Diagnosis and management of minimal recurrences of macular histoplasmosis.

Disease in the macula from ocular histoplasmosis has been ascribed to (1) traction of a scar, (2) fresh areas of choroiditis, and (3) reactivation of a scar. Traction of a scar is probably a rare cause. The rationale for early use of corticosteroids in attacks of ocular histoplasmosis is based on the hypothesis that the underlying disease is an inflammation. The concept of a choroiditis could fit with what is assumed to happen in the case of second and third hypotheses, those of fresh choroiditis and reactivation of a scar. The goal of therapy is to stop the inflammation before it is clinically recognizable by the ophthalmologist, so that little or no damage to vision results. Whether corticosteroids might work by suppression of an immunological response or simply by curtailing the severity of the choroiditis, or both, is not known. We do know from clinical experience that corticosteroids do not appear to be deleterious to the ocular histoplasmosis. When they were first tried, we were wary about using them in a "fungal" disease. As experience grew, we learned that our mistakes were usually not from using too great a quantity of corticosteroids for too long a time but the opposite; from using too small amounts of corticosteroids for too short a time. Clinically, most attacks of macular histoplasmosis occur at the sites of previous scars, with little or no sign of any choroiditis. At present, there are six poorly defined hypotheses of how this may occur: (1) symbiosis, (2) secondary infection, (3) vascular decompensation [2], (4) immunological reaction [3], (5) altered structure [1], and (6) failure of precapillary arteriole [5]. Corticosteroids might be helpful in any of these instances. I believe that the attack that usually takes the form of an enlargement of the atrophic histo spot is caused by an immunological response in this area that develops into a mild spreading choroiditis. It is possible that with a reduction of the patient's resistance, live H. capsulatum or an antigenic component of it escapes from one of the viscera to lodge in the sensitized area of the atrophic choroid where a choroiditis previously existed. At this site, a fresh, mild choroiditis is activated. This choroiditis then persists for a variable period before either becoming quiescent or progressing into the neovascular stage, with the growth of a net through Bruch's membrane and the pigment epithelium and under the sensory retina. The rationale for the early and intensive use of corticosteroids is to try to abort the attack of choroiditis before it reaches the stage of becoming recognizable by the ophthalmologist.


Therapy of chorioretinitis presumed to be caused by histoplasmosis.

We acknowledge that for most patients with istoplasmic chorioretinitis, the only treatment available is steroids. We agree with Schlaegel that steroids have to be used in adequate doses and for long periods of time. Alternate-day treatment should be instituted as soon as possible. Because it  takes the adrenals 10 days to to weeks to be suppressed by sterid therapy, we treat our patients with daily doses for as short a time as possible and then witch over o alernate-day treatment. A short-acting steroid such as prednisone, prednisolone, or methylprednisolone should be used at the outset if long-term therapy is necessary and one anticipates using alternate-day therapy...


Presumed histoplasmic maculopathy: xenon photocoagulation.

Every investigation into the efficacy and role of photocoagulation in the management of PHM has been handicapped by the lack of a valid control series. In all first eyes, the results of photocoagulation are better than in second eyes. The increased salvage rate of central visual acuityof 20/50 or better in first eyes without photocoagulation is on the order of 15.8 percent to 28.6 percent-versus 25 to 38 percent in first eyes with photocoagulation (an average of 54 percent salvage rate for all first eyes). However, in second eyes, even though the number of eyes is small, it appears that nonphotocoagulated eyes do better than those that have been photocoagulated: 46 percent of nonphotocoagulated second eyes versus 33 percent of second eyes with photocoagulation retain central vision of 20/50 or better. Comparison of our results with some of the other published studies indicates some disparity in results [1-5], arising, most plausibly, from variations in the severity of the maculopathy just prior to photocoagulation. It is our contention that carefully designed prospective studies are needed, in which cases would be randomized for treatment in groups classified according to severity of the process (for example, size of SNV, proximity of SNV to fovea, and amount and location of subretinal hemorrhage). In order to obtain sufficient cases for analysis, a collaborative study may be essential in which the results and analysis of the cases are compiled by an independent party not involved in the treatment of evaluation of the patients. Despite this lack of clinical corroboration, it is my firm belief based on clinical experience that photocoagulation does have a role in the management of this vision-threatning process.


Presumed histoplasmic maculopathy: clinical course and prognosis in nonphotocoagulated eyes.

In this chapter, we have tried to identify some of the variables related to the visual prognosis in eyes with presumed histoplasmic maculopathy. We are cognizant that a constellation of other as yet unidentifiable variables also may play a role in the visual prognosis. Also, we have reported our visual results in patients who were nt photocoagulated. Many of these patients received corticosteroid therapy in some form, but we found it impossible to compare treatment ot nontreatment groups. Our results for visual prognosis is all nonphotocoagulated eyes are in general agreement with those available in the literature. For instance, Gass et al. [1] report 20 of 38 eyes (52.6 percent) with visual acuity of 20/200 or less. Also, this same study documents retention of 20/30 or better central vision in 13 of 38 eyes (34 percent), and the visual results in our study for all 54 nonphotocoagulated eyes parallel the reported findings of Schlaegel et al. [3] where 59 percent of eyes ended with a visual acuity of 20/200 or worse, 30 percent with vision of 20/50 or better, and 18 percent with vision of 20/30 or better...


Ocular lesions in the Earth Day, 1970, histoplasmosis epidemic.

The relationship between systemic histoplasmosis and this particular clinical picutre of a central choroiditis with peripheral atrophic lesions in the fundus was postulated by Woods in 1960 [19]. Since that time there have been many studies attempting to substantiate his hyptthesis [1, 3-5, 7-18]. In a large study performed in Walkersville, Maryland, which is an area endemic for histoplasmosis [14], the prevalence of the characteristic peripheral histoplasmic lesion in the fundus was 27 per 1000 population. The prevalence was 44 per 1000 population with positive histoplasmosis skin tests. In a similar study done in sothern Ohio, the prevalence of peripheral fundus lesions was 1.6 percent of 1417 patients examined [1]. Several generalizations can be made from the information obtained in studying the students involved in the Willis flu, and these can be compared with information from the control students from Bellingham. First, the acute infection at Willis School did not cause significant ocular abnormalities. This finding is supported by the fact that no significant differences occurred in the fundus lesions seen in the control group of students who lived in the same geographic area but were not clinically ill from histoplasmosis. Our evidence shows that the eyegrounds of the individuals living in this area were different from those of the students who lived outside the central Ohio area. How do we account for the similarity of ocular lesions in the affected students and the Delaware control group? Perhaps by the age of 11 or 12, a person living in the histoplasmosis belt will have already been exposed to histoplasmosis, resulting in the characteristic scars that are seen. If, in fact, histoplasmosis is the etiological agent in the patients who are diagnosed as having presumed ocular histoplasmosis, difficulty arises in understanding why those individuals involved in the epidemic did not have more scars than the control group. Perhaps the numbers of patients examined were not large enough to reflect the difference that really may exist. An interesting observation is that 4 (67 percent) of our control students with significant lesions had negative histoplasmosis skin tests. Of course, other organisms may have caused these lesions which have not yet been implicated as causative agents in the presumed ocular histoplasmosis syndrome.


Benign breast disease and cancer.

We report the necessity for thoroughly understanding the physiopathology of benign breast lesions in order to treat each type of lesion adequately. Three groups of women are outlined as a practical approach to this problem. Subadipose mastectomy is proposed to treat heteronodular mastopathy. This operation is compared with the subcutaneous mastectomy proposed by plastic surgeons.


Giant teratomas with benign glial abdominal seeding, mimicking diffuse abdominal carcinomatosis.

Teratomas of children represent an important part of oncology. A small percentage of teratomas in this age group is malignant and associated with a rather poor prognosis. In most cases, the malignant element is a mature ectodermal derivative, i.e., epidermal epithelium. Abdominal seeding associated with teratomas is usually considered clinically and pathologically malignant. In a few cases, the teratomatous masses are associated with abdominal seeding of essentially mature neuroglial elements and chances of long survival are good. Therefore, recognition of neurogenic teratomatous tumors associated with glial seeding is important since it will preclude unnecessary surgery and irradiation or chemotherapy. Conservative management seems to entail a good prognosis even if occasional postsurgical complications such as adhesions, fibrous bands or obstructions occur. The two presented cases illustrate the clinical and pathological entity of large ovarian teratomas associated with neuroglial abdominal seeding and their good prognosis at four and five years respectively following surgery alone. These two cases support the experience in the other 25 cases reported in the world literature that these lesions are benign clinically and pathologically.


Otoneurological problems in head injuries and their management.

In facial nerve injury, the guidelines for treatment are time of onset, electrical responses, other concomitant damage such as CSF otorrhea or ossicular disruption, and associated infective conditions such as cholesteatoma. Four patients with CSF otorrhea responded well to conservative treatment, one patient needed postauricular mastoidectomy as there was an associated cholesteatoma and one required surgery when conservative treatment failed to stop the otorrhea. Two cases of deafness due to ossicular disruption were seen in the postoperative convalescent phase. Five other cases were discovered during routine examinations for conductive deafness. All seven patiens underwent surgery for incudostapedial joint separation.


The "turban" nevoid basal cell syndrome. Current management with surgery, chemotherapy and immunotherapy.

"Turban" nevoid basal cell syndrome is a congenital disease that presents with multiple subepidermal epitheliomas, primarily on the scalp. Other secondary findings may be present such as cysts in the mandible and bifid synostotic rib. A combination of treatments proved beneficial in this disease. Surgical excision was used for treatment of large symptomatic lesions such as painful ulcerating and enlarging tumors. Chemotherapy was used to arrest and cause regression of small and dormant lesions. Immunotherapy was used to control the primary disease. Such treatment cured most of the disease and offered a fruitful life to the patient, who is presented to illustrate this multiple disciplinary approach.


On the increase of the percentage of females among patients with infectious and calculous renal diseases and on its possible causes.

