Ocular findings in botulism type B.

Ocular findings in botulism type B. In April 1977, fifty-nine persons became ill with type B botulism in a large, common-source outbreak. A combination of signs and symptoms that should make the clinician strongly suspect botulism was derived from the histories and ocular findings of these persons. Certain signs of third cranial nerve dysfunction reliably predicted in which patients ventilatory insufficiency would develop.


Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy. The accuracy of diagnosis of 455 thyroid nodules evaluated by cytological and histological specimens obtained by fine- and large-needle biopsy, respectively, was compared with that for 1,094 nodules previously evaluated by clinical methods. The use of cytohistological data halved the number of patients with suspected cancer and doubled the number of patients to be observed. Cancers identified at operation for high and intermediate cancer-risk patients increased 75%, and operation for diagnosis of benign disease decreased 70%. Forty-two of 47 excised cancers were included in the cytohistological probable cancer group. Only 29 of these cancers were so classified clinically. Two cancers not diagnosed cytologically were suspected histologically and vice versa for one cancer. All 51 excised cytohistologically benign nodules were benign. There were more false-positive findings with cytological than with histological specimens.


[Synergistic effect of ampicillin and dicloxacillin on penicillin and cephalosporin-susceptible Escherichia coli (author's transl)]. An effect of a combination of ampicillin (ABPC) and dicloxacillin (MDIPC) on penicillins and cephalosporin-susceptible E. coli was determined. Minimum inhibitory concentrations of the combined drug were as same as that of ABPC, but bacterial growth was inhibited by the combined drug stronger than ABPC, low activity of beta-lactamase was detected in sonicated E. coli 0.225 cells, and this activity was inhibited by relatively low concentration of MDIPC. We considered that a weak synergism of the combined drug might attribute to the inhibition of the beta-lactamase activity by MDIPC.


[Hormonal and metabolic disorders in ischemic heart disease]. There were under observation 440 patients with ischemic heart disease due to atherosclerosis of the coronary arteries in the phase of exacerbation of the disease and 52 patients suffering from hypertensive disease with a clinical picture of ischemic heart disease; 192 practically healthy individuals were examined as controls. Significant increase in the levels of cholesterol, triglycerides, and glucose in blood of the patients with ischemic heart disease and of those with hypertensive disease was revealed. In patients with ischemic heart disease marked by pain and disorders of the rhythm as well as in individuals with hypertensive disease hormonal-metabolic shifts, monotypical in character, were noted. It is suggested that hormonal-regulatory disorders are of primary character in atherogenesis.


[Human aging and the problems of cardiology]. The author underscores the importance of studying the physiology of the aging organism for understanding the genesis of the development of pathologic processes in the cardiovascular system inherent in elderly and old persons, the peculiarities of their clinical course, treatment and prophylaxis. The close ties linking gerontological and cardiological research are revealed in the article in describing certain clinical peculiarities of ischaemic heart disease and arterial hypertension in individuals who are 60 years and older. New data are presented on the genesis of arterial hypertension in elderly and old individuals and its connection with the peculiarities of the clinical course of the disease at this age.


[Change in the index of neutrophil damage in infectious allergic myocarditis and its sequelae]. The reaction of damage to the blood neutrophils (the IND test) by a soluble cardiac antigen was studied in 10 healthy individuals, in 15 persons with infectious-allergic myocarditis and in 13 persons with myocarditic cardiosclerosis. Autoallergic shifts in relation to the cardiac antigen were revealed in half of the patients with infectious-allergic myocarditis and in one third of persons with myocarditic cardiosclerosis. The shifts were more marked in patients with infectious-allergic myocarditis.


Energy balance and growth: experience in treating children with malnutrition. If an analogy between growth failure in renal disease and chronic malnutrition exists, experience in the dietary management of severely malnourished children may be of relevance. For children with chronic malnutrition, the energy cost of weight gain is approximately 5 kcal/g, and the maintenance energy requirement is close to 1.5 times the basal metabolic rate. Infants fed proprietary formulas with vegetable oil added in order to increase energy density have increased their total energy intake. This increase has been of immense benefit in rehabilitating malnourished children and has resulted in rapid rates of weight gain.


Metabolic and nutritional factors in children with renal insufficiency. Uremia is associated with a decrease in muscle and adipose tissue mass and a low weight-for-height ratio. These findings are related to dietary deficiencies in uremia--particularly energy deficiency and to metabolic disorders characteristic of uremia. These latter have features of an exaggerated catabolic state which may be modified by other stresses, e.g. short starvation or high-protein diets. Recommendations for diet therapy for children with uremia are of limited value because of the lack of definitive studies. At present, diet should be adequate in energy to improve nitrogen balance and weight gain commensurate with age. There may be advantages to using a protein:energy ratio in the diet that is lower than the ratio used in conventional diets.


Mechanisms of glucocorticoid inhibition of growth. Mechanisms whereby glucocorticoids might inhibit growth are reviewed from the perspective of glucocorticoid effects on cell metabolism and growth. Although glucocorticoids given to patients decrease levels of growth hormone and possible somatomedins, the effect of glucocorticoids on growth is not reversed when growth hormone is given. Glucocorticoids inhibit cell growth in culture. Cell inhibition correlates with binding of steroids to the glucocorticoid receptors. Some tissues are very sensitive; others are insensitive. In cell culture, changes in sensitivity can be associated with changes in binding, but this is not always the case in tissues of the animal. The mechanisms of inhibition of cell growth are not known. It could be due to steroid-induced synthesis of inhibitory proteins or to blocking by receptor-steroid complexes of the synthesis of RNA. Steroids may affect uptake of substrates, e.g., glucose or amino acids, which in turn affects growth. The inhibitory actions of glucocorticoids on individual tissues may explain why these steroids inhibit growth in the animal. It is not known, however, how the steroid inhibits linear growth in mass or which cell types are most important targets for such effects.


Statural growth of children with renal disease. Growth retardation occurs in 35 to 65% of children with kidney disease. It is especially common in children with congenital diseases of the kidney, anomalies, and inherited disorders. Acquired disease, however, also may impair growth, particularly where renal function (GFR) is below 25 ml/min/1.73 m2. Therapy used in renal disease, notably prednisone, also impairs growth. Chronic dialysis therapy, both hemodialysis and peritoneal, are associated with poor growth. Several specific changes in renal disease are associated with growth failure. These include, in addition to azotemia, acidosis, hyposthenuria, renal osteodystrophy, endocrine disorders and resistance to hormone action, and nutritional disturbances.


Abnormal amino acid and protein metabolism in uremia. The many alterations in amino acid and protein metabolism in renal failure are often poorly defined, and the available data concerning them are usually descriptive. Nonetheless, certain factors play an important role in the altered amino acid and protein metabolism of uremia. These include malnutrition caused by poor nutrient intake, loss of nutrients during dialysis, and abnormal metabolism of nutrients. Other factors include uremic toxins, superimposed catabolic illnesses, endocrine disorders, and the reduced capacity of the failing kidney to synthesize or degrade certain hormones, amino acids, peptides, and small proteins. These aberrations have complex interrelationships which sometimes potentiate each other. It is possible that the administration of sufficient quantities of energy, vitamins, and minerals, as well as the dietary manipulation of protein, amino acid and ketoacid intake may improve the metabolism of amino acids and proteins. Vitamin B6 and zinc have special requirements that may affect protein or amino acid metabolism.


Acidosis and growth in nonuremic renal disease. Our data demonstrate that correction of acidosis is sustained in children with type 1 RTA when alkali therapy is given in doses of 5 to 14 mEq/kg/day. The large doses are required as a result of renal bicarbonate-wasting. Children with type 1 RTA and acidosis who have significant growth impairment experience catch-up growth and attain normal stature for their age when correction of acidosis is sustained. Whether chronic acidosis impairs growth in any clinical condition except type 1 RTA is not settled. Whether sustained correction of acidosis with alkali therapy will allow attainment of normal stature in children with nonuremic diffuse renal disease is not yet determined. With the increasing availability of microchemistry and microgasometry and the new standards for growth based on mean-parent height [40], it can be anticipated that answers to these clinically important questions will be forthcoming.


Childhood renal osteodystrophy.

Childhood renal osteodystrophy. The processes of growth and remodeling that characterize growing bone are vulnerable to the biochemical effects of uremia. These processes are affected by the alterations in vitamin D metabolism and hyperparathyroidism that commonly occur with chronic renal insufficiency. Uremia interferes with cartilaginous developments as well. These changes, which are similar radiographically to vitamin-D-deficiency rickets, differ in their basic histological and biochemical evolution. They account for growth failure and deformity of long bones, which contribute to the short stature of children with renal insufficiency.


Somatomedin and growth retardation in children with chronic renal insufficiency. The somatomedins are a family of growth hormone-dependent insulin-like peptides which have been postulated to mediate the actions of pituitary growth hormone on skeletal tissue. The somatomedin peptides are part of a larger family of growth factors. Somatomedin has been measured by bioassays, by radioreceptor assays, and recently by a radioimmunoassay. Bioassays are influenced by glucocorticoids, sulfate, heparin, and other inhibitors; radioreceptor assays from different laboratories presently give conflicting results but early experience with the immunoassay is promising. Somatomedin levels are low in hypopituitary states, in malnutrition, and in general when growth hormone is low. Somatomedin's levels in uremia are variously reported. Most bioassays report low values, although the hole of inhibitors is not clear. Values by radioreceptor assays are normal or elevated, but their specificity is unproven. No data are available using radioimmunoassay. No study has addressed end-organ responsivity in uremia.


Growth and glucocorticoids in children with kidney disease. Glucorticoid therapy inhibits statural growth. Alternate-day therapy causes less growth suppression than does daily therapy, and, in experimental animals and children with asthma, it has been associated with normal growth. Although catch-up growth may occur after cessation of steroid therapy, this is not always the case, especially when therapy has been prolonged. In children treated with steroids for glomerulonephritis or nephrotic syndrome and especially in children after renal transplantation, factors other than steroid therapy may contribute to growth retardation. Steroids may suppress growth by direct action on cell metabolism, by inhibition of growth hormone or somatomedin and/or by effects on calcium and phosphorus metabolism. Present knowledge of mechanisms of action and dose-response relationships is complete, and it is difficult to prescribe therapy which will achieve a predictable therapeutic effect without inhibiting growth.


