[A report on studies on the child's adaptation to school and family environment after neoplastic disease]. The objective of this study was to learn the course of child's adaptation process to school and family environment following the neoplastic disease. The study also aimed select the environment and personality factors influencing adaptation effect. The study pertains to the child's personality and how it works at home and at school. It also tries to get to know the child's environment. 65 children of different social environment were studied. Motor functions of these children were limited as the result of tumour disease. Special scale of adaptation was prepared when the research was over. By means of this sale two groups of children were distinguished: those who were well adapted to the environment and those who were not. Statistical analysis was used to compare the groups on account of the following factors: health factors including: a kind of tumour, duration of the disease, prevalence of pain, manipulation and locomotive abilities, visibility of handicap; sociological factors including: age and sex of studied persons, the place of residence and education of parent's, living standard of the family, a degree of family participation in cultural life of the society, mother's attitude towards the insane child. These factors allow to formulate the following dependences: The more a level of the child's locomotive functions, following neoplastic disease approaches to the standard, the more favourable course takes the process of child's adaptation to the family and peers. If a neoplastic disease leaves permanent and always visible handicap then child's adaptation effect to the environment is not favourable. An active participation of the family in socially life is beneficial for regular adaptation of a child. Personality development as the result of participation in cultural life allows socially accepted defence mechanism to work in stress situations connected with the disease. Parent's rational attitude towards an insane child correlates with a beneficial child's adaptation to an environment. Other factors did not differentiate the two groups statistically. During clinicalontgenetic analysis concerning particular studied cases, 3 models of nonfunctional adaptation were distinguished: maladjustment of aggressive type prevailing among the children with permanent physical handicap coming of families characteristic for socially nonaccepted standard of behaviour; maladjustment of neurotic type prevailing among the children coming of compliant families whose adult members manifest neurotic vegetative reactions in difficult situations.(ABSTRACT TRUNCATED AT 400 WORDS)


Maternal age and Down syndrome: age-specific incidence rates by single-year intervals. Maternal age-specific risks of giving birth to a child with the Down syndrome (DS) are given by single-year age intervals. Such data are of value for more precise genetic counseling and in cost-benefit analyses of prenatal diagnosis programs. The data were obtained by linking records of children with DS at the British Columbia Health Surveillance Registry ( BCHSR ) to the appropriate birth registrations to derive maternal ages. The data related to 519 affected children out of a total of 354,880 live births in British Columbia between 1961 and 1970. The results, which are based on a high level of ascertainment, are compared to those reported in the only other published study relating to risks by single-year maternal age groupings, where completeness of ascertainment was estimated to be only 38%.


Influence of seminal additives and packaging systems on fertility of frozen bovine spermatozoa. The following recommendations and conclusions are based upon results of fertility and laboratory studies, and general trends from field investigations. Fertility results due to the addition of enzymes have been variable and contradictory. Flushing of ampules with dry, gaseous nitrogen prior to filling has become a routine practice in processing semen to be frozen. For control of Vibrio fetus and Leptospira pomona, 2,000 micrograms of streptomycin and 1,000 u polymyxin B sulfate should be added per milliliter of raw semen immediately after collection. The extender for initial dilution should contain the same concentration of antibiotics used for raw semen plus 500 u penicillin. The glycerol portion of the extender should contain 500 u penicillin per milliliter. The effect of addition of sugars on fertility has been highly variable. The primary beneficial effect is probably due to their cryoprotective properties. A myriad of concoctions have been added to bovine semen and the results have been highly variable with respect to both motility and fertility. Results of subsequent experiments have rarely proven that addition of exotic compounds or mixtures has been of value. Higher mean fertility was obtained with semen in straws in 14 of 21 comparisons with ampules. The differences in favor of straws ranged from 1.1 to 18.9; while the range in favor of ampules was .1 to 4.4 percentage points. Fertility obtained with pellets has ranged from minus 12.8 to plus 11.9 percentage points in nonreturn rate (NR), compared to the corresponding NR with semen in ampules. Fertility of semen in ampules was higher in five of eight studies. Fertility of pelleted semen has ranged from minus 9.5 to plus 6.0 percentage points compared with straws. Fertility was higher for semen in pellets in only one of five investigations. Pellets should not be used until the potential for pathogenic contamination and exchange of spermatozoa among pellets is eliminated. There is a potential for higher fertility with semen in straws as compared to other packaging systems, but the issue of liquid nitrogen (LN) entry and possible contamination of semen should be further investigated. In general, fertility obtained with semen frozen in the .25 ml straw has been equal to or higher than semen in larger packages. However, they cannot be unequivocally recommended due to other considerations. From laboratory studies, it appears that greater spermatozoan survival is obtained when semen frozen in straws is thawed in water at 35 C or above.(ABSTRACT TRUNCATED AT 400 WORDS)


Isolation and characterization of nuclei from Neurospora crassa. A procedure was developed for isolating nuclei from either the conidial or germinated conidial growth phase of Neurospora crassa. A frozen conidial suspension was lysed by passage through a French pressure cell, and the nuclei were freed from the broken cells by repeated homogenization in an Omni-Mixer. Pure nuclei were obtained from the crude nuclear fraction by density banding in a Ludox gradient. The final nuclear yield was 20 to 30%. The nuclei had a deoxyribonucleic acid (DNA):ribonucleic acid (RNA):protein ratio of 1:3.5:7 and were active in RNA synthesis. The nuclei, stained with the DNA stain 4,6-diamidino-2-phenylindole, appeared under fluorescence microscopy as bright blue spheres, 1 micron in diameter, essentially free from cytoplasmic attachments. Chromatin extracted from the nuclei in a 70 to 75% yield by dissociation with 2 M sodium chloride and 5 M urea had a DNA:RNA:protein ratio of 1:1.05:1.7. Chromatin reconstituted from this preparation exhibited a level of RNA polymerase template activity lower than that of pure Neurospora DNA, but the maximum level of reconstitution obtained was only 10%. Fractionation of Neurospora chromatin on hydroxylapatite separated the histones from the chromatin acidic proteins. The normal complement of histone proteins was present in both the reconstituted and dissociated chromatin preparations. The acidic protein fraction exhibited a variety of bands on sodium dodecyl sulfate gel electrophoresis ranging in molecular weight from 15,000 to 70,000. The gel pattern was much more complex for total dissociated chromatin than for reconstituted chromatin.


Isolation and characterization of nondefective transducing lambda bacteriophages carrying fla genes of Escherichia coli K-12. In Escherichia coli K-12, 11 fla genes and a hag gene are located between his and uvrC, making two clusters at map positions 42.5 and 43.0 min. Nondefective transducing lambda phages for these genes were isolated. Low-frequency-transducing donors were constructed starting from lysogens of lambda cI857 in which the prophage is integrated at a secondary attachment site at 44 min on the E. coli map. Two strategies were used to delete the region between the prophage and the fla genes. Deletion mutants of the supD locus between fla and the prophage were isolated by selecting for loss of Su1+, an allele of supD. A strain with a deletion starting within the prophage and ending at a position close to the fla genes was isolated from heat-resistant derivatives of the lysogen. A lysogen of lambda b2 was then constructed in which the prophage had integrated at the site of the defective prophage by means of recombination with residual lambda deoxyribonucleic acid. From low-frequency-transducing lysate of the donor strains thus constructed, either directly or in combination with a procedure that extends the loci transduced, various lambda pfla's were isolated. lambda pflaL1 carries all nine fla genes at 43 min, and lambda pflaH14 carries hag and two fla genes at 42.5 min.


Aorticopulmonary window associated with tetralogy of Fallot. Report of one case and review of the literature. A case of aorticopulmonary window associated with tetralogy of Fallot is reported with its clinical, hemodynamic, angiocardiographic, surgical, and necropsy findings. The difficulty in diagnosing a tetralogy of Fallot in the presence of a large aorticopulmonary shunt is emphasized. It is also noted that the only means of discovering the infundibular stenosis of the right ventricle is by angiocardiographic study of the right ventricular outflow tract. The difficulty in distinguishing truncus arteriosus from an aorticopulmonary window coexisting with a ventricular septal defect is discussed, and it is pointed out that the only means of differentiating these two anomalies is the angiocardiographic finding of two sigmoid valves. An embryological hypothesis concerning the pathogenesis of this association is also discussed.


In vitro assays of the efficacy of antimicrobial agents in controlling Chlamydia trachomatis propagation. The antimicrobial susceptibility of a low-laboratory-passage, slow-growing, genital Chlamydia trachomatis strain was studied by five different procedures with the use of McCoy cells pretreated with 5-iodo-2-deoxyuridine. The effects of antimicrobial agents when added to cultures on day 0 or day 2 after inoculation with C. trachomatis and the effects of washing and reincubating treated cultures in antimicrobial-free media were investigated. Tetracycline and erythromycin inhibited C. trachomatis growth at concentrations attainable in human serum, although their actions were reversible and significantly higher concentrations were needed to "cure" 48-h infected cultures. On a weight basis, spectinomycin was relatively ineffective in inhibiting C. trachomatis growth. The minimal inhibitory concentration of penicillin measured by our assay procedures was higher than that reported by other investigators. The five assay procedures used in this study were reproducible, and our results indicate that we can obtain more pertinent information about the efficacy of an antimicrobial agent in controlling C. trachomatis growth by using a combination of these assays than by simple minimal inhibitory concentration determinations, as had been previously described by other investigators. In addition, we failed to demonstrate changes in tetracycline susceptibility of C. trachomatis isolates from two patients who had received tetracycline therapy.


Thymocyte-macrophage roles in autoimmune diseases. Thymocytes and macrophages can be involved in the generation and perpetuation of autoimmune disorders in many ways. Evidence continues to mount for their active role. Although a significant association seems likely, one should remember that B cells and complement-directed granulocyte destruction may be equally if not more important. Furthermore, a combination of processes is not precluded by any fundamental biological law. Appropriate and effective therapy requires acceptance of this concept and further studies should attempt to define the interrelationships of these processes and focus upon methodology to determine their relative roles in a given situation.


