Prostacyclin formation by myometrial & decidual fractions of the pregnant rat uterus. Chopped samples of myometrium, decidua and extrinsic blood vessels from the pregnant rat uterus when incubated at room temperature generated a prostacyclin-like substance. Activity in the incubation mixtures was compared against authentic prostacyclin in two assay systems: relaxation of strips of bovine coronary artery and inhibition of ADP-induced aggregation of rabbit platelet-rich plasma. Results estimated from inhibition of platelet aggregation showed that activity generated by all samples was low on day 12 of pregnancy (less than 0.25 ng/mg). However at the time of delivery (day 22) myometrial synthesis had increased 18.5 fold to over 3 ng/mg of prostacyclin whereas decidual production had only increased 5 times. As there was no increase in synthesis by the extrinsic uterine blood vessels over this period it is proposed that the myometrial muscle cells are the probable source of the prostacyclin-like material.


[Production of colicins V and V2 in vitro and in vivo. Study of their inhibitory action on phagocytosis by peritoneal macrophages]. In recent years, a possible relationship between pathogenicity and colicinogeny in some Escherichia coli colicin V-producing strains had been inferred. In our laboratory, we have elaborated a simple in vitro method for the production of colicin V free of large, non dialyzable macromolecules and presumably of bacterial endotoxin. This allows study of the effects of colicin V in vivo without an undesirable added physiological response of the experimental animal to endotoxin. All the Col V+ strains we have studied displayed a greater ability to survive in the peritoneal cavity of mice than the Col V- strains. Also, we have detected colicin V in peritoneal fluids of agonizing mice injected with Col V+ strains. Phagocytosis by peritoneal macrophages seemed to be inhibited in vitro in the presence of colicin V. Colicin V is not toxic in vivo in low concentration, after intraperitoneal or intravenous injection but it may favor the multiplication and the invasiveness of the strains that produce it.


Comparative study of carbuterol and salbutamol from metered aerosols in bronchial asthma. In a double-blind crossover trial carbuterol and salbutamol were administered by aerosol for 7 days each to 20 patients with reversible obstructive airways disease. In addition to assessment of subjective response, objective measurements were made of response of the respiratory system (FEV1, FVC, MMEFR) and cardiovascular system (pulse rate, blood pressure, ECG) to each drug. Both carbuterol and salbutamol were found to be effective, well-tolerated bronchodilators when given over a 7 day period; there was no significant difference between the drugs in any of the parameters studied. Carbuterol is a safe and effective alternative to salbutamol.


Retention and effectiveness of a chemically polymerized pit and fissure sealant after 2 years. Following a single application of a chemically polymerized fissure sealant (Concise Enamel Bond System) 60% of the sealants were present after 2 years of examination. The effectiveness of the treatment was highly significant and the caries reduction, irrespective of the sealant status, was found to be about 50%. The caries reduction was 98% in sealed pairs where the material was fully retained.


Oral use of chlorhexidine gluconate toothpaste in epileptic children. The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and G I values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.


Pineal compounds with antigonadotropic activity. The work presents the experimental data reported by specialty literature as well as those reported by the authoress on studying the pineal substances with antigonadotropic activity, namely the indole compounds and pineal polypeptides. The effects observed after administration of melatonin--prototype of the pineal-indole family--and of more or less purified pineal extracts are presented. The matter discussed upon is whether or not melatonin or arginine-vasotocin are the pineal hormones responsible for the complex actions induced by the pineal extracts.


Metronidazole in Crohn's disease. A double blind cross-over clinical trial. Twenty-two patients with active Crohn's disease treated with salazosulfapyridin or prednisone, were in addition given metronidazole 1.000 mg daily or placebo for two months each in a double-blind cross-over study. No statistically significant effect was observed on the overall clinical condition in the 20 patients who completed the trial, although haemoglobin rose and ESR fell significantly in the metronidazole periods. In the 6 patients with colonic involvement only an improvement was registered both in symptoms and laboratory values.


The role of caerulein in tests of exocrine pancreatic function. Secretin (1 CU/Kg) plus Caerulein (100 ng/Kg) or Cholecystokinin (1 or 2 IvyU/Kg) were given by rapid intravenous injection (Schedule 1) or by continuous infusion (Schedule 2) to 63 control subjects (C) and 69 patients affected by chronic pancreatitis (CP). Duodenal juice was collected for two and four 30-minute periods in schedule 1 and schedule 2, respectively. Volume, bicarbonate, and enzyme content were measured. Secretin-Daerulein, by rapid intravenous injection, showed a strong overlapping between C and CP values and led to some side-effects. Secretin-Caerulein by continuous intravenous infusion gave almost identical results as the Secretin-Cholecystokinin.


Pre-medication for endoscopy. A trial of atropine, pentazocine or pethidine as a supplement to diazepam. The effects of giving atropine, pentazocine or pethidine, 30--45 minutes before intravenous diazepam have been assessed and compared with a control group given diazepam alone in a double-blind controlled trial of pre-medication for upper gastrointestinal endoscopy involving 143 patients and 6 endoscopists. Atropine or pentazocine increased the success rate of the procedure (p 0.007) but gave no other definite benefit. Pethidine improved the degree of sedation (p 0.01) and the success rate (p 0.007); the combination of pethidine given before diazepam ranked first of all the four treatment regimes. The patients' opinion of the procedure correlated with the duration of endoscopy and the experience of the endoscopist.


The influence of beta-sitosterol on biliary cholesterol saturation and bile acid kinetics in man. beta-Sitosterol, administered in doses of 12 g/d, resulted in a mean decrease of 11% in serum cholesterol and of 12% in biliary cholesterol saturation after 6-8 weeks. Sustained effects were found in some individuals treated for longer periods. Significant changes in bile acid kinetics could not be detected. The results lend support for further investigations of sitosterol as a possible adjunct therapy in cholelitholytic treatment.


Methyl-prostaglandin E2 analogues for healing of gastro-duodenal ulcers. 117 patients were submitted to the randomized double-blind clinical trial. Methylated analogues of prostaglandin E2 administered orally markedly suppressed gastric acid secretion and--in comparison to placebo--accelerated cicatrization of duodenal ulcers, but not of gastric ulcers. The resistance of some ulcers to healing was not dependent on gastric acid secretion.


Effect of cimetidine on pentagastrin-stimulated gastric acid and pepsin secretion before and after 6 weeks of cimetidine treatment. To see whether the effect of cimetidine changes during a treatment period, the effect of intravenous cimetidine on pentagastrin-stimulated gastric acid and pepsin secretion was studied before and after a 6-week course of oral cimetidine treatment, 1 g/day, in 10 duodenal ulcer patients. Pentagastrin, 1.5 microgram . kg-1 . h-1, was infused for 165 min, and cimetidine, 1.2 mg . kg-1 . h-1, was added by concomitant infusion during the last 90 min. The second secretion test was carried out 60 hours after the last dose of cimetidine. Acid and pepsin secretion, in response to pentagastrin stimulation, was not significantly changed after 6 weeks of daily cimetidine treatment. The response to pentagastrin plus cimetidine was, however, significantly higher at the end than at the start of the treatment period. The results suggested a slightly reduced effect of cimetidine after prolonged use.


Immunohistochemical investigation of gastrin-producing cells (G cells). Estimation of antral density, mucosal distribution, and total mass of G cells in resected stomachs from patients with peptic ulcer disease. The mucosal distribution of G cells was quantitatively mapped in resected stomachs from 42 patients (12 with gastric ulcer, 11 with duodenal ulcer, 14 with duodenal ulcer and uremia, and 5 with gastric cancer). Along the histological border of the proximal part of the pyloric antrum there was in all patient categories a transitional zone of varying extent, with a low G-cell density before the cells disappeared in the body of the stomach. The proximal end of the duodenum contained considerably fewer G cells than in the antrum, and the number was virtually equal in all groups. Within the antrum there was in the material as a whole a gradual increase in G-cell density from the proximal to the distal part, but this difference was not apparent for the gastric ulcer patients. When corresponding antral segments were compared between the various patient groups, the G-cell density was found to be significantly decreased in the distal antrum of the gastric ulcer patients. In all patient categories, except the duodenal ulcer group with uremia, the circumferential distribution of G cells showed reduced density along the curvatura minor. For the material as a whole there were great individual variations in the overall antral G-cell density, in the antral area corresponding to the distribution of G cells and in the total G-cell mass; these three variables were not significantly related to diagnosis, age or sex.


Does the oesophageal balloon compress oesophageal varices? The pressure transmitted to the oesophageal wall was measured in 3 patients with bleeding oesophageal varices controlled by balloon tamponade. The pressure transmitted was considerably lower than the pressure inflated, and all patients suffered retrosternal pain when the transmitted pressure rose to 40 mm Hg. Furthermore, the diameters of oesophageal balloons of 23 Sengstaken-Blakemore tubes (Rüsch) were measured at increasing inflation pressure. The compliance was very high. All balloons bulged at median inflation pressures of 75 mm Hg, and the pressures fell to a median of 55 mm Hg unaffected by further inflations. The diameter at 40 mmHg was 27.3 mm. In the light of these observations it remains still to be explained how the oesophageal balloon of the Sengstaken-Blakemore tube effects haemostasis in bleeding oesophageal varices.


In vitro mitogen stimulation of synovial fluid lymphocytes from rheumatoid arthritis and juvenile rheumatoid arthritis patients: dissociation between the response to antigens and polyclonal mitogens. The in vitro responses to mitogens of synovial fluid lymphocytes obtained from eight patients with rheumatoid arthritis (RA) and eight patients with juvenile rheumatoid arthritis (JRA) were studied. The results were compared to the transformation of the patient's peripheral blood lymphocytes stimulated with the same mitogens. Both RA and JRA synovial fluid lymphocytes showed a low transformation to the polyclonal mitogens PHA and PWM with a low ratio PHA-response/PWM-response. The stimulatory effect of purified protein derivative of tuberculin (PPD) was high, whereas a Candida albicans antigen preparation gave a more variable stimulation of the synovial fluid lymphocytes. In some patients the complete mitogen transformation profile of lymphocytes obtained from synovial fluid, synovial tissue and peripheral blood was studied. The results of the synovial fluid and tissue lymphocytes were similar.


