[Comparison of cardiac and vascular effects of sulfentanil (R 30730), a new analgetic, and fentanyl (author's transl)]. In 31 patients with congenital or acquired heart disease, functional class III NYHAC, effects of Sulfentanil (R 30730)--a new analgetic--on hemodynamics, inotropic state and myocardial oxygen consumption have been investigated intraoperatively, during extracorporeal circulation and postoperatively. Results are compared to a fentanyl-group and control-group. There was almost no change in cardiac index and stroke index. In comparison to fentanyl (dose relation fentanyl: sulfentanil = 10:1) there was a more pronounced decrease in aterial pressure, left ventricular pressure, peak dp/dt and myocardial oxygen consumption (-20%) in the sulfentanil-group. In contrast to the fentanyl-group there was, however, no increase in total pulmonary resistance with sulfentanil.


[Cardio-circulatory effects of aminophylline (Euphyllin) (author's transl)]. In 24 patients with congenital or acquired heart disease, functional class II--IV New York Heart Association Classification, effects of aminophylline on hemodynamics have been investigated intraoperatively, during extracorporeal circulation and postoperatively. Aminophylline caused a decrease in arterial pressure, left ventricular pressure, right and left atrial pressure, total systemic resistance and total pulmonary resistance. At the same time there was an increase in heart peak, peak dp/dt, cardiac index and stroke index. Our results demonstrate beneficial cardiac and extracardiac effects of aminophylline in man.


Effect of n-dipropylacetate on the consolidation of a brightness discrimination. The posttraining intrahippocampal injection of the GABA level enhancing substance n-dipropylacetate revealed an improvement of the retention performance in a brightness discrimination task in rats.


Factitious (self-inflicted) skin wounds. We represent 4 of our recent cases of factitious skin wounds. The general aspects of these wounds--including etiology, diagnosis, detection, and treatment--are discussed.


Uses of the rectus femoris myocutaneous flap. The rectus femoris myocutaneous flap is quite useful for definitive immediate coverage of complex wounds within its territorial arc. We describe 4 cases to illustrate the capabilities of this flap. The indications for, the anatomy of, and the surgical technique for transfer, as well as the functional sequelae in two nonparaplegic patients are discussed.


Treatment of total loss of the Achilles tendon by skin flap cover without tendon repair. We present two cases of conservative treatment of total loss of the Achilles tendon. In our opinion the functional result is acceptable, without tendon grafting. The action of the sural muscles is transmitted through scar underlying the pedicled flaps used to resurface the wounds.


A method for repair of cryptotia.

A method for repair of cryptotia. The key points in our method of repair of cryptotia are (1) to cover the skin defect on the posterior aspect of the ear after it is dissected from the head, and (2) to repair the cartilaginous deformity. We describe the use of a temporal skin flap for the former. For the latter, we make parallel incisions on the back of the superior crus and transfer a small graft of conchal cartilage there. The conchal cartilage graft "splints" the repaired crus against cicatricial contracture.


The effect of total maxillary advancement on facial growth. The effect of total maxillary advancement on the growing skull was examined in 25 pigs, subjected to facial operations of varied severity at the age of 5 weeks (elevation of periosteum, simple osteotomy, and osteotomy immobilized by wire fixation, with or without bone grafts) and in controls. When the animals were killed 8 months later, the body weight had increased tenfold and the skull size had doubled. In 5 pigs whose maxillae were advanced 10 mm by bone grafts, the relative increase in length was not maintained. The overall skull length showed no difference from the control measurements. The extent of the growth in the area adjacent to the osteotomy was less than in the controls, but the same as in pigs subjected to periosteal elevation only. Scattered areas of bone damage were seen with no consistent pattern. Incision of the periosteum over the frontal bone decreased the local blood supply, increased the adherence of the periosteum to the bone, and affected bone growth locally.


Measurement of skin blood flow in delayed deltopectoral flaps, using local clearance of 133Xenon. A study was made to determine the skin blood flow at the deltoid region in 89 cases, and the regional blood flow of delayed deltopectoral flaps, using the local clearance of 133Xe. The change in the skin blood flow, before and after a delay procedure of the deltopectoral flap, was measured in 27 patients--and the following results were obtained. (1) There was a linear tendency to a decreasing flow, one found to be statistically significant, with increasing age of the patient. (2) A significant correlation was found between the skin blood flow and the blood flow of the subcutaneous tissue. (3) The blood flow after we raised one side of a deltopectoral flap and lined it with a split-skin graft was higher than that found after a U-shaped undermining and not lining a flap. (4) The rate of successful transfer of a deltopectoral flap was found to be low when the 133Xe clearance rate was less than 0.07.


Radical excision of huge angioma of face, with reconstruction: case report. We present a case of a massive angioma of the face treated by radical excision and subsequent reconstruction. At present the patient feeds normally, she speaks well, and she is taking a post-graduate course in mining engineering.


Surgical correction of burn deformities of the nose. We present a method for reconstruction of the everted nostrils of the burned nose. Through a "ram's horn" incision, the everted vestibular lining and lower lateral cartilages are mobilized and repositioned, and the resultant defect is covered with a full-thickness skin graft. The linear scar is created as part of a circle, so that the postoperative contracture will improve the alar contour.


Use of thin, mobile skin flaps in pollicization of the index finger. A method for pollicization of the index, using very thin skin flaps, is described.


Experimental effects on surrounding fibrous capsule formation from placing steroid in a silicone bag-gel prosthesis before implantation. Soft-gel miniprostheses of silicone were implanted subcutaneously into 75 male rats. Groups of prostheses were preinjected with saline, a commercial form of triamcinolone acetonide, or a suspension of crystalline triamcinolone acetonide. The softness of the prosthesis mound later was measured objectively, and the capsules surrounding the implants were analyzed by histology, SEM, and chemistry, at various intervals up to 120 days after implantation. The control implants developed a normal laminar capsule. With an incidence increasing up to 100 percent at 120 days, the steroid-treated implants were surrounded by capsules lacking an inner membrane. The inner membrane of the laminar capsule had a high protein content (relative to normal tissue) and a relatively reduced collagen content, while the diffuse capsule resulting from the TA treatment had a high protein content and a high collagen content (about the same as normal tissue). No differences were found in the softness of the mounds of the implanted prostheses. The effect of the TA treatment was explained on the basis of its collagenolytic effect, which could gradually erode the normal capsule membrane. Capsule firmness could not be related to the architecture or the protein or collagen content in our findings. We hypothesize that normal capsule firmness may be related to the amount and kind of interconnection between the loose outer zone of connective tissue and the surrounding tissue.


High-pressure injection of silicone gel into an axilla--a complication of closed compression capsulotomy of the breast. Case report. A case is reported in which a closed compression capsulotomy for fibrous capsular contracture was followed by rupture of the implant bag with the immediate appearance of silicone gel in the axilla. A possible mechanism, analogous to that of high-pressure injection injuries of the hands, is hypothesized.


Treatment of a large hemangioma by dermal overgrafting. Case report. A large capillary hemangioma was treated by cutaneous dermal overgrafting, with control of the ulceration, infection, and bleeding for 10 years to date. The patient has been successfully rehabilitated.


Prostaglandin-mediated inhibition of noradrenaline release: V. A comparison of the neuroinhibitory effect of three prostaglandins: E2, I2, and 6-keto-PGF1alpha. The effect of PGE2, PGI2, and 6-keto-PGF1alpha respectively on the contractile response of the isolated, field-stimulated guinea pig vas deferens was investigated. All three PGs were capable of inhibiting the contractile responses of the vas deferens, but the concentrations required varied considerably: PGE2 was about 700 times more active than PGI2 and about 4600 times more active than 6-keto-PGF1alpha in this respect. It is suggested that PGI2, although formed in tissues with sympathetic innervation, does not play a physiological role as inhibitor of sympathetic transmitter release.


The high yield of prostacyclin biosynthesis by the iris and its effects on the intraocular muscles. Iris, and to a lesser extent ciliary body, from cat and rabbit produce considerable amounts of prostacyclin (PGI2) after incubation of the tissue with 1-14C arachidonic acid. These tissues also generate PGI2-like material after gentle squeezing. It is likely that major metabolites found previously in iris and aqueous humor actually were 6-keto-PGF1alpha. It is concluded that PGH2 and PGI2 are synthetized at the same location. PGI2 induces a contraction of the sphincter and dilator and a relaxation of the ciliary muscle if the tissues had been previously exposed to indomethacin. Thromboxane A2 (TxA2) has either no effect or may cause a slight relaxation of the sphincter.


The conception of man in Mao Tse-tung thought. In 1940, long before the People's Republic of China came into being, Mao Tse-tung declared: The aim of all our efforts is the building of a new society and new nation of the Chinese people. In such a new society and new nation, there will be not only a new political organization and new economy, but a new culture as well. Twenty-six years later, the world witnessed the Great Cultural Revolution (GCR), in which Mao himself took an active leading role. The very idea of a cultural revolution is revolutionary enough. Never before in history has there been such an ambitious attempt to create a new man, with a new culture, in a new society. Unparalleled in both its scope and intensity, the GCR is a unique social experiment that has directly involved a fifth of mankind, and has profound implications for mankind as a whole. What are the philosophic  assumptions about man embodied in Mao Tse-tung Thought, the guide to action in the Chinese revolution? How are these assumptions linked to Mao's political ideology? What is the relevance that Mao's conception of man has for contemporary psychology? The present essay is an attempt to answer these questions.


Anxiety and plasma cortisol at the crest of the circadian cycle:reappraisal of a classical hypothesis. Near-maximal anxiety by subjective and behavioral criteria was evoked and terminated in phobic patients by initiation and termination of rapid live confrontation ("flooding in vivo") with the specific stimulus that each avoided, at a time approximating the crest of the circadian cycle of adrenal cortical function. The procedure was associated with moderate, but not marked, elevations of plasma cortisol above control levels in some, but not all, subjects. Differences in anxiety levels as self-rated by the patients did not account for differences in cortisol response. The findings should stimulate further reevaluation of the hypothesis that affective arousal is the key psychological determinant of adrenal cortical function. Dissociation between subjective-behavioral arousal and plasma cortisol during flooding may be a manifestation of what behavior therapists call "desynchrony of fear."