Measurement of growth in children with renal insufficiency. The serial measurement of stature, weight, skin-fold thickness, mean arm circumference, skeletal maturity, and where appropriate, stage of sexual development are recommended as suitable indices for assessing growth in children with kidney disease. Methods of expressing the data for evaluating the individual child are generally used methods. Emphasis is given to relating stature to bone age in evaluating growth potential. Methods for comparing growth rates in groups of children are less well-developed. Using standard deviation scores is recommended for comparing stature in two groups of children or in the same child observed at the end of two different regimens. Weight using ideal weight-for-height as reference from a group of children can be treated statistically. Data of skinfold thickness and arm circumference from two groups can be handled statistically only when the groups are comparable in age and sex.


[On the history of the teaching of squint (author's transl)]. After an introduction on the value of history also from modern medicine, the teaching of strabismus from the earliest begin at the time of Hammurapis (1700 BC) up to our times is broadly described. The old greek and latin ideas are analysed linguistically. The work of Johannes Müller and Emil Javel is especially emphasized with regard to advances in the teaching of squint and its treatment. Landolt, Maddox, Sattler and Bielschowsky above all have usefully completed these aspects. The knowledges over squint which were forgotten in many places in the first third of our century were rediscovered and considerably extended, at first by Worth, and later especially by Lyle, Bangerter, Hugonnier, Cüppers, and last but not least Heinrich Harms.


[The effect of low concentrations of pilocarpine with phenylephrine on intraocular pressure in glaucoma (author's transl)]. Orientating preliminary trials showed that the reducing action of pilocarpine on intraocular pressure is considerably enhanced by adding the alpha-receptor stimulant phenylephrine. Pilocarpine eyedrops 1% and pilocarpine drops 1% with phenylephrine 0.25% were compared in two double-blind crossover studies. Pressure reduction was more pronounced after administering the combination, the width of the pupil remaining unchanged. Attention is drawn to the advantages of pressure reduction without narrowing of the pupils in the treatment of all types of open-angle glaucoma. Miosis is of therapeutical advantage only in angle-closure glaucoma; hence, for reasons of safety, administration of phenylephrine should be avoided.


[Control of the viability of the endothelium of the graft in keratoplasty (author's transl)]. Since we use a very strict control of the viability of the endothelium of the graft, we have no more failures in corneal grafting, even not in cases with bad prognosis, such as Fuch's endothelial dystrophy. On the contrary, in corneal grafting without this control, we had a failure in 20% of the cases.


[Lamellar keratoplasty, ipsilateral rotation-autokeratoplasty and contralateral autokeratoplasty (author's transl)]. During the years 1967--1977, there were performed about 500 mostly perforating keratoplasties. Among these there were special groups: 50 lamellar keratoplasties (43 central, 7 marginal), 5 perforating ipsilateral rotation-autokeratoplasties 2 perforating contralateral autokeratoplasties. The results encourage to use these special keratoplasties more often instead of the usual perforating keratoplasty.


[Electronically controlled motor-trephine for keratoplasty under the microscope (author's transl)]. An electric driven Motor-Trephine for Kerato-plasty is presented. By electronic control the rotation speed of the trephine can be adjusted between 0 and 1000 RPM and shown by a digital indicator. The trephine improves the microscopical view of the operationsfield during the trephination. The trephine is produced by Hans Geuder Ltd.


[Conjunctival covering (Harms) (author's transl)]. The authors report on 7 cases of conjunctival flap cover in the technique of Harms and Mackensen (1963) in cases of leackage of the bleb after filtering operations. The technique consists in excision of the thin conjunctiva of the bleb, undermining of the conjunctiva until the fold, arched incision of the cornea in front of the bleb, incarceration of the conjunctival lip in the corneal incision with fixation by continuous suture with monophile nylon-string (10X0). In 6 of 7 cases the intraocular pressure was spontaneously regulated after the operation with morphological functioning bleb in 4 cases.


The effect of metoprolol on IOP (author's transl). The beta1-selective beta-blocking agent Metoprolol gave a significant intraocular pressure decrease in different groups of open angle glaucoma patients in a concentration of 1% and 3%. The magnitude of effect corresponded to 33% of the untreated pressure level. The maximum of the therapeutic response occured within 4 hrs after local application of the drug. A significant IOP decrease could be observed over 8 hrs after single application. There was no more effect after 24 hrs. Metoprolol eye drops did not affect pupillary diameter, pulse rate or blood pressure. The drug was tolerated well in all patients tested both subjectively and objectively after a single topical application.


[Cross-stitch suture in perforating keratoplasty (author's transl)]. 50 perforating keratoplastic operations were performed with cross-stitch suture in about 1 1/2 years. In 10 patients, the cornea was directly transplanted from the eye of the donor to that of the patient; in 40 cases, the cornea of the donor had been preserved for a short time. 49 patients had a clear transplant at the time of discharge about 3 weeks after the operation.


[Suture loosening after keratoplasty and methods for correction (author's transl)]. An analysis of histological and clinical findings in 102 keratoplasties confirms that suture loosening is often associated with defects found in Bowman's membrane and in the superficial stroma. These structures of the cornea serve as the major supporting layer for a suture. In cases of more generally weakened corneal tissue, like in keratokonus, suture loosening is also a relatively frequent occurance. In this paper we report on our experiences with correction methods, post-operative care and immunoprophylaxis after correction.


[Primary reconstruction of injured canaliculi (author's transl)]. Experiences of 163 patients with injuries of the canaliculi which were treated by different methods between 1960--1975 are presented. Of the 125 cases who were available for follow-up examinations, in 83.4% the injured canaliculus was patent. The advantages of retrograd introduction of the supporting silicon material is discussed. In more than 90% patency will be reached if microsurgical readaptation of the injured canaliculi by 3 direct sutures is done.


[Osteo-keramo-keratoprosthesis (author's transl)]. A high percentage of plastic keratoprosthesis is rejected again or intraocular infections occur because there is a cleft-like open junction between anterior chamber and lacrimal film. Only the ketratoprosthesis by Strampelli (1970) settles firmly in the cornea without the above risks, because the autogenous transplanted bone unites well with the grafted labial mucosa. 5 years of investigation have confirmed that glass ceramic Ceravital unites firmly with bones (Blencke et al. 1973, Strunz et al. 1977c, Bunte et al. 1977). For the osteo-keramo-keratoprosthesis Ceravital is used the same location as Dentin for the osteo-odonto-keratoprosthesis. The new surgical method has the advantage that 1. toothless patients can be operated, 2. the anterior chamber cannot flatten because the ceramic disk has the same shape as the corneal surface, and 3. broader optical cylinders can be used, by which a widening of the visual field is achieved.


[On the treatment of Terrien's marginal dystrophy (author's transl)]. Many techniques have been described for the treatment of Terrien's marginal dystrophy, which are intended to reduce the astigmatism, reduce complications and prevent a progression of the disease. Described here is a technique for performing a lamellar keratoplasty without rupturing the very thin recipient cornea while preparing the graft bed.


[Results of Cüpper's "thread fixation" in squinters with inconstant angle (author's transl)]. The results of strabismus operations on strabismus patients with variable angles are presented. The so-called "Fadenfixation" (Cüppers) is compared with the usual recess-resect method. Of the 62 cases of strabismus with variable angle which were operated without the "Fixation", only 3 cases were parallel post-operationem. By combining the recess-resect method with the "Fadenfixation" either on both eyes or on only one eye, a nearly parallel position was obtained in most cases. In some cases, following a "Fadenfixation" on one eye, a remaining constant angle was removed by a simple recess-resect procedure on the fellow eye. In 30% of the cases of esotropia, the "Fadenfixation" was the method of choice.


The renal kallikrein-kinin system in human and in experimental hypertension. The kallikrein-kinin system in the kidney is localized in the distal nephron, where it appears to be linked to processes that control water and electrolyte excretion. Some evidence exists that the effect of the renal kallikrein-kinin system is partially mediated by the release of prostaglandins. It has not yet been determined whether endogenous kinins affect the function of the nephron directly or indirectly by changes in renal blood flow distribution. Further, a number of studies in animals and humans indicates that kallikrein excretion is decreased in most types of hypertension, with the exception of hypertension caused by an excess of mineralocorticoids (where kallikrein is increased). In rats susceptible to the hypertensive effect of salt, kallikrein is conspicuously decreased. In renal diseases, urinary kallikrein excretion is also decreased. Finally, it still needs to be determined whether or not low kallikrein excretion is a pathogenetic factor in hypertension and renal diseases.


The effect of anticomplementary cobra venom factor on hyperacute rat cardiac allograft rejection. Cobra venom factor was used as a probe to evaluate the effect of depression of recipient hemolytic C3 activity on the sequential morphologic features of hyperacute cardiac allograft rejection in the rat. A series of ACI cardiac allografts transplanted to Lewis recipients presensitized &with ACI skin grafts was studied at arbitrary time periods over the initial 24 hours posttransplantation. The usual morphologic features of hyperacute rejection in this model, platelet aggregation, intravascular fibrin, endothelial destruction, neutrophil infiltration, and myocardial necrosis, were not observed in all allografts when recipient hemolytic C3 activity was virtually undetectable at the time of transplantation. Furthermore, allograft binding of rat C3 was not detected by immunofluorescence, although staining for IgG was commonly encountered. Despite profound depression of recipient hemolytic C3 activity, however, mononuclear cells were observed within the allograft microcirculation by 2 hours posttransplantation, and changes consistent with early cellular rejection were present in allografts examined at 24 hours. This study provides evidence that complement activation by graft-bound alloantibody is a critical effector mechanism of hyperacute rejection in this inbred rat model.


[Human prolactin (author's transl)].

[Human prolactin (author's transl)]. Human prolactin (hPRL) is the most recent anterior pituitary hormone in human endocrinology, whose structure has been elucidated in 1977. The possibility to measure hPRL in serum has led to a rapid increase of our knowledge of prolactin-physiology and -pathophysiology in men. hPRL is the only anterior pituitary hormone which is under predominantly inhibitory hypothalamic control. The effects of prolactin in the various species differ considerably, whereas in men it acts mainly upon the mammary gland and the gonadal system. Hyperprolactinemia leads typically to hypogonadism, amenorrhea and frequently galactorrhea. The hyperprolactinemia-hypogonadism-syndrome has been identified as a separate entity in recent years. Because of the relative frequency of this disease prolactin measurements have become of great importance in the diagnosis of sterility. Depending on the cause of hyperprolactinemia a neurosurgical, radiotherapeutical or medical treatment is indicated.