Antibodies to smooth muscle and other tissue components in infectious mononucleosis. Antibodies to tissue components were studied by the indirect immunofluorescent method in 24 patients with infectious mononucleosis (IM). Smooth-muscle antibodies (SMA) were found in 70.8% of the patients, and in only one (3.8%) of 26 controls. SMA in patients were of the IgG (54.2%), the IgA (12.5%) and the IgM (41.6%) class. IgM-SMA occurred in the early phase of the disease, while IgG-SMA were found both early and late in its course. It was not possible to demonstrate that the development of SMA was due to liver involvement. Antinuclear antibodies, parietal-cell antibodies and antibodies to the cytoplasm of renal tubular cells were not detected significantly more often in patients than in controls. The serum concentrations of IgG, IgA and IgM were elevated in the acute phase of IM, and it was found that the Ig values were higher in patients with SMA than in those without.


Hemolytic streptococci among infants in a maternity department. Report of an outbreak. Reports of several streptococcal infections among babies after discharge from a maternity department initiated an epidemiologic study. Out of 100 infants in the 3 maternity wards 67% were colonized on the umbilicus with hemolytic streptococci group A. It was assumed that the spread had occurred from infant to infant in connection with the nursing. By means of new and strict hygienic routines, isolation and penicillin treatment of the colonized infants the spread was rapidly brought to an end. A retrospective study among the children delivered up to 6 weeks earlier showed that no less than 64% had had clinical signs of infection of possible streptococcal origin. Infections had also occurred among many family members. The observations emphasize the importance of strict hygienic routines and continuous bacteriologic surveillance in maternity departments, as well as close contact between maternity departments and health centers for children.


Group B beta-hemolytic streptococci in an intramural neonatal population. An intramural population of 2480 neonates (88.7% of total births at the Grace Maternity Hospital, Halifax, Canada) was studied by rectal swabs collected within one hour after birth. Group B streptococci were recovered from 54 (21.7/1000 livebirths). Of these, 12(4.8/1000 livebirths) became symptomatic; all were term infants and none was born after prolonged membrane rupture. Two infants with pneumonia (0.8/1000) had severe life threatening illness; one was infected with group B streptococcus, serotype III, the other with both serotypes Ia and II. Serotyping of isolates showed equal distribution of types Ia, Ib, II and III but the symptomatic group showed a predominance of serotype III.


"Discontinuous" antibiotic therapy for urinary tract infections. Although it is a common belief that most antibiotics require 4 doses daily, on theoretical grounds such frequent administration may not be necessary (at least for bactericidal antibiotics) and can compromise patient compliance. In 548 patients with urinary tract infections studied under double-blind conditions, 1 g of cephradine orally twice daily provided results equivalent to those obtained with 500 mg of cephradine given 4 times a day. A total of 242 (89%) of 272 patients in the b.i.d. group and 246 (89%) of 276 patients in the q.i.d. group responded well and rapidly. The incidence of adverse reactions attributable to cephradine was equivalent in the two groups.


Pathogenicity in mice of strains of Candida albicans with different in vitro sensitivity to 5-fluorocytosine. The pathogenicity in mice of 7 strains of Candida albicans with different in vitro susceptibility to 5-fluorocytosine (5-FC) was investigated. Resistant strains were not less virulent than susceptible strains. This is contradictory to findings reported for candida strains resistant to polyene antibiotics, which were less pathogenic than susceptible strains. The implications of these findings are discussed.


Candida peritonitis in a patient receiving chronic intermittent peritoneal dialysis. A 59-year-old woman with end-stage renal failure due to chronic pyelonephritis developed Candida albicans peritonitis after receiving chronic intermittent peritoneal dialysis for 4 months. She was successfully treated with 5-fluorocytosine added to the dialysis fluid.


The closure of urinary-vaginal fistulas. Reported series of urinary-vaginal fistulas repaired by a vaginal approach show at least 85% primary closure. However, many patients have had several unsuccessful operations elsewhere prior to the final repair. This means that regularly successful closure is possible, but it demands a certain "know-how" and engagement. In search for the general principles leading to such successful primary closure, different published techniques have been studied. It appears that the essential features are the establishment of a proper distance between the inner vesical and the outer vaginal epithelium and the creation of broad raw surfaces to be ajoined. The operation should not involve any risk of enlarging the existing fistula, and the transfer of normal tissue to the site of the repair and the interposition of tissue between the cavities to be separated are sound reconstructive procedures. A personal technique based on these principles is presented. The gynecologists of to-day most often refer urinary-vaginal fistulas to the urologists, who almost without exception prefer a suprapubic transvesical approach. It is strongly recommended that the large majority of urinary-vaginal fistulas should be repaired by the vaginal approach which is a minor intervention. The plastic surgeon should be engaged in the management of urinary-vaginal fistulas.


Keloids treated with topical injections of triamcinolone acetonide (kenalog). Immediate and long-term results. In a prospective trial, the results of local steroid treatment of keloids have been studied. 52 patients were treated with Kenalog (triamcinolone acetonide) injections alone, whilst in 15 patients, steroid therapy was combined with excision of the keloid. The combined treatment gave no better results than injection therapy alone. The early result of treatment was the complete flattening of the lesions and cessation of itching in the majority of cases. However in one-third of the cases partial recurrence was found after one year, and after 5 years, the recurrence rate was 50%.


The early ingrowth of an autogenous bone inlay into an artificial defect in the rabbit mandibula. The "take" and incorporation of two different autogenous bone grafts to an artificial defect in the rabbit mandibula was studied by means of conventional light microscopy, fluorescence miscroscopy and X-ray photography. The ingrowth rate was compared between a longitudinally split autogenous full thickness humeral bone graft in 21 rabbits and an autogenous full bone graft from the iliac crest in 14 rabbits. The rabbits were sacrificed at weekly intervals right to the end of the first month postoperatively, and morphological analyses were made. It was found that both types of graft became progressively incorporated into the mandibular defect. The humeral graft was better attached to the host bone but the graft cortex was not bone labelled to the same extent as when an iliac graft was used.


Prostatic carcinoma treated with 2,6-cis-diphenylhexamethylcyclotetrasiloxane (Cisobitan). Thirteen patients with stage III or IV carcinoma of the prostate were treated with 2,6-cis-Diphenylhexamethylcyclotetrasiloxane (Cisobitan, a new organosilicon compound. The drug proved to be a strong antiandrogen and exerted all the known effects of estrogens, including feminization and cardiovascular complications. It is therefore doubtful whether Cisobitan will be a reasonable alternative to estrogens in the treatment of patients with advanced prostatic cancer.


Peritoneal dialysis and heparin.

Peritoneal dialysis and heparin. In a prospective, controlled and double-blind investigation the influence of heparin--added to the dialysis solution--on the lapse of peritoneal dialysis is studied. The material comprises 9 patients, all of whom had 2 peritoneal dialysis, one with and one without heparin added to the dialysis solution. A significantly higher inflow and outflow were found in the heparin group. Further the total length of one dialyted procedure--which according to literature never seems to have been exposed to an investigation-the results of the present investigation supports the theoretical considerations of adding heparin to peritoneal dialysis solutions.


Renal transplantation in polycystic kidney disease. Thirty-one renal transplantations were performed in 25 patients with end-stage polycystic disease of the kidneys. Of the 14 recipients transplanted with both polycystic kidneys in situ and followed for at least 6 months, 10 had a previous history of urinary tract infection. Four of these 14 recipients had relapsing urinary tract infection after transplantation, the other 10 have been at risk on immunosuppressive therapy for a total of 152 months and have had no trouble that could be attributed to the presence of the polycystic kidneys. Despite the potentiality of polycystic kidneys to be a source of post-transplant infection when left in situ, a good outcome of renal transplatation could be achieved without preparative bilateral nephrectomy. The one-year patient and graft survivals are comparable to those obtained in our total transplantation series and renal transplantation is considered to be an acceptable therapy in polycystic disease.


Angiography and isotope renography in acute rejection of renal transplant. Isotope renography and transplant angiography were performed during 37 acute episodes of renal transplant rejection. Renography demonstrated rejection in 70% of the irreversible and 55% of the reversible processes. Angiography, though reliable in irrerversible rejection, was diagnostic in only 30% of the reversible cases. Renography is the method of choice for diagnosing rejection and its accuracy is improved by repitition. Angiography should be reserved for patients whose renal function is not restored by treatment for rejection.


[Serum immunoglobulins during immunosuppressive therapy following kidney transplantation]. Immunoglobulins IgG, IgA and IgM and the complement factor C'3 were measured in the serum of 103 kidney allograft recipients. As compared to those in 50 patients on hemodialysis treatment, 100 hospitalized patients and 100 blood donors, the mean values for IgA, IgG and C'3 were significantly decreased. IgM was higher than in blood donors. The longitudinal profile in 6 transplant patients showed remarkably stable immunoglobulin concentrations. No association between low IgG levels and infections or rejection episodes was observed.


[Hemorrhoids: recognition and current therapeutic possibilities]. Up to 5% of the patients of a general practitioner have terminal bowel disease, most frequently hemorrhoids. Any patient who presents with ano-rectal discomfort or anal blood losses should undergo thorough proctologic examination including rectoscopy. Digital palpation is insufficient as only 10% of rectal carcinomas can be reached. The treatment of hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or suppositories. If these symptomatic measures fail, treatment by injections is indicated. This method may be complicated by localized or extensive necrosis of the rectal mucosa, the cause of which is assumed to be an immunologic event resembling the Arthus phenomenon in which bacterial or possibly pharmacologic substances may act as antigens. Therefore, a method of provoking coagulation without using foreign substances was sought. Thermocoagulation by the infrared coagulator appears to be a suitable method: first experience tends show equal efficacy with coagulation by injection treatment. Prolapsing hemorrhoids are still treated by barron ligation. The precise management of each therapeutic approach is described.


The therapeutic efficacy of electroconvulsive therapy (ECT). A double blind controlled trial of ECT and simulated ECT. A double-blind controlled trial of ECT versus simulated ECT is described. The results show that real ECT is significantly superior to simulated ECT in the treatment of depressive illness.