Low back pain in the primary care setting. A study of the natural presentation, course, and treatment of low back pain in the primary care setting was undertaken. One hundred and forty-four charts listing low back pain as a problem were reviewed at a family practice center for a period of one year. A profile of the patient evaluated by the primary care physician emerged, revealing a high incidence of associated weight problems (70 percent), psychologic problems (33 percent), and hypertension (19 percent). The rate of actual or suspected disc disease (1.4 percent) was much lower than that reported in series from referral centers. This study of low back pain in the primary care setting illustrates the usefulness of outpatient study in defining a problem category, recognizing disease as a symptom complex, suggesting modalities of treatment, and designing a curriculum for the primary care physician.


Experimental evaluation of anterior chamber lenses fixated with Dacron. Four new designs for anterior chamber intraocular lenses using Dacron fibers to achieve fixation were studied. After implantation in rabbit eyes, no lens dislocation occurred. Postmortem examination found firm Dacron adherence to iris tissue in all eyes. Clinically, no difference was noted in the amount of inflammation in eyes receiving a lens with or without Dacron. One new lens design was found to have substantial advantages over the other three models. However, a high incidence of corneal edema was found following insertion of all four experimental lenses.


The skin in Parkinson's disease.

The skin in Parkinson's disease. The characteristic oily skin in individuals with parkinsonism has long been observed by clinicians. The oiliness seems to be associated with periods when the disease is most active. This seborrhea has been observed particularly in post-encephalitic parkinsonism, as well as in idiopathic paralysis agitans. It also occurs in phenothiazine-induced parkinsonism.


Lumbar discography. Its value in diagnosis and treatment of lumbar disc lesions. Lumbar discography has been performed in over 1500 patients at St. Luke's Episcopal Hospital, and a report concerning 683 cases has been previously published. The authors review an additional 199 cases, finding that decision making was influenced by discography in 155 cases (78%). A positive discogram was surgically confirmed in 111 patients (56%). In 14(7%) the disc was found to be normal at surgery. One hundred six patients (53%) had positive discograms with negative or equivocal myelogram. In 36 patients with a positive myelogram, the discogram was corroborative, although most patients with positive myelograms did not have discography. Sixty-nine patients (35%) did not have surgery.


A more precise diagnosis for low-back pain. Five common syndromes productive of low-back and leg pain are presented as the basis for clinical investigation to arrive at an early and definite diagnosis in low-back pain problems. The five are posterior facet syndromes, sacroiliac-piriformis syndrome, herniated nucleus pulposus, central spinal stenosis, and nerve entrapment in the lateral recess. All may present with a common symptom complex of low-back, buttock, trochanteric, and posterior thigh pain. Specific details from history, physical, and radiographic examination may allow separation of these entities, but proof of diagnosis requires data from response to treatment, facet and nerve injection, myelography, discography, and computerized tomography (CT) scan.


Biomechanical testing as an aid to decision making in low-back pain patients. Frequently, the diagnosis of disease of the low back is a difficult matter due to the multitude of factors affecting the patient's symptoms. In this report an attempt is made to use biomechanical testing to objectify certain aspects of the diagnostic process. Our philosophy is that a biomechanical assessment is one of the disciplines that should be brought to bear on the low-back pain patient. A group of biomechanical tests has been developed by adding quantitative measurement techniques to certain standard clinical maneuvers: muscle testing, range of motion testing, and straight leg raising testing. Moire fringe topography is employed for studying posture. Results of application of these techniques to 117 patients and 10 controls indicate potential utility in the method for epidemiologic and clinical research.


A lumbar disc surgery predictive score card. A retrospective evaluation. This report assessed the relationship between patient selection and the outcome of lumbar disc surgery. Patient selecting is assessed by means of a predictive scoring technique previously reported. Because of the dynamic and ever-changing status of the lumbar spine with the passage of time, patient selectivity seems to be less critical after 5 years. For the first 5 years, however, the outcome of lumbar disc surgery seems to be directly related to patient selectivity.


The role of laminectomy, facet rhizotomy, and epidural steroids. A retrospective review of the treatment of chronic back and extremity pain is presented. Laminectomy is most effective for pain secondary to direct compression of the neural elements. Treatment of pseudoradicular pain requires identification of the source of pain input. Facet rhizotomy is specific for pain arising from the posterior primary rami. Pain input from the recurrent sinuvertebral nerve requires epidural injection.


Epidemiologic and clinical studies of long-term prognosis of low-back pain and sciatica. In order to justify the selection of therapeutic measures for low-back pain and sciatica, epidemiologic and clinical studies were performed of the natural histories or the long-term prognosis of those symptoms. The main conclusions drawn in relation to decision making are as follows: low-back pain is more frequent than sciatica or intermittent claudication, but the latter is more disabling; acute attacks are generally more disabling than chronic pain, and the frequency may be more closely related to poor prognosis than the duration; radiologic findings are of little value in differentiating the incidence and degree of the symptoms during life; myelographic or peridurographic abnormalities do not always suggest poor prognosis.


Reliability and reproducibility of clinical findings in low-back pain. The data obtained from the history and examination of patients with low-back pain and sciatica have been subjected to an observer variation analysis. Redesign of the proformata resulted in a reduction of the observer error from 33% to 18% for the history, but no improvement in the finding of a 30% observer error in the examination. The clinician has a simple choice: if he wishes to obtain a large amount of detailed information he must realize that much of it will be unreliable; if he is prepared to limit the information then he will increase its reliability.


Mitochondrial ATPase.

Mitochondrial ATPase. Considerable progress has been made in recent years in our understanding of the phosphorylating apparatus in mitochondria, chloroplasts, and bacteria. It has become clear that the structure and the function of the ATP synthesizing apparatus in these widely divergent organisms is similar if not virtually identical. The subunit composition of F1, its molecular architecture, the location and function of substrate binding sites, as well as putative control sites, understanding of the component parts of the oligomycin-sensitive ATPase complex, and the role of these components in the function of the complex all are under active investigation in many laboratories. The developing information and the new insights provided have begun to permit experimental approaches, at the molecular level, to the mode of action of the ATPase in electron-transport-coupled ATP synthesis.


Four cases of pregnancy with low estrogen production due to placental enzymatic deficiency. 4 cases of normal pregnancies associated with low estriol excretion and resulting in healthy infants are described, in which by in vitro studies on the placentas a steroid 3-sulfatase deficiency was found in 3 cases and a lack of activity of the aromatizing system was found in the 4th case. A reduced activity of the aromatizing system was also shown in one of the cases affected by steroid 3-sulfatase defect. The placental 3 beta-hydroxysteroid dehydrogenase, delta 4,5-isomerase system was measured in 3 cases and results were normal. The repetition of the specific lack of steroid 3-sulfatase was observed in 2 successive pregnancies of the same patient (case T.C.). It is interesting to note that, at variance with other reports, this patient delivered 2 fetuses, both female.


Rectus hematoma: a clinical diagnosis confirmed by ultrasound. In 2 women the diagnosis of rectus hematoma could be established by ultrasound and the further clinical course. Echoscopy is stressed as a technique which is helpful to the patient and the clinician in avoiding unnecessary operations.


Enlarged left atrium causing possible false positive echocardiographic diagnosis of pericardial effusion. Echocardiographic examination in a patient with IHSS, mitral insufficiency, and cardiomegaly suggested the possibility of a pericardial effusion. Echocardiographic M-mode scanning documented the continuity of the space posterior to the pericardium with an enlarged left atrium. Subsequent cineangiographic studies confirmed an enlarged left atrium and the absence of pericardial effusion. Left atrial enlargement may cause a false positive echocardiographic diagnosis of pericardial effusion.


Oxalate, calcium uptake and ATPase activity of sarcoplasmic reticulum vesicles. Ca++-uptake and Mg++-Ca++-dependent ATPase activity of skeletal muscle sarcoplasmic reticulum vesicles were reciprocally affected by increasing the oxalate concentration from 0 to 4 mM. At 0-0.1 mM oxalate approximately 17% of the calcium was removed by the vesicles from the medium while the ATPase activity was maximal (approximately 0.66 mumoles Pi mg-1 protein min-1). Between 0.1 to 0.2 mM oxalate the ATPase activity was reduced to one-fifth but the uptake rose sharply and 100% of the 45Ca++ was removed from the medium. The uptake was maintained at this level at oxalate concentrations greater than 0.4 mM but the ATPase activity remained inhibited. The kinetics of Ca++-uptake and ATPase activity were also differentially affected by oxalate. In the presence of oxalate, ruthenium red had only a very slight inhibitory effect on the calcium uptake. Addition of 0.1 mM EGTA removed 80% of the Ca++ from preloaded vesicles within 10 min. The formation of insoluble Ca-oxalate salt on the surface of the vesicle is suggested by these results. Calculations based on the Ksp of the calcium oxalate salt are presented to show its formation and the possible speciation of a Ca-oxalate complex which may affect the Ca++-uptake and ATPase activity.


The clinical use and value of non-invasive diagnostic techniques in peripheral arterial occlusive disease. The clinician confronted with the need for the objective evaluation of peripheral vascular problem has a variety of simple noninvasive techniques available which can prove highly useful in the early detection of occlusive disease, its functional assessment and in the selection of those problems which requires further definitive evaluation by angiographic methods. The non-invasive techniques offer the additional advantage of applicability to the serial evaluation of patients before and after surgical or medical therapy.


Platelet lysis and aggregation in shear fields. A rotational viscometer was used to study the effects of shear stress on platelets in human platelet-rich plasma (PRP). For 5-min exposure times, shear stresses above 160 dynes/cm2 induced platelet lysis (as determined by release of platelet lactic dehydrogenase). For 30-s exposure times, shear stresses greater than 600 dynes/cm2 were required to induce platelet lysis. The platelet counts of sheared PRP were decreased to as low as one-fifth the original count due largely to shear-induced aggregation. The count is a minimum at intermediate stress levels (200-400 dynes/cm2). Higher stresses induce disaggregation as well as lysis. The diminution in the counts was partially reversed in 2 h incubation after cessation of shearing. Experiments were carried out with three different viscometer configurations so that the shear stress and the solid surface area access could be varied independently. Surface access was not a significant variable in the conditions of the experiments. Thus aggregation and lysis may be induced by stress effects alone as well as by solid surface effects. The results also show that the response of platelets to shear stress is strongly dependent on exposure time. Platelets are much less resistant to shear stress than red cells for relatively long exposure times. However, the converse is true for very short exposure times.