The renin-angiotensin-aldosterone system. Past, present and future. "The present results indicate that there is a close relationship between the incretory function of the kidney, which is shown by the discharge of renin and similar materials, and the function of the adrenal cortex, especially the zona glomerulosa, which is the place of production of the sodium-retaining hormone aldosterone . Salt load inhibits the production of renin and aldosterone, while salt deprivation stimulates the production of both. The excess of sodium-retaining corticoids (DOC or aldosterone) together with sodium suppress the secretion of renin, while a deficiency of cortical hormones (adrenalectomy, morbus Addison) increase it." ... "Under these conditions the development of experimental renal hypertension could be explained as follows: the narrowing of the renal artery stimulates the secretion of renin which itself increases the formation or discharge of mineralocorticoid hormones (aldosterone or similarly acting corticoids). The resulting retention of sodium does not lead to the normal reduction of renin secretion in the ischemic kidney, so that corticoid production in the adrenal cortex is further stimulated despite no need for it."


Ganglioside structures and distribution: are they localized at the nerve ending? Gangliosides generally provide a small portion of the complex carbohydrate content of cell surfaces. An exception is the central nervous system where they comprise up to 5--10% of the total lipid of some membranes. This tissue is unique in that the quantity of lipid-bound sialic acid exceeds that of the protein-bound fraction. Over 30 different molecular species have been characterized to date. These range in complexity from sialosylgalactosyl ceramide with 2 sugars to the pentasialoganglioside of fish brain with 9 carbohydrate units. Virtually all cellular and subcellular fractions of brain that have been carefully examined contain gangliosides to one degree or another, but the majority of brain ganglioside is located in the neurons. Their mode of distribution within the neuron has not been entirely clarified by subcellular studies. Calculations based on reported values for axon terminal density and synaptosomal ganglioside concentration in the rat reveal that nerve endings contribute less than 12% of total cerebral cortical ganglioside. It is concluded that the plasma membranes of neuronal processes contain most of the neuronal ganglioside. These and other considerations suggest the possibility that gangliosides may be distributed over the entire neuronal surface.


Alcoholism and the MMPI. A review.

Alcoholism and the MMPI. A review. The use of the Minnesota Multiphasic Personality Inventory in studies of the personality characteristics of alcoholics, marital interaction and alcoholism, alcoholism scales, and treatment outcome is reviewed.


The institutional phase of the Washington Total Abstinence Movement. A research note. Many of the practices and beliefs of the Washingtonian Total Abstinence Movement were adopted by reformatory homes for "drunkards" that were established in Boston, Chicago and Philadelphia in the mid-1800s.


Chronic peritoneal dialysis in juvenile-onset diabetes mellitus: a comparison with hemodialysis. Fourteen juvenile-onset diabetic patients accepted for renal transplantation and maintained on chronic peritoneal dialysis during a 3-year period were compared with a similar group of 43 patients accepted for renal transplantation and maintained on hemodialysis. The 1-year survival in each group was similar (52% on chronic peritoneal dialysis; 55% on hemodialysis), but there was a striking difference in progressive morbidity. Seven patients on chronic peritoneal dialysis were blind in one or both eyes at the onset, and visual acuity improved in two, including one bilaterally blind patient who achieved 20/35 vision bilaterally; none worsened. In the hemodialysis group, 12 patients were totally blind in one or both eyes and 11 additional patients became blind or had severe deterioration in vision; none improved. Neuropathy progressed in only 1 patient on chronic peritoneal dialysis, whereas it worsened in 17 patients on hemodialysis--9 to the extent that they needed braces or canes or were nonambulatory. All patients on chronic peritoneal dialysis were home trained and were dialyzed at night, with seven being able to work full or part time; virtually none of the patients on hemodialysis were able to work. Chronic peritoneal dialysis was relatively free of technical complication, and no significant difficulty was encountered in diabetic control, in the anephric state, or during abdominal surgery. Chronic peritoneal dialysis appears to have less associated morbidity than does hemodialysis in the treatment of chronic renal failure of juvenile-onset diabetes mellitus.


Two-gradient hypothesis of primary embryonic induction. The "two-gradient" hypothesis of primary embryonic induction was developed by Sulo Toivonen and his school in 1938--1968. The model postulates two inductive principles distributed as gradients in the inductor tissue. The prospective neuroectoderm becomes first uniformly neuralized by one of the factors, and only afterwards segregation is brought about by cells mesodermalized by the other inductor. The short review summarizes the experimental evidence for the "two-gradient" hypothesis.


Contact reactions influencing cell locomotion of a mouse sarcoma in culture. An investigation of the behaviour of cells of the mouse transplantable sarcoma S180 in culture by time-lapse cinematography has been made to determine how the spreading of a population from an explant is affected by contact reactions between the sarcoma cells; and how the invasion of a fibroblast population is affected by contact reactions with the fibroblasts. Although the sarcoma cells show a form of contact inhibition to each other, this has little influence on the spreading of a population, which is brought about very largely by diffusive movement, in sharp contrast to the spreading of a fibroblast population. The invasion of a fibroblast population by S180 cells takes place as a consequence of defective contact inhibition; though contact inhibition (but not contact paralysis) of the S180 cells has an appreciable incidence. During invasion the S180 cells, though moving on the exposed surfaces of the fibroblasts, may be largely using the collagen substratum between the fibroblasts for their locomotion. The arrangement of the fibroblasts produces some degree of contact guidance of the sarcoma cells.


Lectin binding in early mouse embryos.

Lectin binding in early mouse embryos. Lectin binding in early mouse embryos was used to explore possible changes in cell surface properties during early development. Embryos at different stages of development were stained with fluorescein-coupled Concanavalin A (FITC-Con A) or wheat germ agglutinin (FITC-WGA). In zygote to 8-cell embryos, fixed with paraformaldehyde before staining or stained at 4 degrees C before fixation, the fluorescein-coupled lectins gave a continuous ring-like labelling of cell surfaces. When unfixed embryos stained at 4 degrees C with low concentrations of FITC-Con A (10--20 microgram/ml) were incubated at 37 degrees C they showed a continuous surface labelling at zygote stage but a patch-like aggregation of Con A-binding sites in 2-cell stage and older embryos. Use of higher lectin concentrations ( greater than 100 microgram/ml) did not result in patch formation at 37 degrees C. FITC-WGA gave a spotty but unaggregated labelling pattern also at 37 degrees C. The results show that in the early stages of mouse embryogenesis developmentally associated changes occur in the binding behaviour of Con A but not of WGA.


Factors affecting physician participation in a state Medicaid program. Critical to policy planning for a program of national health insurance or a National Health Service is an understanding of the strengths and weaknesses of current federally-supported health programs. One program which has been subjected to criticism is Medicaid. A major problem facing Medicaid is the high proportion of physicians who refuse to participate in the program, thus preventing the target population from obtaining access to medical care. A telephone survey was conducted to assess the attitudes and behavior of a stratified random sample of physicians regarding their participation in a Medicaid program. Physicians were asked to identify major advantages and disadvantages of the program to individual patients, to society and to their medical practice. Non-participants were asked to identify the major reasons why they did not participate in the program. Medical specialty was the only significant demographic determinant of participation. Inadequate reimbursement, excessive paperwork, patient abuses of the program and bureaucratic complexity were among the most prominent factors contributing to nonparticipation. Implications of these findings are discussed with respect to the role of primary care providers' perceptions in the planning of future national health programs.


[Retroperitoneal injuries: introduction (author's transl)]. Injuries of the retroperitoneal organs occur mainly in patients with multiple traumas. Spine and spinal muscle provide an effective protection against blunt trauma from behind. In the front the thin peritoneal layer is just a biological border. Therefore injuries of the abdominal and retroperitoneal organs frequently occur together. Direct clinical examinations are limited by the specific anatomical situation; further invasive diagnostic procedures deal mainly with indirect effects of retroperitoneal injuries. Massive hemorrhage with consequent retroperitoneal hematoma is the dominant pathophysiologic course; mortality is high.


[Postthrombotic syndrome 1978 (author's transl)]. Venous reconstruction is frequently endangered by the slow velocity of the blood. Thrombotic occlusion may be prevented by a temporary arteriovenous shunt. The conventional technique of temporary arteriovenous shunting, however, bears the danger of late arterial stenosis. Furthermore, the transposition of blood into the subcutaneous region may result in a dilation of the venous graft. This is demonstrated in a case of Palma's operation. The early results with a suspended ring suture of our own design are encouraging. Surgery of secondary alterations in case of postthrombotic syndrome is illustrated by some outstanding examples.


[Injuries of the maxillofacial region (author's transl)]. The essence of the Basle study on city traffic accidents is a 60% decrease of head injuries following the increase of car occupants wearing seat belts. The Heidelberg study shows similar results. The frequency of facial and cervical soft tissue injuries is 27% with 114 belt wearers and 71% with 1250 car occupants not wearing seat belts. The pattern of lacerations caused by the windshield is discussed. Duly fixed seat belts offer a real chance of survival and only minor injuries at a collision speed of 70 km/h.


[III. Continued education in surgery. A. Prospective studies, methods for determination of therapy results. Topics on and results of prospective studies in surgery]. Since the first clinical prospective trial of J. Lind in 1753, the controlled study has proved to be an essential instrument in clinical research. Possible topics include: pharmacologic prophylaxis of complications such as stress ulcer, thrombosis, etc., indications for operation, preoperative preparation, choice of surgical procedure, and techniques or postoperative treatment. Examples for each topic are given.


[Planning and data analysis in prospective controlled clinical trials (author's transl)]. Planning of prospective controlled clinical trials in surgery requires the use of test and control groups, sufficiently frequent repetition of experiments, random allocation of patients to the groups (example), and balancing. The descriptive data analysis should be performed in a stepwise manner (list of new data, rank list, range, median, quartiles, histogram, mean value standard deviation). The advantages of the median-quartile-system and the prerequisites for application of various significance tests are pointed out. In the conduct of controlled clinical trials, the consultative role of experimental surgeons is proposed.


