A Review of Commonly Used Intrauterine Contraceptive Devices.

The radiographic appearances of the most commonly used intrauterine contraceptives devices are reviewed, and methods are suggested to determine the extrauterine location of these devices. Complications resulting from the use of these devices are also discussed.


Expansion of an air-filled subdural space during nitrous oxide anesthesia.

The long-term administration of nitrous oxide anesthesia during craniotomy as well as following closure of the parietal craniotomy flap (under no tension) leads to significant expansion of the residual air bubble trapped under the dura. A case is presented in which an extracerebral avascular space, filled only with gas, caused a marked shift of the intracranial structures and uncal herniation secondary to nitrous oxide anesthesia during craniotomy and postcraniotomy angiography.


Acute, Post-Traumatic Subdural Hygroma. Natural Course with Angiographic Documentation.

Acute, post-traumatic subdural hygromas, in contrast to benign chronic subdural hygromas, may be life-threatening. Two cases are presented in which a rapidly enlarging subdural hygroma either prevented improvement over a 1-2 week period or resulted in rapid deterioration of the patient. Angiographic documentation and the natural course of this condition are revealed.


Regional Myocardial Blood Flow Measurement in the Evaluation of Patients with Coronary Artery Disease.

Myocardial imaging with 133-Xe and a gamma camera was employed to evaluate total and regional myocardial blood flow. The technique detected vasodilatation after injection of papaverine or diatrizoate. Contrast medium caused transient vasodilatation with return to baseline flow within five minutes. Myocardial tissue flow tended to decrease as coronary artery stenosis became more severe. There was overlap of flow measurements in patients with and without coronary artery disease. Coronary flow measurements made at rest are not considered to be an essential clinical tool. gpreater diagnostic benefit is obtained from the scintigram which distinguishes between akinesia caused by ischemia and akinesia due to extensive scarring.


The combined use of Gated Cardiac Blood Pool Scanning and Myocardial Imaging with Postassium-43 in the Evaluation of Patients with Myocardial infarction.

Fourteen patients with transmural myocardial infarction were studied by gated cardiac blood pool scanning (to determine regional ventricular function) and 43-K myocardial imaging (to determine the regional distribution of myocardial perfusion). An akinetic area on the gated scan and an area of decreased tracer concentration on the 43-K image were detected. The area of reduced 43-K concentration averaged 33.5% of the left ventricular circumference which correlated (r = 0.74, p less than 0.01) with the area of infarction determined by the zone of akinesis, 34.2% of left ventricular circumference. The extent of akinesis and left ventricular ejection fraction were significantly different in those patients with left ventricular failure than in those without failure.


Radionuclide angiography in graded carotid stenosis. An experimental study with angiographic correlation.

Radionuclide and contrast angiographies were performed in 10 dogs. In 6 dogs unilateral or bilateral (partial or total) carotid occlusions were produced by silk ligatures. Follow-up angiographies were carried out at intervals up to 6 months following surgery. Visual assessment of the radionuclide carotid angiogram was compared to quantitative analysis of the time-activity curves over these areas. Several parameters of these curves were reviewed. The ratio of the slopes, was the most sensitive parameter of the assessment of carotid artery stenosis. The ratio of the slopes of the curves in normal dogs (mean 96 plus or minus 5.2 S.D.) was significantly different from that in animals with stenosis greater than 80% (mean 67.3 plus or minus 16.9 S.D.).


Adverse reactions (aseptic meningitis) from 111-indium-DTPA cisternographic examinations.

Cisternographic examinations have become a relatively common procedure in the evaluation of patients with suspected communicating hydrocephalus. Adverse reactions to radiopharmaceuticals are relatively uncommon, particularly with the commonly used agents such as 111-In-DTPA and 169-Yb-DTPA. Adverse reactions after lumbar intrathecal instillation of 111-In-DTPA in three patients are described.


99m-to-polyphosphate bone imaging in Legg-Perthes disease.

99m-Tc--polyphosphate bone imaging was useful in distinguishing Legg-Perthes disease from other childhood hip disorders in 40 patients. In 33 Legg-Perthes patients, imaging provided earlier and more accurate information concerning the extent of the necrotic and revascularization process involving the hip than radiographs  alone. This advantage could both facilitate treatment selection and provide a more objective baseline from which to judge treatment results. Preliminary experience also suggests that the technique may offer some insight into the pathogenesis of Legg-Perthes disease.


Clinical course of patients with squamous cell carcinoma of the upper respiratory and digestive tracts with no evidence of disease 5 years after initial treatment.

Eleven hundred sixty-three patients with squamous cell carcinoma of the upper respiratory and digestive tracts, treated from January 1948 through December 1965, had no evidence of disease five years after the initial treatment and no other manifestation of squamous cell carcinoma within the first five years. After five years, the incidence of disease at the initial location, in the vicinity, or in remote sites was found to be identical in the surgical and irradiation groups. There is a correlation between severe late complications in the irradiated patients and the volume of tissue irradiated.


Delayed hypersensitivity to DNCB and survival following radiation therapy in patients with solid malignant tumors.

Delayed hypersensitivity to dinitrochlorobenzene (DNCB) was tested prior to radiation therapy in 206 patients with solid tumors. The patients were separated into a DNCB-positive group who showed a significant response to DNCB and a DNCB-negative group who did not. After one year, it was found that patients with a positive DNCB reaction had a statistically better chance of survival than those with a negative DNCB reaction. Although this is not proof that DNCB testing can indicate those patients who should be excluded from radical therapy, it can help identify those who may respond favorably to extended efforts at palliation or cure despite clinically advanced disease.


Effect of absorption edge filters on diagnostic x-ray spectra.

The spectra of diagnostic x-ray beams were measured with a germanium semiconductor dectector. With this system it was possible to define the K-alpha-1, K-alpha-2, K-beta-2 characteristic peaks of the tungsten target. The effects of various filters on the beam using characteristic absorption edges to create a "bandpass" effect were studied. Gadolinium filtration of the diagnostic beam used for contrast studies selectively removed both higher energy photons (greater than 50 keV) and lower energy photons (less than 33 keV) thus enhancing contst for iodine and barium while substantially reducing radiation dose.


The capability of fluoroscopic systems to determine differential roentgen-ray absorption.

A clinical fluoroscopic unit used in conjunction with a TV image digitization system was investigated to determine its capability to evaluate differential absorption between two areas in the same field. Fractional contrasts and minimum detectability for air, several concentrations of Renografin-60, and aluminum were studied using phantoms of various thicknesses. Results showed that the videometric response, when treated as contrast, shows a linear response with absorber thickness up to considerable thicknesses.


Exposure of the radiologist to scattered radiation during angiography.

At least 90% of the exposure of a radiologist's crystalline lens and right hand to scattered radiation during angiography, investigated by thermoluminescent dosimetry, proves to be due to radiography during and immediately after manual injection of the contrast medium. Therefore, manual injection should be replaced by remotely controled injection by means of an injector. The exposure of a radiologist's gonads (measured behind a lead apron) proves negligible. At the low exposure rates to be expected, integrating measurements should be made.


The quantitative description of a radiation therapy plan.

A computer program has been designed to describe radiation therapy plans in numerical as opposed to graphical terms. Treatment is specified by using the average dose in the target area. The rationale for its development and an illustration of its use are given.


Analysis of errors in three-dimensional reconstruction of radium implants from stereo radiographs.

The present method of steroe shift for three-dimensional (3-D) reconstruction of radium implants has been found to produce displacement errors. Analysis shows that the maximum displacement error decreases as the shift (S) increases with fixed focal spot-film distance (H), while conversely for a fixed shift distance the maximum displacement error with increased focal spot-film distance. The authors suggest that sufficiently accurate 3-D reconstruction may be achieved when H greater than or equal to 100 cm and H/S less than 2.


Cyclotron fast neutron RBE for various normal tissues.

The relative biological effectiveness (RBE) values of fast neutrons as a function of dose in the range of dose per fraction being used clinically are reported for effects on several normal mouse tissues. The specific tissues examined were: thymus, spleen, white blood cells (WBC), testes, and small intestine. The RBE values for damage to the thymus (1.2), spleen (1.2), WBC (1.0), and testes (3.0) were independent of neutron dose size. In contrast, the RBE for the small intestine varied between 2.7 and 3.4 and was dependent on the size of the neutron dose. The RBE for intestinal death (2.4) and hematopoietic death (1.1) also is reported.


Dose-time relationships for skin reactions and structural damage in rat feet exposed to 250-kVp x rays.

The effects of fractionated irradiation on the feet of rats were the subjects of a time-dose study. The doses required to produce various levels of early skin damage, late skin damage, and late structural damage were determined for single doses and for treatments employing three fractions per week and lasting up to 50 days. The data did not follow the relationship first proposed by strandqvist, in which dose is proportional to time-n; rather, when the normal-tissue reactions were plotted on a linear-coordinate graph, they formed parallel time-dose isoeffect curves with distinct positive curvatures.


Biphasic injection for femoral and aorto-femoral arteriography utilizing a standard pressure injector.

A simple method of obtaining a biphasic injection of contrast material with a standard pressure injector was developed for aorto-femoral and unilateral iliac-femoral arteriograms. An improvement in the degree of arterial filling, the quality of visualization,and the almost complete elimination of repeat injections was noted.


"Arthrography diagnosis of synovial cysts of the knee.".

A lateral view of the knee in 90 degree flexion can reveal popliteal cysts which do not show on routine arthrography. Flexion causes transfer of intra-articular fluid to the posterior portion of the joint space, lowering pressure within the cyst and allowing it to fill with contrast media.


T-tube tract dilatation for removal of large biliary stones.

A technique used for removal of residual biliary tract stones, too large to be withdrawn through a T-tube tract, is reported. Telescoping Teflon catheters were used in one patient to dilate the tract sufficiently to remove the stone with the Dormia type wire basket.


The influence of route of vaccination on the systemic and local immune response in the pig.

The influence of the route of vaccination on the systemic and local immune response has been studied in the sow with ferritin antigen using three methods of vaccination: 1. intramuscular with Freund's complete adjuvant (FCA); 2. intramammary without FCA; 3. intramammary with FCA. Intramammary vaccination was found to be superior to intramuscular vaccination in producing both a local and systemic response. Folowing stimulation by either route, antibody activity was found in all immunoglobulin classes, the major amount of antibody activity in a body fluid correlating with the major immunoglobulin class in that fluid. Antibody production was increased in all immunoglobulin classes by using FCA. Vaccination of one gland resulted in antibody activity in the secretions of the other mammary glands.


