--tolerant against the bulk of normal human serum proteins--with highly purified non-suppressible insulin-like activity (NSILA-S), an antiserum was obtained which made possible the development of a double-antibody radioimmunoassay. Its sensitivity is about 30 pg NSILA-S per tube or 150 pg NSILA-S/ml. The specificity exceeds that of the bioassay used for comparison which is based in the stimulation by NSILA-S of 125IUDR incorporation into chicken fibroblasts in culture. The radioimmunoassay is sufficiently sensitive and specific to allow direct NSILA-S measurement in serum or plasma samples of humans and experimental animals. In human plasma samples NSILA-S levels, carrying between less than 0.15 and 25 ng/ml , were found to have an average of about 4 ng/ml. In rats higher levels were observed with a mean of 7.7 ng/ml in 4-week-old animals, increasing to about 60 ng/ml in 6-month-old rats. In fasting rats the NSILA-S plasma level is reduced. In acid-treated samples of plasma considerably higher NSILA-S amounts are found.


Polymorphonuclear leucocyte function in hypothyroidism.

The quantitative nitroblue-tetrazolium test demonstrated that polymorphonuclear leucocytes from patients with hypothyroidism reduced the dye less well than leucocytes from euthyroid persons. The ability of these cells to ingest and kill staphylococci were unimpaired. The abnormality of the nitroblue-tetrazolium test in hypothyroid patients was corrected after their treatment with thyroxine.


Failure of cyprohepatdine to inhibit vasopressin-stimulated cortisol release in a patient with Cushing's disease.

A case of a 21-year-old woman with Cushing's disease due to a pituitary tumor is described. The patient was treated with cyprohepatadine for 4 weeks immediately following pituitary alpha-particle irradiation. A standard vasopressin test to measure ACTH-mediated cortisol release was performed four times: prior to pituitary irradiation, after irradiation, after 4 weeks of cyproheptadine therapy, and off cyproheptadine for 2 weeks. Cyproheptadine failed to modify vasopressin-stimulated cortisol release in the patient described. This study suggests that cyproheptadine, which has previously been shown to decrease ACTH secretion, probably acts principally at the hypothalamic, rather than at the pituitary level.


[Basic peptides in bee venom, II. Synthesis of two pentapeptides from the sequence of the mast-cell-degrading peptide (author's transl)].

The synthesis of two protected pentapeptides is described. The peptides are fragments of the sequence of a mast-cell degranulating peptide from bee venom. The fragments Boc-Lys(Z)-Ile-Cys(SiPr)-Gly-Lys(Z)(I) and Boc-Pro-His(Trt)-Ile-Cys(Trt)-Arg(Tos) (II) were synthesized conventionally. The deprotection of the alpha-amino group by HCl/acetic acid of Boc-Ile-Cys(SiPr)-Gly-Lys(Z) was accompanied by a disulfide exchange at the cysteine residue. After the hydrolysis of fragment II with 6N HCl, allo-isoleucine could be detected by gas chromatography and amino-acid analysis.


[An enzymic assay for the determination of vitamin B12 (author's transl)].

A procedure which extends the very sensitive propanediol-dehydratase reaction for 5'-deoxy-5'-adenosylcobalamine determination to cyanocobalamine and hydroxocobalamine is described. In this procedure, the cobalamines are adenosylated by vitamin B12 coenzyme synthetase and the resulting 5'-deoxy-5'-adenosylcobalamine can be determined by the propanediol-dehydratase reaction. Aldehyde, the product of the latter, can be registered by the alcohol dehydrogenase reaction.


Neuraminic acid derivatives newly discovered in humans: N-acetyl-9-O-L-lactoylneuraminic acid, N,9-O-Diacetylneuraminic acid and N-acetyl-2,3-dehydro-2-deoxyneuraminic acid.

The free and glycosidically bound acylneuraminic acids from human serum and saliva and the free acylneuraminic acids from human urine have been characterized by thin-layer chromatography and gas-liquid chromatography/mass spectrometry. Acylneuraminic acid mixtures obtained from serum and saliva contain mainly N-acetylneuraminic acid and N-acetyl-9-O-L-lactoylneuraminic acid, whereas small amounts of N,9-O-diacetylneuraminic acid are also present. No free N,O-diacylneuraminic acids could be detected in the urine samples. None of the investigated fluids contained N-glycoloylneuraminic acid. The unsaturated N-acetyl-2,3-dehydro-2-deoxyneuraminic acid is usually a component of the free acylneuraminic acid fractions of serum, saliva and urine. The body fluids of a patient with sialuria contain the same O-acylated and unsaturated N-acetyl neuraminic acid derivatives as mentioned above, but the total amounts of free acylneuraminic acids in these materials are significantly higher than found for normal persons.


Studies on the kynurenine adminotransferase activity in rat liver and kidney.

The kynurenine aminotransferase activity of supernatant and mitochondrial fractions obtained from rat liver and kidney was studied with L-kynurenine and L-3-hydroxykynurenine as substrates. A substrate inhibition with L-kynurenine at concentrations higher than 6-7mM was observed with all four enzyme preparations. This did not happen with L-3-hydroxykynurenine as a substrate. Moreover, the liver mitochondrial enzyme shows a Km for pyridoxal phosphate 2-4 times smaller than the other preparations when assayed with L-3-hydroxykynurenine as a substrate. Therefore, the accumulation of xanthurenic acid and not of kynurenic acid in B6 deficiency could be related both to this high activity of liver mitochondrial kynurenine aminotransferase with L-3-hydroxykynurenine, even at small concentrations of B6, and to substrate inhibition observed with L-kynurenine and not with L-3-hydroxykynurenine.


Haemocyanins in spiders, III. Chemical and physical properties of the proteins in Dugesiella and Cupiennius blood.

The haemolymph of the tarantulas, Dugesiella (Eurypelma) californica and Dugesiella (Eurypelma) helluo contains high molecular weight haemocyanin (80-82% of total blood proteins) and a second protein not related to haemocyanin (18-20%). In the Lycosid spider, Cupiennius salei, haemocyanin (75% of total blood protein) occurs in two states of association. The haemocyanins were isolated by ultracentrifugation, gel filtration, isoelectric focusing, or preparative gel electrophoresis. Their sedimentation constants are 36.7 S (both tarantulas), 23.4 S and 15.9 S (Cupiennius). After alkaline dissociation, polypeptides sedimenting at 5.8 S (D. californica) and 4.7 S (Cupiennius) were obtained. The molecular weight of the intact functional subunit is (by sedimentation equilibrium) 70 300 (D. californica) and 69 900 (Cupiennius). Copper analysis results in closely similar values. By sodium dodecylsulphate gel electrophoresis, molecular weights of 71 000 (D. californica), 72 000 (Cupiennius) and 74 000 (D. helluo) were obtained. Denaturation with various agents did not lead to smaller polypeptides. The amino acid composition of the haemocyanins was determined (Table 1). The amino end group is blocked. The haemocyanins contain 1.2-1.5% of neutral carbohydrates and 0.3-0.5% of glucosamine (possibly acetylated). The neutral carbohydrates were identified with glucose, mannose, fucose, and arabinose, glucose being the dominant species. Neuraminic acid was not detected. The haemocyanins of the three species cannot be distinguished by their carbohydrate moieties, while there is a significant difference in amino acid composition between tarantula and Cupiennius haemocyanins. The second, non-respiratory protein isolated from spider blood sediments with 16.1 S (Dugesiella) or 15.9 S (Cupiennius). Its isoelectric point is at pH 5.5 It is stable in weakly alkaline solutions but can be denatured to yield polypeptide chains with molecular weights of 95 000 and 110 000. The amino acid composition is reported. As in the haemocyanins, the N-terminus is blocked. The carbohydrate content is 0.9%, glucose being the only sugar identified.


Hydrophobic agaroses: basis for a model of multivalent effector-receptor interactions.

An increase in the density of butyl residues bound to Sepharose 4B leads to an enhancement of the affinity of these gels for phosphorylase b in the presence of 1.1M ammonium sulfate. A Hill coefficient of 2.9 indicates that a minimum of ca. 3 binding sites is involved in the positive cooperative adsorption of this enzyme. Binding studies of phosphorylase b on butyl-Sepharose of a specific degree of substitution demonstrate that the affinity of the gel for this ligand decreases as a function of fractional saturation. A Hill coefficient of 0.44 indicates negative cooperativity as a result of multivalent binding. From these observations a multivalent, mobile receptor model is derived which can explain such characteristics of effector-receptor interactions as: positive and negative cooperativity, high binding constants and low dissociation rate constants. The application of this model to experiments taken from the literature on the binding of the multivalent effectors concanavalin A and cholera toxin to fat cells shows that the postulated mode of interactions is probably realized in nature.


Snake venom toxins. The amino acid sequence of three toxins (CM-2e, CM-4a and CM-) from Naja haje annulifera (Egyptian cobra) venom.

