Tests for ischaemia and left ventricular function in young patients with effort-induced chest pain. The type of angina pectoris was determined in 47 women and 27 men aged 40 or less who then underwent quantitative left cineventriculography, coronary arteriography and atrial pacing test with determination of lactate concentrations from arterial and coronary sinus blood samples. The 29/74 patients with atypical angina and no narrowings on coronary arteriography (Group I) gave no pathological atrial pacing tests but 9 had pathological lactate tests. Group II consisted of 27/74 patients with typical angina but normal coronary arteriography. In these the atrial pacing test was pathological in 20 and the lactate test in 11. Coronary narrowings of 50% or more were found in 18/74 patients (Group III), who all had pathological pacing tests but only 9 pathological lactate tests. No statistical differences could be elicited between diagnostic groups in the quantitative evaluation of left ventricular function and it could be regarded as normal in 42/74 patients. The left ventricular mass index exceeded the control level in 6 patients in Group I and in 10 patients in Group II who all had a net lactate production upon pacing. The end-diastolic volume index was above control level in 11 patients in Group II, in whom the ST depression in pacing test was the only finding indicating ischemia. The hoop stress values exceeded the control level in both of these subgroups. In Group III 7 patients had a high left ventricular mass index and 4 a billowing mitral leaflet. The changes observed suggest disturbed functioning of left ventricle.


Cholescintigraphy in the determination of disturbed hepatobiliary function in acute cholecystitis. The hepatobiliary transit of 99mTc-diethyl-IDA was studied in 50 cases of acute cholecystitis. The intrahepatic transit was characterized by the liver mean transit time of the tracer. The extrahepatic passage through the biliary tract was assessed from a series of scintigrams. The data were classified according to previously obtained knowledge of normal and pathological states of the liver and the biliary tract. (Normal liver mean transit time less than or equal to 70 minutes, normal appearance-time of the tracer in the biliary tract less than or equal to 15 minutes and in the intestine less than or equal to 20 minutes, no retention of the tracer in the biliary tract in cases of later appearance-times). Abnormal hepatobiliary transit of the tracer was recorded in 27 cases; it was retarded at the intrahepatic level in 11 cases, at the gallbladder neck in 3 cases, distally in the biliary tract in 12 cases, and a tight extrahepatic obstruction was seen in 1 case. In consequence, acute cholecystitis is often associated with disturbed hepatobiliary function. The functional changes in acute cholecystitis were similar to those associated with other hepatobiliary disorders of either intrahepatic or extrahepatic origin.


Plasma lidocaine concentrations after different methods of releasing the tourniquet during intravenous regional anaesthesia. Different methods of tourniquet release have been proposed to decrease the concentrations of local anaesthetic released into the systemic circulation at the end of intravenous regional anaesthesia. The effect of releasing the tourniquet intermittently with 5 seconds (group I) and 30 seconds (group II) deflation periods or at once (group III) was studied in 25 adult patients after intravenous regional anaesthesia with 40 ml of 0.5% lidocaine. The venous plasma lidocaine concentrations from the contralateral arm were measured by gas chromatography. There was no leakage of lidocaine from the occluded arm into the systemic circulation. The mean maximum plasma lidocaine concentration in group I 1.99 +/- 1.45 (SD) microgram/ml, in group II 1.33 +/- 0.54 microgram/ml and in group III 1.56 +/- 0.88 microgram/ml (P greater than 0.05) was below the toxic concentrations reported in the literature. There were subjective complaints such as dizziness and ringing in the ears in 4 out of the 7 patients in group I, in 2 out of the 9 patients in group II and in one of the 9 patients in group III (P greater than 0.05). There was no correlation between the duration of tourniquet time (range 12-87 minutes) and the maximum plasma lidocaine concentration. The intermittent release of the tourniquet did not decrease the venous plasma lidocaine concentrations in the contralateral arm; neither did comparing the lidocaine pharmacokinetics in 5 patients of group II after tourniquet release and in the 5 healthy volunteers after a single 100 mg intravenous lidocaine injection reveal any differences.


Rehabilitation of Caisson's disease with spinal cord involvement. Fifteen cases of Caisson's Disease or Decompression Sickness with spinal cord involvement treated at the Department of Rehabilitation Tan Tock Seng Hospital, from 1973 to 1978 are described. All the cases had bladder and bowel function involvement. Five cases developed bone complications, one of whom was referred to us primarily for rehabilitation after he had an operation for collapsed right femoral head which occurred two years after the incident.


Rehabilitation of traumatic spinal cord lesions--results of 145 cases treated between 1973 and 1977. An analysis of 145 traumatic spinal cord lesions admitted to the Department of Rehabilitation Medicine, Tan Tock Seng Hospital, between 1973 and 1977 is made. The annual incidence based on this figure and on a population of 2.2 million was 16.3 per million population. 68% of the cases were within the employable age group of 15 to 45 years. 40% of them were due to industrial accidents, 36% from road traffic accidents and 24% resulted from other causes like domestic accidents, sports mishaps and criminal violence. An analysis of the site of lesion shows that 71 cases had lesions at the cervical level, 50 at the thoracic lumbar region, 9 at the upper thoracic region and 15 at the lumbar region. After a course of rehabilitaion 66% were able to walk either independently or with some form of aids, 27% were wheelchair-bound and the rest were bedridden at time of discharge. In self-care activities 79% were independent, 15% were partially dependent and the rest totally dependent after rehabilitation.


Treatment of chancroid with Bactrim.

Treatment of chancroid with Bactrim. Bacterim in either oral or intramuscular injection forms were given to 67 patients with Chancroid. It was found that after one week of treatment, clinical cure rate was 46.3% and bacteriological cure rate was 73.1%. After two weeks, the clinical cure rate was 77.6%. Three patients (4.5%) had persistent sores at the end of two weeks and only one of these (2.5%) was bacteriologically active. Twelve patients defaulted. Adverse side-effects were observed in five patients. The effectiveness of Streptomycin, Sulphonamide and Tetracyclines, the other commonly used therapeutic agents, was discussed and compared with Bactrim. It was concluded that Bactrim was a safe and effective drug to use, and recommended as an alternative to Streptomycin and Sulphonamides in the management of Chancroid.


Arthrography--a diagnostic aid to knee injury. Injuries of the knee often present diagnostic problem. Using double contrast arthrography, each segment of the two menisci can be studied in detail. In addition, ligamentous tears can be detected. This method is particularly useful when the clinical signs are non-specific and the symptoms atypical. In the present series, double contrast arthrography was performed in 100 cases of suspected internal derangement of the knee. Abnormal radiological findings were recorded in 31 cases. Confirmation of the diagnosis was available in 17 out of 21 patients, subjected to surgery, giving a pre-operative diagnostic accuracy of 81%. This figure could be improved with experience and can be further enhanced, if used in conjunction with arthroscopy.