The study of sex distribution revealed an increase of the percentage of females among more than 12 000 patients with pyelonephritis, renal tuberculosis and nephroureterolithiasis in the period 1959-73 from 69 to 75%, from 63 to 69% and from 54 to 64%, respectively. The tendency revealed may be explained by a decrease of the role of general causal factors, which are of the same importance for males and females, and by the relative increase of the role of local factors, which are of greater importance for females due to pregnancy, delivery, and gynecological disorders. The role of the latter factors in the pathogenesis of infectious and calculous renal diseases in women is confirmed by the study of the history and the fate of female patients and by a more frequent affection of their right kidney. Women after complicated pregnancy and delivery, gynecological diseases and genital surgery need regulat dispensary urological observation to prevent and detect early infectious and calculous renal diseases.


Determination of the glomerular filtration rate by the minute diuresis at a specific gravity of 1001.

A new method is described for determination of the glomerular filtration rate, based on the fact that at an urinary specific gravity of 1001 the final urine is concentrated 6.67 times, as compared with the primary glomerular filtrate. The glomerular filtration rate is evaluated by multiplication of the minute diuresis at a specific gravity of 1001 by the factor 6.67. In this manner the chemical analysis of urine and blood is avoided. Urine with a specific gravity of 1001 is obtained by water loading much the same as in the dilution test of Volhard. For checking the accuracy of the method, comparative studies were conducted with creatinine clearance in 36 patients and with 51Cr-EDTA clearance in 33 patients. The difference in the values of the glomerular filtration rate, evaluated by the above-mentioned two methods and the new method was statistically not significant (p greater than 0.05). The method is recommended for the early detection of disturbances in the glomerular function prior to the occurrence of azotemia.


Potassium load from blood transfusion in dialysis patients.

When a transfusion of packed red blood cells is given, the net potassium load results from lysis of some cells and absorption of potassium by surviving cells. Potassium load was calculated which results from administration of 1 unit (200 cc.) of packed RBC and also that resulting from administration of sufficient packed cells to yield 200 cc. of surviving RBC. Although the acute load of potassium due to cell lysis increases as blood is stored for longer periods, the absorption of potassium by surviving cells also increases. Thus, net potassium load may be least if blood is stored for about one week. Hence the acute potassium load and the net potassium burden a patient receives from a transfusion can be considered when transfusion therapy is selected.


Spermolithiasis.

Spermolithiasis has been a neglected subject of discussions and of published observations. This may be due to the fact that the process is fairly uncommon and does not seem to involve serious clinical consequences. It presents, on the other hand, important differential diagnostic aspects in connection with the pathology of the true pelvis and may give rise to misinterpretations unless its possibility is kept in mind. The importance of this rare syndrome is pointed out. Its etiology, pathology, symptomatology, differential diagnosis and therapy are discussed. Five observations are reported.


Significance of transaminase determination in seminal fluid.

GOT activity of the seminal fluid plasma was examined in 161 cases. High values were found in cases with astheno- and necrospermia, and in those with an increased spermatozoon count, low values were found in cases with oligospermia. The authors consider GOT determination in seminal fulid plasma a useful supplemental test in the diagnosis of male sterility.


Recent changes in the assessment of urogenital tuberculosis.

The urogenital tuberculosis has undergone a change in form and clinical assessment. The absolute proportion of urogenital tuberculosis cases has fallen off sharply since 1967. The nmber of surgical interventions is also remarkably reduced. The cases exhibiting a milder stage have significantly increased, while the severe cases have decreased. This change of tuberculosis has made a conservative therapy favorable; therefore the current operative indication is somewhat different than 15 years ago. The time of release from the stationary treatment depends first on the animal experiment and bacterial findings; furthermore, tests are necessary to determine the status of immunity. It was revealed with urogenital tuberculosis, through regular examination of the menstrual blood of women, that the number of positive cases among women was considerably higher, than among men. In contracted bladder a surgical intervention is often necessary due to intense pain and incontinence. We prefer the rectal bladder with sigmoid pull-through inside the sphincter ani, whereby excellent success can be achieved. The study shows that the clinical assessment of tuberculosis is somewhat different today than is was earlier. Tuberculosis underwent a change in form that must be taken into consideration with respect to operative indication.


Renal calcification in genito-urinary tuberculosis a clinical study.

1. Calcification in renal tuberculosis is not warranting a healing process, but may be a clinical manifestation of the disease. 2. Calcification presenting at least one year after the start of treatment should be considered differently from calcification  first seen on presentation, and s,ould be treated in the same way as renal calculi. In view of the high incidence of associated active renal tuberculosis, calcification present when first seen should be removed, preferably with partial excision if the lesion is amenable to this form of treatment, but if it is not removed, patients should be followed up indefinitely, as complications can occur at any time. 3. Extra-renal calcification is more common in patients suffering from genito-urinary tuberculosis who present with renal calcification. 4. The incidence of renal calcification in patients suffering from renal tuberculosis is increasing. This could either be due to the host, the pathogenic organism, or possibly the treatment. As the host and treatment have not changed, it would suggest some alteration in the character of the organism.


Estimated frequency of acute and chronic renal insufficiencies in a Transdanubian region of Hungary.

The literature on the incidence of chronic and acute renal insufficiency is reviewed and the results of own investigations in an area with a population of 1,560,000 are presented. Data were collected in questionnaires. The yearly incidence of patients with chronic uraemia requiring active therapy was estimated at 33 per 1 million population. The number of acute cases was 45 per million. The necessity of increasing the dialysis capacity is stressed. The importance of peritoneal dialysis in the therapy of uraemia cases which do not meet the requirements of the acute and chronic dialysis programmes is emphasized.


1975 Memorial Award Paper. Image generation and display techniques for CT scan data. Thin transverse and reconstructed coronal and sagittal planes.

The various limitations to computerized axial tomographic (CT) interpretation are due in part to the 8-13 mm standard tissue plane thickness and in part to the absence of alternative planes of view, such as coronal or sagittal images. This paper describes a method for gathering multiple overlapped 8 mm transverse sections, subjecting these data to a deconvolution process, and then displaying thin (1 mm) transverse as well as reconstructed coronal and sagittal CT images. Verification of the deconvolution technique with phantom experiments is described. Application of the phantom results to human post mortem CT scan data illustrates this method's faithful reconstruction of coronal and sagittal tissue densities when correlated with actual specimen photographs of a sectioned brain. A special CT procedure, limited basal overlap scanning, is proposed for use on current first generation CT scanners without hardware modification.


Further investigation and initial clinical use of advanced CT display capability.

The AUR Memorial Award Paper (this issue, pp. 403-416) described a technique for providing thin transverse CT sections and for redisplaying this transverse CT data as coronal or sagittal anatomic planes. This paper presents additional experience with cadaver models and the results of initial applications of the method to data obtained from living patients. The technique potentially enhances the clinical usefulness of CT scanning by providing precise triangulation and resolution of normal and abnormal structures.


Renal collateral blood supply after acute unilateral renal artery occlusion.

Preformed arterial collaterals are critical to renal parenchymal survival after acute total renal artery occlusion. This study was designed to delineate and quantify preformed collaterals and assess their response to vasodilators. A Swan-Ganz catheter induced a sudden, total occlusion of a renal artery sufficient to reduce distal arterial pressure to near zero and prevent perfusion through the renal artery. Arteriography assessed the effectiveness of the occlusion and delineated the collateral arterial pathways. Strontium, cerium-, and chromium-labeled microspheres measured renal blood flow and cardiac output 1, 60, and 120 minutes after occlusion. In two additional series of experiments either contralateral nephrectomy was performed 5 to 8 days before the study, or dibenzylene, dopamine, or glucagon were administered in an attempt to increase blood flow through the collaterals. Collateral renal blood flow was demonstrated in all dogs. Mean blood flow to the occluded kidneys ranged from 0.13 +/- 0.05 cm3/minute/g to 0.22 +/- 0.08 cm3/minute/g, about 5% of control values. Neither prior contralateral nephrectomy nor vasodilator agents increased the flow to the obstructed kidneys. In the dogs with intact contralateral kidneys, however, there was a progressive decrease in cardiac output during the experiment, which was not found in uninephrectomized animals. We concluded that preformed arterial channels are available to maintain a small, but probably critical level of perfusion following sudden total occlusion of the renal artery. Neither hypertrophy due to prior contralateral nephrectomy nor active vasodilators modify flow through the preformed channels. It is likely that total renal ischemia provides a maximal stimulus for vasodilatation. The pattern of hind limb collaterals differed strikingly from those of the kidney, with maintenance of a greater portion of a normal flow and rapid increase in flow within 1 hour after femoral artery occlusion. Thus, data concerning collateral circulation cannot be generalized from one vascular bed to another even in the same species.


Characteristics of tantalum dust and dust generator for bronchography.

The two tantalum powders, "5mu" and "1.4mu", available from Fansteel Metals, are characterized with respect to particle size. Results show that these powders cannot be used directly for tantalum bronchography, but require fractionation to achieve a range of sizes for effective use in tantalum bronchography. This task can be accomplished with the BAHCO Micro Particle Classifier. The powder designated "1.4mu" is superior to the "5mu" powder because about 60% by weight can be salvaged by separation for use in bronchography, compared to only 7% by weight of the "5mu" powder. Theoretical considerations of particle deposition in the human respiratory tract indicate that the material obtained with throttle 16 of the BAHCO is best suited for tantalum bronchography. The dust generator is a good tool to deliver a dust cloud into the lung. The generator can operate for approximately 2 1/2 hours before the brush of the brush feed must be replaced; a procedure taking about 10 min. Additional maintenance is unnecessary. The breathing resistance of 1.1 inch of water imposed by the generator system, and which has to be overcome by the patient, is judged acceptable. The bronchograms obtained by introducing tantalum dust for 10 min into an artificially ventilated dog lung were clear, with deposition heaviest at bifurcations. These results suggest that the generator should now be used for human bronchography.


Investigation of 125I as an isotopic source for mammography.

An isotopic radiation source 125I was investigated for use in soft tissue radiaography, with particular attention to possible use in mammography for mass screening. Film sensitivities, exposure rates, absorbed doeses, contrast and resolution were determined, and compared to conventional x-ray units. It was found that contrast and resolution were comparable to 30 kVp x-rays (W anode) but that surface absorbed dose was reduced by a factor of two with 125I. These results experimentally verified the advantage to be obtained from monoenergetic radiations, which had been predicted from theoretical considerations by others. Duration of exposure was estimated to be between 4 and 12 sec with a 40 Ci source. The 60-day half life of 125I may necessitate its use in conjunction with an image intensification system or electron radiographic techniques, in order to preclude source replacement at inconveniently short intervals.