Three toxins (CM-2e, CM-4a and CM-7) were purified from the venom of Naja haje annulifera by gel filtration on Sephadex and by ion-exchange chromatography on CM-cellulose. They comprise 60 amino acid residues and are cross-linked by four intrachain disulphide bridges. The complete amino acid sequences of the three toxins have been elucidated. The toxicities, the serological properties, the sequences and the invariant amino acid residues of toxin CM-2e, CM-4a and CM-7 resemble the corresponding properties of the cytotoxin group.


Liver cell heterogeneity. The distribution of pyruvate kinase and phosphoenolpyruvate carboxykinase (GTP) in the liver lobule of fed and starved rats.

Pyruvate kinase and phosphoenolpyruvate carboxykinase activities were determined in microdissected freeze-dried liver cells from the periportal and pericentral area of the liver lobule. Pyruvate kinase activity was measured by a microfluorimetric procedure adapted to 20-200 ng tissue dry weight. In livers from fed rats, its activity was twice as high in the central zone as in the periportal cells; starvation reduced this gradient by decreasing central activities. Phosphoenolpyruvate carboxykinase activity was measured by a microradiochemical technique in 100-300 ng tissue dry weight. In livers from fed rats, this enzyme was nearly 3 times more active in the periportal cells than in the central area. Starvation increased this enzyme in both zones with a more pronounced change in the central cells. The results indicate a heterogeneous distribution of enzymes of carbohydrate metabolism in the liver lobule. Gluconegenesis seems to be localized preferentially in periportal hepatocytes, whereas the glycolytic enzyme was found to be more active in cells surrounding the pericentral liver cells.


[The sequence of a dimetric hemoglobin (component IIbeta, Chironomus thummi thummi, Diptera) (author's transl)].

The primary structure of the dimeric hemoglobin CTT 11beta from the insect larva Chironomus thummi thummi (Diptera) is given. The sequence of a dimeric hemoglobin is presented for the first time. Some details of this primary structure are discussed and compared with human alpha-chains. The sequence was determined automatically.


CPK isoenzymes in evaluation of myocardial ischemic injury.

Enzymatic criteria for diagnosis of myocardial infarction have suffered from a lack of specificity, since enzyme elevations also occur in noncardiac disorders. The MB isoenzyme of creatine phosphokinase has provided a way out of this difficulty. Not only is it specific to injured myocardium but a recently developed plasma assay makes possible both diagnosis and, in many cases, measurement of the extent of damage.


Reconstruction ('undiversion') of the diverted urinary tract.

Two operations to permit urinary drainage had been performed in a 2 1/2-year-old boy born with obstructing urethral valves, but infections and other compications were a constant threat, especially since the child had only one functioning kidney. After the anomalous valves were ablated endoscopically, the urinary tract was reconstructed, as shown here, to "undivert" the previously fashioned ileal loop bypass.


Dietary fiber and diverticular disease.

Can the regular consumption of bran and other fibrous foods help in preventing diseases of the colon? Indirect evidence supports the idea, although much remains to be learned. It seems probable that bulkier feces could increase the diameter of the colon and prevent sudden sharp rises in pressure that are believed to be responsible for the formation of diverticula. For most people, fiber is probably harmless and it may do some good.


Partial hepatectomy for metastatic carcinoma.

Three years after colonic resection for a rectal carcinoma, the patient evinced some weight loss and alkaline phosphatase elevation. Detailed workup revealed what appeared to be a solitary, well-defined metastatic lesion of the right hepatic lobe. Since the patient could be considered a good candidate for surgery, and given the grim prognosis of alternative approaches, hepatic lobectomy was carried out, as described here.


GI problems in children: II.

Accurate differentiation of such disorders as intrahepatic and extrahepatic cholestasis and the two types of megacolon must precede attempts at treatment. Gastroesophageal reflux, viral hepatitis, and Reye's syndrome are also discussed.


Blood glucose: how reliable an indicator of brain glucose?

It is usually assumed that the concentration of glucose in the brain reflects that in the blood, so that measuring the latter provides an accurate index of the former. However, in two experimental situations analogous to anoxia and salicylate poisoning, brain glucose was found to be dangerously low in the presence of normal or even elevated blood glucose levels, and in these experiments administering glucose prolonged survival.


A cytotoxic substance in insect cell culture spent media.

Spent media from five different insect cell lines when inoculated into Trichoplusia ni (TN-368) cultures produced cytotoxicity resulting in rounding and detachment of cells. The substance in spent medium from the established cellline Carpocapsa pomonella (CP-169) is believed to be a toxin, based on the failure to serially passage the agent, the early appearance of the cytotoxic effect, and the inability to detect microbes by culturing techniques as well as by electron microscopy. The ability to extract the toxic substance from CP-169 cells indicates that it is cell associated. Biophysical and biochemical properties of the CP-169 cytotoxin are presented.


[Problems of amoebiasis (author's transl)].

The problem by the amoebiasis is to differenciate the symptoms against the other similar diseases of the gastro-intestinal tract, also in cases of amoebic-abscesses in liver, lungs, brain and other organs. The presence of zystes and minutaforms of E. histolytica in the stool is not to identify with amoebic-dysenterie. Dysenterie in the tropics can have many different reasons and not alone amoebic infection. Persons with amoebic-infection are under the hygienic condition of central-europe not a risk for their surrounding persons and not like persons who excrete salmonelles. For the diagnostic the restoscopical picture and the X-ray of the colon are very important. To clear the diagnosis amoebic-liverabscess serological tests, , immunelectrophoresis and immundiffusion are necessary, especially szintigraphic or sonographic examination; For therapie of amoebiasis we have to-day very good drugs. Even the liver abscess early diagnosed is possible to cure.


[Treatment of schistosomiasis haematobium with metritionate in OPD-patients (author's transl)].

40 patients--5 to 50 years of age--voiding eggs of Schistosoma haematobium in their urine--underwent treatment with Metrifonate at the OPD of Bong Mine Hospital, Liberia. The patients received 10 mg/kg body weight 3 times at a fortnight's interval. The drug was swallowed under medical supervision. 27 patients no longer passed eggs after the 1. dose of Metrifonate, 37 no longer voided eggs after the 2. administration. 1 patient did not show up for control after the 3. dose. Theoretically he may not be healed. 1 other patient who came for control after 12 months had been exposed to reinfection and again voided eggs in her urine. She had been negative after the 2. treatment. Reinfection may have happened. Patients could be controlled over a period of 6-14 months. Thus, Metrifonate seems to be an effective drug in the treatment of urinary schistosomiasis. Side-effects (nausea, abdominal pains, and--very rare--vomiting) were mild and disappeared spontaneously within less than 24 hours after medication. Patients did not have to interrupt school, daily activities, and treatment. Statistically, Metrifonate did not show any influence on transaminase SGOT, SGPT, and LDH during and after the course of treatment. The same evaluation applies to eosinophilia. There is no increase or decrease of this particular type of cell during and after treatment 7 patients showed alterations of their ECG curves. There were changes of the T-wave in V1-4. In adults traces were normal again several months after completion of treatment. It seems to be difficult to interpret ECGs in West African youngsters. X-ray photos of the lungs never revealed any pathological findings which could be connected to the course of treatment. Metrifonate seems to be a valuable drug in treatment of Schistosoma haematobium-infection. The drug is well tolerated if the treatment scheme--mentioned above--is used.


[Fatal diphtheria in a 26-year-old man. Repetitorium; Known and current aspects of diphtheria].

This paper reports on a 26 year old male who died of toxic diphtheria with all typical features such as: Bullneck, paralysis of the soft palate, renal failure accompanied by proteinuria and--most notably--myocarditis (very typical microscopically) with circulatory disturbances and finally left and right hand failure. The myocarditis hat caused increases of SGOT, SGPT, CPK, LDH and HBDH to values not seen before by us in the course of myocarditis. The patient had been immunized against diphtheria as a child. Initial treatment consisted of the application of ampicillin which caused rapid regression of the local symptoms in the pharyngeal region including the bullneck-symptom; of course the course of intoxication was not influenced, even after the patient had been admitted to the hospital, the disease correctly diagnosed and antitoxin given three days before death.


[Assessment of the efficiency of vaccination against influenza (author's transl)].

The efficiency of the vaccination against influenza resp. its assessment depends on methodological factors, on the vaccine in use and on the epidemiological situation. According to serological tests protection rates (p) may be found of 0,8-0,9; a combined clinical and serological evaluation leads to a value of p=0,7 and after clinical estimation p=0,5. For statistical evaluation it is important to know whether the groups of persons to be compared were randomized or selected. Vaccination groups consisting of volunteers were selected in as much as the vaccines apparently exhibited a higher premorbidity than the control groups. Further on the protection rate is influenced by the number of vaccinations performed. Another very important factor is the composition of the vaccine in use, which should be in accordance with the recommendations of the WHO. Concentration of antigen and addition of adiuvant also influences the efficiency of inactivated vaccines. The antigenic composition is also relevant in live attenuated vaccines. Epidemiological factors are of importance in as much as the efficiency of the vaccination rises with the morbidity of the population. However, even in interepidemic periods the vaccination offers a certain degree of clinically observable protection (0,3). The indication for vaccination against influenza is influenced by age. In older persons the vaccination depresses morbidity and mortality rates, in middle aged working people lower morbidity and a drop in days of absence resulted as consequence of a vaccination campaign, whereas in children shedding of virus is prevented by the vaccination.