Environmental carcinogenesis: an integrative model. An integrative theory is proposed in which environmental carcinogenesis is viewed as a process by which the genetic control of cell division and differentiation is altered by carcinogens. In this theory, carcinogens include physical, chemical, and viral "mutagens," as well as chemical and viral gene modulators. Existing explanations of carcinogenesis can be considered either as somatic mutation theories or as epigenetic theories. Evidence seems to support the hypothesis that both mutations and epigenetic processes are components of carcinogenesis. The mutational basis of cancer is supported by the clonal nature of tumors, the mutagenicity of most carcinogens, high mutation frequencies in cells of cancer-prone human fibroblasts lacking DNA repair enzymes, the correlation of in vitro DNA damage and in vitro mutation and transformation frequencies with in vivo tumorigenesis, age-related incidences of various hereditary tumors, and the correlation between photoreactivation of DNA damage and the biological amelioration of UV-induced neoplasms. Since both mutagens and gene modulators can be carcinogenic it may be that carcinogens affect genes which control cell division. An integration of the mutation and epigenetic theories of cancer with the "two-stage" theory and Comings's general theory of carcinogenesis is proposed. This integrative theory postulates that carcinogens can affect regulatory genes which control a series of "transforming genes." A general hypothesis is advanced that involves a common mechanism of somatic mutagenesis via error-prone repair of DNA damage which links carcinogenesis, teratogenesis, atherosclerosis and aging. Various concepts are presented to provide a framework for evaluating the scientific, medical, and social implications of cancer.


The influence of age, sex, and the use of oral contraceptives on the inhibitory effects of endothelial cells and PGI2 (prostacyclin) on platelet function. The inhibitory effects of human endothelial cells (ECM) and PGI2 (prostacyclin) on platelet function have been examined in 60 healthy subjects. 5 groups were studied. I. 10 women (19-33 yrs.); II. 10 women (21-31 yrs.) using combined oral contraceptives; III. 10 postmenopausal women (45-66 yrs.); IV. 20 men (24-48 yrs.) and V. 10 men (48-71 yrs.). Spontaneous platelet aggregation in platelet-rich plasma (PRP) was commonly observed in groups II, III, and V. This was prevented when PRP was incubated with ECM, aspirin (ASA), or PGI2. ADP-induced platelet aggregation (PA) was always reduced by ECM, but significantly less in groups II and III. Collagen-induced PA was inhibited by ECM, but less in groups I, II, III and V than in young men (IV). ECM significantly reduced collagen-induced prostaglandin (MDA) production in platelets. Again, the inhibitory effect was significantly reduced in groups II and III. Platelet factor 3 activity, measured after exposure of PRP to ADP, was significantly reduced by ECM, but was significantly less in groups II, III, and V than in group I. Less of an inhibitory, effect of PGI2 upon ADP-induced PA was shown by all groups of females than by the two groups of males.


A chemical approach to the mechanism of B-lymphocyte activation. I. The pure presentation of haptens does not activate B lymphocytes. In an attempt to definitively determine whether the pure presentation of haptens (on repetitive, non-metabolizable carriers) to B lymphocytes triggers differentiation to antibody-producing cells, dinitrophenyl and trinitrophenyl groups have been covalently coupled to potentially inert carriers (polymethylmethacrylate, chlorinated polyethylene and cellulose). The resulting conjugates (with three different degrees of hapten substitution) are not immunogenic. It is therefore concluded that the pure presentation of haptens to B lymphocytes does not trigger antibody formation.


The effects of pre-admission antibiotics on the bacteriological diagnosis of pyogenic meningitis. To assess the effects of pre-admission antibiotics on the accuracy of bacterial diagnosis in pyogenic meningitis, the case records of 154 patients admitted to an infectious diseases unit during a 10-year period (1966-1975) were reviewed. The causative organism was identified in 140 patients (91%). Although 63 patients had received antibiotics before admission, a bacteriological diagnosis was still possible in 57 of these (90%).


The significance of serum-sensitive bacilli in gram-negative bacteremia. Clinical findings from 76 patients (median age 67 years) with gram-negative bacteremia were analysed and related to the sensitivity of the blood isolates to the bactericidal activity of normal human serum. 28 strains (37%) were resistant, an equal number intermediately sensitive and 20 markedly sensitive (26%). No correlation was found between serum sensitivity and origin of the bacteremia, presence of fever or blood granulocyte count. The frequency of shock in immunocompromised patients with serum-resistant strains was 60% (6/10); in those with intermediately or markedly sensitive strains it was 44% (8/18). In the non-immunocompromised patients with resistant strains the frequency of shock was 33 (6/18) versus 10% (3/30) in those without such strains. Thus the risk of developing shock with gram-negative bacteremia seems to depend on both parasite and host factors, although in this study only the latter were statistically significant. We conclude that serum-sensitive strains can invade the blood stream in spite of the serum bactericidal activity and cause severe disease in some patients.


Typing of group B streptococci from the throat and urogenital tract of females. Group B streptococci were isolated from the urogenital tract of 54 of 168 patients (32%) examined at a gynecological outpatient department. 11 (7%) of the patients were group B throat carriers. In contrast to the frequency of type III group B steptococci in the urogenital tract (41% of group B streptococcal carriers) only 1 of 11 strains isolated from the throat belonged to type III. Apart from 1 patient who carried type III streptococci in the urogenital tract, all patients who were both throat and urogenital tract carriers harboured the same type in both sites. Significantly more patients who were only throat carriers of group B streptococci or harboured another type in the throat than in the urogenital tract, harboured lactose-fermenting group B streptococci as compared to patients who were only carriers of group B streptococci in the urogenital tract. These results pointed out the possible existence of "throat-preferring" and "urogenital-preferring" group B streptococci.


Antibody response in thirteen patients with Bacteroides fragilis infections. 13 patients with Bacteroides fragilis infections were studied for antibody response against the infecting strain using indirect immunofluorescence (IFL), passive hemagglutination (HA) and tube agglutination (TA). With indirect IFL significant titre changes in IgG were found in 12/13 cases, in IgA in 8/13 and in IgM in 4/13 cases. With passive HA significant titre changes were found in 11/13 cases and with TA in 6/11 cases. The rise in antibody titre was fast and persisted for a long time in most cases. Of the methods used the indirect IFL was the most convenient for clinical use.


Tobramycin in patients with various infections: a clinical evaluation. 22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days. Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests. In 16 patients either cure of clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could nto be evaluated. One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus. In one patient, slight but clinically significant renal impairment occurred.


Bacteriological and clinical studies of sulbenicillin. A new semi-synthetic penicillin, sulbenicillin, was evaluated with regard to clinical effect on infections caused by Pseudomonas aeruginosa and other bacteria, serum concentrations obtained after intravenous administration and antibacterial spectrum, in comparison with the closely related antibiotic carbenicillin. The antibacterial spectra of sulbenicillin and carbenicillin were similar but the MIC values were lower for sulbenicillin against most of the bacterial strains tested. The serum concentrations obtained after administration of 5 g sulbenicillin were significantly higher than those obtained after 5 g carbenicillin although no significant differences in serum half-lives were observed. The clinical effect of sulbenicillin--alone or alternating with carbenicillin--on pseudomonas infections with varying localisation was found to be good in 11 and fair in 3 of 16 treated patients. Two treatment failures were cases of chronic wound infection. In addition to the pseudomonas infections, 9 of the patients also had concurrent infections with other bacteria, e.g. pencillinase-producing staphylococci and Klebsiella, and in all these cases bacterial growth was eliminated during therapy. No serious side effects were observed during sulbenicillin treatment but some of the patients developed massive growth of fungi in the urine, which disappeared after the treatment was stopped.


Single dose treatment with Tiberal of Giardia lamblia infection in children. A new metronidazole derivative, Tiberal (Ro-07-0207, Roche Laboratories), was evaluated in 22 children with Giardia lamblia infection. Seven patients received an oral dose of 1 g twice daily for one day; the remaining 15 patients received a single dose of 50 mg/kg. Parasitological cure was noted in all 22 patients. Significant side effects were observed only in those children who received the drug at the higher dosage regime. The present study also confirms the findings of other authors that a mucosal imprint method is more reliable than examination of stools, duodenal juice or jejunal biopsy material for the detection of G. lamblia infection.


Complications with permanent endocardial electrode systems. A comparison between two types of electrodes. The study comprises 375 patients who had received an endocardial pacemaker electrode primarily. A stylet electrode of the Medtronic type was used in 165 patients and of the Elema type in 79 patients. Elema's flexible electrode model 588 EMT was used in 131 patients. The total number of electrode complications was surprisingly high. In 92 out of the 375 patients, 141 serious episodes of pacing failure occurred during the observation period of from 6 to 42 months. The complication rate increased with pacemaker function time. The stylet electrodes gave the highest complication rate. The choice of vein for introducing the electrode into the heart seems not to affect the complication rate significantly. Nor did the initial threshold value of stimulation influence the complication rate to any marked degree. The pacemaker manufacturers have devoted much effort to producing long-life impulse generators but there is also a great need for well-functioning long-life electrodes.


[Epidemiology and clinical aspects of malaria in Switzerland]. Plasmodium falciparum is the predominant plasmodium species in Africa south of the Sahara to a proportion of 80% and more. Two thirds of all cases of malaria in Switzerland are imported from Africa. Accordingly, malignant malaria is more frequently diagnosed in Switzerland than tertian malaria. Malignant malaria usually presents atypically, e.g. as acute gastrointestinal disease or as shock. The lethality is high. The majority of Swiss travellers are not protected effectively against malaria. A group particularly at risk are tourists of 20--30 years of age. It is suggested that travel agencies, official bodies and the medical profession should intensify public information regarding the dangers and prevention of malaria.


