Studies of tuberculosis in man in relation to infection in cattle.

A study has been made in Sweden to investigate whether the risk of tuberculous infection and its trend with time in man in different areas were related to varying prevalences of tuberculous infection in cattle. It was found that the level of the infection risk in man was related to the prevalence of tuberculous infection in cattle, varying from 3-4 per cent in 1935 at age 15 in counties with less than 2 per cent infected cattle to 5-8 per cent in counties with 20 per cent infected cattle or more. However, the downward trend to the risk of infection with time was not to found be associated with the prevalence of tuberculous infection in cattle. The correlation between the risk of infection in man and the prevalence of infection in cattle in the 24 Swedish counties was positive and highly significant (+0-79). The relationship between cattle tuberculosis and tuberculosis in man was further studied by correlating infection in cattle with tuberculosis mortality and morbidity in man. The correlation with mortality was negative and highly significant (-0-77), i.e. counties with little cattle tuberculosis had a high tuberculosis mortality in man, and vice versa. There were similar large negative correlations with measures of tuberculosis incidence. When variations between the counties in relevant environmental factors, namely capital, urbanization and overcrowding, were taken into account, a strong positive association remains between the prevalence of infected cattle and the risk of tuberculous infection in man, but the associations with tuberculous mortality and morbidity, though they remain negative, become weaker. It is suggested that the probable explanation of these findings is the long-term protection against adult infection with human tubercle bacilli conferred by bovine infection in childhood.


Present effectiveness of BCG vaccination in England and Wales. A report from the Research Committee of the British Thoracic and Tuberculosis Association.

From a survey of notifications of tuberculosis in England and Wales it is estimated that each 100,000 BCG vaccination of school-children in 1966-71 prevented 15 notifications of persons aged 15-19 years in 1973. Making allowance for the declining infection risk, it is probable that each 100,000 vaccinations in 1966-71 will eventually prevent about 133 notifications in the 15 years following vaccination. It is estimated that one notification of tuberculosis will be prevented by 750 vaccinations given in 1968, by 1,500 vaccinations in 1973, by 3,000 vaccinations in 1978, and by 5,000-10,000 vaccinations in the 1980's.


A study to assess the intradermal, triangular needle and bifurcated needle techniques in the administration of BCG to newborns.

BCG at birth was administered to 3,297 new born babies in Hong Kong using the intradermal, simple triangular and bifurcated needle techniques. Tuberculin testing at 3 months showed similar mean reactions for the intradermal and simple triangular needle methods, namely 9-74 mm and 9-87 mm with 9-94 mm for the triangular needle method when the BCG strength was doubled. Using the bifurcated needle the mean reactions were significantly lower; 8-69 mm, 9-01 mm with double strength BCG and 8-92 mm with puncture through a skin drop. It is concluded that the bifurcated needle is not a satisfactory method of administering BCG to newborns even if the concentration of BCG is increased. In circumstances such as in small maternity units, where the intradermal technique is not warranted, it is recommended that the simple triangular method should be used.


Tuberculosis of the abdomen in Ibadan: a clinico-pathological review.

An account is given of the age distribution and clinical features of 178 patients suffering from abdominal tuberculosis who were treated in the University College Hospital, Ibadan, Nigeria. The importance of peritoneal biopsy and laparotomy in diagnosis is discussed. The main findings at necropsy are described. The importance of early diagnosis is stressed.


Bone abscess due to Mycobacterium xenopi.

Destructive infection of a cuneiform bone due to M. xenopi is described. The organism was isolated and its significance established by a strong skin reaction to xenopi antigen and by demonstration of bacilli in the lesion with fluorescence microscopy. This evidence of metastatic disease suggests that an alimentary route of infection as an alternative to inhalation could be considered.


The risk of tuberculous infection in Sweden.

Large sections of the population of Sweden were tuberculin tested during the 1940s prior to BCG-vaccination. This material has been used to estimate the risk of tuberculous infection and its trends with calendar year and age. An analysis of the results of approximately 200,000 tuberculin tests in military recruits and schoolchildren was made, using the method developed in the Tuberculosis Surveillance Research Unit. The risk of infection was estimated to be 2-8 per cent at age 10 in 1935, the rate decreasing by 9-0 per cent annually. There was also a substantial increase in the risk with each year of age, amounting to 8-6 per cent for each year of age. Separate analyses of the risk of infection and its trend with time for each of the individual 24 counties and the city of Stockholm, showed considerable variations in the level of the risk between the different areas. These are related to variations in tuberculosis in cattle in a further report. In seven areas information was available from earlier surveys in schoolchildren or recruits, using the same method of testing. In these areas separate estimates of the calendar trend of the risk of infection and the age trend have been made. The decrease in the risk with calendar year and the increase with age seem to apply in each of these counties, as in the whole of Sweden. The reliability of the findings was tested by comparing the estimated risk of infection for the whole of Sweden and the tuberculous meningitis mortality rate in children aged 0-4 years between 1925 and 1935. There was a similar trend in the risk and in the mortality rate. Between 1935 and 1940 the decline in the tuberculous meningitis mortality rate became steeper, and amounted to about 11-5 per cent annually between 1935 and 1945. Special measures for the protection of uninfected but exposed children became increasingly common during the 1920s and 1930s, and these were supplemented with BCG-vaccination at a later date. From July 1939 all milk sold for human consumption had to be pasteurised. It is suggested that all these factors may have contributed to the more rapid decrease in the tuberculous meningitis mortality in young children after about 1938.


Adrenergic innervation of the human parathyroid glands.

The sympathetic innervation of human parathyroid glands has been studied with fluorescence histochemistry. For the first time, sympathetic adrenergic nerve terminals could be demonstrated close to the endocrine cells. The morphological findings permit the conclusion that the adrenergic transmitter noradrenaline can reach a large part of the parenchymal cells, where it may possibly influence hormonal release.


Polyglycolic acid (PGA, Dexon) sutures in neck surgery.

The limitations of catgut, which has been the only available absorbably suture material for surgical work are well known. In the present study, catgut and PGA (Dexon) are compared in 123 patients undergoing neck surgery with respect to wound complications. Dexon appears to offer a favourable alternative since this synthetic, absorbable suture material produces fewer early tissue reactions.


The relationship between glycogen content of leg muscles and working capacity in patients with intermittent claudication.

The relationship between the glycogen content of the vastus lateralis muscle and the working duration was determined in 6 patients with intermittent claudication. The working duration was determined on a bicycle ergometer at a load of 450 kpm/min. Muscle glycogen was determined in percutaneous needle biopsy specimens. The resting glycogen content in the vastus muscle increased significantly after depletion of the stores by physical exercise followed by glucose feeding for 2 days. This increase was associated with an increased working duration. This improvement of the working duration connected with high muscle glycogen content was a temporary phenomenon. When the duration was measured shortly after exercise, i.e. after depletion of the glycogen stores it was reduced to the preexperimental level. The improved working duration associated with increased glycogen content of leg muscles did not seem to be related to the improved walking capacity in claudication patients after physical conditioning.


Hiatal hernia. A follow-up study.

A series of 68 patients who had been surgically treated for hiatal hernia were followed up and re-studied. Several repair procedures were used, but an antireflux operation was carried out in 80% (49 Nissen-Rossetti fundoplications and 6 Belsey Mark IV repairs). The primary hospital mortality rate was 3%. Late results were evaluated by studying the patients with endoscopy, cineradiography, and intraluminal pH probe. The overall clinical late results were good in 96%, excluding the 3% primary mortality rate. To achieve these results, however, several secondary operations were necessary. Good primary results after antireflux procedures were obtained in 89%. The present surgical principles are: (1) the hernias of the good-risk normoacid patients are repaired with a Belsey Mark IV procedure, (2) the hernias of hyperacidity patients are repaired with transabdominal fundoplication combined with parietal cell vagotomy without drainage and (3) moderate oesophageal strictures with an antireflux procedure followed by periodical oesophageal dilatation. Resection of oesophagus is reserved for advanced strictures only.


Lysolecithin-mediated inflammatory reaction in rabbit gallbladder. Permeability increase and enzyme liberation.

Aseptic inflammation in the gallbladder wall was studied in vitro using rabbit gallbladders. Wall permeability changes, measured as changes in the transmural passage of radioactively labelled hippuran and biligraphin as well as enzyme (acid phosphatase) release from wall to lumen were registered as parameters permitting quantitative assessment of an inflammatory process. Lysolecithin, a surface-active substance of possible significance in the pathogenesis of acute cholecystitis was chosen as inflammation-inducing agent. When 6-20 mg/ml lysolecithin was instilled into the gallbladders, dose-dependent increases in permeability and enzyme release occurred. No effects as compared with controls were seen when 2 mg/ml was instilled. Lysolecithin-treated gallbladders showed morphological signs of inflammation as opposed to untreated. The data reported are consistent with earlier observations that lysolecithin may cause inflammatory lesions to the gallbladder wall. The experimental model used may prove useful in examining the effects of aggressive and protective agents upon the gallbladder mucous membrane.


Studies on small intestinal obstruction. II. Blood flow, vascular resistance, capillary filtration, and oxygen consumption in denervated small bowel after obstruction.

Intestinal circulation was studied during in vitro perfusion of denervated small intestine of the cat shortly after release of an in vivo small-bowel obstruction. Blood flow, vascular resistance, capillary filtration, and oxygen consumption were determined. No significant differences were demonstrated between obstructed and non-obstructed intestines. The presently studied facets of small-bowel microcirculation thus exhibit a virtually normal function 30 minutes after decompression of a bowel obstruction. The pertinent literature affords evidence that a distension impairs bowel viability; it would seem that this impairment is rapidly ameliorated following decompression of the bowel.


The effect of peritoneal lavage on the postoperative course after colonic anastomosis and perforation in the rat.