Effect of ionic and non-ionic contrast medium on aortic and pulmonary arterial pressure. An angiocardiographic study in rabbits.

Effects in angiocardiography from injections into the right atrium of rabbit hearts of a new, non-ionic contrast medium (Amipaque) were studied and were compared with the effects from injections of an ionic medium (Isopaque Coronar) at a dose of 3 ml/kg rabbit and concentration of 370 mg I/ml. Forty-seven experiments in 11 rabbits are reported. Amipaque produced a significantly (p less than 0.001) smaller increase in pulmonary arterial pressure (29%) than Isopaque Coronar (82%). Simultaneously (within 12 seconds from the beginning of an injection) Amipaque produced an increase in aortic pressure of 21%. About 10-15 seconds later when the contrast media had reached peripheral vessels Amipaque produced a significantly (p less than 0.001) smaller decrease of aortic pressure (12%) than the decrease produced by Isopaque Coronar (40%). The differences found between the two types of contrast media are believed to be related to, among other factors, their different osmolality. The osmolality of Amipaque was about one third of the osmolality of Isopaque Coronar.


Cholangiographic excretion studies. Solu-Biloptin and Biligrafin comparison.

The biliary concentration and output of two cholangiographic agents, Solu-Biloptin (calcium ipodate) and Biligrafin (meglumine iodipamide), were compared in labrador dogs. The maximum output of ipodate was approximately 20 mumol/min compared with 16 mumol/min for iodipamide. The maximum bile iodine concentration with both ipodate and iodipamide was similar (18-20 mgI/Ml) but the molar concentration of ipodate was almost twice that of iodipamide. Iodipamide was found to be much more choleretic, producing 0.025 ml of bile/mumole excreted compared with 0.009 ml/mumole for ipodate. Compared with iodipamide the lower choleretic effect and higher molar concentration of ipodate suggests that hepatic conjugation of the oral agent may permit its excretion in bile salt micelles.


Characteristics of smokers, nonsmokers and ex-smokers among 10,000 adult males in Israel. I. Distribution of selected sociodemographic and behavioral variables and the prevalence of disease.

Sociodemographic and behavioral characteristics of nonsmokers and smokers were compared in a large sample of working men aged 40 to 65 years. The prevalence of several diseases was compared. There was a significantly higher percentage of smokers among those born in the Middle East (outside Israel) and North Africa. Smokers were characterized by crowded housing (a high number of persons per room); low levels of education; little leisure-time physical activity; and a tendency to be nonreligious. Current cigarette smoking gradually decreased with age, while smoking a cigar or pipe only, increased. The demographic and behavioral profile of current smokers in general, and of "heavy" (larger than or equal to 21 cigarettes/day) smokers in particular, resembled that of those who had smoked at any time. Both the current and the "heavy" smokers were more often later immigrants to Israel, had more children, and were physically active at work, frequently being engaged in manual labor or technical work. Prevalence of myocardial infarction, angina pectoris, definite peripheral arterial disease, intermittent claudication and peptic ulcer was significantly higher among those who had smoked at any time. Apart from silent myocardial infarction and intermittent claudication, subjects with these conditions also included a significantly higher percentage of former smokers. Former smoking was also related to age, number of years in the country, less crowding at home, low activity at work, and a low calorie intake (particularly of protein and carbohydrates).


Fears during pregnancy. An interview study of 200 postpartum women.

Within 48 hr of delivery, 200 women were questioned about their fears and anxieties during pregnancy. Fears during pregnancy were reported by 81% of the mothers; 52% reported fears about the birth of a malformed child, 29% about a mentally defective child and 28% about the death of the child. Differences were found in the incidence of fears and superstitions in relation to ethnic group, educational background and parity. The results are similar to those of the British study conducted by the Royal College of Midwives in 1966.


Modification of the Rappaport rapid test in large-scale testing for syphilis. Evaluation of the rapid plate and rapid card tests.

The Rappaport rapid (RR) plate and card tests were developed as modifications of the RR tube test to permit rapid and inexpensive screening of large numbers of subjects for the diagnosis of syphilis. More than 2,000 sera were examined in parallel by the Venereal Disease Research Laboratory (VDRL) slide test, the rapid plasma reagin (RPR) card test and the RR plate and card tests. There was complete agreement between the RR plate and card tests and the VDRL slide and RPR card tests in 96.6% of sera. In a selected group of 1,530 sera examined, in addition, by the fluorescent treponemal antibody absorption (FTA-ABS) test, there was agreement between the RR plate and card tests and the FTA-ABS test in 74.3% of sera and between the VDRL and RPR tests and the FTA-ABS test in 73.7% of sera. The RR plate test was found to be sufficiently sensitive and specific for the diagnosis of syphilis, although the VDRL slide test is perhaps more sensitive in primary and late latent syphilis. Since the antigen used in the RR tests is colored and stable and the sera do not require inactivation before the test, the tests are easier to perform than the VDRL slide test: the RR plate and card tests could therefore replace the VDRL test as a screening test, with hardly any loss of accuracy.


[Alterations of connective tissue in granuloma anulare and in necrobiosis lipoidica. Microradiographic studies].

The microradiogram of granuloma anulare was compared with that of necrobiosis lipoidica. In the areas of cellular infiltration, the amount of connective tissue missing depended on the degree of infiltration. Apparently the collagenous bundles were destroyed, not pushed aside. In the necrobiotic type of necrobiosis lipoidica, the damage to collagenous tissue was more severe than one would have expected from the stained sections. The collagenous bundles were generally swollen, and there was a complete lack of normal high-density bundles in the damaged areas, in contrast to granuloma anulare and to the granulomatous type of necrobiosis lipoidica, however, the damage to the collagenous tissue seemed less severe in the microradiograms than in the stained sections. Differences between granuloma anulare and necrobiosis lipoidica were to be found in the microradiogram (see tables), but in general a differential diagnosis is only possible in severe cases, in spite of the different clinical picture.


[Trichorrhexis congenita. Scanning electron microscopic studies on a congenital disorder of hair growth].

1. A congenital disturbance of hair growth belonging to the "trichorrhexis nodosa" group is described. Clinically, abnormal hair fragility since birth was the leading symptom. There was no detectable amino-aciduria. 2. The scanning electron microscope (SEM) reveals localized alterations of the hair shafts. These are irregularities of the cuticular pattern, partial fractures of the cortical filament bundles, and complete fractures with broom-like splintering of the hair ends. 3. There is no generally accepted definition of the symptom or the disease of "trichorrhexis nodosa". Further SEM analysis and collection of such hair anomalies is proposed. As in the case described here no "nodes" of the hair shaft were observed, it is presented as "trichorrhexis conginita".


[The local treatment of the keratoacanthoma with 5-fluorouracil].

In the last two years thirteen patients with keratoacanthomas were treated with 5% f-fluorouracil ointment at the Department of Dermatology II of the University of Vienna. Treatment lasted from two to eight weeks depending upon the size of the tumor. In all cases there was clearing of lesions with good cosmetic results. During an average follow-up period of 7.4 months for all patients there was no recurrence of the tumors.


[The effect of bath additive concentration and the water temperature on the refatting effect of oil bath additives].

The refatting effects of three different oil bath products was tested in 30 healthy subjects. In each case the concentration of the therapeutic bath oils and the temperature of the bath water were varied. It could be demonstrated in 2 of the tested products that a threefold increase in the concentrations (as recommended by the companies) significantly enlarges the refatting effect. A further increase in the concentrations significantly reduces this effect. An increase in the temperature of the bath water from 32 degrees to 38 degrees C significantly lessened the refatting effects of all 3 products.


[Acryronitril as a contact allergen].

A case of allergic contact dermatitis following the use of a Plexidur finger splint is reported. The allergen was acrylonitrile, one of the original constituents of the polymer Plexidur.


[Pathology of connective tissue and nerve fibers in lichen sclerosus et atrophicans and in genital atrophies].

Comparative histological and neurohistological investigations in various atrophic conditions of the vulva (lichen sclerosus et atrophicans, vulvar kraurosis and senile vulvar atrophy) have been performed. Lichen sclerosus et atrophicans is an idiopathic disease within the group of atrophic inflammatory conditions. The main lesions involve the subepidermal zone which is surrounded by an inflammatory infiltration and shows at the same time the degeneration of all the fibrous and cellular components of the tissue. The resulting metabolic disturbances in the lesions enhance the degenerative processes. A neurohistological examination revealed pronounced symptoms of degeneration in the peripheral nervous system, which seems to be confirmed by the changes in LSA-lesions. Kraurosis vulvae is a separate disease and a peculiar variety of "sclerosing atrophy" leading to atrophy of the vulva and stenosis of the vaginal orifice, with atrophy of the elastic fibers, and with signs of the atrophy of the peripheral nervous network without features of degeneration. Senile atrophy of the vulva is an involuntary process without inflammatory features, in which the thinning of the entire skin and atrophy of the appendages and elastic fibers is accompanied by atrophy of the peripheral nervous system. The obtained results stress the differences which justify classification of these conditions as separate entities.


Input-output analysis and the hospital budgeting process.

Two hospitals budget systems, a conventional budget and an input-output budget, are compared to determine how they affect management decisions in pricing, output, planning, and cost control. Analysis of data from a 210-bed not-for-profit hospital indicates that adoption of the input-output budget could cause substantial changes in posted hospital rates in individual departments but probably would have no impact on hospital output determination. The input-output approach promises to be a more accurate system for cost control and planning because, unlike the conventional approach, it generates objective signals for investigating variances of expenses from budgeted levels.


Scalability of Community Participation in Health Program Decisions.

The achievement of significant levels of influence on six program decision areas by communities served by health care program is investigated using Guttman scale analysis in a sample of 50 Children and Youth comprehensive health care projects in the United States to determine whether such achievement occurs in an ordered or a random sequence. Evidence presented indicates that the achievement of relative levels of community influence is orderly for initial levels of influence; higher levels of community influence apparently do not follow the same order. Implications of these findings for planning and predicting the development of personal health service programs are discussed.