[Serum ferritin in renal insufficiency, hemodialysis and kidney transplantation]. 87 patients with end-stage renal failure on long-term hemodialysis, 25 not on dialysis and 37 with renal transplants have been studied. Serum ferritin was measured by immunoradiometric and radioimmuno-assay. The correlation between the two methods was excellent (p less than 0.001). In 25 patients on long-term hemodialysis a good correlation was found between serum ferritin levels and stainable iron (p less than 0.001). All patients with adequate iron stores had serum ferritin levels above 60 ng/ml, whereas only one out of 10 with decreased or absent iron stores had a higher leve (118 ng/ml). According to these criteria the iron stores were decreased in 59% of our patients on long-term hemodialysis, decreased or adequate in 14% and adequate or increased in 27%. There was no correlation between serum ferritin levels and serum iron and total iron binding capacity. The distribution pattern of the serum ferritin levels was log normal and did not significantly differ in the three groups studied, although the patients with renal transplants had nearly normal hemoglobin and creatinine levels. Elevated serum ferritin levels in patients (21%) on hemodialysis could only partly be explained by repeated transfusions or chronic infections.


Antiserum treatment of gram-negative bacteremia. In order to lower the mortality rate from gram-negative bacteremia, 136 patients were treated with human antiserum against core glycolipid, or with control nonimmune human serum, in a double-blind clinical trial. The antiserum was prepared by immunizing healthy young men with a vaccine composed of heat killed cells of the J5 mutant of E. coli 0111 B4. Since the core glycolipid in this mutant is not encumbered with "O" side chains, it can stimulate antibody against the core glycolipid possessed in common by the different species of gram-negative bacteria responsible for lethal bacteremia in patients. No serious reactions occurred in over 300 men receiving this vaccine, and the J5 antiserum gave striking broad-spectrum protection against experimental gram-negative bacteremia and endotoxemia. When human J5 antiserum was administered to seriously ill bacteremic patients, the mortality rate was virtually cut in half, as compared to controls. The death rate from gram-negative bacteremia was 14% in patients treated with J5 antiserum, and 26% in those given nonimmune control human serum. Among patients in profound gram-negative bacteremic shock, the recovery rate rose from 29% in controls to 82% in those treated with J5 antiserum (p = 0.02). On the basis of these encouraging results we propose to treat more bacteremic patients with J5 antiserum, because larger groups are needed to establish the full significance of the initial findings.


Low repetitive DNA content in Aspergillus nidulans. DNA-DNA reassociation experiments show that the genome of Aspergillus nidulans consists of approximately 97 to 98 percent unique and 2 to 3 percent reiterated sequences. The reiterated DNA sequences have a complexity of about 11,000 base pairs and are repeated approximately 60 times per haploid genome. Ribosomal RNA-DNA hybridization experiments indicate that most of the repetitive DNA codes for ribosomal RNA.


Conformational changes in 16S ribosomal RNA induced by 30S ribosomal subunit proteins from Escherichia coli. Laser light scattering has been used to evaluate conformational differences between free 16S RNA and several specific protein-16S RNA complexes. Proteins that interact strongly with the 16S RNA early in subunit assembly stabilize the RNA chain against unfolding in 1 mM Mg2+ and actually promote the formation of a more compact teriary structure in 20 mM Mg2+. A vital function of these proteins may therfore consist in altering the configuration of the RNA so that further assembly reactions can take place.


The medical use of gallium radionuclides: a brief history with some comments. The use of gallium radionuclides in nuclear medicine dates back to the late 1940s, following the observation in toxicologic studies that gallium tended to localize to a high degree at sites of osteogenic activity. Initial attempts in the early 1950s to use 72Ga for clinical diagnosis and therapy of malignant bone lesions were unproductive. However, the basic information gained then in the preclinical and clinical investigations was quite instrumental in generating the present-day use of gallium radionuclides as effective radiopharmaceutical agents. Although initial clinical trials of 72Ga were unproductive, subsequent studies with 68Ga and 67Ga, together with advances in nuclear medical instrumentation, resulted in the identification of gallium radionuclides as effective tumor- and abscess-localizing agents. A major factor in the recognition of the peculiar biologic properties of gallium radionuclides was the existence of a carrier (stable isotope) effect. Also, it appears from basic studies of the mechanism(s) of the uptake of gallium in tumor tissue that the biodistribution of gallium involves many essential biologic processes. The future use of gallium radionuclides may, therefore, actually very well fall more into the field of basic biologic investigations rather than into the field of nuclear medical diagnosis.


Gallium-67 imaging in abdominal disease. Gallium-67 imaging is useful for detecting sites of intra-abdominal inflammation, including subphrenic abscesses, postoperative infection, pyelonephritis or perinephric abscesses, and peritonitis. Positive images may be obtained within several hours of injection, but are more reliable at 24 hr. The results may be used to guide ultrasound or computed tomography studies, which give a detailed anatomic picture of the abscess. Gallium-67 imaging has also been used to detect abdominal neoplasms, but results are less impressive. Abdominal lymphoma is detected in just over 50% of sites. Gastrointestinal, renal, and gynecologic neoplasms are detected even less frequently. However, 67Ga is useful for detecting recurrence of 67Ga-avid neoplasms, and has been reliable in detecting hepatomas and nodal spread of seminoma. When used selectively in patients with neoplastic disease and suspected abscesses, 67Ga is an effective method for diagnosing abdominal disease.


Massive skin necrosis in Rocky Mountain spotted fever. The occurrence of massive skin necrosis of approximately 50% of the body surface area in an 8-year-old girl with Rocky Mountain spotted fever is reported. Although the surgeon will not often be confronted with the management of Rocky Mountain spotted fever or its complications, certain therapeutic corollaries can be outlined, based upon the observed similarity between this particular complication of severe skin loss and the syndrome of purpura fulminans: (1) heparinization for the consumptive coagulopathy and disseminated intravascular clotting; (2) correction of hypovolemia and hypoproteinemia; (3) decompression by escharotomy and/or fasciotomy if indicated; (4) topical chemotherapeutic coverage of necrotic skin; (5) full-thickness eschar excision combined with biologic dressings directed toward autograft wound closure; and (6) appropriate extremity splinting and physiotherapy.


Treatment of psoriasis with 8-methoxypsoralen and sunlight. Photochemotherapy with 8-methoxypsoralen and sunlight (PUVA-SOL), administered three times weekly, proved effective in the treatment of psoriasis. Weekend photochemotherapy (modified PUVA-SOL) also appeared useful as an adjunct to standard topical corticosteroid therapy. Careful measurement of ambient long-wave ultraviolet light (UVA) in the treatment locale and respect for the phototoxic potential of PUVA-SOL are necessary for success. The long-range toxicity of psoralen photochemotherapy remains undetermined.


Respirator paradox.

Respirator paradox. Massumi, in 1973, presented three distinct clinical conditions in which he described a reversal of the expected variations of blood pressure relative to respiratory activity. He termed this phenomenon reverse pulsus paradoxus. One of his cases was a patient with congestive heart failure receiving intermitten positive pressure ventilation (IPPV). The same phenomenon has been documented in many of our intensive care patients who were receiving IPPV, with or without PEEP. A variety of underlying clinical conditions were included. We have called this response of blood pressure respirator paradox. A theoretic mechanism related to changes in afterload is offered as one possible explanation of these findings. Occurrence of respirator paradox after open heart surgery may complicate the problem of early diagnosis of cardiac tamponade.


Tumor immunology and interferon.

Tumor immunology and interferon. Host defense mechanisms against cancer depend on an intact cellular immunity system. Immunosurveillance depends on thymus lymphocytes which, when sensitized, form lymphokines. One of the important lymphokines produced by  T-lymphocytes is called interferon, well known for its antiviral effects. Recent experimental evidence points also to the potential effectiveness of interferon against malignancies. Interferon and interferon-inducers have been found to alter the course of solid tumors, leukemia, sarcomas and lymphomas in experimental animals, possibly by stimulating the reticuloendothelial system to produce tumor rejection or by altering the surface of cells to change tumor and host reactions.


Adult respiratory distress syndrome.

Adult respiratory distress syndrome. Treatment of the adult respiratory distress syndrome requires an understanding of the current concepts of the pathogenesis of this syndrome. The clinical features and pathophysiology are briefly discussed. Differential diagnosis requires the exclusion of pulmonary infection and left heart failure. Therapy is aimed at correction of the associated initiating disease process and the maintenance of tissue oxygenation. The latter requires increased inspired oxygen concentration, maintenance of an adequate cardiac output, and maintenance of a normal hematocrit level and body temperature. The therapeutic role of intravenous albumin, diuretics, and steroids in this syndrome is still controversial. Currently accepted modalities for improving oxygenation, when oxygen by face mask proves inadequate, include intubation and ventilation with postiive end-expiratory pressure. Other promising technics for improving oxygenation which do not require intubation are continuous positive airway pressure applied by face mask, continuous negative chest wall pressure, and alterations in posture. The long-term prognosis in survivors appears to be good, with only mild residual pulmonary functional abnormalities.


An unusual cutaneous manifestation of group A streptococcal bacteremia. A case of streptococcal bacteremia presenting with disseminated nodular lesions is presented. Although the incidence of group A streptococcal bacteremia has declined, the disease may affect both normal and immunologically compromised children. Early recognition and prompt antibiotic therapy are required to ensure a favorable outcome.


Bullet embolus: heart to right femoral artery. Our case report of survival from a cardiac gunshot wound with subsequent embolization to the right femoral artery has included plain films and arteriographic confirmation, a review of the mechanics of intracardiac bullet embolization, its incidence, survival rates, and management, and review of the literature.


Group B streptococcal osteomyelitis in adults. Osteomyelitis due to group B Streptococcus occurred in two adult male patients. Both patients responded to parenteral penicillin G. A review of the literature verifies that group B Streptococcus has been an exceedingly rare cause of osteomyelitis in adults.


William Harvey, physician and scientist. William Harvey was born in 1578 and died in 1657. He studied arts at the University of Cambridge and medicine at the University of Padua. He was a Fellow of the College of Physicians of London and physician to St Bartholomew's Hospital and to King James I and King Charles I. His discovery of the circulation of the blood was announced in his Lumleian Lectures to the College of Physicians and later published in his book, De Motu Cordis. His other major work was on embryology, published under the title De Generatione Animalium. Harvey was distinguished in many fields of medicine and medical science and is widely regarded as the founder of modern physiology.