Peritoneal lavage was given during four days to rats subjected either to transection and re-anastomosis or perforation of the descending part of the colon or caecum. Control rats were treated in the smae way but did not receive peritoneal lavage. The rats which were treated with a colonic anastomosis and peritoneal lavage had significantly less abdominal adhesions, peritonitis and peritoneal fluid observed at autopsy 11 or 60 days after surgery. No rats developed anastomosis insufficiency and all survived. Peritoneal lavage in rats subjected to colonic or caecal perforation increased  the survival time and reduced the mortality rate, the frequency of adhesions and the signs of peritonitis. An increased frequency of peritoneal adhesions was observed after extensive mobilization of the colon during operation when no peritoneal lavage had been given. The peritoneal lavage catheter per se did not cause adhesions.


Serum cholinesterase activity in burned patients. I: biochemical findings.

The purpose of the study was to determine the magnitude and the aetiology of alterations in serum cholinesterase activity (pseudocholinesterase) in burned patients. Sixty burned patients with an estimated area of burn between 3 and 72% of body surface were investigated. Serum cholinesterase activity, serum albumin concentration and serum bilirubin were measured at various time intervals. The magnitude as well as the rate of fall of serum cholinesterase activity was found to be closely correlated with the severity of burn injury. Minimum levels were often reached 5 to 6 days after the burn injury, at which time the activity might have been depressed by more than 80 per cent. In the most severely burned patients, the activity sometimes remained low for months despite wound healing. Apart from the severity of the burn injury in the individual patient, several important factors determined the level of serum cholinesterase activity at a given time. These included the presence or absence of local or systemic infections, the event of recent surgery such as slough removal or skin grafting, and blood transfusions. The decrease in serum albumin concentration following the burn injury occurred earlier than the decrease in serum cholinesterase activity. Minimum levels were often reached during the first 24 h, after which time the concentration rose to reach fairly constant but decreased levels after 4 to 5 days. Apart from this initial phase, the changes in serum albumin concentration were roughly proportional to the changes in serum cholinesterase activity. The possible reasons for these findings are discussed.


Influence of glucagon on systolic time intervals during induction of anaesthesia with barbiturate.

The systolic time intervals and calculated parameters of PEP/LVET (pre-injection period/left ventricular ejection time-ratio) and 1/PEP2 before and after induction of anaesthesia with the barbiturate enibomal (Narcodorm) were studied noninvasively in eight surgical patients after pre-treatment with a bolus dose of glucagon. The mean difference between the PEP/LVET-ratio before and after induction was 0.06, and the mean difference between 1/PEP2 before and after induction was -8. The corresponding values in the control group consisting of 12 patients were 0.09 and -28, respectively, suggesting a somewhat greater depression of cardiac function in this group. However, no statistically significant difference at the 5% level was found between changes in the glucagon group and controls. The influence of barbiturates and glucagon on cardiac function is discussed.


Recent observations on ependyma and subependymal basement membranes.

Directly under the ependyma, and between the ependymal cells, there are basement membranes which form labyrinths connecting with the perivascular basement membranes of the subependymal vessels. The basement membranes exhibit differences in form, position, and distribution, and they can be distended by fluid absorption into large lacunae. The membranes can be identified as glycoprotein and glylcolipid substances. Electron microscopic studies have shown the differences between the basement membrane labyrinths of the human, the rabbit and the rat. In the human, the labyrinths contain isolated collagen fibrils. Basement membranes generally line all connective tissue spaces and form their interstitial borders. From this point of view, the subependymal basement membrane labyrinths can be seen as interstitial spaces near the ventricles, forming pathways between the ependyma and the subependymal capillaries or postcapillary veins.


Arterial oxygen tension and high intracranial pressure.

Arterial oxygen and carbon dioxide tension was measured in spontaneously breathing rabbits whose intracranial pressure was raised by a freeze lesion, oil embolism, or hydrostatic pressure. Reports elsewhere had stated that high intracranial pressure led to hypoxaemia. In this series of experiments, arterial oxygen tension appeared to rise and carbon dioxide tension appeared to drop. Both changes were slight and not significant statistically. There was no evidence to suggest that arterial hypoxaemia is caused by high intracranial pressure.


rCBF in impending brain death.

Regional cerebral blood flow (rCBF) was measured in three patients after relief of elevated intracranial pressure and restoration of normal cerebral perfusion pressure. Two patients, studied within 4 hours after closed head injury were found to have marked impairment of cortical blood flow and elevation of cerebrovascular resistance. We suggest that this picture is indicative of impending brain death, and may be the result of a long period of severe cerebral ischemia. The third patient, who had a shorter period of intracranial hypertension occurring during anaesthetic induction, responded to reduction of ICP quite differently with a transient relative hyperaemia. The physiopathological explanations for these two different types of flow response and their possible clinical significance are discussed.


Early diagnosis of metastases in the epidural space.

Examination of the cerebrospinal fluid (CSF), and myelography, were performed in most of 89 consecutive patients with X-ray evidence of vertebral metastases to test the value of these examinations in the early detection of neoplastic involvement of the epidural space. Patients were divided into 3 groups. In 7 cases (group I), the vertebral metastases were asymptomatic. Fifty-nine (group II) had symptoms or signs of radicular lesions but not of spinal cord compression. Twenty-three showed various stages of spinal cord or cauda equina compression (group III). Involvement of the epidural space was demonstrated on myelography in almost 50% of patients from groups I and II by a partial (29%) or complete (19%) arrest of the opaque medium. In addition, five patients in group II with normal myelograms had increased levels of CSF protein. Leucocyte counts were within normal limits in all patients. Neoplastic cells were found in two cases. It is suggested that in patients with only radiological evidence of neoplastic involvement of the epidural space and complete myelographic blocks, laminectomy, followed by radiation therapy, should be performed. Patients showing partial blocks should receive radiation therapy only.


The effect of surgical immobilization after laminectomy in the treatment of advanced cases of cervical spondylotic myelopathy.

Surgical immobilization of the cervical spine after laminectomy is proposed for the treatment of severe cervical spondylotic myelopathy (CSM) occurring with diffuse stenosis of the spinal canal (congenital or acquired). In 20 consecutive patients showing advanced CSM and cord compression at various levels, a laminectomy with posterior fixation was made, in most cases with the aid of a metal plate. In the evaluation of the severity of the myelopathy a slight modification of the Nurick scale was used. With the exception of three patients who developed complications unrelated to the technique, the results were very good as demonstrated by the long lasting improvement in the performance of the patients. The results emphasize the role which mechanical factors may play both, in the genesis of the disease and in the failures of the plain laminectomy.


Herniated lumbar discs in teenagers.

Forty-three patients under the age of 19 in whom a lumbar disc protrusion was diagnosed and surgically demonstrated are reviewed. The symptomatology resembles that of adults. In 19 cases there was clear relation of trauma to the onset of symptoms. The results of surgical treatment are discussed.


[The surgical approach to spontaneous intracerebral hematomas (author's transl)].

Following a recent statistical survey of 56 cases over a period of 3 years the authors considered the choice between the frontal or the parieto-temporal approaches to intracerebral haematomas. From their anatomical studies they considered that the frontal route is the better for approach to haematomas of the external capsule, whereas the parieto-temporal approach is preferred for haematomas of the internal capsule.


Familial occurrence of bilateral intracranial occlusion of the internal carotid arteries (Moya Moya).

In a family of 14 brothers and sisters, 3 cases of occlusive disease of the large intracranial vessels (Moya Moya) were found. Each of the three had one or more cerebrovascular attacks and a typical cerebral angiogram. Eight other members of the family had severe headaches. Angiography was carried out in three of these with normal findings.


Hepatic lesions in pancreatitis. Clinicoexperimental data.

Patients with active liver cirrhosis display greater abnormality in pancreatic function tests, viz. steatorrhea, hyperamylasemia, than patients with inactive cirrhosis. In autopsy specimens taken from patients dying from cirrhosis, parallel morphologic changes were noted in the liver and pancreas, viz. in postnecrotic cirrhosis, necrosis and necrobiosis predominated in the pancreas. In patients with portal cirrhosis, sclerotic changes rather than necrobiosis was observed in the pancreas. On the other hand, experimental acute and chronic pancreatitis induced in dogs displayed hepatic lesions whose degree and extent were correlated with the duration of the pancreatic inflammation.


Cancer in Crohn's disease. The danger of a by-passed loop.

Carcinoma developed in an excluded segment of small bowel in an 80-year old male patient, 40 years following the onset of regional enteritis and 33 years after by-pass of the terminal ileum. Within the past four years, four patients with malignancy occurring in excluded segments of the bowel in Crohn's disease have been reported from the institution. Two occurred in the small bowel and two in the colon. In three patients the lesion was associated with enterovesical fistula suggesting a possible relationship. This complication stresses the need to encourage resection rather than by-pass of all inflammatory lesions and to view all long-standing by-passed loops of intestine with suspicion. An international tumor registry of cancer in Crohn's disease is desirable to continue to document the true incidence of cancer in Crohn's disease.


Standard and augmented secretin testing in chronic pancreatic alcoholic disease.

Sequential standard (1.0 U./kg.) and augmented (4.0-5.0 U./kg.) secretin response to the pancreas has been briefly compared in normal subjects and in patients with combinations of alcoholism, cirrhosis and alcoholic pancreatitis. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is adequate for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma. The augmented test is of particular value when the response to 1 U./kg. produced equivocal results, inasmuch as augmented stimulation enhances the masked secretory deficiency. The administration of the augmented stimulus to alcoholic patients yielded data which suggest a new hypothesis of pathogenesis for alcoholic pancreatitis, e.g., the postsecretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Alcohol is thought to induce fatty degeneration of the pancreatic cell initially. Continued injury leads to necrosis and fibrosis.


A new factor in the blood of patients with peptic ulcer. Distribution in blood fractions.

Previous work on a factor in the blood of patients with peptic ulcer which contracts smooth muscle was confirmed and the work extended to investigation of the activity of blood fractions. Whole heparinized blood and its fractions were tested on a strip of guinea pig ileum and height of contraction and latent period were used as criteria of activity. Whole heparinized blood of ulcer patients had significantly higher activity than that of normal controls. Differences between the fractions of ulcer patients and controls were less significant. With the lysed buffy coat, however, while the differences between the height of contraction between the groups did not differ statistically, the speed of the reaction (shorter latent period) was significantly greater in the ulcer patients. The cellular alterations causing this response are unknown.


Some innovations in the technic of the one-second needle biopsy of the liver.