[Colon anastomosis: single-layer (row) suture (author's transl)]. Comparison of two groups of patients with different anastomosis techniques (622 large-bowel resection) demonstrates a lower rate of complications with the single-row anastomosis. These observations were proved in dogs and rats. The double-row suture prolonged the healing process, delayed revascularization, and led to the formation of intramural abscess and stenotic intraluminal roll building. These problems were not observed in single-row anastomosis, which is designed to promote faster healing.


[Colonic suture technique: double-layer suture (author's transl)]. A comparison of the results with single- and double-layer adapting sutures without general proximal colostomy shows no differences. This fact is supported by our experiences in 106 resections of the left half of the large bowel.


[On the importance of cholesterol granuloma (author's transl)]. Cholesterol granuloma consists of solid metabolic waste products. The essential cause is a closed unaerated space in the middle ear cleft with proliferation of the mucosa, a connective tissue increased production of mucous and their subsequent organisation. During the resorption of this poorly digestable mucous cholesterol crystals are formed which in turn leads to small haemorrhages, increased fibrous tissue formation as well as the accumulation of foreign body giant cells. The analysis of 101 specimens showed different histological forms of cholesterol granuloma due to the different duration of the local pathological process. In the final stages the granulation tissue undergoes dystrophic calcification or necrosis. There is no influence on the adjacent bone. Cholesterol granuloma does not seem to be an important clinical entity. The therapy is the same as for the infectious process that is also present in the same ear.


Preservation of a radionecrotic larynx by excision of thyroid cartilage with flap coverage. Necrosis of the larynx following radiation therapy is a rare complication leading to severe disability and even death. Generally accepted treatment has consisted of incision and drainage, debridement, and tracheotomy or even total laryngectomy. One patient developed chondronecrosis of the thyroid cartilage and was treated by excision of the entire thyroid cartilage and overlying skin with subsequent coverage by a unipedicled cervicothoracic flap. The patient has had his tracheotomy corked or been decannulated for 11 months with preservation of a useable larynx.


[Evolution towards generalization and cancer of a muco-cutaneous leishmaniasis treated with corticoids. (Report of a Chadian case) (author's transl)]. The authors present a case of muco-cutaneous leishmaniasis in the Republic of Chad. In that case, a long duration treatment with corticoids entailed the generalization of the disease in the form of a secondary kala-azar and the appearance of a histiocytosarcoma on the scar left by the oriental sore. Comments on the pathogenesis of leishmaniasis are then exposed.


Effect of ethanol and its metabolites on glucose mediated insulin release from isolated islets of rats. Effects of ethanol and its metabolites, acetaldehyde and acetate, on insulin secretion were studied in isolated islets from normal rats. Addition of ethanol to the incubation media inhibited glucose mediated insulin release in a dose related manner. Prior exposure of islets to ethanol during the preincubation period had no influence on subsequent insulin response to either glucose or glucose plus ethanol. Acetaldehyde inhibited while sodium acetate potentiated insulin response to glucose. It is concluded that ethanol has a direct inhibitory effect on glucose mediated insulin release from rat islets.


In vitro resistance test of human leprosy bacilli to anti-leprous drugs. Sensitivity to anti-leprous drugs of M. leprae isolated from an L-type leprosy patient was tested using M--Y 14b liquid medium by direct and indirect methods. The results revealed that the strain, SR61-L74, was almost completely resistant to DDS, and responded only to the long-term administration of Streptomycin and Isoniazid. However, the strain was completely sensitive to rifampicin which had never been administered previously. The subsequent administration of rifampicin resulted in a rapid improvement of the patient's clinical symptoms. It can be concluded that the in vitro method, both direct and indirect, to test the sensitivity of M. leprae to anti-leprous drugs is economic, and accordingly available practically as one of the routine examinations in the laboratory of ordinary leprosaria. This must be very beneficial to the treatment of leprosy patients.


The lethal action of 2-phenoxyethanol and its analogues upon Escherichia coli NCTC 5933. Bactericidal activity has been assessed for a number of glycolmonophenyl ethers towards Escherichia coli NCTC 5933, and the action of one analogue, 2-phenoxyethanol, has been studied in greater detail. For this compound the onset of bactericidal activity towards Escherichia coli occurred at concentrations which also induced considerable increases in drug uptake, marked leakage of cytoplasmic constituents, the cellular penetration of N-tolyl-alpha-napthylamine-8-sulphonic acid, and morphological changes consistent with gross membrane damage. However, temperature coefficients of rates of cellular leakage of low molecular weight cytoplasmic constituents, and rates of kill, were markedly different and suggested that the two phenomena were not integrally related, but that each was a consequence of some other action of the drug. Drug levels considerably below those possessing lethal activity, however,  promoted the ready efflux of potassium ions from cells and caused disorganisation of the outer lipopolysaccharide-rich regions of the cell envelope.


Some features of the reaction of intracellular bacteriophages T1 to UV irradiation. The reaction of complexes pf phage T1-cells of E. coli B or E. coli Bs-1 to UV irradiation was investigated. The complexes were irradiated at various stage of infection, and their survival, extent of Hcr and Phr, were evaluated. It was found that the UV resistance of phage DNA in the second half of the latent period fluctuates. Hcr after UV exposure at these stages of infection operates in a small volume. The ability of intracellular phage to photoreactivate when cells of E. coli B were infected is constant after irradiation at many stages of infection, except the early ones. In the complexes of phage T1-bacteria of E. coli Bs-1 this ability declines while infection is promoted. The daughter phage particles released from UV irradiated complexes undergo Phr and Hcr only after irradiation at the late stages of infection. This was not the cases when complexes of phage-bacteria were irradiated during the first half of the latent period. A possible tole of UV-damaged phage DNA in propagation of infection and in maturation of phage particles is discussed.


Effect of chloramphenicol and cyanide on the increase in UV resistance of intracellular bacteriophage T1. The effects of chloramphenicol and cyanide on the increase in UV resistance of intracellular phage T1 infecting cells of E. coli B or E. coli Bs-1 were investigated. The inhibitiors were added to the cells 3 min prior to infection and to the complexes of phage-bacteria 3.5 and 6.5 min after adsorption of phage by the cells. The data obtained are not in agreement with the suggestion that increase in UV resistance of intracellular phage is mainly due to the accumulation of phage DNA inside the host cells. It is suggested that a very important role in this resistance is played by the interaction of phage DNA with the cell membranes.


Estimators of the number of objects per area unbiased by edge effects. A survey is given of principles for obtaining an estimate of the numerical density of profiles not biased by the edge effect in planar samples. Various practical problems of implementation of the principles are discussed. None of the methods represent the ideal combination of independence of assumptions concerning both profiles and frame as well as independence of information external to the frame. The counting rules usually employed in the determination of numerical density are biased and also unnecessarily complicated. For manual work only two unbiased principles apply. The choice between them is mainly determined by the ease by which they are implemented.


Beclomethasone dipropionate aerosol in the treatment of children with severe perennial rhinitis. Twenty-two children suffering from severe perennial rhinitis were treated with intranasal beclomethasone dipropionate (300 microgram/day) and an identical placebo aerosol in a double-blind cross-over trial. The results confirmed the value of beclomethasone dipropionate in improving nasal symptoms and signs due to perennial rhinitis, and allergic eye symptoms caused by associated conjunctivitis.


Maternal herpetic breast infection: another hazard of neonatal herpes simplex. After the death of an eight-day-old breast-fed neonate with disseminated herpes simplex, the mother was found to have herpes simplex infections of both nipples. This complication of neonatal herpes infection does not appear to have been reported previously.


Malaria: a new facet of heroin addiction in Australia. A case of vivax malaria is described. The patient, who had occasionally abused heroin intravenously, shared injection equipment with an addict who had previously contracted malaria in Southeast Asia and who had failed to complete an adequate course of treatment.


[Computer-aided reading of ECG (author's transl)]. Computer-aided reading of 12-lead scalar ECGs was performed in 1800 cardiovascular patients with a tracing-and processing-system of IBM, Periphere Computer Systeme and Schwarzer using the Bonner analysis program. After analog-to-digital conversion and storage on a floppy disk the ECG data were transferred by telefone during night because of lower rates to the IBM computer at Munich. In the same way the prints were received from there. The review by a cardiologist showed correct interpretations in about 90%. False negative and other inadequate readings were found in 6% while false positive results were obtained in almost 1%, the remaining percents belonged to technical troubles.


Utilization of an automated ECG interpretation system in an ambulatory health service. A computerized ECG interpretation system was incorporated into a large ambulatory health care service. The central unit has several terminals located at various regional cardiological clinics. In each clinic 80--120 ECG's are taken daily, of which 56% are interpreted as normal tracings. The interpretation system is currently utilized to separate automatically normal from abnormal tracings. Normal tracings are not re-checked by a cardiologist and the report is delivered directly to the family physician. In order to evaluate the reliability of the computer interpretation of normal ECG's (i.e., the percent of false-negative readings), 500 tracings interpreted by the program as normal were selected at random and read independently by three cardiologists. It was found that in 4.6% of the cases additional remarks were supplemented to the computer statement by at least one of the cardiologists. Most of the computer-cardiologist disagreements were of limited clinical importance. It was concluded that this system could be used as an effective tool for simultaneously processing ECG's from several remote locations, serving large ambulatory populations. By using the assistance of the computer system, marked reduction in cardiologists' time and cost could be achieved.


Practical considerations in gamma camera line spread function measurement. In recent years the modulation transfer function (MTF) has played an important role in the quantitation of imaging performance of gamma cameras. The most common method of MTF determination requires line spread function (LSF) measurement. This paper reviews methods used for LSF measurements with special consideration given to the practical aspects of LSF measurement and MTF calculation. An analysis of errors in LSF measurements is made and means to reduce or to avoid these errors are discussed. Recommendations regarding practical considerations for LSF measurement and MTF calculation are presented in tabular form for convenience.


Yeast temperature-sensitive mutants specifically impaired in processing of poly(A)-containing RNAs. The selection at 22 degrees C of yeast cordycepin (3'-deoxyadenosine) sensitive mutants which would be temperature-sensitive at 37 degrees C allowed the obtention of mutants specifically impaired in processing of Poly(A)-containing RNAs at 37 degrees C. The mutants displaying this phenotype belong to two different loci. The biochemical study of the physiological function which is blocked by the mutation has revealed that the level of radioactive Poly(A)-containing RNAs found in a 5 min pulse after a 10 min shift at 37 degrees C is 6 times less in the mutants than in the wild type without reduction of the non Poly(A)-containing RNAs fraction. Further studies have shown no alteration in the two Poly(A) polymerases activities and suggest strongly a faster decay of Poly(A)-containing RNAs in the mutants.