Plasma cortisol levels in normal volunteers receiving either betamethasone valerate or desoximetasone by topical application. Desoximetasone (Topisolon; Hoechst), a new topical steroid, and betamethasone 17-valerate were compared with respect to their effects on hypothalamic-pituitary-adrenal function as evidenced by plasma cortisol concentrations. Three grams of each test preparation were applied daily for 21 days to intact skin of the ventral aspects of alternate forearms of 15 normal volunteers. Five received betamethasone 17-valerate 0.1%, 5 desoximetasone 0.05%, and 5 desoximetasone 0.25%. Plasma cortisol levels were determined before and after the initial applications on days 1, 3, 10, 17, 22, 24 and 28. These values were compared with the mean control values by analysis of covariance. There was no significant difference in plasma cortisol levels. The value of performing similar studies on larger skin areas and with larger doses is discussed.


Double-blind study of ketoprofen and indomethacin in juvenile chronic arthritis. Ketoprofen (Orudis; Maybaker), whose use has not previously been reported in choldren, was compared with indomethacin in a double-blind crossover trial in 30 children with juvenile chronic arthritis. Both drugs proved to be safe and effective analgesics and anti-inflammatory agents although indomethacin emerged as the preferred drug. Perhaps higher doses of ketoprofen would be safe and more effective. Side-effects were few and mild. The problems of patient compliance and the assessment of pain in children are discussed.


A job well done--a short history of Dr James Moroka. James Moroka was one of the first Black South Africans and definitely the first Tswana national to obtain a medical degree. After graduating from Edinburgh University he practised for 58 years as a general practitioner in Thaba 'Nchu. He also played a leading role in the sociopolitical history of his people.


Progress in the use of elemental diets in infants and children. The clinical use of elemental diets to provide adequate nutrition in the infant or child in a catabolic state will, undoubtedly, increase as experience confirms the effectiveness and safety of this technique. The value of total parenteral nutrition and nutrition given through the peripheral vein should, in no way, be underestimated, since many infants and children will still require this form of nutrition during periods when the intestine is not available for alimentation. The use of elemental diets in the transitional period between total parenteral nutrition and more conventional feedings as well as in providing nutritional support when the intestine is totally or partially available provides a method of earlier discontinuance of parenteral nutrition and, hence, decreases the incidence of mechanical, metabolic and septic complications associated with intravenously administered nutrition. Each patient should be considered individually and a decision made as to whether or not enteral hyperalimentation can be used in place of, or in conjunction with, parenteral nutrition.


Immunotherapy for cancer.

Immunotherapy for cancer. It seems nonetheless reasonable to take a skeptical view of immunotherapy for cancer. If the immunologic response can be brought to bear meaningfully and effectively upon the tumorhost relationship so that the host is spared, then let it be proved by appropriate clinical trials. Without unrealistic expectations, it may be easier to tolerance the gradual realization that immunotherapy may be only peripherally important in the control of malignant disease.


Primary carcinoma of the gallbladder.

Primary carcinoma of the gallbladder. Data from 6,222 patients with primary carcinoma of the gallbladder reported upon in the past 15 years have been analyzed. The disease occurs predominately in elderly females who often present with extremes of clinical symptoms, suggesting, on one hand, benign calculous disease or, on the other, advanced incurable malignant disease. Laboratory and x-ray data tend to confirm the clinical diagnosis of incurable disease, but do not aid in determining those patients with early, potentially curable lesions. The biologic nature of the tumor makes most carcinomas unsuspected findings at the time of operation and limits those patients presenting with resectable disease to about 25 per cent. The over-all five year survival of patients with carcinoma of the gallbladder is only 4.1 per cent. Furthermore, virtually the only survivors are those with lesions resected early that were not apparent to the operating surgeon and of the papillary cell type without significant invasion of the wall of the gallbladder. If the tumor is recognized and believed to be resected, survival is only 2.9 per cent, with failures caused by locally recurrent tumor. Despite the obvious failure of management of carcinoma of the gallbladder, therapeutic advantage has not been taken of the tumor's propensity to remain locally invasive by extending the scope of the traditional cholecystectomy to include en bloc hepatic wedge resection and regional lymphadenectomy in treating patients with recognized malignant tumors. Reoperation for delayed hepatic resection and lymph node dissection should be considered in selected patients with carcinoma unsuspected at operation but noted in the resected specimen. Selected application of this approach might offer the chance of cure to a small, but definite, group of patients who are currently being undertreated.


Compartmental syndromes.

Compartmental syndromes. Because the compartmental syndrome occurs under such a wide variety of circumstances and because early diagnosis is vital, it is essential that all physicians be familiar with this condition. Results of relatively simple clinical tests permit the diagnosis in most instances. Ancillary diagnostic techniques may prove helpful in questionable instances. Prompt, complete decompression of the affected compartments can preserve function and minimize complications.


Protein and fat utilization in shock.

Protein and fat utilization in shock. A previous study demonstrated that in the dog, shock, regardless of its etiology, resulted in increased  oxidative utilization of substrates which form lactate and pyruvate as intermediary metabolites. The study implied a concomitant decrease in free fatty acid oxidation, as the oxidative pathway of the latter does not involve the lactate-pyruvate step. To test this hypothesis, free fatty acid metabolism was investigated by infusing carbon-14 labelled fatty acid in 12 normal dogs, in nine animals in shock due to controlled cardiac tamponade, and in six animals with endotoxin shock. The shock state was characterized by significant (p less than 0.05) decrease both in arterial fatty acid concentration and in free fatty acid turnover. In addition, both the rate of free fatty acid oxidation and the percentage of the total CO2 derived from free fatty acid oxidation were significantly (p less than 0.05) diminished. In contrast, urea production rates were higher in shock, and the calculated maximum contribution of protein oxidation to total CO2 production rose from 23% in the control animals to 50% in the test groups.


Renal autotransplantation in dissecting aortic aneurysm with renal artery involvement. A dissecting aortic aneurysm in a 60-year-old woman resulted in renal artery insufficiency and medically uncontrollable hypertension. Following a nephrectomy and renal autotransplantation, the patient's renal insufficiency improved dramatically and her hypertension became easily manageable with antihypertensives. Nephrectomy with renal autotransplantation is discussed as an alternative to conventional renal artery reconstruction in cases where reconstruction is either too hazardous or impossible to perform.


[Recombinant DNA studies, a controversial subject which is also promising from the point of view of veterinary medicine (author's transl)]. The hereditary characters of organisms are bound up in the DNA of their genomes. Genetic information is expressed by a complicated mechanism. The process by which this occurs and the control of the degree of expression in bacteria and a number of the other lower organisms are known only in broad outline. There usually is no exchange of DNA between organisms of unrelated species in nature. "Foreign" DNA can be linked to bacterial plasmid DNA and multiplied in the laboratory as a recombinant DNA molecule in bacteria using the recently discovered so-called restriction enzymes. Expression of bacterial DNA can thus be accomplished in a different, unrelated bacterium. In principle, this means that the natural barriers between unrealated species of organisms may be passed by. Human and animal DNA can also be multiplied in bacteria by this method. Previous recombinant DNA studies showed that the mode of expression of genetic information in the higher organisms differs markedly from that in bacteria. The initially sanguine expectations regarding the practical use of recombinant DNA research, for instance in the production of biologically important substances by bacteria, will therefore possibly not be realized at short notice. On the other hand this technique has added considerably to the knowledge of expression of genes within a short space of time. This is particularly true of the mechanisms of pathogenicity of E. coli, the bacterium which plays such an important role in veterinary medicine. The recombinant DNA technique is briefly reviewed in the present paper. The uses are broadly outlined, and one of these, which could be of importance in veterinary medicine, is described in greater detail. International discussions of potential hazards, and therefore also of the admissibility of this type of experiment, are griefly summarized.


Dependency of transcoronary circulatory transport function on coronary perfusion pressure and flow. Transcoronary circulatory transport function was computed from the dye-dilution curves recorded simultaneously at the entrance (aortic root) and exit (coronary sinus) of the coronary circulation after the injection of dye bolus into the femoral vein in open-chest dog. The effect of coronary perfusion pressure and flow on the first (delta-t) and second (deltapi2) moments of the transport function was examined before and during intra-aortic angiotensin infusion. It was observed that the relative dispersion (deltapi2 1/2/delta-t) in the canine coronary circulation is the largest among the organ-circulations that have been examined by the investigators, suggesting that cardiac wall is highly heterogeneously perfused, and that the relative dispersion was variable depending on the coronary perfusion pressure and flow. It is concluded that sole measurement of the moment of transcoronary transport function such as -t cannot be a reliable indicator of the coronary circulatory disturbances. The underlying mechanisms for the dependency of the relative dispersion on the perfusion was discussed.


Immunohistochemical demonstration of somatostatin-containing cells in the human placenta. Present study using immunohistochemical methods clearly demonstrated the presence of somatostatin-containing cells in the human placenta. These cells were located in the cytotrophoblastic layer, while the layer of syncytiotrophoblasts showed no positive reaction. With the progress of gestation, these immunoreactive somatostatin-containing cells disappeared. It was suggested that somatostatin or somatostatin-like substances play an important role in the maintenance of gestation.


Urinary tract calculous disease after renal transplantation. We report 3 cases of a series of 372 (0.8 per cent) renal transplant recipients in whom urinary tract calculi developed as a complication of the procedure. In each patient symptoms were minimal and not classic of calculous disease. We disagree with the contention that all such patients have either hypercalcemia, infection, or tubular acidosis, although thorough evaluation is indicated. We believe this entity should be considered in problematic renal transplantation patients. Conservative therapy is advocated when the situation permits.


Heparin as antibacterial agent in rabbit bladder. Previous studies performed in our laboratory indicated that the primary antibacterial defense mechanism of the rabbit bladder is the antiadsorptive action of the surface mucopolysaccharide. The increased bacterial adsorption that occurs when the bladder is denuded of this layer was prevented by the instillation of heparin. Additional studies showed that the protective effect of heparin is inhibited by protamine, a further indication that the bladder's "antiadherence factor" is a mucopolysaccharide. Small amounts of heparin, applied directly to the mucoprotein-deficient bladder or to the surface of the inoculated bacteria, produced a statistically significant reduction in bacterial adsorption.