[Lysosomal proteinasen and peptidasen in serum of children with inflammatory diseases (author's transl)].

In the serum of 43 children the activities of proteinases and peptidases by mean of 41 substrates have been determined in order to get knowledge of overall activities and differentiation of lysosomal proteolytic enzymes. Proteinases, cathepsins A, B, C and D, aminopeptidases, carboxypeptidases, dipeptidases, tripeptidases and aminoacidarylamidases have been checked. The enzyme pattern of the serum of a collective of 15 healthy children or those without serious clinical signs is demonstrated, also the alterations and differentiations in the serum of children with leucemia, pneumonia, inflammatory diseases of the respiratory tract, other inflammatory diseases and common diseases. Leucyl-glycyl-glycyltripeptidase, glycyl-glycyl-glycyltripeptidase, a proteosterase, carboxypeptidase A, a neutrale proteinase and basic proteinase (cathepsin B) and cathepsin C are increased. A distinct elevation has been found only in children with leucemia and pneumonia.


Hydrocephalus due to prenatal infection with the lymphocytic choriomeningitis virus.

The results are presented of serological examinations in a total of 4235 subjects including blood donors (341 persons), pregnant women (1784), newborns (833), patients with malignant tumours (248), patients with influenza-like diseases (548), patients with abacterial meningitis (295), infants under one year with hydrocephalus (40), infants under two years with other nervous system diseases (110), mothers of seropositive children with hydrocephalus (12) and mothers of seronegative children with hydrocephalus (24). The investigations revealed 16 cases of serologically confirmed prenatal lymphocytic choriomeningitis virus infection. Immunofluorescent antibody to this virus was detected in the children in most cases at high titers and in their mothers at moderate and low titers. In 14 children hydrocephalus was manifest, one child was suffering from infantile cerebral palsy, and one child from congenital right side blepharoptosis. Foci of chorioretinal degeneration were found in 14 patients. During pregnancy six mothers had an influenza-like illness; the other ten mothers denied any disease associated with fever.


Concentrations of cefazolin in human skeletal muscle.

Tissue concentrations of cefazolin were measured in 18 patients undergoing urological operations. Specimens of skeletal muscle and blood were taken simultaneously at predetermined intervals. The concentrations in serum and homogenized skeletal muscle were determined by means of the agar well diffusion method. A comparison of standard curves obtained with phosphate buffer solution and the supernatant of muscle homogenate revealed no substantial binding of cefazolin to the supernatant of muscle homogenate. Because of methodological difficulties in determining the different compartments of a tissue specimen concentrations in tissue were not corrected. Within two hours after a short infusion (25 min.) of 2 g of Cefazolin in muscle tissue a peak concentration of 20 mug/g was reached. A tissue level above 10 mug/g maintained for three hours. This concentration is high enough to inhibit nearly all strains of E. coli, Klebsiella, Salmonella, Shigella and a large part of Proteus mirabilis, whereas nearly all gram-positive bacteria are inhibited at a lower concentration.


Viridans streptococci associated with periapical dental abscesses.

Viridans streptococci isolated in apparently pure culture from periapical dental abscess have been examined. It has been found that each abscesses is associated with only one type of a given species of Streptococcus. The distribution of types of Strep. mitis found in abscesses differed from the distribution in healthy mouths, but no particular type occurred significantly more often in abscesses than in mouths.


[The patient as a source of bacteria in intensive care units: influence of antibiotics and tracheal intubation (author's transl)].

133 patients in an intensive care unit, who prior to admission had not shown any signs of bacterial infection and had not received antibiotic treatment, were assigned to two groups at random. One group received antibiotic prophylaxis with penicillins or cephalosporins (+Pat.), the other group did not receive antibiotics (-Pat.). Staph. aureus was the most frequent facultative pathogen in tracheal secretions and in the environment of "-Pat.". This organism was significantly more frequent in "-Pat." than in "+Pat." in both the tracheal secretions and the environment. Klebsiella spp. outnumbered all other species in "+Pat.". They were significantly more frequent in tracheal secretions of "+Pat." than of "-Pat.". In the first week of hospitalisation marked changes were seen in bacterial flora of tracheal secretions of "+Pat.". Colonization with grammnegative bacteria rose to nearly 100%, the frequency of Staph. aureus diminishing at the same time. Monitoring by contact cultures revealed that gramnegative rods were significantly more numerous in the environment of "+Pat." than of "-Pat.". Matching bacterial strains cultured from tracheal secretions and from the environment of the patients proved that "+Pat. spread significantly higher numbers of their gramnegative bacteria into the environment. The same is true of "-Pat." for Staph. aureus. Intubation had no noticeable effect on the degree of contamination of the surroundings with Staph. aureus. Gramnegative rods were significantly more frequent in tracheal secretions of patients with intubation than in patients without. The same trend was observed for environmental contamination. As the clinical results of this study have shown, antibiotic prophylaxis does not protect patients from infections to the extent expected. Patients, and particularly intubated patients, receiving antibiotic treatment have to be considered as sources of highly resistant gramnegative organisms.


Ototoxicity and nephrotoxicity of netilmicin.

Comparative functional and histological tests were performed in eight groups of ten quinea pigs each, which were administered 50, 75, 100 and 150 mg of netilmicin respecitvely b.i.d. for 29 days, 15 and 25 mg of gentamicin and 50 and 100 mg of amikacin per kg body weight respecitvely b.i.d. and in one control group of ten animals. The tests showed a low degree of ototoxicity and nephrotoxicity of netilmicin.


[The nitroblue tetrazolium test in the diagnosis of purulent meningitis (author's transl)].

The nitroblue tetrazolium (NBT) reduction test was performed in 26 children suffering from purulent meningitis using the technique of Gifford and Malawista modified by Kim et al. 53.,% of the children showed a relative and absolute elevation in the nelative NBT-value only, 15.4% had an absolute elevation of the formazan cell count only, and 19.2% showed values within the normal range. While the elevation of the relative NBT-value is important for diagnosis, results showing normal absolute and relative NBT-values or elevate absolute NBT-values only should not be used for establishing the diagnosis of bacterial infection. In such cases the negative result may demonstrate a neutrophil dysfunction state during severe systemic illness.


[The problem of resistance to antibiotics: a focal point of research in molecular genetics (author's transl)].

The molecular basis of bacterial resistance to antibiotics is discussed as an example of one of the focal points of research in bacterial genetics. The practical implications of research in this field are pointed out, and measures for curbing antibiotic resistance are suggested.


[Clinical study of septicaemia (author's transl)].

The internationally accepted term septicaemia is used to describe illnesses in which pathogenic microorganisms are present in the blood. Septicaemia should be defined according to the causative organism, the portal of entry and the underlying disease. In the last 16 years the causative organisms in 788 cases of septicaemia in our hospital were found to be gram-positive cocci in 28.1% gram-negative rods in 37.6%, and other organisms in 24.i%. Infections with Psuedomonas in particular have become more frequent in recent years. The range of causative organisms in septicaemia varies considerably with the patient groups involved. Thus patients with myeloid insufficiency contracted primarily gram-negative septicaemia. As in the past, the pathogens in endocarditis today are primarily streptococci. In hemodialysis staphylococci and gram-negative rods are shown to occur with equal frequency. The most important clinical manifestation of septicaemia is fever with rigor. The poor prognosis in gram-negative septicaemia is mainly due to the onset of septic shock. Skin colonisation is often a typical sign of septicaemia and can also sometimes serve as a diagnostic indication. Hemorrhagic pustules surrounded by a zone of inflammation are typical in septicaemia caused by meningococci or gonococci. Skin eruptions are rare in septicaemia caused by streptococci of staphylococci. Whereas skin eruptions are absent in septicaemia due to enterobacteria, they are very often present in septicaemia caused by Pseudomonas. In bacterial endocarditis a wide variety of skin lesions can occur.


[Ototoxicity of the aminoglycoside antibiotics (author's transl)].

A report is given on advances in our knowledge of the ototoxicity of aminoglycoside antibiotics. The pharmacokinetics of gentamicin, tobramycin, sisomicin and amikacin in the inner ear, cerebrospinal fluid, compartments of the eye and serum were determined by means of pharmacokinetical investigations. The influence of long-term treatment, and the effects of otitis media and uremia were also studied. Furthermore, the influence of therapeutic methods on ototoxic damage was investigated, and the ototoxicity of these antibiotics was compared. The experiments were performed in guinea pigs, concentrations of the antibiotics being measured by a microbiological method and confirmed by investigations with C14 labeled gentamicin. The hair cell degeneration pattern after administration of the new aminoglycosides was determined using surface preparations. The prophylactic effect upon ototoxicity of the administration of dimercaptopropanol or of dividing up the daily dosage was examined. Studies were made of ototoxicity in children, and in patients with otitis media or renal impairment, and the effect of simultaneous ethacrynic acid or noise was assessed. The problem of delayed and progressive ototoxicity, and the reversibility of ototoxic damage caused by these antibiotics was examined histologically, and the ototoxicity of gentamacin, tobramycin, sisomicin and amikacin was compared. The influence of the new aminoglycoside antibiotics upon the amount of acidic and alkaline phosphatase and unspecific esterases in the inner ear was studied. The clinical importance of the latest experimental findings is emphasised. The clinical picture of ototoxic damage after administration of the new aminoglycoside antibiotics shows no special characteristics. The ototoxicity of these antibiotics after topical use is mentioned. Attention is drawn to guidelines for the prevention of ototoxic damage by aminoglycosides.