Prostacyclin: a potentially valuable agent for preserving myocardial tissue in acute myocardial ischemia. Prostacyclin, a potent, naturally occurring prostaglandin exerts a variety of cardiovascular and cellular actions of potential value in acute myocardial ischemia. These properties include the reduction of systemic blood pressure without changing heart rate, the lowering of coronary vascular and total peripheral resistance, the inhibition of platelet aggregation and the concomitant formation of thromboxane B2, and the reduction of the release of lysosomal enzymes.


Fluorescence-immunocytochemistry: simultaneous localization of catecholamines and gonadotropin-releasing hormone. Gonadotropin-releasing hormone and dopamine were identified simultaneously in the same block of tissue from the median eminence of the rat brain. Two distinct bands of dopamine terminals were found in the lateral median eminence: an inner band which overlapped the gonadotropin-releasing hormone terminals and an outer band which appeared juxtaposed to portal capillaries.


Rejection of male skin grafts by splenectomized female mice. Female mice of the C3H strain normally do not reject skin grafts from males of the same strain; however, 40 percent of splenectomized C3H female mice completely rejected C3H male skin grafts applied 2 weeks later. All splenectomized females showed at least transitory signs of graft rejection.


Technical considerations in in vivo thyroid studies. Radionuclide thyroid studies, although among the oldest of clinical nuclear medicine procedures, continue to show growth and change. In the 7 years since thyroid studies were last reviewed in the Seminars, there have been marked changes in the preferred ways of doing these studies. In the areas of radiopharmaceuticals, 131I remains a useful agent in selected circumstances, but 99mTc-pertechnetate has become the agent of choice for imaging applications. Iodine-123 represents an exciting possibility for the future if problems in cost and radiopurity can be solved. New data on the dosimetry of the various agents allow for more rational choices among them, and useful guidelines can now be given for the use of these radiopharmaceuticals in problem areas such as pregnancy, nursing, and the pediatric age group. The scintillation camera with a pinhole collimator has become the instrument of choice for thyroid imaging, and the use of computers and the availability of systems for fluorescent scanning have added new possibilities for thyroid evaluation. Ancillary techniques such as ultrasound scanning also offer the possibility of improved diagnostic accuracy. These developments are reviewed in the context of clinical studies, together with a discussion of specific clinical applications and a brief look to the future.


The treatment of thyroid carcinoma with radioactive iodine. Radioiodine (131I) treatment of well-differentiated thyroid carcinoma is a well-evaluated therapeutic model for nuclear medicine which has never been equaled by subsequent developments. It is still a unique method of treating cancer. The treatment of thyroid cancer begins with a systematic approach to the most common first symptom or sign; a neck mass. Data have accumulated to show that well-differentiated thyroid cancer does kill commonly enough to warrant aggressive treatment, even in young individuals. There is also evidence that the more complete the thyroidectomy, the lower the death and recurrence rate of the thyroid cancer, and the more effective the use of 131I in both detecting and treating metastases. There are now considerable data demonstrating that 131I after surgery decreases both the recurrence rate and death rate from well-differentiated thyroid cancer.  After uptake is "ablated", there is a 1%--2% recurrence rate in patients with the most extensive disease at the time of the initial treatment. This recurrence is effectively retreated with another dose of 131I. Surgery and 131I should be used as long as they are effective before resorting to teletherapy. There are now considerable data to show that the morbidity of surgical and 131I treatment is reasonable in contrast to the recurrence and death rate from nonaggressively treated well-differentiated thyroid carcinoma. Serious consideration should be given to using a low iodine diet before treatment with radioiodine.


Familial cancer and cancer families.

Familial cancer and cancer families. From this brief review is should be evident that the hereditary varieties of common cancers are characterized by a high degree of genetic heterogeneity. The specific types of hereditary cancers can be identified by focusing on the histologic types and sites of involvement, not only of the primary neoplasm, but also of associated neoplasms and associated conditions or stigmata, as well as by focusing on the age of the patient at the time of diagnosis, tumor localization and frequency, and the mode of inheritance. Identification of specific types of hereditary cancers has important utility as a means of isolating homogeneous groups of patients and unaffected relatives for studies aimed at elucidating the mechanisms of carcinogenesis.


Perioperative antibiotics in major elective gynecologic surgery. The efficacy of a three-dose, perioperative regimen of cefazolin or placebo in reducing postoperative infectious morbidity was evaluated in a double-blind study in 206 patients undergoing elective vaginal or abdominal hysterectomy. Postoperative infectious morbidity was defined as: an oral temperature of 100.4 F (38 C) or greater on any two postoperative days (excluding the first day), positive bacteriologic cultures, or pus from a wound. In premenopausal patients, cefazolin significantly reduced the incidence of postoperative infectious morbidity; 19% of the cefazolin group who had abdominal hysterectomy had evidence of infection compared to 71% of the placebo group, and 10% of the cefazolin group who had vaginal hysterectomies had evidence of infection compared to 37% of the placebo group. In postmenopausal patients undergoing abdominal hysterectomy, cefazolin also reduced the incidence of postoperative infection compared to placebo, but the difference was not significant (20% compared to 37%).


The use of neurolept analgesia for gastro-intestinal endoscopy. A prospective double-blind study of the effects of sedation in 142 patients undergoing gastro-intestinal endoscopy was performed. Four regimens were studied (neurolept analgesia with and without topical anaesthesia, and anticholinergic and topical anaesthesia, with and without diazepam). Droperidol and fentanyl without topical anaesthesia yielded the best results as far as tolerance and side-effects were concerned. It is suggested that this form of neurolept analgesia be used for gastro-intestinal endoscopy.


Early diagnosis of opportunistic systemic fungal and nocardial infections. An approach to the expediting of the diagnosis of opportunistic systemic mycoses is presented. Communication between clinician and microbiologist is basic to this approach. The importance of the clinical assessment of the individual patient, coupled with a high index of suspicion, is stressed. Our experience with 11 of 42 cases of systemic mycosis over a 28-month period is analysed. For the diagnosis of fungaemia a method for the microscopical examination of peripheral blood is briefly evaluated, and a membrane filter blood culture technique is shown to be valuable, yielding results in 16-24 hours. In the absence of fungaemia the considered microscopical examination of suitable specimens, when feasible, is the most rapid method available. Serological methods may be helpful in early diagnosis, but this is often hampered by the absence of baseline sera and by the lengthy nature of some tests. Newer indirect methods such as gas chromatography are being developed but have not yet been used routinely.


Ureteric obstruction in renal allograft recipients. In 50 consecutive renal allograft recipients, operated upon between September 1975 and March 1977, we have encountered 10 cases of ureteric obstruction. The patients fell into two groups: those with ureteric obstruction of early onset due to intraluminal blood clot, oedema of the distal end of the ureter, ureteric tip necrosis or extrinsic compression by the spermatic cord, and those with obstruction of late onset due to ureteric fibrosis. Two cases of ureteric obstruction due to oedema and 1 due to intraluminal blood clot resolved spontaneously. Transurethral ureteric meatotomy, a recommended procedure for the relief of ureteric obstruction in suitable cases, was successful in 1 of our patients. The remaining 6 patients required open surgical procedures for relief of obstruction. In no instance did ureteric obstruction result in death or graft failure.


Infective complications in renal allograft recipients. Infective complications were analysed in 74 patients who underwent renal transplantation. Bacterial infections were seen in 69%, viral infections in 48% and fungal infections in 17% of these patients. The urinary tract was involved in 56% of patients, the lungs in 24% and the upper respiratory tract in 17%. Less common were cellulitis (7%), CNS infections (4%), and other sites of infection.


The use of synthetic luteinizing hormone-releasing hormone to induce ovulation. The therapeutic use of synthetic luteinizing hormone-releasing hormone (LH-RH) to induce ovulation has been explored. Three dosage schemes have been compared: a single dose of LH-RH, multiple doses of LH-RH, and LH-RH used in combination with human menopausal gonadotrophins (HMG). The results of these three schemes are presented and compared; the last regimen has proved most successful, with a high pregnancy rate, a low incidence of multiple pregnancy and no evidence of ovarian hyperstimulation.


Examination of the immunoglobulin classes involved in the serological response of pregnant sheep to Aspergillus fumigatus. Pregnant sheep inoculated with Aspergillus fumigatus conidia developed agglutinating and precipitating antibodies for mycelial antigens. The agglutinins were initially exclusively of the IgM class, but were later supplemented by IgG antibodies, although IgM production was usually sustained throughout the serological response. Precipitins active in the immunodiffusion test were of the IgG class. They developed later in the immune response than agglutinins and declined more rapidly. The precipitins and IgG agglutinins were more closely associated with recent active infection than IgM agglutinins.


Kidney homogenate, a test medium to determine the inhibitory effect of antimycotics on yeasts. The test procedure described in this paper aims at assessing the effectiveness of antimycotics against yeasts. The inhibitory effect on Candida albicans growth is determined in the presence of kidney homogenate, an in vitro test medium offering fungal growth conditions similar to physiological conditions. The inoculum consists of kidney material from Candida-infected mice. By dilution with kidney material from uninfected mice the initial number of viable particles is standardised. Specimens withdrawn from this inoculum are mixed with different concentrations of the test substance and incubated for 24 hours. The inhibition of fungal growth is assessed on the basis of the number of colony-forming units in comparison with controls to which no test substance was added. The growth phase of C. albicans during incubation in vitro resembles that observed in the kidney in vivo, i.e. besides yeast cells, the fungus produces a great number of pseudomycelia and mycelia. The results of the tests conducted with the top-ranking antimycotics give good evidence of their therapeutic efficacy. The testing of further active substances revealed advantages of the new test model over existing test methods.


Study of the role of pigeons in the dissemination of Cryptococcus neoformans in nature. Cryptococcus neoformans was recovered from droppings collected within the first 24 h from pigeons experimentally fed with a dose of 5 X 10(6) cells. The fungus proved to multiply well though differently in the sterilized pigeon and chicken excreta seeded with the organism. In  both unsterile types of droppings no viable cells of C. neoformans were detected after 4 weeks incubation. Isolated bacterial flora from the intestinal contents of apparently healthy pigeons showed a complete inhibitory effect on the growth of C. neoforms in vitro. It has been concluded that pigeons do not favor multiplication of the fungus in their gut and consequently they do not seem to play an active biological role in dissemination of C. neoformans in nature.