Primary cadaver kidney transplantation in older patients: survival equal to dialysis. In our experience, primary cadaver kidney transplantation is a reasonable alternative to dialysis in the older patient with ESRD. The probability for a transplant success is no different from that of other age groups receiving their first grafts from cadaver donors and the quality of life after transplantation is equal to or exceeds that obtained with chronic dialysis.


Determining arterial pressure, left atrial pressure and cardiac output from the left pneumatic drive line of the total artificial heart. These data presented here demonstrate how careful analysis of mock loop testing can lead to useful measurements for long-term calf experiments. The accuracy of the data rae primarily dependent upon a valid circulatory system analog and good experimental technique. These methods of determining arterial pressure, left atrial pressure and cardiac output have allowed us to obtain recordds of these important parameters for periods as long as 100 days in calves with total artificial heart implantation. These methods have also enabled us to automatically control the artifical heart under conditions of rest, exercise and pharmacologic treatment with the use of only one external pneumatic drive line pressure transducer.


[Indications for the use and the procedure of transverse gastric resection with preservation of the pyloric sphincter]. On the grounds of experimental and topographo-anatomic findings and surgical experience with 62 patients the authors present the indications for and technic of transverse resection of the stomach with the preservation of the pyloric constrictor. Three modifications of this operation developed by the authors are described. These modifications were used for the treatment of peptic and duodenal ulcer, polyposis and benign tumor of the stomach. The peculiarities and nerves, maximal vascularization and innervation of the pyloric constrictor, natural passage of the food from the stomach.


[Surgical aspects of a temporary heterotopic transplantation of the liver]. The ways of settling some surgical aspects of a temporary heterotopic transplantation of the liver are analysed in the article. According to the obtained data the placement of the graft into the iliac zone of the abdominal cavity is the most convenient for a temporary heterotopic transplantation of an additional liver. An adequate vascularization of the additional organ can be effected via hepatic artery, which simplifies considerably the removal and replacement of this organ. For a free placement of the graft the weight of the donor should be 2 or 3 times less than that of the recipient.


[Treatment of acute pancreatitis with 5-fluorouracil]. The authors developed an outline for the treatment of acute pancreatitis with 5-fluorouracil which consists in a single or double injection of 250 mg of the drug. The method was used in 54 acute pancreatitis cases. A single intravenous injection of 250 mg of the drug proved to be sufficient for arresting the acute process in edematous and edemo-hemorrhagic pancreatitis. This method helps to shorten the treatment period. Clinical data were confirmed by experimental findings in 12 dogs.


[Life cycle of Frenkelia. IV. Pathomorphological findings in the organs of experimentally infected bank voles]. In 1975 the buzzard (Buteo buteo) was found to be the final host of Frenkelia clethrionomyobuteonis. After this discovery it became possible to investigate systematically the pathomorphology of the infection in the intermediate host, the bank vole (Clethrionomys glareolus). Fifty bank voles were infected orally with a suspension of sporocysts recovered from the faeces of experimentally infected buzzards. Each rodent receive 7000 sporocysts. Six controls each were given a faecal suspension from a non-infected buzzard. The voles were killed between 1 and 140 days after infection and examined histologically. Between the 5th and 8th day of the infection during the schizogonic multiplication of the parasite a focal necrosis of liver cells and of the liver parenchyma is observed followed by a reversible resorptive inflammation associated with siderophagia and the occurrence of giant cells. The spleen was spodogenously enlarged up to twice its normal size. There also was haemosiderosis of the bone marrow, the liver and the spleen up to 25 days after infection. At the same time the erythropoiesis in the bone morrow, the spleen and in the lymph nodes increased; there also was a lymphoid hyperplasia in spleen and lymph nodes. About 10 days after infection a reversible infiltration with lymphocytes and plasma cells developed in the liver, heart and brain. This infiltration was again detectable as perivascular and meningeal reactions in the brain after the 49th day after infection. The second asexual multiplication of the parasite was seen histologically in the grey and white matter of the central nervous system after the 18th day of infection. The developing cysts increased in size continuously thereby compressing the surrounding nervous tissue. Disseminated focal necrosis with resorptive inflammatory components was prominent in the parenchyma of the brain after the 49th day of infection. It was possible to differentiate between damage in single organs and systemic pathological lesions. The lesions in single organs were directly connected with the development of parasitic stages in the liver (schizonts) and in the brain (cysts). The generalized lesions occurred in the haemopoietic system after an impairment of the blood during the first asexual multiplication. They also occurred in the immunocytic systems after the first and during the second asexual multiplication and during the relatively late cystic phase of the parasite in the brain. The pathogenesis of the disintegration of blood cells is not clear. The immunocytic reaction can be considered an immunological response of the host against the parasite. The effect of the development of the cysts on the function and structure of the central nervous system is expected to lead to an increasing impairment of the motility of the intermediate host.


A freeze-etching study on experimental murine mastitis. Streptococcal mastitis was produced experimentally in mice inoculated by the intramammary route; freeze-etched preparations from the affected mammary glands were studied by electron microscopy. The inoculated cocci were seen free in the acinar lumen, within luminal phagocytes and within cells of the epithelium. No significant pathological changes were noted in the junctional complexes between secretory epithelial cells. The results were comparable to those obtained by ultrathin sectioning and indicated that, while cocci can transfer from the acinar lumen into the substance of the epithelium and towards a subepithelial location, the junctional complexes between epithelial cells present a potential barrier to movement through the intercellular spaces.


[Bone tumor macroelements].

[Bone tumor macroelements]. Neutron-activation method was employed to determine the concentration of magnium, sodium, chlorine, phosphorus and calcium in different bone tumors. In relation to normal skeletal tissue in tumor tissues higher concentrations of chlorine and sodium but lower concentrations of calcium and phosphorus were found. The greatest changes in the macromolecular content were noted in sarcoma tissues. Bone tumors differ reliably one from the other by concentrations or ratios of macroelements concentrations, this fact may be used for the differential diagnosis.


[Effect of diets with a varying protein content on fibrinolysis in ischemic heart disease]. A comparative influence of an antiatherosclerotic diet with a reduced proportion of protein (65--70 g) and of a diet with an amount of protein in line with the physiological standard (100--110 g) on the fibrinolysis and lipids spectrum of the blood was studied in 60 patients with ischemic heart disease. The antiatherosclerotic diet is shown to have most favourable effect both on the fibrinolytic system and on the lipids metabolism with the protein proportion of 100--110 g, i.e. in keeping with the physiological standards. A reduction of the protein content in the diet of patients with ischemic heart disease lowers the effect of treatment and does not have any positive influence on the function of the fibrinolytic system.


[Utilization of clinical biochemical examination methods with obese children for establishing the use and assessment of the effectiveness of comprehensive therapy]. A broadened procedure to be used in examining abese children are described. These include an analysis of the history data according to specially worked out schemes, the determination of the basal metabolism and energy expenditures of the naturt of fat deposition, characteristics of the lipids metabolism and the coefficient of the effectiveness of the alimentary fatty acids metabolization.


[The influence of surgery upon leucocyte function (author's transl)]. 14 patients who underwent a standardized total hip joint replacement were investigated in order to detect postoperative impairment of chemotactic or phagocytic function of their polymorphonuclear leucocytes. A chemotaxis assay in modified Boyden [3] chambers and the nitroblue-tetrazolium assay were used. 25 healthy control persons served for the assessment of normal values and the reproducibility of the respective test. Patients were investigated preoperatively and on the first, third and sixth postoperative day. While phagocytosis remained unchanged throughout the period of investigation, chemotactic leucocyte function was regularly significantly depressed on the first postoperative day. The defect in postoperative chemotaxis might, despite of an unimpaired phagocytic capacity, contribute towards an increased risk of postoperative infections.


[Aphasia and neurolinguistics].

[Aphasia and neurolinguistics]. General dominance is a basis of human language. Neurolinguistics deal with this phenomenon and with central language disturbances. Collaboration with general linguistics and neuropsychology is necessary. The most important symptoms of aphasia and the problems of classification and of speech therapy are discussed.


[Isoenzymes, methodology and clinical significance (author's transl)]. In recent years the determination of serum enzyme activities has played an increasing role in clinical chemical diagnosis. Because the enzyme composition of single organs is qualitatively and, to a certain extent, quantitatively similar, the diagnostic value of enzyme activity determinations is often diminished. Each serum enzyme can be separated into isoenzymes which stem from different organs and make specific organ diagnoses possible. This separation is possible through chemico-physical and immunological methods. Electrophoretic, chromatographic and immunological methods for the determination of creatine phosphokinase isoenzymes the immunological method is superior to the electrophoretic method in precision and accuracy. Artefacts through storage do not occur in the immunological method. New aspects of the clinical value of the determination of isoenzymes of alkaline phosphatase (AP, E.C. 3.1.3.1), creatine phosphokinase (CK, E.C. 2.7.3.2) and lactate dehydrogenase (LDH, E.C. 1.1.1.27) were studied in the following 8 patient groups: 1. The value of AP isoenzymes for determining liver damage due to chronic alcoholism. 2. The distribution of AP isoenzymes in dialysis patients with special regard to the intestinal isoenzyme. 3. The immunological demonstration of carcino-placental antigen of AP in tumours of the lung. 4. The demonstration of intestinal isoenzymes of AP in chylous effusions. 5. The profile of LDH isoenzymes in pulmonary alveolar proteinosis in serum and in lung lavage-fluid. 6. The usefulness of CK-MB isoenzyme as proff of cardiotoxicity of pharmaceuticals. 7. The profile of CK isoenzymes in central and peripheral nervous system diseases, especially the appearance of CK-BB in serum and the behaviour of CK at the blood spinal fluid barrier. 8. The appearance of unusual isoenzyme patterns in newborn infants and in pregnant women in comparison with normal adults. The determination of isoenzymes is of great clinical importance, even if the total serum activity of the particular enzyme is not elevated.