Study of lumbar disc pathology among a group of dockworkers. Low back disorders pose a serious health problem among workers engaged in heavy manual lifting and carrying. In order to determine the extent to which this type of activity may contribute to the prevalence and pattern of lumbar disc degeneration, a group of dockworkers doing heavy lifting and carrying and a control group of clerks were compared. The prevalence of disc changes was higher among the dockworkers at all disc levels studied (T12-L5). No significant differences in pattern of distribution of affected discs were demonstrated. A higher prevalence of anterior and posterior disc changes, occurring more in combination than singly, was observed in the dockworkers. There was a significant excess of such combined changes in the T12, L4 and L5 discs among the dockworkers, compared with only L5 involvement in the controls.


Surgical treatment of mandibular prognathism--a review of 25 cases. Mandibular prognathism is a common developmental jaw deformity with functional disabilities and facial disfigurement, characterised by a prominent mandible. Very satisfying cosmetic and functional results can be achieved by surgery and the literature is replete with surgical techniques for correcting this deformity. This paper discusses the surgical treatment of mandibular prognathism and reviews a series of 25 consecutive patients treated by an extra-oral technique known as Subsigmoid Oblique Osteotomy (Vertical Subcondylar Osteotomy) during a seven-year period, (1969-76).


Additional day-to-day precision estimates based on regional chemistry quality control data. State-of-the-art precision values are presented for the following serum constituents: aldolase (EC 4.1.2.13), alpha-hydroxybutyrate dehydrogenase (EC 1.1.1.30), cholinesterase (EC 3.1.1.8), cortisol, gamma glutamyl transferase (EC 2.3.2.2), haptoglobin, immunoglobulins, lactic acid, leucine aminopeptidase (EC 3.4.1.1), total lipids, osmolality, protein fractions, T3 uptake, thyroxine and vitamin B12. Precision estimates are based on values reported for four lyophilized serum pools analyzed by participants in the Pennsylvania Association of Clinical Pathologists regional quality control program for clinical chemistry, during 1976, 1977 and 1978. Use of the upper limit of the "most common range" of precision (that range including the 75 percent most precise laboratories) as a warning level for trouble-shooting is advocated.


Heparin induced platelet aggregation: in vitro confirmation of thrombotic complications associated with heparin therapy. Eleven patients who developed thromboembolic complications while receiving heparin were studied for a possible adverse reaction to heparin as the cause of their progressive thrombosis. Fifteen additional patients who were receiving heparin for recurrent thromboembolism, but who did not develop signs of thrombotic complications, were studied as patient controls. The most significant finding was an abnormal in vitro aggregation response to heparin alone in all of the patients who developed complications who were tested for it (64 percent). None of the patient controls demonstrated this abnormality. In addition, thrombocytopenia was noted in all of the former but in only one of the latter. Results of prothrombin times, fibrinogens and fibrin split products eliminated disseminated intravascular coagulation as the cause of the thrombocytopenia in the majority of cases. Finally, an approach to the early detection of the abnormal heparin response is presented and guidelines for its therapeutic management are recommended.


Measurement of salicylsalicylic acid and salicylic acid in plasma by high pressure liquid chromatography. Salicylsalicylic acid (SS) and salicylic acid (SA) both appear in plasma after the oral ingestion of the former. They can be estimated in the presence of each other after extraction into dichloromethane using high pressure liquid chromatography. SS is unstable in plasma, being converted to SA in vitro. Conversion can be prevented by using ethylene diaminetetraacetic (EDTA) as an anticoagulant and carrying out the extraction in the cold. An aliquot of the extract is dried and dissolved in methanol. Weak solutions of SS in methanol are unstable at room temperature. Methanolysis can be prevented by the addition of dilute hydrochloric acid. By adding phenylbutazone to the plasma as an internal standard, variations in extraction and sample application are nullified. Quality control is achieved by concurrent extraction of two different plasma standards containing SS and SA in known amounts. About 40 ng of SS and SA can be detected; reproducibility at 200 ng and above is better than 6.5 percent.


Secretion of nickel in rabbit saliva.

Secretion of nickel in rabbit saliva. Secretion of nickel into unstimulated and stimulated saliva of rabbits was studied after a single intraperitoneal injection of nickel chloride labelled with 63Ni. Maximum 63Ni in unstimulated saliva was obtained in specimens collected one hr after maximum serum-63Ni was reached and two hrs after the nickel administration. Compared to serum-63Ni, the secretion of isotope into saliva was low whether or not stimulation was carried out. After 24 hrs, only traces of radioactivity were left in saliva. Forty to 60 percent of salivary-63Ni was ultrafiltrable. Most nickel associated with salivary proteins was weakly bound. Two acidic protein fractions obtained by gel filtration of saliva seemed to bind nickel firmly at neutral pH. No such binding of nickel to salivary proteins was observed after the in vitro addition of normal saliva to 63NiCl2.


Circadian rhythms of serum aldosterone, cortisol and plasma renin activity in burn injuries. Circadian rhythm of serum aldosterone and cortisol concentrations and of plasma renin activity (PRA) were measured by radioimmunoassay in 10 adults with thermal injuries. The determinations were begun 6 to 48 hours after the injury and continued for five consecutive days four times a day. In all patients, the normal pattern of the circadian rhythm for all three hormones disappeared and values remained quite high at any time of the day or the night. Four patients developed an hypertensive crisis with quite elevated levels of aldosterone, cortisol and plasma renin activity. The same hormones were also found very elevated in two hypotensive patients with 80 percent or more of injured body surface who were in agonal conditions and succumbed to the injury.


Application of electroimmunoassay to the study of plasma protein synthesis in cultured hepatocytes. Electroimmunoassay has been applied to the study of plasma protein synthesis and secretion in liver cell cultures. The assay is performed on unconcentrated samples of culture medium containing the secreted plasma proteins and yields results within 2 hours. The characteristics of plasma protein production by the cultured hepatocytes coupled with the sensitivity of this assay permit the study of plasma protein in synthesis and its regulation by hormones and other agents without the routine use of radioisotopes.


Clotting, activated partial thromboplastin and coagulation times in monitoring heparin therapy. The automated-activated coagulation time, manual-activated coagulation time and the activated partial thromboplastin time were compared to the whole blood clotting time in the measurement of hypocoagulation of heparinized blood. The normal ranges and degree of reproducibility were determined for each clotting assay. Each method was examined for its sensitivity to various concentrations of heparin. In addition, blood samples from patients treated with heparin were assayed by all four methods and their results were compared. The results indicated that the manual-activated clotting time correlated best with the whole blood clotting time, was sensitive to low concentrations of heparin, formed a discernible clot within a convenient time period in blood containing high concentrations of heparin, was reproducible and was easily performed.


[Three hypothalamic tumours: clinical, biologic, X-ray and therapeutic study (author's transl)]. On the basis of 3 cases of hypothalamic tumours (glioma of the hypothalamus or of the stem of the pituitary, glioma of the hypothalamus or of the optic chiasma, pinealoblastoma), the authors emphasise: (1) the existence of a special endocrine "formula" since it often combines anterior pituitary insufficiency, diabetes insipidus and moderate hyperprolactinaemia; (2) the remarkable efficacy, in all 3 cases, of cobalt therapy, tumour regression becoming complete during the 6 to 10 months following the end of radiotherapy; (3) the post-radiotherapeutic endocrine complications, endocrine deficit becoming greater whilst the tumour disappeared; (4) the diagnostic possibilities and above all regular surveillance now made possible by tomodensitometry.