Some leads to the etiology of cancer of the large bowel. 1. Large bowel cancer is common in the Western countries and is relatively rare in the developing countries. 2. It is related to diet, probably to dietary meat or fat. 3. It has been postulated that the Western diet results in a high concentration in the large bowel of bile acids and that these are metabolized by the gut bacteria to carcinogens or cocarcinogens. 4. There is evidence in support of this postulate from studies of populations in various parts of the world and from a retrospective case-control study. 5. A role for dietary fiber has also been suggested, but there is little evidence in favor of this.


Problems and resolution of lower extremity venous disease. Venous aberrations in the lower extremity, whether acute or chronic, have disastrous effects on individual patients, their families, and society in general. Whether the challenge is the treatment of varicose veins or that of maintaining patency of a venous reconstruction, it is obvious that many questions remain unanswered. Additional experimental research and clinical experience must be documented in carefully organized scientific studies.


Intraoperative protection of the myocardium. It appears obvious that in evaluating gross mortality and morbidity, clinical statistics are insufficient to demonstrate which form of a myocardial protective measure is safest. Previous studies indicate that significant ischemic injury may not be detectable by routine measurements of contractility. Only microscopic examination of the heart at a later period will allow detection of the patchy ischemic injury. In patients, loss of cardiac reserve as measured by postoperative catheterization, particularly compliance studies, and stress testing may be the final clinical arbiter of this controversy.


Critical comparison of renal transplant survival between recipients of live related donor and cadaver organs. Survival statistics of 163 cadaver and 60 live related donor renal transplants from a single center were analyzed. Survival rates at one, two and three years for 38 first cadaver transplants matched for a haplotype and 34 first live related donor haplotype matched kidneys were virtually the same. In addition, nine, four antigen matched cadaver transplants had a comparable survival rate at one, two and three years to the larger group of 25 HL-A identical live related donor kidneys. When poor risk cadaver recipients were excluded from the entire cadaver group, the graft survival rate approached that of the live related group at one year but declined more rapidly at two and three years than did the live related donor group. Thus, cadaver renal transplantation in this series appears to be an alternative to comparably matched live related donor transplants. An increased effort should be made to identify and use brain death cadaver donors for transplantation. As more donors become available and national sharing systems are improved, a strong case can be made to avoid the use of live related donor kidneys, except in instances of a perfect match.


The effect of adenosine and allopurinol on the tolerance of the collapsed lung to warm ischemia. The collapsed left lungs of dogs were subjected to 1 hour of normothermic ischemia in situ followed by immediate ligation of the contralateral pulmonary artery. Adenosine in a dose of 50 mg/kg prolonged the survival of the dogs significantly. In the survivors only transient changes in the chest x-ray were seen, and no changes in arterial oxygenation were observed. The pulmonary architecture was well preserved on histological studies 14 days after operation. Animals whose ischemic lungs were not protected by adenosine showed an immediate drop in arterial oxygenation and a massive infiltrate of the ischemic lung. Histological study of the lungs showed a complete breakdown of the capillary-alveolar barrier. Allopurinol alone was ineffective by itself and was not able to improve the survival achieved with adenosine further. We conclude that it is possible to prolong the tolerance of a deflated lung to normothermic ischemia by pretreatment with adenosine.


St. John Ophthalmic Hospital. An ancient tradition of service revived in the Holy Land. In Jerusalem in 1888, the Hospital of St. John was founded to combat the eye diseases prevalent in the Middle East. Since that time, this institution has survived world wars and local ones, and the geographic confusion created by redefinition of national borders. The author reviews the remarkable 90-year history of this institution, with special emphasis on her 13-year personal association there.


100 years of the visual cycle.

100 years of the visual cycle. One--hundred years have passed since Franz Boll and Willy Kühne first characterized rhodopsin and discovered the visual pigment cycle. Some of the events and individuals of that period are described, and color photographs are presented to show the appearance of rhodopsin in the living retina.


[Food poisoning in cattle caused by ingestion of brewers' grains contaminated with Clostridium botulinum type B (author's transl)]. In 1977, outbreaks of disease associated with serious losses occurred on twenty cattle farms. This disease was due to the fact that the animals had been fed brewers' grains. The clinical picture was marked by anorexia, profuse salivation, regurgitation and dehydration. The course of the disease varied with the severity of the attack. Toxicological tests were negative. Cl. botulinum type B as well as toxin type B were found to be present in the brewers' grains fairly often. As a rule, Cl. botulinum was also detected in the rumen contents and faeces. The treatment of the animals is described; this resulted in recovery in a number of cases. When experimental animals were fed brewers' grains from farms on which outbreaks had occurred, this induced similar clinical pictures. The results of studies on the aetiology and pathogenesis are discussed. It is concluded that the clinical picture was an atypical form of botulism caused by Cl. botulinum type B. Possible causes of this abnormal clinical picture are discussed in greater detail.


Reticulum cell sarcoma (histiocytic lymphoma) of the orbit. The clinical and pathologic features of 13 patients with biopsy-proven reticulum cell sarcoma of the orbit are reviewed. All of the patients were adults, in contrast to many previous reports that have emphasized how common this tumor is in children. Eight patients presented with proptosis and without prior diagnosis of lymphoma, and 5 patients developed orbital deposits in the course of a known systemic lymphoma. Of the 8 patients whose orbital biopsies established the diagnosis, 4 were found concomitantly to have other sites of disease, and 4 patients developed other evidence of lymphoma from 2 to 15 months after orbital biopsy. None of the cases in this series was interpreted as a primary orbital lymphoma. The histopathologic findings, the problem of histogenesis, and the need for systemic staging of cytologically malignant orbital lymphoma are discussed.


[Ultrasound in tumor diagnostics and treatment planning (author's transl)]. The fundamental requirements of irradiation planning are discussed delimitating the minimum and maximum demands of planning. Different possibilities to represent the topographic relations within the irradiation plane of the patient's cross-section are described. The computer-assisted system for irradiation planning, installed at our hospital by means of MAT construction, is discussed. A pathway is shown which leads to individual treatment planning and considers dosimetrically the actual conditions of the patient who will undergo radiation therapy. The possibilities and limits of ultrasonic cross-sectional imaging are demonstrated.


[Problems of incorporation of removable dentures with special reference to psychosomatic changes due to aging]. The successful use of technically unobjectionable plate dentures is a very complicated process that depends upon the patient's psychic attitude towards the removable prosthesis, the motivation, the ability of the sensory terminal organs in the oral cavity to get accustomed to the foreign body (the prosthesis), the adaptation and the learning of new sequences of reflex movements as a motor-muscular performance of perfection. These three factors, which the author regards as essential prerequisites of the incorporation (i. e., the untroubled mechanical use of the prostheses), are interpreted in the light of clinical experience and opinions from the most recent literature.


Trampolines and triangles. The surgical pathology of the vitreous. The vitreous cavity may be invaded by cells penetrating through dehiscences in the inner limiting lamina of the retina, and exaggerated vitreo-retinal adhesions may also develop at such sites. The vitreous often separates from the inner limiting lamina except at these anomalous adhesions, and retinal traction thus results from excessive movement of the otherwise detached gel; traction on the retina may also follow proliferation and contraction of invading cells on the retinal surface, along the posterior hyaloid interface, or traversing the gel. Traction complications are liable to occur at sites of vitreo-retinal adhesion during surgical removal of opaque gel, while division of transgel strands and epiretinal or posterior hyaloid membranes may be necessary in order to relieve retinal traction.


Doyne Memorial Lecture, 1977. The superior oblique tendon. New concepts concerning the anatomy of the tissues surrounding the superior oblique tendon are presented. A safe visual approach to the tendon after its penetration through Tenon's capsule is described. The various surgical procedures and techniques developed to weaken the overacting superior oblique muscles associated with A pattern and the taut superior oblique muscle found in Brown's syndrome are reviewed.


Double--blind clinical trial of adenine arabinoside and idoxuridine in herpetic corneal ulcers. The results are reported of a fully controlled randomized double-blind clincial trial of adenine arabinoside and idoxuridine ointment in sixty patients with herpetic ulceration of the cornea. Although both antivirals showed a trend towards superiority over placebo, the therapeutic effect did not reach statistical significance in spite of the known efficacy in laboratory animals. Further studies in rabbits are reported; these indicate that systemic immunity may play a role in combating virus proliferation in recurrent disease, and it is considered this disguises the efficacy of topical antiviral therapy in clinical trials, thus necessitating an estimated requirement for approximately fifty patients per treatment group to obtain significant effects. It is concluded that an antiviral is valuable in the treatment of ulcerative herpetic keratitis, particularly in primary disease and in the presence of systemic and local immunosuppression after the use of topical adrenocorticosteroid. In recurrent disease, where a trigger factor is known, experience has shown that therapy can be profitably administered before the onset of clinical disease.


Failure of diethylcarbamazine as a provocative test in subperiodic Wuchereria bancrofti filariasis. The effect of diethylcarbamazine (DEC) on levels of microfilaraemia in 70 patients with subperiodic, Pacific-variant Wuchereria bancrofti infection was studied one hour after oral administration of 5 mg/kg of drug. In contrast to the immediate DEC-induced increase in microfilaraemia which had been previously described in patients with nocturnally periodic filariasis, diethylcarbamazine failed to elicit such a response in patients with subperiodic bancrofti infection. Indeed, one hour after oral DEC the number of circulating microfilariae was reduced to about 8% of pre-treatment values.


Trasylol (aprotinin) and kidney preservation. Experiments carried out in rats and sheep have shown that Trasylol (aprotinin) is helpful in protecting kidneys from the harmful effects of ischaemia. After critical periods of ischaemia, renal failure was less frequent in the treated groups, and glomerular leakage of 131I-labelled albumin was greatly reduced.


Major histocompatibility complex and non-major histocompatibility complex antigens on mouse ectoplacental cone and placental trophoblastic cells. The expression of major histocompatibility complex and non-major histocompatibility complex antigens on mouse trophoblast cultured from two defined stages of development was investigated by the sensitive in vitro mixed haemadsorption assay. Outgrowths obtained 3 to 5 days after explanation of 7 1/2-day ectoplacental cones contained a mixed population of cells. Those with a giant cell morphology showed no haemadsorption with congenic H-2 antisera and were reactive with non H-2 antiserum only in the CBA strain. Other, smaller cells were reactive for both H-2 and non-H-2 in all strains examined except for C57BL, where the cells were nonreactive for H-2. Monolayer cultures of 13 to 14-day placental suspensions tested 24 hr after preparation were strongly reactive for both H-2 and non-H-2. The identity and alloantigenic status of the cells are discussed in relation to their function in maternal-foetal immunological interactions.