Relationships of concentrations of certain blood constituents with milk yield and age of cows in dairy herds.

Regression analyses were performed on data from 48 Compton metabolic profile tests relating the concentrations of certain constituents in the blood of dairy cows to their milk yield, age and stage of lactation. The common partial regression coefficients for milk yield, age and stage of lactation were estimated for each blood constituent. The relationships of greatest statistical significance were between the concentrations of inorganic phosphate and globulin and age, and the concentration of albumin and milk yield.


Neutralising antibody to herpesviruses dervied from wildebeest and hartebeest in wild animals in East Africa.

The sera of 728 game animals, collected in East Africa, were tested for neutralising antibody to a strain (WC11) of wildebeest herpesvirus, which is an important cause of malignant catarrhal fever of cattle. In addition, 290 of these sera were tested for neutralising activity against a closely related herpesvirus (K/30) from hartebeest (Alcelaphus sp.). Antibody was frequently present in three species of the subfamily Alcelaphinae (wildebest, hartebeest and topi) and one of the subfamily Hippotraginae (oryx). No activity was found in the sera of nine other species of four additional subfamilies. The proportion of hartebeest sera positive for WC11 virus (60 per cent) was not significantly different from that neutralising the K/30 isolate (77 per cent) and antibody titres against the two agents did not differ significantly. Of 62 topi sera 40 per cent neutralised WC11 virus, while all of three oryx sera were positive. It is suggested that the antibody detected in hartebeest, topi and oryx was induced by infection with viruses related to, but not identical with, the WC11 and K/30 strains. Some characteristics of the latter indicated that it was not the usual herpesvirus of hartebeest and may have been derived from wildebeest. It is proposed that the group of viruses involved should be provisionally designated as 'alcelaphine herpesviruses' in order to separate them from the rest of the 'bovid' herpesviruses, a name proposed by the Herpesvirus Sbucommittee of the International Committee on the Nomenclature of Viruses.


Changes in the ultrastructure of cardiac muscle in steers deprived of copper.

Young Friesian steers were fed for nine months on copper supplemented or depleted diets. Immediately after they had been killed, tissues were taken from the myocardium for examination by electron microscopy. Copper deficiency was associated with extensive changes in myofibrillar and mitochondrial morphology and distribution. It is suggested that the ultra-structural changes in the myocardium were specifically attributable to copper deficiency, the most likely underlying biochemical defect being lost of cytochrome oxidase activity.


Effects of female sex hormones on uterine motility and reactivity to oxytocin in goats.

Uterine motility was recorded for several weeks in 10 ovariectomised goats, using small intra-uterine balloons, to study the effects of female sex hormones on uterine activity and reactivity to oxytocin. Oestradiol stimulated uterine contractions and increased both the sensitivity and intra-uterine pressure response to oxytocin. When progesterone was administered in addition to oestradiol, spontaneous uterine motility became irregular with low amplitude contrations; the sensitivity and reactivity to oxytocin was significantly depressed.


Iron stores of liver, spleen and bone marrow, and serum iron concentrations in female dairy cattle in relationship to age.

Storage iron in spleen, liver and bone marrow of cattle significantly increased after three years of age, reached mximal concentrations at five years and remained constant until nine years of age. Storage iron concentrations were always highest in the spleen. In liver and bone marrow much lower concentrations were found. In contrast to storage iron, serum iron remained relatively constant between one and eight years of age.


Seasonal variations in the gastro-intestinal nematode populations of Scottish hil sheep.

In each of two consecutive years, groups of breeding ewes were removed from a hill farm in the west of Scotland on four occasions, namely late pregnancy, early lactation, autumn and early winter. At slaughter the major nematode genus present in the alimentary tract was Ostertagia, with O circumcincta the predominant species but three species previously found in Scottish hill sheep, Bunostomum trigonocephalum, Strongyloides papillosis and Chabertia ovina were absent. An absolute increase in total nematode burden and faecal egg count was apparent in the ewes commencing in late pregnancy, reaching a maximum during lactation and falling again in autumn and early winter. This peri-parturient increase in the nematode population could not be solely attributed to the maturation of previously inhibited larval stages but was primarily the result of the development of recently ingested infection; the latter situation thought to be due to a temporary relaxation of immunological response by the ewe at parturition or early lactation. Serum pepsinogen values in ewes remained elevated throughout the grazing season and were always higher than those of their lambs, suggesting that the ewe, although allowing few parasites to become established, was under considerable challenge in the autumn. The worm burdens of the lambs were always low in autumn and early winter with Ostertagia spp being the major genus present during the autumn and Trichostrongylus spp being the predominant genus during the early winter.


Villous atrophy in pigs orally infected with Salmonella cholerae-suis.

The macroscopic and microscopic appearance of villous atrophy in weaned pigs orally infected with Salmonella cholerae-suis is described. The other intestinal diseases of pigs in which villous atrophy occurs are discussed.


The hepatic uptake of individual free fatty acids in sheep during noradrenaline infusion.

Hepatic portal and arterial blood flow and the net hepatic uptake of individual free fatty acids (FFA) were measured in sheep during intravenous infusions of saline and noradrenaline (2 mu kg-minus 1 min-minus 1). During noradrenaline infusion in FFA increased in the circulating (arterial) plasma in amounts oleate greater than palmitate greater than stearate. Changes in the hepatic uptake of FFA opposed these changes in plasma FFA composition; the hepatic uptake of oleate increased more than that of palmitate, and the uptake of stearate fell slightly, but not significantly.


Preparturient changes in allantoic fluid and fetal plasma from chronically catheterised ewes.

Before birth a marked rise in the potassium/sodium concentration ratio of allantoic fluid coincided with a similar rise in the corticosteroid levels of fetal plasma. The prepartum corticosteroid increase started at 134-136 days gestational age whether delivery occurred at 141 or 151 days.


The effect of the administration of Solanum malacoxylon on the chick.

Replacement of the drinking water of chicks maintained on a normal mixed protein diet with an aqueous extract containing the equivalent of 5 g of the dried leaves of Solanum malacoxylon (DLSM) per 100 ml for one month produces a hypercalcaemia (23-49 per cent), hypomagnesamia (28-37 per cent), hypophosphataemia (26-34 per cent), hypouricaemia (29-34 per cent) and a decrease in plasma alkaline phosphatase activity (54-98 per cent). The ash content of the defatted, dried tibiae and the body weight of the DLSM treated chicks were also significantly lower (37-7 per cent and 17-79 per cent respectively) than the corresponding values for the untreated birds. The results obtained are similar to those reported for hypervitaminosis D3 in the chick.


Anthelmintic activity of pyrantel tartrate against Ascaridia galli in fowls.

At a dose of 15 mg/kg body weight, pyrantel tartrate was 18-51, 99-63, 100 and 100 per cent effective in chickens treated at 10, 20, 30 and 40 days respectively after infection with Ascaridia galli. Similarly, 25 mg/kg was 14-44, 100, 100 and 99-63 per cent effective.


Experimental Rift Valley fever in West African Dwarf sheep.

West African Dwarf sheep were challenged with a low mouse brain-passaged Rift Valley fever virus (Ib-AR 55172) isolated from Nigeria. Viraemia, mild febrile reaction and neutralising antibodies were demonstrated in inoculated animals.


A simple method for isolating leucocytes from bovine blood and their separation into lymphocyte and granulocyte fractions.

A method for the separation of leucocytes from bovine blood and its separation into lymphocyte and granulocyte fractions is described. The method, involving flash lysis of the erythrocyte population, was found to yield large numbers of viable cells suitable for maintenance in tissue culture medium and hence of value in immunological studies.


Experimental infection of lambs with an aerosol of Pasteurella haemolytica.

Specific pathogen free lambs were exposed to an aerosol of Pasteurella haemolytica. Ten lambs vaccinated with an adjuvanted killed P haemolytica vaccine and nine units of P haemolytica administered in an aerosol. Pneumonia histologically indistinguishable from natural pneumonic pasteurellosis occurred in one vaccinated lamb and in four control lambs.


Protein electrophoretic pattern of Pasteurella haemolytica.

Electrophoresis in polyacrylamide gels of the constituent proteins of the 12 serotypes and an untypable strain of Pasteurella haemolytica showed a pattern of bands that divided the group into two. This division conformed to the A and T biotype groupings of Smith (1959) although the serotype A9 showed only minor band difference from the three T serotypes 3, 4 and 10. It was not possible by this method to separate all the type strains from each other by the specific recognition of the patterns of protein mobilities produced.


Regional and total lung function studies in patients with hemidiaphragmatic paralysis.

Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.


Regional ventilation-perfusion relationships.

Regional ventilation-perfusion ratios have been determined in 12 healthy subjects, 16 patients with pulmonary embolism, and 22 patients with chronic obstructive lung disease. The ventilation-perfusion ratios were determined from xenon-133 ventilation studies and 99-tc-m-labeled particle perfusion scans, using either the fractional exchange of air or the relative distribution of tidal volume per unit volume as the numerator of the ratio. A comparison of these two methods showed comparable distributions of regional ventilation-perfusion relationships in the healthy subjects and patients with pulmonary embolism. However, in the patients with chronic obstructive pulmonary disease, the fractional exchange method clearly separated this group of patients from the others.


[Nomogram for the determination of arterial oxygen partial pressure of man in relation to high altitude and in dependence from age (author's transl)].

If somebody ascends from sea level to higher altitude within a short time, the change of the atmospheric conditions can be a danger for his life. Therefore, a nomogram was constructed which allows to read off the arterial oxygen partial pressures and the corresponding arterial oxygen saturation in relation to altitude. On the basis of the oxygen partial pressure of the atmosphere determined by steps of 500 m from sea level up to an antitude of 10,000 m, we calculated the decrease of the oxygen partial pressure from the inspired air to the arterial blood. When passing our airways, the inspired oxygen partial pressure is dimished by the adaptation to BTPS conditions and by the increasing CO2 partial pressure when approaching the alveolar gas exchanging zone. Another oxygen partial pressure gradient formed by inhomogeneities of ventilation to perfusion, diffusing capacity to perfusion and shunt perfusion is found at the alveolar-arterial barrier. The value of this alveolar-arterial oxygen partial pressure difference is closely correlated to age. With the values of the single steps, the nomogram was constructed. Seven abscissas show the oxygen partial pressure gradients from the inspired air at a distinct altitude to the arterial blood. In relation to a lot of CO2-depending oxygen dissociation curves, it is possible to read off additionally the corresponding arterial oxygen saturation for a person in rest up to an altitude of 10,000 m.