[Thyrotoxic periodic paralysis: case report (author's transl)]. Boy 19, french -- Attacks of hypokaliemic flaccid tetraplegia in 1972 -- 4 months later thyreotoxicosis -- Disappearance of neurologic symptoms and euthyroid condition after carbimazole. Relapse 5 years later of concomitant thyreotoxicosis, hypokaliemic tetraplegia attacks and lower limbs myalgias. Normal conventional and enzymatic light histology of quadriceps. Anomalies of membraneous system (T system and sarcoplasmic reticulum) on electron microscopy -- subtotal thyroidectomy -- hormonal and neurologic total recovery. Caucasoid erythrocyte and HLA groups.


ABO blood groups and renal disease.

ABO blood groups and renal disease. This study compares the frequency of ABO blood group distribution between 184 patients with renal parenchymal diseases and 3,820 apparently healthy subjects. The renal diseases were confirmed by renal biopsy studies in all patients. The distribution of renal patients among the blood groups was significantly different (p less than 0.01) from the blood group distribution of normal subjects. The differences occurred mainly in the B and O Groups with renal patients showing a 7 percent increase in Group B and a 10 percent decrease in Group O.


[In vivo regulation by calcium of the thyroidal iodine metabolism and its modulation by sodium, in the rat (author's transl)]. In vivo experiments, in the rat, using diets deficient in calcium, or sodium or both ions, proved these cations to regulate the thyroidal iodine metabolism. Calcium enhanced iodine entry into the thyroid and the intrathyroidal iodine and T4 pools. T4 level in serum was also increased by calcium. Sodium enhanced iodine entry and secretion. The two cations have local regulatory functions on the thyroid gland and do not affect TSH levels in serum and the hypophysis. The effects of calcium and sodium are interdependent, sodium deficiency suppressed the effects of calcium and the effects of sodium were significantly limited by calcium deficiency. Results from chromatography of the thyroid extracts and data from the literature are compatible with the hypothesis of calcium enhancing iodine entry and accumulation into the thyroid gland mainly through an effect on exocytosis of thyroglobulin, the was this ion enhances exocytosis of protein in stimulus-secretion coupling. An addition to this theory is pur forward in order to reconcile with it the whole set of experimental data obtained with the two cations, in vivo and in vitro, on thyroidal iodine metabolism.


[The study of the influence of prolactin on gonadal steroids metabolism by the human chorionic gonadotropin test. Plasma and urinary determinations in 27 subjects (control, hyperprolactinemic, normoprolactinemic but hypogonadic subjects) (author's transl)]. In order to determine whether hyperprolactinemia besides its action at the hypothalamic level, acts at the gonadal level, a serie of 28 stimulations by Human Chorionic Gonadotropin (HCG : 5 000 IU X 3) is reported. The following parameters were measured in plasma and in urine before and during 4 consecutive days following the injection of HCG : Progesterone (P), 17 OH Progestérone (17 OHP), Androstenedione (A), Testostérone (T), Dihydrotesterone (DHT), Estrone (E1), 17 beta estradiol (E2), Urinary Androstanediol (Adiol) Testosterone Glucuronide (G.T.) and phenolsteroids (PS). The test was performed in both sex, in 3 different groups including normal, hyperprolactinemic and normoprolactinemic but hypogonadic subjects (hypopituitarism). These data suggest that in hyperprolactinemic subjects: there is no steroid 5 alpha reductase abnormality in male patients, and there is no gonadal resistance to HCG stimulation in both sex, at least to the high doses of HCG used in this study.


[Determination of 6 pituitary hormones in the cerebrospinal fluid. Control subjects, prolactin adenomas, empty sella syndrome and hypothalamic disorders (author's transl)]. Cerebrospinal fluid (CSF) and serum concentrations of TSH, ACTH, FSH, LH, GH and PRL were measured simultaneously in 34 subjects divided into 3 groups: I-12 normal subjects (6 males and 6 females); II-12 prolactin adenomas (3 males and 9 females); III-5 empty sella syndromes, 3 hypothalamic disorders, 1 chromophobe adenoma, 1 pituitary dwarfism. It is concluded that: 1) pituitary hormones are the normal constituents of CSF but the level can be undetectable and in any case lower than the serum level. 2) there is a positive correlation between serum and CSF concentration of PRL when serum PRL is higher than 20 ng/ml, indicating that the CSF level is influenced by serum level. 3) in prolactin adenomas, only prolactin is elevated in the CSF. 4) there is no correlation between the high level of CSF-PRL and a suprasellar extension of the adenoma.


[Gonadal dysgenesis in a mother and her daughter (author's transl)]. The authors present two cases of gonadal dysgenesis in a mother and her daughter. Caryotypes were 46, XX/45, X for the mother (RHG-banding) and 46, X, i (Xq)/45, X for the daughter. Some researches in family did not show any abnormalities to explain this very exceptionnel event in a mother and one of her 3 daughters.


[Serum testosterone after HCG in thyroidectomized or hyperthyroid male rats (author's transl)]. Serum testosterone levels were measured by radioimmunoassay in young male rats before and after IM HCG (500 IU) in basal conditions, after thyroidectomy, or during thyroxine administration. Basal testosterone levels decreased significantly with time in control group (p less than 0.025) and in thyroidectomized rats (p less than 0.025). After HCG, testosterone increased in the 3 groups. There was no difference between control and hypothyroid groups but a lower response (p less than 0.005) in hyperthyroid rats.


[Plasma aldosterone and renin activity in hypopituitarism (author's transl)]. Plasma renin activity (P.R.A.) and plasma aldosterone were measured in twelve patients having hypopituitarism. Both mean values of this group were significantly lower than in normal subjects (P.R.A. recumbent: p less than 0.001, upright: p less than 0.001, plasma aldosterone: recumbent: p less than 0.02, upright: p less than 0.005). Hyporeninism is a controversed feature in hypopituitarism. Our preliminary data suggest that it is not directly correlated to ACTH or cortisol deficiency. Nevertheless it may explain the hypoaldosteronism prior reported in such patients.


[Immunoreactive somatostatin in rat hypophysial portal blood (author's transl)]. Somatostatin levels have been determined by radioimmunoassay in hypophysial portal blood of pentobarbital-anesthetized male rats. In euthyroid rats, the mean level was 158 +/- 27 pg/ml (n = 8); somatostatin was undetectable (less than 30 pg/ml) in systemic blood of these rats. Thyroidectomy and excess of T4 did not modify the levels of somatostatin in hypophysial portal blood.