Fermentation, isolation, and biological activity of maduramycin: a new antibiotic from Actinomadura rubra. In a continuing search for new antibiotics, the species Actinomadura rubra (Sveshnikova et al.) J. Meyer et M. Sveshnikova 1974 (strain IMET 13001) was found to produce a red pigment with indicator properties, designated maduramycin. The pigment (C28H22O10; m.w. 518 m/e-; m.p. 305--310 degrees C (dec.); UVmax 225.307 nm) possesses a strong antimicrobial activity against gram-positive bacteria, including strains which produce inactivating enzymes for some commercial antibiotics. Maduramycin forms a complex with serum albumin, but no complex formation with DNA was observed using absorption spectroscopic and polarographic methods. Maduramycin additionally inhibits the action of some enzymes. The LC50 of maduramycin in mice was greater than 250 mg/kg on intraperitoneal administration. Fermentation, isolation, and some of the chemical and biological properties of this new antibiotic are described.


Kinetics of growth and substrate consumption of Escherichia coli ML 30 on two carbon sources. When E. coli ML 30 is grown in batch culture on a mineral salt medium containing a mixed carbon source of glucose and pyruvate, there is no sequential utilization of the carbon sources. The consumption of glucose and pyruvate takes place simultaneously with reciprocal influence (inhibition) on rates of substrate uptake. The specific growth rate is greater than mupmax for pyruvate but smaller than musmax for glucose. In the paper three cases of kinetics of growth and of substrate consumption at several combinations of initial substrate concentrations are considered. A mathematical model is proposed and investigated. The model allows to describe the growth on glucose or on pyruvate not only as singular carbon sources, but also as a mixed carbon source with reciprocal inhibition on rates of substrate uptake. By data fitting parameters of growth and substrate consumption were found.


The pathophysiology and clinical aspects of hypercalcemic disorders. FOR THE PURPOSES OF THIS REVIEW, THE VAST AND INCREASINGLY COMPLEX SUBJECT OF HYPERCALCEMIC DISORDERS CAN BE BROKEN DOWN INTO THE FOLLOWING CATEGORIES: (1) Physiochemical state of calcium in circulation. (2) Pathophysiological basis of hypercalcemia. (3) Causes of hypercalcemia encountered in clinical practice: causes indicated by experience at the University of California, Los Angeles; neoplasia; hyperparathyroidism; nonparathyroid endocrinopathies; pharmacological agents; possible increased sensitivity to vitamin D; miscellaneous causes. (4) Clinical manifestations and diagnostic considerations of hypercalcemic disorders. (5) The management of hypercalcemic disorders: general measures; measures for lowering serum calcium concentration; measures for correcting primary causes-the management of asymptomatic hyperparathyroidism.


[Balzac and the limits of psychology].

[Balzac and the limits of psychology]. In contradiction to the general meaning that Balzac belongs to one of the first representative authors, who described their figures according to the assumptions of motivational psychology--including psychoanalytic, i. e. subconscious motivation--the Ref. gives proof, that Balzac has overcome these limited premises of actual psychology. Balzac saw human existence under the aspects of passions, the pathetic, the tragic, the apriori of psychology in general, which is the possible itself, the dependence further of any individual identity on situative variabilitis--all aspects transcend motivational psychology and show its limits. Balzac should be considered as a predecessor of an anthropological-existencialistic psychology, his biography can not be understood by the application of psychoanalytic "Klischees", it is rooted in the contradictions of human nature, that are antilogical in them selfes.


[Critical discussion of Paul Watzlawick's, John Weakland's and Richard Fisch's therapy model]. The analysis of the treatment-model, that Watzlawick et al. developed in reference to his "pragmatic communication theory" shows in addition to many theoretical inadequacies that despite the "easy-to-imitate"-impression the reproducibility of the described therapeutic techniques is definitely insufficient.


[Determination of the severity of mitral stenosis by hemodynamic and echocardiographic parameters]. M-Mode and two-dimensional echocardiographic examinations were performed in 70 patients with pure or prevailing mitral stenosis. Mitral valve excursion, mitral valve opening area (MVOAe) and diastolic E-F slope were determined and compared with the gradient across the valve and the opening area obtained during cardiac catheterization. Mitral valve excursion and E-F slope showed mean values of 1.71 cm and 1.98 cm/sec. respectively and were indicative of a stenosed mitral valve. Correlation between E-F slope and gradient with MVOAe was poor. The correlation coefficient was r = +0.56 and r = 0.34 resp. MVOAe compared favorably to the mitral valve area determined at cardiac catheterization (r = + 0.96) and the gradient across the mitral valve (r = 0.90)9 We conclude: 1. Determination of the mitral valve opening area by means of two-dimensional echocardiography represents a valuable addition in the assessment of the severity of mitral stenosis. 2. M Mode echocardiography indicates the presence, but not the severity of mitral stenosis. 3. Computerized planimetry is superior to the manually planimetered opening area and represents a reproducible, exact and time-saving procedure.


[On the usefulness of bone scintigraphy for detecting loosening of articular prostheses (author's transl)]. The most important complication of articular substitution is the loosening of the prostheses as a result of permanent overstraining, trauma, chemical or infectious noxae. The value of bone scintigraphy in the diagnosis of loosening of the endoprothesis was examined in 53 articular prostheses (49 hip joints and 4 knee joints). A pathological scan was evident in all cases where the prosthesis had become loose (18 cases), whereas a normal scan was found in 34 firmly positioned prostheses. A false positive scan occurred in one case of periarthritis. Bone scintigraphy can be employed as a means of diagnosing loosening of prostheses after a period of nine months following the operation; up to that time, enhancement can be due to the operation. A positive scan in case of loosening of the prosthesis is manifested earlier than radiological signs. For this reason, scintigraphy can be recommended as a routine examination method in pain after articular substitution surgery.


[The Hak-Hagir skin conduit].

[The Hak-Hagir skin conduit]. By a still broader side to side anastomosis of the ureter with a pedicle flap of the abdominal skin in form of a conduit and its hitherto satisfying results this seems to develop as a suitable methode for the suprapubic passage of the urine.


A "pull-out" technique for "cut down" operations. It is a common experience that some patients continue to attend outpatient departments with their cut-down wounds long after their primary disease is cured. This is so because a cut-down is done usually in an emergency situation with poor aseptic rituals. More often than not the patient is in shock and in urgent need of fluids but his peripheral veins are collapsed. It is often found that the ligature used to tie off the vein is responsible for the persistence of infection. When it is removed and an associated abscess(if any) drained cure results. A new simple technique has been devised and described here for cut-down operations which overcomes the problem.


[A swallowed needle found in the kidney pelvis]. The case of a young female patient is discussed. The authors removed out of the renal hollow system of this patient a needle. The foreign body passed perorally into the renal pelvis after perforation of the duodenum. There the thicker end of the needle was encrusted; a pyelonephrosis, then a septic condition developed. After removal of the needle the kidney operated on showed a good function.


[Allogenic transplantation of sterilised bones and halfjoints (author's transl)]. The bones and halfjoints were gained under non-sterile conditions. They were sterilised using 1% formaldehyde solution and preserved with 2% formaldehyde--sugar solution or 50% honey solution. 102 allogenic transplants were performed in 100 patients. The results are very satisfying. The method described is effective, of universal practicability and guarentees constant available high class bone material for transplantation.


[Acute arterial obstructions and emergencies in vascular surgery (author's transl)]. Acute arterial obstruction due to embolism or thrombosis require surgery within 6 hours in case of complete ischaemia. The removing of the occluding material can be done in every hospital under local anaesthesia using a Fogarty-catheter. Reconstruction of injured arteries must be accomplished immediately after preliminary haemostasis by local compression in a surgical department with a special equipment for vascular diagnosis and surgery. The rupture of an aneurysm of the abdominal aorta signifies a poor risk for the patient. To obtain a chance quick diagnosis, shock-therapy and an immediate transport into a specialized hospital for surgery are indispensable.


[Results of 289 cadaver kidney transplantations at the Berlin-Friedrichshain centre (author's transl)]. Developement and organization of kidney transplantation in the GDR was studied, with data of 289 patients who underwent transplantation at the Kidney Transplant Centre, Berlin-Friedrichshain being analyzed. The five years graft survival was 42% and the patients survival 62%. In case of combined treatment of transplantation and dialysis it was 70%. The main cause of transplant failure was rejection with a frequency of 12,1%. On the basis of an improved immunosuppression regime the mortality rate decreased from 37,6% to 12,3%. The introduction of a new method of ureteroneocystostomy resulted in a lower rate of urological complications. The importance of the preparation of the recipients, of the HLA-tissue typing as well as the influence of blood transfusion on the late prognosis of grafts will be discussed.


[Postoperative anastomotic stenosis after anterior resection of the sigmoid colon and rectum (author's transl)]. 149 patients underwent anterior resection of the sigmoid colon and the rectum with decompression-transverse colostomy. In 10 cases stenosis of the anastomosis was observed. The development of the stenosis is believed to have been caused by a small leak in the anastomosis, leading to secondary bacterial infection and hence scar formation. It is suggested that a one layer through and through silk suture promotes the eventual stenosis.


[Computer evaluation of tocograms following administration of Spasmalgan (denaverin)]. Computer analysis of tocograms after administration of Spasmalgan (Denaverin). The influence of spasmolyant Spasmalgan on 5 parameters of labour has been examined in 50 intraamniotic derived tocograms by on line fetal monitoring. Only a little increase of the basal tone has been shown after administration of Spasmalgan. The method is recommended for testing the uterotropic influence of pharmacons in labour.


[Development of intensive monitoring in obstetrics]. As early as about the turn of the century the causes for the discharge of the meconium under labour were studied and the attempt was made to record alterations of the cardiac sound under the influence of labour pain as well as the behaviour of the fetal heart by means of the electrocardiogram. In the development of obstetrics certain stages can be observed which in the past few decades entailed a great many changes, such as changing from delivery at home to delivery at hospital, parasitological clarification of intrauterine infections and the revelation of the pathogenesis of the Mhn. Studies of the physiology of intrauterine respiration, direct measurements of the oxygene pressure in the fetal blood represent the base for the future development of perinatal medicine. An essential improvement of the fetal supervision has come about ever since amnioscopy, cardiotocography, supersonic diagnostics, hormono- and enzyme analyses were introduced. Problems of organization and the future tasks of perinatal medicine are shown on the basis of maternal mortality at district level and perinatal mortality of the hospital.