Dextran-induced anaphylactoid reactions in man: role of dextran reactive antibodies.

Dextran reactive antibodies (DRA) were studied in 123 patients having experienced dextran-induced anaphylactoid reactions (DIAR) during 1970-1975. No evidence for reaginic DRA was obtained by radioallergosorbent technique and passive cutaneous anaphylaxis in Cynomolgus monkeys; total IgE levels were within normal range. It is concluded that DIAR are not mediated by dextran-specific reagins. Further, no reaginic antibodies against potential contaminants from the dextran manufacturing process were demonstrable. In two population samples of normal human sera from Sweden and Germany hemagglutinating DRA (IgG, IgA, and IgM classes) were found in 63 and 74%, high titres (16-256) comprising 14 and 25%. In dextran reactors a direct positive correlation between titres of hemagglutinating DRA and increasing severity of DIAR was observed. The accumulation of high DRA titres in severe reactions may be taken as circumstantial evidence for the causal role of hemagglutinating DRA in these cases. However, if high titres of DRA alone were responsible for triggering DIAR, the expected frequency would be more than thousand times higher than the reported global incidence of DIAR. To explain this discrepancy, involvement of certain Ig classes or subgroups, possibly in combination with other predisposing factors is suggested. In mild reactions DRA appear to play a negligible role. Positive dextran wheal and flare reactions, often correlated with high titres of hemagglutinating DRA, were seen in 32% of dextran reactors, indicating that skin tests are of limited predictive value. No significant difference between sexes, age groups, or pre- and intraoperatively started dextran infusions was observed; association with certain diseases was not apparent.


Effect of catecholamines and sympatholytics on survival and circulatory parameters in protracted anaphylactic shock of guinea pigs.

Protracted anaphylactic shock of guinea pigs led to death in over 90% of the animals, and good protection was obtained with an infusion of adrenaline after dibenamine pretreatment. Adrenaline alone, in doses which prevented the anaphylactic fall of arterial blood pressure, had no beneficial effect. Practolol abolished the therapeutic action of the combination of dibenamine/adrenaline. Stimulation of beta-receptors by isoproterenol did not increase the survival rate. With dopamine, however, a significant prolongation of the survival times was obtained.


The requirement of thymus competence for both humoral and cell-mediated steps in expulsion of Nippostorngylus brasiliensis from mice.

The worm damaging process (step 1 of Nippostrongylus brasiliensis expulsion from rodents) does not occur in congenitally thymus-deficient (nude) mice as determined by worm morphology, female worm fecundity, and kinetics of worm expulsion upon transfer into normal rats. Expulsion of damaged N. brasiliensis (step 2) does not occur subsequent to transfer of such worms from rats into nude mice. Morphological changes and reduced fecundity appeared in adult worms from normal thymus-bearing mice as early as the first day of patency (day 6 of infection). Thus, the worm damaging process is initiated several days earlier in mice than in rats and may, therefore, account for the reduced longevity of N. brasiliensis in mice compared with rats.


Cryoprecipitates and immune complexes: differentiation between cold insoluble immune complexes and nonspecific cryoprecipitates.

Cold insoluble circulating immune complexes occurred in 77% of rabbits immunized with 125I BSA. 9.8% of the total cryoprotein was 125I BSA. This represented 43% of the serum antigen. Tripling the antigen concentration in vitro decreased the amount of cold insoluble antigen by as much as 83%. In nonspecific cryoprecipitates only 0.4% of the total cryoprotein was 125I BSA. This represented only 0.028% of the serum antigen. Tripling of the antigen concentration in vitro increased the amount of cold insoluble antigen. Cold insoluble circulating immune complexes occur at a critical antigen-antibody ratio and can be differentiated from nonspecific cryoprecipitates.


Effect of alterations in metabolic rate on the duration of tolerance in neonatally injected animals.

Exposure to low environmental temperature caused a decrease in the half-life of human albumin (HA) in rabbits injected with 20 mg HA at birth, and a twofold increase in the proportion of animals which lost their tolerance by 150 days of age. Administration of thyroxin produced an even greater effect with respect to tolerance loss. Simlar mechanisms may be involved in the effects of cold exposure and thyroxin administration on tolerance duration. One possible mecahnism is that the duration of tolerance is dependent upon the metabolic half-life of the tolerance-inducing antigen. An alternative mechanism could be a cold- or thyroxin-induced enhancement of the recruitment of immunologically competent cells from an undifferentiated population of stem cells.


Studies on passive transfer of anti-dextran and anti-egg albumin reactivity in the rat.

We were unable, passively, to transfer reactivity against dextran to the skin or peritoneal mast cells of non-dextran-reactive rats, by using serum or material eluted at pH 3 from mast cells of spontaneously dextran-reactive rats. When the dextran-reactive donor rats had also been immunized against egg albumin (EA) with pertussis vaccine (inducing IgE anti-EA antibody), passive sensitivity against EA (but not against dextran) could easily be transferred. The results indicated that the anti-dextran reactivity is not due to IgE antibody. Systemic reactions against dextran and EA differed in pattern, supporting the concept that the two substances acted through different mechanisms.


IgE production in five inbred rat strains following immunization with alum-precipitated egg albumin.

Five inbred rat strains were assessed for their ability to mount IgE responses to alum-precipitated egg albumin (alum EA). Fischer (FI) and Lewis (LE) rats which possess the B1 at the major histocompatibility (Ag-G) locus exhibited weak IgE responses to this antigen. High titer IgE responses were obtained in rats possessing the B3 allele at the Ag-B locus. In some instances the anti-EA IgE response was enhanced following an infection with Nippostrongylus brasiliensis. An effort was also made in these studies to determine whether or not there is some correlation between high IgE production and a depressed capacity for cellular immunity. The basis of these experiments was twofold: (a) recent reports have shown elevated serum levels of IgE in some clinical diseases where cellular immunity is depressed, and (b) in the studies reported here, high titers of IgE were obtained in one rat strain known to be somewhat deficient in its capacity for cellular immunity, whereas very low titers were produced by a strain which is much stronger in this respect. From the results obtained, there appears to be no correlation between IgE production and an inherently weaker capacity for cellular immunity.


Adenylate cyclase activity in heart and lung: effect of epinephrine and histamine in control and sensitized guinea pigs.

The effect of epinephrine and histamine on adenylate cyclase activity in lungs and hearts of control and ovalbumin-sensitized guinea pigs was investigated. Epinephrine at 10(-6) M concentration stimulated adenylate cyclase from both organs of the sensitized animals but had no effect on the enzyme from control tissues. At 10(-4) M, epinephrine stimulated equally the enzyme activity from the control and sensitized lungs and hearts. Histamine, 10(-6) and 10(-4), stimulated equally adenylate cyclase in tissues from both groups of animals. The results suggest that ovalbumin sensitization leads to hypersensitivity of the beta-adrenergic receptors to epinephrine without changing their sensitivity to histamine.


Diagnosis of reaginic allergy with house dust, animal dander and pollen allergens in adult patients. I. A comparison between RAST, skin tests and provocation tests.

RAST analyses were performed with house dust, animal dander and eleven pollen allergens in 410 adult patients with asthma and/or rhinitis and the findings were compared with skin test and provocation test results. The overall correlation between 1,316 provocation tests and RAST was 78% and the correlation between 1,778 skin tests and RAST was 66%. The relationships between RAST and in vivo tests differed considerably from allergen to allergen. No significant differences were found between various age groups. According to the in vivo tests the RAST showed more often positive results in patients with pronounced allergy than in patients with low-grade allergy. Higher RAST classes were most often combined with positive in vivo tests. It is concluded that in cases with RAST classes 2-4, a reasonably well-established allergy diagnosis can be reached without the inclusion of additional in vivo tests. In other cases, however, application of further diagnostic methods is required.


Immunoglobulins in nasal secretion with special reference to IgE. I. Methodological studies.

Different ways of collecting relatively large volumes of nasal secretion with as physiological a composition as possible were studied. Nasal secretion was collected by the so-called nasal spray washing method from 5 patients with allergic rhinitis due to pollen and 5 healthy persons during a pollen-free season. The collection was performed without any provocation and following nasal provocation with histamine or allergen solution. With the radioimmunosorbent test, in which the lower limit of measurement was 0.1 units/ml, IgE could be quantified in 52 of 60 analysed secretions. IgA, IgG and albumin were demonstrated in all secretions. In the allergic patients, following histamine and allergen provocation, a relative increase in the concentration of IgE and albumin and a significant decrease of the IgA/albumin ratio in nasal secretion was found. In the healthy subjects, such changes in the secretion were observed only after histamine provocation. Calculations also suggested some local production of IgE, but not at all of the same order of magnitude as of IgA.