Clinical studies on peripheral hemodynamics in arterial hypertension. Digital blood pressure and flow were measured in both normal subjects and patients with essential hypertension by means of the apparatus which have been recently devised, and peripheral vascular resistance was calculated according to Poiseuille's law in order to compare them. 1. Digital blood pressure is higher, the digital blood flow is less and the peripheral vascular resistance is stronger in patients with essential hypertension than in normotensives. 2. Hypertensive patients with ischemic heart disease, calcification of the aortic arch, left ventricular hypertrophy and heart size greater than 53% of the cardio-thoracic ratio were higher in the digital pressure, less in the digital flow, and stronger in the peripheral vascular resistance than those without these findings of the heart and the aortic arch. 3. The curve of relationship obtained from many cases of both normotensives and hypertensives between the digital blood flow and the peripheral vascular resistance forms a hyperbola. 4. Peripheral vascular resistance in both normotensives and hypertensives increased gradually with age up to 50-60 years, and decreased slightly thereafter. The resistance was stronger in patients with essential hypertension than in normotensives through all ages.


Muscle structure and function in the goose, quail, pheasant, guinea hen, and chicken. 1. Metabolic functions, fiber composition and, in some cases, mitochondrial morphology have been investigated in the pectoralis major and sartorius of the goose, quail, pheasant, guinea-hen, broiler chicken and laying hen. 2. In the pectoralis only two types of fibers, red and white twitch fibers, are found in all birds studied except in the quail, where a third twitch fiber also occurs. Red fibers form the main part in the quail and goose, white fibers in the rest. In the sartorius at least three types of fibers, two twitch and one tonus are found in all birds except in the guinea-hen where only two fibers can be found. 3. The metabolic pattern of the muscles, based on determination of specific activities of metabolic key enzymes, varies greatly among the birds. Three groups can be discerned from the ratio between aerobic and anaerobic activities or between fatty acid oxidation and carbohydrate metabolism. The metabolic patterns are reflected in the fiber combinations of the muscles. 4. The size and number of the mitochondria vary among different animals and different fiber types. The metabolism of red and white fibers is discussed.


A comparative study of brain Ca2+-ATPases. 1. Particulate brain ATPases from various vertebrates were optimally activated by Ca2+, Mg2+ or Mn2+. 2. Specific enzyme activity with AT32P as substrate was low in lower vertebrates and increased on the evolutionary scale. 3. The properties of the brain ATPases suggested that most of the activity was associated with plasma membrane ecto-ATPase.


Changes in the specific activity of N-acetyl-beta-D-hexosaminidase in the rat epididymis with age. The specific activity of the lysosomal enzyme N-acetyl-beta-D-hexosaminidase was determined in the caput and cauda of the epididymis of rats as a function of age. The activity peaks at six weeks of age in both parts of the epididymis but is higher in the cauda. The results indicate a relationship between changes occurring in sperm in the epididymis and the lysosomal enzymes.


Effects of high hydrostatic pressures on the activity of the membrane ATPases of some organs implicated in hydromineral regulation. 1. The effects of high hydrostatic pressures have been studied on the ATPases extracted from tissues implicated in iono- and osmoregulation of a frog and various teleostean fishes. Pressure affects enzyme activity in the same qualitative way, whatever the tissue and the species considered. 2. The Mg2+ ATPase activity is maximally enhanced at 250 kg/cm2. A slight inhibition is observed at higher pressures up to 1000 kg/cm2. 3. The (Na+ + K+)ATPase is little affected by low pressures but strongly inhibited at 500 kg/cm2 and more. 4. The results are discussed in terms of pressure effects on the recently described protein-lipid interaction linked to ATPase activity.


Control of ciliary activity in paramecium--IV. Ca2+ modification of Mg2+ dependent dynein ATPase activity. 1. Dynein proteins were solubilized from demembranated cilia of Paramecium by extraction at high ionic strength. 2. Mg2+-dependent ATPase (EC 3.6.1.3) activity of crude dynein extracts was inhibited by micromolar concentrations of Ca2+ ions. 3. Sepharose 4B chromatography of the crude extracts yields three dynein fractions. The major fraction contains a single protein and is insensitive to Ca2+ ions. Two other fractions, both heterogeneous in composition, show opposing Ca2+ ion sensitivity expressed as a Ca2+ dependent alteration in MgATP2- dependent ATPase activity. The Ca2+ ion sensitive forms show altered electrophoretic mobility on native polyacrylamide gels in the presence and absence of Ca2+ ions. 4. The data provides evidence for a Ca2+ ion dependent concomitant alteration in both molecular form and hydrolytic activity of the dyneins. The results are discussed in terms of a possible molecular mechanism for Ca ion regulation of ciliary activity in terms of the sliding microtubule model.


Study of cortical spindles during sleep in the rat. A systematic analysis of the dorsally accessible cortical areas has been undertaken so as to study the space-time distribution, the intrinsic characteristics and the physiological appearance modalities of cortical spindles in the rat. After falling asleep, the animal presents anterior spindles of which the number, duration and amplitude increase as sleep with slow waves deepens. These spindles are fully developed during intermediate state which precedes and follows paradoxical sleep, where they are associated with a theta rhythm in the hippocampus and the visual cortex. These spindles, at their maximum in anterior regions, lose intensity as one approaches the cerebellum. Uniquely during slow wave phase of sleep, the rat presents posterior spindles which are predominant in the occipital region, are less marked in parietal and cerebellar regions and disappear in the frontal cortex. Less frequent than anterior spindles, they are significantly distinguished by their lower amplitude, higher frequency and shorter duration.


Adenosine triphosphatase activities in Trypanosoma cruzi. 1. Subcellular fractions obtained from epimastigotes of Trypanosoma cruzi, disrupted by three different procedures, contained in addition to the already known Mg2+-activated adenosine triphosphatase (ATPase; E.C.3.6.1.4), a Ca2+-ATPase activity. 2. The Ca2+-ATPase (a) was activated by low concentrations of CaCl2 (apparent Ka, 80 microM); (b) had a Km for ATP of 0.6 mM (at 1 mM CaCl2, pH 8.0); (c) presented a broad pH curve (optimum 7.1-8.6); and (d) was insensitive to oligomycin concentrations which inhibited the Mg2+-ATPase present in the same preparations. 3. All attempts to find a (Na+-K+)-activated, ouabain-inhibited, ATPase have been unsuccessful, in spite of the fact that living epimastigoes of T. cruzi are able to concentrate K+ and exclude Na+ from the medium.


Solubilization and some properties of the Mg2+-activated adenosine triphosphatase from Trypanosoma cruzi. 1. Grinding of epimastigotes of Trypanosoma cruzi with glass powder in a mortar yielded a Mg2+-activated adenosine triphosphatase (ATPase) preparation which was highly sensitive to oligomycin. 2. Chloroform treatment of the particles resulted in the solubilization of an ATPase which was (a) activated by MgCl2; (b) slightly inhibited by CaCl2; (c) activated by sulphite and bisulphite; (d) had an optimum pH of 7.6; and (e) had a Km for ATP of 2.1 mM (in the presence of 4 mM MgCl2). 3. The solubilized enzyme was insensitive to oligomycin and leucinostatin, which inhibited the membrane-bound ATPase, though inhibited by efrapeptin and quercetin. 4. The results indicate that the chloroform-extracted enzyme is a soluble F1-ATPase similar to those isolated from mammalian mitochondria.


Purification and properties of two isoenzymes of beta-N-acetylhexosaminidase from Turbo cornutus. 1. beta-N-acetylhexosaminidase isoenzymes from the gastropod, T. cornutus, were purified and their properties studied. 2. The two isoenzymes, designated A and B were separated by DEAE-Sephadex column chromatography and further purified by CM-cellulose, Concanavalin-A-Sepharose-4B and Sephadex G-200 column chromatography. 3. beta-N-Acetylhexosaminidase A and B were purified 416 and 208 fold, with yields of 10.6 and 5.1%, respectively. 4. The two isoenzymes appear homogeneous on polyacrylamide gel electrophoresis, with the A form migrating faster towards the anode than the B form. 5. The purified isoenzymes are virtually free of all other common glycosidase contaminations. 6. The apparent molecular weight of both beta-N-acetylhexosaminidase A and B is about 100,000 when estimated with gel filtration column chromatography and the pH optimum for both is 4.0. 7. Both beta-N-acetylhexosaminidase isoenzyme activities are stimulated by Cl-, Br-, F-, I- and NO3-, and inhibited by Hg+, Ag+, Fe3+, N-acetylglucosamine and N-acetylgalactosamine. 8. The Km values of beta-N-acetylhexosaminidase A and B for the substrate p-nitrophenyl-beta-2-acetamide-2-deoxy-D-glucopyranoside were 2.9 and 3.2 mM, respectively.


Structural comparison of hexosaminidases in primates. 1. beta-Hexosaminidase (hex) structure was compared in various primates, using thin-layer isoelectric focusing on polyacrylamide gels and quantitative microcomplement fixation. 2. Isoelectric focusing revealed no intraspecies differences and similar interspecies patterns. 3. Hex A and B are evolving at a moderate, but equal, rate and in a manner consistent with accepted phylogenetic patterns. 4. Quantitative microcomplement fixation revealed a closer homology between human hex A and chimpanzee A or human hex B and chimpanzee hex B than between human hex A and human hex B.


[Chagas myocardiopathy. Presentation of a case]. 1. The first case of Chagasic Miocardiopathy with complete immunologic confirmation is described. 2. The clinical, radiological, and electrocardiographic basis of the case were analyzed. 3. The specificity and the sensibility to the different seroimmunologic reactions in the Chagasic Disease was discussed. 4. An emphasis is placed on the fact that Chagas illness is not a rare entity in the Mexican Republic. 5. We recommend that a campaign of serologic investigation is begin to discover the true frequency of this illness.


Effects of acute starvation on carbohydrate metabolism in rat salivary glands. 1. Effects of acute starvation on enzymes of carbohydrate metabolism were determined in rat submandibular and parotid glands. 2. Activities of glycolytic enzymes were high in submandibular gland, but those of pentose phosphate pathway and glycogen metabolism were high in parotid gland. 3. Enzyme activities were lowered by acute starvation. Refeeding the rats with solid diet restored the enzyme activities, but with liquid diet, only partial recoveries were found in submandibular gland.