A model of the pathways of inhaled medicaments to their receptor sites.

From controlled inhalation experiments with bronchotropic substances, it becomes clear that the 'dust model of the lungs' is inadequate in explaining the 'facts and findings' of drug inhalation. Two pathway flow charts are worked out, permitting a more specific description of the transport processes involved, in order to meet the need for a more appropriate model.


A short-term memory in the respiratory centres: statistical analysis.

It has been observed previously that the successive values of depth and duration of respiratory cycles recorded in man are not independent random variable. The present study has been performed in order to test whether a serial dependence of the characteristics of the respiratory cycles results from an inherent property of the central respiratory oscillator. In the "isolated respiratory centre" preparation of the cat (spinalized, bivagotomized, curarized and artificially ventilated) the following respiratory data have been studied: the value of integrated phrenic discharge per breath (S), inspiratory duration (TI), expiratory duration (TE) and total cycle duration (T), at rest and during hypercapnia and hyperthermia. Each recording in a steady-state condition provided a set of four series of data; using statistical analysis of time series the following results were obtained: 1. In each series the successive values are not independent random variables. This suggests that a cycle may be considered as an event whose characteristics condition those of the following cycle. 2. TE is not independent of the preceding TI, and TI is not independent of the immediately preceding TE. However, this last relation cannot be asserted in hypercapnia and hyperthermia. 3. A positive correlation exists between S and TI. This result indicates that a simultaneous adjustment of S and TI, in terms of one another, does exist in absence of the vagal mechanism.


Vertical gradients of pleural and transpulmonary pressure with liquid-filled lungs.

In supine dogs with saline-filled lungs the vertical gradient of pleural surface pressure (VGPpl) was not significantly different from -1 cm H2O/cm and that of transpulmonary pressure (VGPtp) was not significantly different from zero. Hence the hydrostatic gradient of the liquid was entirely taken up by the chest wall, the ribs being rigid in the direction of gravity and the diaphragm facing an equal hydrostatic gradient on both sides. In head-up dogs VGPpl was -0.8 cm H2O/cm when the level of the liquid in the filling system was 19.5 cm below the lung top and -0.5 cm H2O/cm when this level corresponded to the top. The hydrostatic gradient of the liquid was not entirely taken up by the rib cage because of its uneven regional compliance and VGPtp was reversed with respect to that of the air-filled lung. With fluorocarbon (specific gravity 1.75) filled lungs in the supine posture VGPpl was about -1.28 cm H2O/cm and VGPtp was reversed. In the head-up posture VGPpl was about -1.2 cm H2O/cm and VGPtp was reversed.


Intraspecies differences in lung metabolism and granular pneumocyte mitochondria.

The authors used waltzing and nonwaltzing mice to examine granular pneumocyte mitochondria and lung oxygen consumption and protein synthesis. They found that the oxygen consumption of lung slices from waltzing mice is higher than that of lung slices from nonwaltzing mice. The volume density of granular pneumocyte mitochondria is higher in waltzing than nonwaltzing mice as is their number per 100 mum-3 of cytoplasm. The mean, length, width, volume and surface density of individual mitochondria are the same in both groups. The incorporation of [14-C]leucine by lung slices into protein in a surface active lung fraction is greater in lung slices from waltzing than nonwaltzing mice. This difference occurs in the face of similar levels of free leucine in both groups. The authors conclude that there are intraspecies differences in lung oxygen consumption and protein synthesis and in the volume density and number of granular pneumocyte mitochondria.


Occlusion pressure as a measure of respiratory center output in conscious man.

The output of the "respiratory centers" has been estimated by measuring ventilation, inspiratory muscle power, EMG of the diaphragm, and by various other means, each of which has serious disadvantages. The static pressure generated by the inspiratory muscles at FRC against an obstructed airway is here suggested as a useful alternative. Ten conscious, normal, sitting human subjects were subjected to CO2 rebreathing (Read, 1967) and their airways were occluded at end-expiration at intervals without the subjects being aware in advance. The inspiratory pressure waves so generated were found to be distorted by conscious or unconscious responses to the occlusion which had a minimum latency of 0.15 sec. The pressure generated at 0.1 sec after the onset of inspiration (P0.1) was nevertheless easy to measure and was reproducible in each subject. The CO2 response obtained by plotting P0.1 against PCO2, was curvilinear, the P0.1 increasing more rapidly at high PCO2. The P0.1 is independent of pulmonary mechanics. Since it measures the rate of rise of inspiratory activity and not the peak activity it is also independent of mechanisms that alter the respiratory pattern by affecting inspiratory duration, in particular the vagal volume-related inspiratory-inhibitory reflex. It is concluded that measurements of P0.1 represent a useful index of the output of the respiratory centers.


Breath holding and rebreathing at low and high altitude.

Breath holding and rebreathing have been carried out at sea level in lowlanders and at high altitude in acclimatized lowlanders and in highlanders. It has been shown that the values of gasping time, breath-holding time, rebreathing time and the composition of the alveolar gases at the breaking point are modified by chronic hypoxia, especially in highlanders. The modifications observed can be explained by different sensitivities to humoral stimuli of the different groups of subjects. The importance of nonhumoral factors, as studied by comparing apnea and rebreathing, seems modified at altitude, especially in highlanders, although the mechanism of this change is unknown.


Gas transport efficacy of gills, lungs and skin: theory and experimental data.

The general functional principles encountered in respiratory organs of vertebrates are investigated. Generally three steps are involved in external gas exchange in vertebrates: (1) convective transport by flow of external respiratory medium, air or water (=ventilation); (2) transfer of gas between external respiratory medium and blood by diffusion (=medium/blood transfer); (3) convective transport by blood flow (=perfusion). According to the arrangement of external medium flow relative to capillary blood flow four construction principles may be distinguished: (a) counter-current system (fish gills), (b) cross-current system (avian lungs), (c) ventilated pool system (mammalian lungs), and (d) infinite pool system (amphibian skin). The gas transfer performance of these systems is analyzed in terms of conductances, relative partial pressure differences and limitations attributable to ventilation. to medium/blood transfer and to perfusion. The theory is applied to analysis of gas exchange data obtained in an elasmobranch fish, domestic fowl, dog and a lungless salamander. The analysis shows that, despite distinct differences in maximum efficiencies of these systems, the differences in efficiency values actually attained are much less pronounced, and may be even less marked when taking functional inhomogeneities into account which are neglected in this study.


On equation of gas transport in the lung.

Based upon Weibel's lung model, an equation which describes one-dimensional gas transport in the lung is derived. It is shown in this equation that the gas transport in the airways is due simultaneously to bulk motion and longitudinal diffusion. The longitudinal diffusion consists of the usual molecular diffusion and an apparent diffusion which arises from nonuniform distribution of the gas to the airways and a profile-interaction effect of the gas due to Taylor's mechanism in each individual airway. Expressions for the apparent diffusion coefficient are obtained. This apparent diffusion, which has been neglected in almost all previous studies of gas transport in the lung, is shown to be of dominant importance in the upper airways.


The functional anatomy of the pulmonary circulation of the domestic fowl.

The architecture of the pulmonary circulation in the domestic fowl was studied in 30 birds of different breeds by injection techniques and serial sections. The branches of the cranial, caudomedial and caudolateral rami of the pulmonary artery form interparabronchial arteries which are essentially transverse to the long axis of the parabronchi. At the periphery of the parabronchus they give rise to intraparabronchial arterioles which form capillaries in the exchange tissue. Most of the capillaries drain into atrial veins via intraparabronchial venules. The atrial veins lie near the parabronchial lumen below the interatrial septa. Some of the capillaries empty into septal venules which form a network underneath the atrial muscles and empty into the atrial veins. The atrial veins draining any particular region converge into a single intraparabronchial vein which penetrates the exchange tissue radially to join an interparabronchial vein. The interparabronchial veins contribute to the cranial and caudal radices of the pulmonary vein. The anatomical pathways of blood and gas indicate a cross-current relationship between pulmonary arterial blood and bulk parabronchial gas flow, and a counter-current relationship between capillary blood and gas in the air capillaries.


Sudden cold water immersion.

Cold water is known to facilitate the drowning process. To gather information on the possible relationship between ventilation and cold stimuli, measurements of inspired and expired breath by breath ventilation and alveolar PCO2 were made on 8 male subjects suddenly immersed in both cold (11 degrees C) and warm water (28 degrees C). The mean ventilation for all subjects for the 1st three breaths following cold water immersion was 94.5, 71.3 and 94.6 L/min (BTPS) as compared to 60.0, 36.2 and 38.5 L/min (BTPS) for warm water immersion. Alveolar CO2 fell dramatically in cold water from a pre-immersion mean value of 36.4 torr to 23.9 torr, whereas there was only a change associated with the first few breaths following immersion in warm water. In prolonged cold exposure, ventilation was still markedly above that observed in warm water after 5 min. There was no relationship between skin fold thickness and ventilatory response over the period studied. A large increase in ventilations is likely to result in inefficient swim stroke mechanics. This, combined with a high probability of inspiration of water, may contribute to death as a consequence of cold water exposure.


A sigmoid model of the static volume-pressure curve of human lung.

The authors present a sigmoid mathematical model of the pressure-volume curve of the human lung, based on a relationship between the specific compliance and the maximal pulmonary volume: (see article). This model fits better the experimental data obtained in 20 young normal adults than the currently used exponential model of Salazar and Knowles (1964). The independence between the constant K' and body height is interpreted as a constancy of pulmonary structure for normal subjects of the same age range.


Postnatal growth of the mammalian lung: lack of influence by carbon monoxide exposure.