A virological study of human kidney explant cultures from renal allograft recipients. Human kidney tissue obtained at pretransplant nephrectomy from 13 adults and 1 child with end stage renal disease was cultured to provide a source for attempted detection of viruses. Cultures were observed throughout their life span for cytopathogenic viruses. Supernatants from 13 cultures were tested for hemagglutinating viruses (including measles, rubella, influenza, parainfluenza, and mumps) using various species of red blood cells. Kidney cells were cocultivated with Vero and human foreskin cells and indirect immunofluorescence was attempted in one instance. No viruses were detected. Nevertheless 9 of the 14 patients developed infections with herpes group viruses post-transplant. Either replicating viruses were not present in the kidneys of the patients prior to transplant or the techniques used were not adequate to detect them However, the establishment of organ cultures from patients with chronic renal disease is practical and may be a useful method for further virological investigation.


Effects of conjugated and nonconjugated antithymocyte globulin and trenimon on T lymphocytes and skin graft rejection. These studies were undertaken to investigate the use of a technique for "homing" of an alkylating agent to lymphocytes as an immunosuppressive approach to inhibit allograft rejection. Trenimon (Tr) was bound covalently to antithymocyte globulin (ATG) and the effects of the complex on peripheral blood cells, thymus cells, spleen cells, and on foreign skin graft rejection assessed. When rabbit ATG was bound covalently to Tr, an alkylating agent, the conjugate (ATG-Tr) retained both complement-dependent antithymus cell acitivity and alkylating activity in vitro, but these activities were reduced. In vivo ATG decreased lymphocytes and increased neutrophils in the blood. ATG-Tr reduced circulating lymphocytes to lower levels and partially attenuated the rise in neutrophils. The in vivo effects of ATG, Tr, ATG-Tr, and ATG mixed with Tr (ATG + Tr) on thymus cells, spleen cells, T lymphocytes in the spleen, and rejection of a foreign skin graft were compared. Tr decreased all cell types, especially thymocytes, but did not delay graft rejection. ATG and ATG-Tr decreased thymocytes, eradicated T cells from the spleen, and delayed graft rejection 3-fold. ATG + Tr decreased thymocytes as Tr had done, eradicated T cells from the spleen, and delayed graft rejection 5-fold. It was concluded that ATG-Tr possessed antithymocyte antibody activity and Tr alkylating activity, but did not confer an immunological advantage over ATG alone, and that ATG and Tr mixed together unbound acted synergistically to delay graft rejection.


Detection of B cell antibodies in renal transplant recipients. A retrospective study for the presence of lymphocytotoxic antibodies was performed on sera collected from 119 kidney graft recipients. Sera that had been collected on days 12 to 19 post-transplant were tested for cytotoxic reactions against a panel of human peripheral blood lymphocytes from 60 unrelated donors and 37 to 47 cultured human lymphoid cell lines (LCL). Forty-nine sera were negative against peripheral blood lymphocytes but contained cytotoxic antibody against cells on the LCL panel. Several sera were tested on E rosette-purified peripheral blood lymphocyte B cells and T cells from five donors whose LCL had also been tested. LCL appeared to be more sensitive to cytotoxic reactions than their B cell counterparts and may identify additional specificities which may not be related to the B cell alloantigenic system. Mixed lymphocyte culture blocking experiments were carried out against all combinations of these five cells. Some sera showed reactions of identity for B cells and LCL, and blocked the appropriate stimulator cells in mixed lymphocyte culture. Two sera that were positive for LCL but negative for B cell blocked only responder cells in the mixed lymphocyte culture.


Prediction of long-term kidney transplant survival rates by monitoring early graft function and clinical grades. Statistically significant correlations were found between kidney graft function at 1 day, 1 week, or 1 month and long-term graft survival. Transplant centers with poor early results usually had poor long-term outcome. Assignment of clinical grades to patients with transplants also correlated significantly with subsequent graft survival. It is concluded that monitoring early graft function and clinical grades can be utilized in the assessment of new treatment protocols after relatively short transplant follow-up.


Allogeneic bone marrow transplantation in aplastic anemia--report of 25 cases. Bone marrow transplantation using an HLA-MLC-identical sibling is the most valuable treatment of severe aplastic anemia.2,6,7 Between November 1973 and March 1977, 25 consecutive patients have been treated by marrow transplantation in our unit. Nine patients are alive with complete hematologic restoration between 3 months and 3 years. The high mortality can be largely accounted for by marrow graft rejection (14 patients). Despite the small number of patients, we have tried to identify prognostic factors associated with marrow graft rejection. They are mainly the existence of anti-HLA antibodies, the sex difference, and the normal PHA and MLC response before grafting. After the graft, the disappearance of anti-HLA antibodies has a good prognostic value. The appearance of autolymphocytotoxins seems to correlate strongly either with rejection or graft-versus-host disease.


Magnesium: not essential for renal preservations by initial perfusion and hypothermic storage. Experimental observations regarding the role of divalent magnesium ion in hypothermic renal preservation have presumed the inclusion of this substance in synthetic preservation media. Retrospective analysis of the validity and application of these experimental data and consideration of the problems related to precipitation of magnesium salts in "intracellular" perfusates has instigated investigation related to the necessity of including this ingredient in our previously described hyperosmolar intracellular electrolyte solutions. Omission of magnesium chloride from these perfusates has not adversely affected ultimate renal function in canine kidneys preserved for 2 and 3 days following perfusion and storage in these solutions. The absolute necessity of including magnesium in these solutions in order to effect successful renal preservation is challenged.


Anaemia treatment trials in a rural population of Tanzania. In a coastal population in whom anaemia was common, two randomised controlled trials were undertaken to investigate the effectiveness of treating iron deficiency anaemia at a dispensary and at primary schools. For anaemic adult villagers treated at a dispensary, one dose of tetrachlorethylene for hookworm infection and a once per week visit to collect medicines were found to be satisfactory. A small but significant increase in haemoglobin level was produced by four weeks oral iron therapy, but this was only maintained after seven months by the group that had initially also received tetrachlorethylene. In children (5-14 years) no significant rise in haemoglobin level was obtained by using oral iron and/or TCE, either at the dispensary or at the primary schools. This suggests that malaria was a more potent cause of anaemia in these children.


The hepatic toxicity of antituberculosis regimens containing isoniazid, rifampicin and pyrazinamide. This paper reviews hepatic toxicity during chemoprophylactic treatment with isoniazid alone, and during the treatment or retreatment of active pulmonary tuberculosis with regimens containing one or more of the drugs isoniazid, rifampicin and pyrazinamide. Chemoprophylaxis with isoniazid carries a risk of drug-induced hepatitis, and this risk needs to be weighed against the advantages of preventing tuberculosis morbidity. The risks of hepatitis during standard treatment based on isoniazid are very small, and most patients who develop hepatitis recover. Moreover, it is often doubtful whether hepatitis is in fact drug-induced, and a proportion of patients who develop it already have liver disease at the time treatment is started. The risks are acceptable in the treatment of bacteriologically active disease. There is no consistent evidence that giving rifampicin with isoniazid in the initial treatment of tuberculosis increases the risk of hepatitis; in particular, transient abnormalities in the results of tests of liver function during the early weeks of treatment do not imply serious toxicity; patients who are rapid acetylators of isoniazid are not, as has been suggested, exposed to any special risk, and patients with known liver disease can also be treated without undue risk. Retreatment regimens based on rifampicin plus ethambutol carry a low risk of hepatitis, even though patients who need retreating have often experience toxicity during their initial treatment. Frist-line or second-line regimens containing pyrazinamide in currently accepted dosages, given daily or intermittently, carry a low and acceptable risk of hepatic toxicity. Finally, current studies of daily and intermittent short-course regimens based on isoniazid, rifampicin and pyrazinamide will extend our knowledge of hepatic toxicity. Because such regimens involve small total quantitites of drugs given over short periods they are likely to give rise to less hepatic toxicity than regimens of standard duration.


Polycythemia after kidney transplantation: influence of the native kidneys on the production of hemoglobin. 3 patients with renal transplantation who developed polycythemia presented normalization of the hemoglobin levels immediately after nephrectomy of the native kidneys. This observation induced the authors to study the role of the native kidneys in the genesis of polycythemia in recipients of renal allografts. Comparison was made among 32 patients submitted to renal transplantation, with maintenance of native kidneys (group I) and among 31 under the same conditions, but without the native kidneys (group II). Both groups were comparable according to age, sex, rejection crisis incidence and immunosuppressive therapy. It was observed that the hemoglobin levels of group I were significantly higher (p less than 0.05 to p less than 0.005) than those observed in group II, from the 3rd to the 30th posttransplantation month, becoming comparable from the 36th to the 54th months. The hemoglobin production, measured by the kinetics of labeled iron (59Fe), was higher in patients of group I. The authors concluded that the native kidneys are responsible for the observed polycythemia after a kidney transplantation.


[Extrarenal manifestations of renal cell carcinoma: the primary metastatic lesion (author's transl)]. In 18 patients, histologic evaluation of a solitary distant metastasis with characteristic hypernephroid pattern subsequently led to the diagnosis of renal cell carcinoma. The metastatic lesion was treated surgically in 15 cases; 14 patients underwent radical surgery and one patient with a solitary kidney underwent partial nephrectomy. Osseous metastases were predominant (12 out of 18). There was an excellent morphologic agreement between metastatic and primary lesions: in no case were metastases less differentiated than the primary tumor. Therefore in all cases of metastases with hypernephroid structures an aggressive search for renal malignancy is required. Five-year survival was 5% and identical to a group of 61 patients with metastases and a symptomatic renal cell carcinoma at diagnosis. The poor prognosis was not influenced by surgical extirpation of the solitary metastasis.