Immunoglobulins in nasal secretion with special reference to IgE. II. Seasonal studies of Timothy-specific IgE-antibody in patients with allergic rhinitis.

14 adult patients with allergic rhinitis due to timothy pollen were observed for 13 weeks during the grass pollen season. IgE, IgA and timothy-specific IgE antibodies could be quantified in all serum and secretion samples. Total IgE and specific IgE antibodies in both serum and secretion reached significantly higher levels in samples taken during and after the pollen season than before the season. These seasonal changes proved to be significantly more pronounced in nasal secretion than in serum. An indication of local production in the nasal mucosa of IgE, IgA and secific IgE antibodies was also found.


Anaphylactoid reactions in rats and the blood sugar level.

When the blood sugar level in rats is reduced by insulin, the carrageenan-anaphylactoid reaction in one hindpaw is inhibited although the dextran-anaphylactoid reaction in the other hindpaw of the same animals is potentiated. When the blood sugar level is raised after alloxan pretreatment, the carrageenan reaction is potentiated whereas the dextran reaction is inhibited. The results support the hypothesis that the two local irritants exert their effects by involving different mechanisms.


In vitro activity of anti-DNA antibodies from SLE patients in antibody-dependent cell-mediated cytotoxicity.

Peripheral blood lymphoid cells from normal individuals were cytotoxic to target cells coated with DNA when incubated with serum from patients with systemic lupus erythematosus (SLE) but not when incubated with serum from normal subjects. Sera from SLE patients with clinically acitve disease were more active than sera obtained from those patients in remission. In the absence of normal lymphocytes, SLE sera were not cytotoxic to the DNA-coated cells. The active fraction in the serum appeared to be IgG anti-DNA antibodies. These studies indicate that anti-DNA can operate through the antibody-dependent cell-mediated cytotoxicity mechanisms in vitro.


Carrageenan and dextran in rats.

Carrageenan injected subcutaneously into one hindpaw of the rat produces an anaphylactoid reaction which prevents the same paw responding to a second dose 14 days later but does not alter the response to dextran. However, dextran does not modify the response of the hindpaw to a subsequent dose of either dextran or carrageenan 14 days later. When using these models of inflammation for testing the anti-inflammatory activity of drugs, valuable extra information may be gained by adopting the cross-over technique and using both paws of each animal.


Factors in the tissue eosinophil responses in human immediate hypersensitivity reactions.

Factors underlying the eosinophil responses in the tissue sites of immediate hypersensitivity reactions have been investigated. A quantitative assessment of the number of eosinophils appearing in skin test reactions to ragweed antigen and compound 48/80 in ragweed-sensitive humans has been compared with several other parameters. There was a moderate, statistically significant, correlation with serum levels of IgE-class antiragweed antibody; also, eosinophil responses were minimal or absent in minimally positive threshold dilution skin tests. Tissue eosinophil responses were generally limited to those with baseline blood eosinophil levels of at least 150 mm3; however, there was no correlation between blood and tissue eosinophil levels in individual subjects. These findings suggest that the pathogenesis of the observed tissue eosinophil responses may be multifactorial.


From heroin to methadone-social role changes and reinforcement differentials in relation to outcome on methadone. Part II. The study of social role changes.

The life-styles of addicts who are Successful, Marginally Successful, and Failures in a methadone maintenance program are examined by in-depth interviews in five time periods-early family life, the preheroin period, late heroin, premethadone, and methadone maintenance. The hypothesis is confirmed that the more the methadone patient has managed to develop a new and more conventional set of peer group, familial, and occupational roles, the greater the likelihood of his success on methadone maintenance. The in-depth view of the groups over time suggests that the pattern of alternation of positive reinforcements and punishing situations may be associated with outcome.


Behavioral competence training: a model of rehabilitation.

Approaches to the treatment and rehabilitation of drug abuse populations are examined. It is argued that a new model is needed which will more effectively assist in the task of rehabilitation than traditional psychiatric treatment or completely medically oriented programs. A Behavioral Competence Training Model is proposed, based on learning concepts of behavior and psychosocial definitions of adjustment. Its implications for assessment, therapeutic design, and research are discussed. It is concluded that despite possible limitations, the model has a definite place in the rehabilitative process, and may effectively be included in any multiform program serving a diverse population.


The veridicality of addicts' self-reports in social research.

This report examines the accuracy or veridicality of information obtained through interviews with drug addicts. Comparisons were made between the self-reports on six items of the interview and official records of the Baltimore City Police Department, the Baltimore City Juvenile Court, and the Federal Bureau of Investigation. The findings provide no evidence of systematic distortion intended to "cover-up" the criminal side of addict life. While errors of recall probably do affect self-reports, the incomplete status of official records frequently used to validate self-reports should be of equal concern.


Group embedded figures test performance as a predictor of cognitive impairment among alcoholics.

The present study investigated the sensitivity of the Group Embedded Figures Test (GEFT) as a predictor of cognitive impairment among alcoholics. The GEFT, Shipley-Hartford, and Memory-for-Designs tests were administered to 90 male alcoholics. GEFT performance correlated significantly with measures of impairment even when the influence of age and education were controlled. Field-dependent Ss performed at a significantly more impaired level on measures of abstract reasoning, perceptual-motor function, and short-term visual-spatial memory when compared with intermediate and field independent Ss; no differences were found among groups on general verbal ability. The results suggest that the GEFT might profitably be included in screening batteries for impaired cognitive function.


Drug dependence and self-esteem.

A number of recent studies have dealt with variables related to self-esteem, but despite suggestions in the literature, there are few empirical studies concerned with the association between self-esteem and drug dependence. In an investigation of self-esteem, 71 subjects completed semantic differential forms for their self and ideal-self concepts. Four hypotheses were investigated. It was predicted that differences in self-esteem (as measured by the discrepancy between self and ideal-self concepts), would be found between inpatient and outpatient groups, males and females, intravenous and oral users, and between drug-dependent subjects and a control group. No differences were found between inpatients and outpatients, or between intravenous and oral groups. However, females who were dependent upon drugs were found to have lower self-esteem than males in terms of the evaluation factor. No such sex differences were found between all drug groups and the control group on the evaluation and potency factors. It is suggested that the results show considerable deficiencies of self-esteem among drug-dependent patients, and that female addicts are especially deficient in this respect. In terms of etiology, this association between drug dependence and low self-esteem may indicate that those individuals with a deficient self-image who are exposed to drugs may be at risk; this may carry implications also for alcohol and nicotine dependence. It is suggested that self-image therapy may be of value for certain drug-dependent patients, especially females.


Nonmedical drug use by high school students: a three-year survey study.

The characteristics of high school student nonmedical drug users and nonusers were assessed by three successive yearly surveys. The surveys asked about respondents' personal, parent, and family characteristics; their behavior; their attitudes concerning themselves; their parents and family, adult society, and school. Drug use estimates for respondents' parents and peers, as well as themselves, were also assessed. Drug users were consistently different from nonusers in many areas. The incidence of drug increased in each of the three successive surveys, drug users tending to be older and male. With regard to behavior, drug users more frequently acted in a nonadult approved manner than nonusers. Drug users estimated their parents more likely to use alcohol and cigarettes, and estimated more peers to use nonmedical drugs than nonusers. Prediction of drug users from the data could be made with 80% and better accuracy. The findings are discussed in terms of their significance in understanding the nature of adolescent drug use.


A follow-up study of dropouts from a methadone maintenance program.

This is a follow-up study of 112 dropouts from one of the largest methadone maintenance programs in New York City. It was found that 47% of the sample were on methadone at other programs at the time of the follow-up interviews, 26% were drug-free, 16% were using drugs, and 11% were in institutions. However, because of certain sample biases, inferences to the total population of dropouts were made through weighted estimates. A more accurate, although approximated, percentage distribution of the outcomes is that 20% of all dropouts were on methadone at other programs, 43% were drug-free, 23% were using heroin again, and 14% were in institutions. Some of the implications of these findings are discussed.


An application of stepwise discriminant analysis to the characterization of military heroin dependents, illicit drug users, and psychiatric patients.

This application of stepwise discriminant analysis explores a way to structure skewed-sample interview data, discusses some implications of the results and the conceptual limitations of assumptions about deviancy, and suggests a focus for future studies of the complex phenomena of drug abuse. The methodology differs from previous reports in that it uses a constant probability level, letting the computational procedure determine the number of significant variables. It also provides a method of determining the "chance" level (the amount of correct classification when there are no differences between the groups) so that the observed correct classification values may be usefully interpreted.


Prediction of successful response to multimodality treatment among heroin addicts.