Livelihood benefits of small improvements in the life table.

This article proposes and illustrates a new lower bound on the economic benefits of reducing the number of deaths due to a particular cause and specifies the underlying economic and demographic assumptions. Unlike previous estimates of the increase in a population's output due to the extension of working lives, this new bound includes the present value to the existing population of avoiding future deaths from the cause. The estimated lower bound of $20 billion benefit from eliminating U.S. male deaths due to kidney and related diseases exceeds by an order of magnitude a previous estimate that considers only current deaths.


Roles of international advisors.

Consultation, collaboration, and direct services are described and distinguished as three different roles which advisors play. Drawn from the author's field experience, factors affecting the success of each role are presented. Consultation is further classified as expert, resource or process. Certain advisory problems are described: cultural shock and the interpersonal threats of knowledge, position and take-over.


Decision making theory: a consultant's guide to getting technical information used.

A simple model of the decision making process of a consultee can help clarify his data needs, and thus can guide a consultant in how to present and how to obtain better use of his technical information. Seven characteristics of developing countries which affect decision making are described. An approach to advising, matched to the nine elements of decision making, is suggested.


Evaluating the impact of program consultation in health services.

This article describes a methodology developed to be useful to both consultant and consultee in evaluating their mutual efforts to improve agency health service programs. Reporting forms and instruction manuals based upon the concept of mutuality in consultation were used by 19 consultants in 29 consultations. Two-thirds of the respondents reported some increase in problem-solving ability. The implications of evaluating program consultation are discussed, as are certain issues in consultation: definition, implementation, process, utilization, impact delays, interpersonal interactions, hidden agendas, organizational learning, and outcome measurements.


[The child and the otolaryngologist (author's transl)].

Figments of imagination and previous experiences enter into each clinic room emotional situation, and the apprehensions of the child, the parent and the doctor must be anticipated and acknowledged. The possibility of conflict should thus diminish. Awareness of the child's reaction and consideration of this should be the basis of doctor-patient rapport rather than physician authority. This article discusses with several illustrations the special situation of the ENT specialist.


[Facial nerve anomalies found at surgery (author's transl)].

Facial nerve anomalies found at surgery are reported, and are classified as Minor and Severe. A solitary malformation is rare. Duplication of the nerve in its tympanic segment as well as branching within the mastoid bone with an unusual route close to the mastoid cortex was also observed. Malformations of the nerve in connection with other anomalies of the ear were encountered in 20% of all ear anomalies that underwent surgery. There was no direct correlation between the degree of the ear deformity and the facial nerve malformation. Two cases of severe malformations were seen whereby in one with a minor ear deformity the nerve was seen lying at the level of the tympanic membrane. In the other instance the nerve had an additional well developed duplication in the correct position, although a lesion on the duplicated nerve showed that it was non-conductive.


[The surgery of otogenic facial paralysis (author's transl)].

Twenty five patients with lesions of the Fallopian canal were assessed: in 13 the canal was destroyed, in 7 the nerve sheath was involved and in 5 the nerve fibres were involved. Electrical and clinical testing was normal of patients with minor involvement of the nerve fibres. In poorly pneumatized mastoids the probability of osteitis close to the facial nerve must be remembered because of the dangers of latent localized mastoiditis. In all patients with chronic otitis media with granulations, cholesteatoma and osteitis the Fallopian canal should be metriculously explored surgically, and when found involved in disease it is recommended that the nerve be examined and that a "small decompression" of bone without slitting the sheath be performed.


[Diagnostic studies of facial nerve function in bell's palsy (author's transl)].

In early Bell's Palsy the nerve excitability test (NET) still proves to be a very simple and reliable method for determining whether or not a decompression operation is necessary. However, two weeks after the onset of the paralysis, pathological findings in the NET may require verification by electromyography.


[Facial neuroma without facial paresis (author's transl)].

Over a 15 year period during which 12156 operations were performed for improvement in hearing 2 facial neuromas were diagnosed. In both patients aged 55 and 61 years no treatment was considered indicated. One case which had a conductive deafness for 5 years, had a diagnostic tympanotomy and biopsy in 1961 and during the subsequent 10 years no paresis developed.


[Applied phoniatry: II. Functional dysphonies (author's transl)].

Definition and classification of functional dysphonies are problematic. Division into phonoponosis and phononeurosis is used. The terms hyperkinetic and hypokinetic dysphonia are replaced by definitions of hyperfunctional and hypofunctional dysphonia which are better applicable in clinical work. Etiology and symptoms of functional dysphonies and some pragmatically important aspects of therapy are described.


[Modern photo-endoscopic techniques for examination of the nasopharynx (author's transl)].

Advances in electrotechniques and optics in the last years have led to the use of fiberoptic endoscopes in the examination of the nasopharynx. A modified photo-endoscopic method is reported, utilizing a Hopkins' lens system which is introduced intraorally. A robot-reflex camera with variable optics and focal distance is used for photographic documentation of nasopharyngeal findings. The efficiency of the method is demonstrated by selected clinical examples.


[Otosclerosis in children (author's transl.)].

11 children (13 ears) have been operated upon for otosclerosis. In ten cases the stapes footplate was found totally fixed, with histological verification of the diagnosis of otosclerosis. Conservative surgery of the oval window was possible in only four cases. All other patients required total removal of staples or footplate. Findings indicate that clinical otosclerosis occurring in childhood results in an otosclerotic process in the oval window region with total fixation of the footplate. Thus, correction usually requires removal of at least the entire footplate.


[The prevention and management of tracheal and laryngeal steeosis in children (author's transl)].

During chronic intubation or tracheostomy in children, there is a risk of stenosis at three sites: the cricoid ring, the tracheostomy and the area of tube cuff inflation. The following measures are recommended to prevent this occurrence: endoscopic examination of the mucous membranes when changing the intubation tube or the tracheal cannula: nasotracheal intubation with the smallest possible diameter tubes when chronic intubation is required; use of the "open-type" tracheostomy utilizing mucosaskin retraction sutures but with out removal of tracheal cartilage. Careful inflation of the cuff and regular changing of the position of the cuff in ther cervican trachea also lower the risk of pressure-induced injury. Infection or co-existing metabolic disease increases mucosal sensitivity to pressure. Several stenosis of the laryngotracheal regions frequently requires staged laryngeal and tracheal plastic reconstruction. The curvature and stiffening of the ventral wall of the trachea can be achieved by the implantation of arched homograft cactilage taken from a tissue bank.


[The postoperative management of the alcoholic (author's transl)].

The paper deals with observations on alcoholics suffering from withdrawal symptoms after surgery. Apart from differential diagnostic comment suggestions are made concerning the immediate treeatment of these patients. A therapeutic scheme is proposed which has proved valuable in relevant cases. Chlormethiazol (Distraneurin) appears to be the treatment of choice.


[The responsibility of the Otolaryngologist and noise induced "accident prevention regulations" (author's transl)].

According to the noise induced Accident Prevention Regulations each employee's auditory threshold must be tested before working in a noisy enviornment [greater than or equal to dB(A)], and this threshold must be reviewed at intervals of 1 to 3 years. The regulations regarding method of examination and interpretation of observation must be followed.


[A method of otological student teaching (author's transl)].

A mechanism of teaching is described which enables students in their examination of the ear to recognise certain diseases. Pathological changes of the tympanic membrane can only be recognised by correct observation.


[Drainage of deep mediastinal infections following perforation of the cervical esophagus (author's transl)].

Deep mediastinal infection following cervical phageal perforations can be managed successfully using double-barreled sump drainage under low suction with intermittent normal saline irrigations. By so doing, the additional hazards of thoracotomy and contamination of the pleural cavity can be prevented.


[Falk's lacrimal sac surgical technique for stenosis (author's transl)].

The lacrimal sac as such is sacrificed in Falk's extra-nasal dacrocystorhinostomy. It is opened along its entire extent and embedded in toto into the lateral nasal wall. This procedure proved to be successful in most kinds of lacrimal duct stenosis. Its indications have now been extended to include those with obliteration of the lacrimal canaliculi and where the sac is itself obliterated. In such cases a thin silicone tube passed into the lower lacrimal punctum through the inferion lacrimal canaliculus and into the nose.


[Immunoglobulin and electrolyte levels in sialadenosis of the parotid (author's transl)].

A comparison of 15 patients with sialadenosis of the parotid gland and 15 control patients was made of their levels of immunoglobulins A, G and M, sodium, potassium, calcium, chloride, albumin, inorganic phosphate, cholesterin, uric acid and creatinin. Those patients with sialadenosis, in comparison with the control group and the findings in other reports, show reduced immunoglobulin A and increased potassium in the parotic secretion. The disturbance of function of the acinic cell is discussed.


[Where lies the boundary between common sensation and taste perception in electrogustometry (author's transl)].

The shift of the electrogustatory threshold following section of the corda tympani has been investigated in 14 patients. Postoperatively the anterior half of the tongue showed complete ageusia. Two thirds of the patients were able to recognize stimulations of 50-127 muA as a burning, and not a sour metallic, sensation for at least 1-2 weeks. Probably the trigeminal nerve endings perceive this burning sensation during the period of taste bud degeneration. A similar situation exists in cases where the gustatory fibres are interrupted proximal to the gustatory ganglion, because the tasts buds do not degenerate. It is therefore important to ask the patient to describe the sensation experienced. Only a sour metallic taste during electrogustometry should be regarded as a true gustatory sensation.


[The fronto-orbital approach in the treatment of post-traumatic fronto-basal cerebrospinal rhinorrhoea in children (author's transl)].

This paper deals with the advantages and limits of the paranasal (fronto-orbital) extradural approach for closing the leakage in 11 children with cerebrospinal rhinorrhoea after fronto-basal fractures. According to the classification of Escher, particularly the more localized types (II, III, IV) of lesions in the frontal base can be treated with good functional and cosmetic results: there was one partial failure out of 12 operations for closing the leakage in the frontal base of the skull.


[Surgical management of sudden deafness (author's transl)].

The conservative treatment of idiopathic sudden deafness generally shows good results. There are, however, some cases resistant to therapy which may be treated surgically by vestibulotomy. Reports are made on personal experiences as well as those of other authors. Vestibulotomy is recommended for those patients in whom the possibilities of conservative therapy have been exhausted and severe hearing loss has occurred.