The one-second liver biopsy technic, published about 18 years ago, has undergone, in the course of the years, some minor modifications, suggested by the practical experience and by the critical evaluation of published and unpublished complications. Some instrumental innovations are described. A new design skin perforator and a penetration limiter are proposed. The clinical use of biopsy needles of different size is discussed. Moreover, the importance of some technical aspects of the practical execution of the biopsy, which are frequently neglected, is pointed out. Finally, the biopsy technic, in its up-to-date version is summarized and the opportunity of a further trial to confirm the validity of the innovations suggested is emphasized.


Spontaneous internal biliary fistulas.

Etiology, diagnostic investigations and surgical procedures on 58 patients with spontaneous internal biliary fistulas are reported. Cholelithiasis and peptic ulcer were found to be the presumptive cause of fistula respectively in 53 and five patients. Preoperative diagnosis was established on 31 patients while in the remaining 27 fistula was found incidentally at surgery. Surgical treatment included a wide variety of operations which were performed on the basis of the pathologic features of fistula. Over all mortality rate was 5 percent and morbidity 13 percent. The unsatisfactory results of the surgical treatment of internal biliary fistulas are another strong argument for performing early cholecystectomy in all the patients with cholelithiasis.


The prevalence of gastric autoantibodies in chronic alcoholics.

One hundred fifty alcoholic men and women and 150 age and sex-matched nonalcoholic controls (after exclusion of pernicious anemia and cancer of the stomach) were evaluated for the presence of parietal cell antibodies (PCA). Blocking and binding intrinsic factor antibodies (IFA) were determined in the PCA positive sera. The prevalence and age and sex distribution of PCA in the alcoholics and nonalcoholics was identical. In alcoholics above the age of 60 years, the incidence of PCA, although higher than in those of the younger age group was similar to that in the nonalcoholics of the same age group (in men 6.3 percent and 7.3 percent and in women 7.5 percent and 10.0 percent respectively). Antral gastritis of moderate or severe degree was the frequent lesion in alcoholics. This form of gastritis was not associated with any significant increase in the incidence of PCA. No patients with sera positive for IFA were detected among the 22 PCA positive patients. There is no evidence for humoral derangement of the gastric autoimmunity in chronic alcoholics.


Primary small bowel plasmacytoma with intracellular fibrils.

This is a report of a rare plasma cell tumor, an extramedullary plasmacytoma arising in the small bowel. The tumor first occurred in the jejunum without evidence of multiple myeloma. One year later, classical signs of multiple myeloma appeared. The rarity and unusual course of this tumor plus the finding of intracellular fibrils make the case worthy of note.


B-glucuronidase in duodenal secretions.

Determination of B-glucuronidase activity was carried out in 203 subjects including 60 controls. A modified technic for assaying B-glucuronidase activity was used that employs glass column chromatography and Sephadex. Although the lowest mean value was in the group of patients with cancer of the pancreas, there was wide range of activity of B-glucuronidase in all groups and subgroups and considerable overlap in values between them. It was concluded, therefore, that B-glucuronidase activity assay of the duodenal contents was of no value as a diagnostic test for cancer of the pancreas or for distinguishing between the several diseases affecting the pancreas.


Changing concepts of duodenitis.

Nonspecific duodenitis exists as a clinical entity distinct from duodenal ulcer disease. Duodenoscopic findings take two general forms: 1. nodularity and erythema, 2. erosions and friability. Both forms usually tend to improve with time but do not necessarily disappear. Although frequently a mild illness, the hemorrhagic erosive form of duodenitis is a potentially serious complication causing marked gastrointestinal bleeding and should be considered in patients taking aspirin-alcohol or following severe physiologic stress. Lastly, most patients initially seem to respond to anticholinergic, tranquilizer or antacid therapy but clinical correlation with long-term treatment will require controlled studies.


Effect of alcohol on total urinary hydroxyproline excretion.

Urinary hydroxyproline excretion was measured in 33 patients regularly drinking over 80 gm. alcohol daily. Those with changes of cirrhosis on liver biopsy excreted significantly more hydroxyproline than those with normal appearances, fatty change or hepatofibrosis. In 16 patients, the excretion was measured both when they were drinking and when abstaining from alcohol, in the form of several beverages. The rate of excretion was significantly higher after alcohol has been withdrawn. This result raises the possibility that alcoholic beverages may inhibit collagen degradation. If substantiated, it further suggests that the effect of alcohol on collagen metabolism may be of importance in the pathogenesis of alcoholic cirrhosis.


The removal of an esophageal papilloma by endoscopic means. A case report and brief review of the literature.

The case of a 77-year old white male on anticoagulant therapy who developed sudden onset of gastrointestinal bleeding is presented. A benign esophageal papilloma was a fortuitous finding. The papilloma was removed in toto by fiberoptic endoscopic polypectomy. A brief review of this rare lesion is presented and the importance of a careful endoscopic examination as well as the therapeutic/curative potentialities of the procedure are stressed.


The radiology corner. Porcelain gallbladder.

Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis. Diagnosis is suggested on the plain abdominal roentgenogram by identifying thin curvilinear calcifications in the right upper quadrant. Because porcelain gallbladders fail to visualize on oral or intravenous studies, cholecystosonography may be used to confirm the location of the calcifications within the gallbladder wall.


Observations on the core particle of hepatitis B virus and the DNA polymerase associated with hepatitis B antigen.

Several methods are presented for the purification of core particles of hepatitis B virus (HBV) from nuclei of infected human hepatocytes. No endogenous DNA polymerase activity was found in any of the preparations of core particles even when circular double and single stranded DNAs were used as exogenous templates. The DNA polymerase activity associated with serum HB Ag was not stimulated by circular DNAs. Sodium dodecyl sulfate (SDS) at concentrations of greater than or equal to 0.1% inhibited the DNA polymerase activity of serum HB Ag. Exogenous templates such as native and activated calf thymus and Micrococcus lysodeikticus DNAs did not stimulate the DNA polymerase of serum HB Ag even in the presence of low concentrations of SDS. It is suggested that the DNA polymerase associated the HB Ag is specific for its own DNA as template.


DNA and DNA polymerase in the core of the Dane particle of hepatitis B.

The core of the Dane particle was shown to contain a DNA polymerase and a circular double stranded DNA with a molecular weight of 1.6 X 10(6) daltons which served as the primer-template for the enzyme. The product of the DNA polymerase reaction was in a base paired form and was covalently attached to the circular DNA. Neither the circular DNA nor the attached DNA product of the enzyme reaction was attacked by the DNase or released from intact cores until the cores were disrupted with sodium dodecyl sulfate, suggesting that they are internal components of the core. The DNA polymerase is a specific marker for Dane particles and can be used to distinguish sera with high and low concentrations of Dane particles. The DNA polymerase reaction can also be used to radiolabel Dane particle cores for a specific and sensitive radioimmunoprecipitation assay for antibody against the hepatitis B core antigen (anti-HBc).


Viral hepatitis, type B, in experimental animals.

Evidence of natural infection with hepatitis B virus (HBV) in chimpanzees was followed by demonstration that this species provides a highly sensitive animal model system for experimental type B hepatitis. With rare exceptions, inoculation of sero-negative chimps with materials containing infectious HBV produces serologic evidence of infection including appearance of circulating hepatitis B surface antigen (HBs Ag) and subsequently development of antibody to HBs Ag and hepatitis B core antigen. Serum enzyme elevations indicative of liver damage occurred in 31 of 46 aminals infected to date. The antigenic subtypes of HBV in the inocula breed true in the infected animals, and HBV titers of sera containing the adw and ayw subtypes have been established as 10(7.5) infectious units/ml. Rhesus monkeys also provide a valuable animal model for type B hepatitis, but they appear to be less sensitive than chimps, and they do not develop evidence of liver damage.


Tissue and organ culture studies of hepatitis B virus.

Techniques have been developed for the cultivation of human and nonhuman primate liver cells in tissue and organ culture. Progressive non-cytocidal involvement of the normal cytoplasmic and nuclear components of cultured liver cells has been demonstrated by specific attachment of fluorescent antibody to hepatitis B core and surface antigens after inoculation of the cultures of human origin with known infective sera and with clinical material. Hepatitis B surface antigen may be produced, although infrequently, in inoculated liver organ cultures but serial passage has not been achieved. Serial passage of hepatitis B virus has been reported with fragments of human embryo liver cultivated on the chorioallantoic membrane of the developing chick embryo. Intranuclear virus-like particles have been localized in hepatocytes of cultured explants of liver biopsies obtained from infants with chronic hepatitis B antigenemia. Further studies are urgently required to determine whether cultivation of hepatitis B virus can be firmly established in readily available cell and organ cultures.


Female and married: damaging to the therapy profession?

The first half of this paper describes the socialization process of women to their role in life. An examination is made of the literature and the lessons female children are taught about their place in the adult world in relationship to men. This "place" is typified by the hospital structure where the majority of therapists are employed. The second half of the paper looks into four aspects of professionalism--motivation, autonomy, commitment, and a sense of community--and examines each with the added dimension that membership in the therapy professions is predominantly female and married. Criteria for professionalism are defined on a continuum. Female occupational therapists fit much of this criteria, but conflicts of motherhood and career have a negative effect on their professional life and thus on their profession as well.


Promising prospects: students choosing therapy as a career.

Careers in health fields are becoming increasingly popular among college students, and therapy (occupational, physical, and speech) is one of the fastest growing of these fields. To identify the characteristics of potential therapists, a group of subjects who had entered college as first-time, full-time freshmen in 1966 and who indicated in 1970 that they planned on a career in therapy were compared with aspirants to other health careers with respect to demographic characteristics, sources of college financing, academic achievement, and education/employment status as of 1970. In addition, their attitudes and values--as revealed by self-ratings, life goals, and reasons for choosing the career of therapy--were examined. Prospective therapists were found to have outstanding academic records, high rates of baccalaureate completion, and specific skills that seemed to qualify them for success in the career. They were stongly oriented toward working with people, had altruistic goals and values, and were highly confident of their interpersonal skills.


Clinical aspects of infantile asthma.

