Surface epithelium of the fetal guinea-pig ovary: a light and electron microscopic study.

The surface epithelium in fetal guinea-pig ovaries was examined from the time of early sexual differentiation, about 34-days, until approximately ten days before birth. At day 34 the epithelium varied greatly in appearance as seen in the light microscope and possessed a superficial layer of flattened or culoidal cells. By day 58 the epithelium had changed into one layer of regularly arranged columnar cells. During the same period the number of germinal cells decreased. Connections between the germinal cords and the surface epithelium were observed from day 34, being especially numerous and broad at days 34 and 42 and decreasing in number and size from day 46 onwards. The basement membrane beneath the epithelium gradually increased in thickness. In the electron microscope two types of somatic cells could be distinguished. One type formed a superifical single layer connected by junctional complexes and exhibited intracellular bundles 60 A microfilaments running straight through the apical part of the cell, attached to junctional complexes on either side. These bundles were found frequently between days 34 and 42, but were rarely seen after the forth-sixth day. Microvillous projections into the coelomic cavity were especially numerous from day 34 to day 46. The other type of somatic cells lay in close proximity to the germinal cells: microfilaments or junctional complexes were not observed. The subepithelial basement lamina was continuous with that surrounding the connections and the germinal cords.


Smooth muscle in lymph node capsule and trabeculae.

This study focuses on the confusion in existing literature concerning the presence of smooth muscle in the capsule and trabeculae of lymph nodes. Human and bovine nodes from several anatomical areas and several individuals of each species were examined by conventional light, electron and fluorescence microscopy. Smooth muscle cells, independent of blood vessels, were demonstrated in the trabeculae and capsules of lymph nodes of both species examined by all three techniques. The need for further study on the function of these cells is indicated.


Cellular renewal in the enamel organ and the odontoblast layer of the rat incisor as followed by radioautography using 3H-thymidine.

Renewal of the cell populations of the incisor was studied in 100 gm male rats injected with a single dose of 3H-thymidine and sacrificed at various times from one hour to 32 days after injection. Radioautographs showed that a cohort of labeled cells within the enamel organ, odontoblast layer, and pulp was carried passively with the erupting incisor from the apical end towards the gingival margin where the life cycle of these cells was terminated. Labeled cells in the upper and lower incisor, although traversing different absolute lengths, were found in approximately the same functional stage of their life cycle at similar times after the injection. Thus, by one and on-half days labeled ameloblasts began inner enamel secretion and, by eight days (upper) or nine days (lower), complement outer enamel secretion. By 32 days labeled ameloblasts had traversed the entire enamel maturation zone and were located at the gingival margin. Labeled odontoblasts followed closely the movement of labeled ameloblasts. The mean rate of ameloblast migration was 567 mum/day on the upper incisor and 651 mim/day on the lower. For the odontoblasts this rate was 55 mum/day (upper) and 631 mum/day (lower). Finally, it was found that as the rat age, the duration of the life cycle for epithelial and pulp cell populations of the incisor increased because of growth within the lonitudinal axis of the tooth. It was concluded that the apical end of the incisor literally "grows backward" in the bony socket, and hence, the duration of the life cycle becomes greater simply because it takes cells longer to physically reach the gingival margin.


A circadian rhythm of mitotic activity in the uterine luminal epithelium of the rat: effect of estrogen.

The study was designed to determine whether or not the rat uterine luminal epithelium exhibits a mitotic circadian rhythm and to ascertain the effect of estrogen treatment at different time periods on the uterine epithelial mitotic response. Immature rats were injected with either sesame oil (controls) or 60 ng of estradiol-17 beta at eight time periods and were necropsied 24 hours after treatment. Colchicine was administered IP two hours before autopsy. Peak mitotic activity was observed during the nocturnal phase (0300) for both the control and estrogen-treated rats. The nadirs were recorded during the diumal phase (1800 and 1200 for the control and estrogen groups, respectively). The differences between low and high values were 1100% for the control rhythm and 101% for the estrogen animals. The data demonstrate the existence of overt circadian rhythms in the uterine epithelium for both control and estrogentreated rats.


The fine structure of the trophospongial layer of the kangaroo rat placenta.

The trophospongial layer of the near-term kangaroo rat placenta was examined in the electron microscope. Two ultrastructurally different cellular zones were distinguishable - an inner zone adjacent to the labyrinth and a basal zone located mesometrial to the inner zone. Inner zone cells contained a well developed granular ER and Golgi apparatus as well as polymorphous membrane-limited granules. The cells also contained modest amounts of glycogen and lipid droplets. Basal zone cells were also rich in ER; some cells had dilated ER cisternae containing a highly structured material which appears as a sheet of hexagons when viewed en face. Basal zone cells may, among other things, function as glycogen storage cells, since they had large cytoplasmic accumulations of glycogen. Unlike the situation in some other rodents, maternal blood draining from the trophospongial layer was always contained in channels lined by a layer of squamous cells which, in turm, was separated from the trophospongial cells by a basal lamina. The trophospongial zones are compared with the trophospongial regions of other rodent placentas and possible functions are considered.


Distribution of lumbar and sacral afferent axons in submucosa of cat urinary bladder.

Lumbar and sacral afferent axons in the submucosa of the urinary bladder were recognized by degeneration in seven cats subjected to spinal ganglionectomies. Of 2,935 observed terminating axon profiles, 145 were found degenerating. Lumber afferent axons were 3.7 times more numerous than sacral afferent axons in the submucosa, a reversal of the ratio reported for the muscle coat of the bladder. Sacral afferent axons were evenly distributed to different regions of the bladder, but lumbar afferents were concentrated in the bladder neck. Apparent afferent endings in the submucosa of the urinary bladder were principally free nerve endings. Synaptic vesicles were found in 57% of observed terminating axon profiles. The bladder neck had more terminating axon profiles of all kinds than other regions of the urinary bladder.


An angiographic study of the fox testis in various stages of sexual activity.

The arteries and veins of the fox testis were studied using an angiographic technique. The postnatal development of the testis involved only minor modification of the vasculature. In the non-breeding season both the arteries and veins of the adult fox testis undergo extensive spiralization which completely disappears during the breeding season. When the sequence of morphological changes in blood vessels are related to available data on changes in testicular size, blood flow and connective tissue content, it is obvious that the vascular spiralization is passive and related to shrinkage of the organ and dose not primarily influence the testicular blood flow.


Myoglobin polymorphism in the pollan (Osteichthyes: Coregoninae).

Three electrophoretically separable phenotypes of heart and lateral line muscle myoglobin were found in the Irish pollan (Coregonus pollan). This polymorphism appears to be under the control of two co-dominant alleles. The allele frequencies were found to be virtually identical in samples from two lakes which have probably been isolated since the close of the last Ice Age. A significant excess of heterozygotes was found in samples from both lakes. This myoglobin polymorphism appears to be balanced, maintained due to heterozygote superiority.


Genetical control of phosphoglucose isomerase isozymes in the Japanese quail erythrocytes.

Three phenotypes of phosphoglucose isomerase (PGI) from the Japanese quail erythrocytes were observed by horizontal starch gel electrophoresis. Population and family data from one laboratory population of quail was consistent with the  theory that PGI polymorphism was controlled by two codominant, autosomal alleles designated PGIF and PGIS with gene frequency values 0.25 and 0.75, respectively. The study supported the earlier view that the Japanese quail is highly polymorphic with regard to biochemical variation.


Alterations in reactivity of the blood factors of cattle red cells after pronase treatment.

Pronase treatment of cattle red cells produced various effects: (a) an increase in reactivity of the J factor and evolution of a specific cryptoantigen; (b) decrease in the A-B, G2, K, I1, O2, O3, P, Q, T1, Y2, A', B', E'2, E'3, I', K', O'-L'-V-L and M2 factors, but (c) no change in the specifity or in the titre of the remaining 16 different blood factors. Most of the pronase-affectable blood factors were destroyed in a rather narrow but characteristic range of pronase treatment intensities. However, at like intensities, variations were demonstrable due to the fact that the blood factor occurred (a) in red cells from different individuals, and (b) in different phenogroups or subgroups of the B locus.


Effects of neonatal castration and testosterone injection on adult open-field behaviour in rats with atypical sex difference in defecation.

In the open-field test, male rats usually defecate more and ambulate less than females. A strain was studied in which the males defecate less than females, while still ambulating less. Infants of this strain were castrated (males) or injected with testosterone propionate (females) and tested in the open field as adults. There were significant effects of these neonatal treatments on ambulation, but not on defecation, in contrast to previous reports for the latter measure in rats showing a sex difference in defecation taking the usual direction. It is suggested that absence of the usual direction of a sex difference normally under the developmental control of androgen may indicate a genotype which has escaped from such control. Finally, a number of 'sibling' effects' were observed, i.e. effects on the adult behaviour of the members of one sex in a litter produced by treatments administered in infancy to members of the other sex.


Effects of stimuli emanating from the nest on the reproductive cycle in the ring dove. II: building during the pre-laying period.

The nest is a major focal point of the reproductive cycle in the ring dove (Streptopelia risoria). This study shows that the state of the nest is an important determinant of the type of nest-building exhibited. For example, birds faced with an empty nest bowl every day removed more material from dispensers and built more actively than did those allowed to construct nests normally. Conversely, those given completed nests were not very active, but were more efficient in using the little they removed from the dispensers and showed a reversal of sex roles in building. The relations between nest-building and egg-laying, and between male and the female are discussed.


Effects of stimuli emanating from the nest on the reproductive cycle in the ring dove. III: building in the postlaying period and effects on the success of the cycle.

Nest-building as a functional activity is shown to continue well into the incubation period of the ring dove (Streptopelia risoria), its intensity depending on the state of the nest. The presence of a nest has profound consequences on breeding success: pairs with no nests did not incubate well and did not hatch their eggs. Pre-laying disruption of the nest or of the usual roles of the male and female had no effect on incubation as long as a nest was present when the eggs were laid. It is concluded that the presence of a nest is necessary for the proper establishment of incubation. The possible role of the nest in incubation is discussed.


Postnatal development of locomotion in the laboratory rat.

In laboratory rats (Rattus norvegicus) aged 1 to 21 days emergence of postural and locomotor skills was studied in the open field and in experimental situations with homing used as motivation. Righting is mediated initially by curving and rocking of the trunk, later head and shoulder are rotated, and lastly the hindlimbs turn and provide co-ordinated support. Pivoting prodominates during the second half of the first week, crawling during most of the second week, and walking or running by the end of the second week. Balancing on narrow paths and compensating for lateral displacement on rotating rods mature later, as do various skills (climbing up or down on inclined surfaces, rods and ropes, and jumping across gaps) that require substantial hindlimb co-ordiantion.