The growth and internal partitioning of the lung are increased in young animals exposed to high altitude. Neither the mechanism whereby O2 lack brings this about nor the anatomic site of action of hypoxia is known. To test whether extrapulmonary tissue hypoxia can stimulate lung growth in the prescence of normal alveolar PO2, pulmonary morphology was studied quantitatively in young rats exposed to 208 ppm carbon monoxide for 29-30 days. The results show no effect of this exposure on lung dimensions and thus argue against extrapulmonary tissue hypoxia as the relevant stimulus in the increased lung growth that occurs at high altitude.


A single-unit carbon dioxide-oxygen sensing microelectrode system.

A membrane-covered CO2 microelectrode system is described; it consists of a platinum electrode surronded by a ring-shaped Ag-AgCl electrode, both in contact with an electrolyte layer composed 10 minus 3 M/l quinhydrone in 0.1 N KCl. The resulting oxidation-reduction potential is shown to vary linearly with the logarithm of the PCO2 of the medium. Response time for 95% deflection to a step change in PCO2 of 65 mm Hg is about 1 min i.e. considerably less than in the macroelectrode described previously, but stability is decreased at the same time. Since oxygen in concentrations up to about 21% (air) did not influence the CO2 response and the presence of both CO2 (10.33%) and quinhydrone (10 minus 3 M/l) did not alter the oxygen polarogran, this electorde may be used independently as an oxygen electrode as well. Stability and response time for oxygen were similar to those of the Clark electrode. Possibilities and limitations for in vivo estimation of PCO2 and PO2 are discussed.


Phenylbutazone and hepatitis.

During a comparative trial  between enteric-coated and rectally administered phenylbutazone in patients with rheumatoid disease, one patient developed a mild hepatitis. She had recently concluded a long period of gold therapy. The natural history of phenylbutazone hepatitis is reviewed on the basis of 41 case histories, and the experience with this individual patient interpreted accordingly.


[Radioimmunoanalysis of plasma testosterone].

A simple radioimmunoassay procedure for the determination of testosterone concentration in plasma is described. Small amounts of plasma, 0,5 ml for males and 1 ml for females, are extracted with diethyl ether. Recoveries for the extraction are obtained by the addition of labelled tesosterone. The radioimmunoassay is performed directly on the extracts without further purification. Separation of the free from the antibodie bound testosterone is achieved with dextran coated charocoal. Under the used conditions, the calibration curve covers a range between 0,5 and 1,5 ng per sample. Reproducibility is acceptable with a coefficient of variation of 7%. The normal values are slightly higher than those obtained with methods using some purification step of the extract before the assay but due to its simplicity the described method is a suitable one for clinical purposes.


A radiological assessment of osteoarthrosis of the knee: experiments in observer error.

In a trial to determine the best palliative physiotherapy for the painful osteoarthrosic knee, radiological assessment was suggested as a measure for testing homogeneity of treatment groups. Preliminary observer error experiments showed that an accepted standard grading scheme was unsatisfactory. A different system was designed in which all three knee compartments were graded separately (medial, lateral and patello femoral), based on a comparison of supine and erect films. The two systems have been compared in use on the same set of radiographs, and the observer error results are presented. The advantages of grading each compartment separately are discussed.


Cutaneous extensibility in health and disease.

The results are recorded of a number of studies performed over the last few years using a simple and reproducible method for investigating the extensibility of intact skin. A major advantage of this method lies in the fact that it causes the patient no discomfort and leaves his skin without blemish. We have found abnormal behaviour of skin in response to applied stress in the heritable connective tissue disorders: Ehlers-Danlos Syndrome, cutis laxa, and pseudoxanthoma elasticum, and in the acquired disorders of acromegaly, hypopituitarism and scleroderma. An abnormal elastic modulus, however, was found only in pseudoxanthoma elasticum and the growth-hormone disorders.


[Sensitivity of the thyroideal cell to external irradiation].

Evaluation of the variation in thyroid function utilizing 131I uptake in patients exposed to external radiation to the thyroid gland for reasons not related to this gland. The study was initiated with 54 patients who were examined prior to irradiation. They received an average dose of 5.650 r to the gland in a period of 5-6 weeks. Upon completion of the radiation therapy an abrupt drop in the uptake values occurred reaching the hypofunction range and one month later there is a recovery to 80% of the initial level and the value remains stable up to one year. Followed, year after year, a progressive reduction occurs in the uptake value up to a period of 6 years when the 2 surviving patients have returned to the hypothyroid level. The number of patients during the latter years of the study is too low to be statistically significant. The usefulness of this observation is discussed and a comparison is made of the external irradiation effects and the effects of 131I therapy.


[Occurrence and clinical characteristics of thyroid cancer in a hospital population].

The authors reviewed 83.250 clinical histories from the files of a hospital, among which they found 49 thyroid carcinomas whose characteristics they study. It is interesting to note the great incidence of papilliferous carcinoma (53 per cent of cases); a most marked incidence of the condition in female patients; the slight difference in the age of the patients with all types of carcinoma; and, above all, the atypicity of the onset symptoms in a large number of cases (28 per cent). According to these data, the authors suggest that it is advisable to bare in mind the possibility of the presence of thyroid carcinoma in patients with such unmatched pictures as suppurative thyroiditis, sciatica or cervical adenopathy, with absence of goiter, etc.


[Treatment of obesity in patients with changes of carbohydrate metabolism].

The combination of dextroamphetamines, biguanides and choleretics seems to be a good therapy for obese patients with carbohydrate intolerance, since the ponderary curve and carbohydrate tolerance improve. Results obtained are statistically significant.


[Clinical evaluation of glipizide. Results of a multicentric study in Spain].

In this study, with the evaluation of 621 diabetics under treatment, it is shown that glipizide is a potent oral sulfonilurea which controlled satisfactorily the blood sugar levels in 83,5% of diabetics without previous treatment, 67% of the cases with positive response to previous anti-diabetic therapy and 51,3% of the patients that had not responded to previous treatments. The most frecuently used dosage was 5 mg daily, with a minimum of 2,5 mg and a maximum of 30 mg. Tolerance and safety observed was excellent.


[Osmosensitive neurons in the retrochiasmatic area of the hypothalamus. An ultrastructural study].

An ultrastructural study has been conducted of the response of rat retrochiasmatic area neurons to an intraperitoneal injection of hypertonic sodium chloride. The formation of numerous communications between nuclear envelope and the granular endoplasmic reticulum (GER) is seen as a response of these neurons to the osmotic stimulus. Some of the GER cisterns may establish contact with the neuronal membrane. The quantity of polyribosomal rosettes increases, especially in the nuclear cytoplasmic infoldings. These results are interpreted as a change in the programmed activity of synthesis of these neurons. Previous electrophysiologic studies appear to demonstrate the possibility of these neurons being osmoreceptors. These ultrastructural observations seem to confirm this hypothesis.


[Muscular involvement in rheumatic pelvispondylitis].

The authors explored a group of patients suffering from rheumatic pelvispondylitis from the point of view of muscular lesions: clinical muscular examination, anatomo-pathological investigation of the muscle (optical microscopy, histochemistry), electromyographic investigation, and determination of certain serum and muscle enzymes. Some muscular anomalies were observed, which were predominant in the muscles of the lumbar grooves, although there were some lesions of the quadriceps muscle, with a myogenous appearance, but without inflammation. The clearest anomalies were neurogenic and were present particularly in the muscles of the lumbar grooves.


[Treatment of idiopathic femur head necrosis with an appropriate cup with cylindrical support].

The objective of treatment of necrosis of the femoral head by means of an appropriate cup is to protect the sequestrum and to avoid secondary arthrosis. Hemispherical cups have a tendency to be easily deformed; cups with cylindrical support should be used in preference as they are mechanically stable and make it possible to cover the femoral head in cases of relatively extensive necrosis. Good results are obtained quickly and are often spectacular : in 90 percent of the cases operated on, pain disappeared or was reduced and normal socio-professional activity was again possible. A clinical and radiological study of 30 hips treated at least 2 years previously, established that the result was stable in the majority of cases : there was one real clinical and radiological deterioration, two cases of pinching of the interspace. This operation is thus worth while in all cases of necrosis, at the stage when the sequestrum is clearly delimited and when there is clear deformation of the contour of the femoral head. It also seems to be worth while at the "eggshell" stage, when the lesions detected at the time of an operation are aften considerable and appear non-reversible : the quality of the results obtained mean that the criteria of tolerance should be much more severe.


[Changes in the intramedullary pressure in the dog, induced by the section of the pressor nerves].

Effect of section of sino-aortic nerves on intramedullary bone marrow pressure in the dog. In the dog, after section of sino aortic nerves, the intramedullary bone marrow pressure decreases immediately by vasoconstriction. Injection of propranolol decreases further this pressure possibly by action on beta receptors in the bone.


[Mode of action of chlorambucil. Initial metabolic studies using carbon 14 isotope labeling. Rheumatological implications of their results].

Mode of action of chlorambucil first metabolic studies by means of carbon-14 labelled isotpoes rheumatological implications of the results. Chlorambucil, gamma [rho-di(2-chloroethyl) aminophenyl] butyric acid, was labelled in either the carboxylic group (Ia), the mustard radical (Ib), or the carbon atom in the aplha position in the carboxylic group (Ic). The first studies by total autoradiography of mice, by organ fixation, by analysis of urine, faeces, and  expired air of rats, and by microautoradiography of sections of organs and smears of tissues from rats and rabbits produced the following results: the metabolism of chlorambucil includes a long hepatic time; the molecule undergoes beta-oxidation almost certainly in the liver; thenthe oxidized form become localized in two potential target organs: the thymus and the bone marrow; there is no elective fixation in normal joints of any ot the three labelled compound studied; on the other hand, with all three molecules, there was elimination via the bile ducts, slight movement into the thoracic canal, and labeling ofHarder's glands (particularly with Ia and Ic); elimination of the three compounds in urine was complex. These facts suggest that chlorambucil undergoses activation in the liver, in the same way as cyclophosphamide; however, the similarity end there. The other steps in metabolism give rise to different molecules for these compounds. The high concentrations of chlorambucil in the thymus and the labelling of the marrow cells indicate that the action of this cytostatic compound is primarily immunodepressive.


Hip diseases with rapid chondrolysis. Clinical and anatomical comparison.