Pet18: a chromosomal gene required for cell growth and for the maintenance of mitochondrial DNA and the killer plasmid of yeast. Mutations in the pet18 gene of Saccharomyces cerevisiae (formerly denoted pets) confer three phenotypes on mutant strains: (i) inability to respire (petite), (ii) inability to maintain the double-stranded RNA killer plasmid (sensitive), and (iii) temperature sensitivity for growth. We find that pet18 mutants lack mitochondrial DNA. However, despite their inability to maintain the killer RNA plasmid and mitochondrial DNA, pet18 mutants still can carry the other yeast plasmids, [URE3--1], [PSI], and 2-micron DNA. The temperature sensitivity of the pet18 mutants is not expressed as a selective defect in total DNA, RNA, or protein synthesis.


A mutation to 5-methyltryptophan dependence in the tryptophan (trp) operon of Salmonella typhimurium. II. Studies of 5-methyltryptophan-dependent mutants and their revertants. Mutants of S. typhimurium with a defect in the first structural gene of the trp operon can utilize anthranilic acid (AA) as a growth factor. Among a group of 5-methyltryptophan (MT) resistant derivatives of trpA mutants we encountered several with a novel phenotype: they actually grew better in the presence of MT than in its absence. Normally MT inhibits growth of S. typhimurium at the concentration we employed due to its ability to act as co-repressor of the trp operon and as a feedback inhibitor of anthranilate synthetase (AS) the first enzyme for tryptophan biosynthesis. Mutations to MT-dependence were only found in strains carrying extremely polar trpA mutations. In all cases analyzed, mutations causing MT-dependence mapped at the extreme operator distal end of trpA. The mutation trpA515 responsible for MT-dependence in strain SO61 (genotype trpA49trpA515) was recombined away from the polar mutation. The strain thus obtained, SO495 was totally dependent on MT for growth on AA supplement. Strain SO495 lacks AS and under repressing growth conditions synthesizes the trp enzymes constitutively at 2--3 times the basal level. Under derepression, while the levels of the distal enzymes, as represented by tryptophan synthetase--beta subunit (TSbeta), did not increase there was a marked drop in the activity of anthranilate-PRPP phosphoribosyltransferase, (PRT) the enzyme catalyzing the second step of tryptophan biosynthesis. trpA515 was found to revert to prototrophy at a low frequency (about 10(-8)) which was not increased by chemical mutagens or ultraviolet radiation. In contrast, it was found to revert to MT-independence (growth on AA in the absence of MT) at a fairly high spontaneous frequency (about 10(-6)) and this frequency could be increased approximately tenfold by mutagens causing base substitutions or deletions but not by frameshift mutagens. About one hundred MT-independent revertants of trpA515 were mapped and found to fall into three general classes: (A) mutations at or near the trpA515 site (B) secondary mutations located upstream from trpA515, (C) deletions of various sizes. Based on a detailed genetic and physiological study of twelve representative MT-independent revertants, it appears that trpA515 may be caused by the insertion of a piece of DNA with some of the properties described for the IS elements found in Escherichia coli. The trpA515 insertion should contain (in this order), a transcription terminator, a low efficiency promoter and, probably, a translation start signal.


Tissue substitutes in experimental radiation physics. In this review of tissue substitute materials, the historical development of the important systems is traced from the early 1900's. Tabulations of the constituents, elemental compositions, specific gravities, and the photon and electron interaction characteristics of 64 materials are given together with recommendations of systems having useful simulation properties. Formulation and manufacturing procedures are described and possible future developments in both materials and phantom research are outlined.


Genetic and biochemical analysis of mutants induced by bacteriophage Mu DNA integration into Klebsiella pneumoniae nitrogen fixation genes. Polar mutations were obtained by integration of bacteriophage Mu c+ or Mu cts DNA into the Klebsiella pneumoniae nif genes located on plasmid pCE1, a derivative of pRD1. In addition, nif deletions were isolated from nif::Mu cts plasmids. Complementation data allowed the characterization of twelve nif cistrons, nine corresponding to previously identified genes. Polar effect of Mu DNA insertions suggested the existence of at least six transcription units: 1) nif K, nif D and nif H--2)nif A and nif L--3) nif E and a new gene--4) nif B--5) nif F--6) nif J. Nif K, nif D and nif H, which are most probably the structural genes for nitrogenase, seem to belong to the same operon transcribed from nif H to nif K. This was confirmed by SDS gel autoradiography of pulse labelled proteins. Moreover it was possible to identify, on the autoradiograms, a polypeptide which likely is the product of nif J and whose biosynthesis is under the control of nif A.


Distribution of mitochondrially inherited drug-resistance genes to tetrads from young zygotes in yeast. Pairs of strains of opposite mating type were isolated from a strain of Saccharomyces cerevisiae. From these isogenic strains, mitochondrially inherited resistant mutants to antimycin A and erythromycin were isolated. By using the two resistance genes as mitochondrial markers, it was proposed that the distribution of the mitochondrial genomes from zygotes to tetrads seemed not to be random but the genomes from either a or alpha parent would be selected with approximately equal frequencies after zygote formation and subsequently distributed uniparentally to meiotic products.


Restriction map of the antibiotic resistance plasmid R1drd-19 and its derivatives pKN102 (R1drd-19B2) and R1drd-16 for the enzymes BamHI, HindIII, EcoRI and SalI. The conjugative R plasmid R1drd-19, mediating antibiotic resistance to ampicillin (Ap), chloramphenicol (Cm), kanamycin (Km), streptomycin (Sm) and sulfonamides (Su) was mapped using the restriction endonucleases BamHI, HindIII, EcoRI and SalI. BamHI generates 5 fragments (A-E) with molecular weights between 46 x 10(6) 0.25 x 10(6) dalton, and HindIII 8(A-H) between 42 x 10(6) dalton (representing mainly the RTF) and 0.25 x 10(6) dalton (representing the main part of the RTF) and 0.1 x 10(6) dalton. EcoRI recognises 17 sites and produces fragments (A-Q) with molecular weights between 11.7 and 0.1 x 10(6) dalton. SalI yields 7 fragments (A-G) of 16.5 to 2.0 x 10(6) dalton. A physical map was constructed from fragments obtained by partial digestion of R1drd-19 with one restriction enzyme, by double and triple digestion of the DNA with two or three enzymes with and without isolation of individual bands from preparative gels. In addition the restriction patterns of several mutants of R1drd-19 were compared with it. Evidence is presented which indicates that the derivatives of R1 investigated are generated by extended deletions, namely the copy mutant pKN102 which has lost the Km resistance, R1drd-16, which has lost all resistances other than Km and the Kms derivative of R1drd-16, which represents the pure RTF. The map of R1drd-19 is remarkably different from those of R100 and R6-5. Its molecular weight was estimated to be 62.5 Md. The circular fragment order for BamHI is: A-C-B-D-E, for HindIII: A-D-C-B-F-H-E-G, for EcoRI: A-C-K-B-F-J-O-D-H-L-G-P-Q-N-I-E-M- and for SalI A-B-C-D-G-F-E.


Lambda transducing phages for the nalA gene of Escherichia coli and conditional lethal nalA mutations. Defective lambda transducing phages for the nalA region of the Escherichia coli chromosome were isolated from a lysogen in which lambda is inserted in the nearby glpT gene. The three classes of transducing phages designated lambdanrdA, lambdaubiG, and lambdadnalA contained bacterial DNA extending from glpT through nrdA, ubiG, and nalA, respectively. The bacterial genes are in the left arm of the lambda chromosome. Of the eleven polypeptides coded by lambdadnalA that were resolved by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate only one was not also specified by lambdadubiG. This 105,000 dalton polypeptide is the nalA gene product. The electorphoretic mobility and isoelectric point of this protein were unaffected by a nalA mutation (nalA48) that confers nalidixic acid resistance. Temperature-sensitive and amber mutations in the nalA gene were isolated using a lambdadnalA48 lysogen which is heterodiploid for nalA. The conditional lethality of these mutations proves that nalA is an essential locus.


Endonuclease alpha from Saccharomyces cerevisiae shows increased activity on ultraviolet irradiated native DNA. Endonuclease alpha isolated from the nucleus of the yeast Saccharomyces cerevisiae is a DNA endonuclease which has been shown to act preferentially on denatured T7 DNA. The purified enzyme is more active with UV-irradiated native T7 DNA than with unirradiated substrate. The relation between damage, measured by pyrimidine dimer concentration, and excess endonuclease activity is most readily explained by local denaturation caused by presence of pyrimidine dimers. When three radiation sensitive mutants of yeast were tested for the level of endonuclease alpha present, none were found lacking the enzyme. However, nuclei of strain rad 1-1, a mutant that may be defective in heteroduplex repair as well as excision repair, were found to contain reduced levels of the endonuclease. The enzyme isolated from this strain had less than one half the specific activity of similar preparations from wild type yeast.


Detection of aberrant nuclear DNA metabolism in a conditional mutant of Saccharomyces cerevisiae. A single recessive nuclear gene mutation has been isolated from strain 123.1C of Saccharomyces cerevisiae which appears to be conditionally deficient in nuclear DNA metabolism. Growth of the mutant strain at the elevated temperature of 36 degree C results in rapid loss of cell viability. However, no apparent reduction in the rate of radioisotope incorporation into DNA was detected during this period. When haploid cells carrying this temperature sensitive lesion were exposed to the restrictive temperature for varying lengths of time, returned to the permissive temperature, mated with a non-temperature sensitive strain and then the resulting diploids made to undergo meiosis, a greatly reduced number of viable spores were produced. Genetic analysis of the viable spores produced by these diploids has revealed aberrant auxotrophic marker segregation patterns. Thus, these results suggest that the mutated gene hardbored in this strain plays a vital role in the metabolism of the nuclear genome.