The probable role of interferon in allergy.

Sera from 35 patients suffering from autoimmune or allergic diseases such as bronchial asthma, lupus erythematosus, rheumatoid arthritis, Werlhoff disease (autoimmune form), hemorrhagic vasculitis and neurodermatitis and sera from 70 donors were examined for the presence of interferon. Interferon was found in the sera of 17 of the patients but not in any one of the donors' sera. It is suggested that anit-interferon immunoglobulins against human leucocyte interferon should be employed in the treatment of autoimmune or allergic diseases because of the positive clinical results that were obtained. The different hypotheses describing the role of interferon in immunity and allergy are discussed.


Further studies in allergenic identity between house dust and the house dust mite, Dermatophagoides farinae Hughes, 1961.

The sera from 99 Japanese asthmatic subjects were studied for the allergenic similarity between house dust and the House-dust Mite, Dermatophagoides farinae Hughes, 1961. A close correlation (correlation coefficient 0.92, P less than 0.01) was obtained between house dust and the mite with the radioallergosorbent test (RAST). High correlation was not noted between house dust and other allergens such as smoky brown cockroach, Periplaneta fuliginosa, Aspergillus, book lice, Liposcelis bostricophilus, Cheyletus malaccensis and Tribolium confusum. IgE antibody to the mite reduced significantly after the incubation of the sera with house dust and IgE antibody to house dust reduced markedly after the incubation of the sera with the mite. These results further support the view that the mite is the most important allergenic component in house dust.


The total eosinophil count and adrenal function in asthmatic children.

In 36 asthmatic children 8:00 a.m. plasma cortisol levels were compared with changes in their total eosinophil count (TEC) from 8:00 a.m. to 9:30 a.m. All children with low cortisol levels had decreases in TEC of less than 2%, whereas 78% of children with normal cortisol levels had decreases greater than 15%. All children with decreases greater than 15% had normal cortisol levels.


Evaluation of cryo-stimulation test for the diagnosis of cold urticaria.

A cryo-stimulation test performed on 300 allergic and non-allergic individuals showed that this test is positive in most of the cold urticaria patients but negative in patients having other allergic or non-allergic disorders. The chief causes of false positive reactions were a state of atopy and dermographism.


[Vascular lesions of the endometrium in spontaneous abortion].

On the basis of a histological study of vascular lesions of the endometrium following 108 cases of spontaneous abortion, the authors propose the following conclusions: 1) In the first six weeks of pregnancy, early abortion results more often from a primary ovular defect than from any abnormality in the maternal environment, of endogenous or exogenous origin and capable of resulting in a lesion of the endometrium or its vascularisation. The structure of the walls of the spiral arteries of pregnancy is almost invariably normal. 2) By contrast, in late abortions, arterial lesions--and in particular fibrosis--may play a role. This occurs however when the basal arteries with a well-differentiated elastic structure are involved. The spiral arteries of pregnancy and the utero-placentar arteries are involved only by lesions of vasculitis secondary to inflammatory phenomena as  a result of retention of the products of conception or by pseudo-atheromatous lesions resulting from the deposition of degenerated cyto-trophoblastic elements, but never from true arteriosclerotic lesions.


[Liquid cholesterol crystals, physical substrate of atheroma].

The study of the atheromatous arterial walls has been carried out on fresh specimens by frozen sections and polarization examination. Thus, it has been proven that the first deposits of cholesterol take place in the intima under the form of liquid crystals. These are very susceptible to temperature variations. They turn to liquid globules above 40 degree centigrad and partially reappear under the action of the cold.


[Measurement of blood viscosity using a rotatory viscosimeter with coaxial cylinders].

The authors describe a microviscosimeter with coaxial cylinders which requires only a small volume of sample. They draw up formulae permitting to obtain in a simplified way, fluid rheograms, in particular for biological fluids. Furthermore, they consider the use of this viscosimeter for the study of the rheological properties of blood and plasma. Thus, at 30 degrees C, the plasma and serum have a newtonian behaviour, whilst the viscosity of total blood depends mainly on the hematocrit and the rate of shearing. One may thus verify Casson's law (tau 1/2 = tauo 1/2 + S gamma 1/2) which represents approximately the rheological equation of normal blood and permits one to calculate a threshold for viscous outflow.


[Osseous echinococcosis. Apropos of 6 anatomo-clinical observations].

Concerning these six cases, the authors recall the rarity of osseous localization of Hydatidiform disease, isolated as a rule, arising in the adult and preferentially involving the ilium, spinal column, femur, humerus and scapula. Being slowly progressive, the condition is revealed by pain, swelling and above all spontaneous fractures (long bones), or signs of root or medullary compression (spinal column), followed sometimes by fistula formation. Radiological diagnosis is often difficult with an osteolytic appearance without appreciable reactional osteogenesis. As for laboratory investigations, they are only of value in orientation; immunofluorescence being the weakest. The extent of osseous lysis frequently demands extensive surgery. From the anatomical standpoint, the hydatid variety of Echinococcosis has a specific intra-osseous development: beginning in the spongy bone, the architecture is intermediary between the hydatid appearance and the alveolar variety. Some cases however comprise a unilocular appearance with a suspicion of adventitial reaction. Extension into the soft parts frequently adopts a macroscopic appearance identical with that of visceral forms. Bony lysis is dependant on osteoclastic resorption or foci of necrosis while reactional osteogenesis is reduced. Medullary cellular reactions are determinant in the anatomical progress: osteitis or histiocyte and plasmodial reaction to the cuticle fragments.


[Cystic lymphangiomyomas of the uterus].

About 7 cases the author describes a uterine tumor made up of serous cysts with endotheliform covering and small areas of immature leio-myocytes.


[Nodular tumor of the filum terminale: cellular ependymoma].

Cellular type, nodular ependymomas of the filum terminale are rare. They have to be well known since their histological diagnosis is difficult and since they could be mistaken for metastases, when their prognosis after surgical exeresis is excellent. These notions are recalled about an anatomoclinical case.


Scanning electron microscopy of Heinz bodies in feline erythrocytes.

Whole blood and partially lysed blood films from 5 cats having 20 to 91% of the erythrocytes containing Heinz bodies were examined, using the light microscope and the scanning electron microscope. Heinz bodies were detected in the intact erythrocytes from 3 of the cats as abruptly elevated and distinctly demarcated protuberances in various shapes, sizes, and locations. The Heinz bodies were located just beneath the cell membrane either centrally or near the cell margin and varied in their projectional magnitude. Brilliant cresyl blue staining of blood of these 3 cats revealed prominent Heinz bodies within, and projecting from, the erythrocytes. In contrast, Heinz bodies were not identified on scanning electron microscopy of intact erythrocytes of the remaining 2 cats even though Heinz bodies were found on their blood films stained with brilliant cresyl blue. Scanning electron microscopy of partially lysed blood smears of all 5 cats revealed Heinz bodies of various sizes in the erythrocyte ghosts. Furthermore, blood smears from the 3 cats having distinct Heinz bodies in intact erythrocytes revealed small dense intracellular granules distributed singly or coalesced in small clumps. Further aggregation of these clumps was assumed to result in the formation of a single large Heinz body. The 3-dimensional nature of Heinz bodies was clearly apparent in lysed blood smears.


Distribution of acid and alkaline phosphatases in canine skin.

Azo dye methods were used to determine the distribution of acid phosphatase (ACP) and alkaline phosphatase (ALP) in the skin of 25 Beagle dogs. ALP activity was found in dermal papillae of hair follicles regardless of their state of activity, in Huxley's layer of the inner root sheath of anagen stages, in myoepithelial cells of apocrine sweat glands, in germinative cells of sebaceous glands, in vascular endothelium, and in mast cells. The ACP activity was found in the epidermis, outer and inner root sheaths, keratogenous zone, hair cuticle and medulla, duct of sebaceous gland, and sebum. The results indicate that ACP and ALP are distinctive enzymes serving different biologic functions. The principal role of ALP in the skin appears to be dephosphorylation for adsorption and transport of chemical substances necessary for growth and maintainence of the pilary system and glandular adnexa. The ACP appears to be primarily involved in the breakdown of phospholipids and in necrobiosis of keratinocytes.


Equine serum lipids: serum lipids and glucose in Morgan and Thoroughbred horses and Shetland ponies.

Concentrations of serum phospholipids, triglycerides, total cholesterol, nonesterified fatty acids, and glucose were determined for 9 months (September, 1972, to May, 1973) in 19 fasting horses and ponies (8 Morgan horses, 7 Thoroughbred horses, and 4 Shetland Ponies). Morgan horses had higher concentrations of total lipid than did Thoroughbreds, although the relative proportions of each type of lipid were similar in the 2 breeds. Shetland Ponies had higher nonesterified fatty acid and lower glucose concentrations than did either breed of horse. In both breeds of horses, concentrations of serum triglycerides in the cold months (December to March) were lower than those in the warm months. In the Shetland Pony, there was no seasonal variation in triglycerides, but a significant increase was seen in concentration of nonesterified fatty acids in the cold months. The significance of these findings is discussed.


Scanning electron, light, and immunofluorescent microscopy of intestine of gnotobiotic calf infected with calf diarrheal coronavirus.

Intestinal lesions in 2 gnotobiotic calves given (oral inoculation) calf diarrheal coronavirus were studied by scanning electron, light, and immunofluorescent microscopy. The calves were euthanatized at 34 and 73 hours after the onset of diarrhea. Lesions in the small intestine were similar to those reported in animals affected with transmissible gastroenteritis of swine. Small intestinal villi were shortened, some adjacent villi were fused, and villous epithelium was composed of low cuboidal to squamous cells. In the ansa spiralis coli, there were atrophy of the colonic ridges and marked differences in length and spacing of the microvilli on individual epithelial cells.


Intravenous johnin and tuberculin tests in cattle vaccinated with Mycobacterium paratuberculosis cells and subsequently inoculated with Mycobacterium bovis.

Calves at 30 days of age were vaccinated with a killed whole-cell Mycobacterium paratuberculosis vaccine. Four months later, these calves were inoculated with Mycobacterium bovis. The intravenous tuberculin and johnin tests were applied both before and after inoculation. The results of the hematologic investigation had extremes at both high and low values and were too unsuitable for statistical analysis. The intravenous tuberculin test is considered unsuitable for diagnosis of bovine tuberculosis in cattle vaccinated against paratuberculosis.