Infantile asthma presents a major therapeutic challenge to the practicing physician. The typical infant with asthma is a 14-month-old boy with recurrent episodes of wheezing since the age of seven months. Nasal eosinophilia is found less often than in older allergic children; however, 47 percent of infants with asthma will have either peripheral blood or nasal secretion eosinophilia to aid in the recognition of their atopic diathesis. The younger the infant (both at age of onset and at age of evaluation) the more likely are foods to be important factors in his allergic respiratory disease. His disease is unlikely to interfere with growth during infancy but may do so later in life. Hyposensitization is more likely to be required later in childhood if he does not respond to dietary manipulation. Despite appropriate therapy, wheezing may continue to be a problem during childhood and this is significantly correlated with the presence of a positive nasal smear at the time of initial allergy evaluation.


Egg sensitivity and eczematous manifestations in breast-fed newborns with particular reference to intrauterine sensitization.

In 10 newborn breast-fed infants with eczematous manifestations, sensitivity to egg was confirmed by indirect elimination and provocation tests in the mother and direct provocation and elimination tests in the infant in the weaning period. In almost all of the mothers hemagglutinating antibody titers against egg were high in the amniotic fluid. The role of intra-uterine sensitization to food in the etiology of eczematous manifestations in newborn breast-fed infants is discussed.


The value of inhalation challenge testing as an office procedure.

One hundred seventy-three bronchial challenge tests were performed as an outpatient procedure on 35 selected clinic patients. The incidence of positive tests was sufficiently high and the procedure tolerated well enough to suggest this as a practical office procedure if carefully done in properly chosen patients.


Reactions to hidden agents in foods and drugs can be serious.

Agents used to color, flavor, preserve or identify medication frequently used in the treatment of allergic diseases may in themselves produce severe allergic or toxic reactions. Some cross-react with Aspirin. Aminopyrine, Indomethacin (indocin), Mefensmic Acid (ponstel) to which an allergic patient may be sensitive. Three case reports are presented.


Basic concepts of behavior therapy: an experiment involving disturbed adolescent girls.

This paper attempts to summarize some of the basic principles and approaches of behavior therapy that occupational therapists may find useful for application in many areas of practice. It attempts to do this by describing an experimental application of the behavioral modification approach within a treatment unit for disturbed adolescent girls. Two social skills, compliance and social greeting, are dealt with in this article. These skills are two of the many behaviors labeled "performance survival skills" shown in recent studies to be necessary for successful community adjustment.


A sensory-integration program for blind campers.

An occupational therapy pilot program with emphasis on sensory integration was introduced into a six-week day camp for 18 blind children. The therapist screened and assessed the children through a number of tests that did not require sight. A treatment session was held five mornings each week that stressed individual therapy, and involved balance, movement, and body form concepts. The campers' performance improved in vestibular integration, in lessening of fear of movement, and, in some, in improved integration of reflexes. Plans have been made to continue the program in succeeding summers.


Allergy epidemiology in the St. Louis, Missouri, area. V. Cereal ingestants.

Among the cereal ingestants, rice, rye, wheat, corn and oats, provocative skin tests of patients differed according to age. Sensitivity to rice and oats was low for children and that to rice in particular was high for adults, suggesting a differential immunological response to rice allergens. Compared to patient grass pollen reactions, response to ingestants was noticeably lower. Cross-reactivity among ingestants was also lower, particularly between oats and the other cereals.


Influencing behavior to improve attendance at occupational therapy in a psychiatric setting.

In order to increase attendance at occupational therapy of acute psychiatric patients, two reinforcement procedures were tried: Procedure 1 used prompting and social reinforcement, where Procedure 2, in addition, used a positive reinforcer. The two procedures increased both the attendance and the percentage of time used significantly when compared to baseline. The results are discussed in terms of applications and consistency with other findings.


"Shock lung" resulting from perfusion of canine lungs with stored bank blood.

An in situ lung perfusion model was used to study the impact of stored bank blood, with or without dacron wool filtration, on morphologic and functional derangement in canine lungs. Autologous blood was stored 24 hours or 21 days in ACD solution and then passed through standard recipient set filters before perfusion through the left lower lung lobes of dogs equipped to have pressure and gas tensions monitored from pulmonary artery, vein and bronchus. In an additional group of dogs, 21-day stored blood was additionally filtered through dacron-wool prior to lung perfusion. Pulmonary vascular resistance increased markedly for lungs perfused with stored blood, whether or not dacron-wool filtered, as compared with lungs perfused with fresh blood. Effective compliance decreased in both groups of lungs perfused with stored blood, and arteriovenous oxygen gradients decreased significantly in these groups as compared with fresh blood-perfused lungs. As an index of congestion, wet/dry lung weight ratios increased for both groups perfused with stored blood which also showed gross and microscopic evidence of pulmonary edema. As a measure of microaggregated blood debris, screen filtration pressure determinations were not significantly different in fresh or stored canine blood in ACD. We conclude from observations of these canine lung perfusions that pulmonary anatomic and functional injury can result from the use of stored bank blood which may be modified, but not eliminated, by depth filtration. We infer that microaggregated blood debris is not the primary noxious factor in stored canine blood, and a toxic serum-borne factor may be implicated.


Protective effect of steroids on liver ischemia.

Occlusion of the afferent liver circulation for variable periods of time would be advantageous to temporarily control bleeding from profound lacerations or during extensive resections. Because of its low tolerance to ischemia we attempted to protect the liver with steroids during inflow occlusion. Total hepatic ischemia was produced in rabbits by ligating the portal triad and gastrohepatic ligament for 30 minutes. A 10 per cent survival was obtained in untreated controls whereas pre-treatment with methylprednisolone improved survival to 100 per cent. Methylprednisolone injection after occlusion improved survival only to 57 per cent. There were profound pathohistologic and electron microscopic changes in untreated controls. In animals treated with methylprednisolone either before or after occlusion changes were minimal or absent. This treatment was used in four trauma patients in whom occlusion of the liver inflow was carried out for various periods of time. Even though no significant statement can be made from such small group, the early postoperative course was remarkably smooth and stable. Methylprednisoline protects the liver during warm ischemia, especially if given before occlusion, and decreases the mortality from this maneuver in experimental animals.


Thrombosis at the site of interruption of the vena cava: a consideration in prophylactic treatment of pulmonary embolism.

This study confirms the method of Ratnoff in inducing the hypercoagulable state in dogs, and further demonstrates that there is a varying thrombogenic factor when the vena cava is interrupted by ligation, staple plication, suture plication, serrated clip, and a smooth clip. The incidence of thrombosis caused by ligation, staple plication and suture plication would suggest that these are not suitable methods for prophylactic use. That no thrombosis occurred with the smooth clip would suggest that as a prophylactic measure, the smooth clip may be preferable to a serrated clip.


Predictive value of ultrasonically derived arterial pressure in determination of amputation level.

There is a real need for a reliable guide to determine the lowest level of successful limb amputation. Factors such as wound edge bleeding and clinical judgment cannot be minimized but, when clinical experience had been the sole index, AK amputation has too often resulted. The availability of a pocket-sized Doppler ultrasound pulse detector has made thigh or ankle systolic pressure recording a simple bedside procedure. Our analysis shows that a thigh pressure of 50 mm Hg correlates well with success of BK amputation. This fact can be added to the clinician's judgment in better rehabilitating the elderly ischemic amputee.


General surgery and trauma.

While some degree of specialization is essential in surgery there remains a place for the general surgeon. The tendency to regard surgical intensive care as a specialty should be resisted. Similarly the surgery of trauma should remain in the field of the general surgeon in full co-operation with the orthopaedic surgeon and, in special circumstances, the neurosurgeon.


Intestinal absorption following small-bowel resection.

Proximal or distal small-bowel resection was performed on female Wistar rats. Water, glucose, electrolyte, and bile acid absorption from the perfusate was studied in bile-fistula sham-operated rats and in animals 3 months after intestinal resection, using an in-vivo recirculation perfusion system. The jejunum and caecum, but not the colon, showed adaptive increases in intestinal absorption after resection of the ileum, and supranormal bile acid absorption and enhanced glucose, water, and electrolyte absorption were demonstrated in the ileum after jejunal resection. The improvement in diarrhoea observed in some patients after right hemicolectomy may be due to compensatory changes in the residual colon; rectal mucosal thickness becomes significantly increased after right hemicoletomy.


Mass screenings for cervical cancer in Finland 1963-71. Organization, extent, and epidemiological implications.

In Finland, up to 100,000 smears are taken annually from Finnish women, who number more than 2 millions, in conjunction with the mass screening programme organized by the Cancer Society of Finland. About 400,000 smears were taken during the period 1963-71; the detection rates per 10(5) were found to be 69 for invasive cancer, 6 for microinvasive carcinoma, 168 for carcinoma in situ, 127 for dysplasia of high degree. Those previously married, and those experiencing bleeding on sexual intercourse, formed high risk groups (relative risk 2 and 6) whereas those previously electro-coagulated had a relative risk of 0.13 only. Probably no changes will occur in the time trends of mortality rates as a result of the screening. The incidence of invasive carcinomas was found to be decreasing by time, although the increase in carconoma in situ cases exceeded this decline.


HL-A antigens in patients with persistent palmoplantar pustulosis and pustular psoriasis.

HL-A typing was performed in a series of 22 patients with persistent palmoplantar pustulosis, 14 patients with palmoplantar pustulosis and psoriasis, 15 patients with generalized pustular psoriasis and 45 patients with uncomplicated psoriasis. None of the patients with persistent palmoplantar pustulosis alone had relatives with psoriasis, which was a common finding in the other groups. The HL-A antigens 13 and 17 were markedly increased in the group of uncomplicated psoriasis. In the group of patients with persistent palmoplantar pustulosis alone neither of these antigens was increased, as compared with a control population. Four patients with persistent palmoplantar pustulosis and psoriasis had HL-A 17 or 13 and two patients with generalized pustular psoriasis had HL-A 17. In the latter group HL-A 27 occurred in eight cases and correlated with the presence of sacro-iliitis. It was concluded that persistent palmoplantar pustulosis is an entity genetically distinct from psoriasis even if psoriatic patients might have an increased tendency to develop this type of pustular reaction.