Coxopathies with rapid chondrolysis: Comparison of clinical and anatomical findings. Clinical, radiological, laboratory, and antomical data concerning 14 coxopathies with rapid chodrolysis are presented with reference to 12 patients aged from 37 to 77 years. Three criteria define this affection: reduction of the joint space by at least 50 per cent, in one year or less; chondrolysis completed in 1 to 3 years; complete narrowing in the superior part of the joint; isolated narrowing, exceptionally with a discrete osteophytosis. The pain rapidly becomes very severe. Such symptoms are, at first, indicative of coxitis, but the establishment of a radio-clinical picture of coxopathy rapid chrondrolysis is more indicative of an arthrosic origin. This could represent a particular evolutive stage of coxarthrosis related to the initial chondrolytic phase of rapid destructive coxarthrosis. From an early stage, the anatomical facts indicate an association between the degenerative lesions and the non-specific inflammatory lesions of the synovial membrane. These facts are interpreted, on the basis of data in the literature, as an indication of synovial lesions caused by the liberation of osteocartilaginous fragments. The problem of the pathogenesis of this rapid chondrolysis is then discussed.


The effect of induced arterial hypertension upon regional blood flow in subcutaneous tissue in patients with arterial insufficiency of the legs.

In nine patients with arterial insufficiency of the legs, the effect of induced arterial hypertension upon blood flow in subcutaneous tissue was correlated to the changes of blood flow in subcutaneous tissue during dependency. Arterial pressure was increased by constant intravenous infusion of angiotensin. Blood flow in subcutaneous tissue was measured 10 cm distal to the head of fibula, at the lateral malleolus, and at the base of the first toe by means of the xenon washout technique. It was found that in areas where blood flow decreased during dependency, blood flow decreased during angiotensin infusion. An increase in blood flow during angiotensin infusion was seen in areas where blood flow increased during dependency. It is concluded that the effect of angiotensin infusion on blood flow and of therapeutically induced hypertension can be predicted from the effect of orthostatic changes on blood flow. The results obtained support the hypothesis that the vessels behave as passive channels (i.e. blood flow depends mainly upon arterial perfusion pressure) in areas where the normal vasoconstrictor response to increased transmural pressure is abolished.


Microcalorimetric measurements of heat production in whole blood and blood cells of normal persons.

Microcalorimetric measurements have been made of the heat production in whole blood and its major cell fractions. All measurements were made with samples from normal subjects. The average heat effect value found (plus or minus S.D.) for whole blood was 62 plus or minus 7 mW/l. The value obtained for erythrocytes was 82 plus or minus 6 mW per liter of packed cells suspended in phosphate buffer at pH 7.4. For lymphocytes and for polymorphonuclear leukocytes heat effect values were 4.6 plus or minus 1.8 and 1.2 plus or minus 0.4 pW/cell, respectively, for cells suspended in buffer. For plasma suspensions corresponding values were 2.2 plus or minus 1.4 and 3.5 plus or minus 1.0 pW/cell, respectively. For thrombocytes suspended in plasma the heat effect value was 59 plus or minus 8 fW/cell. Heat production in cell-free plasma was close to zero. Using heat effect values determined for the different cell fractions, values could be calculated for whole blood samples which were in full agreement with the values obtained by direct measurements of whole blood.


The concentration of ketone bodies, free fatty acids, and glycerol in the blood of obese perons after injection of insulin and glucose. Studies before and during absolute fasting.

The blood patterns of acetoacetate (AA), 3-hydroxybutyrate (3-HB), free fatty acids, and glycerol were registered after intravenous injection of insulin or glucose in seven obese persons. In each individual investigated the study with insulin was carried out first and that with glucose 2 days later. Both sets of studies were repeated after 8 and 10 days of absolute fasting. In the studies both before and during fasting the concentration of AA and 3-hb in blood varied independently of lipolysis. It is concluded that determination of only one of the ketone bodies is an insufficient expression for changes in total ketone body concentration ana that the peripheral metabolism of AA during the fasting studies was less than the production of AA after injection of insulin or glucose, whereas the opposite was the case in the prefasting studies.


Cardiopulmonary function in former girl swimmers and the effects of physical training.

Sixteen former girl swimmers were studied in 1971 before and after 12 weeks of physical training. These girls constituted a representative selection from a group of 30 girls swimmers studied in 1961 (3). Maximal oxygen uptake increased by 14%, to 2.47 l/min, whereas heart volume and vital capacity remained unchanged. Cardiac output and intrapulmonary gas exchange were also studied in 6 girls. Cardiac output in maximal exercise was 15.3 l/min; heart rate, 185 beats/min; stroke volume, 83 ml; and the arteriovenous oxygen diffence, 15.6 ml/100 ml. The stroke volume did not show the usually good correlation with heart volume. Normal values for V-E/V-O2, V-A/VO-2, V-A/Q, and PAO2-Pao2 were found both at rest and during exerice. The increase in maximal oxygen uptake after training was related to the increase in stroke volume. No increase was found in values for pulmonary gas exchange nor in the maximal arteriovenous oxygen difference. The results obtained suggest that a long period of previous intense physical training does not significantly influence the maximal aerobic power later in life when again sedentary. Moreover, the observed increase of 14% in VO2, max after 12 weeks of training may not be large enough to prove any advantageous effects when training is resumed.


Characterization of R-type vitamin B12-binding proteins by isoelectric focusing. II. Comparison of cobalophilin (r proteins) from different sources.

The R-type vitamin B12-binding proteins, here called cobalophilin, in human plasma, serum, leukocytes, gastric juice, amniotic fluid, and milk, were characterized by isoelectric focusing and gel filtration. Cobalophilin from all these sources in microheterogenous, consisting of several isoproteins with isoelectric points (pI) between 2.3 and 5.0. Isoproteins with pI values of 3.0, 3.3, 3.6, 3.9, and 4.2 were found in most of the cells and fluids studied, but in different proportions. Milk contains isoproteins with pI values mainly between 4.0 and 4.7, and such components also occur in considerable amounts in saliva. The cobalophilin in these fluids also has a smaller Stokes radius than that from other sources. On the basis of the isoelectric patterns and the Stokes radii the isoproteins of cobalophilin are tentatively divided into two populations, a glandular one occurring in milk and saliva and a myelogenic one occurring in all the cells and fluids studied but only occasionally in milk.


Determination of amylase activity and amylase isoenzymes in serum and urine using a solid phase blue starch substrate.

The alpha-amylase of serum and urine was determined in 40 healthy people using the modified "Phadebas Amylase Test". The original method was modified by decreasing the incubation volume to one millilitre and by adding to all urine speciemens a small amount of albumin in saline. The normal values obtained are slightly higher than those obtained by the original method. The amylase isoenzymes were likewise determined from the serum and urine of the same 40 healthy people. For separation were used electrophoresis on cellulose acetate and Phadebas tablets as substrate. These urine and serum isoamylases were investigated and compared. The distributions obtained deviate somewhat from ones reported earlier. The clinical usefulness of isoamylase is briefly discussed.


Digital densimeter for simple determination of urinary density.

Urinary density can be determined by measuring the change in the natural frequency of a hollow oscillator when filled with liquids of different density. The method requires only 0.6 ml of sample, and the precision is plus or minus 2. 5 - 10-4 g/cm-3. For clinical use a determination rate of approximately 60 samples an hour with a precision of 1 - 10-3 g/cm-3 may be reached.


Bone-marrow biopsy with the bordier trephine.

The experience gained within a 12-month period in 89 bone-marrow biopsies performed by means of the Bordier trephine is reported. The Bordier trephine is larger (inner diameter, 5 mm) than other previously described instruments devised for bone-marrow biopsy. The specimens are taken from the region posterior to the anterior superior iliac spine below the iliac crest, using a special cutting technique by which the bone is completely perforated. The trephine is easy to use and, by the proper technique, invariably yields suitable histological material. From a diagnostic point of view, the large size of the specimen obtained is a great advantage. The only complication encountered in the series was the development of a haematoma in a non-thrombocytopenic patient. EDTA is recommended for the decalcification of the specimens.


Morphological features in the peripheral blood film indicating the presence of cryoproteins.

Light gray, irregular threads in a May-Grünwald & Giemsa stained blood film made of EDTA-blood some time after drawing may sometimes call attention to a previously unsuspected cryoproteinaemia. The cryoproteinaemia discovered in this way in our patient consisted of IgG complexes resulting in proteinuria. After treatment with prednisone and cyclophosphamide the cryoproteinaemia and proteinuria disappeared.


The effect of vitamin E on haemolysis in paroxysmal nocturnal haemoglobinuria: in vitro and in vivo studies.

The administration of vitamin E, a natural antioxidant, to a patient with paroxysmal nocturnal haemoglobinuria (PNH) failed to diminish the urinary excretion of 59-Fe as monitored by 59-Fe whole body counting and urinary loss of isotope. However, in vitro vitamin E corrected the increased sensitivity of PNH red cells to haemolysis by hydrogen peroxide. These results support the concept that the susceptibility of PNH red cells to lipid peroxidation is an in vitro phenomenon bearing little relation to the mechanism of in vivo haemolysis.


Erythropoietin formation in rats with experimental hypersplenism.

Splenomegaly accompanied by anaemia, increased reticulocyte and decreased thrombocyte counts, was induced in Wistar rats by a long-term intraperitoneal administration of methylcellulose. Compared to controls, hypersplenic rats showed significantly enhanced utilization of 59-Fe by red cells and increased titre of erythropoietin. After the exposure of rats to hypoxic hypoxia corresponding to an altitude of 7,000 m for 6 h, no difference in the erythropoietin titre was found in either group. The results suggest that experimental hypersplenism alone does not affect the production of erythropoietin and does not stimulate the formation of an inhibitor of erythropoietin or erythropoiesis. The increased titre of erythropoietin and enhanced utilization of radioiron by red cells in rats with hypersplenism were found to be due to haemolytic anaemia leading to the stimulation of erythropoiesis.


Erythrophagocytosis in the human bone marrow as disclosed by iliacal bone biopsies.