Uv-inducible repair II: its role in various defective mutants of Escherichia coli K-12. Involvement of UV-inducible protein(s) in repair of various E. coli K-12 cell strains has been investigated using a procedure of double UV irradiation and postincubation with chloramphenicol. From the course of dose survival curves the following conclusions concerning significance of a UV-inducible protein have been drawn: 1. It is a very important for wild type cells; in these cells its early occurrence is necessary to prevent killing. 2. It is involved in repair of excision-deficient cells; however, its action early after UV is less urgent. 3. It is not involved at all in repair of lex mutant cells; 4. It exhibits some effect on survival of recA as well as recB mutant cells. We conclude that the protein is involved in excision repair as well as in resumption of DNA replication.


A site of action for tRNA mediated regulation of the ilvOEDA operon of Escherichia coli K12. Transfer RNA (tRNA), rho factor threonine deaminase and the ilvO locus are molecular participants in the regulation of isoleucine-valine (ilv) biosynthesis. Isogenic strains have been constructed with the hisT76 mutation in pairwise combination with ilvO mutations, the rho221 mutation and the ilvDAC115 deletion mutation. The role of the altered tRNA of the hisT76 mutation was found to be independent of the sites of action of the ilvO- mutation, rho factor, and threonine deaminase. The expression of the ilvOEDA operon is stimulated 2-fold when the hisT76 mutation is present in strains containing either ilvO- or rho221 mutations. The expression of the ilvOEDA operon remains nonrepressed in a hisT76 strain deleted for threonine deaminase. These results indicate that the hisT76 undermodified tRNAs are influencing the initiation of transcription of the ilvOEDA operon.


[Non-leukemic disease of the central nervous system in children with acute lymphoblastic leukemia. I. Somnolence syndrome (author's transl)]. Prophylactic irradiation of the skull and intrathecal application of methotrexate has proven to be highly effective in preventing central nervous system disease in acute lymphoblastic leukemia or non-Hodgkin-lymphoma. Prophylactic treatment may be complicated by a somnolence syndrome occuring 4--8 weaks after the end of irradiation. The main features of this clinical entity are somnolence, lethargy, dullness, anorexia, headache, and vomiting. EEG frequently displays a distinct slowing of activity. All symptoms are reversible after 3--49 days. The syndrome clearly is consequence of skull irradiation. Its metabolic basis probably is transient disturbance of myelinization.


The taxonomy of binding sites in proteins. Conservation of polypeptide fold and mode of ligand binding is frequently found within proteins of related function. Examples illustrating this phenomenon are taken from NAD linked enzymes, nucleotide binding proteins, polysaccharide binding proteins, heme binding proteins and enzymes with essential Fe--S complexes or zinc atoms.


[Non-leukemic disease of the central nervous system in children with acute lymphoblastic leukemia. III. Subacute sclerosing panencephalitis (author's transl)]. Diseases of the central nervous system (CNS) occurring during treatment of acute lymphoblastic leukemia (ALL) may be of leukemic or nonleukemic origin. Well known examples for CNS disease of nonleukemic origin are somnolence following prophylactic CNS irradiation, methotrexate-induced encephalopathy and acute infections caused by bacteria, viruses and toxoplasma gondii. Less known is the fact that also subacute CNS infections may occur in patients undergoing cytostatic therapy. Progressive multifocal leukoencephalopathy and subacute sclerosing panencephalitis (SSPE) are examples of this category of disease. Up to now 11 well documented cases of SSPE were reported occurring during treatment of ALL. Main clinical features were disorders of behaviour, consciousness and speach, seizures, paresis and inappropriate secretion of ADH. Several authors were able to demonstrate a deficiency of cellular immunity in patients with SSPE. In some cases this deficiency was consistent with reduced reactivity of T-lymphocytes against measles antigen only. The presence of inhibiting factors may be responsible for this phenomenon. Other authors found a normal or increased function of cellular immunity in SSPE; In hamsters occurrence of SSPE is induced by the simultaneous injection of hamster-adapted SSPE virus and antihamster lymphocyte serum. We, therefore, conclude that also in humans SSPE appearing during treatment of ALL is due to immunosuppression.


[The injured nose of the newborn. A review (author's transl)]. In the newborn the following traumatic alterations of the nose can be seen: lesions of the soft tissues, flat noses (30--60%), damage by tubes, fixed nasal deformities (0.5%), treatable anterior septal dislocations (2--23%), and combined septal deformities (up to 50%). The literature of the last 100 years is reviewed as to the high frequency of these alterations, their etiology, diagnosis, and treatment, which is necessary within the first days of life. Therefore routine examination of each newborn by an oto-rhino-laryngologist is recommended.


The role of inducible gene rer of Escherichia coli K-12 in DNA repair and mutagenesis. Further characterization of a UV- and gamma-ray-sensitive mutant of Escherichia coli K-12 mutated in gene rer revealed that, as a result of this mutation: (1) neither bacterial capacity to excise thymine dimers from its DNA nor capacity to reactivate UV-irradiated phage lambda (Hcr+) was affected; (2) sensitivity to EMS and MC was increased; (3) WR of phage lambda was poor, whereas pre-irradiation growth of the mutant in MM only marginally restored WR; (4) the yield of UV-induced mutations was normal on MM, whereas on RM a decline below the spontaneous level was observed; and (5) induction of prophage by UV was not affected. The medium effect on UV sensitivity was largely post-irradiation. The rer recA double mutant was as UV sensitive as recA alone, and the media-dependent UV sensitivity exhibited by the rer strain disappeared in the double mutant. We provide further evidence to strengthen the earlier suggestion that rer might be involved in the control of replication of damaged DNA rather than participating directly in repair. It is further proposed that the rer+ gene is inducible and has a role in post-replication repair.


Bromouracil mutagenesis and mismatch repair in mutator strains of Escherichia coli. A screening procedure based on the formation of papillae on individual bacterial colonies was used to isolate mutants of Escherichia coli with high mutation rates in the presence of bromouracil. Most of the mutants obtained had high spontaneous mutation rates and mapped close to the previously known mutators mutT, mutS, mutR, uvrE and mutL. Except for mutants of mutT type, these mutators also showed high mutability by bromouracil. Transfection experiments were performed with heteroduplex lambda DNA to test for mismatch repair. The results suggest a reduced efficiency of repair of mismatched bases in mutators mutS, mutR, uvrE and mutL, whereas mutants mapping as mutT appear normal. The results support a connection between spontaneous and bromouracil-induced mutability and repair of mismatched bases in DNA.


Mutagenic interaction between near-(365 nm) and far-(254 nm)ultraviolet radiation in repair-proficient and excision-deficient strains of Escherichia coli. The mutational interaction between radiation at 365 and 254 nm was studied in various strains of E. coli by a mutant assay based on reversion to amino-acid independence in full nutrient conditions. In the two repair-proficient strains (K12 AB 1157 and B/r), pre-treatment with radiation at 365 nm strongly suppressed the induction of mutations by far-UV, a phenomenon accompanied by a strong lethal interaction. The frequency of mutations induced by far-UV progressively declined with increasing dose of near-UV. Far-UV-induced mutagenesis to T5 resistance was almost unaltered by pre-treatment with near-UV. In AB 1886 uvrA there was no lethal interaction between the two wavelengths but the mutagenic interaction was synergistic. This synergism was maximal at a 365-nm dose of 8 X 10(5) J m-2. It is proposed that in the wild-type strain, cells containing potentially mutagenic lesions are selectively eliminated from the population because of abortive excision of an error-prone repair-inducing signal. In excisionless strains, 365-nm radiation may be less damaging to the error-prone than to the error-free post-replication repair system. Alternatively, mutation may be enhanced because of the occurrence of error-prone repair of 365-nm lesions by a system that is not induced in the absence of 254-nm radiation.


Influence of the recF143 mutation of Escherichia coli K12 on prophage lambda induction. Prophage lambda induction in a recF143 mutant of E. coli K12 was studied. The recF143 (lambda) lysogen was inducible by UV irradiation or treatment with mitomycin C. However, the time required for the onset of derepression brought about by these treatments was longer in the recF143 mutant than in rec+ strains, suggesting that the induction pathway was altered in the recF143 mutant. The recF143 (lambda) lysogen was induced at very low doses of UV irradiation or mitomycin C treatment. Moreover, the presence of the recF143 mutation increased the sensitivity to thermal induction of a tif strain.


Effects of chemical and physical mutagens on the frequency of a large genetic duplication in Salmonella typhimurium. I. Induction of duplications. In Salmonella typhimurium a simple selection has been described to detect bacteria that are merodiploid for almost one-third of the chromosome. The selective procedure is based upon improved utilization of L-malate as the sole carbon source in merodiploid strains. The spontaneous frequency of the duplication in haploid strains is approximately 10(-4) per cell plated. Following the exposure of a haploid strain to mutagenic agents, there is a dose-dependent increase in the duplication frequency above the spontaneous level. In this paper we describe the induction of genetic duplications in Salmonella typhimurium by X-rays, ultraviolet light (UV), ethyl methanesulfonate (EMS), nitrous acid, and the azaacridine half mustard, ICR-372.


Effects of chemical and physical mutagens on the frequency of a large genetic duplication in Salmonella typhimurium. II. Stimulation of duplication-loss from merodiploids. Strains of Salmonella typhimurium which contain a duplication of approximately 30% of the genome may be obtained by a simple selective procedure. These strains are highly unstable, losing the duplication when grown on non-selective medium. In this paper we report that treatment of merodiploid bacteria with mutagenic agents stimulates the rate at which haploid segregants are obtained from merodiploid strains. The mutagens which have been tested for this effect are X-rays, ultraviolet light (UV), ethyl methanesulfonate (EMS), and the azaacridine half-mustard ICR-372.


Disappearance of Ph1-positive cells in four patients with chronic granulocytic leukemia after chemotherapy, irradiation and marrow transplantation from an identical twin. Four patients (21, 41, 13 and 38 years of age) with a history of chronic granulocytic leukemia for 12, 10, 11, and 106 months, respectively, were treated with dimethyl busulfan, cyclophosphamide, 920 rads of total-body irradiation and intravenous marrow infusion from normal, genetically identical twins. Serial chromosome analyses were performed on marrow aspirates cultured without mitotic stimulants. No Ph1-positive cells were detected in the marrows from the normal twins, whereas just before therapy, all 100 metaphases examined from each patient were Ph1-positive. Chromosome analyses were performed three to five times per patient after transplantation, and not a single Ph1-positive cell was detected. The patients remain hematologically normal 22, 23, 26 and 31 months after transplantation. The results show that the Ph1-positive clone can be eradicated by vigorous therapy and that the marrow in chronic granulocytic leukemia can be repopulated by stem cells from normal twins.