Ca2+-activated adenosinetriphosphatase activity in the gills of freshwater-and seawater-adapted eels (Anguilla rostrata). 1. Ca2+ -activated ATPase activity was higher in the gills of freshwater acclimated eels than in the gills of seawater acclimated eels. 2. The properties of the enzyme and the amount of protein extracted were identical in freshwater and seawater acclimated eels.


Isoenzyme patterns of cultured Trypanosoma cruzi: changes after prolonged subculture. 1. The isoenzyme patterns of four soluble enzymes in seven stocks of T. cruzi were determined by electrophoresis. According to their patterns they could be classified into four sets. 2. The isoenzyme patterns of two stocks were influenced by the number of subcultures. 3. Five stocks from man are distinct from those derived from a silvatic reservoir. 4. Since the isoenzyme patterns of a stock isolated from a patient with acute disease were similar to those of a silvatic reservoir, its recent introduction into the domiciliary cycle is postulated.


ATPase stimulated by Na+ or K+ in gills of the freshwater mussel Anodonta. 1. Microsomal preparations from the gills of the freshwater mussel anodonta cygnea cellensis show Mg2+ -dependent Na+ - or K+ -stimulated ATPase activity, which is not inhibited by ouabain. 2. Na+ - or Ka+ -ATPase activity is decreased by Ca2+, acetylcholine, choline, and tetramethylammonium, but slightly increased by ethyl alcohol. 3. It is tentatively suggested that Na+ - or K+ -ATPase is involved in the mechanism of active monovalent cation uptake through the gills of freshwater mussels.


Pyrolytic carbon-coated Dacron grafts.

Pyrolytic carbon-coated Dacron grafts. A new pyrolytic carbon surface (ULTI) was tested on a loosely knitted dacron substrate in dogs. Patency was 97.5% as compared with a control of 33%. Physical properties of the dacron were not altered by the ULTI carbon deposition process. This modified pyrolytic carbon on a dacron substrate is a very promising vascular biomaterial for small vessel replacement.


Long-stay patients in the London Borough of Tower Hamlets. In September 1974 a study was made of all residents of the East London Borough of Tower Hamlets, aged 65 or more, who were known to have been receiving continuous medical and nursing care in hospital for more than a year. There were 91 geriatric and approximately 100 psychiatric patients, representing just under 1 per cent of the population over 65. Eighty geriatric and 15 psychiatric patients were studied in detail. Physical and mental incapacity were assessed on the basis of performance of practical tasks and simple tests of ability, and social incapacity from a study of social circumstances. Both geriatric and psychiatric patients showed extreme disability. Geriatric patients showed physical and intellectual incapacity, psychiatric patients intellectual incapacity. The commonest diagnosis among geriatric patients was dementia (70 per cent). Social factors, while unfavourable, did not in themselves account for prolonged hospital stay. The finding of only a very small number of long-stay patients handicapped by physical disability alone suggests that the majority of such patients are at home.


Enzyme typing of human hair roots.

Enzyme typing of human hair roots. Sufficient phosphoglucomutase activity was found to be present in plucked hair noses bearing either fragmentary or complete outer root sheaths to enable typing of individual roots by starch-gel electrophoresis. Hair roots collected by brushing were found to contain very little PGM activity. Other isoenzyme systems were detected in hair roots but in insufficient quantities to make typing feasible.


[Report of a cased of carcinoma of the hypopharynx successfully treated by immediate pharyngogastrostomy (author's transl)]. The treatment of carcinoma of the lower part of the pharynx and upper oesophagus presents many difficulties. One of the outstanding problems being that of repair of the defect after excision of the pharyngo-oesophageal portion of the alimentary tract. This paper describes an operation in which the mobilized stomach is transposed after blunt dissection of the oesophagus via a posterior mediastinal tunnel without thoracotomy to a position high in the neck, with anastomosis of the fundus to the pharynx at the level of vallecula. This type of oesophagectomy was first tried bei Turner 1936 for carcinoma of the thoracic oesophagus. The main advantage of this form of repair is that it can restore normal swallowing within a few days in this difficult clinical situation.


[The immunglobulin-content of human parotid saliva (author's transl)]. By means of radial immundiffusion, the content of IgA, IgG, IgM and IgE in 22 healthy persons was measured. The parotid saliva has been collected under standardized stimulation-conditions in 10 minutes-fractions during a time of 30 minutes. While IgM and IgE could not be found with this method, IgA and IgG were present in a concentration easy to be measured. For the two immunglobulins, a different and characteristical change in their concentration was found during stimulation. This difference can be explained by the different origin of the substances.


Some hormonal factors (hypophysectomy, castration and testosterone administration) modifying the course of "compensatory" muscle hypertrophy in the rat. 1. Maximum compensatory hypertrophy of the soleus and plantaris muscle in male rats is attained seven days after tenotomy of the gastrocnemius muscle (39% and 9% respectively). When tenotomy of the gastrocnemius was performed seven days ater hypophysectomy, hypertrophy in these two muscles was aproximately half that found in control animals. 2. After 81-day castration of young male rats the weight of the saleus and plantaris was reduced and hypertrophy following tenotomy of the gastrocneumius muscle did not develop. 3. Chronically castrated rats received testosterone two weeks prior to tenotomy of the gastrocnemius and a week during the muscle hypertrophy phase. Hypertrophy of the soleus in castrated rats which had received testosterone seven days after tenotomy of the gastrocnemius was 25% as compared with muscles of castrated animals. The corresponding value in the plantaris muscle was 10%. 4. These results indicate that even calf muscles of the rat, namely the soleus and plantaris muscles, are significantly affected by testosterone under these conditions, although it is not, as yet, clear whether its action is direct or indirect.


The effect of splenectomy on bone marrow haematopoiesis in mice. Splenectomy was performed in strain H mice. Erythrocyte macrocytosis and an increase in the reticulocyte, leucocyte and thrombocyte count were found in the peripheral blood of splenectomized animals; only the erythrocyte count fell in the first 3 weeks after splenectomy. Changes in the myelogram during the first weeks after splenectomy were characterized by an increase in the proportion of cells of the erythrocytic and lymphocytic series. The stem cell count in the bone marrow (determined after Till and McCulloch) was slightly elevated on the 8th day after splenectomy, but in subsequent weeks was rather lower than the control group values. Whatever the post-splenectomy interval at which bone marrow was taken from splenectomized mice, there was no significant difference in the transplantation effect of bone marrow cells on white and thrombocyte haematopoiesis. Bone marrow transplantation was found  have a stimulant effect only on the reticulocyte count and the sooner bone marrow was collected after splenectomy, the more pronounced the effect. Changes in the myelogram and splenogram of irradiated mice to which the bone marrow cells of splenectomized mice had been transplanted were relatively small.


[Biochemical findings in proteincomposition of secretions of human malignant parotid tumours, chronic parotitis and sialadenoses (author's transl)]. In comparison to former investigations in pleomorphic adenoms and Wharthin tumours in the present paper secretion of IgA, lysozyme in correlation to flowrate and total secretion in glands with malignant tumours, inflammations and Sialadenosis were estimated. Thereby 12 patients with malignomas of the parotid gland, 11 patients with chronic parotitis and 12 with sialadenoses were examined. The following results were found: 1. The concentration of protein, IgA and Lysozym is significantly higher than in normal glands and in glands with pleomorphic adenomas and Wharthin tumours. 2. Differentialdiagnosis of Sialadenitis and Sialadenosis of parotid glands is possible by estimating the examined parameters. Thereby in glands with sialadenosis flowrate is higher than in normal glands, and significant lower in glands with sialadenitis. Moreover concentrations of IgA and Lysozyme and protein in glands with sialadenitis are evaluated.


Effect of hydratation on renal water and sodium excretion in patients with renal arterial stenosis (S) and essential hypertension (EH). Water and electrolyte excretion after a large water load and a small Na load was studied in a group of healthy volunteers (C) and in patients with renal arterial stenosis (S) and essential hypertension (EH). It was found that both groups of hypertensive patients reacted to this stimulus by higher Na, Cl, Ca and Mg excretion tan group C. In the two hypertension groups, cumulative Na excretion was comparable in size, but cumulative water excretion was significantly greater in group EH than in group S. The results indicate that these differences can be attributed to different localization of reduced Na reabsorption in the nephron. Signs of a decrease in Na resorption were found in the distal part of the nephron in both hypertension groups, but in the EH group they were also found in the proximal part.


[Sudden deafness in connection with mumps (author's transl)]. The authors report three cases of sudden deafness due to mumps. On the first and second case (children) the deafness was severe perceptive and bilateral; in the first case the perceptive deafness occurred on the eight day while in the second case the forteenth day from the onset of mumps. On the third case (male adult) the deafness was unilateral, sudden with degeneration of vestibular, which occurred during virumia of mumps. The characteristic of this case is that the total deafness of right ear is associated with right parotitis and right orchitis. According to bibliography the pathogenesis, the time of deafness, appearance and the degree of hearing loss are discussed.


[Laryngocele and Carcinoma (author's transl)]. A case of laryngocele and carcinoma is presented. A carcinoma of the right ventricular pouch has developed after a long period of chronic inflammation of the larynx. A big internal ipsilateral laryngocele was found in the larynx specimen. The incidence of laryngocele and carcinoma is demonstrated by available literature and by own investigations. Problems concerning the difficulty of diagnosis and pathogenesis are discussed.


Utilization of 15N-urea administered into the sheep small intestine. The retention and excretion of intrajejunally administered 15N-urea was studied in four experiments on two sheep with a permanently fistulated small intestine. In the first 7 days after the administration of 2 g 15N-urea, 18.26% was excreted in the faeces and 19% in the urine; 62.74% was retained in the organism. Urinary excretion took place mainly on the first day and from the 3rd to the 7th day no 15N was present in the urine. The rate of 15N excretion in the faeces was roughly the same for the first 4 days and then fell; on the 7th day there was no 15N in the faeces. The proportion of 15N-urea retained in the organism and excreted in the urine was 81% showing that urea in the ruminant gastrointestinal tract is largely linked up into metabolic circulation as part of the general exchange of nitrogenous compounds.