[I. Methods for investigation of the voice (author's transl)].

A survey of possibilities and methods for examining voices in otorhinolaryngologic practise is given as an introduction to a series of articles on applied phoniatrics. In the present review, an attempt is made to demonstrate a pragmatic view of diagnosis and therapy for phoniatric disorders. The voice as the carrier of human speech is considered to be an expression of the total personaltiy so that the phoniatric investigation cannot be resitrcted to disturbed laryngeal function alone. All aspects of the voice as it relates to the individual and his surroundings are included within the diagnostic evaluation.


[The value of audiological screening tests in paediatric practice (author's transl)].

Pure tone threshold levels using play audiometry were compared with the sound screening test in 100 children in whom the acoustic-palebral reflex was also tested. The following conclusions are drawn from the findings. 1. A mild hearing loss and a loss above 1 000 cps in not demonstrable on the screening test. 2. A moderate hearing loss is undetected in two thirds, when only the screening test is used. 3. 10% of children with a severe hearing loss appeared to have normal hearing using the screening test only. 4. The failure to demonstrate with a few exceptions the acoustic-palpebral reflex suggests at least a moderate hearing loss, but the presence of the reflex is not proof of normal hearing.


[An improved and practical electrogustometer].

Basic considerations in the construction of an electrogustometer led to the use of electronically regulated equipment. The changing body resistence is automatically regulated, but the electric voltage of 220 volts AC necessitated special precautions. The decibel scale as proposed by Tomita seems the most convenient. The range of stimulation of 3-318 muA and the 4 dB current increment, which is regarded as the lowest pathological difference between the thresholds of the two sides of the tongue, made this equipment in practice very convenient.


[Electromyography and electroneurography in peripheral facial nerve paralysis (author's transl)].

The function of the facial nerve can be examined by 4 electrodiagnostic methods. In the nerve excitability test and electroneurography the facial nerve itself is stimulated over the stylomastoid foramen, whereas chronaximetry and electromyography are performed in the muscles. In the majority of patients with Bell's palsy it is possible to make a more or less favourable prognosis by clinical examination alone. As soon as the paralysis is evident only these diagnostic tests give an accurate prediciton. The early realisation of a poor prognosis is surgically important. Chronaximetry and electromyography do not facilitate early assessment of the prognosis. The nerve excitability test and electroneurography can assist in the prognosis within the first 6 days after the onset. This is especially so with electroneurography, in which the muscle action potentials are examined during facial stimulation. A continual decrease of amplitude of the action potential of 50% in 2 days and a complete loss of potential in 4 to 6 days indicate a total nerve degeneration with an unfavourable prognosis.


[Vasomotor rhinitis: a side-effect of hormonal contraception? (author's transl)].

In order to detect a possible influence of hormonal contraception on the development of vasomotor rhinitis, a five-months rhinoscopic survey was conducted on 460 women whose ages ranged from 18 to 40 years. 67 (32.7%) of the 205 women taking oral contraceptives, and 77 (30.2%) of a control group of 255 women were found to have vasomotor rhinitis. A questionaire was used in the survey, and included the following items: contraceptive preparation used, duration of use, and nasal distress associated with medication or prior pregnancies. In contrast to the findings of other authors, it was not possible to correlate the development of vasomotor rhinitis with the administration of oral contraceptives during the present study. Moreover, results were not altered by taking into account the composition of the different contraceptive drugs used. The statistical significance of the present study was established by the comparison of findings with a randomly selected control group of patients during the same period of time.


[The pathogenesis of the nasopharyngeal bursa (Tornwaldt's disease) (author's transl)].

The pharyngeal recess, first described in 1842 by Mayer, is a cavity in the middle of the nasopharynx, just between the nasal septum and the ventral tuberculum atlantis. It was assumed to be an excavation of the pharyngeal mucous membrane often persistantly fixed to the embryonic spine (Chorda dorsalis). It might be therefore, looked upon as a malformation. The recess is always stuffed with mucous membrane of the pharyngeal tract and ends next to the adenoids. It might pass into the occipital bone as an epithelialized cleft surrounded by connective tissue. Cystic transformation of the recess was first described by Tornwaldt in 1885, causing discomfort in the epipharyngeal and adjacent areas, and was named Tornwaldt's disease. The clinical data of 12 patients with pharyngeal cysts are presented. The conclusion is made, that we have evident lack of knowledge between the rare clinical manifestation of the pharyngeal recess only in adults on the one hand and the almost constant presence of the pharyngeal recess in human embryos on the other. It is therefore assumed, that frequent inflammatory discharge of the nasopharynx during life initiates the development of the nasopharyngeal cyst and not vice versa.


[Histological study of otological homografts (incus, cartilage and fascia) (author's transl)].

To summarise our morphological findings of this study the following conclusions are drawn: In bone grafts growth of vital cells originating from the Haversian canals is clearly demonstrated. The growth of connective tissue in the Haversian system is understandable on general principles of pathology. The morphology of the change of osteocytes from fibrocytes through osteoblasts is photographically clearly shown and is in keeping with the findings of Steinbach and of Kerr and Smyth. New bone formation was detected at earliest nine months after implantation. Our investigations do not confirm whether this new bone formation occurs persistently in all cases or to what extent the original homograft material, preserves in cialit solution, takes part in this process. A similar mechanism of tissue regrowth should be accepted in homograft cartilage. We have studied two cases, one after 6 months and the other after 5 years following implant. The three fascial grafts examined compare with earlier publications, with oedema, slight inflammation and little shrinkage occurring. The suitability for grafting of homograft incus, cartilage and fascia we believe to have been demonstrated.


[Solitary bronchial papilloma (author's transl)].

A solitary papilloma of the left main bronchus in a 48 year old man is described. The patient had a one year history of cough, hemoptysis and bronchospasm. Bronchoscopy and repeated removal of the tumour through the bronchoscope failed to control it, and local recurrence finally made pneumonectomy necessary.


[Oncocytoma with rare localization (author's transl)].

A rare case of oncocytoma involving the nose and paranasal sinuses is reported. Although the tumor is benign histologically, extensive local destruction as well as life-threatening hemorrhage can occur. Recommended treatment for the tumor is wide surgical exposure with radical extirpation.


[Fundamental frequency analysis - a contribution to the objective examination of the speaking and singing voice (author's transl)].

The applicability of a newly developed fundamental frequency analyzer to diagnosis in phoniatrics is reviewed. During routine voice examination, the analyzer allows a quick and accurate measurement of fundamental frequency and sound level of the speaking voice, and of vocal range and maximum phonation time. By computing fundamental frequency histograms, the median fundamental frequency and the total pitch range can be better determined and compared. Objective studies of certain technical faculties of the singing voice, which usually are estimated subjectively by the speech therapist, may now be done by means of this analyzer. Several examples demonstrate the differences between correct and incorrect phonation. These studies compare the pitch perturbations during the crescendo and decrescendo of a swell-tone, and show typical traces of staccato, thrill and yodel. Conclusions of the study indicate that fundamental frequency analysis is a valuable supplemental method for objective voice examination.


Evaluation of gonorrhea control efforts.

Organized gonorrhea control programs came into being in 1972-73 and have four major aspects: education, case finding through culture "screening," treatment of cases, and case investigation. Experience in Upstate New York indicates that case investigation and the provision of public diagnostic and treatment facilities are the most important of these. A relatively stable reported incidence of gonorrhea 1972-74 despite more aggressive detection of cases suggests that control efforts are beginning to interrupt the transmission of gonorrhea.


Nanaomycins, new antibiotics produced by a strain of Streptomyces. III. A new component, nanaomycin C, and biological activities of nanaomycin derivatives.

A new component, nanaomycin C, has been isolated from culture medium of Streptomyces rosa var. notoensis, which had been found to produce nanaomycins A and B. Nanaomycin C is an amide of nanaomycin A. Biological activities of nanaomycin C and several derivatives of nanaomycin A are also shown. Acetylnanaomycin A exhibits as strong activities against Gram-positive bacteria, fungi and Mycoplasma gallisepticum as nanaomycin A.


Antibiotic A-130, isolation and characterization.

An antibiotic, A-130, was isolated from a strain identified as Streptomyces hygroscopicus, strain A-130. The antibiotic belongs to the nigericin group and like dianemycin, has an alpha, beta-unsaturated ketone chromophore in its molecule. A-130 is active against gram-positive organisms.


DB-2073, a new alkylresorcinol antibiotic. I. Taxonomy, isolation and characterization.

A new antibiotic, DB-2073, was isolated in crystalline form from the fermented broth of Pseudomonas sp. B-9004. The compound is a alkylresorcinol antibiotic. The antibiotic melts at 86-88 degrees C. The molecular weight of 236 was determined by mass spectroscopy and the molecular formula was calculated as C15H24O2. The antibiotic has antimicrobial activity against Gram-positive bacteria, mycobacteria and fungi.


DB-2073, a new alkylresorcinol antibiotic. II. The chemical structure of DB-2073.

DB-2073 (I), an antibiotic produced by Pseudomonas sp. B-9004, was obtained as a pure crystals state having a formula of C15H24O2 (ME 236). The characterization indicated that I was a resorcinol antibiotic and it was elucidated as 2-n-hexyl-5-n-propylresorcinol.


Isolation of isoflavones inhibiting DOPA decarboxylase from fungi and streptomyces.

By screening of culture filtrates of fungi and streptomyces for activity in inhibit dopa decarboxylase the following isoflavone compounds were obtained: psi-tectorigenen (I), genistein (II), orobol (IV), 8-hydroxygenistein (V) and a new compound (III). III was elucidated to be 3', 4', 5, 7-tetrahydroxy-8methoxy isoflavone. Among these isoflavones, IV and III showed the strongest activity in inhibiting dopa decarboxylase. All these isoflavones also inhibited histidine decarboxylase and catechol-O-methyltrasnferase. Activities of these compounds to inhibit tyrosine hydroxylase and dopamine beta-hydroxylase were examined. Orobol which showed no or only slight inhibition of tyrosine hydroxylase and dopamine beta-hydroxylase exhibited a significant hypotensive effect on spontaneously hypertensive rats.


Biosynthesis of formycin. Formation of formycin from formycin B.