Plasma variations in testicular and adrenal androgens during prolonged physical exercise in man. The evolution of the relationship between cortisol and testicular androgens was verified on two teams of respectively 10 and 9 male subjects (average age 34) running 100 km races in an average time of 14 hours. When compared to a control population of the same age, these trained athletes exhibited reduced testicular androgen levels (T and DHT) and increased adrenal androgen (delta 4) and cortisol levels with no significant alteration of LH. The period of recovery is characterized by rapid return to normal of the hormonal parameters whereas testosterone levels continue to increase in the following days. This hormonal picture, which reappears under certain pathological situations or when subjects are exposed to heavy stresses, seems to prove that the testicular androgens could be, both by their metabolic and psychic action, one of the limiting factors of physical aptitude to sustained effort.


[25 OH CC (25-hydroxycholecalciferol in spasmophilia) (author's transl)]. The level of 25 OH CC in plasma was evaluated in spasmophilia (126 cases) comparatively with normal persons. This level is significantly decreased in spasmophilia. Therapeutic by 25 OH CC of the calcipenic symptoms was tested with good clinical results. Some precautions are necessary when spasmophilia is associated with idiopathic hypercalciura.


[Neonatal screening of congenital hypothyroidism. Introduction]. Neonatal screening of congenital hypothyroidism will be generalized in France during the next year, after it has been experienced in three regional areas. The data obtained from these experiences have shown that TSH assay is probably the safest way to detect most cases of thyroid failure in newborns. The Round Table organized by the Societé Française d'Endocrinologie has given opportunity to discuss previous trials and their results, and to prepare the large-scale organization of this new progress in preventive medicine.


Interactions between steroidreceptors.

Interactions between steroidreceptors. Interactions between the estradiolreceptor and the progesteronereceptor are known to exist in the uterus. The "priming effect" of estradiol is likely to exist also in human and rat mammary tumors. In detecting also the progesteronereceptors along with the estrogenreceptors, one cannot only demonstrate the presence but also the activity of the estrogenreceptor. This finding should improve the response rate of hormonesensitivity to receptorpositivity. However preoperative irradiation possibly induces negative progesteronereceptortiters in human breast tumors.


[Thyroid protein synthesis and insulin: influence of the hormone concentration (author's transl)]. Canine thyroid slices were preincubated at 37 degrees C in the glucose-free TC 199 medium following in vitro addition of monocomponent insulin at increasing concentrations: from 10(-5) to 1 IU/ml. After 30 minutes, the incubation was continued in the presence of 3H-leucine (20 microCi/ml) for 1 h. The incorporation of radioleucine in the homogenates was determined as dpm/mg of protein. Insulin added in vitro significantly enhanced the mean 3H-leucine incorporation in the thyroid proteins at all concentrations tested. A maximal effect was obtained within the range 10(-3)-1 IU per ml. The response at lower concentrations, close to the physiologic conditions in man, was still pronounced. These data suggest that insulin strongly stimulates the thyroid synthesis up to a concentration of 10(-5) IU = 0.4 ng/ml, which has been found to be effective in the hormone-receptor binding studies.


[Neonatal screening for hypothyroidism by simultaneous determination of T4 and TSH on filter paper (author's transl)]. A simultaneous determination of T4 and TSH has been done on 48 000 new borns since January 1st of 1977 in the Midi-Pyrénées district. 15 cases of hypothyroidism have been detected, an incidence of 1/3 200 new borns. TSH values always were above 80 microU/ml; T4 values are under m-2 sigma in 11 cases, normal in 2 cases (8,8 and 9 micrograms/dl) and between -1 and - 2 sigma in 2 cases. A thyroid scanning with 123 odine or 99 Tech, has shown the absence of thyroid in 6 cases, an ectopic gland in 7 cases and a thyroid in a normal position in one case. A treatment has been possible before the first month of life in each case. The average D.Q. for the seven oldest new borns (m = 11 months) is 96. The simultaneous determination of T4 and TSH is a sensitive and specific screening method for hypothyroidism. False-negative are avoided and the number of false-positive results is reduced. All cases of hypothyroidism can be detected (primary hypothyroidism, hypothalamo-hypopituitary hypothyroidism, TBG deficiency, etc...) Then, an early and certain diagnosis is made possible (T4 low and TSH increased).


Incomplete versus complete cerebral ischemia: improved outcome with a minimal blood flow. It has been reported that incomplete cerebral ischemia with cerebral blood flow less than 10% of control may be more damaging than an equal period of complete ischemia. In this study, the effects of severe, incomplete cerebral ischemia on neurological outcome and cerebral metabolism were studied in dogs anesthetized with nitrous oxide. The results were compared with those of a previous study concerned with the effects of complete ischemia. Dogs could sustain only 8 to 9 minutes of complete ischemia with return of normal neurological function, whereas maintenance of a cerebral blood flow rate less than 10% of control extended this limit to 10 6o 12 minutes. Following a 10-minute exposure, only dogs undergoing incomplete ischemia regained a normal cerebral oxygen consumption within 90 minutes; similarly, animals subjected to incomplete ischemia enjoyed a faster return of EEG activity than dogs exposed to complete ischemia of the same duration. Cerebral metabolite levels did not prove to be a good index of return of neurological function. Within periods of cerebral ischemia in which meaningful neurological recovery might be expected, we conclude that some blood flow is better than no flow.


[Problems encountered during intensive routine scale performace of paper T4 and TSH radioimmunoassays (author's transl)]. High sensitivity attained in radioimmunoassays explains the important role played by specialized laboratories as screening partners for early neonatal hypothyroidism detection. In this paper, the author tries to point out optimal technical conditions to be followed while performing at routine scale T4 and TSH paper immunoassays choice of filter paper, blood collection and storage, assay, quality control, assay mecanization, computer calculation of results).


Perisulcal infarcts: lesions caused by hypotension during increased intracranial pressure. A pattern of cortical necrosis surrounding the cerebral sulci and similar to ulegyria was found in 5 patients. The lesions were widely disseminated in all parts of the hemispheric cortex, affecting mostly the deep cortex of several adjacent sulci. They were hemorrhagic in 3 patients, ischemic in the others. Each patient had suffered a severe brain injury and became comatose thereafter. Increased intracranial pressure was evident from clinical findings, necropsy changes, or both. While in coma, each patient had at lease one episode of hypotension. The data suggest that perisulcal infarcts are a manifestation of diminished vascular perfusion during a period of increased intracranial pressure.


Primary aberrant third nerve regeneration. The clinical and neuroradiological features in 4 patients with the syndrome of aberrant regeneration of the third nerve are presented. In contrast to what is commonly seen, the syndrome was not preceded by third nerve palsy. A petrous apex-cavernous sinus meningioma was the underlying lesion in all 4 patients. Surgical and pathological confirmation of the diagnosis was obtained in 3. Regardless of whether the other ocular motor nerves are spared (as in our patients) or involved (as in other cases reported in the literature), primary aberrant regeneration of the oculomotor nerve appears to be characteristic of a cavernous sinus meningioma.