In an effort to identify predictor variables associated with successful response to multimodality treatment among heroin addicts, this investigation compared addict-clients classified by means of behavioral ratings into success and failure groups on 16 social history and 18 psychological variables using stepwise discrimination techniques. Statistical analyses correctly classified 100% of the treatment failure group and 92% of treatment successes. Successful clients were characterized by more advanced educational achievement at intake, later onset of opiate use, higher scores on MMPI Scales Es and L, and lower scores on MMPI Scale 7. Results suggest that collection and nanlyses of such data at intake may provide a reliable basis for prediction of treatment outcome as well as an objective means for early identification of "high risk" individuals who may require a more concentrated and individualized therapeutic effort.


Evaluation of drug prevention programs by youths in a middle-class community.

Based on an analysis of data fron a survey of middle-class junior and senior high school youths in a New York City surban community, this paper examines: (1) young peoples' reaction to various drug prevention programs in which they have involved and (2) the program topics they would like to see discussed. Important relationships are found to exist between substance use, prevention program evaluations, and desired program topics. The results suggest that the youths selectively relate to and want prevention experiences that confirm their substance relationships.


Retention of patients in the New York City methadone maintenance treatment program.

The retention, termination, and readmission of patients admitted to the New York City Methadone Maintenance Program from November 1970 through the end of 1973 were analyzed. Sixty-seven percent of patients remained in continuous treatment for 1 year and 50% for 2 years. The retention of patients admitted in successive years declined. Women had somewhat higher retention than men, as did patients over age 30 compared with those 30 or under; there were no differences among ethnic groups. Termination rates were determined for specific reasons for termination from the program as a function of length of time in treatment and also for calendar trimesters. A sharp increase in the rate of voluntary terminations was noted during the second and third trimesters of 1973. Rates of readmission to the program were obtained, specific for reason for first termination and length of time in initial treatment. One out of five terminated patients was readmitted to the program within 24 months.


Connections of superficial and internal adrenal veins.

Histologic specimens, microangiograms, as well as corrosion and dissection preparations of 220 human adrenals were evaluated in order to determine the venous pattern. All the glands were subjected to examination after injection of Micropaque into the central vein. Numerous connections of intra-and extraglandular veins were demonstrated. They varied in calibre from a few microns to 2 mm. The distribution of anastomoses was not uniform. They was much more numerous of the anterior aspect than on the posterior of renal surfaces of the gland. The anastomoses play an important part in adrenal function and adrenal circulation, creating the possibilty of bidirectional onflow of the venous blood from the gland. Such venous arrangement permits to ligate safely the central vein and to fill both venous systems (intra-and extraglandular) with opaque medium during adrenophlebography.


Tumours of the testis. A report of 128 cases.

The records of 128 patients treated between 1960 and 1971 at the University Hospital, Lund, because of tumour of the testis were analysed in respect of age at onset of the tumour, symptoms, histology, diagnosis, treatment and survival rate. Teratoma occured in 67 cases, in the majority at the age of 20-30 years. Treatment consisted in orchiectomy, lymphadenectomy, administration of cytostatics and radiation alone or combined, depending upon the histology and spread of the tumour. The 5-year survival rate was 40%. Sixty-one patients had seminoma, most of which appeared between 30 and 40 years of age. The patients were treated with orchiectomy and radiation. The 5-year survival rate was 82%.


Uremic autonomic neuropathy: evaluation of ephedrine sulphate therapy for hemodialysis-induced hypotension.

The hemodynamic response to ephedrine sulphate were studied in a patient on maintenance hemodialysis therapy with chronic renal failure due to renal amyloidosis. The evaluation (including cardiac catheterization studies) and estimation of responses to Valsalva maneuvers before and after ephedrine administration documented the diagnosis of autonomic insufficiency. Oral ephedrine failed to influence the episodes of severe dialysis-induced hypotension. Also the patient did not benefit from the infusion of Aramine. These studies suggest that catecholamine stores of adrenergic nerves may be depleted in uremic patients with clinical signs of autonomic neuropathy.


Double renal biopsy with Menghini needle.

The complications of percutaneous renal biopsy with Menghini needle, performed in 400 cases by the author, are reviewed. Position of the kidney was located by intravenous pyelography and was checked by further radiography if 1. the pyelogram was of inadequate technique, 2. the kidneys were small, or 3. ptotic. In two thirds of the cases the specimens were taken in duplicates, so as to provide sufficient material for light-, electron-, polarization-microscopic and immunofluorescent studies. On the evidence of the present observations the technique of double biopsy involves no higher incidence of complications than the conventional procedure, nor did it cause complications of major severity in the individual cases.


Typing of hyperlipoproteinemia in an Israel hospital.

In this study we report on lipid and lipoprotein levels among a patient population at the Hadassah University Hospital, Jerusalem. The normal group consisted at 65 examinees whose mean plasma cholesterol and triglyceride levels were 208 and 104 mg/dl, respectively. Lipoprotein lipid levels were determined after ultracentrifugation and specific polyanion precipitation. All procedures were monitored by lipoprotein electrophoresis on paper. The mean levels of very low density, low density and high density lipoproteins of the normal group, expressed as cholesterol, were 24, 140 and 44 mg/dl, respectively. Of the 285 patients investigated, 280 were classified as having lipoprotein patterns of type IIa (117), IIb (90) or IV (73); two patients had type III; and three patients had type V hyperlipoproteinemia. All groups differed considerably in their plasma lipid and lipoprotein levels. Based on individual values the ratios of plasma triglyceride to plasma cholesterol and plasma triglyceride to very low density lipid cholesterol were calculated. The low density lipoprotein cholesterol content was also calculated by subtracting the high density lipoprotein and an assumed very low density lipoprotein cholesterol content (plasma triglyceride level divided by 5) from the total plasma cholesterol. It is suggested that by the use of these values, together with lipoprotein electrophoretic procedures, the ocrrect typing of hyperlipoproteinemia can be established for most patients, without the use of the ultracentrifuge.


Effects of exposure to Finnish sauna.

Pathophysiological effects of exposure to Finnish sauna (80 to 90 C, 30 to 40% relative humidity) were investigated in 60 volunteers--33 men and 27 women aged between 18 and 63 years. The volunteers entered the sauna after a rest period of 20 min, and remained there for 20 min or until they suffered discomfort. Weight, height, rectal and skin temperatures, blood pressure, heart and respiratory rates and ECG were recorded 20 min prior to the sauna, during the sauna, and 20 min after leaving the sauna. Marked physiological changes appeared in the first few minutes in the sauna without any prodromal warning. At the 20th min the mean heart rate was 143 +/- 25 (SD) beats/min (greater than 160 beats/min in 32% of the subjects). Mean rectal temperature was 38.6 +/- 0.6 (SD) C (greater than 39 C in 22%): mean skin temperature was 40.4 +/- 1 (SD) C (greater than 40 C in 35%); mean systolic blood pressure was 130.5 +/- 26.6 (SD) mm Hg (greater than 160 mm Hg in 17%); and mean diastolic pressure was 66.6 +/- 15.9 (SD) mm Hg (greater than 50 mm Hg in 17%). The mean total sweat loss was 457 +/- 264 (SD) g. Three subjects experienced syncope, and one developed an anginal attack; ECG changes suggestive of coronary insufficiency were recorded. No decrease in blood pressure occurred in patients with preexisting high blood pressure. It is concluded that sauna bathing involves dangers to the bather's health, which may appear suddenly, without prodromal warning signs.


Cardiovascular complications in matched pairs of low and normal renin hypertensive patients.

A nomogram for plasma renin activity (PRA), based on 31 normal volunteers, was constructed, and the 95% tolerance limits were computed to the regression line of PRA on 24-h urinary sodium excretion. On this nomogram, reproducibility of the PRA profile for the same patient with essential hypertension was good. Retrospectively, 20 essential hypertension patients with low PRA were matched for age and sex with essential hypertension patients with normal PRA. No statistically significant difference was found between the two groups in either the number of cardiovascular complications or in the blood pressure means. It is concluded that the incidence of cardiovascular complications tends to be similar in all cases of essential hypertension of a similar degree of severity.


Variations in acoustic admittance related to type of ear tip. A plea for a standardized method.

In order to assess the validity of using various ear tips, tympanometry and acoustic admittance were studied in 20 young healthy subjects, and three different types of ear tip used to seal the external auditory canal. Significant variations in the admittance components and tympanometry curves were observed, resulting most probably from changes in the canal volume and the physical nature of the tipe. It appears advisable to develop and adopt an appropriate, standard ear tip for studies of admittance audiometry.


Effect of levan on the stages of development of experimental allergic encephalomyelitis.

Experimental allergic encephalomyelitis was induced in male guinea pigs of the N13 strain by inoculation of an emulsion of basic protein of myelin with complete Freund's adjuvant. The disease was also passively transferred to other animals of the same strain by i.p. injection of sensitized lymphocytes obtained from donors inoculated with the antigenic emulsion eight days previously. Daily administration of levan markedly reduced the incidence and severity of the disease in actively sensitized animals. Little, if any, effect was obtained by levan treatment of animals with the passively transferred disease. The findings indicate that the previously reported inhibitory effect of levan on the development of experimental allergic encephalomyelitis is probably due mainly to a derangement of the afferent path (stage of sensitization). Administration of levan also causes a depletion of lymphocytes in the lymph nodes and this may presumably also affect the efferent path.