Age-related differences in the effect of glucagon on metabolism in rat liver. The authors found differences in the metabolic response of 10- and 120-day-old rats to glucagon. In 10-day-old young, the administration of glucagon was followed in 5 min by an abrupt small increase in the blood sugar level, which continued to rise and attained the maximum 2 hours after the injection of glucagon. In adult rats there was an abrupt large increase in the blood sugar level in the first minutes after administering glucagon; after that the blood sugar level fell, but remained significantly higher than in the controls. In a series of experiments on the isolated perfused liver, no differences were found in glucose and protein release from the liver into the perfusion medium, but the protein concentration in the liver of the younger rats fell. The results show that the liver of young rats, after the injection of glucagon, draws on its own protein resources for the substrates needed for gluconeogenesis.


Diclofenac sodium (Voltaren): results of a multi-centre comparative trial in adult-onset rheumatoid arthritis. A short-term trial has been performed under double-blind conditions in 50 adult patients with rheumatoid arthritis to compare diclofenac sodium (Voltaren) with both indomethacin and placebo for efficacy and tolerability. The duration of the trial was two weeks and was a between-patient comparison of 25 mg t.i.d. diclofenac sodium, 25 mg t.i.d. indomethacin or placebo using a double-dummy technique. Forty-eight patients completed the trial. In the majority of parameters examined, diclofenac sodium was superior to placebo and indomethacin in therapeutic effect. One patient was withdrawn from the trial because of intolerance to indomethacin and one other because of severe joint pain under indomethacin therapy. Neither active compound caused clinically significant changes in blood picture or urine analysis.


Long-term tolerability study of Voltaren. Clinical and laboratory examinations were conducted in order to assess the long-term tolerability of Voltaren, a new anti-inflammatory and analgesic agent. Pre-treatment, repeated on-treatment and after-treatment investigations of haemoglobin, erythrocyte count, total and differential leucocyte count, platelet count, SGOT, SGPT, alkaline phosphatase, total serum proteins and urinary protein and sugar were conducted in 13 patients. The period of treatment with Voltaren was 110 to 559 days. In all these tests, there were no unwanted effects attributable to long-term treatment with Voltaren. Our study would indicate that Voltaren is a safe drug which has no effect on the organs of haemopoiesis, nor on hepatic or renal function, even in long-term therapy. Therefore, Voltaren can be used as an anti-inflammatory and analgesic agent not only in short-term therapy but also in the long-term treatment of chronic diseases.


A double-blind clinical trial to determine if an interaction exists between diclofenac sodium and the oral anticoagulant acenocoumarol (nicoumalone). A double-blind crossover trial between diclofenac sodium and placebo was carried out in 32 hospitalized patients who were thought to be stabilized on concurrent anticoagulant therapy with acenocoumarol. The object of the trial was to investigate any possible interaction between diclofenac and anticoagulant by monitoring prothrombin times daily through the four week period. No statistically significant difference between placebo and diclofenac could be shown and some problems of accurately monitoring prothrombin times are discussed.


A long-term double-blind clinical trial of ibuprofen and indomethacin in rheumatoid arthritis. Two-hundred and eighteen individuals with rheumatoid arthritis were randomly assigned to six months treatment with ibuprofen (900-1800 mg/day) or indomethacin (75-150 mg/day). The drugs were equally effective in the treatment of rheumatoid arthritis while the incidence of indomethacin side-effects was 1.5 times greater than the incidence of ibuprofen side-effects.


Studies on Ponstan (mefenamic acid): I. Gastro-intestinal blood loss; II. Absorbtion and excretion of a new formulation. Using improved techniques in a study of faecal blood loss no significant change over control level occurred during administration of mefenamic acid 500 mg t.i.d. for six days. This lack of gastro-intestinal bleeding is at variance with earlier findings for this compound. Studies of two mefenamic acid formulations (250 mg capsule and 500 mg filmseal tablet) showed no significant difference in area under blood level curves or in urinary output data, indicating equivalent total absorption. The 500 mg film-coated tablet gave significantly higher serum levels at 0.5 hours, whereas the 250 mg capsule gave significantly higher serum levels at 6 and 8 hours.


Clinical study on the efficacy of O-(beta-hydroxyethyl)rutoside (HR) in varicosis of pregnancy. In a double-blind trial involving 69 patients, the effect of O-(beta-hydroxyethyl) rutoside (HR)* in the treatment of varicosis of pregnancy has been investigated. The number of patients subjectively improving in the active drug group was significantly greater than in the placebo group; patients receiving HR also showed a small but significant decrease in leg circumference. Throughout the eight-week period of the trial, there were only minimal side-effects and healthy babies were delivered with good Apgar-scores.


Isoxsuprine in primary dysmenorrhoea. Its effectiveness in premenstrual tension. The drug combination including isoxsuprine 10 mg, acetaminophen 250 mg and caffeine 30 mg was administered to 80 patients divided into two groups, 40 with premenstrual tension and 40 with clinically diagnosed primary dysmenorrhoea. The study was carried out by the double-blind method and the patients were distributed at random. The results obtained show an excellent or very good response in 95% of cases of premenstrual tension and in 92.5% of cases of dysmenorrhoea. When the overall effectiveness of the compound in both conditions is considered, we find it to be 93.75%. A general discussion of the findings is presented in relation to age, civil status, time of appearance of dysmenorrhoea, nature of pain, accompanying symptoms, previous treatment, other non-drug therapies, results obtained, time within which symptoms were alleviated, total dose of the drug and side-effects. It is concluded that the orally-administered therapeutic combination is effective in both dysmenorrhoea and premenstrual tension.


A comparison of mazindol (Teronac) with diethylpropion in the treatment of exogenous obesity. Fifty obese patients were entered into a 12-week parallel group study of mazindol with diethylpropion in a general practice group. Both drugs produced weight loss, but patients on mazindol lost 19.9 lbs in 12 weeks, while those on diethylpropion lost 11.6 lbs, a statistically significant difference (p less than 0.01). At each visit during the trial, patients had lost more weight with mazindol, but this was only significant statistically in the period 8-12 weeks (p less than 0.01). Patients developed tolerance to the effect of diethylpropion in the last period (8-12 weeks) but this was not evident in those patients taking mazindol. The number of side-effects was less in the mazindol group and mainly of an adrenergic, peripheral type, while those in the diethylpropion group are mainly of the central stimulant type.


A placebo controlled trial of viloxazine with and without tranquillizers in depressive illness. Two double-blind four-way crossover studies are reported, comparing the antidepressant effect of 14-day courses of: viloxazine, viloxazine with a tranquillizer either perphenazine or diazepam or tranquillizer alone, against a placebo. In one study the antidepressant effect of viloxazine at a dose of 150 mg daily was statistically greater than that of placebo, whilst in the second study viloxazine was statistically superior to diazepam (15 mg daily). In depressed patients with a clear anxiety component, viloxazine alone seemed preferable to a combination with a tranquillizer as such a combination did not produce an enhanced clinical effect and the incidence of side-effects was possibly increased. Viloxazine was generally well tolerated and side-effects, when they occurred, were generally a mild upper gastro-intestinal disturbance.


Clinical experience with Ro 5-3350 (bromazepam). A pilot study using Ro 5-3350 was followed by a double-blind trial comparing Ro 5-3350 and chlordiazepoxide in a total of 25 patients who were either hospital in-patients or previous in-patients attending an out-patients follow-up clinic. The patients all had a long history of obsessive-compulsive or phobic symptoms. The visual analogue scale, the Taylor Manifest Anxiety Scale and clinical ratings were used to measure the response to treatment. In all three rating methods used, those patients who had received Ro 5-3350, chlordiazepoxide and then Ro 5-3350 in that order, consistently favoured Ro 5-3350. When the clinical ratings were examined by diagnostic groups, it was found that the phobic patients all gave favourable responses to Ro 5-3350. Two of the six patients with severe anxiety or agoraphobic states who had been treated with Ro 5-3350 over periods ranging from three to five years received the medication during the whole term of pregnancy and they were delivered of full-term normal babies. The results suggest that Ro 5-3350 (bromazepam) is a potent anxiolytic most likely to be effective in the relief of visceral manifestations of anxiety. The incidence of side-effects was low and there were no toxic effects reported.


Methaqualone discrimination in gerbils: interactions with bemegride and imidazoline (DH-524). Gerbils were trained in a T-maze to discriminate methaqualone (MTQ), either 16 mg/kg, 12 mg/kg, 8 mg/kg, or 4 mg/kg, from the no drug condition. Discrimination was proportional to dose, MTQ 16 mg/kg vs. no drug being the most rapidly discriminable condition. Challenge of MTQ discrimination with bemegride and imidazoline showed that bemegride, but not imidazoline reversed the MTQ discrimination. The median effective dose of bemegride was related to the amount of MTQ used (16-8 mg/kg).


[Participation of interoceptive afferent excitations in sensory integration processes of cat visual cortex neurons]. In experiments on cats immobilized with diplacine it is shown that stimulation of the vagal and splanchnic nerves exerts a substantial influence on the neuronal background activity of field 17 in the brain cortex. Neuronal responses as prolonged tonic changes in impulse frequency were seen more often. Complex phasic neuronal responses with steady inhibitory periods and periods of activation appeared more rarely. The development of phasic reactions could begin both with activation and initial inhibition of the activity. Predominantly excitatory responses resulted from the splanchnic nerve stimulation. They could be also seen during somatic stimulations. The degree of neuronal involvement into the responses and their intensity increased by trains of stimuli. Visceral and somatic influences on the visual cortical neurons are shown to be mediated by the lateral hypothalamus and midbrain reticular formation.


Algorithm for management of pulmonary complications in burn patients. An algorithm for management of pulmonary complications in burn patients on the same basis as in patients with adult respiratory distress syndrome is outline. Pao2 of less than 60 torr (F(I)O2 0.21-0.4, PaCO2 over 40 torr, pH less than 7.35, respiratory rate over 40/min, and clinical evidence of compromised upper airway were the indications for initation of aggressive intensive respiratory care. This consisted of nasotracheal intubation, arterial cannulation, pulmonary artery catheterization, and establishment of mechanical ventilation. The algorithm further defines the subsequent management of these patients as far as need for continued mechanical ventilation, fluid and electrolyte balance, hemodynamic stability, and renal function.