Immunoglobulins in cattle vaccinated with leptospiral bacterins.

The growth-inhibition test was used to detect specific antibodies against Leptospira interrogans serotype hardjo in isolated immunoglobulin (IgG and IgM) fractions of serums from cattle vaccinated with leptospiral bacterins. The growth-inhibiting antibodies were detected mainly in the IgG class. Agglutinated clumps also occurred with the IgM fraction. The serums collected from cattle 4 months after vaccination were negative in the microscopic agglutination test.


Measurement of phagocytosis of 32P-labeled Staphylococcus aureus by bovine leukocytes: lysostaphin digestion and inhibitory effect of cream.

A procedure to measure phagocytosis by blood and milk neutrophils was developed. One milliliter of heat-killed 32P-labeled Staphylococcus aureus ([32P]SA) (180-200 X 10(6) CFU), 1 ml of phosphate-buffered saline solution (PBSS), and 2 ml of serum, whole milk, skimmed milk, whey, or PBSS were incubated in duplicate for 60 minutes at 37 C. Isolated blood or milk nuetrophils (polymorphonuclear leukocytes (PMN), 25 X 10(6) cells/ml; 1 ml) were added and incubated at 37 C for 30 minutes. Unphagocytosed [32P]SA organisms were lysed by incubation with 5 ml of lysostaphin (10 U) at 37 C for 30 minutes, and the PMN and phagocytosed T2P]SA were removed by centrifugation. Radioactivity of the supernatant was determined in a scintillation spectrometer and was used in estimate the percentage of [32P]SA phogocytosed. With this procedure, 25 assays in duplicate could be conducted each day with an expected coefficient of variation between duplicates of 5.6%. Blood PMN phagocytosed 80, 44, 74, 72, and 11% of the [32P]SA when incubated in serum, whole milk, skimmed milk, whey, and PBSS, respectively. Mik PMN phagocytosed 78, 44, 72, 74, and 22%, respectively. The addition of cream to either skimmed milk or serum reduced phagocytosis of [32P]SA by both blood and milk PMN. The inhibitory effect of cream was verified by the microscopic observation that PMN containing large quantities of ingested fat contained fewer S aureus. Seemingly, PMN upon entering the alveoli of the mammary gland become less efficiently phagocytic for bacteria, because of the presence of milk fat globules. This phef intramammary infection by invading mastitic pathogens.


Pathogenesis of in utero infection: experimental infection of eight- and ten-week-old porcine fetuses with porcine parvovirus.

Selected numbers of fetuses in each of 4 pregnant gilts were exposed to a porcine parvovirus by injecting the virus into the allantoic fluid at gestation day 56 or 70. The fetuses were examined on postexposure day 7 or 14. When pregnancy was terminated, 2 of 15 exposed fetuses were dead. Several fetuses tested at post-exposure day 14 had hemagglutination-inhibiting antibodies to porcine parvovirus. Virus was detected most frequently and in highest concentration in the parenchymatous organs of thorax and abdomen of fetuses exposed on gestation day 56. A small amount of antigen was in neurons and capillary endothelium of cerebral and cerebellar cortexes.


Ultrastructural changes in liver of the rat fed hexachlorobenzene.

Changes in hepatic ultrastructure were observed in rats given hexachlorobenzene (HCB) as a component of the diet in concentrations of 5, 10, and 25 ppm for 3, 6, and 12 months. A significant change was in the cellular regions normally containing smooth endoplasmic reticulum (SER). Sometimes the SER proliferated and at other times it appeared to be replaced by quantities of storage product presumed to be glycogen. Proliferation of SER was often associated with the smaller doses of HCB and the increase in storage products with the larger doses of HCB. However, dose relationships were variable. The most significant changes were in mitochondria which became elongated or swollen. Swollen mitochondria were occasionally as large as nuclei. Usually only a fraction of the mitochondria in a cell appeared abnormal. Storage bodies 1 to 4 mum in diameter developed in some cells. These bodies were surrounded by a double membrane derived from the endoplasmic reticulum and may have been the partly digested remains of degenerated mitochondria.


Morphologic heterogeneity of a strain of swine influenza virus (A/swine/Wisconsin/1/68, Hsw1N1) propagated at different temperatures.

Strain A/swine/Wisconsin/1/68 (WI/68) swine influenza virus (SIV) was propagated in embryonating chicken eggs at 33, 35, or 37 C. The SIV harvested from eggs incubated at 33 C invariably had higher hemagglutination (HA) and egg infectivity titers than did SIV propagated in eggs at the 2 higher temperatures. When SIV inoculum propagated at 33 C was inoculated into separate groups of eggs and incubated at 33, 35, and 37 C, the SIV harvested from inoculum incubated at the 2 higher temperatures had significantly lower infectivity and HA titers than did that propagated at 33 C. By electron microscopy (EM), viral particles of Wi/68 were of various sizes and shapes regardless of the temperature used to propagate the virus. However, in contrast to what was seen in SIV harvested from innoculum incubated at 33 C incubation, pleomorphic shapes and particles with surface abnormalities were much more frequent in SIV harvested from inoculums kept at the 2 higher temperatures. Approximately one-third of the particles from 35 and 37 C incubation either were spikeless or were relatively deficient in surface spikes.


Luteolysis with prostaglandin F2alpha or an antiserum against an equine pituitary fraction in hysterectomized mares.

Luteolysis, determined by corpus luteum weight and progesterone concentration in jugular blood, occurred in uterine-intact and in hysterectomized mares after injection of prostaglandin F2alpha or of an antiserum against an equine pituitary fraction. Results indicated that luteolytic effects of exogenous prostaglandin F2alpha and inhibition of the endogenous luteotrophic activity of the hypophysis (pituitary gland) by antiserum did not involve the uterus.


Equine toxoplasmosis: a survey for antibodies to Toxoplasma gondii in horses.

A nationwide sample of horses was tested to determine the prevalence of toxoplasma antibodies in equine animals. Of 1,294 serum samples from horses tested by the microtitration indirect hemagglutin test, 20% were positive. Among the popular breeds of horses, the following antibody prevalences were found: Arabian, 19%; Paint, 22%; Quarter Horses, 13%; Thoroughbred, 24%; and Standardbred, 17%. The antibody prevalence increased from 2% in horses 1 year of age to 18% in 2-year-olds, and rose to 38% in horses 12 years of age. Significant differences were not evident by broad geographic locations across the United States. However, there were differences in prevalence according to premises where the horses were kept. On some ranches, there was no evidence of infection, whereas up to 67% of the horses on other premises were seropositive for toxoplasmosis.


Survival of Ancylostoma caninum on bare ground, pea gravel, and concrete.

Studies were done to determine the survival of infective Ancylostoma caninum 3rd-stage larvae on 3 ground covers commonly used in dog run construction: bare ground, pea gravel, and concrete. Changes in numbers of recovered larvae were compared to meterologic data and the most significant weather variables were determined. Larvae were recovered 1 to 7 days on bare ground. Larvae survived longer in the fecal mass (mean of 3 days) than on the bare ground (mean of 2 days). Rain was the most significant variable, in that it was positive in its effects (higher larval count) early in the experiment (causing fecal mass breakdown and release of larvae) and negative (lower larval count) later in the experiment (spreading larvae away from test site). Larvae were also recovered 1 to 7 days on pea gravel. They were recovered for a mean 2.6 days from the fecal sample, a mean of 1.5 days from the rocks directly below the fecal mass, and a mean of 1.3 days from the remaining rocks. Here also, rain was the most significant weather factor. It was negatively significant (lower larval count) for the fecal mass (spreading of the larvae) and positive for those in the pebbles (increasing the moisture in the pebbles). Survival time of larvae on concrete was shorter than that on the other 2 substrates: from 0 to 2 days. Larvae were recovered a mean of 1.3 days from the fecal mass and a mean of 0., days from the surrounding concrete. Rain was positively significant early in the experiments in that it released trapped larvae from the fecal mass. Sunlight consistently was negatively significant (lower larval count) due to its lethality to the unprotected larvae.


Observation of the secretion on the surface of the bronchioles with the scanning electron microscope.

The secretion covering the surface of the bronchioles can be demonstrated with the scanning electron microscope if fixative is introduced into the pulmonary artery or directly into the lung rather than through the trachea. Buffered glutaraldehyde, ethanol, or an ethanol-ether mixture can be used as a fixative. With this method of preparation the surface secretion appears as a smooth coating covering the cilia and cells. The secretion is insoluble in ethanol ether or chloroform methanol, suggesting that there is little lipid contained in it. Reasons are cited for believing that the major component of the secretion is a protein that arises from the Clara cell.


Vascular interdependence in postmortem human lungs.

Interdependence of arteries and the surrounding lung was estimated in excised, postmortem human lungs. At low vascular pressures, vessel diameter increased as the lung was inflated. At high vascular pressures, vessel diameter decreased as the lung was inflated. Compared to the effects of interdependence in excised dog lobes, those in human lungs at low transpulmonary pressures were small. The following conclusions were reached: (1) the diameter of intrapulmonary arteries is stabilized (more constant with changes in intravascular pressure) when the lung has a high transpulmonary pressure; (2) increases in pulmonary vascular resistance at high lung volumes may be related to extra-alveolar, as well as intra-alveolar, vessel compression; (3) interdependence in human lungs differs markedly from interdependence in dog lungs.


Relationship of arterial-alveolar nitrogen tension to alveolar-arterial oxygen tension, lung volume, flow measurements, and diffusing capacity in cystic fibrosis.

Pulmonary function in children with cystic fibrosis was assessed by the arterial-alveolar PN2 difference adjusted to sublingual temperature. The resulting values were compared with the alveolar-arterial PO2 difference, arterial PCO2, and standard measurements of lung volume, flow, and diffusing capacity. The arterial-alveolar PN2 difference was nearly one half of the PO2 difference, both early in the disease and at a more advanced stage. Analysis taking into account the O2 dissociation curve and the possibility that alveolar temperature is higher than sublingual temperature suggested that all of the PO2 difference could be explained in terms of ventilation-perfusion imbalance in gas-filled units of the lung. Reduction of fractional CO uptake with increasing PN2 difference suggested that the decrease in diffusing capacity in cystic fibrosis may be explained by ventilation-perfusion inequality. A significant relationship between arterial PCO2 and the PN2 difference supported the view that ventilation-perfusion inequality is the cause of CO2 retention when present. The PN2 and PO2 differences were abnormal before the standard tests of lung volume and flow, but in general, the correlation was excellent. Because the PN2 difference was not superior to the PO2 difference in detecting early disease, and because the technical problems in its measurement are considerable, it is not recommended as a routine measurement.