Echocardiographic findings in constrictive pericarditis. A case report.

The echocardiographic findings in a 73-year-old woman with constrictive calcified pericarditis are presented. The diagnosis was confirmed by physical examination, chest X-rays and cardiac catheterization. The echocardiogram demonstrated abnormal motion of the interventricular septum and of the left ventricular posterior wall, multiple thickened echoes of the posterior pericardium, and a localized dense band of anterior pericardial echoes, which corresponded to the calcification seen on the chest X-ray.


Prenatal diagnosis of heterozygous beta-thalassemia.

The parents of a child with homozygous thalassemia of the beta O variety requested prenatal diagnosis during a subsequent pregnancy. At the 19th week of pregnancy, a sample of blood containing fetal cells was obtained by placentocentesis. Radiochromatography of globin chains demonstrated production of a beta-chain with a beta/gamma synthetic ratio of 0.049, which is low for this gestational age. The conclusion that the child would be heterozygous for the beta-thalassemia gene was confirmed after birth.


Hypercalcemia during the polyuric stage of acute renal failure.

Hypercalcemia developed during the polyuric phase of acute renal failure in a patient with crush injury. The hypercalcemia persisted for one week, with a maximal serum calcium level of 13.1 mg/dl. Possible mechanisms for the hypercalcemia are discussed, with emphasis on the combined effect of extensive tissue damage and acute renal failure.


Chordal rupture: a common complication of myxomatous degeneration of the mitral valve.

In two patients with a clinical picture of acute mitral insufficiency, the presence of chordal rupture secondary to myxomatous degeneration of the mitral valve was disclosed during surgery. There was no evidence of previous rheumatic valvulitis, subacute bacterial endocarditis or other etiologies. It appears from the literature and from the cases described that ruptured chorda tendinea is a not uncommon complication of myxomatous transformation of the mitral valve. While this fact has been mentioned in anatomophological reports, clinicians are less aware of the association. In the absence of supportive evidence for a rheumatic or arteriosclerotic etiology, a clinical picture of acute mitral insufficiency should suggest ruptured chorda tendinea secondary to myxomatous degeneration of the mitral apparatus. This is particularly true in older patients, especially among those followed for a midsystolic click-late systolic murmur or an apical pansystolic murmur of pure mitral regurgitation.


Osteogenesis imperfecta with mitral insufficiency due to ballooning of the mitral valve. A case report.

A further case of osteogenesis imperfecta with valvular heart disease is added to the 12 already reported in the literature. The presence of a dilated mitral annulus and a ballooned mitral leaflet in this case together with the findings reported in the literature leave little doubt as to the relationship between the valvular lesion and the underlying connective tissue disorder.


Predictive value of cervical dilatation rates in labor in multiparous women.

A modified version of Philpott's partogram, previously used by us to analyze patterns of labor in primiparous and grand multiparous women in Israel, was applied to multiparous women. The results for labor in multiparous women closely resemble those found for primiparous and grand multiparous labors. The rate of cervical dilatation, as measured early in the active phase of labor [initial rate (IR)], is an accurate indicator of the outcome of labor. Ninety-eight percent of all multiparas with an IR of cervical dilatation of 0.75 cm/h or greater delivered spontaneously. Sixty-two percent of women with an IR of less than 0.75 cm/h required an assisted delivery or cesarean section. Mean IR of cervical dilatation for spontaneous deliveries, assisted deliveries, and cesarean sections were, respectively, 1.53, 0.67, and 0.46 cm/h. No significant differences were observed among different population groups. Cervical dilatation rates among all parities appeared similar. The only major difference was in dilatation rates for assisted delivery in primiparas, which were faster than in labors in multiparous or grand multiparous women.


Fertility and perinatal and infant mortality in the Jewish population of Beersheba and the Negev, 1972.

There were 4,569 Jewish births in the Negev (southern Israel) in 1972, the first year of birth registration by the Unit for Evaluation and Planning of Kupat Holim and the Ben-Gurion University center for Health Sciences. The crude birth rate was 28.8 per 1,000 population, with 130.7 live births per 1,000 women aged 15 to 44 years. Total fertility was 3.9 per woman, varying from 3.4 in the kibbutzim and 3.5 in Beersheba to 5.2 in the moshavim (collective settlements) and 3.7 to 6.3 in the development towns. Late fetal and perinatal death rates were 9.4 and 19.0/1,000, and the neonatal and infant mortality rates, 11.0 and 18.1/1,000 respectively. The proportion of males was 0.51, the twinning rate was 9.5/1,000 women delivered, and 1.1% of babies were illegitimate. Low birth weight (less than 2.5 kg) was recorded in 6.9% of births. Fifty-three percent of births were to immigrant mothers from North Africa; the remainder were divided equally among mothers born in Israel, the Asian Near East, and Western countries. The Asian immigrant group was at high risk for infant death, with a rate of 3.64/1,000 as compared with 14.8, 14.2 and 5.8 recorded for the offspring of mothers born in Israel, North Africa and Western countries, respectively. Patterns of mortality in relation to maternal age, birth order and education were similar to those reported for developed countries.


Tay-Sachs disease in a Moroccan Jewish family:  a possible new mutation.

The parents of a Jewish Moroccan family, in which a previous child had died of Tay-Sachs disease, both proved to be carriers of the mutant gene. Hexosaminidase A activity in the father was similar to that in Ashkenazic heterozygotes, while the mother showed extremely low hexosaminidase A activity in peripheral leukocytes. Amniocentesis was performed on the mother during a subsequent pregnancy; the fetus proved to be affected and the pregnancy was interrupted. Acrylamide isoelectrofocusing of fetal liver and leukocytes of additional family members revealed a variant mutation for Tay-Sachs disease.


Frequency and distribution of sister chromatid exchanges in human peripheral lymphocytes.

The frequency and distribution of sister chromatid exchanges (SCE) were examined in a population of 10 normal individuals (five males and five females) and compared with those in patients with various numerical and structural chromosomal aberrations. Statistically significant differences within each group were observed among the normal subjects as well as among patients with similar cytogenetic aberrations. A consistent nonrandom distribution of SCE, with regard to chromosome length, was demonstrated, with a significant increase of SCE in the centromere region of some chromosomes.


Coexistence of factor XI (plasma thromboplastin antecedent) deficiency and Gaucher's disease.

The findings of Factor XI (plasma thromboplastin antecedent) deficiency in a patient with Gaucher's disease was investigated. A family study, which included measurements of leukocyte glucocerebrosidase activity and Factor XI levels, revealed that the two genetic disorders segregated independently. One of 12 additional unrelated patients with Gaucher's disease showed a diminished Factor XI level and two of seven unrelated  Factor XI-deficient patients showed decreased glucocerebrosidase activity. It is possible that the common occurrence of both genetic disorders results from a high gene frequency of both defects in Ashkenazic Jews.


Effect of calcium content of diet on absorption of diphenylhydantoin.

The effect produced by changes in the calcium content of the diet on the plasma concentration of diphenylhydantoin was studied. In subjects on a high calcium intake, plasma diphenylhydantoin levels were significantly lowered, probalby resulting from both the formation of an insoluble calcium-drug complex and the direct effect of calcium on the intestinal membrane. A similar but less pronounced effect was observed when calcium-rich foods were excluded from the diet. These observations indicate the need for a balanced calcium diet during diphenylhydantoin treatment.


Chronic saline loading in anoxic renal failure in rats.

The effect of saline loading was compared in two types of experimental acute renal failure--due to i.m. administration of glycerol or to anoxia. In the glycerol model, chronic saline loading for about three weeks  prior to the experiment achieved almost complete prevention of the uremia. The blood urea and serum creatinine levels 24 h after the experiment were 44 +/- 2 and 1.3 +/- 0.3 se) mg/dl, respectively. The values for the water-drinking rats were 292 +/- 23 and 3.7 +/- 0.4 mg/dl, respectively. In the anoxic model of acute renal failure, produced by uninephrectomy and contralateral renal artery clamping, chronic saline loading reduced the severity of the resultant uremia, although less impressively than in the glycerol model. The blood urea and serum creatinine 24 h after the experiment were 148 +/- 15 and 1.8 +/- 0.2 mg/dl, respectively. The values for the water-drinking rats were 237 +/- 15 and 2.3 +/- 0.2 mg/dl, respectively. Plasma renin activity was similar in the saline-loaded rats in both the toxic and anoxic models. It seems, therefore, that all known models of acute renal failure have at least a common pathogenic mechanism, which can be influenced by chronic saline loading prior to onset of the disease, and which is most probably not renin dependent. In the anoxic model additional factors, which cannot be counteracted by chronic saline loading, are active in the development of uremia.


Distribution of room size in hospitals.