Occurrence of non-Hodgkin's lymphoma after therapy for Hodgkin's disease. We studied the clinical and pathological features of six cases of non-Hodgkin's lymphoma (diffuse undifferentiated in four cases and diffuse histiocytic in two cases) occuring in patients treated for Hodgkin's disease. All six patients had received both radiation and chemotherapy. Abdominal or gastrointestinal involvement was present in five of the six cases. None of the patients had evidence of Hodgkin's disease when the diagnosis of non-Hodgkin's lymphoma was made. Five of the six patients were among a study group of 579 patients with Hodgkin's disease, prospectively followed since diagnosis. At 10 years the actuarial risk of development of non-Hodgkin's lymphoma in this study group is 4.4 per cent (1.2 to 15.0) (per cent probability with 95 per cent confidence limits) and is similar to that of developing acute leukemia: 2.0 per cent (0.3 to 12.9). Non-Hodgkin's lymphoma is a second tumor that may occur late in the course of patients treated for Hodgkin's disease--particularly in patients who have received both radiation therapy and chemotherapy. Like acute leukemia, non-Hodgkin's lymphoma may be another cancer that represents a substantial late risk of combined-modality therapy.


Pigmentation and autofluorescence of Cryptococcus species after growth on tryptophan and anthranilic acid media. Cryptococcus neoformans and Candida albicans produced a pink pigment from media containing tryptophan. Approximately 30% of the C. neoformans strains produced large amounts of the pink (purple after 6 days) pigment in the absence of light whereas 70% of the Cryptococcus neoformans strains, as well as C. laurentii, C. albidus, C. diffluens, and C. albicans also produced the pink pigment with light being required for significant early production (2--6 days). Significant production did occur for Cryptococcus but not Candida species in the dark after extended incubation (10--25 days). C. terreus produced brown pigments from tryptophan and C. luteolus produced a trace of a buff pigment. Most Candida species produced either pink or brown pigments but not both. In contrast, many Cryptococcus species producing the pink pigment simultaneously produced brown pigments. C. terreus, C. albidus, and C. diffluens produced brown pigments from anthranilic acid whereas C. neoformans, C. laurentii, C. luteolus, and the medically important Candida species did not produce significant amounts of pigments from anthranilic acid. Cryptococcus and Candida species were autofluorescent when tryptophan was a major nitrogen source whereas yeast cell autofluorescence was not observed when anthranilic acid.


Antibody formation in experimental immunizations with Candida albicans ribosomal fractions. Sera of mice immunized with ribosomal fractions of Candida albicans showed the presence of anti-C. albicans antibodies, detected by the gel-immunodiffusion, agglutination and immune adherence tests.


Experimental mycosis in immunosuppressed rabbits. I. Acute and chronic candidosis. Chronic candidosis was established in rabbits by the injection I.V. of 2 X 10(6) cells of C. albicans. The rabbits were assayed every week for 14 weeks for the appearance of candida antigen and anticandida antibodies in serum and other body fluids. Tests were carried out in double diffusion plates; antigen against hyperimmune rabbit sera and antibody against Candida cell sap antigen preparation. A sensitive specific passive hemagglutination procedure was also developed which used chromate treated cells. In rabbits with chronic candidosis not treated with cyclophosphamide antigen was detected in 4x concentrated serum between the fifth and sixth week. At about the same time antibodies were demonstrable and thereafter antigen was no longer detected. Maximum antibody titer occurred between the eight to 10th week and disappeared thereafter. If cyclophosphamide 30 mg/kg was given at this point, anticandida antibodies reappeared in high titers, persisted from three to four weeks and then disappeared. At autopsy no evidence of candidosis was present. If rabbits were pretreated with cyclophosphamide 60 mg/kg for one week before inoculation and given the drug weekly thereafter no antibody was detectable but antigen and antibody were present in body fluids (not serum) at post mortem.


Experimental mycosis in immunosuppressed rabbits. II. Acute and chronic aspergillosis. The influence of immunosuppression on the course of experimental aspergillosis was investigated. Rabbits (2.2--2.5 kg) were divided into four groups. Group one received no drugs and was given 10(6) spores intravenously (IV) or intratracheally (IT) on two occasions one week apart. Weight gain or loss, appearance or disappearance of aspergillus antigen and/or antibody, and detection of aspergillosis at autopsy were followed. Group 2 received weekly injections of cyclophosphamide (70 mg/kg) starting two weeks prior and throughout the experiment. Animals in group three received either 1.14 or 2.25 mg/kg/day methyl prednisolone and group four received 2.28 mg/kg/day methyl prednisolone and 70 mg/kg/week cyclophosphamide. In group one, serum antigen levels were detected within a week of infection followed by antibody (I.D.) levels for three months. All animals grew normally and no infection was detected at autopsy. In group 2, animals survived one but not two challenges and had Ag but no Ab. In group 3, animals survived two challenges at the lower drug level but not the higher. All animals in group 4 succumbed to one challenge.


A simple liquid medium for chlamydospore formation in Candida albicans. A new, relatively simple and inexpensive liquid medium was devised to produce all structural forms of C. albicans. Optimum conditions to induce the yeast cells, germ tubes, pseudohyphae and chlamydospores along with the methods to obtain them are described.


The status of histoplasmosis in Brazil.

The status of histoplasmosis in Brazil. Thirty four cases of the progressive form of histoplasmosis, five epidemics of the mycosis, many histoplasmin skin test surveys and few clinical or histological evidences of the benign form of the disease were reported in Brazil. The occurrence of the infection in animals and the isolation of H. capsulatum from soil have also been reported.


[Presence of sexual forms (cleistothecia and Hülle cells) in a case of human maxillary sinus aspergillosis caused by Aspergillus nidulans in association with Aspergillus fumigatus]. The authors observed, in a biopsic sample from a human maxillary sinus, the coexistence, in parasitic stages, of two different Aspergillus species: A. fumigatus and A. nidulans. After having described the morphologies of each species, in sections on slides, and particularly those of cleistothecia and Hülle-cells for the second, they draw attention to the three interests of such an observation: -- rarety of observing Aspergillus nidulans in a parasitic stage, in spite of its particular thermotolerant character. -- association of two different Aspergillus species in a same sample, in parasitic stages, observed in man for the first time, at least according their informations. -- presence of reproductive sexual forms, observed in vivo for the first time, in an Aspergillus species.


The regulatory region of the trp operon of Serratia marcescens. The nucleotide sequence of the regulatory region of the trp operon of Serratia marcescens is presented. It contains a transcription termination control site in the transcribed leader region preceding the first structural gene of the operon as well as a regulated promoter/operator transcription initiation region. The structural organisation of the leader region differs substantially from that of Escherichia coli.


The regulatory region of the biotin operon in Escherichia coli. It is proposed that the biotin anabolic operon in Escherichia coli is transcribed divergently from two partially overlapping face-to-face promoters. A mutation that increases transcription in vivo creates an additional promoter in vitro. The putative operator contains an imperfect palindromic sequence that partially overlaps the promoters. The regulatory and genetic implications of these findings are discussed.


Estradiol potentiation of hypothalamic uptake of LH-RH from the CSF. Ovariectomized (Ovx) rats were treated (s.c.) with estradiol benzoate (E2B) for 7 days, and then 10, 25 or 100 ng LH-RH were microinjected into the 3rd ventricle. Intraventricular LH-RH elevated plasma LH at 10 and 30 min in a dose-response manner. In experiment 2, Ovx rats were treated with E2B or oil for 7 days and then intraventricularly injected with 25 ng LH-RH. Two days later, 100 ng LH-RH were systemically administered. E2B treatment resulted in a greater release of LH in response to the intraventricular administration of LH-RH but not to the systemic injection. A direct measure of median eminence (ME) uptake of LH-RH was used in experiment 3. Ovx-E2B or oil-treated rats were decapitated 10 min after intraventricular injection of 125I-LH-RH, 125I or 3H-glycine. The ME region of the hypothalamus, cortex, anterior pituitary (AP) and plasma were solubilized and their radioactivity determined. E2B increased the radioactivity in the ME following injection of 125I-LH-RH but not in other tissues. Tissue uptake of 125I and 3H-glycine were similar in E2B or oil-treated rats. These data indicate E2B facilitates the incorporation of LH-RH into the ME from the cerebrospinal fluid (CSF).


Anterior approach for removal of a cervical intradural tumor: case report and technical note. A case of an intradural extramedullary meningioma of the cervical spine excised through an anterior approach is reported. This permitted a complete excision without manipulation of the cord followed by a rapid and complete recovery. The technique of excision and bone grafting is described.


Surgical management of unilateral and bilateral coronal craniosynostosis: 21 years of experience. From 1955 to 1975, 116 patients with unilateral and bilateral coronal synostosis, including 39 with craniofacial dysmorphism, were treated surgically. Five techniques were used: multiple linear craniectomies, linear craniectomies with supraorbital grafting, morcellation craniotomies, lateral canthal advancement of the supraorbital margin, and radical cranio-orbitofacial reconstruction. Analysis of clinical and radiological indices of the synostotic process, coupled with evaluation of the surgical results, indicates that the anterior skull base is the site of origin of the bony dysplasia. Therefore, early creation of artificial sutures in the skull base is recommended to provide adequate expansion of the frontal bones and consequently of the entire facial skeleton.


Os odontoideum in children: neurological manifestations and surgical management. The os odontoideum is a congenital anomaly of the 2nd cervical vertebra. It is an ossicle that is separated from the body of the axis by a variable transverse gap. This weakens atlantoaxial stability. When ligamentous support also fails, subluxation ensues. Compressive myelopathy and vertebral artery obliteration may occur. Eight cases, all in children, were studied prospectively. The neurological manifestations and surgical indications and treatment are discussed.


Hereditary paroxysmal ataxia: response to acetazolamide. From early childhood, eight patients in a kindred had paroxysmal bouts of ataxia, dysarthria, and nystagmus. The disorder was inherited as an autosomal dominant. Attacks occurred weekly and lasted 1 to 6 hours; there were slight cerebellar signs between attacks. Although the etiology was not determined, a serendipitous trial of acetazolamide completely abolished attacks, and all patients have remained free of attacks for as long as 5 years.