Pulmonary arteriovenous differences in serum antiprotease activity during experimental pneumonitis.

The trypsin-inhibiting activity in pulmonary arterial blood and in blood of the left atrium was measured in rabbits with bacterial or papain-induced pneumonitis. In both experimental models, the trypsin-inhibiting activity was significantly lower (P less than 0.001 and P less than 0.002) in blood after it had passed through the inflamed lung than in pulmonary arterial blood. Healthy rabbits had no arteriovenous difference of antitryptic activity in the pulmonary circulation. Consumption or alteration of inhibitors by protease in the inflamed tissue is a reasonable explanation for this difference. We interpreted these data as supporting the hypothesis that protease inhibitors in serum exert a protective function against proteolytic enzymes during inflammation. In conditions of low serum protease-inhibiting activity, as in alpha1-antitrypsin deficiency, proteolytic damage to lung tissue could result.


Vocal cord paralysis due to pulmonary tuberculosis.

Tuberculosis must be considered in any patient with vocal cord paralysis. Mediastinoscopy, added to the usual diagnostic procedures, may be useful in the differential diagnosis.


Evaluation of nitrogen analyzers.

Commercial N2 analyzers are in current use in tests for pulmonary closing volume. To determine whether differences between instruments might lead to inconsistencies in the measurement of closing volume, we compared the performances of 3 different N2 analyzers. The tests involved measurement of accuracy under constant and varying conditions, response to transient changes in N2 concentration, long-term stability, and an assessment of mechanical integrity. There were moderate differences in accuracy among the 3 instruments that can be essentially eliminated at N2 concentrations less than 40 per cent by changing the calibration procedure for one of the instruments. There were also moderate differences in instrument stability, dependence on environmental conditions, and mechanical quality.


Phytohemagglutinin (PHA) skin test in patients with sarcoidosis.

A group of 17 patients with histologically confirmed sarcoidosis were examined for the presence of anergy and the intracutaneous response to 2 mug of purified phytohemagglutinin (PHA); lymphocytes of 15 of these patients were studied for in vitro blastic response to PHA-M. Although 8 of the patients were anergic and 8 had impaired in vitro response to PHA, all patients showed a normal response to intradermal injection of PHA. It was concluded that patients with sarcoidosis have an intact intradermal response to PHA, suggesting that the anergy seen in this disease results from impaired initiation of the delayed hypersensitivity reaction and not from impaired mononuclear cell responsiveness. The PHA skin test may be a useful adjunct in the evaluation of anergic patients.


Cord factor not toxic in rats.

Systemic toxicity and local inflammatory activity of cord factor were compared between mice and rats. In mice, repeated intraperitoneal injection of cord factor caused a marked worsening of general condition and high mortality. The swelling of footpads injected with cord factor was also marked in mice. In contrast, injection of cord factor produced no such toxic reactions in rats, except that repeated intraperitoneal injections of high doses of cord factor induced an accumulation of ascites.


Status inequality and stress in marriage.

Emotional stresses that are experienced in marriage are traced to differences in spouses' status origins. Linking status differences to such stress are a number of intervening conditions. People to whom status advancement is important and who have married mates of lower status are apt to have a sense of loss that leads, in turn, to a disruptions of reciprocity, expressiveness, affection and value sharing in marital exchange. Such disruptions then act as immediate antecedents to emotional stress. It is through this process that the status order of the larger society can reach out to have a deleterious influence on the emotional states arising out of marital transactions.


Transverse myelopathy in systemic lupus erythematosus. Report of three cases and review of the literature.

Three cases of transverse myelopathy associated with systemic lupus erythematosus were reported, and 23 similar cases previously reported were reviewed. A diagnosis of systemic lupus erythematosus was made in only 60% before the onset of transverse myelopathy. The time of onset of myelopathy was randomly distributed during the disease. The most common presenting neurologic symptom was numbness, or weakness of the legs, or both. A unique association between the acute stage of transverse myelopathy and marked reduction of cerebrospinal fluid glucose concentration was observed. Thirteen patients died, 9 had permanent neurologic deficits, and only 4 recovered nearly normal function. Eight patients had ischemic necrosis of the spinal cord at postmortem examination, and vascular lesions were found in the spinal cord of 3 additional patients. The value of steroid treatment was uncertain. Patients who were started on steroid therapy within 24 hours of the onset of myelopathy may have benefited.


Quantitative assessment of hepatic function by breath analysis after oral administration of (14C)aminopyrine.

The rate of hepatic metabolism of dimethylaminoantipyrine (aminopyrine), which occurs primarily through N-demethylation, was assessed by measurement of the specific activity of 14CO2 excreted in breath samples obtained 2 hours after oral administration of a trace dose of [14C]aminopyrine. The percentage of administered 14C excreted in 14CO2 in 2 hours was 7.0 +/- 1.3 (SD)% in control patients, and significantly less (P less than 0.01) in patients with portal cirrhosis (2.6 +/- 1.2%), fatty liver (4.7 +/- 1.1%), hepatitis (2.6 +/- 1.4%), and hepatic malignancy (3.5 +/- 1.8%). In 16 of 24 subjects with cholestasis not caused by malignant disease the mean 14CO2 excretion was normal. The 14CO2 excretion in patients with portal cirrhosis correlated highly with aminopyrine metabolic clearance rate (r equals 0.92), serum albumin (r equals 0.75), and retention of bromsulphalein (r equals 0.73). Abnormal 14CO2 excretion returned to normal in patients with hepatitis, when the hepatitis resolved. The data suggest that the aminopyrine breath test is a safe, simple, qualitative and quantitative liver function test.


Juvenile polyposis and gastrointestinal carcinoma. A study of a kindred.

A kindred contained at least 10 members with single or multiple juvenile polyps of the stomach and large intestine. Several additional polyps had both adenomatous and juvenile features. Eleven members of the kindred have had gastrointestinal carcinoma of the stomach, duodenum, pancreas, or proximal colon. The pattern of inheritance in this kindred suggests either a single or two closely linked autosomal dominant determinants for gastrointestinal carcinoma and polyposis. Management of this kindred is complicated due to the occurrence of gastrointestinal carcinoma without polyposis.


Extreme hypermagnesemia as a cause of refractory hypotension.

A 62-year-old woman with adequate renal function who consumed large quantities of magnesium citrate presented with lethargy and hypotension. The hypotension was refractory to all conventional therapy. Her serum magnesium was 12.5 meq/litre (normal, 1.5 to 2.5). She was found to have a perforated duodenal ulcer; peritoneal aspirate magnesium concentration was 12.2 meq/litre. Hypotension improved with intravenous calcium and peritoneal dialysis. This case shows that hypermagnesemia may be accompanied by severe refractory hypotension, and that intestinal disease may predispose to hypermagnesemia in patients ingesting large quantities of magnesium despite normal renal function. Dialysis removes excess magnesium and reverses its toxic effects.


Sideroblastic anemia with splenic abscess and fatal thromboemboli after splenectomy.

A man with sideroblastic anemia had a splenectomy because of a salmonella abscess of the spleen that had ruptured into the colon. Two months later he developed recurrent thrombophiebitis and fatal thromboembolism associated with thrombocytosis. A review of the literature showed multiple additional cases of sideroblastic anemia with thrombocytosis and thromboembolism after splenectomy. In many of these cases the patient died. Splenectomy for treatment of a sideroblastic anemia probable is contraindicated. If splenectomy is done, long-term therapy to avoid thromboembolic complications probably should be maintained for many months or even years.


Bacterial endocarditis caused by Oerskovia turbata.

Oerskovia turbata is a yellow, motile actinomycete, which before now has only been found in soil and has not been known to cause disease in man or animals. It was isolated from 29 cultures of blood taken during 6 months from an urban pensioner after homograft replacement of his aortic valve. The combination of ampicillin, sulfamethoxazole, and trimethoprim was lethal for O. turbata in vitro; however, antimicrobial therapy alone failed to eradicate the patient's infection. Cure was achieved after the infected homograft was replaced with a prosthetic aortic valve. Although the source of O. turbata in this patient is unknown, sterilization of homograft valves with antimicrobial solutions is difficult. Moreover, environmental contamination during cardiopulmonary bypass is common. Oerskovia turbata is another opportunistic pathogen of man.


Handwashing practices for the prevention of nosocomial infections.

Handwashing is generally considered the most important procedure in preventing nosocomial infections, because many types of these infections may be caused by organisms transmitted on the hands of personnel. Personnel should wash their hands before and after significant contact with any patient. The risk of personnel acquiring transient hand carriage of organisms is usually greatest after contact with excretions, secretions, or blood; patients at greatest risk are those undergoing surgery, those with catheters, and newborn infants. Although handwashing with an antiseptic agent between patient contacts is theoretically desirable, handwashing with soap, water, and mechanical friction are sufficient ro remove most transiently acquired organisms. Antiseptic agents may produce excessively dry skin if used frequently, and any regimen of handwashing that leads to dermatitis negates the purpose of handwashing. We favor antiseptics for handwashing before surgery and other high-risk invasive procedures and in the care of newborn infants but prefer soap and water for other handwashing.


Peer review by criteria mapping: criteria for diabetes mellitus. The use of decision-making in chart audit.

The UCLA Experimental Medical Care Review Organization (EMCRO), in an attempt to minimize the problem of applying a general list of criteria to each patient with a specific condition, has developed a method called Criteria Mapping. This method uses sequential judgments based on the specific clinical data for the individual patient to assess the quality of care by medical record audit. The method does not penalize the physician for omitting unnecessary procedures by allowing alternate decisions when appropriate, and provides supporting reference materials to allow nonphysicians to make reliable medical interpretations of the data in medical records. It is expected that this method will more accurately reflect the physicians' intentions, and that process, when measured by this approach, may correlate better with the outcome of medical care.


Glucagon secretion in acute and chronic pancreatitis.