On biological half-life of potassium in man.

The highly sensitive whole-body counting technique makes quantitative determinations of nanocurie amounts of gamma-emitters within the body possible. So such counters are especially suitable for the long-term measurement of tracer retention and excretion rates. In the present study, the biological half-life of body potassium in ten male volunteers was determined using 42K as tracer. The group was measured using two different types of whole-body counters. A 43-cm standard chair technique was used with counter A and a multidetector linear scanning technique with counter B. The oral tracer dose of 12-15 muCi 42K to volunteers made it possible to estimate the biological half-life of potassium, which varied from 10 to 28 days, the mean being 16 days. The total body potassium determinations were carried out with the 42K- and 40K-methods. The results of the parallel determinations performed with Counter A agreed well with those of Counter B. A good consistency was also found in the body potassium values of individual subjects, obtained using both the methods separately for each counter.


Effect of amiloride on digitalis-induced electrocardiographic changes.

In 10 out of the 13 healthy subjects a single oral dose of 1.25 mg of digoxin induced S-T-J depression and T wave flattening in the exercise ECG. Treatment with potassium-sparing diuretic, amiloride, at a dose of 5 mg twice daily for one week reversed the digoxin-induced S-T-J depression but had no effect on the T wave changes.


Pulmonary function in tetraplegic and paraplegic patients.

Dynamic spirometry and arterial blood gas analyses were performed in a series of 12 tetraplegic and 8 paraplegic patients. A marked restrictive impairment of ventilatory function was found in all patients with tetraplegia, the mean vital capacity (VC) and one second forced expiratory volume (FEV1.0) were less than half of the predicted normal values. Paraplegia was accompanied only by a slight ventilatory restriction in five patients, while three showed normal respiratory function. Signs of airways obstruction were not revealed in either group. Arterial oxygen tension was normal in all patients. With one exception, elevated PaCO2 values were not found in the series. Hyperventilation (decreased arterial PCO2) was a common finding, it was regarded to be partly due to the effects connected with the examination procedure.


Liver biopsy and liver function tests in 28 consecutive long-term alcoholics.

Liver cirrhosis was not found by needle biopsy performed on 28 consecutive male alcoholics of "skid-row" type, but 14 had fatty degeneration and 14 normal histology of the liver. Hypoalbuminemia was the most consistent finding. The combined galactose tolerance test could not predict fatty degeneration. There was no correlation between the laboratory tests used to assess liver function and the degree of fatty degeneration.


Clinical findings in relation to morphology in breast carcinoma.

In 117 women with breast cancer, breast size, tumour size, suspicion of malignancy and clinical stage (Columbia Clinical Classification) were assessed clinically by palpation. Tumour size, degree of differentiation, malignancy grading (Ackerman), co-existent cystic fibroadenosis and axillary node metastases were assessed histopathologically. Differentiation was also assessed cytologically. There was good agreement between clinical and pathological measurements of tumour size. Ackerman's histopathological grading of malignancy correlated with the other criteria better than some other systems of malignancy grading. A higher histopathological malignancy grade was found in larger tumours and older patients. There was no clear relationship between cytological and histopathological malignancy grading. Lymph node metastases occurred three times more often in large breasts than in small ones, in spite of relatively slight differences in tumour size. Cancers in breast with cystic fibroadenosis were smaller, less malignant histopathologically and had fewer lymph node metastases than cancers in breasts without cystic fibroadenosis. "Definite cancer" on palpation was more often associated with a highly malignant tumour than a less suspected palpatory finding.


[Lymphoid hyperplasia of the colon].

Report of the cases of two infants presenting with lymphoid hyperplasia of the colon, occuring after intestinal obstruction associated with enterocolitis. In one case, it was histologically proved. These cases emphasize the problem of the real meaning of lymphoid hyperplasia of the colon, as well as the meaning of its relationships with enterocolitis. Evolution was benign and it seems that there is no peculiar symptomatology.


[Capillary blood coagulation in the healthy premature newborn].

Blood coagulation of healthy premature newborns, since birth, was studied for 45 days by a method of capillary blood sampling in a plastic tube. The most often measured clotting factors allowed to establish control coagulation times for the tests performed in premature sick infants. In this study, the clotting factors were identical in at-term and premature children. Vitamin-K dependent factors showed the most important deficits; however, at birth their levels seemed higher in at-term newborns. They reached control values after one month, with a progressive evolution. The other blood-clotting factors were normal.


[Renal papillary necrosis in an infant].

Report of a case of renal papillary necrosis in an infant, following acute dehydration with cardio-vascular failure. Evolution was favourable and diagnosis was established retrospectively by I.V. urogram.


[Cerebral malformation and thanatophoric nanism].

Report of one case of atypical osteo-chondrodysplasia, which was classified as a thanatophoric dwarfism, with neuropathological examination of the brain. Microgyria and cytological changes were in the ectocinerea. Too heterotypies in the neuronal place were observed.


An experimental evaluation of alternative communication systems as used for medical diagnosis.

While the problem of providing adequate health care to remote populations has been widely recognized, little research has been undertaken to evaluate alternative systems designed to provide such care. An essential part of such a system is the communications link between the doctor and the community he is serving. Studying this two-way subsystem is the context of primary diagnosis and patient management, efficiency and effectiveness of color television, black and white television and hands-free telephone were compared with physical presence consultation. No significant differences in performance were found among the three systems using telecommunications. Physical presence consultation was found superior only for detecting secondary medical problems. Significant rank order correlations were found, however, between the years of experience of the consulting physician and both diagnostic accuracy and appropriate patient management. Also, the attitudes of the patients, doctors and nurses alike ranked physical presence over color television over black and white television over hands-free telephone for medical consultations.


Preparation and properties of concanavalin A-binding glycopeptides derived from rat brain glycoproteins.

Mannose-rich glycopeptides derived from brain glycoproteins were recovered by affinity chromatography on Concanavalin A-Sepharose. These glycopeptides, which adsorb to the lectin and are eluted with alpha-methylmannoside, constitute about 25--30% of the total glycopeptide material recovered from rat brain glycoproteins. They contain predominately mannose and N-acetylglucosamine (mannose/N-acetylglucosamine = 3), as well as small amounts of galactose and fucose. Approx. 65% of the Concanavalin A-binding glycopeptide carbohydrate was recovered after treatment with leucine aminopeptidase, gel filtration on Biogel P-4, and ion-exchange chromatography on coupled Dowex 50-hydrogen and Dowex 1-chloride columns. The purified glycopeptide fraction contained six mannose and two N-acetylglucosamine residues per aspartic acid and possessed an apparent molecular weight of about 2000 as assessed by gel filtration and amino acid analysis. Galactose and fucose were absent. Treatment of the purified glycopeptides with alpha-mannosidase drastically reduced their affinity for Concanavalin A, suggesting the presence of one or more terminal mannose residues.


Effect of multiple injections of allogeneic spleen cells on methylcholanthrene carcinogenesis in the mouse.

Weekly injections of irradiated splenic cells from multiple genetic origin significantly reduces susceptibility of mice to carcinogenesis with one injection of 0.1 mg of methylcholanthrene.


Effect of varying differentiator frequency response on recorded peak dP/dt.

The effects of varying the differentiator cutoff frequency on the recorded peak first derivative of left ventricular pressure were assessed. High fidelity, solid state pressure transducers and recording equipment were used. In the canine heart with a basic periodicity of 1-3 Hz, the differentiator frequency response required to record an accurate peak dP/dt is influenced by the value of peak dP/dt. In the range of peak dP/dt between 1 500 and 9 000 mm Hg/s (200 and 1 200 kPa/s), a differentiator cutoff frequency of at least 90 Hz was required to record accurately peak dP/dt.


Histological and ultrastructural studies of the basal disk of Hydra. III. The gastrodermis and the mesoglea.

The gastrodermis and mesoglea of the basal disk of Hydra were investigated to conclude a three-part series of papers. The gastrodermis is composed of digestive cells (most predominant cell type), mucous and nerve cells (both immature and fully differentiated). The principal function of the digestive cells appears to be storage of protein, lipid and glycogen reserves which are utilized by neighboring cells. Mucous cells apparently use some of the reserves to synthesize their secretions which lubricate cells and prevent cell damage during egestion of waste through the aboral pore. The function of the gastrodermal nerve cells is uncertain. The mesoglea of the basal disk, contains the same structural components as seen in other regions of the polyp. It is reasonable to assume that it maintains the same function of cell adhesion and migration. As the mesoglea converges on the aboral pore, it loses its structural integrity and cells are sloughed off the column.


Binding interactions of progesterone and other C21 steroids with rat uterine cytosol.

The binding of progesterone and other C21 steroids by rat uterine cytosol preparations was studied by equilibrium dialysis. Scatchard plots and preliminary computer-assisted analysis indicated at least two types of binding sites for progestrone. Individual Scatchard plots for cortisol and corticosterone binding were linear with Ka's 0.4 and 1.4 times 10(9) M-1, respectively. Inhibition analyses and modeling of competition experiments suggest, however, that the situation is more complex. There was no binding of labeled dexamethasone.


[The effect of pivampicillin and probenecid on experimental syphilis in rabbits].

The oral single-dose-treatment of the acute gonorrhoeal urethritis of the male with 1.4 g pivampicillin and 1.0 g probenecid is one of the possible alternatives to a parenteral penicillin treatment. Experiments were performed on rabbits to determine if this dose of pivampicillin and probenecid could cure a simultaneously acquired syphilis at a very early stage of incubation. 300 treponems (Nichols strain, T. pallidum) were inoculated intratesticularly and 3 days later pivampicillin and probenecid were administered in doses which produced antibiotic serum levels similar to those in patients who had received a single oral dose of 1.4 g pivampicillin and 1.0 g probenecid. Controls over a 15-weeks period showed that this dosage did prevent the development of syphilitic orchitis and reactivity to the quantitative FTA-ABS-test. It is concluded that the treatment of acute gonorrhoea with 1.4 g pivampicillin and 1.0 g probenecid in general is sufficient to cure a simultaneously acquired syphilis.


Role of anion translocation across the mitochondrial membrane in the regulation of urea synthesis from ammonia by isolated rat hepatocytes.