Therapeutic trial of tilorone in ALS: lack of benefit in a double-blind, placebo-controlled study. Sixteen patients with amyotrophic lateral sclerosis (ALS) participated in a double-blind, placebo-controlled study using tilorone hydrochloride, a drug active against a variety of DNA and RNA viruses in animals. On the basis of neurologic examination, pulmonary function studies, quantitative muscle examination, speech recording, and periodic filming of functional muscle strength, it was concluded that at a dose of 1 gm per week, tilorone did not alter the course of ALS.


The emergence of the concept of screening for disease. Public health officials, industrial leaders, and insurance companies early in this century optimistically advocated the potential for improved health and productivity through regular physical examinations. Doctors and the public, fed both by the exigencies of war and the experience of new technology, later joined the pursuit of protection from hazard--physical, social, and economic. But these very technologies--newer and more "mechanistic"--changed interest in the annual checkup into a fervor for "mass screening." By the 1970's the quarrel shifted from affective questions to matters of effectiveness and efficiency. Has progress been real?


Understanding the persistence of human resource problems in health. Four current and central problems in health manpower--total numbers, geographic distribution, field of practice, and productivity--are analyzed in the light of the recommendations of the Committee on the Costs of Medical Care. The persistence of these problems since 1932 is due to limited mobility within health occupations, and other differential controls of human resources. Efforts to correct manpower imbalances through educational solutions ignore the role of educational institutions in perpetuating social inequality. Traditional patterns are challenged in an exploration of new sources of change.


Intern and resident organizations in the United States: 1934--1977. Hospital house staff movements for collective bargaining have persisted for more than 35 years. The problems addressed seen equally persistent--inadequate pay, excessive hours, poor working conditions, and low standards of training and patient care. Interns and residents continue to face the organizational handicaps of transient membership, poor funding, and apathy, yet negotiated contracts indicate limited legal successes. Improved patient care conditions are less evident than improved house staff conditions.


[Anti-islet cell antibodies in insulin-dependent diabetics. Preliminary study]. Anti-islet cell cytoplasm antibodies (ICA) were noted in the serum of insulin-dependent diabetics, but not in subjects with insulin-independent forms. These antibodies seem to represent an immunological marker for two forms of the disease, one in which ICA appears shortly after onset and later disappears, and another ("autoimmune") form in which ICA is detectable for long periods and persists along with other signs of alteration of the immune system.


Transcription of rat liver chromatin by Escherichia coli RNA polymerase: template properties after protein restriction. Transcription was determined in liver chromatin from rats fed for 6 days, an optimal (20%) or suboptimal (3%) amount of high-quality protein. Transcription by Escherichia coli RNA polymerase (EC 2.7.7.6) was lower after prolonged incubation with chromatin from rats fed 3% as compared with 20% protein. Differences were detected in the transcripts of the two types of chromatin after analysis by sucrose density gradient centrifugation. But no measurable differences were found in the melting profiles at low ionic strength of the two chromatin preparations. Transcription per milligram chromatin DNA was 25-fold higher using E. coli RNA polymerase instead of rat liver RNA polymerase II. The use of UTP as radioactive precursor in the absence of ATP, GTP and CTP resulted in a low labelling of RNA. One [lambda32P]UTP nucleotide was incorporated/8 UMP nucleotides. The product obtained was sensitive to ribonuclease treatment. In the presence of ATP, GTP and CTP [lambda-32P]UTP nucleotide incorporation was reduced and that of UMP nucleotide was increased giving a ratio of 1:188.


Urinary tract infection in general practice. In three studies, 616 patients (610 female and six male) presented with symptoms suggesting urinary tract infection (UTI). Of these, 321 had greater than 100 X 10(6) bacteria per litre in a midstream urine sample. None of the presenting symptoms could be considered to be a reliable indicator of bacteriuria. Ninety percent of infected urines and 44 percent of uninfected urines had a raised white cell concentration. Escherichia coli was the most common infecting organism (71.3 percent). Next were Gram positive cocci at 15.6 percent, Proteus mirabilis (7.5 percent), and Klebsiella-Enterobacter species (0.7 percent). At follow-up over 30 days 25.6 percent of patients initially infected again had infected urine. The organisms isolated from initial MSUs were sensitive to most antibacterial agents by disc-sensitivity testing. The expected urine levels of drugs used in the study greatly exceeded the measured minimum inhibitory concentration.


A comparison between the macrophage migration inhibition test (MMI) and the leucocyte adherence inhibition test (LAI) in patients with melanoma and carcinoma of the colon. Patients with progressing tumours have circulating leucocytes which are sensitised to tumour specific antigens and their serum contains blocking factors. Patients who have tumours which have been successfully destroyed do not have circulating blocking factors although their lymphocytes continue to remain sensitised to the tumour antigens. Two tests, known to detect cellular sensitisation and serum blocking activity, the leucocyte adherence inhibition test (LAI) and the macrophage migration inhibition test (MMI) have been compared in a small group of patients with malignant melanoma and carcinoma of the colon. There was agreement between the results of both tests in over three-quarters of the tests performed and in those which failed to agree neither test was favoured in relation to the known tumour state of the patient. Thirty-two tests were performed in 22 patients, there was one false positive with MMI testing, seven false negative results for the LAI test and six for the MMI test.


The jejunoileal bypass and pregnancy.

The jejunoileal bypass and pregnancy. The combined experience regarding pregnancy in the jejunoileal bypass patient is too limited to draw any firm conclusions. Nevertheless, the observations made in this report suggest that: (1) Safe elapse of time from shunt procedure to pregnancy has not been established and the risk of pregnancy during the period of rapid postoperative weight loss remains speculative. Limited experience suggests that there is only a relative risk during this period of metabolic derangement. (2) Pregnancy does not appear to influence the expected clinical or metabolic changes commonly observed postoperatively in the bypass patient. Dietary supplementation should be based on the weight trend, serial laboratory chemistries, and the presence or absence of ketones in the urine. (3) Neonatal outcome appears to be good in pregnancies of patients with intestinal shunt operations. It has been suggested that small for dates babies are frequent in this group of patients. This point lacks conclusive documentation. (4) Birth control pills for contraception are not advised in intestinal bypass patients because of the uncertain intestinal absorption of the medication and the subsequent risk of an unwanted pregnancy.


Pituitary response to LHRH in midtrimester pregnancy. The effects of lutenizing hormone releasing hormone (LHRH) on serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), thyroid stimulating hormone (TSH), and growth hormone (GH) were studied in 10 women in the second trimester of pregnancy. Serum LH was measured using the LHbeta-RIA, with the anti-betaLH serum being preabsorbed with purified hCG. This assay was unaffected by hCG levels up to 500 IU/ml. Basal serum levels of LH was undetectable and basal FSH levels were low in these 10 women. No release of LH or FSH was observed after administration of 100 microgram of LHRH. However, there was a statistically significant rise in PRL from mean basal levels of 139.9 ng/ml to a mean peak level of 159.0 ng/ml at 30 minutes after LHRH administration. Both TSH and GH displayed small elevations at 15 minutes after LHRH administration; however, these elevations were not significant because of the wide range in responses. The results of this study indicate that gonadotropin release is inhibited during the second trimester of pregnancy. Finally, it appears that pregnancy is a condition in which LHRH administration results in a nonspecific release of several hormones.


Vaginal flora in women undergoing hysterectomy with antibiotic prophylaxis. One objection occasionally raised against the use of routine antibiotic prophylaxis for pelvic surgery is the concern that the flora of treated patients will be altered, thus favoring the emergence of different, potentially more resistant organisms. This report summarizes experience with 100 women undergoing elective hysterectomy who were subjected to short-term cefazolin, penicillin, or placebo prophylaxis. The changes in preoperative versus postoperative flora were similar among antibiotic-treated and placebo-treated groups. In general, postoperative isolation of gram-negative aerobes and Bacteroides sp increased, and isolation of gram-positive aerobes (except group D streptococci) decreased in antibiotic-treated and placebo-treated groups. The clinical implications of these findings are discussed.


[Clinical and therapeutic study (phase II) using VP-16/213 and methyl-CCNU in patients with inoperable, recurring or metastasizing carcinomas of the gastriointestinal tract]. We carried out a phase-II-study in patients with tumors of the gastrointestinal tract, in order to test the effectiveness of the combination of VP-16/213 and ME-CCNU. We studied 15 patients (3 carcinomas of the stomach, 12 colon carcinomas) in a mostly advanced state of illness (disseminated, n = 13). One patient with gastric cancer attained a partial remission with a duration of remission of 9.1 months and a survival time of 14.1 months; the other two patients with cancer of the stomach were non-responders. 1 of 12 patients with colon carcinoma showed a partial remission (PR) (= 8.3%, or 12.5% in untreated patients n = 8), 7 patients showed no change (NC = 58.3%) and 4 patients had progressive disease (PD). The median duration of remission was 4.9 months, the median survival time 7.9 months. With reference to the success of therapy the median survival time was 10.5 months for patients with partial remission and no remission compared with 4.7 months for patients with progression. Toxicity consisted of nausea and vomiting (n = 11), loss of appetite (n = 10), granulocytopenia (n = 9), thrombocytopenia (n = 8) and hairloss (n = 8). The results achieved are comparable to those of monotherapy with the nitrosoureas.


[Tamoxifen therapy in previously treated female patients]. We did a pilot study in 35 pretreated cases with disseminated metastatic breast cancer. These patients got a therapy of about 20 mg/day. We evaluated objective remissions, but also subjective responses. In good correlation to similar trials we found benefits in 35%.


[Extraneural metastasis of an oligodendroglioma in ventriculo-peritoneal shunt]. The clinical and pathological report presents a seven-week old girl suffering from signs of raised ICP. A ventriculo-atrial shunt was inserted and replaced by a ventriculo-abdominal shunt due to occlusion at 15 months of age. At 16 months, craniotomy and resection of an oligodendroglioma was performed and the shunt was preserved. The child died at 18 months due to extensive local recurrence. Autopsy revealed massive peritoneal metastases of the tumor. This is the eleventh published case of canalicular metastases of glioma.