In the design of such complex buildings as hospitals the planner's problem is to provide a minimal amount of permanent structure so that it shall not get in the way of functional behavior of the occupants and their ability to change their environment. The purpose of this study was to discover which intervals seem to occur in hospitals by measuring the room size distribution found in existing buildings or buildings ready for construction. The results seem to confirm that the range of room sizes required is small and that exceptions are relatively rare.


How many beds should a hospital department serve?

Departmental cost functions are constructed for selected hospital departments, using total number of beds in the hospital served as a proxy output measure. Calculation of maxima or minima for the resulting cost functions reveals that, on average, different departments have extremes in their cost functions of different levels of output. A relative cost index is constructed, using parameters of the departmental cost functions, and departmental costs are compared across regions. The significance of departmental differences in optimum output is discussed with regard to sharing of services and modified system design.


Episodes of illness and access to care in the inner city: a comparison of HMO and non-HMO populations.

Using data from a 1974 household survey, accessibility to ambulatory care is compared for residents of an inner-city area (East Baltimore) whose usual source of care is an HMO (the East Baltimore Medical Plan) and residents of the same area with other usual sources of care. Accessibility is measured by the probability of receiving care for an episode of illness. Results from multivariate linear and probit regressions indicate that children using the HMO are more likely to receive care than are children with other usual care sources, but no significant differences in the probability of receiving care are found among adults. Evidence of a substitution of telephone care for in-person care is also found among persons using the HMO. Data from a 1971 household survey of the same area suggest that selectivity is not an important confounding factor in the analysis.


A social systems model of hospital utilization.

A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services.


An approach to an index of hospital performance.

Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a test on data collected from 32 Texas hospitals.


Psychological and neurodevelopmental outcome of high risk newborn infants.

Among 142 high-risk-newborns, 111 could be regularly followed-up to 3 years of age. 79 (71%) are normal, 6 (5.5%) have minor neurological sequels, 9 (8.1%) have major neurological sequels, associated in 4 cases with mental deficiency, 16 (14.5%) have developmental abnormalities (speech delay, behavioral problems, perceptual-motor and praxis disturbances), and one mental deficiency without neurological sequels. Neonatal cerebral distress proved to be the most dangerous clinical situation with regard to the ultimate neurodevelopmental prognosis (73.6% of neurological sequels or developmental abnormalities). The presence of transient abnormalities of tone in the course of the first year of life was associated with ultimate developmental abnormalities in 33.3% of the cases. Social and cultural status seemed to play a role in the intellectual, linguistic and perceptual-motor performance of this group of infants. In spite of these encouraging results, the need for a systematic long term follow-up of high risk newborns is stressed, since neurological sequels and developmental abnormalities are approximately 4 times more frequent in this group than in a normal infantile population.


[Early treatment of cerebral movement disorders: findings among 50 school children].

It is difficult to assess objectively the effectiveness of treating children with cerebral palsy during the first year of life. 50 pupils with cerebral palsy were selected for handicap and intelligence and carefully examined. All children were treated with the neurodevelopmental technique of BOBATH, 22 of them within the first year of life, 28 thereafter. The examination in school age showed differences between the two groups. When treatment is commenced before nine months of age, children with spastic diplegia resulting from premature birth are unlikely to require special schooling for reasons of their physical handicap. After early treatment, patients with severe neuromuscular dysfunction in early life frequently display disturbances of a predominantly ataxic nature when reaching school age. Spasticity appears to respond well and athetosis less favorably to early treatment. More severe brain damage in the early treated children is possibly indicated by the higher incidence of epilepsy. Pupils who were treated early show significantly fewer behavioural disturbances, with the exception of cases where symbiotic neurosis in the mother is present. This is important for the development of the personality and the individual capacity of integration.


Cutaneous pO2-measurements in newborns with respiratory distress syndrome.

Correlation between cutaneously measured pO2-values and arterial pO2 in 9 newborns with respiratory distress syndromes was investigated with the Basel skin-electrode [3]. At an electrode temperature of 42 degrees C, correlation was low (r = 0.63), at 43 degrees C the coefficient increased to 0.71 at 44 degrees C the over all statistical correlation improved markedly (r = 0.97). cpO2 for given paO2-values, however, varied widely: reliable discrimination between hypo-, normo- and hyperoxemia was impossible. Continuous registration allows recognition of the consequences of common clinical situations and nursing manipulations on cpO2. The electrode, however, is still susceptible of technical modifications.


Hepatic toxicity of antituberculous drugs in children.

Three cases of children who developed hepatic toxicity of different degree while on antituberculous treatment with isoniazid and rifampicin are reported. The clinical picture is presented and the pathogenesis of the hepatic damage is discussed. The pathological findings in the liver are those of a drug induced hepatitis. The combined treatment of tuberculosis in children with isoniazid and rifampicin is potentially dangerous and should be reserved for cases in which resistance to other drugs has been demonstrated.


Vascular obstruction of the superior renal calyces in children.

The authors describe 5 cases with a pathology peculiar to the superior calyces due to vascular compression, observed from 1969 to 1975 among 938 urographic tests performed in the Pediatric Clinic of Florence. Three of these cases have been checked up to this date. In every patient the urographic tests show clear evidence of a vascular compression at the level of the right upper calyces, associated with stasis and/or ectasis. In two cases there is a symptomatology of abdominal pains; in the remaining 3 patients haematuria is revealed. It is important, particularly in children, to follow the course of the clinical and urographic features, in order to carry out a surgical intervention at the right moment, according to the evolution of the process. The chronic segmental (upper pole) pyelonephritis is the most dangerous evolution.


Primary proximal renal tubular acidosis; A therapeutical approach and long term follow-up.

This paper reports a case of proximal renal tubular acidosis followed during 4 years, in a 4-year-old girl. High doses of alkali could not be administered owing to gastric intolerance of the patient; diuretic therapy carries the risk of causing severe dehydration or hypotension. We administered such a dose of NaHCO3 to obtain a normal blood pH--with persistent hyperventilation-, subnormal bicarbonatemia, and acid urine. This treatment could cause an improvement of rickets, growth and laboratory data. At present, the biochemical data, including urinary excretion of bicarbonate with normal bicarbonatemia, are normal; this indicates a spontaneous recovery of the syndrome. We think that low doses of alkali are useful in the transient form of proximal renal tubular acidosis to prevent bone lesions and failure to thrive. But even in the irreversible form of this syndrome--when high alkali doses and diuretics cause dangerous effects--this therapy may be useful to treat some symptoms.


On the homology of the alisphenoid.

The relationships of the elements of the cavum epiptericum in a hypothetical primitive mammalian precursor are reconstructed, and these are analysed in relation to the development of recent mammals, especially the fruit bat Nyctinomus johorensis. The alisphenoid in mammals is part cartilage bone, part membrane bone. The mammalian homologue of the primitive reptilian processus ascendens appears to be internal to the maxillary nerve. If so, then the 'lamina ascendens', that portion of the alisphenoid of mammals which lies between maxillary and mandibular nerves, cannot be a true processus ascendens but must be neomorphic. It is suggested that the mammalian lamina ascendens arose from an upgrowth of the root of the quadrate ramus of the epipterygoid in cynodonts, separating foramen rotundum from foramen ovale. In Ditremata the alisphenoid is completed by an element of membrane bone; this, it is suggested here, originated as the anterior lamina of the periotic in cynodonts, which is retained in monotremes. It is suggested that the alicochlear commissure of mammals originated as the later flange of the periotic in cynodonts.


An autoradiographical study of [3H]thymidine incorporation into subcutaneously transplanted mouse molar teeth. Cell proliferation and migration in transplanted teeth.

Mice bearing either allografts or isografts of 10 day old molar teeth were injected with [3H]thymidine to identify proliferating and migrating cells within the graft and surrounding tissues. In isografts proliferating cells were found successively in the area underlying the cervix, in the cervical pulp and the coronal pulp. However, cells did not migrate from the cervical host tissue into the pulp, and it was concluded that donor cells are responsible for reparative processes in tooth isografts. Very few labelled cells were identified at any time in tooth allografts, which were not repaired. It is suggested that allografts are not repaired because allogeneic inhibition prevents the residual donor tissue from proliferating and differentiating. Inhibition of proliferation of residual cells may also account for the absence of a cell-mediated immune response to tooth allografts.


The interfrontal bone and mutant genes in the mouse.

The relationship between corrected skull width and the presence and size of an interfrontal bone is discussed with regard to the effect of certain mutant genes in the mouse known to affect the development of the neural tube. All genes reviewed which increase the incidence of the interfrontal bone and affect the neural tube also change the proportions of the adult skull.


Retardation of bone growth in triamcinolone-treated mice.

Immature mice were treated for up to 8 weeks with daily doses of triamcinolone diacetate. The epiphyseal cartilage plate and its surrounding bone from the humeral head were studied histologically at regular intervals. Concomitantly, roentgenographic measurements were performed on the humeri in toto. By the tenth injection significant morphological changes were noted in the cartilaginous plate, followed by complete cessation of bone growth. Severe triglyceride accumulation appeared in the experimental livers and humeral bone marrow. Osteoporosis also occurred and became severe from the fifth week of triamcinolone administration. Possible explanations for the above findings are discussed.