[Neonatal screening of congenital hypothyroidism with TSH measurement in dried blood spots on filter paper. A two years experience (author's transl)]. Systematic screening for congenital hypothyroidism was started in Lyon in september 1976. This screening was coupled with PKU, using the same dried blood samples on filter paper obtained on the 5th day of life. TSH levels were determined by radioimmunoassay adapted for dried blood samples (Kit Abbott). In 24 months, 56 176 samples were analyzed. The critical level calling for control was successively raised from from 20 to 30, now 40 microUI/ml of serum. A high level of TSH was found in 307 children (0,55%). Pathological deliveries were found in most of these infants (neonatal injury, cesarean, section forceps or ocytocic perfusion, neonatal icterus) and a second or a third measurement showed normal TSH level. Congenital hypothyroidism, was found detected in 18 infants: 12 ectopic gland, 5 athyreosis and 1 dyshormonogenesis. Treatment was begun at a mean age of 38 days (29 to 50 days).


[Odintologic studies on the dentition of Pan troglodytes verus]. The examination of 90 Pan troglodytes verus skulls from the collection of the Institute of Anthropology of the University of Giessen did not reveal the existence of a tuberculum Carabelli. Against that a well marked cingulum of the upper molars could be observed. Nearly half of the P2 showed two roots; one of the P1 had only one root. The two-rooted P2 are characteristic by a longitudinal groove on the buccal side, which may indicate bifurcation of the teeth. Agenesia of teeth was found in 3.6% of all cases, supernumerous teeth in one, respectively, two cases. Furthermore, a number of similarities with the tooth form of modern man was ascertained.


[Morphologic and pathologic findings in teeth and jaws from the middle bronze age (Pitten, Lower Austria)]. The detailed examination of the masticating apparatus of 18 skulls from the Middle Bronze Age in Pitten (Lower Austria) revealed numerous pathological findings of the teeth. Most remarkable were frequency and extent of dental abrasions. In addition to it, indications on inflammatory processes in the marginal parodontium were obtained, combined with partly immense formations of concrements on the surfaces of the teeth. The incidence of dental caries was relatively low. Abnormal positions of the teeth and pathological processes concerning the development of dentition as well as the eruption of the wisdom teeth could be observed repeatedly. Conclusions on insufficiences of the oral hygiene in this time follow especially from the concrement findings and from the inflammatory reactions of the marginal parodontium.


Physical variation in three Assamese castes. The paper deals with variation with regard to certain physical traits like AB0 blood groups, cerumen type, cross section of head hair, finger patterns and anthropometric characters in three Assamese caste populations, namely Brahmin, Kalita and Kaibarta representing three strata of the Assamese caste society. The study reveals that in respect of AB0 blood groups, cerumen type and finger patterns the Kaibartas stand apart from the Brahmin and Kalita, who are similar to one another. With regard to the other traits a different picture is observed. When the castes are arranged in hierarcheal order, the hair becomes coarser from the Brahmin to the Kaibarta through the Kalita. The metric values also can be arranged in a similar manner when certain values show a decrease from the lower to higher caste and others increase. While dealing with the nature of variation an attempt has also been made to look for the possible reasons. It appears that a host of factors like ethnic migration, inflow of genes, isolation are involved to cause variation.


Ethnic diversity in Punjab as based on finger dermatoglyphics. Four ethnic groups of Punjab having same dialect viz. Khatris, Jats, Brahmins and Muslims were taken to see ethnic differences in regards to the distribution of whorls, loops, and arches of finger dermatoglyphics. The results show that there is a great diversity in the four groups for these parameters. These groups were compared with similar ethnic groups of other places having different dialect. The results reveal that there seems to be ethnic affinity between the group known by same name and which is true for all the four groups.


[Actinomyces rimosus resistance to oxytetracycline]. High frequency of spontaneous and UV-and acridine dye-induced variants susceptible to oxytetracycline (OTC) and deprived of the capacity for synthesizing this antibiotic was observed in strain LST-118 of Actinomyces rimosus. The cells of strain LST-118 of Act. rimosus contained extrachromosomal DNA not found in its OTC susceptible variant BS87, which provides evidence in favour of participation of the extrachromosomal genetic elements in control of OTC resistance of the cells of Act. rimosus, LST-118. The OTC resistance in strain LST-118 is of inducable character. The resistance level is increasing from the beginning of the antibiotic synthesis and initially the subinhibitory concentrations of OTC in the medium were the inductors triggering cellular mechanisms ensuring resistance of the cell to the increasing concentrations of OTC in the medium. The capacity for absorption of OTC in Act rimosus is 2--3 times lower than that in E. coli. The experiments with labeled tetracycline showed that the cells of the actinomycete absorbed OTC when it was present in the medium. The absorption of the main amount of the antibiotic was registered during the first 5 minutes. The difference in absorption of OTC by the cells of the antibiotic resistant and sensitive strains was insignificant.


[Effect of lincomycin on its own producer, Actinomyces roseolus, in periodic cultivation in a liquid medium]. Lincomycin added to the cultivation medium induced a number of changes in the organism producing it during its ontogenesis when grown recurrently on liquid media. It was found that lincomycin inhibited the culture growth and decreased the absolute amount of the antibiotic synthesized while the specific activity of the culture increased. A number of cytomorphological rearrangements relevant to the adaptive protective reactions was found. It is suggested that an increase in the resistance of the culture to the antibiotic produced by it at the late developmental stages is the result of the above protective reactions.


[Express method of determining phenylacetic acid in the culture broth during the biosynthesis of benzylpenicillin]. Phenylacetate acid (PAA) is transferred by extraction from the fermentation broth filtrate into toluol. The extract is applied to a Silufol plate with an aluminium foil lining (silica gel sorbent, Czechoslovakia). Reference solutions of PAA are also applied to the same plate. The reference and test solutions are applied dropwise (spots of 5--6 x 10(-3)m in diameter). For PAA development the spots are sprayed with a freshly prepared saturated solution of potassium manganate in 6N H2SO4. PAA of the test samples is developed as a dull ring against grey background and that of the reference solution is developed as a circle. The amount of PAA in the spot is determined by using correlation between the spot area and the amount of PAA applied. One plate of 225 X 10(-4) m2 can be used for about 300 analyses. One analysis takes 300--600 seconds.


[Effect of the products of the vital activity of yeast-like fungi on levorin synthesis]. The effect on levorin synthesis of the cells and fermentation broth filtrates of Candida tropicalis after their cultivation in the fermentation medium was studied. It was found that the yeast-like fungi belonging to Candida excreted during their development some products capable of stimulating the synthesis of levorin by 40--60 per cent. When the actinomycete producing levorin was grown on the medium containing 80 per cent of the filtrate the level of levorin synthesis was the same as that observed with mixed cultivation of the actinomycete and C. tropicalis. The study on the conditions providing accumulation of the stimulating substances showed the following: production of the stimulating substances started during the first hours of the yeast growth and reached its maximum by the 48th hour, these substances being consumed by the actinomycete during the fermentation process. Aeration is required for production of the stimulating substances but its high levels are not necessary.