Erythrophagocytosis in human bone marrow has been studied in selected series of iliacal bone biopsies embedded in methacrylate or epoxy resin. Using established light microscopic criteria for recognition of the early digestive erythrophagic vacuole, intense erythrophagic activity was encountered in a series of 5 patients with haemolytic disease. A series of 32 biopsies, selected to represent 'normal' bone marrow, demonstrated low or modest erythrophagic activity in all cases. The findings are in accordance with previous demonstration of erythrophagocytosis in human bone marrow at autopsy and point to the bone marrow as the main site for destruction of aged red cells in the healthy human organism.


Studies of leukocyte exudates in cyanate-treated animals.

Cyanate (NCO), which impedes sickling by increasing the oxygen affinity of sickle haemoglobin, may react with many proteins in the body and potentially interfere with many functional systems. Leukocyte glycogen was studies because elevated liver glycogen has been noted after high dose NCO treatment in rats. Leukocyte function was also studied in peritoneal exudates. In animals given NCO alone, blood leukocyte glycogen was 2.8 plus or minus 0.3 (SE) mg per 10+9 WBC while control values were 3.3 plus or minus 0.6, a difference not statistically significant. In casein-induced peritoneal exudates, more WBC were recovered from NCO-treated animals (265 x 10+6 WBC vs. 214 x 10+6 WBC; P = 0.0009). Glycogen in blood leukocytes of casein-stimulated animals was not significantly different from NCO-treated animals. Leukocyte glycogen in peritoneal exudates was markedly increased over blood leukocyte glycogen in both controls (19.4 plus or minus 0.6 vs. 2.7 plus or minus 0.3 mg per 10+9/WBC; P less than 0.0001) and NCO-treated animals (17.5 plus or minus 0.7 vs. 3.6 plus or minus 0.5 mg per 10+9 WBC; P less than 0.001), although levels in exudates from control and NCO-treated animals did not significantly differ from each other. 14-C-glucose incorporation into glycogen was significantly increased (P = 0.020) in exudate leukocytes of NCO-treated animals. Initial phagocytic rates were equal in exudate leukocytes of control and NCO-treated animals. Although NCO treatment has demonstrable effects on ome aspects of leukocyte glycogen metabolism, exudation of leukocytes and phagocytic function are not impaired.


The role of blood platelets in the precipitation of soluble fibrin by endotoxin.

This study is intended to clarify whether or not platelets are essential to endotoxin-induced precipitation of soluble fibrin representing the second phase of microclot formation. Renal glomerular microclots could be observed in extremely thrombocytopenic rabbits to the same extent as in normal rabbits after the injection of endotoxin into animals with circulating soluble fibrin. Thrombocytopenia was induced by feeding rabbits busulphan, and soluble fibrin was produced by infusing ancrod. The experiments indicate that platelets are not essential to the endotoxin-induced precipitation of soluble fibrin.


Neutrophil kinetics in corticosteroid induced neutrophilia measured by plasma lysozyme.

A single dose of prednisone (2 mg/kg orally) resulted in a mean rise in neutrophil counts to 2.3 (range 1.5-3.6) and a mean decrease in plasma lysozyme to 0.73 (range 0.50-0.87) times the value before the steroid was given in 10 haematologically normal persons. There was no change in the intraneutrophilic lysozyme activity. It is concluded that the decrease in plasma lysozyme is compatible with a reduction in the egress of neutrophils to the tissues and a decrease in the neutrophil turnover rate.


The DNA content of megakaryocytes from the bone marrow and vessels of the lung in rats.

Comparative microspectrophotometry of the DNA content of Feulgen-stained megakarocytes from the bone marrow and from those retained in the pulmonary circulation showed that the ploidy classes 8 N, 16 N and 32 N are found in both bone marrow and pulmonary circulation, whereas the 64 N class is found in the bone marrow ocal 'naked nuclei'.


Cytogenetic studies in myelomatosis.

Cytogenetic studies have been carried out on bone marrow aspirates from 25 patients with myelomatosis. Abnormal stem lines were present in 7 of the patients; the remainder had a diploid chromosome complement. In most patients - also in those without an abnormal clone - some metaphases had a blurred appearance similar to that seen in bone marrow aspirates from patients with acute leukaemia. In many of the chromosome preparations obtained before cytostatic therapy some metaphases with structural aberrations on the chromosomes were seen. Evidence is presented that in the patients with abnormal stem lines in the bone marrow, the chromosome abnormalities are confined to the myeloma cells and are not found in the erythrocytic or granulocytic precursors, which thus do not seem to be involved by the neoplastic process. Based on the present resuts and on a review of the relevant literature some general cytogenetic features are emphasized which may contribute to a better understainding of the disorder. Especially, it is demonstrated that in myelomatosis the cytogenetic changes are much more uniform than in other malignant disorders with the exception of chronic myeloid leukaemia.


Erythropoiesis inhibiting factor(s) in intact and haemolyzed red blood cells.

A previous report have shown that both intact red blood cells (RBC) and an equal number of haemolyzed cells were able to inhibit erythropoiesis on ESF-induced erythropoiesis, suggesting a cell compound to be responsible for the inhibitiory effect. Haeme and haeme compounds have been found to stimulate or inhibit both erythropoiesis and haeme synthesis. The present work presents data on the inhibitory effect of haemolyzed RBC and compounds from intact RBC on erythropoiesis. The inhibiting factor was found to be of a small molecular size and of the same range as a urinary erythorpoiesis inhibiting factor (EIF). The inhibitor did not contain haeme. Both Fe+2 and Fe+3 were tested, showing no reduction of the 59-Fe incorporation into RBC in the test animals. The inhibition could not be due to dilution of the 59-Fe with unlabelled iron from the haemolyzed cells. On the contrary, Fe+3-ions rather stimulated erythropoiesis, probably due to increased amounts of available iron. Haemolysates were prepared from RBC with different amounts of immature cells. With increasing amounts of reticulocytes, a reduction of the inhibitory effect occurred. Also foetal cells showed less inhibition than an equal amount of adult cells. After high speed centrifugation, the inhibitory effect of haemolysates was found in the supernatant, while ghost cells exerted no inhibition. No species differences were found using both exhypoxic polycythaemic mice and rats. An inhibiting factor was liberated into the incubation medium when RBC were incubated for 20 h. No haemolysis occurred during the incubation period. Mature, adult RBC therefore contain a substance which is different from haeme, with a negative feedback on erythropoiesis.


Delta Beta-Thalassaemia in two yugoslavian families.

Members of two Yugoslavian families were found to have delta-beta-thalassaemia. Interaction of beta-thalassaemia with delta-beta-thalassaemia occured in two young children producing a clinical condition which is somewhat less severe than that of homozygous beta-thalassaemia. Results from biosynthetic analyses indicate that the degree of globin chain imbalance in double heterozygotes for beta- and delta-beta-thalassaemia is similar to that in homozygous beta-thalassaemia. Fetal haemoglobin of all heterozygotes contained G-gamma and A-gamma chains in an average ratio of about 2:3 whereas that in the two double heterozygotes had G-gamma and A-gamma chains in a ratio of 3:2.


Conformation of the hinge region and various fragments of human IgG3.

A study of the circular dichroic (CD) spectra of various fragments of human IgG3, including the isolated hinge region, Fh, has shown that the hinge region has a high degree of an unusual secondary structure, unique within immunoglobulin material recorded to date. This structure appears to be rigid and aperiodic throughout the hinge region and is compatible with a repeated amino acid sequence. The conformation of the isolated Fh fragment is the same as that of the bound hinge region; also, there is no substantial conformational interaction between the hinge region and the Fab or Fc fragments of human Igtg3. a comparison of the CD spectra of Fc and pFc fragments isolated from an IgG1 and an IgG3 myeloma protein has shown that subclass differences of amino acid sequence do not substantially alter the conformation of these fragments.


Nude mouse embryo: ectodermal nature of the primordial thymic defect.

Sterile female homozygous nude mice were rendered fertile through a graft of thymic epithelium from heterozygous littermates 3 days after birth. Homozygous nude embryos were compared with embryos age (8-18 days). In nude mice, the embryological anomaly is noticeable from the 11th day of gestation and essentially consists of a failure of the ectoderm from the 3rd branchial cleft to proliferate and differentiate into a cervical vesicle. As a result, the endoderm from the 3rd pouch degenerates into cystic formations instead of differentiating.


The primary structure of allergen M from cod.

The complete primary structure of allergen M of cod (Gadus callarias L.) is presented. The amino acid sequence of fragment TM1, the NH2-terminal peptide of allergen M, was elucidated by the dansyl-Edman method. It consists of 75 amino acids and 1 glucose residue (mol. wt. 8,492). By summation of the sequence data of fragment TM1 and the previously reported fragment TM2, the intact allergen M has 113 residues (mol. wt. 12,328). Fragment TM1 of cod shows less homology (30.6 percent) with the corresponding fragments of other reported fish species than does fragment TM2 (42.1 percent); the intact allergen M shows 34.5 percent homology. The single half cystine of allergen M was shown to be blocked. Gas chromatographic analysis of the reduced and nonreduced allergen M suggested that the glucose is bound to Cys 18 through an S-glucosidic bond.


Temporary skin reactions to penicillins during the acute stage of infectious mononucleosis.

During the acute stage of infectious mononucleosis (IM), 16 out of 19 patients have reacted to skin tests with ampicillin and/or benzylpenicillin or their derivatives. Two thirds reacted to ampicillin and less than half (10/19) to benzylpenicillin, or their derivatives. No reaction was observed with cloxacillin. The lack of reactivity in 3 of 7 patients and the circumstance that the frequency of reactions with the penicilloylated Escherichia coli proteins makes it likely that the greater reactivity to penicillins and in particular to ampicillin in IM is not due mainly to protein impurities, but chiefly to the antibiotic molecule as such. There was no definite relationship between reactivity and clinical involvement. After the acute stage, disappearance of skin reactivity was noted. Intracutaneous testing with penicillins may be used to monitor the increased cutaneous reactivity during acute IM, and it may be helpful when the acute stage is over to determine when a patient may use these antibiotics without side reactions.


Bacteremia: the significance of outside versus inside hospital origin.

168 patients with bacteremia seen in 1965-1969 were studied with regard to mortality rate, age and sex distribution, sources of infection, predisposing factors and infecting organisms. Special attention was drawn to outside hospital originating bacteremia vis-a-vis hospital-acquired bacteremia. In general, the results obtained were essentially in agreement with earlier experiences elsewhere. The most striking observations were, firstly, the grave prognosis associated with hospital-acquired bacteremia and, secondly, the dominant role played by gram-negative bacilli.