[Pathogenicity of atypical mycobacteria]. Human diseases caused by atypical mycobacteria are reviewed. Pulmonary illness and childrens' lymphadenitis are the commonest, but cutaneous, disseminated, bony, articular, renal and meningeal diseases are also produced by atypical mycobacteria. Disseminated infections are often manifested by fever, hepato-splenomegaly and hematologic changes. Most diagnosis are made by sputum and gastric-juice cultures, bonemarrow and liver biopsies. Disseminated diseases are often fatal but may be cured with medical treatment. In general, atypical mycobacterial diseases are quite similar to tuberculous diseases in different organs. A unique isolation of atypical mycobacteria is not diagnostic "by it self", and other conditions are required. Diagnostic criteria and treatment are discussed.


[Stimulation of replanted extremity muscles and its effect on energy processes]. Medicamental stimulation has a definite positive effect on metabolism of macroergic compounds in the muscles of the replanted and contralateral extremeties. Application of medicamental stimulation reduced the time for the muscle reparation, increased considerably the level of creatine-phosphoric acid and ATP both in the replanted and intact extremeties as well as restored the succinate dehydrogenase activity. 4-Methyluracil applied in combination with vitamins proved to be the most effective preparation under conditions of the experiment.


The aetiology of acute pancreatitis.

The aetiology of acute pancreatitis. The most common aetiological factors of acute pancreatitis in an unselected group of 215 consecutive surgical patients were biliary tract disease (40.0%), alcoholism (20.0%) and gastroduodenal ulcer (4.2%). In women, biliary tract disease was by far the most common cause (61.3%), but in men considerably high frequencies of alcoholism (48.3%) and gastroduodenal ulcer (15.7%) were noted as at least one possible aetiological factor. This deserves a special notation when contemplating prophylactic measures to prevent recurrences of acute pancreatitis.


Amniotic fluid removal prior to saline abortion. To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15-20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.


Medulloblastoma. Treatment results.

Medulloblastoma. Treatment results. A series of 44 patients with medulloblastoma is presented. The treatment was primary operation followed by irradiation of the entire CNS. The 3-year and 5-year survival rates for children and adults together were 36 and 33 per cent, respectively, and for children alone 37 amd 33 per cent, respectively. No certain difference in the prognosis for boys and girls was found.


High dose medroxyprogesterone-acetate treatment in advanced mammary carcinoma. A phase II investigation. In a phase II investigation of high dose medroxyprogesterone treatment of advanced and previously with other methods heavily treated patient with mammary carcinoma, 7 of 25 patients had a partial remission with a median duration of 5 + months. In a further 7 patients the disease became stationary. As measured by Karnofsky's scale, a median improvement of 20 points was obtained in these 14 patients. In 4 of 15 patients who had not responded to Tamoxifen treatment, a partial remission occurred following MAP therapy. The patients tolerated MAP well.


Skin reactions in mouse by fractionated neutron irradiations with the same NSDn. The results of three fractionations of neutron irradiation with the same NSDn were examined for skin reactions in mice. No significant differences were observed between these fractionations given two times a week (15 Gy/12 fractionations/39 days, 14.6 Gy/10 fractionations/32 days and 14.08 Gy/8 fractionations/25 days). The result suggests the value of a high dose per fraction given two times a week.


Demographic investigation of mammary carcinoma in Northern Sweden. The age standardized incidence rates for female breast carcinoma were calculated for the 3 northernmost counties in Sweden and their municipalities for the period 1959 to 1971. Large variations were found that could not be explained by random distribution. Lower incidences were encountered in the less urbanized municipalities in the western and northern parts. The largest relative difference between low-incidence and high-incidence municipalities concerned the post-menopausal period.


Hemofiltration during extracorporeal circulation (ECC). In cardiac surgery hemofiltration can be used: 1. to balance fluids during ECC, especially in long-term perfusion; 2. to carry out open heart procedures in patients with terminal renal insufficiency; 3. to treat acute hyperkalemia. The model of the 12.5 by 4.5 cm DIAFILTER TM and the model of operation are described. The compounds of the ultrafiltrate (UF) are identical with that of plasma water. Particles with a molecular weight of less than 50,000 can pass freely across the filtration membrane. The filtration capacity is 100 cc/min UF (Q blood: 300 cc/min, pressure across the membrane 600 mm Hg and hematokrit (Hkt) 25%). The technical details of operation are explained. Its general use as well as its simplicity is demonstrated in 10 patients.


Management of ascending suture line sepsis by excision on the ascending aorta and insertion of a left ventricular apex to aorta conduit. A new technique used in the management of infection of an aortic suture line following aortic valve replacement and subsequent episodes of severe hemorrhage resulting from suture line disruption is described. In a planned, staged procedure, a left-ventricular-apex-to-aorta conduit was inserted followed by excision of the supracoronary aortic root and ascending aorta, incorporating all infected tissue. This technique demonstrates that near total excision of the ascending aorta is possible and coronary artery flow can be maintained with only a minimal supravalvular aortic chamber.


Program evaluation of Texas mental health and mental retardation centers. The diversity of programs offered by the 24 mental health and mental retardation centers in Texas required that program evaluation take a management-by-objectives approach, with each center examined as a unique system with its own goals, techniques, and activities. The approach required the centers to develop statements of management objectives, which they did with varying degrees of success. The evaluations were carried out by site-visit teams. The authors describe the evaluation process, the difficulties encountered, and some of the beneficial effects.


Modification of red cell membrane structure by cholesterol-rich lipid dispersions. A model for the primary spur cell defect. Cholesterol-rich membranes are the hallmark of "spur" red cells. Spur cells accumulate cholesterol from cholesterol-rich serum lipoproteins. Previous studies suggested that this added cholesterol is responsible for both the altered morphology and the destruction of spur cells. To examine this process in the absence of other serum factors, cholesterol-lecithin dispersions with varying amounts of unesterified cholesterol (C) relative to phospholipid (P) were prepared, and their influence on normal human red cells was studied. Cholesterol-rich lipid dispersions (C/P mole ration greater 1.0) transferred cholesterol to both red cell membranes and serum lipoproteins, and cholesterol-poor dispersions (C/P mole ration less 1.0) depleted red cells of cholesterol. Changes in membrane cholesterol paralleled changes in membrane surface area, as calculated from osmotic fragility, with a 0.22 percent variation in surface area per 1.0 percent variation in cholesterol content. Cold-induced compression of membrane surface area was increased in cholesterol-poor red cells (C/P equals 0.4), whereas the surface area of cholesterol-rich membranes (C/P equals 1.80) underwent no compression. Although the Na and K permeability of red cells severely depleted of cholesterol was increased, lesser degrees of depletion had no effect, and the permeability of cholesterol-rich cells was normal. However, increasing membrane cholesterol caused a progressive decrease in red cell deformability, as measured by filtration. Cholesterol-poor red cells were spherocytic in appearance and cholesterol-rich cells were broad and flat, indicative of their surface areas. In addition, cholesterol-rich cells had an irregular contour due to folding of the periphery of the cell. This shape abnormality was identical to that of both spur cells after splenectomy and normal red cells incubated in spur serum. Normalization of the C/P of spur serum by added phospholipid prevented the increase in membrane cholesterol and surface area and the transformation of cell shape. These studies establish that the cholesterol content of red cells is dependent on the C/P of their milieu, either lipoproteins or cholesterol-lecithin dispersions. Moreover, the surface area, deformability, and contour of cholesterol-rich red cells are a direct function of their increased membrane C/P. Although cholesterol-rich spur cells are further modified in the circulation of patients with spleens, this abnormality of the membrane lipid bilayer, induced by cholesterol-rich cholesterol-lecithin dispersions, represents the primary spur cell defect.


Inhibition of hormone-stimulated lipolysis by clofibrate. A possible mechanism for its hypolipidemic action. The present study was undertaken to investigate the mechanism of the antilipolytic action of clofibrate (p-chlorophenoxyisobutyrate). Clofibrate, in the dose range of 10-80 mg/199 ml, inhibited the initial rate of norepinephrine-stimulated lipolysis 17-44 percent in isolated rat fat cells. At a dose corresponding to therapeutic levels in vivo (10 mg/100 ml) clofibrate also inhibited hormone-stimulated lipolysis by 20-30 percent in fragments of human subcutaneous fat. Inhibition of lipolysis by clofibrate occurred at all concentrations of norepinephrine and ACTH (0.02-0.1 mug/ml) but did not occur with equilipolytic concentrations of dibutyryl cyclic AMP, suggesting a proximal site of action on the lipolytic sequence. Clofibrate reduced by 60 percent (315plus or minus40 vs. 120plus or minus25 pmol/g lipid; meanplus or minusSEM) the norepinephrine-stimulated initial rise in cyclic AMP, measured 10 min after addition of hormone. Because the antilipolytic effect occurred in the presence of glucose and without altering cellular ATP levels, the reduction in intracellular cyclic AMP levels could not be attributed to uncoupling of oxidative metabolism or to secondary effects of free fatty acid accumulation. In the secondary effects of free fatty acid accumulation. In the presence of procaine-HC1, which blocks hormone-stimulated lipolysis without inhibiting cyclic AMP accumulation, addition of clofibrate prevented the hormone-stimulated rise in cyclic AMP. Clofibrate did not affect the activity of the low-Km 3',5'-cyclic AMP phosphodiesterase in norepinephrine-stimulated adipocytes. These data suggest that the antilipolytic effect of clofibrate is due to its suppression of cyclic AMP production by inhibition of adenylate cyclase. The drug's hypolipidemic action may in part be explained by its antilipolytic effect, which deprives the liver of free fatty acid substrate for lipoprotein synthesis.