[Mechanism of the effect of proteolytic enzymes on antibiotic pharmacokinetics]. Possible relation between the changes in the penicillin pharmacokinetics and coagulograms under the effect of trypsin in rats and man was analysed. It was found that parenteral administration of the enzyme was accompanied by a simultaneous increase in the penicillin blood level, oliguria, a decrease in the antibiotic amount excreted with urine and drop of the fibrinogen level in plasma. The latter is consequent on intravascular coagulation which results in temporary impairment of the excretion function of the kidneys defining the changes in the penicillin pharmacokinetics under the effect of trypsin.


Electronystagmography in neurological diagnosis. Electronystagmography (ENG) is a technique for recording nystagmus and other eye movements; our technique, based on the utilization of a bioelectrical potential which exists between the retina and the cornea, has been reported in detail elsewhere in a monograph [29]. ENG has been used particularly by otologists to record caloric nystagmus and study labyrinthine function [2, 4, 16, 19]. This technique should have even greater applications in the diagnosis of neurological disease, since nystagmus and abnormalities of ocular and vestibular functions are symptoms frequently encountered by the neurologist. This paper illustrates this point with three case reports.


Cross-correlation analysis of the lateral pulvinar and scalp EEG in man. Cross-correlation analysis of the EEG between the lateral pulvinar and various cortical regions was made after EEG was recorded during stereotactic pulvinectomy. Cross-correlation analysis of the alpha-waves between the lateral pulvinar and the scalp EEG showed that the lateral pulvinar has the highest degree of functional connection with the pre-central area, diminishing in degree with the parietal and frontal areas, and has poor functional connections with the occipital area. From these results, it might be concluded that the lateral pulvinar may be related to motor function by functional connections with the pre-central area rather than the parietal area.


Alafosfalin, a new inhibitor of cell wall biosynthesis: in vitro activity against urinary isolates in Japan and potentiation with beta-lactams. A new phosphonopeptide, alafosfalin, was evaluated for in vitro antibacterial activity and for synergism with beta-lactams, using 475 Japanese clinical isolates from urinary tract infections. Alafosfalin was found to be highly active against Escherichia coli and moderately active against Serratia, Klebsiella, Enterobacter, and Citrobacter, but less active against gram-positive organisms than were beta-lactams such as cephazolin or ampicillin and inactive against indole-positive Proteus, Pseudomonas, and Acinetobacter. Potentiation with the two beta-lactams (fractional inhibitory concentration less than or equal to 0.5) was found in 10 to 40% of susceptible strains in 4:1 and 1:4 combinations, and to a lesser extent in those species or genera that were insensitive to alafosfalin alone. No cross resistance was seen between alafosfalin and the beta-lactams or any other commonly used antibacterial agents tested. Effect on selected ampicillin-resistant strains, differential sensitivity to alafosfalin among resistant strains of various types, and sensitivity of alafosfalin-insensitive E. coli and Klebsiella to other antibiotics are also discussed.


Agar medium for use in susceptibility testing of bacteria from human periodontal pockets. An agar medium (medium V) was formulated to determine the minimal inhibitory concentrations (MICs) of antimicrobial agents for bacteria encountered in human periodontal pockets. The medium contained (per liter) Trypticase, 15 g; yeast extract, 5 g; sodium chloride, 5 g; glucose, 2 g; sodium pyruvate, 2 g; sodium formate, 1 g; sodium fumarate, 1.5 g; sodium succinate, 0.1 g; Tween 80, 0.25 ml; agar, 15 g; hemin, 5 mg; and menadione, 0.5 mg. The growth of 50 oral strains was compared on this and six other media which included: Wilkins-Chalgren agar, Schaedler agar, Brucella agar, Trypticase-soy blood agar, and Schaedler and Brucella agars supplemented with whole blood. Growth, for most strains, was greatest on medium V. Medium V was also compared with Wilkins-Chalgren agar, using the same oral strains, to determine the MICs of the following antibiotics: penicillin, tetracycline, chloramphenicol, clindamycin, and erythromycin. The MICs of these antibiotics were essentially the same on both media when growth was quantitatively similar.


Assay of serum tobramycin levels with the Bactec 460. Serum tobramycin levels of synthetic and patient specimens were determined by the Bactec 460. The results were compared with those obtained from the same specimens by radioimmunoassay. These studies suggest that assays performed by either method should be run in duplicate or triplicate to achieve maximum accuracy. The studies also suggest that results obtained by the Bactec method are at least as reliable as those obtained by the radioimmunoassay method.


Urinary casts as an indicator of renal tubular damage in patients receiving aminoglycosides. We assessed the value of quantitative cast excretion as an early marker of renal tubular damage in 154 seriously ill patients. One hundred twenty-four of these received aminoglycoside antibiotics, and 30 of the 124 experienced a rise in serum creatinine of 0.5 mg/dl or more during therapy. The remaining 30 of the 154 patients  were treated with other antibiotics and served as controls. Casts were quantitated in random urines collected before morning diuretic doses. Cast counts in control patients averaged 44 +/- 51 casts during the intensive care unit admission. Patients given aminoglycosides without a significant rise in serum creatinine of 0.5 mg/dl or more excreted 153 +/- 196 casts, significantly more than controls. In comparison to both the control and nontoxic patients, the 30 nephrotoxic patients excreted significantly more casts (625 +/- 364) and were significantly higher as early as 9 days before serum creatinine first rose. Daily urinary cast counts are a rapid and inexpensive means of identifying early renal tubular damage in critically ill patients given aminoglycosides.


Lipid composition and sensitivity of Prototheca wickerhamii to membrane-active antimicrobial agents. The lipid composition of Prototheca wickerhamii ATCC 16529 is presented and discussed in relation to the unique susceptibility of the organism to drugs of three membrane-active antimicrobial classes: the polyenes, the polymyxins, and the imidazoles. The presence of ergosterol in the neutral lipid fraction of the membrane is likely responsible for the exquisite susceptibility to amphotericin B. The presence of a large quantity of free fatty acids in the membrane appears responsible for imidazole susceptibility. The membrane determinants of polymyxin B susceptibility are less well defined.


Comparative nephrotoxicity of SCH 21420 and amikacin in rats. The nephrotoxic potentials of the new aminoglycoside SCH 21420 and amikacin were compared in a rat model. Groups of rats received 100, 200, 300, or 600 mg of either drug per kg per day for 14 days. Enzymuria, urine osmolality, protein excretion, and blood urea nitrogen were monitored at periodic intervals, whereas creatinine clearance and pathological changes were determined at sacrifice. Amikacin caused more enzymuria at the two lower doses as well as greater proteinuria and blood urea nitrogen elevations at the highest dose than did SCH 21420 (P less than 0.05). Pathological changes were more severe with amikacin than with SCH 21420 at the three lower doses (P less than 0.05); however, at the 600 mg/kg per day dose, the pathological scores and creatinine clearances of animals receiving either drug were not significantly different (P greater than 0.05).