Occurrence and significance of hemolytic streptococci groups b-u in human infectious disease.

245 strains of hemolytic streptococci, isolated from 225 patients with infectious diseasses, were grouped serologically according to Lancefield. About 40% belonged to group B and half of them were found in the genito-urinary tract. Another 40% belonged to the groups C and G, half of them being found in the respiratory tract and often as the only potentially pathogenic organism. About 10% of the isolates belonged to other of the groups E to T, including M streptococci, and were found under similar circumstances as the C and G isolates. The last 10% could not be referred to any of the groups A-U. In 4 cases group B streptococci were found as the only potentially pathogenic organism in typical erysipelas, and in 4 cases of septicemia the only bacterial finding from blood was a streptococcus of the groups B, C or G. In these cases, as in most others in which an etiological significance could be ascribed to steptococci of other groups than A, the patient was in a bad general condition, due to very high age, agranulocytosis, ethylism or narcomania.


The nitroblue tetrazolium (NBT) test and white blood cell count in acute throat infections.

The clinical value of the NBT test and of leucocyte counts in the aetiological differentiation of acute throat infections was investigated. In our hands a frequency of less than 13% NBT positive neutrophils is considered as normal and a test value above 19% as "positive", i.e. indicating a bacterial infection. More than 19% or more than 1 800 NBT positive neutrophils per mm-3 blood were found in 10 of 18 patients with an infection caused by beta-haemolytic streptococci, in 1 of 2 patients with a Mycoplasma pneumoniae infection and in 1 patient with both a streptococcal and mycoplasmal infection, but in none of 19 patients with a viral infection. Since 8 of 18 patients with streptococcal throat infection had normal NBT test results, the NBT test apparently is of limited value in the early recognition of these infections. A high NBT test value would however support the diagnosis. The white blood cell and neutrophil counts were of little value in the differentiation between streptococcal and viral throat infection.


Properties of some staphylococcus aureus strains associated with spontaneous l-phase transformation.

Spontaneous L-phase production was found in 7 of 14 investigated Staphylococcus aureus strains. A common characteristic of the strains producing L-phase variants spontaneously was their ability to develop L-colonies on a solid medium with 1.0-1.5% NaCl by the action of methicillin, whereas other strains required higher NaCl concentrations. Further, in 6 of the 7 strains the ability for spontaneous L-phase production was associated with high L-phase productivity in the presence of methicillin. The pattern of alpha-, beta- and delta-hemolysin production in a strain was not correlated to spontaneous L-phase production.


Treatment of chronic staphylococcal osteomyelitis with cloxacillin and dicloxacillin--a comparative study in 12 patients.

12 patients with chronic staphylococcal osteomyelitis were treated with cloxacillin (6 patients) and dicloxacillin (6 patients) in a prospective, comparative study. The drugs were given perorally in the dose 1 g every 4th hour and serum concentrations were followed. 0.5, 1 and 2 hours after administration the serum level of dicloxacillin was about double that of cloxacillin. The lowest serum level of dicloxacillin at the time of administration of the drugs was nearly 3 times as high as the level of cloxacillin. An evaluation of clinical benefit and side-effects revealed no differences between the drugs. The prolonged serum level of dicloxacillin may permit a longer interval between doses than the administration of cloxacillin.


The role of pet cats in the seroepidemiology of toxoplasmosis.

The occurrence of toxoplasma antibodies was studied in 3 selected groups of humans by means of complement fixation (CF) and indirect immunofluorescence antibody (IFAT) techniques. High occurrence of antibodies was observed among the owners of pedigree cats (CF: 55%; IFAT: 67%), which differed significantly from the values of the control material (35% and 33%, respectively). Having a pet in the family did not increase the proportion of reactors among controls. No significant correlation was observed between the antibody occurrence and the period for which a pet had been kept, nor the raw meat consumption of the cats or humans themselves, or the hunting habits of the animals.


Herpes zoster and recurrent herpes simplex.

87 patients with the clinical diagnosis of herpes zoster were seen during a one-year period in 8 general practices in Glasgow, the rate per 1 000 practice population being approximately 2.4. Of these, 78 (90%) had serological evidence of active infection with herpes zoster. A history of recurrent herpes simplex was obtained in 25 (32%) of the 78 patients with confirmed herpes zoster; 63 (81%) of these 78 had complement-fixing (CF) antibodies to herpes simplex. Thus, latent herpes simplex infection did not prevent herpes zoster nor modify the severity of herpes zoster. In most of the patients CF antibodt to varicella-zoster was not detected within 5 days from appearance of the rash. After the acute phase of the illness CF antibody titres fell fairly rapidly, the geometric mean titre being 189 at 2-4 weeks after the rash, 27 from 3-6 months, and 8 from 12-18 months. The rapid rise and decline in CF antibody after herpes zoster infection compared with the unchanging CF titres associated with recurrent herpes simplex infection suggest that varicella-zoster and herpes simplex virus differ in their mechanism of latency.


Treatment of toxoplasmosis with trimethoprim-sulphamethoxazole.

Toxoplasmosis is known to complicate diseases with impaired cellular immunity. For treatment of toxoplasma infections atoxic drugs should be used to avoid depression of the bone marrow. The hitherto recommended treatment, pyrimethamine in combination with sulphonamides, is often associated with severe side-effects. The present study presents the results of treatment with trimethoprim and sulphamethoxazole in 7 patients, clinically and serologically diagnosed as having toxoplasmosis. Good therapeutic results were observed in 5 patients with lymphoglandular toxoplasmosis and a significant reduction of the dye test titres were found in 6 patients. In one patient, however, a relapse of clinical symptoms and a reversion to high dye test titres were observed 6 1/2 months after the end of the treatment. Treatment had to be discontinued in one patient due to an allergic reaction.


Case report: fatal Yersinia enterocolitica septicaemia.

Yersinia enterocolitica type 3 was isolated in blood cultures from a previously healthy 81-year-old woman with fever. A high agglutinin titre against this organism was demonstrated in the patient's serum. Antibiotic therapy was given according to sensitivity tests but the outcome was fatal due to uraemia.


Case report: septicaemia due to Yersinia enterocolitica in a non-compromised host.

A case of septicaemia due to Yersinia enterocolitica serotype 3, biotype 4, in a non-compromised host is described. The patient showed severe signs of gram-negative septicaemia. Treatment with sulphamethoxazole-trimethoprim (Bactrim) was unsuccessful in spite of full sensitivity, bactericidal and synergistic effects in vitro. Tetracycline gave full restitution.


Idiopathic retroperitoneal fibrosis.

Two out of five patients with idiopathic retroperitoneal fibrosis treated at the Aker Hospital, and the Department of Urology, Ullevål Hospital, Oslo, Norway, are reported. They had pronounced early symptoms, similar to collagen disease, and were therefore treated with corticosteroids long before the correct diagnosis was established. The effect of this treatment was immmediate with prompt and striking improvement. Some pathological and immunological considerations are discussed. Serological and histopathological methods, including a mixed agglutination test, were used in order to find an immunological activity, but no such activity could be demonstrated in the present material. Still, the clinical course, the histological appearance, and the excellent therapeutic effect of corticosteroids seem to show a resemblance to connective tissue disorders.


Renal distension in response to water-soluble contrast medium and various diuretics.

Measurement of the increase in area of the renal silhouette, as it appears on radiographs following the administration of water-soluble contrast medium and certain diuretics, seems to be useful in the diagnosis of renovascular hypertension. In order to assess the optimal technique for such measurements, washout urography was performed in 32 hypertensive patients in two consecutive examinations so that the distensive effect of etacrynic acid, furosemide and hypertonic mannitol, respectively, were compared with that of urea in the same patients. In spite of their stronger diuretic effect, none of the above-mentioned diuretics caused a greater renal distension than urea, the maximum increase in area of the renal silhouette being about 7 to 20%, average about 11%. Since urea is probably the best siuted diuretic for the washout test, it seems to be the drug of choice for these diagnostic procedures.


Effects of an antebrachial cimino-brescia arteriovenous fistula on the local circulation in the hand.

A female patient with a side-to-side fistula between the radial artery and the cephalic vein complained of pain in the three radial fingers during dialyses. Using 133-Xenon and histamine injected locally into the thumb musculature, local effective arterial pressure was found to be decreased, and to rise after compression of the fistula, or the radial artery distal to the fistula. The patient's symptoms thus were probably ischaemic and disappeared after ligation of the radial artery distal to the fistula. Ten more patients, of whom 9 had no local symptoms, were studied using the same technique. In 3, systolic blood pressure was measured in the thumb by a strain gauge technique. Some "steal" of thumb blood pressure by the fistula could be demonstrated in all patients but one and retrograde flow of blood in the artery distal to the fistula in 8. "Supernormal" Xenon wash-out occured when the pressure head was restored to normal by compression of the fistula or the radial artery distal to it. This is probably due to a compensatory increase of the distal vascular bed. The technique can be used for investigation of patients with suspected ischaemia distal to an arteriovenous fistula, and to indicate the appropriate treatment, usually ligation of the artery distal to the fistula.


Renal bloodflow and function in the rabbit after surgical trauma. I. An experimental study.

The aim of the present study was to examine the influence of surgical trauma on renal blood flow (RBF) and renal funciotn. The renal vessels were catheterized in lightly anaesthetized rabbits and the dye-dilution technique was used to measure renal blood flow and cardiac output. The renal fraction of the cardiac output (RBF % CO), the total peripherauation of the glomerular and tubular function was made by measuring the extraction of EDTA and of Hippuran. A decrease in the cardiac output was accompanied by a diminution of renal blood flow. Renal blood flow was reduced, regardless of whether surgery or puncture of the kidney was performed, probably due to vasoconstriction in the kidney caused by an increase in sympathetic tonus or in the concentration of plasma catecholamines. Manipulation of the renal artery seemed to stimulate further vasoconstriction in the ipsilateral kidney by a direct effect. The glomerular and tubular function decreased initially, independently of surgical trauma, and it is therefore assumed that the initial renal vasoconstriction includes the afferent arterioles. Renal function was not greatly influenced by handling of the renal artery.