Avascular necrosis following renal transplantation. Experience with 449 allografts with and without high-dose steroid therapy. From January 1, 1971, to January 1, 1976, 173 renal allografts were transplanted into 146 patients. Intravenous methylprednisolone (IVMP) was given to all mismatched recipients in a dose of 1 Gm. on the day of transplant and in varying amounts during acute allograft rejection. In 7 patients, 4.8 per cent of 146 patients and 4 per cent of 173 allografts, with a minimum follow-up of fifteen months avascular necrosis of one or more joints developed with an average of 9.4 months after transplantation and a range of five to eighteen months. The total dose of IVMP given to the patients with aseptic necrosis varied between 3 and 18 Gm. from the time of transplantation until the onset of skeletal symptoms. This incidence was nearly identical to the 5 per cent of 242 patients and 4.3 per cent of 276 renal allografts from the same center performed between January 1, 1963, and January 1, 1971, when intravenous steroid pulse therapy was not utilized. Since January, 1971, total joint replacement of the hip or knee were performed in 4 of the 7 affected patients six to sixteen months after the onset of symptoms. Renal function remained stable after surgery in all 4 patients. Virtually normal range of motion was present within three months after surgery. Although the controversy of steroid therapy in the pathogenesis of avascular necrosis still exists, judicious use of high-dose IVMP therapy does not appear to increase its incidence. Early surgery is recommended when the radiologic evidence confirms the clinical findings of avascular necrosis in order to ameliorate pain, correct restriction of movement, and promote full rehabilitation.


Oxybutynin chloride in control of post-trasurethral vesical pain and spasm. Oxybutynin chloride (Ditropan) and placebo were randomized in a double-blind trial to determine the effectiveness of the test agent in controlling post-transurethral pain and spasm. Oxybutynin chloride was found effective in controlling pain and spasm; no significant side effects were noted.


Sickle cell trait: possible contributory cause of renal allograft failure. A black male with known sickle cell trait (hemoglobin AS) received two cadaveric renal transplants in succession. After excellent initial graft function he had what appeared clinically to be an acute rejection episode which could not be reversed by immunosuppressive therapy on either occasion. The histopathology of the removed allografts did not reveal a picture of acute rejection, but instead revealed extensive intravascular sickling of the erythrocytes. This is important especially for the transplant centers in the United States which may have a significant number of the black population among the renal allograft recipients.


[Leg amputation with transposition of the plantar skin and calcaneous tuber in severe mechanical trauma complicated by shock]. Diaphyseal shin amputations with transposition of the plantar skin and calcanean tuber on the neurovascular bundle were performed upon 4 cases. The late results have been studied. The patients use prothesis with the support on the end of the stump, and walk without the walking-stick. The authors believe it possible to carry out such operations, under the conditions of a specialized medical institution, for severe injuries to the lower extremities complicated with shock after a thorough debridement of the wound.


Apparatus for pasteurising teat cup liners between cows in a herringbone parlour. In a herringbone milking parlour, teat cup liners were deliberately contaminated in turn with Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae and Sterp uberis. Contamination was achieved by filling the liners with milk that contained 10(6) test organisms per ml. After the clusters had been back-flushed with water at 85 degrees C for five seconds, normal swabbing methods failed to recover any contaminating organisms from the teat liners in 56 tests out of 64. After 10 seconds back-flushing no recoveries were made in the same number of tests. The apparatus developed to effect this back-flushing for a particular herringbone parlour is described, with details of its routine use during milking. For a 100-cow herd, the running cost of such equipment using a five-second back-flush is estimated at no more than 4 pounds per week and, in its present form, would not add more than 10 seconds to the total milking time for each cow. Improvements in design of the apparatus, and in milking techniques arising from the routine use of the device, are also considered.


[Coliform bacteria in raw and pasteurized milk]. Studied were 360 samples of raw and 1404 samples of pasteurized milk, collected from three milk centers, for the presence of coliform bacteria. It was found that the coli titer of the raw milk varied from 10(-5) up to 10(-7), depending on the season. The regimes of pasteurization applied kill 100 per cent of the present coli organisms. After the thermic treatment the milk was additionally contaminated with coli forms from the containers and the equipment in dependence on the conditions of washing and disinfection. The coli titer of the pasteurized milk varied from 1 to 10(-3). A total of 602 strains of coliform bacteria were isolated from the pasteurized and the raw milk; the bacteria were differentiated by the scheme of Kauffmann. Most commonly encountered were the coli forms of the following genera:Citrobacter (35 per cent), Enterobacter (29.8 per cent), Klebsiella (23.9 per cent), and Escherichia (11.3 per cent). The following species were prevailing in raw milk: Kl. aerogenes, Ent. aerogenes, Ent. cloacae, C. freundi, and C. intermedium. In pasteurized milk dominating were Kl. aerogenes, C. freundi. Ent. aerogenes, and Ent. cloacae.


[Transfer of multi-drug resistance in vivo by salmonellae and shigella in white mice]. The oral infection accomplished by 0.3 cm3 X 10(10) microbial bodies of Salmonella heidelberg and Shigella sonnei in albino mice the pathogens were found to localize in the intestines. The Salmonellae were detected up to the 10th day, and the Shigellae--up to the 14th day. Both Shigella and Salmonella transferred multi-drug resistance to some enterobacteria--E. coli and Proteus as well as to Salmonella typhimurium when the latter was also present in the intestinal tract; of these some 10--40 per cent acquire the multi-drug resistance of Salmonella heidelberg and Shigella sonnei. This type of resistance was most often transferred en bloc for the six, resp., eight markers. On some occasions segregation was observed with the transference of particular markers only.


[Effect of prednisolone on the nucleic acid content and RNA synthesis in human lymph nodes in systemic diseases]. Studies on quantitative DNA content in lymphnode cells in patients with lymphogranulomatosis and reticulosis indicated that small prednisolon concentrations (0.1 mg/100 mg of cells) may be responsible for a reduced amount of DNA. The study of the quantitative content and turnover rate of total RNA has shown by the labeled uridine-H3 precursor incorporation a considerable decrease of RNA content and the reduce incorporation of the label in total RNA (approximately by 40% on an average).


[Immunoglobulins and nonspecific immunity factors in leukemias]. The authors report the data on immunoglobulins G, A, M content and their relationship with other factors of natural immunity in 55 patients with acute myeloblastic leukemia and in 43 patients with chronic lymphatic leukemia. The results have evidenced the impaired synthesis of immunoglobulins in acute in acute leukemia and the reduction of IgA and IgM already in the initial stage of chronic lymphatic leukemia. A correlation between mean values of immunoglobulins content and other factors of immunological resistance allowed a statement to be made that in the absence of impaired immunoglobulins synthesis there is a distinct coincidence of immunoglobulin content curves and titres of agglutinating and bacteriolytic antibodies.


[Delagil treatment of tumorous pleurisy]. A review of the literature is given on the efficacy of intrapleural use of different drugs (embichine, thiophosphamide, 5-fluorouracil, etc. and also acrichin (chinacrin) for malignant pleural involvement with the presence of exudate in the pleural cavity. Under study was the efficacy of intrapleural injection of delagil in 28 patients with pulmonary cancer, breast cancer and other malignant tumors with the presence of exudate in the pleural cavities. The effect, manifested in the cessation of the fluid accumulation, its encapsulation, was observed in 60 per cent of patients, an average duration of the remission being 8.3 months. In highly sensitive tumors (cancer of ovaries, breast cancer) the treatment should be initiated with intrapleural injection of thiophosphamide or embichine, and in case of failure delagil is to be employed intrapleurally. As a rule, side-effects, manifested in chest pains and temperature rise up to 38.5 degrees are of a short duration and require no special therapy.


[Prolonged renal graft survival after repeated blood transfusions (author's transl)]. In order to investigate the influence of pretransplant blood transfusions on renal graft survival, the results in 43 recipients with 10 or more transfusion (group A) were compared with those in 48 recipients with less than 10 or no transfusions (group B). In both groups cadaveric kidneys with mainly 3 or more mismatched histocompatibility antigens were transplanted. The incidence of preformed cytotoxic antibodies was similar in both groups (25.6% and 22.9%, respectively). The cumulative renal graft survival rate was significantly higher in the poly-transfused group: 85.6% +/- 6.1% and 73.4 +/- 7.9% after 1 and 2 years, respectively, in group A in comparison with 73.9 +/- 6.6% and 63.3 +/- 8.1% after 1 and 2 years respectively, in group B (Wilcoxon rank sum test: p less than 0.05). Severe renal rejection with a serum creatinine above 3 mg/100 ml was more frequently observed in group B than in group A. Enhancement due to blocking antibodies must be assumed as a possible explanation for the favourable effect of repeated pretransplant transfusions on graft survival rates.


[The influence of pretreatment with specific antibodies on Renal Xenograft Rejection (author's transl)]. 26 pig kidneys were perfused in a "Gambro" kidney perfusion machine. The perfusates used were unmodified canine plasma and serum, as well as complement-free plasma, gamma-globulin solutions obtained from dogs immunized against pig leucocytes (ALG) and 2-mercapto-ethanol treated ALG (2 ME-ALG). The typical pig-to-dog xenograft rejection was reproduced by ex vivo perfusion with native dog plasma and serum. Using complement-free dog plasma, ALG and 2 ME-ALG pig kidneys could be perfused for several hours without significant increase in perfusion resistance. 22 pig kidneys, pretreated by perfusion for 2 hours with complement-free dog plasma, ALG and 2 ME-ALG, were transplanted on to the vessels of the neck of recipient dogs. Grafts pretreated with decomplemented dog plasma and 2 ME-ALG were rejected in the usual fashion within 5 to 20 min. Pretreatment with ALG resulted in a prolongation of graft function for 80 to 100 min. It is suggested that ALG exerted a transient blocking effect on the cytotoxic action of recipient IgM resembling passive enhancement; this phenomenon may be limited to sites with low antigen density, corresponding to in vitro findings of passive enhancement on cells with low surface antigen density.


[Advances in the surgical treatment of renal calculi (author's transl)]. The most important advances in the surgical management of renal calculi are reviewed and the following current concepts are discussed: operation of the kidney in situ with dorsal muscle-sparing lumbotomy; intrasinusal pyelolithotomy as a modern principle of stone surgery; modern techniques for the localization and removal of stones from the renal pelvis (X-ray, ultrasound, coagulum pyelotomy); methods of hypothermal kidney preservation and operative techniques for staghorn calculi; and modes of surgical stone prophylaxis.