Collaborative evaluation of a proposed reference dilution method of susceptibility testing of anaerobic bacteria. An agar dilution method for susceptibility testing of anaerobic bacteria was evaluated to determine whether results obtained would be consistent enough to recommend it as a reference method. The study was conducted in 10 laboratories where the minimum inhibitory concentrations of six antibiotics (carbenicillin, cefoxitin, chloramphenicol, clindamycin, penicillin G, and tetracycline) were determined against 10 bacterial strains on Wilkins-Chalgren agar prepared by three manufacturers. Minimum inhibitory concentrations falling on the modes varied from 57 to 80% of all determinations and on the mode or within +/-1 log(2) dilution of the mode from 87 to 100% within each laboratory. When data from all laboratories were pooled, minimum inhibitory concentrations from each laboratory agreed with the overall mode 48 to 71% of the time, with an overall agreement at +/-1 log(2) dilution of 96%. This degree of reproducibility allows for recommendation of the procedure as a reference method. Results with three of the test strains were very consistent, and these strains are recommended as control strains: Clostridium perfringens ATCC 13124, Bacteroides fragilis ATCC 25285 and Bacteroides thetaiotaomicron ATCC 29741. The minimum inhibitory concentrations for these strains were on the mode or within +/-1 log(2) dilution of the mode 98, 99, and 99% of the time, respectively. The remaining anaerobic bacteria are recommended as reference strains.


In vitro activity of LY127935.

In vitro activity of LY127935. LY127935 is a unique new beta-lactam antibiotic. Its activity against 536 clinical isolates was studied by using microdilution methods of susceptibility testing and compared with the activities of cefamandole, cefoxitin, and cephalothin. The lowest concentrations required to inhibit at least 90% of strains tested (MIC(90)s) of LY127935 for Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus pneumoniae ranged from 2 to 8 mug/ml. The MIC(90)s for other staphylococci and streptococci were higher. The MIC(90)s for Enterobacteriaceae and Pseudomonas species ranged from 0.12 to 8 mug/ml and 8 to >32 mug/ml, respectively. The MIC(90)s for anaerobes ranged from 2 to >32 mug/ml. As determined by MIC(90)s, LY127935 was consistently the least active antibiotic against facultatively anaerobic gram-positive cocci and the most active against aerobic and facultatively anaerobic gram-negative bacilli. Its position with respect to activity against anaerobes varied from being the most active against Bacteroides fragilis and Clostridium perfringens to the least active against anaerobic cocci. In a population of multidrug-resistant isolates, concentrations of 8 mug or less of LY127935 per ml inhibited 82% of Enterobacteriaceae; concentrations of 32 mug or less per ml inhibited 100% of Enterobacteriaceae and 40% of P. aeruginosa. Increasing the inoculum size by 100-fold did not increase the minimal inhibitory concentrations of LY127935 or cefoxitin but did increase minimal inhibitory concentrations of cefamandole and cephalothin for some Enterobacteriaceae. All four drugs were bactericidal; minimal bactericidal concentrations were the same or one concentration higher than minimal inhibitory concentrations for 91 to 96% of strains tested. The broad spectrum and marked in vitro activity of LY127935 make it a promising new antibiotic.


In vitro antimicrobial inhibition patterns of nutritionally variant streptococci. Twenty-four isolates of nutritionally variant streptococci, previously categorized as species included among the viridans streptococci, were tested for susceptibility to 12 antimicrobial agents. Minimum inhibitory concentrations for these isolates and for a control group of viridans streptococci with no apparent nutritional deficiencies were determined in two microdilution systems. Pyridoxal hydrochloride, which enhances growth of the nutritional variants, was added to one of these microdilution systems but not to the other. An agar dilution method was also used to test the nutritionally variant isolates. Minimum inhibitory concentrations determined by the three methods compared favorably. Penicillin, nafcillin, methicillin, and clindamycin were less effective in vitro against the nutritional variants than were the other antibiotics tested. Streptomycin, however, was less effective against the control isolates.


Oral neomycin dosage schedules for suppression of ammonia production by bowel flora. To better define a minimal but optimal dose of oral neomycin to suppress ammonia production by bowel flora, several dosage regimens were examined in normal healthy volunteers. Fecal urease activity was quantitatively determined and was used as an indirect measure of intrinsic ammonia production by bowel flora. Large doses of neomycin were found to exert inhibition of fecal urease for many days. There was considerable variation in enzymatic activity among subjects even after adjustments were made for protein content of the stool. Depending on the dose, there was a 1- to 3-day lag in neomycin effect on stool urease activity and several days of continued effect. The most effective regimen of those studied was a loading dose of 6 g of neomycin given in three divided doses on day 1, followed by 1 g twice daily.


Action of egg white lysozyme on Clostridium tyrobutyricum. A 500-U ml-1 portion of egg white lysozyme was able to kill 99% of 5 X 10(5) resting vegetative cells of Clostridium tyrobutyricum within 24 h of incubation at 25 degrees C. Spores were completely resistant to lysozyme. Proliferating vegetative cells were severely inhibited, although lysozyme-resistant cells developed in growing cultures in the presence of lysozyme. Whereas early stages of spore germination (loss of optical refractility and heat resistance) were not inhibited by lysozyme, the overall outgrowth of spore cells into vegetative cells was delayed by 1 day in the presence of 500 U of lysosyme ml-1. This delay was independent of the lysozyme sensitivity or resistance of the mother culture of the used spores. It is suggested that this inhibition by lysozyme of the outgrowth of spore cells into vegetative cells of the lactate-fermenting C. tyrobutyricum is the basis for the observation that lysozyme can substitute for nitrate in preventing the "late gas" defect of Edam- and Gouda-type cheeses.


Comparison of antibodies in marine fish from clean and polluted waters of the New York Bight: relative levels against 36 bacteria. Fish from polluted waters are subject to increased prevalence of disease. Because they respond to bacterial pathogens by producing serum antibodies, it was possible to construct a seasonal serological record in three fish species from clean and polluted waters of the New York Bight. Antibody levels were determined by testing sera for agglutinating activity against 36 strains of bacteria. Evaluation of 5,100 antibody titrations showed the following. During warm months, summer flounder (Paralichthys dentatus) from the polluted area had significantly higher antibody levels and antibody to a greater diversity of bacteria than fish from the unpolluted area. Weakfish (Cynoscion regalis) from the same polluted area shared with summer flounder raised titers to many bacteria. The greatest proportion of raised titers was against Vibrio species, although prominent titers were also seen against Aeromonas salmonicida and Haemophilus piscium, bacteria usually associated with diseases in freshwater but not marine fish. Differences between polluted and clean waters were not as evident in winter flounder (Pseudopleuronectes americanus) during cold months. This could be due, in part, to reduced antibody production at colder temperatures. The data illustrate the usefulness of the serum antibody record in identifying environmental exposure to bacteria in marine fish and indicate that the polluted New York Bight apex has increased levels and diversity of bacteria during warm months.