1. In replacement culture with a formycin-producing strain. Steptomyces sp. MA406-A-1, exogenously added formycin B was quantitatively converted to formycin and the conversion was inhibited by adding the chromophore moiety of formycin. 2. The in vitro experiments revealed that the novel enzyme(s) catalyzing the formation and formycin from asparate and formycin B, but not from formycin B monophosphate, was present in this organism. The action of the partially purified enzyme(s) was also inhibited by the chromophore moiety of formycin, whereas the moiety showed no inhibitory effect on the actions of adenylosuccinate synthetase and adenylosuccinate lyase. 3. Adenine auxotrophs lacking either adenylosuccinate synthetase or adrenylosuccinate lyase were derived from strain MA406-A-1 and these auxotrophs were found to readily convert formycin B to formycin in replacement culture. From these results, it was estimated that, under the conditions of replacement culture, formycin B would be converted to formycin in vivo by the action of novel enzyme(s) rather than by the action of enzyme system including adenylosuccinate synthetase and adenylosuccinate lyase.


Evaluation of mycobacillin and versicolin as agricultural fungicides. I. Antifungal spectrum and phytotoxicity.

Two antifungal antibiotics, mycobacillin and versicolin, were studied as agricultural fungicides in the control of fungal infection of rice and jute. Mycobacillin is especially active against Piricularia oryzae at a concentration of 10 mug/ml, and versicolin against Colletotrichum gloeosporioides at a concentration of 2.5 mug/ml. Mycobacillin has no adverse effect on germination of seeds and growth of seedlings of rice and jute plants as a concentration of 500ppm, even for prolonged exposure. (24 or 48 hours); in fact, it is stimulatory. On the other hand, versicolin has showed detectable phytotoxicity at 500ppm for prolonged exposure


Influence of nine surfactants on the activity of oxytetracycline hydrochloride against Lipaphis erysimi Kalt.

The effect of nine surfactants on the activity of oxytetracycline hydrochloride (OCT) was investigated against Lipaphis erysimi Kalt feeding on cabbage plants. All the surfactants, except Emulgator EL and Emulgator IP, at 0.1% increased the efficacy of OTC at 0.25% and the maximum reduction of 83.93% in fertility was observed for the combination OTC+Arkopal N-110. The nymphal development was delayed by various treatments. The treated adults were lighter in weight and smaller in size compared to the control insects. No photoxicity was observed in any case.


The arrangement of germ cells in the rat seminiferous tubule: an electron-microscope study.

The spermatogonia and early spermatocytes of 13 samples of rat seminiferous epithelium (about 0-05 mm2 each) were mapped from electron micrographs of serial sections. Clones of cells, connected by cytoplasmic bridges (syncytia of 2-100 cells), in various stages of spermatogenic development were identified. Maps of 7 separate areas are illustrated. It is concluded that, contrary to the models of spermatogonial proliferation based on light-microscope observations, regions of seminiferous epithelium which are identical in terms of spermatid and spermatocyte criteria have, in fact, quantitative and qualitative differences in their spermatogonial population. The data are interpreted that for a given epithelial area there is a periodic build-up of spermatogonia which then produce several successive quanta of spermatocytes and when the spermatogonia are depleted the process repeats. That cell numbers less than double following a mitotic cycle has generally been attributed to systematic degeneration. Evidence from electron microscopy indicates, however, that at the mitotic peaks not all the syncytia undergo division but that some remain arrested. Similarly, within a dividing syncytium a few cells do not divide while they advance developmentally with the syncytium as a whole. The observed large size of spermatocyte syncytia further argues against systematic degeneration with its attendant fragmentation of syncytia.


The erythroid cells of anaemic Xenopus laevis. I. Studies on cellular morphology and protein and nucleic acid synthesis during differentiation.

Phenylhydrazine has been used to induce anaemia in Xenopus laevis. The dosage used causes the complete destruction of all mature erythrocytes within twelve days. The anaemia results in the initiation of a wave of erythropoiesis and large numbers of immature erythroid cells are released into the circulation. The morphological and biosynthetic changes which these cells undergo as they differentiate in circulation are described. The origin of the circulating erythroid cells is also discussed.


The erythroid cells of anaemic Xenopus laevis. II. Studies on nuclear non-histone proteins.

The mass ratio of nuclear non-histone protein: DNA in the immature circulating erythroid cells of phenylhydrazine-induced anaemic Xenopus is approximately threefold higher than in mature erythrocytes. This is largely due to the presence of increased amounts of low and intermediate molecular weight proteins in the nuclei of the immature cells. There are a few qualitative differences in the components of this class of proteins between the mature and immature cells, the most notable of which is the presence of a protein of molecular weight approximately 115000 in the former which is not detectable in the latter. These changes are discussed in relation to the changing synthetic capacities of cells and to certain generalizations about the function of the nuclear non-histone protein based on studies of other differentiating systems.


Ultrastructural changes and a second mode of flagellar degeneration during ageing of Phytophthora palmivora sporangia.

Ageing of sporangia in Phytophthora palmivora is accompanied by a gradual breakdown of flagella, a transformation of the 'fingerprint' vacuoles, extensive vacuolization of the cytoplasm, accumulation of bundles of microtubules (mastigonemes)contained within cisternae of the rough endoplasmic reticulum, formation of a germination wall lining the inside of the sporangial wall and production of secondary sporangia. The mechanism of flagellar degeneration differs from that observed in directly germinating sporangia. In ageing sporangia and in sporangia induced to germinate directly with germ tubes, there is a close correlation between loss of competence for zoosporogenesis and breakdown of the flagella.


Studies on intercellular invasion in vitro using rabbit peritoneal neutrophil granulocytes. II. Adhesive interaction between cells.

A possible mechanism for intercellular invasion is that the strength of adhesion between host and invading cells is greater than the average of the strengths of homotypic adhesions. This hypothesis has been examined by a study of the kinetics of aggregation of dispersed populations of an invasive cell type (the rabbit peritoneal neutrophil granulocyte) and a host cell type (the chick embryo heart fibroblast) in shaken suspension culture. Since aggregation in mixed populations of the 2 cell types demonstrated tissue specificity, the hypothesis is not supported by these studies, heterotypic adhesions seem in fact to be weaker than homotypic adhesions.


Applications of high-pressure liquid chromatography and field desorption mass spectrometry in studies of natural porphyrins and chlorophyll derivatives.

Mixtures of porphyrins derived from natural sources can be readily separated by high-pressure liquid chromatography both analytically and on a preparative scale. A variety of procedures have been developed not only for the esters but also for free acids, and on the analytical scale quantitation is easily achieved by visible absorption. The retention times are largely characteristic of the number of carboxylic acid side chains (or other polar groups) but further information can be obtained by mass spectrometric studies of the various fractions. Field desorption mass spectrometry is particularly useful for this purpose because the emitter wire can be dipped directly into the eluates. The field desorption spectra of porphyrin free acids and esters as well as their metal complexes give essentially molecular ions with little or no fragmentation in most cases, whereas electron-impact mass spectrometry, particularly of free acids, is impeded by the low volatility of porphyrins. Mixtures can also be analysed by field desorption mass spectrometry, and this provides not only a rapid qualitative assessment of the components of a mixture, but also a check on the subsequent chromatographic separations.


An experimental high-performance photodensitometer for quantitative chromatography. I. Design and construction.

A new and experimental photodensitometer designed for quantitative chromatography is described. The principal features of the instrument were based upon the results of an extensive theoretical analysis and incorporate a mechanical arrangement for the production fo a flying spot and an optical path in which two beams of light are separated after interaction with the medium. The device is constructed so as to be suitable for operation in the three principal modes; in reflectance measurements only the ratio of the beam signals is formed, whilst in transmittance measurements the ratio is converted to logarithmic form, in the fluorescence mode only a single beam is used. The spectral range of the instrument extends from the red end of the visible spectrum to the medium ultraviolet, and quartz optics are utilized in most of the optic elements. A quartz halogen lamp and a xenon-mercury lamp may be used alternatively as the light source. Changeable interference filters are employed to determine the spectral position of the light beams and semiconductor photo-diodes with sensitivities extending into the ultraviolet are used as photo-detectors. In the determination of the sensitivity limits of the device the photo-diodes were replaced by photomultipliers and the apparatus was shown to fulfil most of the calculated thoeretical predictions.


Rapid estimation of trace amounts of ethylenimine by high-pressure liquid chromatography.

A rapid procedure utilizing high-pressure liquid chromatography is described for determining trace quantities of ehtylenimine down to 0.01 ppm. The basis for the method is the quantitative reaction of ethyleneimine with the 1,2-naphthoquinone-4-sulphonate ion (Folin's reagent) to give 4-(1-aziridinyl)-1,2-naphthoquinone. Compared with the spectrophotometric procedure, this method provides a high degree of specificity and sensitivity. The method has been employed to determine ethylenimine in the pyrolysis products of polyethylenimine.


Reversed-phase ion-pair partition chromatography of carboxylates and sulphonates.

A reversed-phase partition chromatographic system for separation of organic anions as ion pairs with quaternary ammonium ions has been developed. Commercial, hydrophobized silica supports are used with 1-pentanol as stationary phase and aqueous solutions of tetrabutylammonium (TBA) as mobile phase. The separation of the aromatic sulphonates and benzoic acid derivatives is demonstrated. The use of the TBA concentration of the mobile phase to regulate the capacity factor of the anions, as a means of improving separation by gradient elution and direct injection of large sample volumes, is demonstrated. The isolation of nicotinic acid from human serum samples is shown.


[Separation of guanidino compounds by means of ion-exchange thin-layer chromatography (author's transl)].

Thirteen guanidino compounds including glycocyamine, glycocyamidine, creatine, creatinine, arginine and guanidinosuccinic acid were chromatographed on thin-layer plates pre-coated with ion-exchange resins. Maximum resolution was obtained on layers of the cation-exchange resin eluted with 0.12 M sodium citrate buffer of pH 5.2, permitting the separation of nine of the thirteen guanidino compounds. Relationships between structure and physiochemical properties and the elution patterns of some selected guanidines were graphically evaluated.


Thin-layer chromatographic determination of barbiturates and phenytoin in serum and blood.