Plasma pancreatic glucagon concentrations were determined in the basal state and after the infusion of alanine in 10 patients with acute pancreatitis (5 in an initial episode of pancreatitis), in 10 patients with chronic pancreatic insufficiency, and in 21 healthy controls. In acute pancreatitis, basal glucagon levels were nine times normal but were higher during the initial attack than with a history of previous attacks. The glucagon response to alanine was also increased threefold to fourfold in initial attacks. In contrast, after recovery from the initial attack of acute pancreatitis, during acute episodes of pancreatitis in patients with a history of previous attacks, and in patients with pancreatic insufficiency, alanine failed to elicit a consistent rise in plasma glucagon. The data suggest that hyperglucagonemia may contribute to the hyperglycemia of acute pancreatitis, particularly during the initial episode. Loss of alpha cell responsiveness to alanine provides a sensitive index of previous pancreatitis.


Amikacin therapy for serious gram-negative bacillary infections.

Amikacin is a new aminoglycoside antibiotic pharmacologically similar to kanamycin. It has a wide range of activity against Gram-negative bacilli, including many resistant to gentamicin. Thirty-six serious Gram-negative bacillary infections were treated with amikacin. Twenty-nine patients (80-6%) responded (cured or improved). Twelve of 13 patients with gentamicin-resistant pathogens responded. Minor ototoxicity occurred in 6 patients and was associated with prolonged therapy or previous aminoglycoside therapy. Possible nephrotoxicity with amikacin was found in 6 patients. Amikacin should be used primarily to treat suspected or known gentamicin-resistant pathogens.


Large artery involvement in giant cell (temporal) arteritis.

Of 248 patients with giant cell arteritis, 34 had evidence that the disease affected the aorta or its major branches. Symptoms suggestive of large artery involvement were intermittent claudication of an extremity, paresthesias, and Raynaud's phenomenon. Physical findings included absent or decreased large artery pulses and bruits over large arteries. Four patients presented with decreased upper extremity pulses as the initial manifestation of their arteritis. Nine other patients under treatment for temporal arteritis or polymyalgia rheumatica first developed evidence of large artery involvement as corticosteroid therapy was tapered or discontinued. Angiography, performed in 10 patients, was helpful in indicating arteritis rather than atherosclerosis as the cause of large artery disease. Three patients died with aortic rupture, and, at autopsy, widespread giant cell arteritis was found. However, when corticosteroids were given in adequate doses, the response was favorable in most patients; intermittent claudication decreased and the pulses improved.


Deficiency of the second component of complement (C2) with chronic vasculitis.

A patient had complete deficiency of the second component of complement associated with chronic vasculitis and increased susceptibility to infection. We discuss here results of the complement profile, histocompatibility typing, and studies of the functional properties of patient plasma or serum in chemotaxis and opsonization in relation to the disease entity and host susceptibility to infection.


A new treatment for hirsutism.

Twenty-four hirsute female patients were treated with 100 mg of depo-medroxyprogesterone acetate intramuscularly every 15 days. Twenty-three showed definite improvement from their abnormal hair growth. All patients with initially elevated 17-ketosteroids in 24-hour urine collections showed a decrease of these metabolites with treatment. In eleven patients the initial plasma testosterone level was elevated and returned to normal values with treatment. The first patient who was submitted to this therapy stopped the treatment for 5 months and started having abnormal hair growth again. With other patients, after initial treatment with depo-medroxyprogesterone acetate intramuscularly, we started using contraception pills containing medroxyprogesterone; this maintained the reduced ectopic hair growth. The most important side effect was amenorrhea.


False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C).

In a female patient with unexplained anemia, ascorbic acid ingestion and apparent false-negative occult blood tests were related. When she stopped ascorbic acid, her stools became strongly reactive ("4+") by three tests for occult stool blood; this association was observed repeatedly. A test developed to measure stool occult blood in the presence of ascorbic acid remained reactive throughout this observation, and the observation was confirmed by in-vitro studies. Current tests for occult blood depend on the pseudoperoxidase activity of heme and are inhibited by low levels of ascorbic acid. Reducing substances chemically similar to ascorbic acid also inhibits occult blood tests; oxidized ascorbic acid and sulfhydryl reducing agents do not inhibit them at physiologic levels.


Spurious Schilling test results obtained with intrinsic factor enclosed in capsules.

Three urinary excretion tests of vitamin B12 absorption were done in 12 patients with classic pernicious anemia. The 24-hour urinary excretion of radioactivity was 2.1% +/- 0.7% (mean +/- SEM) of the ingested dose of cyanocobalamin-57 Co. When cyanocobalamin-57 Co was mixed with hog intrinsic factor in water, excretion increased to 15.6% +/- 1.6%. When cyanocobalamin-57 Co and intrinsic factor were given in two separate capsules, which is now a frequent practice, excretion was 9.5% +/- 2.2%. In 6 patients, use of the results obtained with capsules could have led to an incorrect diagnosis. When cyanocobalamin-57 Co and intrinsic factor are given in separate capsules, binding of radioactive vitamin to intrinsic factor may be incomplete due to inadequate mixing in the stomach or to binding of intrinsic factor to blocking antibody in the gastric juice. The classic technique in which intrinsic factor and cyanocobalamin-57 Co are mixed in water before administration should be used.


Residency training in primary care internal medicine. Report of an operational program.

The Primary Care Program at the Massachusetts General Hospital is designed to develop competence in the full range of problems encountered by general internists delivering primary care. House staff spend 3 years in the program, which starts with internship, includes a senior residency, and fulfills the requirements for board eligibility in internal medicine. Half of the training is provided in outpatient care settings. House staff assume responsibility for organization and operation of an ambulatory medical unit. In addition, there is supervised instruction in office gynecology, orthopedics, ear, nose and throat, dermatology, and psychiatry. Close integration with the traditional inpatient-oriented training program is maintained to ensure commensurate growth and competence in management of acute, life-threatening disease.


Herbal pharmacology and medical therapy in the People's Republic of China.

A scientific delegation visited the People's Republic of China for the purpose of assessing the current status of herbal pharmacology and medicine there. China is attempting to wed traditional and Western medicine so as to take advantage of the potential contributions of both. This wedding seems possible at the empiric level despite theoretical contradictions. Traditional remedies are widely prescribed, but the actual impact of such medication on disease is difficult to assess, because of the failure of the Chinese up until now to evaluate such remedies by modern clinical trial methodology. All Western drugs are readily available in China, and indeed are manufactured for export as well as for use within the country. The current chinese approach to the patient-doctor relation, and some novel ideas with regard to both medical and surgical therapy pose provocative questions for Western physicians.


The effect of chronic administration of a topical antibiotic on the conjunctival flora.

Twenty-two volunteers received topical 0.25% chloromycetin ophthalmic drops without preservatives and 20 received topical 1% methylcellulose ophthalmic drops in their right eyes for up to 12 weeks. The left eyes served as controls. The eye drops were used an average of 3.21 times per day. A slit lamp biomicroscope examination, conjunctival cultures, and antibiotic sensitivities were performed on each visit. No difference in the percentage of positive cultures or negative cultures obtained in the chloromycetin treated eyes could be found when compared with the methycellulose treated group or control eyes. Chloromycetin 0.25% ophthalmic drops without preservative appear to be questionably effective, although harmless, when used for up to 12 weeks, 3 to 4 times per day.


Ophthalmologic findings in malaria.

During the Vietnamese conflict, malaria in epidemic proportions constituted a serious health hazard to our forces. Although rarely encountered worldwide, Falciparum malaria proved to be an extremely lethal and dangerous complicating factor. Ophthalmologic complications of malaria are discussed and particular attention is placed on Falciparum malaria with the report of a case in detail and the presentation of unusual fundus findings.


Various parameters of diabetic retinopathy among clinic populations.

A study of 402 patients was undertaken in a diabetic clinic at a county hospital. Diabetes was more common in females. Diabetic retinopathy varied directly with the duration of diabetes. Retinopathy occurred earlier with late onset diabetes as compared with diabetes occurring in younger patients. The incidence of raised intraocular pressure was 13.1%. Raised intraocular pressure did not seem to protect the eye against diabetic retinopathy. Good control of diabetes did not seem to affect the nature of established retinopathy. The incidence of retinopathy was higher if hypertension was present.


[The spore germination of "Clostridium tyrobutyricum" III.--An hypothesis on the mechanism of initiation (author's transl)].

Spores of C. tyrobutyricum do not contain 3-phosphoglyceric acid (PGA) but a polysaccharide which could replace PGA as an energy source during germination. The absence of PGA, which is an inhibitor of phosphotransacetylase, confirms the role of the acetyl-CoA synthesizing system in the germination initiated by acetate. Spore extracts of C. tyrobutyricum, as extracts of vegetative cells, were found to contain a ferredoxin and exhibited a NADH-ferredoxin oxydase activity which required the presence of an acetyl-CoA regenerating system, suggesting that this enzyme is also involved in germination. From this results, an hypothesis on the role of initiators (acetate and NH4+) in the mechanism of initiation of spore germination in C. tyrobutyricum is proposed. Acetate would have an effect on the utilisation of the endogenous polysaccharide and on glucose catabolism, and therefore, would be an effector for the production of the energy required particularly to transport cations into the spore.


[The intracellular multiplication of "Brucella" The theory for an experimental model (author's transl)].

Brucella melitensis can penetrate and multiply in cells of the BHK21 line. The intracellular bacteria can be counted either by culture after destruction of the cells or by direct examination after staining; in the latter case, the cells are distributed into various classes according to the number of bacteria which they contain. The number of intracellular bacteria increased exponentially and the division time is 12 hours. The intracellular division of the bacteria is independent of the cellular invasion. The infection by bacteria is not a factor related to mortality nor to survival of the cells. Whatever the number of bacteria initially placed on the BHK21 cells (up to 1,000 bacteria per cell), the number of infected cells never increased about 20%, and this indicates that all the cells do not have the same aptitude for the phagocytosis of Brucella. A mathematical model is suggested. Taking all factors into account, the model shows the probability for a certain number of Brucella per cell and, on the other hand, it shows the mean number of Brucella per cell at any particular moment. This model can be used in the case of other bacteria and of other cells, and can be used whenever a precise study of the intracellular multiplication of bacteria is required.


Voluntary unilateral convergent strabismus.

This syndrome has been reported as a medical rarity. However, 16 cases, including 2 families, add to knowledge of the occurrence, age of onset, emotional factors, and to possible genetic basis in the etiology.


Metastatic tumor of the orbit.