In vitro binding of L-triiodothyronine to  receptors in rat liver nuclei. Kinectics of binding, extraction properties, and lack of requirement for cytosol proteins. Isolated hepatic nuclei from euthyroid rats were incubated with tracer (125I)L-triiodothyronine (T3) and increasing doses of nonradioactive T3 for 30 min at 37degrees C. The T3 bound specifically to nuclear sites increased with increasing T3 doses to a plateau, which represented the nuclear binding capacity, M. Addition of 1 mM KCN, NaF, dinitrophenol, oriodoacetate did not affect nuclear binding, indicating that active metabolism was not required. Kinetic studies showed that the nuclear sites were equilibrated with T3 within 30 min of incubation (one-half maximal binding at 3 min) and that the rate of release of T3 in vitro (0.058 min-1) was the same for endogenous T3 or for T3 bound to nuclei in vitro. Nuclear T3 resisted extraction with 0.14 M NaC1 buffered at pH 7.5, but both endogenous hormone and T3 bound in vitro were readily extracted by 0.4 M KC1 at pH 8.0. The elution profiles of endogenous and in vitro-bound T3 from Sephadex G-100 columns showed a common protein peak with a molecular weight of 60-65,000, assuming a globular protein. Scatchard analysis of in vitro displacement studies showed a single class of binding sites. Mean M equals 0.23 times 10-9 M or 0.85 ng T3 for nuclei isolated from 1 g of liver. Mean M closely corresponded to that anticipated from reported in vivo studies. The apparent association constant Ka for the nuclear sites, 5.55 times 108 M-1, was lower than in studies in vivo, probably attributable to the different ionic milieu of nuclei in the incubation buffer and in the intact cell. Thus, the identity of the nuclear T3 binding sites studied in vitro to those reported for endogenous hormone is demonstrated by similar binding capacities, release rates, analogue binding affinities (previously reported), and localization to chromatin nonhistone proteins of comparable molecular weight. The role of cytosol protein in nuclear binding was assessed by comparing binding parameters for extensively washed nuclei and nuclei incubated either with contaminating or added cytosol. No difference in Ka or M was found. Moreover, it was unlikely that specific cytosol proteins were already present in nuclei and functioned during incubation as a shuttle for T3, since Ka and M for nuclei obtained from athyreotic rats were similar to Ka and M for nuclei from euthyroid animals. Thus, an initial interaction between T3 and specific cytosol proteins does not appear to be a prerequisite for translocation of T3 to nuclear sites.


Primary fibrinolysis after oral surgery. A case report of a patient with primary fibrinolysis resulting in hemorrhage after an oral surgical procedure has been presented. A comparison was made between DIC and primary fibrinolysis in patients with carcinoma of the prostate gland; etiology, clinical findings, diagnosis, and treatment were discussed.


Computerized axial tomography in syringomyelia. The ACTA-scanner, a device for computerized axial tomography, permits cross-sectional radiographic study of the entire human body, including the spine. In the ACTA-scan, the spinal cord appears as a roundish formation surrounded by the less dense subarachnoidal cerebrospinal fluid. The spines of 18 patients with verified (nine cases) or suspected (nine cases) syringomyelia were studied by ACTA-scanning. In seven of the verified and in four of the nonverified cases, some evidence of cord cavitation was shown. The cystic part of a cervical-cord ependymoma was also demonstrated. ACTA-scanning is an easily performed, noninvasive, innocuous procedure. This technic, which complements other radiographic methods of evaluating the spinal cord, is particularly suitable for screening and follow-up study of patients with syringomyelia. The easily accomplished recognition of a possible associated hydrocephalus is an added advantage of ACTA-scanning.


Secretion granules of the rabbit parotid gland. Isolation, subfractionation, and characterization of the membrane and content subfractions. A fraction of secretion granules has been isolated from rabbit parotid by a procedure which was found to be especially effective in reducing contamination resulting from aggregation and/or cosedimentation of granules with other cell particulates. The fraction, representing 15 percent (on the average) of the total tissue amylase activity, was homogeneous as judged by electron microscopy and contaminated to exceedingly low levels by other cellular organelles as judged by marker enzymatic and chemical assays. Lysis of the granules was achieved by their gradual exposure to hypotonic NaHCO3, containing 0.5 mM EDTA. The content and the membranes separated by centrifugation of the granule lysate were characterized primarily by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis which indicated that the content was composed of a limited number of molecular weight classes of polypeptides of which three bands (having approximate mol wt 58,000, 33, 000, and 12,000) could be considered major components. The gel profile of the membrane subfraction was characterized by 20-30 Coomassie brilliant blue-staining bands of which a single species of mol wt 40,000 was the conspicuous major polypeptide. Two types of experiments employing gel electrophoretic analysis were carried out for identifying and assessing the extent of residual secretory protein adsorbed to purified granule membranes: (a) examination of staining and radioactivity profiles after mixing of radioactive secretion granule extract with nonradioactively labeled granule membranes and (b) comparison of gel profiles of secretion granule extract and granule membranes with those of unlysed secretion granules and secretory protein dischraged from lobules in vitro or collected by cannulation of parotid ducts, the last two samples being considered physiologic secretory standards. The results indicated that the membranes were contaminated to a substantial degree by residual, poorly extractable secretory protein even though assays of membrane fractions for a typical secretory enzyme activity (amylase) indicated quite through separation of membranes and content. Hence, detailed examination of membrane subfractions for residual content species by gel electrophoresis points to the general unity and sensitivity of this technique as a means for accurately detecting a defined set of polypeptides occurring as contaminants in cellular fractions or organelle subfractions.


Cell cycle and growth stage-dependent changes in the transport of nucleosides, hypoxanthine, choline, and deoxyglucose in cultured Novikoff rat hepatoma cells. Populations of Novikoff rat hepatoma cells (subline N1S1-67) were monitored for the rates of transport of various substrates and for their incorporation into acid-insoluble material as a function of the age of cultures of randomly growing cells in suspension as well as during traverse of the cells through the cell cycle. Populations of cells were synchronized by a double hydroxyurea block or by successive treatment with hydroxyurea and Colcemid. Kinetic analyses showed that changes in transport rates related to the age of cultures or the cell cycle stage reflecte alterations in the V max of the transport processes, whereas the Km remained constant, indicating that changes in transport rates reflect alterations in the number of functional transport sites. The transport sites for uridine and 2-deoxy-D-glucose increased continuously during traverse of the cells through the cell cycle, whereas those for choline and hypoxanthine were formed early in the cell cycle. Increases in thymidine transport sites were confined to the S phase. Synchronized cells deprived of serum failed to exhibit normal increases in transport sites, although the cells divided normally at the end of the cell cycle. Arrest of the cells in mitosis by treatment with Colcemid prevented any further increases in transport rates. The formation of functional transport sites was also dependent on de novo synthesis of RNA and protein. Inhibition of DNA synthesis in early S phase inhibited the increase in thymidine transport rates which normally occurs during the S phase, but had no effect on the formation of the other transport systems. Transport rates also fluctuated markedly with the age of the cultures of randomly growing cells, reaching maximum levels in the mid-exponential phase of growth. The transport systems for thymidine and uridine were rapidly lost upon inhibition of protein and RNA synthesis, and thus seem to be metabolically unstable, whereas the transport systems for choline and 2-deoxy-D-glucose were stable under the same conditions.


Direct biochemical measurements of microtubule assembly and disassembly in Chinese hamster ovary cells. The effect of intercellular contact, cold, D2O, and N6,O2'-dibutyryl cyclic adenosine monophosphate. A study was undertaken to develop a means of quantitating the amount of tubulin present as a soluble pool and as intact microtubules in cultured Chinese hamster ovary cells. A procedure was developed in which these cells grown on monolayer culture in Petri dishes were placed in a "microtubule stabilizing medium" (MTM) consisting of 50% glycerol, 10% dimethylsulfoxide and sodium phosphate magnesium buffer, as described previously by Filner and Behnke. These cells then were homogenized and the homogenate was spun in the ultracentrifuge. Colchicine binding activity was then determined in the supernates and the pellets. The values, when compared with total colchicine binding activity present in replicate homogenates, were used to determine the percentage of tubulin present as intact microtubules. A statistical analysis of thin sections of cells treated with MTM revealed no statistically significant difference between MTM-treated cells and untreated controls. It was further discovered that the relative amount of colchicine binding activity recovered in the high speed pellet varied dramatically, depending upon the cell number of the culture being studied. Preconfluent cultures showed very low colchicine binding activity averaging less than 5%, while confluent and postconfluent cultures often possessed as high as 25% of their total colchicine binding activity in pelletable material. Although cold and D2O treatment had little or no effect on these values, N6,O2'-dibutyryl cyclic adenosine monophosphate increased them. It is hoped that this study will serve as the basis for a reliable quantitative procedure for measuring microtubule polymerization and depolymerization in vivo.


Unlimited division potential of precancerous mouse mammary cells after spontaneous or carcinogen-induced transformation. Serial transplantation of normal mouse mammary gland in young, isogenic hosts results in progressive loss of division potential, and the transplant line is eventually lost. This is interpreted as an expression of senescence at the cell and tissue level, and it inevitably occurs even though experimental conditions for growth are judged to be optimal. An indefinite extension of mammary growth span can be accomplished by transformation of these normal cells into precancerous cell types, which grow as a benign tissue but which may, however, occasionally undergo a second transformation into a malignant carcinoma. All precancerous tissues tested displayed unlimited growth potential, regardless of whether they occurred spontaneously, or were induced by oncogenic viruses or by administration of chemical carcinogens. Precancerous tissues of both ductal and lobuloalveolar morphology grew continuously. These results indicate that release from cell aging, as measured by the acquisition of unlimited growth potential, is associated with the precancerous state per se, and occurs as an early event in the transition from normal to malignant mammary cells.


Contributions of cytoplasmic factors to in vitro cellular senescence. Mass populations of normal human lung fibroblasts were enucleated by centrifugation at greater than or equal to 25,000 g in 4 mug/ml cytochalasin B. The 1 per cent of cells that did not enucleate where rendered nonviable by treatment with mitomycin C. Whole cells were poisoned with a 99 per cent lethal dose of the sulfhydryl reagent iodoacetate. The washed cells were then mixed with the anucleate cytoplasms, fused with inactivated Sendai virus, and planted in rotenone for 20 hours. Whereas normal cells are able to survive this rotenone treatment, the 1 per cent surviving iodoacetate-treated cells cannot withstand this additional stress. However, iodoacetate treated cells that fuse to untreated cytoplasms receive sufficient amounts of active enzymes to allow them to survive. Since this selective system does not rely on using enzymatic mutants, it should permit the selection of hybrids between anucleate cytoplasms and any type of whole cell. Cytoplasmic hybrids were cultured in order to determine their proliferative capacity. The life-spans of cytoplasmic hybrids between young and old cells were compared to those of young/young and old/old controls. Cytoplasmic factors do not appear to control in vitro cellular senescence.