[A method for automatically analysis of antenatal cardio-tocograms (author's transl)]. An off-line computer analysis of antenatal cardiotocograms has been developed. The fetal heart period (interbeat interval), the signals from uterine contractions and fetal movements, the maternal heart period and the continuous time are recorded on magnetic tape. A marking of single steps and of special events during this investigation is possible. For data processing the sequence of measuring values must be divided in shorter intervals (as a rule with a length of 30 seconds).--After this the mean value of FHR and of MHR is calculated for each interval. By computation of the standard deviation (S), the index of instantaneous arrhythmia (IAI), and the number of macrofluctuations of these intervals a quantification of the heart rate short-time-variability and long-time-variability can be performed.


Comparative studies on the isolation of salmonella from minced meat. Comparative studies carried out in four laboratories revealed that in the examination of frozen or fresh minced meat samples tryptone soya broth and glucose mineral salts medium used for pre-enrichment gave the same results as buffered peptone water. The three tetrathionate media (Cardiff formula, Difco and Oxoid) used for enrichment after pre-enrichment, yielded approximately the same number of positive samples and about the same number of frozen and cooled samples was found positive when data of all four laboratories were considered. Between laboratories a considerable variation in results was found. This indicates the necessity to conduct comparative trials in more than one laboratory to validate the use of a specific method for regulatory purposes.


[Evaluation of procedures for hygienic disinfection of hands: comparison of two methods, for artificially contaminating hands and use of an automatic colony-counter (author's transl)]. Testing procedures for the Hygienic Disinfection of hands, two kinds of artificial contamination have been compared: Application of one drop of bacterial suspension onto each fingertip as described in the DGHM-"Richtlinien" and immersion of hands as described in our previous papers. When using our method, fingertips released higher numbers of testbacteria. Since pre- as well as post-values were elevated, disinfection-tests applying one of each contamination method resulted in log10 reductions which did not differ significantly. Using an automated scanning colony counter we were able to save 2/3 of time otherwise required for manual counts. Up to 10(2) colonies per plate manual counts were practically identical with the counters results, whereas with higher colony-numbers the counter showed an increasing tendency to under-estimate the numbers of colonies. Since colonies of skin-staphylococci are not recognised by the automated counter, we cultured our rinsing-fluids on nutrient agar containing 0.05% of sodium-desoxycholate in order to inhibit the autochthonous skin flora. This supplement influenced the colony counts of our test-bacterium to a very minor degree only, the reduction factors were not at all altered.


[Application of a new method for the calculation and description of the resistance of microbiological indicators. I. Testing of several common microbiological sterilization indicators (author's transl)]. The method described by SPICHER and PETERS (1975) for the calculation and description of the resistance of microbiological indicators was tested. As test objects served spore-containing earth according to DIN 58946, Attest indicators (3 M Company, Minnesota) and Oxoid Spore Strips (Oxoid Ltd., London). The tests were performed not only for different batches of indicators but also for preparations of different age. After application of steam (120 degrees C), the indicators were examined for the presence of surviving germs capable of multiplication. When plotting the frequency of indicators with surviving germs (q) against the duration of steam action, S-shaped curves were obtained as expected. By altering the scale of the ordinate (y = lg (-ln(1 - q))), the S-shaped curves could be transformed into straight lines. Thus, the experimentally established paired values could be used for a calculation of regression. This method of calculation proved to be suitable in all cases studied. By indicating the position and the slope of these straight regression lines, the resistance of microbiological indicators can be exactly described (cf. Table 2). This method is applicable not only to indicators containing culture spores but also for native spore-containing earth. The indicators examined differed in their resistance and stability. Seven out of eight batches of Attest indicators (cf Figs. 1 and 2 and Table 1) fulfilled the requirements of DIN 58946, Part 4, for the resistance of bio-indicators for steam sterilization. One of the batches had a slightly higher resistance. The Attest indicators tested were of good stability (see Fig. 1 and Table 1). Where surviving germs were present on the indicators after treatment by steam, their growth was recognizable, in 99% of cases, already after incubation of the cultures for 24 hours. Only two batches of Oxoid Spore Strips were available for testing. One batch was of a higher resistance than required by DIN 58946. The second batch was slightly above the lower limit of the permissible range (see Fig. 3). During storage for 12 months, the resistance of both batches was reduced by 3--4 min. Where the indicators exhibited surviving germs after treatment by steam, growth was recognizable in 87% of the cases after incubation for 24 hours, while for the other indicators, incubation for 48 hours was necessary. The experiments confirmed the good stability of native spore-containing earth (see Fig. 5). Within 4--5 years, the steam resistance of the preparations decreased only by 3--4 min.


Gonadotrophin release during chronic administration of D-ser (TBU)6 LH-RH-EA in functional amenorrhoea. Six women with long-standing functional amenorrhoea were treated with 5 microgram of D-Ser (TBU)6 LH-RH-EA twice daily for 14 days. The functional states of the gonadostats, as assessed by a 25 microgram LH-RH test dose, varied widely before the treatment was started whereas at the end of it they were uniformly low. In all patients D-Ser (TBU)6 LH-RH-EA induced gonadotrophin release, the peak values occuring between day 1 and 3 of therapy. Despite further injections mean gonadotrophin levels declined rapidly therafter and remained in the basal range for the rest of the study. Release of oestradiol was very uncharacteristic. No consistent ovarian response pattern was observed during the analogue administration. It is obvious that chronic stimulation with D-Ser (TBU)6 LH-RH-EA leads to a decreased responsiveness of the pituitary gland.


Maintenance of spermatogenesis induced by HMG treatment by means of continuous HCG treatment in hypogonadotrophic men. In a long-term hypophysectomized male HCG treatment was unable to initiate spermatogenesis. However, a spermatogenesis induced by HMG/HCG treatment could be maintained by HCG alone for 7 years with clinical fertility. In another hypogonadotrophic male HCG was also unable to initiate spermatogenesis. But a spermatogenesis once induced by HMG/HCG treatment could be maintained for more than one year with HCG alone. It is suggested that gonadotrophin treatment of the hypogonadotrophic male should consist of HMG + HCG until complete spermatogenesis is induced followed by maintenance treatment with HCG.


Kidney function in normal man during short-term growth hormone infusion. Kidney function was studied in 9 normal males before and during a 2 h growth hormone (GH) infusion of 50 ng/kg/min. The following variables were measured during each 20 min clearance period: glomerular filtration rate, GFR, effective renal plasma flow, RPF (steady state infusion technique with urinary collections using [125I]iothalamate and [131I]iodohippurate), and urinary albumin and beta2-microglobulin excretion rates (radioimmunoassays). The GH infusion resulted in a 10-fold increase in plasma GH concentration. All the above mentioned variables remained practically unchanged during the infusion except for a small (-5%) but significant decrease in renal plasma flow (P less than 0.01). Our negative results contrast to the findings of increased GFR and RPF during prolonged GH administration and suggest that GH requires several hours or days for its renal effects to become manifest.


Myoinositol and function of peripheral nerves in human diabetics. A controlled clinical trial. Fifty-nine diabetic patients participated in a double-blind study in order to evaluate the efficiency of myoinositol to improve the function of peripheral nerves. Myoinositol in the amounts given was not able to change motor conduction velocity or vibratory perception threshold. No change in retinopathy and several biochemical parameters was observed.


Current research in neuro-epidemiology. Some main trends. Recent epidemiological research has contributed to the understanding of the nature of common neurological disorders like multiple sclerosis, Parkinsonism, and amyotrophic lateral sclerosis. Viral etiology constitutes the most probable environmental factor in multiple sclerosis, but host-related genetic factors are also involved and determine susceptibility. In disorders like Parkinsonism, amyotrophic lateral sclerosis, and epilepsy, heredity seems to play a more important role than earlier believed, and segregation analyses indicate polygenic inheritance patterns. The subacute spongiform encephalopathies fit into a similar concept, and here the hunt for infectious agents has succeeded. Polygenic traits and dominantly inherited disorders seem to aggregate in genetic isolates, as shown through studies from different parts of the world. The reason for this is not quite clear, but selection through assortative matings or other mechanisms may be operating in these populations.


Quantitative electron-microscopic studies of langerhans islets in normoglycemic chinese hamsters of a diabetic strain. On the basis of previous studies of the retina and the pituitary, normoglycemic Chinese hamsters from a diabetic strain were divided into two groups, depending on the thickness of their capillary basement membrane and on the number of somatotrophs. Both values were significantly lower in group I than in group II. Quantitative electron microscopy of the islets of Langerhans showed in group II a tendency to a volume increase for A-cells, to a decrease for D- and B-cells. Also the number of B-granules and the surface area of electron dense material deposited in B-cells appeared to be increased in group II. Hypotheses are offered to explain the islet changes in correlation to previous findings in the retina and pituitary.


Immunoelectron microscopic localization of s-100 protein in cultured rat glioma cells. Immunoelectron microscopic localization of the nervous system specific protein S-100 in the cultured rat glioma cells was successfully conducted by an unique immunocytochemical technique using peroxidase-labeled antigen binding Fab' fragments. The intensely electron dense reaction product for S-100 protein was localized mainly at ribosome granules associated with endoplasmic reticulum membranes and at free ribosome granules. S-100 protein was also associated to some extent with the cytoplasmic and nuclear membranes. A positive reaction was localized at the nuclear pores as if it were being prevented from entering into the nucleus. No activity was found in the nucleoplasm except for a slightly positive reaction product associated with nucleolus. The possible role for S-100 protein in neural cells was discussed in relation to the nuclear acidic proteins involved in genomic regulation.


Adhesive bonding of dental luting cements; influence of surface treatment. Tensile bond strength of four different luting cements to smooth dentin surfaces was measured. A chisel edged, stainless steel ring was cemented to the butt end of a dentin cylinder. The dentin was polished to a plane and smooth surface before cementation. The cements were also applied to dentin surfaces that were treated with a pumice slurry, etched with different acid solutions, or covered with different liners. The results showed that the polycarboxylate cement had a tensile bond strength to smooth, untreated dentin of approximately 4 MN/m2. The zinc phosphate and EBA cements had a bond strength of 0,6 MN/m2 and the composite resin cement had no measurable bond to untreated dentin. All dentin treatments showed in general a decreasing effect on the bond strength of zinc phosphate, polycarboxylate and EBA cements, whereas that of composite resin cement showed a slight increase.