Metastatic tumor occurred in the right orbit of a 50-year-old woman 5 years following bilateral mastectomy. The tumor caused enophthalmus, ptosis and restriction of the ocular movements. The tumor consisted of nondifferentiated cells. Transmission and scanning electron microscopic appearance of the tumor is also reported.


Lysozyme in corneal ulcer.

In the present experimental study the role of lysozyme drops in healing of corneal ulcer of staphylococcal origin (sensitive to chloramphenicol) was studied on 16 albino rabbits. In 8 rabbits, in one eye placibo drops (distilled water) and in the other eye lysozyme 1% were put 4 times daily. In the other 8 rabbits, in one eye chloramphenicol drops 0.4% and in the other eye chloramphenicol drops 0.4% + lysozyme drops 1% were instilled 4 times daily. It was observed that the rate of healing of corneal ulcer was much earlier in the eyes which had local instillation of chloramphenicol drops + lysozyme in comparison to the eyes which had only chloramphenicol drops, lysozyme drops, or distilled water.


Toxic maculopathy part II: A result of quinine usage as demonstrated by fluorescein angiography and electroretinography.

In this paper, further investigation by fluorescein angiography and electroretinography (ERG) was undertaken to substantiate the possible toxic maculopathy due to quinine usage. Again, positive Amsler chart tests were found in 3 of 14 (21%) of the drug addicts with blurred vision, a common complaint among these patients. The results of 5 fluorescein angiography examinations demonstrated no leakage of dye, especially in the macula. Twenty-four ERG examinations revealed no statistical differences between the test group patients and the control subjects. It was concluded that there is a definite need to carefully examine the eyes of any person who has used quinine for a long time since positive Amsler chart tests were found in 37% of the drug addicts.


Herellea vaginicola and ocular infections.

This case report describes a chronic medically-refractory corneal ulcer which eventually yielded Herellea vaginicola from resected corneal tissue. A review of the literature cites the occurrence of this organism as an inhabitant of normal conjunctiva, as an infrequent cause of conjunctivitis, and as the causative agent in two previous cases of corneal ulcers. This case illustrates the difficulty in the isolation of the organism and indicates the need for diagnostic and therapeutic keratectomy in conjunction with a conjunctival flap.


Modification of the Mustardé and Hughes methods of reconstructing the lower lid.

Reconstruction of the lower lid often is a greater task than originally anticipated in preoperative evaluations. The Mustardé and Hughes methods are commonly used for extensive lower lid reconstruction. Certain difficulties encountered in these methods may be minimized by variations in the basic techniques. Structural support for a Mustardé flap may be provided by a free tarsal conjunctival graft rather than a nasal septal cartilage mucosa graft. Late complications following the Hughes procedure include upper lid retraction and entropion. These may be minimized by removing Mueller's muscle from the flap at the time of the original dissection. The Hughes flap may be lysed in 3 to 4 weeks. Lid margin abnormalities, which occur occasionally, are corrected with minor modifications.


Cleft larynx. A report of seven cases.

The purpose of this paper is to familiarize the otolaryngologist with a difficult and frequently missed anomaly. It is hoped that this will increase the number of successfully managed patients with this affliction. Of the seven herein reported cases, four were posterior clefts limited to the cricoid lamina. Three were more extensive laryngotracheoesophageal clefts. Seven cases are thus added to the approximately 30 cases reported in the world literature. The limited cricoid lamina defect can only be diagnosed by endoscopic examination, and is treated medically. Feedings must be given by gastrostomy only. A tracheotomy is indicated only when oral secretions are aspirated into the tracheobronchial tree. The more extensive laryngotracheoesophageal celft requires surgical repair through a lateral pharyngotomy approach. When the cleft is extensive and extends into the chest, surgery must include a thoracic approach. The occurrence of cleft larynx in association with tracheoesophageal fistulae, with or without atresia may be more frequent than generally realized. A search should be made for this anomaly in patients who aspirate after atresia repair has been accomplished, before attributing this symptom to severe stricture formation, or recurrence of the fistula. The problem of aspiration in posterior cleft larynx is due to the lateral and posterior displacement of the arytenoids. This malposition is due to the absence or deficiency of the interarytenoidius muscle so that the posticus muscle is unopposed. The term "posterior cleft larynx" should be used only where the defect is limited to the cricoid lamina, while laryngotracheoesophageal cleft should be applied to the more extensive defect.


Experimental granuloma of the larynx.

This paper describes a series of experiments that were performed in dogs, attempting to reproduce in the laboratory a chronic granulomatous reaction of the larynx. The purpose of this work was to learn about the possible pathogenesis of these lesions and to find the reasons behind their chronicity and recurrence. The practical aspects of this research were to formulate and, hopefully, to develop reasonable diagnostic and therapeutical approaches that could be used in the treatment of patients. The positive and negative results of these experiments indicate that the granulomatous response is probably influenced not only by external factors, but also by intrinsic factors. Clinically these findings led to the concept of not circumscribing judgment to the peripheral changes only, but to the assessment of all facts surrounding each individual case.


Characterization of tumor antigen in epidermoid carcinoma.

Tumor antigens have been isolated from nine epidermoid carcinomas of the head and neck. The most strongly reactive antigens have a molecular weight of congruent to 25,000-50,000 daltons, though other antigens weighing congruent to 120,000-400,000 daltons were noted in six of the tumors. The most strongly reactive antigens had a pI between 8.36 and 8.40. The cross reactivity of these antigens will be studied next. It is hoped that the purified tumor antigen will be useful in the development of an immunodetection system for epidermoid carcinoma.


Some observations on blood microfilters.

Under laboratory conditions 3 types of filter designed to prevent the passage of microemboli into the circulation during the transfusion of stored blood were compared with the standard Baxter BR10 filter, designed only to hold back macroemboli, in respect of resistance to blood flow and damage to the cellular elements of the blood. In both respects the Pall Ultipor microfilter proved more efficient than the Swank IL200 microfilter and the Bentley Polyfilter (PF-127) and, except with 3-week-old blood, was comparable to the Baxter filter.


Surgical experiences in Nepal.

Some examples of surgical problems presenting to the authors during a 2-year attachment to the British Military Hospital, Dharan, Nepal, are described.


Pyriform sinus cancer: a clinical and laboratory study.

In our patient population, cancer of the hypopharynx arose 19 times as often in the pyriform sinus as in the postcricoid space (152:8). Most of the growths were far advanced when first seen (90% T3), and enlarged cervical nodes were present in 66% of the patients. Three year survival rates free of disease were as follows: primary surgical treatment (laryngectomy, radical neck dissection) (8/28) 29%; primary radiotherapy (2/55) 4%; and combined preoperative radiation (12/33) 36%. Serial section studies of 51 surgical specimens indicate that T1 and T2 lesions, especially those confined in the medial wall, are probably curable by radiotherapy. Larger lesions invade deeply into the larynx and resemble transglottic growth in their pattern of spread. Conservation surgery would have been inadequate for all but perhaps one growth in this series of 51 lesions, because of the high rate of invasion by cancer into and through the thyroid cartilage and cricoid ring (22/51). Although surface presentation of this group of pyriform sinus cancers rarely reflected the extent of invasion, each of the 22 growths that invaded portions of the thyroid or cricoid cartilages was characterized by clinical involvement of the apex and lateral wall of the pyriform sinus on laryngoscopy or barium swallow.


Tracheal incision as a contributing factor to tracheal stenosis. An experimental study.

Tracheostomies were performed on 25 mongrel dogs, employing either a vertical or inverted U flap incision in the trachea. Following cannulation for 14 days, the animals were maintained for three months and endolarygeal photographs were taken. At the time of autopsy, comparisons of the gross specimens were carried out, as well as histological sectioning through the tracheal stomal area. Both endolaryngeal examination and study of the gross specimens at autopsy revealed less distortion of the tracheal lumen following the flap versus vertical tracheostomy, especially in those animals having the flap of cartilage resewn to the trachea at the time of decannulation. Measurements of the cross sectional area at the tracheal stoma were also made. In animals having a flap  tracheostomy, the stomal lumen was preserved, regardless of resuturing the flap. However, animals having a vertical tracheostomy lost an average of 18% of the tracheal area when compared with those having a flap incision. Histological examination revealed cartilaginous growth across the tracheostomy incision only in animals having the flap tracheostomy. Support for the flap tracheostomy is provided from animal experimentation.


Rehabilitation of the shoulder after radical neck dissection.

After classical radical neck dissection with removal of the sternocleidomastoid muscle and division of the spinal accessory nerve, there are certain disabling or disagreeable musculoskeletal defects. This paper describes the muscular deficiencies and gives a set of exercises which can be counted on to minimize the problems.


Nontraumatic, nonneoplastic subglottic stenosis.

During a 20-year period, 12 patients with nontraumatic, nonneoplastic subglottic stenosis were seen at the Mayo Clinic. The etiologic factors were relapsing polychondritis, amyloidosis, sarcoidosis, and Wegener's granulomatosis. Because of the diverse initial presentation of the disease, the clinician should consider that the stenosis is a manifestation of a systemic disorder and carry out an otolaryngologic and physical examination with the appropriate roentgenograms and blood and urine tests. Treatment, if a systemic disease is proved, consists of appropriate medication. Surgery may be necessary, depending on the nature of the lesion. Small strictures may not need to be treated.


Radiation failures in cancer of the larynx.

Overwhelming statistics have been published regarding the success of radiation therapy in the management of laryngeal carcinoma. The fate of those patients whose cancers are not controlled by radiotherapy is often left to speculation. An analysis is made of 61 patients with early and advanced laryngeal cancer treated initially with radiation therapy and subsequently operated upon because of recurrent or persistent tumor. Frequently, diagnosis of recurrence is difficult or delayed. Preservation of voice can only be accomplished when recurrence of T1 and T2 lesions is detected early and strict criteria are followed. Conservation surgery is not feasible for early lesions which progress after radiation failure. Advanced T2 and T4 lesions which become radiation failures also require laryngectomy for salvage. In cancer of the larynx, there is a definite, identifiable group of patients in whom surgery would be advisable as the initial therapy.


Rhythms and periodicity in health and disease.

Biorhythms longer than the circadian that influence reactions of people and characterizes some diseases have not received much medical attention. The lay press describes cycles of 23, 28 and 33 days said to regulate moods, intellectual ability and efficiency, respectively. Whether or not three overlapping cycles actually regulate three different vague reactions may be questioned. Of interest, however, are rhythms of similar tempo which control mensis, cyclic changes in male hormones and a number of periodic diseases. Although reports of more than 2500 cases of periodic diseases have been published, physicians generally are skeptical on the subject. Incorrect diagnosis leads to unnecessary testing, surgical exploration and medication.