Renal blood flow and function in the rabbit after surgical trauma. II. The role of constriction in the main renal artery and activation of the alpha-adrenergic receptors.

The impairment of renal circulation and function in connection with general anaesthesia and surgical trauma was investigated in 19 rabbits. The systemic circulation and the renal circulation were evaluated by a dye-dilution technique and glomerular and tubular function by measuring the extraction of 51-Cr-EDTA and 125-I-Hippuran. In Group I measurements were performed before and after manipulation of the left renal artery preceded by topical application of a local anaesthetic. In Groups II and III measurements were performed before and after i.v. injection of, respectively, 0.8 and 3.0 mg/kg body-weight phenoxybenzamine, and then after manipulation of the renal artery. Blockade of the alpha-adrenergic receptors with phenoxybenzamine was found to preserve the renal fraction of the cardiac output. The blockade prevented an initial reduction in the extraction of EDTA and Hippuran, previously ascribed to general anaesthesia, but did not prevent a diminution following surgical handling of the kidney and the renal artery. The local anaesthesia had no effect. It is concluded that general anaesthesia and surgical trauma cause an impairment of the renal circulation due to an increased concentration of plasma catecholamines.


Renal blood flow and function in the rabbit after surgical trauma. III. Effects of temporary occlusion of renal artery.

The renal artery was occluded in rabbits for varying lengths of time with the aid of a balloon catheter. Before and after the period of ischaemia, renal blood flow was measured by a dye-dilution technique and the glomerular and tubular functions were evaluated by measuring the extractions of labelled EDTA and Hippuran. Prolongation of the period of continuous ischaemia from 15 to 60 minutes resulted in a progressive increase in the postocclusive hyperaemia, but in a reduction of the renal function. Compared with 30 minutes of continuous occlusion, 30 minutes of intermittent occlusion caused only slight hyperaemia, but the same degree of reduction in renal function. One day after 30 minutes or 60 minutes of ischaemia, renal blood flow was within the range of the normal flow. After 30 minutes of occlusion, renal function was re-established 7 days later, whereas after 60 minutes of ischaemia, function was still severely impaired 7 days later. Fourteen days after 60 minutes of occlusion, renal function was 50% or less of the normal. Juxtamedullary shunting has not been demonstrated in the present investigation. Metabolic changes and cellular damage remain as possible explanations of the postocclusive changes in renal blood flow and function.


Renal blood flow and function in the rabbit after surgical trauma. IV. Effects of ureteral ligation.

After 1, 2, 4, 7, 14 and 21 days of ureteral occlusion, renal blood flow was measured on both sides by means of a dye-dilution method and the glomerular and tubular functions were evaluated by measuring the extraction of 51-Cr-EDTA and 125-I-Hippuran. The results showed an increase in the weight of the obstructed kidney parenchyma and indicated an incipient compensatory hypertrophy of the contralateral kidney after 14 days of occlusion. The blood flow to the occluded kidney was reduced on the first day after ligation and ranged in all experiments between 24% and 44% of the total renal blood flow, without correlation to the duration of stasis. The blood flow to the contralateral kidney was mostly above the average in the control group. A small glomerular and tubular extraction was noted in more than 50% of the ligated kidneys. The glomerular filtration rate and the clearance of Hippuran by the contralateral kidney were increased after one day of occlusion, but no relationship between the changes in renal function and the duration of ligation was revealed. It is concluded that ureteral ligation causes a decrease in the blood flow to the occluded kidney and an increase in that to the contralateral kidney. The function of the contralateral kidney increases initially, but thereafter only as a consequence of the compensatory hypertrophy which is evident around the 14th day post occlusion.


Serum lipid levels and thromboembolic  complications during estrogen therapy of prostatic cancer.

The effect of diethylstilboestrol diphosphate (DES) and polyestradiol phosphate (PES) on the serum lipid levels of 40 prostatic cancer patients was investigated during a long-term follow-up. In patients treated with DES serum triglyceride levels elevated significantly whereas changes in serum cholesterol and total lipid contents were not significant. In patients treated with PES no significant changes in serum triglyceride, cholesterol and total lipid levels were found. Nineteen out of 40 (48%) of patients developed cardiovasculat complications during the trial; 11 had cerebrovascular attacks, 5 coronary occlusion and 3 thromboembolism in the leg. There was a significant increase in serum triglyceride levels in all patients who developed vascular disorders, whereas the changes in serum cholesterol and total lipids were not significant. The results suggest a possible association between the increase of serum triglycerides and the development of thromboembolic complications.


Congenital absence of the vas deferens.

Fourteen personal cases of agenesia of the vas deferens, bilateral in 12 and unilateral in 2, are described. In 13 of the cases the diagnosis was confirmed by surgical exploration. In most of the cases cytologic examination of aspiration biopsy specimens and histologic examination of surgical specimens of the testes showed that spermatogenesis was normal. The appearance of biopsy specimens of the epididymides were normal except for a certain degree of interstitital fibrosis and dilation of the ductus epididymidis. Endeavours to produce an artificial spermatocele with the aid of an isolated flap of tunica vaginalis in several patients proved unsuccessful. In one patient with a naturally preformed spermatocele the latter was aspirated, and the patient's wife was inseminated with the cellular content from the aspirate. This procedure has been repeated on several occasions, but so far without any subsequent conception. The failure of treatment of these patients may perhaps be due to some change in the function of their epididymides. This possibility is discussed.


Sarcoid reactions in pulmonary neoplasms.

In a consectuive series of 734 patients with malignant tumorous of the lung, sarcoid reactions were observed in the mediastinal lymph nodes in 20 cases, i.e. in 3.2% of the 630 patients in whom these nodes were studied. Among these 20 patients, sarcoidosis was suspected in three. In two of these, granulomata were revealed in the tumour. Another two had metastases in the affected lymph nodes. All the common histological types of lung tumour were represented in the patients, but squamous-cell carcinomata showed a statistically significant preponderance as compared with anaplastic carcinomata. Three causes of such sarcoid reactions have been suggested: 1. an immunological reaction to substances released by the tumour and transported along the lymphatics; 2. an unrecognized sarcoidosis predisposing to lung cancer; 3. the co-existence of sarcoidosis and malignant tumour, possibly due to a common aetiological factor. The significant preponderance of squamous-cell carcinomata observed in this study is in favour of the first theory, because the slower growth and higher tendency to necrosis of this tumour type may be assumed to give rise to a more vigorous and longer-lasting stimulation of the regional lymph nodes.


Reaginic bronchial allergy and the occurrence of reagins against mites in a representative sample of a local Swedish population.

This study involves an investigation of 185 subjects, aged 35--54 years, a representative sample of persons with chronic obstructive lung disease in a local Swedish population. Bronchial asthma was diagnosed in 86 persons, chronic bronchitis in 69 and a combination of bronchial asthma and chronic bronchitis in 30. Reaginic bronchial allergy as a provoking factor was considered as definite when the case history, an intracutaneous test, a bronchial provocation test and a radioallergosorbent test were all positive with regard to one and the same allergen. This was found in 28% of the asthmatics. In 16% of the asthmatics, the diagnosis of reaginic bronchial allergy was not supported by all the four diagnostic criteria used but was considered as probable since the case history or the bronchial provocation test was positive in association with a positive RAST or intracutaneous test with the same allergen. Reaginic (IgE) antibodies in serum to mites (Dermatophagoides pteronyssinus) were found in 20 subjects, 18 of whom also had a positive intracutaneous test for house dust. Four of these 20 subjects had definite and 12 had probable reaginic bronchial allergy. One of the remaining four subjects had chronic bronchitis without asthma. The percentage of definite reaginic bronchial allergy may possibly be increased when reliable bronchial provocations with mite allergen can be performed. Increased IgE levels in serum were found in only eight of the 51 asthmatics with reaginic bronchial allergy and in two of the 65 other asthmatics.


Treatment of steroid-dependent asthma patients with beclomethasone dipropionate aerosol.

Fifty-two steroid-dependent adults with chronic perennial asthma were transferred to beclomethasone dipropionate aerosol. The tests demonstrated a significant improvement with beclomethasone in terms of the diary score, bronchodilator use, and PEF and FEV1.0 measurements, as compared with the previous period of prednisolone treatment. Before the transfer, 26 of the patients displayed one or more diseases or symptoms which were probably due to systemic steroid medication. Morning cortisol levels, along with the response to tetracosactrin had in all cases returned to normal when tests were carried out 41 days after transfer to beclomethasone dipropionate. In a group of 12 patients with the lowest 11-OHCS basal values, the mean of their 11-OHCS values during prednisolone treatment was as low as 0.14 plus or minus 0.06 mumol/l, but tetracosactrin challenge induced an elevation to a normal level, 0.33 plus or minus 0.13 mumol/l. After 41 days of beclomethasone treatment, the corresponding values were 0.56 plus or minus 0.90 plus or minus 0.28 mumol/l. Thirty-seven patients experienced one or more disturbing symptoms after transfer to beclomethasone. In many cases, the symptoms of allergic rhinitis were troublesome and persistent leading to a sixfold increase in the use of antihistaminic tablets. When the patients had learned to exhale through the nose following beclomethasone inhalation, the use of antihistaminic tablets again diminished to some extent. Moreover, two cases of ulcerative colitis were encountered during the beclomethasone treatment. During a follow-up period of one year, 14 patients were again receiving prednisolone; most often, this was due to worsening of the asthma because of respiratory infections. During the beclomethasone treatment, a continuous significant improvement in PEF was noted after isoprenaline inhalation, suggesting that further benefit may be obtained by the employment of bronchodilator aerosols as an essential part of the treatment.


[Cancer of the esophagus and cardia: diagnostic problems].

For many decades, the problem of cancer of the esophagus has been dominated by constant failure in diagnosis and therapy. Today the widespread use of upper digestive endoscopy could seem to constitute, for the moment, the only hope of changing this situation. Leaving aside the clinical, radiological, and enoscopic symptomatology of invasive esophageal cancer, this study is limited to practical considerations on the technology of endoscopic diagnosis in esophageal cancerology; the endoscopic expression of carcinoma "in situ" and chronic irritative esophageal condition; the precancerous and early-stage symptomatology of cancer of the esophagus; and the problem of "pseudo-cancer" of the esophagus.