A method is described for the measurement of blood, serum and/or plasma levels of hexobarbital, phenobarbital, cyclobarbital and phenytoin by ultraviolet reflectance photometry on thin-layer chromatograms. The lowest concentrations measured were 0.3-0.7 mug/ml. The accuracy was similar to that of gas chromatographic procudures. For phenytoin determinations 5-(p-methylphenyl)-5-phenylhydantoin may be used as internal standard. The method has been applied to clinico-pharmacological assays, to the measurement of cyclobarbital elimination in man following a therapeutic dose, and to the study of phenobarbital kinetics in rats using serial blood samples.


Thin-layer chromatographic screening and confirmation of basic drugs of abuse in urine.

Thin-layer chromatographic procedures are presented for the positive identification of methodone, primary metabolite of methodone (2-ethylidine-1,5-dimethyl-3,3-diphenylpyrrolidine), propoxyphene, norpropoxyphene, cocaine, benzoylecgonine, methoqualone, and phencyclidine from urine specimens. Initial screening of specimens is done by developing plates in ethyl acetate-methanol-diethylamine (90:10:1.6). Samples screened positive are confirmed in methylene chloride-methyl ethyl ketone-concentrated ammonium hydroxide (74:25:0.8), depending on the drug(s) indicated by the screening procedure. The method is quite sensitive, detecting most of the listed drugs at levels of 1.0 mug/ml or less.


Microchromatography of hemoglobins. V. Thin-layer chromatography of some hemoglobins on CM-cellulose.

By means of thin-layer ion-exchange chromatography, human hemoglobins A, S, and C in various combinations can be distinctly separated. Also, hemoglobin F can be separated from the A, S, and C components of cord blood samples from infants and in adult blood samples with a relatively high percentage of F (15% or more). The procedure uses CM-cellulose and solutions of Tris-HCl, NaCl, and KCN. A 0.3-mg sample in 5-10 mul of solvent is required. Development can be completed in 30-40 min.


The estimation of N-nitrosamines in tropical regions by reversed-phase paper and thin-layer chromatography.

A simple and convenient procedure based on reversed-phase paper and thin-layer chromatography is reported for the detection and estimation of N-nitrosamines in food products, particularly cured meat. The method can easily be applied in tropical regions when plenty of sunshine is available. It is particularly useful in food-testing laboratories where sophisticated analysical instruments such as the gas chromatograph, mass spectrometer, etc., are not available. By this procedure, it is possible to detect up to 10 mug and to estimated up to 75-mug (reversed phase) and 50-mug (thin layer) amounts of N-nitrosamines.


Fatty acids. IV. Synthesis of all the dimethylene-interrupted methyl octadecadiynoates and a study of their gas-liquid chromatographic properties.

All the dimethylene-interrupted methyl octadecadiynoates have been synthesised and the gas-liquid chromatographic behaviour of these isomers was studied on polar [Carbowax 20M, FFAP, DEGA, DEGS and Silar 10C (recently renamed as Apolar 10C)], semi-polar (XE-60) and non-polar (SE-30, OV-101 and Apiezon L) stationary phases. The possibility of identification and separation of these isomers is discussed. The delta3a,7a isomer was found to decompose on most polar phases and the delta2a,6a isomer could not be eluted from the Carbowax 20M phase.


Changes in estradiol and cortisol production rates in men under the influence of narcotics.

The production rates of estradiol and cortisol in two male opiate addicts while on narcotic maintenance, were in the low normal or subnormal range. There was a sharp several-fold increase upon withdrawal with a subsequent fall to normal values after a period of abstinence. The changes in estradiol production rates were proportionally greater than those of cortisol and suggest that they were due to changes in testicular secretion of the precursor testosterone.


Co-existent diabetes mellitus and diabetes insipidus, a familial disease.

Three male siblings with diabetes mellitus are described, two of whom also had coexistent diabetes insipidus. The co-existence of diabetes mellitus and insipidus appears to represent a single genetic abnormality and may or may not be accompanied by primary optic atrophy. Chlorpropamide was effective in controlling the symptoms of diabetes mellitus and diabetes insipidus.


Hypertension in primary hyperparathyroidism: the role of the renin-angiotensin system.

In four out of seven patients with primary hyperparathyroidism, we have found elevated plasma renin activity (PRA) and blood pressure, both of which returned to normal following surgical correction of the hyperparathyroidism. However, PRA was normal in nonmotensive patients with primary hyperparathyroidism, those with hypercalcemia of other etiologies, and those with secondary hyperparathyroidism. These findings suggest that the renin angiotensin system may play a role in the etiology of the hypertension in primary hyperparathyroidism.


Study on maternal, fetal, and amniotic human prolactin at term.

Prolactin present in maternal blood, fetal blood, and amniotic fluid samples obtained simultaneously at term was examined. The relative concentrations of prolactin in maternal and fetal serum samples were found to vary with each individual case. However, amniotic fluid samples contained a much higher level of prolactin than did both maternal and fetal serum samples in every case. After gel filtration, three separate peaks of immunoreactive prolactin were observed, probably representing three different sizes of the hormone molecule. The main component was small prolactin, constituting at least 69% of the total prolactin immunoreactivity in blood samples and 90% in amniotic fluids. Prolactin was found to be very similar in cord venous and arterial sera, both quantitatively and in terms of heterogeneity. There were more noticeable differences in the percentages of medium and small prolactin present in serum samples than in amniotic fluid samples. Big prolactin was present in all samples; its percentage in maternal serum was slightly higher than its percentages in the other samples. These results suggest that: 1) The mother and fetus carry on independent secretion of prolactin during gestation. 2) The size heterogeneity of prolactin in amniotic fluid differs from maternal hPRL to a greater degree than it does from fetal hPRL. 3) The prolactin in amniotic fluid appears to be of fetal origin.


Immunoreactive relaxin in human serum during the menstrual cycle.

Immunoreactive relaxin was measured in serum obtained at the same time each day from one woman during a normal menstrual cycle and eight other women using selected bleeding schedules. In addition to relaxin immunoactivity, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, estradiol 17beta, and progesterone were measured in the same samples. The data was combined according to the day of the LH peak. Serum relaxin immunoactivity was found to be high over the period of menstruation, its concentration then decreased until the middle of the follicular phase when a peak equal in amplitude to the menstrual peak occurred. Relaxin immunoactivity remained fairly constant throughout the preovulatory LH surge; however, as the LH levels dropped, relaxin immunoactivity increased reaching maximal levels for the whole cycle. Relaxin immunoactivity then increased gradually over the luteal phase and reached a peak when progesterone levels were declining; it then dropped to low levels until menses ensued. It is not possible with the present radioimmunoassay to determine whether the immunoactive relaxin was ovarian or uterine in origin.


Distribution of calcitonin-containing cells in the normal neonatal human thyroid gland: a correlation of morphology with peptide content.

C-cells have been mapped in the thyroid glands of 6 human neonates by means of immunoperoxidase localization of calcitonin and tissue calcitonin content as measured by radioimmunoassay. The C-cells were concentrated in a zone in the upper two-thirds of the lateral lobes bilaterally, where they were identified individually and in small groups in both an intrafollicular and parafollicular distribution. In contrast to findings in the adult, C-cells were predominantly intrafollicular in the neonate. The relative numbers of C-cells counted per unit area of thyroid tissue correlated strongly with the calcitonin content of immediately adjacent tissue sections. In areas rich in C-cells, as many as 75 immunoperoxidase-stained cells per low-power field were counted, and the concentration of calcitonin was as high as 540 to 2100 mU/g fresh weight, values that were as great as 10 times those observed in the normal adult thyroid gland. The prominence of the C-cell population and increased tissue calcitonin content in the human neonatal thyroid gland may reflect an as yet undefined physiologic role for calcitonin in the newborn.


The effect of somatostatin on TSH levels in patients with primary hypothyroidism.

Somatostatin, a growth hormone inhibiting factor (GHIF), was infused into 8 patients with primary hypothyroidism at a dosage of 1000 mug for 105 min. GHIF caused a suppression of TSH levels from 42.6 to 76.9% of preinfusion levels with a mean nadir of 65.0 +/- 4.0%;(mean +/- SEM).


The response of pancreatic and pituitary hormones to pulses and constant infusion of somatostatin.

The inhibitory action of pulses and constant infusion of somatostatin on the secretion of pancreatic and pituitary hormones was studied serially in 7 normal men and 2 untreated acromegalics. In normal men, significant inhibition of basal release of insulin and glucagon was elicited by as little as 1 mug dose of a pulse of somatostatin. Increasing doses of somatostatin (5, 50, 250 and 500 mug) given as a single pulse at weekly intervals produced what appears to be a decreased inhibition of glucagon while no measurable relationship between the dose of somatostatin and the degree of inhibition of insulin was seen. Given during the same day, incremental doses (from 1 to 250 mug) of pulses of somatostain produced a progressive decline in both glucagon and insulin. The elevated basal levels of GH, insulin and glucagon seen in acromegalics, were inhibited by a pulse of somatostatin as little as 2 mug. These inhibitions were sustained during the constant infusion of somatostatin (2.5 mug/min), and a rebound in GH, insulin and glucagon appeared promptly following the infusion.


Nicotine-stimulated release of neurophysin and vasopressin in humans.

Nicotine stimulation, induced by cigarette smoking, has previously been identified as a potent stimulus for vasopressin release in humans. In this study, radioimmunoassay measurements of plasma vasopressin and human neurophysin were performed on samples taken from 14 normal subjects during cigarette smoking. Significant rises in vasopressin occurred in 10 of the 14 subjects and the same 10 had significant rises in neurophysin. Pretreatment with ethanol in 3 subjects either eliminated or greatly blunted the responses of both vasopressin and neurophysin to cigarette smoking. These studies indicate that the release mechanisms for vasopressin and neurophysin are closely linked in humans.


The effect of anticonvulsant therapy on serum levels of 25-hydroxy-vitamin D, calcium, and parathyroid hormone.