Electrothermal atomic absorption spectrometry of trace metals in biological fluids.

Electrothermal atomic absorption spectrometry has five major advantages for measurements of trace metals in biological materials, in comparison to measurements by conventional flame atomic absorption analysis: (1) Trace metal contamination is minimized by avoidance of preliminary chemical extractions and additions of reagents; (2) Sample volumes are small (1 to 50 mu1). The entire sample is vaporized in electrothermal atomization, whereas in most flame nebulization systems only a small fraction of the sample enters the flame; (3) Atoms are released in higher concentrations. In electrothermal atomization, the atom cloud is released into a relatively small volume of gas. In contrast, in flame atomization, the atom cloud is diluted by the high flow rate of gases and by expansion of gases during combustion; (4) Molecular recombination of atoms is retarded by the atmosphere of inert gas which restricts chemical reactions (e.g., oxidation). In contrast, in flame atomization, oxidation occurs very rapidly; and (5) By programmed increments in temperature, electrothermal atomization permits organic constituents to be pyrolyzed prior to vaporization and atomization of metals. Despite these advantages, electrothermal atomic absorption is particularly subject to interferences and sources of imprecision which necessitate critical evaluations in the prospective analyst's laboratory before an electrothermal method can be confidently employed for diagnostic measurements of a specific trace metal in body fluids.


Somatomedin and the regulation of skeletal growth.

Somatomedin is a polypeptide(s) which "mediates" the actions of growth hormone. This pituitary dependent hormone was previously called "sulfation factor," a term derived from the bioassay technique which measures the incorporation of radioactive sulfate into cartilage glycosaminoglycans. Somatomedin has a more general effect upon cartilage; it is necessary for the cell multiplication and cartilage maturation which results in the growth of long bones. Somatomedin is not found in the plasma in growth hormone deficiency and appears following growth hormone administration. A genetic defect in somatomedin synthesis has been identified in the Laron's dwarf. Growth hormone is present in excess in the plasma and growth hormone administration does not stimulate somatomedin synthesis in this syndrome. Insufficient data are available to delineate the role for somatomedin in other growth disturbances. It has been demonstrated that glucocorticoid hormones interfere with both somatomedin synthesis and its biological activity. Purification of somatomedins in plasma has been achieved and radioreceptor or radioimmunoassays will be available in the future for study of growth problems in children.


Acute bacterial arthritis.

Analysis of 29 consecutive cases of acute bacterial arthritis requiring hospitalization reveals the importance of local and systemic immunologic states or conditions which reduce the efficacy of immune responses in the establishment of joint infections. The complications of trauma and surgery are considered as interfering with the normal local immune response.


Tumors of striated muscle.

Three benign forms of muscle tumors and three variants of rhabdomyosarcoma are discussed from the point of view of their histology and behabior. Recent combined modality therapy has significantly improved the prognosis in at least the embryonal form of rhabdomyosarcoma.


Microbial utilization of Pinus radiata bark.

A screening program using suspensions of ground bark in mineral salts media, or extracts prepared from ground bark by treating with hot water, sulfuric acid, ammonium hydroxide, or sodium hydroxide, yielded more  than 200 pure cultures of fungi, yeasts, and bacteria. Only 38 of these have good growth on liquid bark media. All were filamentous fungi, although many bacteria and yeasts were among the cultures that failed to give appreciable growth. Species of Penicillium, Scopulariopsis, Aspergillus, Trichoderma, Cladosporium, and Fusarium were among the most actively growing cultures. Cell biomass yields, as measured by cell nitrogen determination, were too low for  economic production of single cell protein.


D-Glucose isomerase: constitutive and catabolite repression-resistant mutants of Streptomyces phaeochromogenes.

As in other Streptomyces species, the enzymatic conversion of D-glucose to D-fructose is carried out in Streptomyces phaeochromogenes NRRL B-3559 by the inducible enzyme, D-xylose keto isomerase (EC 5.3.1.5). Mutants of this microorganism were selected for their ability to grow on D-lyxose (2-epimer of D-xlose). As a result of the mutational event, the microorganism constitutively produced D-xylose isomerase. As in the parent strain, the constitutive formation of the isomerase was repressed by D-glucose. The fact that this mutant was unable to grow in low D-xylose concentrations in the presence of the D-glucose analogue, 3-O-methylglucose, permitted the isolation of D-xylose isomerase constitutive mutants which were insensitive to D-glucose repression.


Treatment of Salmonella-Arizona-infected turtle eggs with terramycin and chloromycetin by the temperature-differential egg dip method.

Attempts to eliminate Salmonella and Arizona infection from newly hatched turtles were made by dipping fresh eggs in cold solutions of Terramycin and Chloromycetin at 1,000, 1,200, 1,500 and 2,000 mug per ml for either 10, 20, or 30 min. Control groups consisted of hatchings produced from nondipped eggs or eggs dipped in chilled water. In two of the four experiments 5 to 10 eggs were blended on days 15, 30, and 45 post antibiotic dip treatment.  Twenty-five to 60 hatchlings from each control or experimental dip groups were held in containers and the water was tested (excretion method) for Salmonella and Arizona every 15 or 30 days for 180 to 210 days after hatching. Representative turtles were homogenized (blending method) to determine if systemic infections were present. All specimens tested were enriched in tetrathionate and selenite cystine broth. Nondipped eggs and water-dipped eggs routinely showed Salmonella and Arizona present in egg homogenate and hatchlings emerging from these eggs excreted these pathogens. Terramycin- and Chloromycetin-dipped eggs were uniformly negative for these pathogens, only if fresh eggs were dipped. Bacteriological assay of container water and whole turtle homogenate from hatchlings were negative for Salmonella and Arizona if eggs were dipped in 1,000 mug of Terramycin early in the egg laying season or if eggs were dipped in 1,500 or 2,000 mug of Terramycin per ml late in the egg laying season. The results of temperature-differential egg dip studies suggest that this is a feasible and promising method by which to eradicate Salmonella and Arizona from the turtle.


Prodiginine (prodigiosin-like) pigments from Streptoverticillium rubrireticuli, an organism that causes pink staining of polyvinyl chloride.

Red pigments were extracted from Streptoverticillium rubrireticuli strain 100-19, an organism frequently incriminated in pink staining of polyvinyl chloride. These pigments were identified as undecylprodiginine and butylcycloheptylprodiginine.


Identification of a component of crystalline egg albumin bactericidal for thermophilic aerobic sporeformers.

During an investigation of the effect of basic and acidic proteins on the growth of thermophilic aerobic sporeformers, crystalline egg albumin was found to be strongly bactericidal. This finding was uncharacteristic of acidic proteins. The bactericidal fraction was heat sensitive and separated from the non-bactericidal albumin fraction during gel filtration on Sephadex G-75. Cells of Micrococcus lysodeikticus and Bacillus stearothermophilus were lysed rapidly by the bactericidal component, leading to its tentative identification as lysozyme. The bactericidal substance possessed an electrophoretic mobility on polyacrylamide gel containing sodium dodecyl sulfate identical to that of crystalline egg white lysozyme. Users of crystalline egg albumin are cautioned that commerical preparations may be contaminated with lysozyme. Destruction of the thermophilic aerobes by lysozyme should be considered when performing counts on egg products.


Interaction between aflatoxicosis and a natural infection of chickens with Salmonella.

Broiler chicks with a natural congenital infection of Salmonella worthington required a lower concentration of dietary aflatoxin (0.625 mug/g) to depress growth than uninfected chicks (2.50 mug/g).


Utilization of brewery spent grain liquor by Aspergillus niger.

Aspergillus niger was found capable of rapidly converting about 97% of the sugar from brewery spent grain liquor to fungal mass. The yield of dry mycelium, based on the sugar consumed, was approximately 57%. This fungus produced 1.10% titratable acid calculated as citric acid and reduced the biochemical oxygen demand by 96%.


Toxic epidermal necrolysis. Rapid differentiation between staphylococcal- and drug-induced disease.

Based on the difference in the level of epidermal split, staphylococcal-induced toxic epidermal necrolysis (TEN) can be rapidly differentiated from drug-induced TEN. The microscopic pathologic findings of the staphylococcal-induced disease shows epidermal cleavage high in the malpighian layer, while the nonstaphylococcal-induced disease shows a subepidermal split. Rapid differentiation is accomplished by histologically examining a frozen section of peeled skin obtained from a fresh lesion of TEN and by performing a Tzanck preparation on the denuded base. In order to illustrate these techniques, we present the cases of two adult patients with TEN; in one the disease was staphylococcal-induced while in the other it was drug-induced.


Mechlorethamine in psoriasis. Further attempts to induce immunological tolerance.

Further attempts to induce immunological tolerance in 29 psoriatic patients treated topically with mechlorethamine hydrochloride have not been successful using the intravenous route. The rate of sensitization achieved (65%) is not substantially different from the rate for those patients who had no attempt to induce tolerance (55.5%).


Percutaneous penetration following use of hair dyes.

We assess the percutaneous penetration potential of two commercially distributed semipermanent hair dyes. Utilizing several solvent systems in conjunction with thin-layer chromatography (TLC), we found that the commercial formulations contained at least nine component chemicals. Eight adult volunteers had their hair dyed with these preparations and 24-hour urine specimens were collected daily for five days. The urine was lyophilized and extracted with diethyl ether under acid and alkaline conditions. The TLC of urine from four of the eight subjects, taken from one to four days after dyeing the hair, disclosed a purple spot. This spot, though not identified, was the same with both dye preparations. It is likely that these hair dyes not uncommonly penetrate the skin.


Multilating granuloma inguinale.

Granuloma inguinale is an uncommon infectious granulomatous disease of the inguinale area that can insidiously engulf and mutilate tissue. The reported case of granuloma inguinale demonstrated the painless progression of the disease to destroy most penile, scrotal, and inguinal tissue and also showed the subsequent satisfactory therapeutic result with antibiotic treatment. Light microscopy of plastic-embedded thin-sectioned tissue specimens allowed clear demonstration of the Donovan bodies and may be valuable in diagnosis.


Cutaneous manifestations of lightning injury.