Different restriction of bacteriophages T3 and T7 by P1-lysogenic cells and the role of the T3-coded SAMase. The intracellular growth of the phages T3 and T7 is restricted in the presence of the Escherichia coli prophage P1. Phage T3 has a higher ability to express its genome and to damage the host cell than T7. This partial protection of T3 against P1 restriction is due to the T3-coded SAMase, an enzyme which degrades S-adenosylmethionine, the cofactor of the P1 restriction endonuclease. Since we did not observe DNA cleavage in vivo, we conclude that the in vivo action of the P1 nuclease is limited to a SAM-dependent repressor-like binding to T3 and T7 DNA, while further reactions with the DNA (modification vs cleavage) are blocked.


[Glycine dependence of Staphylococcus aureus strains]. Glycine dependent Staphylococcus aureus var. bovis strains (TSCHAPE and RISCHE 1971) were tested for their ability to grow on glycine containing and glycine deprived media. We observed glycine dependence only in minimal media. In complete media the strains grew in absence of glycine. Testing the ability of some glycine precursors we found that in minimal media glycine could be replaced by threonine and in some cases by serine. One mutant (Gly 100 Glyox.r.) was able to metabolize glyoxylate instead of glycine. Aspartic acid was metabolized in presence of glycine. Using 14C-aspartic acid we detected 14C-glycine and 14C-threonine. Presumably the bacteria metabolize aspartic acid to glycine via threonine.


[On some aspects of modern research of arteriosclerosis (author's transl)]. Atherogenesis is the result of interactions of factors originating from blood stream and the reaction of the arterial wall. Basing on this we have a pathogenetic trias: blood--lining membrane--arterial wall. Under these aspects some modern trends of experimental research are discussed. An example of blood-plasmatic injury is the hyperlipidaemia. The permeability of the lining endothelium regulates the infiltration and is influenced by several factors. The reactions of the modified smooth muscle cells in the arterial wall are the most important events in early atherogenesis. The metabolic decompensation of these cells is a main factor in the transition to advanced lesions. The efficiency of the cells is the preliminary condition for the reversibility of atherosclerotic lesions. Only early stages have some chances of regression; one must bear in mind this together with all therapeutical treatments.


C.-E.A. Winslow Day: proceedings of the June 3, 1977 centenary celebration. Sponsored by Yale University, the City of New Haven, and the John B. Pierce Foundation, the C.-E.A. Winslow Day program consisted of speeches by Mr. Leonard Woodcock, President Emeritus, U.A.W., the Honorable Kenneth Gibson, Mayor of Newark, and Dr. Hector Acuña, Director, Pan American Health Organization; reminiscences of Ira Hiscock, Anna M.R. Lauder Professor Emeritus of Public Health, Mary Elizabeth Tennant, Associate Professor Emeritus of Nursing (Public Health), A. Pharo Gagge, Emeritus Fellow, John B. Pierce Foundation, and Mrs. Harriet Welch, Former President of the VNA of New Haven. The proceedings also included the presentation of gifts and the official C.-E.A. Winslow Day Proclamation.


Oliver Wendell Holmes: the professor and autocrat addresses medical matters. Oliver Wendell Holmes, the physician, poet and novelist, was a frequent and at times outspoken commentator on the practice of medicine. His speeches and writings reveal Holmes's remarkable wit and facility in addressing such topics as medical education, drug prescription and medicine in society. Although delivered in the previous century his comments often seem to retain remarkable relevance in the current medical forum.


Double-blind comparison of iodamide and diatrizoate for excretory urography. A double-blind comparison of meglumine iodamide and Renografin 60 (52% meglumine diatrizoate and 8% sodium diatrizoate) for bolus excretory urography was performed. Doses of 0.8 cc/kg. to a maximum of 55 cc were administered to fifty patients, twenty-five receiving each drug.There is a suggestion that iodamide may be superior to diatrizoate in pyelocalyceal opacification while being equal to diatrizoate in parenchymal opacification and in types and severity of side-effects.


[Breath analysis tests in gastrointestinal disorders (author's transl)]. From various breath tests up to now mainly measurement of respiratory 14CO2 and hydrogen have attained clinical application. Breath tests are easily performable, without discomfort for patient or in investigator and do hardly require active support of the patient. On the other hand absorption tests, as 14C-tripalmitate- and 14C-lactose-breath test, are influenced by alterations of the metabolism in a considerable degree, and clinical significance and specificity of the 14C-cholylcycline-breath test remains questionable hitherto. Nevertheless, obtained values which are independent from metabolism, high sensitivity and lack of competitive methods are arguments for the 14C-cholylglycinebreth test for the diagnosis of bacterial overgrowth in the small bowel. Breath analysis of hydrogen seems to be a very sensitive and reliable method for detecting carbohydrate malabsorption, as lactose intolerance.


[The application of methodological aspects of the social sciences to psychoanalytic research--impressions from Tutzing, 1976]. Discussing problems in the application of methodological aspects of social sciences to psychoanalytic research the question was asked whether statistical methodology can be adapted to the multidimensional communicative process of psychoanalysis. Referring to the fact that experimentally and methodologically confirmed research usually demands a reduction of the process to be examined it was pointed out that the results of these studies might undergo a reduction in statement value and practicable clinical relevance accordingly.


Agar-coated dip-slides for the cultivation, storage and transport. Dip-slides which are covered with suitable agar media (e.g. malt extract agar, potato dextrose agar, Czapek Dox agar) are well suited for the cultivation, storage and transport of moulds and phytopathogenic fungi. Most of the organisms develop equally well on dip-slides and in Petri dishes.


Microbial society and its activity in the soil. In this study, with the help of the buried slide method, a qualitative observation of the microsociological association in the soil was assessed. Fungal mycelium cohabiting with bacterial forms, rods as well as cocci, individual colonies of Azotobacter-type cells, and certain algae of Hantzschia species were recorded in a central European typical garden soil. The use of CHOLODNY-STRUGGER combination method was helpful in ascertaining the decaying nature of a soil nematode and also fungal mycelium which, during the process of decomposition, served there as a substrate for bacterial multiplication. Colony of Clostridium-type rod-shaped bacteria existed between the soil particles, acting as living bridges. When examined under fluorescent microscope, the bacterial forms emitted shining fluorescence of green colour which in effect presented them as lighted objects, prominent against the dull red background of soil objects and other decaying substances.


[A comparative study on the therapeutic results between respiratory feedback (RFB) and a placebo treatment]. In a controlled study 24 patients with neurotic and psychosomatic symptoms were treated with Respiratory Feedback (RFB) in 12 consecutive sessions. The observed changes were compared with the results of a control group. Its members were subjected to a nonsystematic treatment causing them to relax (placebo-group). In this group the physical symptoms of three quarters of the patients changed for the worse whereas significant psychic changes were not observed. In the RFB-group, however, significant improvements were to be found in regard to the physical as well as the psychic condition of the patients. The most distictive changes were reduction in the disposition to exhaustion, a decrease of the vegetative symptoms, and a decline of the compleints about heart trouble, poor circulation and pains in parts of the stomach and intestinal system. Psychologically a distinct reduction of fear, neuroticism, increased extraversion scores and a positive change of mood followed. It is being discussed if the observed changes in the RFB-group can be attributed to specific effects of the Respiratory-Feedback (RFB).


Synthesis of vitamin B12 by various species of mycobacteria. The synthesis of Vitamin B12 by five reference strains of species of mycobacteria, the influence of cobalt upton the synthesis and the correlation between the phase of growth and quantitative biosynthesis of Vitamin B12 were studied. Assays were performed on cell extracts and culture filtrates using Lactobacillus leichmannii ATCC7830 (tube method). All five species synthesized Vitamin B12, which could be deomonstrated both in cell extracts and in the culture filtrates. An optimum accumulation of Vitamin B12 by BCG and M. phlei could be observed on the 30th day of cultivation. Addition of cobalt did not influence the growth of BCG and M. phlei, but markedly enhanced the production of Vitamin B12. Cells contained much more Vitamin B12 than culture filtrates did. Vitamin B12 levels in M. smegmatis, M. fortuitum and M. asiaticum were lower than those in BCG and M. phlei.


[Tetracyclines: bacteriostatic or bactericidal drugs? In vitro studies with rolitetracycline, minocycline and doxycycline (author's transl)]. Minimal bacteriostatic and minimal bactericidal concentrations of rolitetracycline, minocycline and doxycycline on 20 different E. coli serotypes and 16 staphylococcus aureus strains have been compared in bouillon and serum. In addition growth curves of all strains in bouillon and serum without and with antibiotics in concentrations corresponding to the minimal inhibitory concentration of each strain have been followed for 24 hours. In E. coli minimal bactericidal concentrations of all 3 tetracyclines in bouillon on average were only twice as high as the minimal bacteriostatic concentrations of the drugs, tested. Minimal bacteriostatic and bactericidal concentrations in serum were significantly lower than in bouillon. 27 out of 20 E. coli strains were inhibited by less than 0.012 microgram/ml. In staphylococci minimal bactericidal concentrations were substantially higher than the minimal bacteriostatic concentrations (on average at least four times higher). In E. coli addition of serum increased the antimicrobial activity of all tetracyclines tested. Growth curves in bouillon tended to show some bactericidal shape at 3, 7 and 24 hours following addition of the tetracyclines at minimal bacteriostatic concentrations. Bactericidal activity of tetracyclines at the MIC was substantially improved by addition of serum. This was not true for staphylococci in which neither minimal bactericidal and bacteriostatic concentrations nor growth curves could be significantly improved by addition of serum.


[Resection and enteroanastomosis in the ligated rabbit gut test as a modified and sparing operating procedure (author's transl)]. For detection of heat labile enterotoxin of E. coli we also carried out the ligated rabbit gut test, which was complicated by a high primary mortality. We modified the operating technique as follows. We interrupted the continuity of the ileum by resection of the segment containing the loops and restored the passage by an end-to-end-anastomosis of the oral and aboral stumps of the gut. The technique is explained by pictures. The strains from patients were incubated in Brain Heart Infusion broth (Difco) by 37 degrees C for 48 hours without shaking. The strains were tested both as suspensions and as sterile filtrates by injection of 2 ml each using positive (O 148:-:28, B 7 A) and negative controls (U 5/41 O 1:K1:H7, neotype strain). We used rabbits (Helle Grosssilber) weighing 1500 to 2500 g. Operation was performed under general anaesthesia with pentobarbital (SPOFA) and under aseptic conditions. After a period of 18 hours the animals were killed, and the index of enterosorpiton was estimated. An index of 1.0 or greater was regarded as positive. This technique is an sparing procedure, the artificial ileus is avoided, the surviving rate of the rabbits is higher, and the possibility is given to carry out long time studies on enteropathogenetic problems. The results of our studies on 17 rabbits with a total number of 100 loops are summarized in a table.