In 20 female patients treated for 2 to 37 years (mean :12) with anticonvulsant drugs, low serum levels of 25-hydroxy-vitamin D (25-OH-D; 6.4 +/- 3.2 ng/ml M +/- SD), relative hypocalcemia (9.2 +/- 0.4 mg/100 ml) and high levels of parathyroid hormone (PTH 277 +/- 165 pg/ml) were found compared to an age-matched control group (respectively 8.6 +/- 3.2 ng/ml, 9.6 +/- 0.3 mg/100 ml and 183 +/- 95 pg/ml) living in the same psychiatric clinic. A significant negative correlation was found between total duration of treatment and either serum 25-OH-D or serum calcium. After treatment with an oral vitamin D3 supplement (2000 IU/day) for 3 weeks, the serum 25-OH-D levels, although increased, remained lower than normal in the epileptic group and neither hypocalcemia nor their secondary hyperparathyroidism were corrected. These data confirm the occurrence of vitamin D deficiency in patients treated with anticonvulsant drugs resulting in hypocalcemia and secondary hyperparathyroidism.


Binding of the sulfates of estradiol-17beta to human serum albumin and plasma.

The binding of the 3 estradiol-17beta sulfates in solutions of human serum albumin (HSA) and in plasma has been studied by the method of centrifugal ultrafiltration. HSA has one binding site for the 17-sulfate with association constants of about 10(5) to 10(6)M-1 at either 4 degrees or 37 degrees and several sites with association constants of 10(3) to 10(4) M-1. HSA has 3 groups of binding sites for estradiol-17beta disulfate, one binding site with association constants of about 10(6) M-1 at either 4 C or 37 C, about 2 binding sites with association constants of about 10(4)M-1 and several sites with association constants of about 10(3)M-1. The binding data of the 3-sulfate of estradiol-17beta are best interpreted by the postulate of the existence of a tetramer in addition to the monomer of the sulfate in solution. With this postulate, HSA has one binding site with an association constant of about 5-10(5)M-1 and seven binding sites with association constants of about 10(3)M-1 at either 4 C or 37 C. More than 99% of the 17-sulfate or the disulfate of estradiol-17beta is bound in plasma at 37 degrees, with all of the binding accounted for by HSA. The estradiol-17beta sulfates compete with one another for binding to HSA. Strong displacement has also been found by androgen sulfates and, less, by estrogen glucosiduronates.


The effect of chlorpromazine on plasma renin activity and aldosterone in man.

The response of plasma renin activity (PRA) and aldosterone to the intravenous administration of chlorpromazine was determined in schizophrenic patients while they were supine and on a normal sodium diet. In all subjects PRA and aldosterone increased during chlorpromazine administration with little or no change in blood pressure. The maximum PRA and aldosterone levels occurred 60 min after the higher dose of chlorpromazine. These data suggest that chlorpromazine affects the renin-angiotensin-aldosterone system and it may interfere with the evaluation of this system in patients receiving this drug.


Benign thyroid nodule with normal iodide trap and defective organification.

Cold thyroid nodules are generally due to impaired iodide uptake, while organification remains normal. In a case of a nodule appearing hot one hour after Tc99 m and cold 24 h after 131I-iodide, in vivo investigations showed that the trapping function was unimpaired and that the defect lay in organification. An early thyroid scan taken with 131I-iodide showed definite radioactivity in the nodule which was dischargeable by K perchlorate. This finding was confirmed by in vitro study of the tissue. Indirect evidence suggests that a defect was present in the H2O2 generating system rather than in peroxidase.


Biological activity of des-asp1-angiotensin II (angiotensin III) in man.

Effects of des-asp1-angiotensin II (angiotensin III) on blood pressure and aldosterone secretion were examined in man. Angiotensin III was equipotent with val5-angiotensin II amide in the stimulation of aldosterone production, but had only 20% of the pressor activity of the later. These results are consistent with those previously reported by other investigators in animals.


Normalization of fasting hyperglucagonemia and excessive glucagon responses to intravenous arginine in human diabetes mellitus by prolonged infusion of insulin.

Infusion of insulin (1 U/hr) for 14 hr suppressed basal glucagon levels and normalized previously excessive glucagon responses to arginine in juvenile-onset, insulin-dependent diabetic subjects, indicating that abnormal pancreatic alpha-cell function in human juvenile-onset diabetes mellitus may be a consequence of insulin lack.


11 beta-Hydroxylase with affinity to C-21-Deoxysteroids from ovaries of patients with polycystic ovary syndrome.

When ovarian mitochondria from a patient with polycystic ovary syndrome (POS) were incubated with [7-3H]17alpha-hydroxypregnenolone and [4-14C]17alpha-hydroxyprogesterone, 11beta-hydroxylated metabolites were obtained. When the same mitochondrial preparation was incubated with [7-3H]17alpha-hydroxypregnenolone and [4-14C]11-deoxycortisol no 11beta-hydroxylated derivatives of 11-deoxycortisol were found. These results are compatible with and support the conclusion that the ovary of POS patients who excrete pregnanetriolone contains an 11beta-hydroxylase capable of hydroxylating C-21-deoxysteroids but not C-21-hydroxysteroids.


New microtechnique for the leptospiral microscopic agglutination test.

A new microtechnique has been developed for the detection of leptospiral antibodies in serum by the microscopic agglutination test. The test was set up in a microtiter transfer plate held in a transfer plate holder, resting on a transfer plate cover. Live leptospiral antigen was added and a second transfer plate cover was placed over the transfer plate during 2 h of incubation at 32 C. After incubation the bottom cover was removed and the complete unit was placed in a specially designed base plate containing microscope slides (50 by 75 mm). The serum/antigen mixture was ejected on to the microscope slides by means of a sharp tap. The agglutination was then read using a 10 X objective, 10 X eyepieces, and a dry, dark field condenser.


Nationwide epidemic of septicemia caused by contaminated intravenous products: mechanisms of intrinsic contamination.

Between 1 July 1970 and April 1971, in many hospitals in this country, there were outbreaks of nosocomial septicemia caused by Enterobacter cloacae of E. agglomerans (formerly Erwinia, herbicola-lathyri). All of these hospitals used infusion products manufactured by one company, Abbott Laboratories, and all affected patients had onset of septicemia while receiving the company's infusion products. Septicemia was epidemiologically and microbiologically traced to intrinsic contamination of the company's screw-cap closure for infusion bottles which was sealed with a newly introduced elastomer liner. Epidemic organisms were isolated from these closures. Investigations both in the laboratory and in the manufacturing plant into the mechanism of contamination of these products revealed the following. (i) Epidemic strains were present in numerous areas throughout the manufacturing plants. (ii) Viable microorganisms gained access to the interior of screw-cap closures after the autoclave step of production. (iii) Cooling closures actively drew moisture through the thread interstices into the inner-most depths of the closure. (iv) Transfer of contaminants from closures to fluid was easily effected by simple manipulations duplicating normal in-hospital use. (v) The red-rubber liner used in the company's screw-cap closures before the introduction of elastomer contained a broad-spectrum antimicrobial inhibitor. The findings from this epidemic and the associated studies show that the screw-cap closure as it is now designed cannot be considered secure for products that must remain sterile.


Experiments on terminal disinfection by formaldehyde vapor in the case of smallpox.

The usually recommended terminal disinfection by formaldehyde vapor is unable to completely inactivate vaccinia viruses embedded in scabs. In view of our results, we recommend doubling the concentration of formaldehyde (10 g of formaldehyde per m3 of space) and prolonging the time of exposure to 24 h for terminal disinfection in the case of smallpox. Subsequent disinfection by scrubbing assumes special importance, since no complete inactivation of the scabs occurs.


Simple procedure for the removal of nonspecific inhibitors of rubella virus hemagglutination.

The adsorption of serum lipoproteins onto an insoluble matrix of colloidal silicic acid results in the removal of nonspecific inhibitors of rubella virus hemagglutinin. The procedure can be performed in 15 min at room temperature. Comparative studies using both the dextran sulfate-CaCl2 and heparin-MnCl2 methods for removal of inhibitors demonstrated that the colloidal silicic acid procedure yielded identical hemagglutination inhibition titers. In addition, it is technically feasible to read titers below 1:8.


Polypectate digestion by Yersinia.

The ability of Yersinia to digest polypectate may be of some value in differentiating Y. enterocolitica and Y. pseudotuberculosis from some of the other fermenting gram-negative bacilli, such as Enterobacter agglomerans, with which they can be confused. Pectolytic activity in Yersinia may also have some teleologic or taxonomic significance about which we do not care to speculate.


Isolation of Vibrio alginolyticus from wound infections.

Vibrio alginolyticus was isolated from two patients with leg wounds. Both had a history of recent exposure to ocean water.


Use of a serologically distinct strain of Thermoactinomyces vulgaris in the diagnosis of farmer's lung disease.

During investigations into farmer's lung disease it was noticed that Micropolyspora faeni (MF) was isolated and identified with ease, but difficulty was encountered in the identification of Thermoactinomyces vulgaris (TV), although an organism resembling TV was frequently isolated. Extracts prepared from the isolates resembling TV (called Thermoactinomyces vulgaris variant, TVV) when tested against the standard TV antiserum by double diffusion, did not produce any precipitin lines. When TVV extracts were tested against the serum of a patient from whom TVV had been isolated from the sputum, +++ precipitin lines were observed. With the TVV extracts the authors have demonstrated the existence of a serologically distinct strain of TV, and also that it would be a useful addition to the routine testing of antibodies to farmer's lung disease.


Spontaneous infarction of the breast.

Five cases of infarction of physiological hyperplastic breast tissue associated with pregnancy or lactation are reported. These presented clinically as lumps in the breast, two of which were painful. Similar cases in the literature are briefly reviewed. The demonstration of an underlying lobular pattern in the present cases and the distribution of the infarcts support the view that the so-called 'adenoma' of pregnancy or lactation is a myth. Organizing vascular thrombi, previously unrecorded in this context, were seen in three of the five cases, and it is postulated that these lesions are the primary cause of the infarction rather than relative vascular insufficiency, as proposed by previous authors.


Extrarenal malignancy and the nephrotic syndrome.

The clinical and histological findings are described of a patient who presented with the nephrotic syndrome and was found at necropsy to have a bronchial carcinoma. Amyloidosis, renal vein thrombosis, and neoplastic infiltration of the kidneys were excluded. The kidneys showed a diffuse glomerulonephritis of mesangiocapillary type. The possible aetiological association between these two conditions is discussed.