Plasma concentrations of diazepam and N-desmethyldiazepam in newborn infants after intravenous, intramuscular, rectal and oral administration. Five newborn infants (birth weight 2900--3600 g) were given diazepam (Valium, LaRoche) for convulsive disorders in 4 equal doses intravenously, intramuscularly, rectally and orally with at least 24 hours intervals. Three infants were given doses of 1 mg diazepam/kg body weight, and 2 0.5 mg/kg. The parenteral solution of the drug was given intravenously, intramuscularly and rectally. Powder of tablets was given orally. After intravenous administration very high peak values of plasma-diazepam concentration were obtained (5775--10800 ng/ml after 1 mg/kg, 2750 and 6450 ng/ml after 0.5 mg/kg). Next to intravenous administration rectal administration caused the most rapid increase in plasma-diazepam concentration. Presumed anticonsulsive concentrations (150--300 ng/ml) were obtained within 5 min with 1 mg/kg as well as 0.5 mg/kg rectally. Rectal administration therefore could be a suitable treatment for seizures in the newborn infant. Accumulation of the main depressive metabolite N-desmethyldiazepam occurred in all infants. This phenomenon must be taken into account when repeated doses of diazepam are administered.


Pubertal development in the Prader-Labhart-Willi syndrome. The sexual maturation in the Prader-Labhart-Willi (PLW) syndrome was investigated in 14 patients, 10 females and 4 males. A wide variability in the pattern of pubertal development was found including delayed puberty in 5 patients and normal puberty in 4 patients; sexual precocity was also observed in 5 patients, true precocious puberty in one patient and incomplete sexual precocity in the form of precocious pubarche in 4 patients. In 5 patients, 3 of them with precocious pubarche, the appearance of the pubertal signs was followed by a delay or arrest in their future development. An LH-RH stimulation test was performed in 11 patients. In the 6 patients who eventually developed normal puberty, the basal levels and the peak responses of both LH and FSH were within the range of those observed in normal controls of the same pubertal stage. In 4 patients showing marked delay or arrest of puberty, the basal levels were normal or low and the responses of LH and FSH to LH-RH were blunted. Priming with repeated LH-RH stimulation in one of the male patients led to an augmented LH response, suggesting a hypothalamic hypogonadotrophism. It is concluded that the lack of uniformity in the pattern of sexual maturation in the PLW syndrome is due to a variability in the location and extent of a hypothalamic lesion, which may comprise an active process continuing beyond the perinatal period.


Longterm follow-up of neonatal septicemia. The longterm prognosis of neonatal septicemia during the first four weeks of life has been estimated. Of 90 infants with the diagnosis of neonatal septicemia during a five-year period, 1969--1973, 65 infants survived the initial treatment. Another two infants died with complications of their main disease, intestinal atresia, at the age of two months. Thus the total mortality in neonatal septicemia in this series was 30%. The remaining 63 children have been investigated between ages of 2 1/2 and 6 1/2 years. Of these 63 children we have found 14 children (22% of the surviving) with handicaps where the septicemia can be regarded as a possible cause of the handicap. Of these 14 children only six had an "uncomplicated" septicemia while four of them had meningitis and four had osteomyelitis. Furthermore, of the 14 handicapped children nine were delivered preterm (28--36 weeks) and all of them had one or more additional neonatal diagnoses than septicemia. The prognosis, both immediate and longterm, of neonatal septicemia in the present series compares favourably to most international studies. The importance of early detection together with an aggresive treatment of the septicemia is stressed and is considered as the main reason for the good prognosis.


Pancreatic B-cell sensitivity to alloxan in vivo. A study of antagonizing compounds, serum inorganic phosphate and acid-base balance. Serum glucose, inorganic phosphate, acid-base balance and islet morphology were studied in mice subjected to different kinds of treatment before alloxan administration. In preceding studies, pretreatment with D-glucose, D-mannose, D-fructose, sodium lactate and NaHCO3, but not with D-galactose, was found to protect against alloxan toxicity. In this study alloxan antagonism was found by pre-treatment with L-leucine, but not with L-arginine or NaH2PO4. Blood analyses, carried out 10 minutes after injection of the test compounds, disclosed that the serum inorganic phosphate concentration was decreased in mice given D-glucose, D-mannose, D-fructose, sodium lactate, NaHCO3, L-leucine, and L-arginine, but was not affected in those treated with D-galactose, and was increased in those receiving NaH2PO4. With the exception of L-arginine, blood pH was increased in the groups which exhibited decreased serum inorganic phosphate concentration; pH was not affected in mice treated with D-galactose, L-arginine and NaH2PO4. Alterations in inorganic phosphate and hydrogen ion concentration may affect the B-cell sensitivity to alloxan ("Pi-pH hypothesis").


Periodic acid Schiff-positive non-glycogenic globules in hepatocytes. Differential diagnostic aspects in screening for alpha-1-antitrypsin globules in an autopsy material. Thirty-eight subjects with diastase-resistant PAS-positive cytoplasmic globules in hepatocytes were found among 238 autopsies. In 15 of the 38 subjects the globules were antigenically alpha-1-antitrypsin, in 23 subjects they were not. The latter globules were found in centrilobular regions, the alpha-1-antitrypsin globules mainly in periportal regions. The non-alpha-1-antitrypsin globules showed less differences in size (6-10 mu) and a smaller number per hepatocyte (1-7) than the alpha-1-antitrypsin globules (1-40 mu and 1-30 per cell). The non-alpha-1-antitrypsin globules were only demonstrated in livers with centrilobular sinusoidal dilatation having, in all cases but one, also centrilobular, confluent necrosis. This type of globules can be assumed to be of differential diagnostic importance mainly in an autopsy material. The nature of these globules is discussed.


Occurrence and distribution of VIP nerves in the nasal mucosa and tracheobronchial wall. Nerves displaying vasoactive intestinal peptide (VIP) immunoreactivity were detected in the upper respiratory tract of guinea pigs, rabbits and cats. VIP nerves were numerous in the cat, less numerous in the rabbit and rare in the guinea pig. In the nasal mucosa, fine varicose VIP nerves were found to surround nasal glands and small blood vessels. In the tracheobronchial wall VIP nerves were observed around seromucous glands, blood vessels and smooth muscle. Ganglia located in the walls of the trachea and main bronchi contained clusters of VIP immunoreactive nerve cell bodies, conceivably representing the origin of the VIP fibres found in this region.


Structural changes in kidneys of patients with oliguric extracapillary glomerulonephritis during immunosuppressive therapy. Structural changes in kidney biopsies were investigated from five patients with primary oliguric extracapillary glomerulonephritis in whom the renal function was adequately maintained during extended combined immunosuppressive treatment. The most important structural change was a pronounced decrease in the number of crescents. Reduction in numbers of crescents in the late biopsies was significantly greater than the increase in the number of hyalinized glomeruli. Tubular parenchyma showed only slight diffuse atrophy, and a moderate interstitial fibrosis was always present during the latter stages of treatment. Disappearance of crescents in the glomeruli was not accompanied by disappearance of immunoglobulins. Successfull immunosuppressive treatment of extracapillary glomerulonephritis causes the disappearance of structural characteristics of the kidney that are diagnostic for this disease.


Clinical relevance of histological grading of cancer of the larynx. Primary biopsies from 52 patients with cancer of the larynx were examined by two pathologists working independently. The malignancy of each case was graded twice with an interval of 1--1 1/2 month according to a histological scoring system elaborated by Jacobsson. The reproducibility of the system was found poor for individual prognostic purposes and no connection between histological grade and clinical course was demonstrated.


Nitroblue tetrazolium (NBT) reduction by bacteria employed for rapid determination of antibiotic concentrations in serum. The ability of bacteria to reduce nitroblue tetrazolium (NBT) to formazan, and the inhibition of this process by antibiotics, have been utilized in a method to determine antibiotic concentrations in serum. Escherichia coli, growing in the presence of increasing but subinhibitory concentrations of antibiotics, produces diminished amounts of formazan. This is photometrically quantified and the optical density obtained with the sample is compared with those obtained with know concentrations. Levels of aminoglycosides below 1 microgram/ml can be measured in the presence of other antibiotics also, and the assay can be carried out in three hours. Good correlation was obtained when 49 serum samples containing varying concentrations of sisomicin were tested simultaneously by the NBT assay and a disc diffusion method.


Identification of Salmonella bacteria by co-agglutination, using antibodies against synthetic disaccharide-protein antigens O2, O4 and O9, adsorbed to protein A-containing staphylococci. Protein A-containing staphylococci sensitized with antisera against synthetic Salmonella O-antigens 2, 4 and 9, representative of serogroups A, B and D, respectively, were used for identification of Salmonella bacteria by co-agglutination. Out of 416 Salmonella bacteria tested the reagents correctly identified all 24 serogroup A strains, 119 serogroup B strains and 39 serogroup D strains. Unexpected agglutination was registered with two of 144 strains belonging to serogroup C 2 with reagent containing antiserum against synthetic O antigen 4. No agglutination occurred when 24 non-Salmonella bacterial strains were tested. Approximately 10(8)bacteria were required for positive co-agglutination. As compared to standard slide agglutination with conventional anti-Salmonella O factor sera, the co-agglutination metod was favourable in that the reactions were stronger, although the concentration of antiserum used was from 20 to 200 times lower. The co-agglutination method could also be used for detection of soluble antigens in the form of lipopolysaccharides from Salmonella bacteria in concentrations of 1 microgram/ml. When the sensitivity of the co-agglutination technique was compared with indirect immunofluorescence (IFL), the IFL method was shown to be at least 1000 times more sensitive.


In vitro locomotion of human leukocytes. Photographically determined distribution in millipore filters at different incubation times. The distribution of leukocytes in Boyden millipore filters after stimulation with casein was determined after 30 and 180 min by the use of a photographic method. After 30 min the distribution was characterized by a second degree curve with a falling slope and after 180 min by a linear curve with a rising slope. The results showed that with most of the modifications of the Boyden method in use at present, the choice of incubation time is crucial for the evaluation of counting results.