The regulation of urea synthesis from ammonia was investigated using isolated hepatocytes from fasted rats. Addition of ammonia alone produced only a small increase of urea formation, which was stimulated 2-fold by ornithine in conjunction with a fall of ATP levels and an accumulation of citrulline. Further addition of oleate or beta-hydroxybutyrate produced an additional 2-fold stimulation of urea formation to approximately 200 mumol/g dry weight/hour. The presence of oleate also protected against the inhibitory effect of 2,4-dinitrophenol on urea synthesis and the cellular ATP content. The data suggest that both the rate of of energy production and the rate of generation of reducing equivalents from endogensou substrates are insufficient to meet the requirements for optimal rates of urea synthesis. Urea formation from NH3 in the presence of ornithine and oleate, but iin the absence of gluconeogenic precursors, was inhibited by butylmalonate, a known inhibitor of malate-phosphate exchange across the mitochondrial membrane, and stimulated by  theaddition of malate and other dicarboxylic acids and amino acids to the cell suspension...


Interpretation of the kinetics of consecutive enzyme-catalyzed reactions. Studies on the arginase-urease system.

Physiocochemical properties of beef liver arginase are reported, particular attention being given to its state of aggregation in the concentration range encountered in enzymic assays. It is shown that a species of molecular weight 114,000 is the operational kinetic unit. Evidence is also provided that arginase does not associate heterogeneously with urease, and therefore, in the absence of macromolecular interactions, the arginase-urease couple provides a suitable experimental system to test the applicability of theory previously developed to guide the interpretation of coupled assay results. Application of the theory led to values of the Michaelis constant and maximal velocity describing the first reaction in the sequence, catalyzed by arginase, which agreed within experimental error with the corresponding values obtained by studying the arginase-catalyzed reaction alone. Comment is also made on the product inhibition of arginase by ornithine, which must be considered in the comparison of experimental results describing the time course of a coupled assay with theoretical solutions obtained by numerical integration.


Accumulation of gene products in the oocytes of the dragonfly Crodulia Aenea L.. I. The nematosomes.

The chromosomes of the active previtellogenic oocytes of the dragonfly Cordulia aenea L. extrude into the cytoplasm a substance, which is subsequently found there in the form of granulofibrillar masses. These nuclear extrusions evolve ultrastructurally into two components, nematosomes and dense masses. The nematosomes are later found transitorily adjacent to the mitochondria and undergo transformations that are synchronized with changes in oocyte activity. It is suggested that the nematosomes are storage structures for long-lived informational RNA and that they man be widely distributed in various types of cells containing such RNA.


Comparative immunology of Galapagos iguana hemoglobins.

The antigenic properties of the major hemoglobin component of the Galapgaos iguanas were studied using second-approximation qualitative and quantitative immunochemical techniques. Phylogenetic distances, relative to the Galapagos marine iguana. Amblyrhynchus cristatus, were established on the basis of immunological cross-reactions.


Comparison between prostaglandin E2 and oxytocin actions on pregnant mouse myometrium.

Effects of prostaglandin E2 (PGE2) and oxytocin on the membrane activity of pregnant mouse myometrium were investigated with the microelectrode method. Sensitivity of the myometrium to oxytocin increased only during the last stage of gestation, however sensitivity to PGE2 gradually increased beginning at the middle stage of gestation. Prolonged treatment with PGE2 but not with oxytocin produced desensitization of the myometrium. When the membrane potential was electrically displaced to the resting level after the membrane had been markedly depolarized by either PGE2 or oxytocin, spike activity was restored. However with PGE2 there was continuous spike generation and with oxytocin periodic burst discharges with silent periods. In Ca-free Locke solution, PGE2 and oxytocin still produced depolarization of the membrane, however, oxytocin produced larger depolarization. The different responses of the membrane to PGE2 and oxytocin are discussed in relation to the roles of Ca ion and to the ovarian and placental hormones during gestation.


The morphologic effects of simultaneous infusion of levarterenol and phentolamine on the canine myocardium.

The effect of simultaneous administration of levarterenol and phentolamine on the myocardium over a 3 hour period was studied in 15 adult mongrel dogs. All animals receiving levarterenol alone had moderate-to-severe subendocardial hemorrhage and necrosis. Four of the 6 animals receiving the simultaneous infusion of levarterenol and phentolamine had little or no hemorrhage or necrosis. These differences are significant (p less than 0.02). It is concluded that the administration of phentolamine simultaneously with levarterenol affords a significant protective effect on the myocardium.


Fascioliasis of livestock and snail host for Fasciola in the Altiplano Region of Bolivia.

Fascioliasis caused by Fasciola hepatica was a serious problem for sheep and alpacas in the Altiplano Region of Bolivia. In some provinces close to Lake Titicaca, the raising of sheep was forced to discontinue, because infection with the fluke made it unprofitable and almost impossible. It was proved that in the Altiplano Region, two species of freshwater snails, Lymnaea viatrix and L. cubensis var., served as intermediate hosts for F. hepatica. In some subtropical areas of Bolivia, these snails could not be found, although other Lymnaea sp. was widely distributed there. As it is possible for Lymnaea sp. to be intermediate host for the fluke, further studies are required on the identification. Acute fascioliasis of sheep occurred in the Altiplano Region principally during a period from May to July, or the dry season. In some areas, the mortality rate of infected sheep was roughly estimated as 15 to 25% annually. Contamination with Fasciola metacercariae of herbage and semi-aquatic plants grown in a swamp in one of these areas was biologically assessed, using guinea pigs. Plants of Compositae and Eleocharis sp. were contaminated most intensely and those of Senicio sp. and Vallisneria sp. carried a fairly large number of cysts, while plants of Scirpus sp. and Ranunclaceae carried only a few cysts. No signs of Fasciola infection were observed in any animal given the plants of Liliaceae.


Protein deprivation in primates: VI. Food preferences of adult rhesus monkeys maintained on low-protein diets.

Three groups of adult female rhesus monkeys, maintained on low-protein diets (.5 gm, 1 gm, and 2 gm protein per kg body weight, were compared with a control group (4 gm protein per kg body weight) on a food-preference task. Food responsiveness was assessed by presenting 8 small pieces of a certain food, equally spaced about the perimeter of a turntable attached to the home cage, and recording number of pieces taken, number of pieces eaten, and elapsed time for taking all 8 pieces. 21 different foods were used in sequence, 3 each from the following 7 categories: cheese, meat, vegetable, nut, cereal, fruit, and candy. Scores on all 3 measures were highly correlated, and the order of preference was generally the same for all groups. The 2 lowest-protein groups accepted more foods at the lower end of the palatability spectrum than did either the 4-gm or the 2-gm group. There was a tendency for the foods least preferred by the protein-deprived monkeys to be themselves high in protein. Thus, although protein deprivation appears to increase the catholicity of food preference, there is no corresponding increase in the relationship between palatability and protein content.


The influence of dietary nitrate on nitrate concentration in egg yolk and albumen.

Sodium nitrate (from 0 to 2,000 p.p.m.) was added to the drinking water of 32-week old S.C. White  Leghorn pullets. Eggs collected once a week for 8 weeks were analyzed for nitrate content. Increasing levels of nitrate in the drinking water resulted in increasing levels of nitrate in albumen and yolk. Higher levels of nitrate were found in the yolk than in the albumen. When birds were started on the experiment, nitrate in the drinking water was reflected by immediate increases in nitrate content of the eggs. The nitrate content of eggs from birds receiving 1,000 p.p.m. NaNO3 (728 p.p.m. NO3-) exceeded the 45 p.p.m. permissible level of nitrate in drinking water for human beings.


Solubilization of a stereospecific opiate-macromolecular complex from rat brain.

A [3H]etorphine-macromolecular complex has been solubilized from rat brain synaptosomal fraction by extraction with the nonionic detergent Brij 36T. Stereospecificity of binding to this solubilized complex was demonstrated by the finding that radioactivity in the complex was virtually eliminated when binding had occurred in the presence of excess levorphanol, an active narcotic analgesic, while it was unaffected by its inactive enantiomorph dextrorphan. Bound radioactivity was dissociated by proteolytic enzymes, sulfhydryl reagents, and heat, suggesting the presence of protein. The bound solubilized macromolecular moiety may be the opiate receptor.


Fine structure of cardiac ganglion trunk in prawn, Penaeus japonicus bates.

The cardiac ganglion trunk of prawn, Peneaus japonicus Bates, is on the middle line of ventral wall of the cardiac tube and consists of nine ganglion cells, many nerve fibers and neuropils. These neuronal elements are insulated by supporting cells and connective tissue fibers. The peripheral area of the perikaryal cytoplasm of the ganglion cell is separated into many compartments by deep invaginations of the cell membrane. Each compartment is packed with a tight network of the agranular endoplasmic reticulum. Among nerve fiber bundles are many small areas of neuropil. Most of the synapses in the ganglion trunk are observed in the neuropil, but there are a few nerve terminals which form synapses with the somata of ganglion cells.


[Studies of the toxic components of Erysipelothrix rhusiopathiae. 2. Communication: Detailed characterization of an extracted endotoxin (author's transl)].

The endotoxins of different Erysipelothrix rhusiopathiae strains were examined in various biological systems, since in earlier investigations (Leimbeck and Böhm, 1975) the lethal effect for 10 day old chick embryos had been found to be highly dependent upon the virulence of the strains. The lethal effect for mice and rats was found to be much less. The toxin of the strain T28 proved to be highly pyrogenic for rabbits and inducing acute shock-effects in swine SCHULZ et al. (1961) already suggested that a shock-like pathogenesis existed in the swine erysipelas infection. Furthermore the endotoxic nature was confirmed by the typical course of temperature after i.v. application of the toxin, the ability to cause the Sanarelli-Schwartzman-reaction (both in rabbits), the protection against toxicity by cortisones, and heat stability. An erysipelas antiserum did not neutralize the toxin. It was found to have low antigenic and apparantly no immunogenic properties and an allergic skin-reaction in experimentally infected swine could not be induced. The toxins of various strains were tested by the macrophagemigration-inhibition test. In respect to a preliminary classification the toxin could be identified as a complexed water-soluble and heat-stable glucoproteid with an estimated molecular weight of 31.700. The polysaccharides were found to be the presumable carriers of toxicity.