[Detection of rubella virus antibodies in single radial haemolysis-test (author's transl)]. Different kinds of erythrocytes (human, pigeon, chicken and sheep) and complement (guinea pig, rabbit and rat) were tested in rubella single radial hemolysis-test (SRHT, hemolysis-in-gel = HIG-test) in order to detect IgG and IgM antibodies. Experiments showed that sera which were used as complement, contained antibodies against different kinds of erythrocytes. If complement from rabbit and rat should be used, an adsorption will be necessary. For serological surveillance sheep and chicken erythrocytes in connection with guinea pig serum as complement were best suited. Positive results were also obtained with pigeon erythrocytes whereas human RBC gave negative reactions. A detection of IgM antibodies in the SRHT was not possible.


A new technique of heterogenous enzyme-linked immunosorbent assay, stick-ELISA. I. Description of the technique. A new quantitative technique is described to perform hererogenous enzyme-linded immunosorbent assay using polysterene sticks as solid phase (Stick-ELISA). Advantage of the technique is a combination of economic antigen and conjugate requirements, rapid and thorough washing procedures, and part adaption to general automation devices present in most hospital laboratories which render the technique equally ideal for small and large series in routine serodiagnosis.


[Experience with a new culture medium for salmonella diagnosis (author's transl)]. A new medium for the cultivation of Salmonella is presented which enables an immediate distinction of Proteus bacteria and Citrobacter. The time needed for diagnosis is reduced, expenditure on staff and material will be reduced. The "positive" salmonella yield from faeces specimens is increased as compared to Leifson agar and SS agar.


Survey of resistance to metals and antibiotics in clinical isolates of Klebsiella pneumoniae in Japan. Clinical isolates of K. pneumoniae (746 isolates) were studied for the resistance to four metals and four drugs. The distribution patterns of their susceptibility to Hg, Cd and As clearly revealed two peaks, but only a single peak of resistance to Pb. It can be seen that resistance was demonstrable in media containing the following concentrations of the metals (micrograms/ml): HgCl2, 10; CdCl2, 400; and Na2HAsO4, 400. In K. pneumoniae, the frequency fo resistance to these concentrations of Hg, Cd and As were 65,8%, 98,3% and 83,8%, respectively. On the other hand, the frequency to antibiotic resistance of K. pneumoniae were 68,1% of SM, 51,2% of TC, 49,7% of CP and 36,7% of KM. Furthermore, many isolates (99,6%) were metal-resistant. Most of these metal-reisitant strains were multiple-metal-resistant and also multiple-drug-resistance. And about 30% of total isolates were metal-resistant but drug-sensitive, whereas the frequency of the metal-sensitive and drug-resistant strains was 0%.


[Design-dependent transmission of bacteria by internal infection of dental turbines (author's transl)]. The results of the present investigation point to an up to now little recognized possibility of bacterial transmission by dental turbines, namely, the intake of spray water by reverse suction from the turbine hand piece into the cooling water system on turning off the unit. Reverse suction is provided in most modern dental turbine units to prevent after-drip and the cooling of the pre-warmed spray. As a consequence, microorganisms of the oral flora and possibly disease-producing bacteria may be carried into the cooling water system and thus be transmitted to the next patient when using the same turbine. In carefully planned experiments employing E. coli as test organisms it could be shown both in simulated manipulation in the oral cavity as well as in in vitro experiments that transmission of bacteria is possible in up to 10 ml of spray water ejected (equivalent to 10 spray water fractions of 1 ml each). In older model turbines without spray water reverse suction, bacteria were absent after ejection of no more than 6 ml of cooling water (in fractions of 1 ml each). In order to avoid transmission of bacteria in spray water of dental turbines it appears necessary to subject the turbine hand piece or the turbine head, resp., to rigorous disinfection and to allow delivery of at least 20 ml of spray water - corresponding to about 20 second's operation - before reusing the unit.


[The value of possible skull-cap replacement surgery]. After describing the valence of the various possible plastic procedures for covering defects of the skull cap, the results obtained by the authors are presented. In childhood, autografting from the inner layer of the wing of the ilium or from the ribs is given preference. In adults, the authors carry out alloplasty with hot-polymerizing methacrylate in order to prevent a second surgical intervention for obtaining autogenous material. If surgery has to be carried out in the vicinity of the paranasal sinuses, autogenous cartilaginous cubes must be inserted between the sinuses and the alloplasty because direct contact of the alloplastic material with the sinuses exposed to infection hazards must be avoided.


[Mycoplasma meningoencephalitis and encephalomyelitis in children]. The authors report of some results of clinico-morphological studies in generalized mycoplasmic infections in 7 babies, who died from meningoencephalitis and encephalomyelitis. Morphological studies of the CNS demonstrated not only structural tissue changes, but permitted to detect the agent-mycoplasma. A clinical diagnosis of mycoplasmic lesions of the nervous system is of certain difficulty due to the polymorphism of neurological signs. The clinical picture of the nervous system affection consisted of disorders of cortical functions in combination with the pathology of the subcortical structures, disorders in the brain stem and the spinal cord. The initial symptom of the nervous system affection in 5 cases was a convulsive syndrome, in 2--bulbar disorders. The authors give some data testifying to a possibility of an intrauterine lesion of the CNS.


Sulphate permease of Escherichia coli K12. Some properties of the sulphate transport system and the isolation of sulphate permease mutants in E. coli K12 are described. The gene coding for sulphate permease is located in the same region as the cysA gene in Salmonella typhimurium.


Preoperative normovolemic hemodilution in total hip arthroplasty. A clinical study. Pre-operative normovolemic hemodilution was used in 20 patients undergoing total hip replacement. The hematocrit was lowered to 25-30% immediately before operation. 23 patients, in whom operative blood loss was replaced with bank blood, served as a control group. In the hemodilution group the amount of homologous blood transfusions was reduced with 50% compared to the control group. There was no significant difference in clinical complications between the two groups. The technique is simple and the increase in anaesthesia and operation time only about 20 min.


Effect of dextran on factor VIII and thrombus stability in humans. Significance of varying infusion rates. The in vivo effect of dextran 70 on Factor VIII (antihemophilic factor) and thrombus stability has been studied in human volunteers after infusion at various rates. Varying the infusion time of dextran from 15 minutes to 2 hours did not result in any differences in the concentrations of dextran, fibrinogen and hematocrit, thus indicating similar degrees of hemodilution. Nor were any differences found in the effect of dextran on Factor VIII and thrombus stability. With regard to the antithrombotic function of dextran by hemodilution and effect on Factor VIII, there does not seem to be any advantage in giving dextran rapidly. This information could be of value in the treatment of elderly patients, for whom thrombosis prophylaxis is especially indicated and whose tolerance for hypervolemia is limited.


Venous function in previously thrombosed legs. A follow-up study of streptokinase-treated patients. The results of streptokinase treatment of deep venous thrombosis in 14 patients are described, the immediate effect evaluated by phlebography and the result of a follow-up examination with foot-volumetry performed to evaluate the venous function in the previously thrombosed legs.


Acute pancreatitis treated with and without addition of insulin. During a five-year period 365 cases of acute pancreatitis were treated one or several times. 165 subjects were treated on 222 occasions without insulin included in the therapeutic arsenal and 258 subjects were treated on 408 occasions with insulin included in the therapy. The insulin treated group had a significantly lower mortality rate (7.9 and 1.9% respectively). No other systematic factors of importance for the difference were found.


Single-dose antibiotic prophylaxis in appendectomy. Prophylactic antibiotics will reduce the number of wound infections after so-called clean-contaminated gastrointestinal operations. The prophylactic regimen must be designed with the pharmacokinetical properties of the used drug, in mind. A safe and simple, easily standardized procedure, applicable in both elective and acute clinical situations is preferable. A single-dose regimen with prophylactic cephaloridine has been tried and evaluated.


[Problems of wound healing during kidney transplantation (author's transl)]. Infection of the transplant bed caused an important morbidity and mortality. Meticulous preoperative preparation and surgical technique, the local irrigation of the transplant site with local antibiotics as well as the barrier-nursing of these high risk patients are all equally important factors to limit infectious complications in the transplant population. Since the use of the barrier-nursing principle, infection rate fell down from 8.1% to 3.6% for primary transplant wounds. The infection rate of the potentially contaminated wounds is much better than the pourcentage obtained in analogous interventions in general surgery. Nevertheless, despite these measures, re-intervention on a transplant still remains much more susceptible to infection because of the high technical difficulty of these interventions.


Effect of prophylactic systemic administration of cephalothin in colorectal surgery. The effect of standardized prophylactic treatment with systemically administered cephalothin (Keflin) was studied in a series of 120 consecutive patients in whom elective colorectal surgery was planned. The patients were divided by random selection into one treatment group and one control group. The same mechanical cleansing with cathartics and tap water enemas was performed in both groups. The patients in the treatment group received intravenously 2 g cephalothin 2 hours prior to the operation, 2 g during the operation and then 2 g every 6th hour during 4 days. 14 cases were excluded for various reasons. In 19 cases only minor operations were performed, such as laparotomy with or without simultaneous colostomy. The overall frequency of infections was 17.5% in the treatment group and 53.1% in the control group. In the 87 cases undergoing major operations, infections were registered in 17.4% of the treated patients and 58.5% of the control patients. The difference is highly significant (p less than 0.001) in both cases. Escherichia coli was present in about 70% of the infections, often together with other aerobic or anaerobic organisms.


Evaluation of collagen film implantation for local haemostasis after transvesical prostatectomy. A study has been undertaken to evaluate the effect of internal implantation of collagen film in man. This was made as a randomized study in 50 transvesical prostatectomies. The film was well tolerated, gave rise to no untoward reactions and had little haemostatic effect.