This report calls attention to a bizarre, almost pathognomonic, cutaneous feature of lightning injury. It has been variously described as "lightning prints," "arborescent" burns, or "feathering," and has long been neglected in the dermatologic literature. Its recognition may be lifesaving in the unaccompanied comatose patient and is important because even delayed resuscitation of lightning victims can be very successful.


Prurigo nodularis. Histological and electron microscopical study.

We describe a typical case of prurigo nodularis, of 15 years' duration, in a middle-aged woman. Histological and electron microscopical examination of the skin lesions revealed distinct changes in the nerve tissue. There were groups of thickened nerve fibers that formed nodules with numerous Schwann cells. Some of the nerve bundles extended to the dermoepidermal junction. Electron microscopy showed very obvious lesions in the Schwann cells and axons. In the Schwann cells there was a lucent cytoplasm with few mitochondria, an absence of endoplasmic reticulum and a few irregular, membrane-bound vacuoles. While the mesaxons all appeared normal, the axons varied greatly in diameter; the small ones appeared normal and contained neurofibrils and neurotubules, whereas the large onew were empty. Every Schwann cell encircled a large number of axons. It may be assumed that the axon swelling is a nonspecific reaction to injury.


Umbilical metastasis from carcinoma of the stomach. Sister Joseph's nodule.

A patient had umbilical metastasis from a carcinoma of the stomach. The umbilical lesion (Sister Joseph's nodule) is a characteristic sign of metastatic tumor, and the diagnosis was confirmed by biopsy. The cutaneous metastasis was associated with visceral metastases.


Bowen disease associated with porokeratosis of Mibelli.

A 73-year-old woman developed Bowen precancerous dermatosis in an area of porokeratosis of Mibelli on her leg. This is the fourth reported case of Bowen disease arising from porokeratosis of Mibelli. The recent literature indicates that porokeratosis of Mibelli may be due to an abnormal clone of cells, predisposing affected individuals to development of malignant neoplasms over the involved areas.


Anonychia with ectrodactyly.

A patient had congenital absence of thumb nails with associated absence of the distal phalanges of the thumbs. We reveiw the pertinent literature.


Pemphigus involving the eyes.

Two persons with pemphigus vulgaris involving the eyes were studied. In one case, in vivo-fixed intercellular deposition of IgG was demonstrated in a specimen from the conjunctiva.


Ionizing radiation therapy in dermatology. Current use in the United States and Canada.

A comprehensive survey of the Task Force on Ionizing Radiation of the National Program for Dermatology was answered by 2,444 dermatologists in the United States and Canada (53.6% of 4,560 questionnaires). Computer analysis of the data showed that 55.5% of dermatologic offices are equipped with superficial x-ray machines and/or grenz ray units and that 44.3% of dermatologists use superficial x-ray or grenz rays regularly. Most respondents (65.8%) favor increased practical instruction in radiotherapy in training programs. A majority (63.4%) want examinations in radiation therapy by the American Board of Dermatology continued or increased. Data dealing with training in radiation therapy, reasons for non-utilization, alternate care, radiation safety, and economic considerations are presented in detail. Common indications for superficial x-ray therapy and grenz ray therapy are listed in order of frequency and percentage of use.


Treatment of mycosis fungoides with topical nitrosourea compounds: Further studies.

Twenty-six patients with mycosis fungoides were treated topically with three nitrosourea compounds: carmustine (BCNU), lomustine (CCNU), and 1-methyl-1-nitrosourea. A high percentage experienced good to excellent results. Remissions following treatment of individual lesions varied from one month to at least three years. Remissions following total body surface treatment varied from two weeks to at least four months. Two of 13 patients treated over the entire body suffered temporary bone marrow depression, indluding one with severe pancytopenia. This toxic effect was attributed to lomustine and was not seen in patients treated with carmustine alone. Thirteen patients highly allergic to mechlorethamine hydrochloride showed no cross-sensitivity to nitrosourea compounds. A primary irritant dermatitis occurred in about one half of the patients and telangiectasia in two. Two patients developed hypersensitivity to nitrosourea compounds. Carmustine is the preferred nitrosourea compound for topical therapy of mycosis fungoides.


Apparently normal skin in lepromatous leprosy: histopathological findings.

Biopsy specimens of apparently uninvolved skin from 34 patients with lepromatous leprosy were studied histologically. Bacilli were found in 30 of 31 specimens from clinically polar or near-polar lepromatous patients but not in the three from nonpolar patients. A predominantly perivascular distribution of infiltrate and bacilli is consistent with a hematogenous spread of infection. Subclinical, diffuse lepromatous leprosy is found in patients with nodular lesions and may precede the development of nodules. Study of apparently uninvolved skin may be helpful in classifying patients, in interpreting immunologic responses, and in elucidating the natural history of the illness.


Long-term intramuscular administration of triamcinolone acetonide. Effect on the hypothalamic-pituitary-adrenal axis.

Five patients received intramuscular injections of triamcinolone acetonide for periods ranging from five months to three years. Metyrapone tartrate testing was used to assess the function of the hypothalamic-pituitary-adrenal (HPA) axis during, after, and, in one case, before the drug therapy. The HPA axis function was found to be suppressed during the period of treatment and up to ten months after cessation of therapy. Lens opacities appeared in two of the five patients while they were receiving triamcinolone acetonide. Results of this study indicate that patients to whom triamcinolone acetonide has been administered should be given supportive doses of corticosteroids during stressful situations (eg, major surgery). They should also receive ophthalmologic examinations every three to six months while they are receiving the medication.


Pseudomelanoma: recurrent melanocytic nevus following partial surgical removal.

Histological markers enable the correct diagnosis of a pigmented lesion that histologically resembles a superficial spreading malignant melanoma and yet behaves in a wholly benign way. This pseudomelanoma occurs in young adults within a few weeks following partial surgical-shave excision of an intradermal melanocytic nevus.


Incontinentia pigmenti and defective neutrophil chemotaxis.

A child with incontinentia pigmenti and chronic erythema multiforme had recurrent bacterial infections. Greatly elevated serum IgE was found. In addition, the patient's neutrophils showed essentially no chemotaxis toward Staphylococcus aureus, Escherichia coli, or Pseudomonas aeruginosa in either patient or control serum. Neutrophil phagocytosis and killing function were normal.


Incontinentia pigmenti in a 21-year-old man.

We report a case of incontinentia pigmenti in a 21-year-old man. The rarity of this disease in men is emphaxized. Lesions in the reported patient have faded but are still easily discernible. Six other cases are reviewed.


Contact urticaria from cephalosporins.

A rare instance of contact-type urticaria resulting from an acquired sensitization to cephalosporin compounds in a chemist is reported. Patch tests elicited an immediate urticarial rather than a delayed contact-type response. Similar control tests to other antibiotics gave negative results. Although the patient's primary complaint was urticaria, prolonged or excessive contact with the cephalosporins caused coryza and dyspnea. Following transfer to another laboratory where the patient worked with other chemicals, there was no recurrence of symptoms.


Contact urticaria from cobalt chloride.

Cobalt chloride should be added to the ever growing list of contact urticants. This chemical is frequently used as a color indicator in provocative sweat testing. In this case, contact urticaria was probably nonimmunologic in origin. Since diphenhydramine and 48-80 (polymonine block this reaction to cobalt chloride, vasoactive amines are at least partially responsible for the urticaria.


Clinical application of regional lung function studies in infants and small children using 13N.

A technique is described for the investigation of regional lung function in infants and children using 13N and a gamma camera. Boluses of isotopic gas are inhaled and perfused while the lung fields are scanned. The child is lightly sedated and breathes normally throughout. Regional function is assessed in terms of the distribution of gas and blood, and the balance between ventilation and perfusion is estimated by comparing an index of the ventilation per unit volume of ventilated lung with that of perfused lung. The use of the method in 8 infants and children with different clinical problems is described to show its application. The method is capable of defining the severity and localization of any abnormality and may also be useful in showing normal function in suspect areas.


Urinary phenolic acid and alcohol excretion in the newborn.

Mean urinary excretion values of some phenolic acids and alcohols have been measured by gas chromatography in 44 neonates (36 males, 6 females) during the first 2 days and days 3-7 of life, and the effect of prematurity and jaundice assessed. 4-Hydroxy-3-methoxymandelic acid (VMA) output rises immediately after birth in term but not in preterm infants. A similar increase in homovanillic acid (HVA) output was restricted to nonjaundiced term babies; in nonjaundiced preterm babies there was a steady rise during the first week. The ratio of HVA to VMA output was higher in these infants than in adults, suggesting a more rapid turnover of dopamine than adrenaline and noradrenaline. Unlike adult values, both HVA and VMA excretion values were directly related to urine volume, an observation perhaps related to renal immaturity. An unexplained reduction in HVA output in jaundiced as opposed to nonjaundiced infants was observed in the first 2 days of life. The ratio of 4-hydroxy-3-methoxyphenylglycol to VMA was about the same as in the adult. p-Hydroxyphenyl-lactic acid (p-HPLA), because of its superior stability, was measured in preference to p-hydroxyphenylpyruvic acid as an index of tyrosyluria. An output of 1 mg p-HPLA/24 h is proposed as the upper limit of normal. Prematurity was associated with a significant rise in p-HPLA output. A dramatic increase in excretion of this acid was noted in jaundiced, compared with nonjaundiced infants, presumably a manifestation of general enzyme immaturity.


Peripheral gangrene in hypernatraemic dehydration of infancy.

Gangrene of the extremities complicating diarrhoea and severe hypernatraemic dehydration occurred in 6 infants. This is a rare complication of gastroenteritis, and its association with hypernatraemia does not seem to have previously been emphasized. The increased blood viscosity resulting from serum hyperosmolarity may have been responsible for the gangrene, and studies in our patients suggested that disseminated intravascular coagulation was present. In addition to fluid and electrolyte replacement, the infants were treated with heparin with some recovery of the affected extremities.


Do the right children have necropsies?. Analysis of selected determinants.

An analysis of the frequency of post-mortem examinations was conducted in the paediatric age group. Among the factors found to influence necropsy rates were (i) age at death, the frequency of necropsy decreasing with age; (ii) cause of death, necropsy frequency varying with major diagnostic groups; (iii) investigation conducted before death, necropsy frequency decreasing when the clinical picture was ill-defined; and (iv) place of death, necropsy being less frequent when death occurred outside hospital. These findings imply (a) that necropsy practices may be governed by habit and convenience as well as by desire to complete the clinical picture, and (b) that more equitable balances in such practices should be sought if there is to be improvement in the quality of mortality data.