[Kidney lesion in mice from an antirenal serum].

Intravenous administration of anti-renal serum in a dose 1--1.6 ml to mice line CBA brought about drastic changes in the kidney ranging from severe dystrophy of the tubule cells to necrosis of the epithelium of the proximal and straight tubules. A smaller dose (0.5 ml) produced initially degenerative changes in individual cells of the proximal convoluted and straight tubules, and 2--6 months later degenerative changes were noted almost in all cells of the tubules referred to above. The glomerular apparatus was affected in a lesser degree. The relative weight of the kidneys of the mice treated with anti-renal serum at the end of the 3rd month was less than that in control animals. The urine contained granular and hyaline cylinders and a considerable amount of protein. Concentration of urea in the blood serum of the experimental animals was found to be elevated.


Cell surface sialoglycopeptide metabolism and surface glycosyl transferase activity in the Ehrlich ascites cell.

1. The in vivo incorporation of radioactivity from [3H]glucosamine into a trypsin labile, cell surface sialoglycopeptide fraction (SGP) of Ehrlich ascites cells was studied in the presence and absence of puromycin pretreatment. The results indicated a much more complete inhibition of incorporation into the surface SGP than in the average intracellular acid insoluble glycoproteins. No evidence of turnover of the carbohydrate portion of the surface SGP independent of protein synthesis could be obtained. 2. However, when intact cells were incubated with labelled uridine 5'-diphosphate-N-actely glucosamine or cytidine 5'-monophosphate (CMP)-sialic acid there was some incorporation largely into acid insoluble material, suggesting the presence of glycosyl transferase activity in the surface. Further evidence for surface activity was obtained when neuraminidase pretreatment of intact cells stimulated incorporation of labelled CMP-sialic acid sixfold and almost all of the incorporated counts could be released by subsequent neuraminidase treatment. Furthermore, a much greater proportion of the incorporated counts could be released by papain than by trypsin treatment of the intact cells. These results suggest that the surface acceptor for exogenously added CMP-sialic acid is not identical to the endogenously synthesized trypsin labile surface SGP.


A comparison of cytogenetics and histopathology in the malignant lymphomata.

The non-Hodgkin's lymphomata are characteristically near diploid with occasional examples having higher chromosome numbers. In contrast, about half the cases of Hodgkin's disease have chromosome numbers in the triploid range. Karyotypes in cases of Hodgkin's disease appear to be more deranged than those found in other lymphomata, even when the cells are in the diploid range. If karyotypically normal cells in the tumours represent some degree of host reaction, then this is most marked in Hodgkin's disease. Long arm deletions of chromosome 18 were identified in cells from 7/31 cases of non-Hodgkin's lymphoma; 5 were follicular and 2 contained both follicular and diffuse areas. The cases showing this deletion had a relatively good prognosis.


A summary of the results of a review of 405 patients with non-Hodgkin's lymphoma at Stanford University.

A résumé of the major advantages of using the Rappaport classification of the non-Hodgkin's lymphomata is presented. The data are taken from a series of 6 papers resulting from a retrospective review of 405 cases at Stanford University. The frequency of nodular lymphomata (44%) is emphasized. The clinical features, response to therapy and natural history of these patients are quite different among the various subgroups. Use of this classification instead of former pathological classifications is urged.


A retrospective analysis of the clinical results in relation to the Rappaport histological classification.

The Rappaport classification of the non-Hodgkin's lymphomata was applied to 460 cases at the Princess Margaret Hospital. Statistically significant differences in the numerical incidence between the nodular and diffuse patterns was found for the entire series and for the lymphocytic, "histiocytic" and mixed cell types individually. All of the undifferentiated types were diffuse. These differences were sustained for the degrees of differentiation within the lymphocytic group. The "histiocytic" group was not subclassified by differentiation. The cell types differed in the numerical distribution of the patterns. The lymphocytics were predominantly diffuse but their nodular forms constituted a higher proportion of the nodular pattern than did their diffuse types of the diffuse group. More of the well differentiated lymphocytics were nodular than were diffuse and they formed a higher proportion of the nodular group than they did of the diffuse. On the other hand, the poorly differentiated lymphocytics were predominantly diffuse and these were less well represented in the nodular group than in the diffuse tumours. The intermediate differentiated types were usually diffuse but slightly better represented in the nodular group. Most tumours of the "histiocytic" type were diffuse and these constituted a higher proportion of diffuse than the nodular tumours. The mixed cell lesions were predominantly nodular and comprised a much higher proportion of nodular lesions than diffuse. No real differences were identified amongst the histological types according to age or sex distributions. The crude survival to 4 years differed significantly for the histological types. For the entire series and for each cellular type, the nodular patterns were superior to the diffuse, although, in the lymphocytic well differentiated types, pattern made no real difference to survival.


Patterns of involvement with malignant lymphoma and implications for treatment decision making.

Decision making in cancer therapy has traditionally evolved through careful observation of the clinical course subsequent to various treatment approaches. This method has also served to delineate the wide spectrum of primary manifestations and patterns of biological behaviour characterizing the malignant lymphomata. Marked disparity has been consistently appreciated between the natural history of lymphomata originating in lymph nodes in contrast to those primary in extranodal sites. The former are usually anatomically generalized at diagnosis whereas primary extranodal lymphomata are commonly localized and more closely resemble carcinomata of the respective organs with their propensity for both regional lymphatic extension and haematogenous spread. Prospective staging of 100 consecutive patients with previously untreated malignant lymphoma has been consistent with this past experience in demonstrating the presence of disseminated involvement in the majority of patients. It has also become apparent that reliance upon either clinical or surgical staging of disease extent is often misleading since widespread disease frequently develops even in those patients staged as having localized involvement and thereby treated with local irradiation. High dose, wide field lymphatic irradiation "á la Hodgkin's disease" seldom constitutes appropriate treatment for patients having lymph node presentations of lymphoma. There is rather a need to recognize the importance of systemic treatment for most cases, negating the utility of routine exhaustive staging since treatment decisions can be based upon readily assessed clinicohistological determinants in the majority of cases.


Diagnostic laparotomy in non-Hodgkin's lymphoma.

Twenty patients with non-Hodgkin's lymphoma (NHL) were investigated by diagnostic laparotomy. These patients were seen over a 3 1/2 year period during which a total of 78 patients with NHL were seen. Laparotomy was considered unsuitable in 58 patients, either because widespread disease was easily demonstrated by simpler means or because of their poor general medical condition. Laparotomy revealed more extensive disease in 14 patients. Although laparotomy is proving to be a worthwhile investigative procedure, it is less likely to be useful as a routine investigation than is the case with Hodgkin's disease. Widespread involvement of mesenteric lymph nodes is common and among the 10 patients with a poor histological grade of tumour, 2 with negative laparotomy findings developed disease in the abdomen within 3 months of operation.


Patterns of presentation and relapse in the non-Hodgkin's lymphomata.

An analysis of the modes of distribution of initial sites of involvement in patients with Stage II and III non-Hodgkin's lymphoma revealed a contiguous pattern of involvement of lymph node bearing areas directly connected by lymphatic channels in 76% of patients with nodular lymphomata and in 84% of those with diffuse lymphomata. The patterns and frequencies of initial relapse following radiotherapy for each histopathological type and stage (Stage I-III) are described. The sites of relapse are analysed in relation to initial pretreatment sites of involvement and in relation to radiation fields employed. The therapeutic implications of these data are discussed.


Staging procedures in mycosis fungoides.

Mycosis fungoides (MF) in deep-seated lymph nodes, spleen or liver appears to be associated with a lack of response of the disease to topical external therapy. Fourteen patients with mycosis fungoides were clinically staged and had a staging laparotomy. Mycosis fungoides was found in the lymph nodes of 3 of these patients, in the spleen in 4 and in the liver in 2 cases. Patients with adenopathy, or with splenomegaly or abnormal spleen scans, should be considered for surgical staging to determine the extent of extracutaneous disease. The documentation of extracutaneous MF becomes necessary in the development of new therapeutic approaches.


Survival in localized nodal and extranodal non-Hodgkin's lymphomata.

A retrospective analysis of 133 patients with localized nodal and extranodal non-Hodgkin's lymphomata whose staging investigations included marrow aspirate and lymphography shows that more than 60% remain alive and disease-free 4 years after initial therapy. Further relapses may occur in this group, particularly in the nodular lymphomata, but so far the majority of relapses and three quarters of the deaths from disease have occurred within 2 years of diagnosis. Of the entire group of patients, only 15% showed an unequivocally nodular pattern and a further 25% a partially nodular, partially diffuse pattern. Thus, 60% of patients had diffuse lymphoma but differences were observed depending upon the site of presentation. In the nodal Stages I and II cases, whereas only 4 of 55 patients with supradiaphragmatic disease showed a nodular pattern, 12 of 24 infradiaphragmatic presentations had nodular lymphoma. This difference was reflected in a lower relapse rate in the latter group. Mediastinal involvement was uncommon but carried a grave prognosis. As far as it was possible to judge, extension to adjacent nodal areas as a cause of relapse was not a common problem and, as observed previously, relapse was much commoner to a wide variety of extranodal sites than is the case with Hodgkin's disease. In this series marrow involvement was documented in only 7 patients but this surprisingly low frequency might be due in part to infrequent marrow sampling after the initial investigations were completed.


Epidermal antigens in lichen planus.

The loss of intercellular and basement membrane antigens has been associated with the development of epidermal cell dysplasia and neoplasia. The antigenic components of the epidermis have been investigated in lichen planus, lupus erythematosus and eczema, using pemphigoid and pemphigus sera by the indirect immunofluorescent staining method. In areas of active lichen planus there was extensive reduction or complete absence of basement membrane antigen. Intercellular antigen was preserved in lichen planus although in some damaged rete ridges it appeared to be reduced. Both these antigens were well preserved in lupus erythematosus and eczema. Loss of epithelial antigens is therefore not confined to the development of neoplasia.


Non-Hodgkin's malignant lymphomata of upper digestive and respiratory tract: natural history and results of radiotherapy.