Neuronal--glial interactions during development and aging. Integration of the central nervous system is an expression of cerebral homeostasis that is essential for the internal ability of the organism to adapt to its changing environment throughout life. It is generally accepted that neurons undergo no further division after differentiation, whereas glial cells continue to proliferate throughout life. The increase in glial cells with advanced age may reflect a compensatory process of the brain to overcome neuronal loss or neuronal functional changes that may occur with age. Therefore, these neuronal-glial interactions during development and aging may play a key role in the integrative capacity of the brain. One of the mechanisms contributing to brain stability is the blood-brain barrier, which regulates the neuronal-glial microenvironment in the mature organism. Neuronal intercommunication is mediated via neurotransmitter substances and a shift may occur from excitation to inhibition and vice versa in some CNS areas with aging. Studies of some aspects of cholinergic, monoaminergic and amino acid neurotransmission show that their maturational patterns are CNS-area specific and that some neurotransmitter processes decline with advanced age. Glial cells, besides participating in the regulation of extraneuronal environment, are also proposed to be involved in neurotransmission mechanisms in the adult and aging CNS and since they are the major CNS cellular compartment that changes with age they may thus contribute significantly to the maintenance of CNS integrative ability and adaptation with age.


Bioenergetic functions of sleep and activity rhythms and their possible relevance to aging. The hypothesis is proposed that sleep constitutes a period of dormancy in which energy is conserved to partially offset the increased energy demands of homeothermy. Phylogenetic data indicate that the complete psysiological and behavioral manifestations of sleep are unique to homeotherms; furthermore "ontogeny recapitulates phylogeny" in the parallel development of slow wave sleep and thermoregulation as exemplified in the opossum. Thus, sleep constitutes a state of reduced metabolism that may represent a variation on the theme of dormancy, functionally lying on a continuum of energy conservation processes, ranging from inactivity and estivation to torpor and hibernation. The high amounts of sleep in infancy may involve conservation of energy and its consequent availability for growth. Decreased amounts of stage 4 and total sleep with aging in humans may represent reduced energy demands reflected by parallel declines in basal metabolic rate and physical activity. Disruptions of circadian rhythms of sleep and wakefulness in humans produce impairments in mood and performance independent of total amounts of sleep obtained, and reduce the amplitude of physiological rhythms. It is suggested that aging processes might also be affected by such disruptions in activity rhythms.


A multisomatic axon in the central nervous system of the leech. There is one particularly large axon in the medial bundle of the nerve cord of the leech. It extends along the entire length of the cord and is connected to a single cell body in each ganglion. The cell bodies in adjacent ganglia are tightly electrically coupled, and dye injected into one cell body can diffuse along the axon and into the cell body of the next ganglion. If the nerve cord is cut between two ganglia, neither end of the axon degenerates. Repair of the axon appears to occur by end-to-end fusion.


Collagenase in the treatment of dermal and decubitus ulcers. The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.


Parthenogenic origin of benign ovarian teratomas. To determine the origin of benign cystic teratomas of the ovary, chromosome-banding studies were done on normal tissues and teratomas from five patients. The normal tissues were heterozygous (+/-) for 17 chromosome polymorphisms at or near the centromere, whereas the teratomas were uniformly homozygous (+/+ or -/-). These findings and those employing electrophoretic variants indicate that ovarian teratomas are parthenogenic tumors that arise from a single germ cell after the first meiotic division.


The neurological deficit associated with sudden occlusion of abdominal aorta due to blunt trauma. A review of the literature revealed five well-documented cases of abdominal aortic injury due to blunt, nonpenetrating trauma. An additional case report is offered. In all cases the level of aortic injury was at or distal to the origin of the inferior mesenteric artery. In five of these reports, including the present case, sudden traumatic occlusion of the distal abdominal aorta occurred and led to associated neurological deficit. The authors submit, based on clinical manifestations, selective angiography of spinal cord vasculature, and the operative experience of others, that these neurological deficits resulted from acute peripheral nerve ischemia and not from spinal cord ischemia as had been assumed in the past. The final neurological deficit due to acute peripheral nerve ischemia may masquerade as that seen with a "transverse" spinal cord lesion. However, the prognosis for recovery of neurological function differs markedly between the two conditions. All surviving patients experienced rapid resolution of their neurological deficits in the immediate postoperative period. Infrarenal aortic occlusion will not produce spinal cord infarction.


Hemoperitoneum from liver cell adenoma in a patient on oral contraceptives. A case of hemoperitoneum from ruptured benign liver cell adenoma in a young woman with a long history of oral contraceptive use is presented. The importance of recognizing the cause of this intra-abdominal emergency is stressed, and comment is made about the entity occurring in women on contraceptive drugs.


The significance of elongation and angulation of the carotid artery: a negative view. Many authors have postulated that angulation of the carotid artery is a cause of stroke and recommend corrective operation. Symptoms attributed to such lesions are often nebulous and unrelieved by the operation, and proof is lacking that unselected patients who have this condition have a risk of stroke exceeding operative risk. A review of 282 cerebral angiograms showed an incidence of elongation and potential angulation of 43 percent in children and 20 percent in adults. Acutal angulation was not found in children, however, and no child was suspected of having cerebral ischemia. Of 47 adults with potential angulation, 17 were suspected of having cerebral ischemia, the remainder having a variety of other lesions, such as tumors, aneurysm, and intracranial hemorrhage. Of the 17 having suspected cerebral ischemia, all had alternative explanations for their symptoms (hypertension, intracranial atherosclerosis), except one whose symptoms were completely inappropriate to the carotid distribution. A single patient had a completed stroke, demonstrable angulation, and only mild hypertension. Elongation and potential angulation of the carotid artery is common but usually coexists with other lesions. If the finding is postulated as the cause for neurologic morbidity the surgeon must be assured that symptoms are clearly neurologic, that no other cause exists, that angulation reduces the carotid lumen significantly and reproduces symptoms, and that the risk of operation is less than the expected risk of stroke in untreated patients.


Experimental and clinical experience with hyperbaric oxygen in the treatment of clostridial myonecrosis. At Duke University Medical Center, 49 patients with proved clostridial myonecrosis were treated with hyperbaric oxygen (HBO) during the past 10 years. Survival in patients with involvement confined to the extremities was 92.3 percent. Survival in patients with combined involvement of extremity and trunk was 53-3 percent, and with primary trunk involvement half of the patients survived. Survival for the entire series was 73.5 percent. Among the 28 patients receiving at least five HBO treatments, 24 survived. Extensive experimental studies were conducted during this same period including in vitro testing and in vivo experimental infections with C. perfringens. Data from the experimental models of gas gangrene indicate a therapeutic benefit with HBO by significantly decreasing both mortality and morbidity rates. The mechanism of action for this appears to be complex but probably includes a direct bactericidal action, bacteriostasis, inhibition of toxin production, and improvement in tissue oxygenation. In the absence of a controlled study, the therapeutic efficacy of HBO in the treatment of clostridial myonecrosis is not fully proved. Nevertheless HBO treatment can be recommended on the bases of sound experimental evidence and the results of favorable clinical experience. Mitigation of this severe but infrequent illness can best be accomplished through prevention, with strict adherence to the principles of wound care.


The pathology of Tangier disease. A light and electron microscopic study. Tangier disease (deficiency of high density plasma lipoproteins) is characterized clinically by: low levels of plasma cholesterol; enlarged, orange-yellow to yellow-gray tonsils and, frequently, peripheral neuropathy. Histologic and ultrastructural studies were made of various tissues from 5 patients with Tangier disease, and comparisons were made of these findings with those in the 12 other patients thus far known to have this disease. Deposits of cholesteryl esters were found in: reticuloendothelial cells (foam cells) in tonsils, bone marrow, skin and jejunal submucosa; Schwann cells in peripheral nerves and myenteric plexus; and in nonvascular smooth muscle cells. These deposits appeared electron lucent and intensely birefringent, varied from spherical to crystalline in shape, often were extensively confluent throughout large areas of cytoplasm, and were not limited by membranes. Certain foam cells in bone marrow also contained membrane-limited clusters of lipid particles resembling chylomicrons. The foam cells in Tangier disease differ morphologically from those in numerous lysosomal enzyme deficiency states, particularly Wolman's disease and cholesteryl ester stroage disease, and in proliferative diseases of the reticuloendothelial system in which cholesteryl esters also accumulate in abnormal histiocytes. Morphologic and biochemical data suggest several hypotheses to explain the accumulation of cholesteryl esters in tissues of patients with Tangier disease. Among these hypotheses, the most likely are considered to be the presence in plasma of abnormal lipoprotein particles that are subject to phagocytic removal by reticuloendothelial cells, and the failure of a process that normally removes locally synthesized cholesterol from cells to plasma. (Am J Pathol 78:101-158, 1975)


Gastric organ culture. A model for reepithelialization. The in vitro organ culture system is useful in the study of the mechanics of gastric reepithelialization, cell migration and exfoliation. Reepithelialization is apparently effected by actively motile cells of all levels of differentiation, and at the completion of the process a new zone of cell exfoliation is initiated at points of contact when cells meet after growing towards the center of the specimen from its opposite margins. Mitotic activity is suppressed during the period of migration. (Am J Pathol 78:23-32, 1975)


Leukemic mitochondria. III. Acute lymphoblastic leukemia. Quantitative and qualitative electron microscopic studies were performed on the mitochondria of leukemic lymphoblasts in 6 patients with acute lymphoblastic leukemia. Similar studies were performed on lymphoblasts from lymph nodes obtained from 10 surgical patients without nodal diseases. Significant quantitative differences between normal and leukemic mitochondria were not observed except for a difference in mitochondrial area per cell (P less than 0.05). This was not significant lacking, qualitative diffecrences were observed. These abnormalities included rare giant mitochondria, disrupted mitochondria with virus-like particles, smaller granules in greater abundance, mitochondrial DNA, and contact between the mitochondrion and nucleus during interphase. Fifty-three percent of the leukemic lymphoblasts contained polyribosomes, as compared to 25% of the normal lymphoblasts. The cells with the polyribosomes contained the giant mitochondria. The leukemic lymphoblasts had an appearance similar to transformed lymphocytes resulting from an immunologic stimulus. This suggests that acute lymphoblastic leukemia may be a disease which is associated with an immunologic response. From the available ultrastructural and biochemical data, it would seem that the leukemic lymphoblast is a product of an abnormal metabolism which affects its ability to differentiate. These ultrastructural findings seem to indicate the need for biochemical investigation of leukemic mitochondria. (Am J Pathol 78:49-58, 1975