A total of 218 non-Hodgkin's malignant lymphomata of the upper digestive and respiratory tract are reported. 72% had Waldeyer's ring involvement and 22% had paranasal sinus involvement. Ilio-lumbar lymphography was performed in 98 cases: 33 lymphograms were abnormal. In 152 Stage I and II patients, loco-regional irradiation gave 129 remissions. Among these patients, 66 suffered a relapse, most of them during the first year after treatment. Primary relapse analysis revealed 18 true recurrences, 10 nodal extensions and 38 extranodal disseminations. The median survival is 14 months for all stages; the survival rate at 5 years is 38% for Stages I and II for patients treated by 60Co alone. No statistical significance in prognosis has been found for age, sex, size of primary tumour, involvement of upper or lower nodes in the neck, histological type nor between Stage I and Stage II. Lymphography and x-ray gastrointestinal examination must be performed routinely before treatment in order to stage patients correctly.


Heterogeneity of bovine snout epidermal prekeratin.

The prekeratin of the snout of cows was extracted with 0-1 mol/l citric acid-sodium citrate buffer, pH 2-6. The results of equilibrium ultracentrifugation analyses of this prekeratin strongly suggest that this protein is not homogeneous. This conclusion is in accordance with the observations of two other investigators whose data infer that there is no major homogeneous keratin precursor in cow's lip or snout epidermis.


Surfometry. A method of evaluating the internal structure of the stratum corneum.

A method is described which enables measurement to be made of the roughness of the surfact of skin surface biopsies. The instrument used in this investigation has previously been employed to measure the degree of unevenness of metal and ceramic surfaces and is called a 'surfometer'. Using this technique the tracings that resulted from examination of normal skin, psoriasis and certain ichthyotic states could easily be distinguished. It was also demonstrated that there was a consistent pattern of change with increasing hydration of the stratum corneum in the absence of easily identifiable morphological alterations.


Mucocutaneous leishmaniasis in guinea-pigs inoculated intravenously with Leishmania enriettii. Preliminary report.

Seven guinea-pigs were inoculated intravenously with a rich suspension of Leishmania enriettii. During the sixth to the seventh week from inoculation, all of them developed lesions within the anterior nasal mucosa and in the vulva or scrotum. In one animal nodules occurred in the forepaws during the tenth week. The histology of the latter showed an epithelioid granuloma with multinucleate giant cells, while in all the others macrophages and monocytes highly parasitized with leishmania bodies, formed the main elements in the granulomatous infiltrate. Lesions seem to develop in the cool, non-hairy areas of the integument and those areas of the nasal mucosa which are constantly bombarded by the inhaled cool air stream. The anterior nasal mucosa, with its leaking venular network, its cool timperature, relative stasis and hypoxia probably provides the optimum micro-environment for the localization, survival and multiplication of the leishmanial protozoon.


Skin manifestations associated with tumours of the brain.

In a 4-year period seventy-seven patients with tumours of the brain were investigated for skin manifestations. These were observed in twenty-four (31-2%) and fall into three main groups: Pruritus. Thirteen patients complained of pruritus. Most characteristic is the pruritus of the nostrils, which was observed in six patients. It can be extremely severe and is a sign of an advanced tumour. Pigmentary disorders were observed in seven patients. In two, vitiligo appeared simultaneously with the brain tumour symptoms. In the others, hyperpigmentation appeared on the face later in the course of the disease. Hyperkeratotic changes were manifest in four patients. Two had a mild hyperkeratosis of the palms and soles. The other two developed in addition an ichthyosiform atrophy of the skin. The possible pathogenesis of the skin manifestations associated with brain tumours is discussed.


Cutaneous extensibility in pseudo-xanthoma elasticum.

In vivo skin elasticity was measured on unaffected forearm skin of twenty-five patients with pseudo-xanthoma elasticum and compared with age and sex-matched controls. The elastic modulus was raised in the recessive type I group and reduced in the dominant types I and II groups. No significant difference in skin thickness was found.


Chronic paronychia and psoriasis.

Nineteen of fifty adult female patients with chronic paronychia and five of fifty adult female control dermatological patients suffered from psoriasis.


'Pseudomorphoea': a side effect of subcutaneous corticosteroid injection.

Three patients are reported who developed cutaneous atrophy in the upper arm following a single injection of a long-acting corticosteroid preparation into the deltoid region.


Effects of intensive application of retinoic acid on human skin.

The daily application of 0-3% retinoic acid to the back produced an acute irritant dermatitis which resolved to a near-normal clinical appearance within 40 days despite continued daily exposure. Hardened skin was markedly altered physiologically. The responses to DMSO, histamine and the histamine liberator, compound 48/80, were sharply enhanced. This reflected enhanced permeability resulting from reduction of the horny layer to less than one-half its normal thickness. Phototoxic and irritant substances produced exaggerated reactions owing to greater penetration. A paradoxical decrease in delayed sinsitivity to streptodornase-streptokinase was attributed to enhanced clearance of the antigen.


Treatment of solar keratoses of the extremities with retinoic acid and 5-fluorouracil.

In contrast to solar keratoses of the face, twice daily application of 5% 5-fluorouracil cream was found to be incapable of destroying such lesions situated on the forearms and hands. Twice daily application of 0-1% retinoic acid was also ineffective. Combined use of these agents eradicated keratoses in all twenty subjects with numerous keratoses of the forearms; in only two was the treatment ineffective for keratoses of the hands.


Oestrogen-induced familial porphyria cutanea tarda.

Two brothers with cutaneous hepatic porphyria are reported. One, aged 64 years, had his disease apparently precipitated by the oestrogen treatment given for carcinoma of the prostate.


Milia occurring in lichen sclerosus et atrophicus.

Large numbers of milia were seen in areas of skin affected with bullae in a 68-year-old woman who had extensive lichen sclerosus et atrophicus. Although milia are frequently seen in other sub-epidermal bullous disorders, they have not previously been reported in lichen sclerosus et atrophicus.


Estimation of fetal weight from ultrasonic measurement of trunk circumference.

A new method of estimating fetal weight from the circumference of the fetal trunk, measured by ultrasound, is described. Comparison of weights estimated in this way with the actual birth weights of 50 fetuses, delivered not more than 48 hours later, shows a mean error in prediction of only 75 g, and in 94 per cent the error was less than 145 g. With such accuracy, the method is of clinical value, particularly in anticipating difficult delivery and in monitoring growth of the fetus at risk.


A critical evaluation of sonar "crown-rump length" measurements.

In a study to evaluate the reproducibility and accuracy of the sonar technique of measurement of the in vivo fetal crown-rump length (Robinson, 1973), a series of in vivo and in vitro experiments was performed in which the random and systematic errors inherent in the technique were assessed. The potential sources of random error were those of operator judgement, movement of the fetus and mother, machine sensitivity settings and measurement from the photograph; while the sources of systematic error were those of oscilloscope scale factor, and velocity calibration inaccuracies, and the effect of beam width. The overall effect of the random errors, that is, the reproducibility of the technique, was assessed in an in vivo blind trial in which three independent measurements were made of the fetus. In a series of 30 experiments the average standard deviation of the three readings was found to be 1.2 mm. Evaluation of the systematic errors by in vivo experimentation, on the other hand, showed that the basic sonar measurements were in error by an overestimate of 1 mm for the beam width effect and 3.7 per cent for the scale factor and velocity calibration errors. A weighted non-linear regression analysis of 334 measurements was performed in order to obtain a "curve of best fit" for the period covering 6 to 14 weeks of menstrual age. The values obtained were corrected for the systematic errors and compared with widely quoted anatomical figures. In the second part of this investigation the original data was further analyzed to determine on a statistical basis the accuracy of the technique as a method of estimating maturity. It was shown that such an estimate could be made to within 4.7 days with a 95 per cent probability on the basic of a single measurement, and to within 2.7 days if three independent measurements were made.


Failure of heparin therapy to affect the clinical course of severe pre-eclampsia.

In view of the association between pre-eclampsia and disseminated intravascular coagulation, three patients presenting with severe pre-eclampsia before the 28th week of pregnancy were treated with heparin. In all three patients, there was deterioration of hypertension and proteinuria that necessitated the withdrawal of treatment after five to six days. During treatment, serum and urinary fibrinolytic degradation products (FDPs) continued to rise or remained unaltered, plasminogen levels showed a steady fall, and the platelet count remained at a reduced level. These data suggest that heparin was an ineffective form of treatment and did not prevent the intravascular fibrin deposition associated with severe pre-eclampsia.


The management of anticoagulant therapy during and after pregnancy.

Fifteen patients were treated with oral anticoagulants during pregnancy. At 37 weeks they were changed to heparin and were given 5 mg of Vitamin K1 by intravenous injection. Labour was induced seven to ten days later. All infants were normal and healthy and in the 12 tested the cord prothrombin times were within the normal range.


Terbutaline inhibition of midtrimester uterine activity induced by prostaglandin F2alpha and hypertonic saline.

The effect of the beta receptor stimulator, terbutaline, on uterine activity induced by intra-amniotic injection of prostaglandin F2alpha or hypertonic saline was investigated in 20 patients undergoing therapeutic abortion in the second trimester. Intrauterine pressure was recorded, and the basal tone, intensity and frequency of contractions and "total" activity (expressed in Montevideo Units or MU), were measured. Uterine activity was higher in the prostaglandin group (mean value 393 MU) than in the hypertonic saline group (mean value 238 MU). However, terbutaline, infused at a rate of 5 to 20 mug/minute, decreased the activity by approximately the same absolute amount in the two groups to a mean value of 214 MU in the prostaglandin group and to 68 MU in the saline group. In some patients of the saline group, terbutaline completely inhibited uterine contractions. Basal tone, which was high in the prostaglandin group (mean value 28 mm Hg) decreased to a mean value of 17 mm Hg during terbutaline infusion. In the saline group the mean value for basal tone decreased from 10-5 to 7-5 mm Hg. It is concluded that uterine activity, induced by intra-amniotic injection of prostaglandin F2alpha or hypertonic saline, can be inhibited by terbutaline. The mechanisms of action for prostaglandins and hypertonic saline are discussed.