Aerobic and facultatively anaerobic bacteria associated with the gut of Canada geese (Branta canadensis) and whistling swans (Cygnus columbianus columbianus). Aerobic and facultatively anaerobic bacteria from the intestinal tracts of swans and geese were isolated and characterized as part of a larger study of the microbiological effects of migratory waterfowl on water quality. A total of 356 isolates were identified by using rapid identification methods and classified by using numerical taxonomy. A diverse population of bacteria was recovered from the waterfowl, and representative strains could be classified into 21 phena. The majority of the aerobic, heterotrophic bacteria found in the gut of the waterfowl were species of Enterobacteriaceae. Streptococcus. Lactobacillus, and Bacillus. Unfortunately, the birds that were examined did not harbor significant numbers of any waterfowl-specific bacterial species. Thus, it may not be possible to assess microbiological impact of migratory waterfowl by using and "indicator" species since avian fecal pollution could not be distinguished from animal and human fecal pollution.


Production and isolation of chitosan from Mucor rouxii. A method for the lab-scale production and isolation of chitosan (polyglucosamine) from hyphal walls of Mucor rouxii was developed. Hyphal wall yields were generally 16 to 22% on a dry cell weight basis, of which 35 to 40% was glucosamine. Chitosan was readily extracted from purified, mycelial walls with acetic, formic, and hydrochloric acids; the last named was the most efficient. The yield of chitosan isolated ranged from 4 to 8% of the dry weight of the cell wall material.


Acceptance by swine and rats of corn amended with trichothecenes. Swine and rats demonstrated the same response factor (i.e., the average amount of corn amended with trichothecenes consumed by animals per the average amount of uncontaminated corn consumed by animals) for consumption of corn amended with 40 ppm of either T-2 toxin or diacetoxyscirpenol Rat response factor for corn containing 40 ppm of vomitoxin was 1.8 times more than corn containing either T-2 toxin or diacetoxyscirpenol at 40 ppm. For the corn containing 40 ppm of vomitoxin, swine response factor was 1.8 times greater than rat response factor.


Susceptibility of Legionella pneumophila to ultraviolet radiation. Distilled water suspensions of Legionella pneumophila were found to be sensitive to low doses of germicidal ultraviolet radiation.


Numerical evaluation of facial pattern in children with isolated pulmonary stenosis. A facial contouring technique, using light sectioning (Cobb, 1972), was modified (Ainsworth and Joseph, 1977) and used in a numerical study of children with isolated pulmonary stenosis (PS) to test the hypothesis that the facial pattern in this condition differs from the normal. Measurements were compared between a group of 20 normal children and a group of 20 children with PS between ages 6 and 10 1/2 years. A distinctive facial pattern emerged. Many anteroposterior measurements were much greater in the PS group, indicating that the tissues were more prominent in the maxillary region. Altogether, 29 measurements showed significant differences (P less than 0.05) between the two groups. Discriminant analyses were carried out to discover which, if any, might be used to predict the group to which an individual should belong. Depending on the variables chosen, between 34 and 37 individuals from the total of 40 were assigned to the correct group--PS or control.


Childhood cystinuria in New South Wales. Results in children who were followed up after being detected by urinary screening in infancy. Homozygous cystinuria was diagnosed in 45 children and 19 of their siblings in the course of routine urine screening of 6-week-old infants in New South Wales. These children were followed for up to 14 years. During this time there were 5 clinical episodes of renal disease which could be ascribed to cystinuria. There was normal mental development in all the children except one. Of 49 children over 3 years, 4 had height centiles less than the midparent height centile, while 45 had height centiles equal to or above the midparent centiles. Family testing in these 45 cases showed that 60% were type I cystinurics, and 35% were of the mixed or compound type (5% were not classified). Data from the parents and grandparents showed that renal tract calculi had occurred in 14 of them. This study shows that children with homozygous cystinuria, detected by urinary screening in infancy, rarely have renal symptoms. Mental development was normal as was growth in height. There was an increased incidence of noncystine stone formation among the relatives of these children. The incidence of homozygous cystinuria in New South Wales in one in 17 286.


Exchange transfusion in newborn infants: effects on granulocyte function. During 23 exchange transfusions, the granulocytes from 27 donors and 16 newborn infants were tested for opsonic activity and granulocyte function by the nitrobluetetrazolium test. Granulocyte function in a newborn baby receiving an exchange transfusion can be altered positively or negatively, depending on the quality of the donor's blood. If exchange transfusion is used in the management of neonatal sepsis, special attention should be given to the immunological properties of the donor blood.


Vertical transmission of hepatitis B surface antigen in carrier mothers in two west London hospitals. 126 children of 102 hepatitis B surface antigen (HBsAg) carrier mothers were delivered at Hammersmith Hospital and Queen Charlotte's Maternity Hospital, between 1971 and mid-1978. Blood tests on 110 of these children showed that 8 out of the 18 with Chinese mothers, but only 6 out of the 92 other children, have become HBsAg positive. The presence of maternal hepatitis B e antigen (HBeAg) is also significantly correlated with transmission of HBsAg to the children. The management of children whose mothers are carriers is discussed.


Folate nutrition and growth in infancy.

Folate nutrition and growth in infancy. The effect of suboptimal folate nutrtion on the growing infant was studied in a population of infants fed a diet based on boiled, pasteurised cows' milk. One group of infants received a daily supplement of 1 mg folic acid from age 2 months, while the other group received a placebo. The infants were seen at bimonthly intervals. In the supplemented group the red cell folate level had increased to twice its pretreatment value by 4 months, and remained at this high level to the end of the first year. Hb concentration and incidence of anaemia were similar in both groups. The incidence of infection in the two groups did not differ. Weights and lengths attained at 6 months, and the rate of gain from 2 to 6 months were higher in infants whose folate levels were above the median value than in those below it. In the second half of the first year the differences between the two groups were no longer evident.


Non-neuropathic Gaucher disease presenting in infancy. The non-neuropathic form of Gaucher's disease was diagnosed in 11 children of non-Jewish ancestry in South Africa; all were under the age of 4. None had any neurological involvement and, apart from the precocious presentation and rapid course, the features in each resembled those of the classical 'adult' or chronic non-neuropathic form of Gaucher disease. By contrast, the condition presented after puberty in 24 out of 28 Ashkenazi Jews who were studied during the same investigation. Activity of beta-glucosidase was defective in both groups of patients and they could not be distinguished by histological criteria. Only one child with the infantile neuropathic form of Gaucher disease was identified during the survey. The preponderance of the atypical non-neuropathic form of the disorder in young children is of practical importance from the point of view of differential diagnosis in any child with hepatosplenomegaly.


Chorioamnionitis and funisitis due to Corynebacterium kutscheri. When isolated from the female genital tract, diphtheroids are usually regarded as commensal organisms. Corynebacterium kutscheri however is a pathogen in laboratory rodents. We report a case in which C. kutscheri was isolated as a pure culture from the umbilical cord and from other surface sites in an infant. Histological examination of the cord and membranes demonstrated the organisms within these fetal tissues. The organisms evoked a fetal cellular response. The importance of recognising commensals as potential pathogens in states of altered host resistance in stressed.


Rectal aspirin--absorption and antipyretic effect. Rectal acetylsalicylic acid was given to 14 children who had undergone open heart surgery. The effect on their temperatures was similar whether 15--30 or 30--50 mg/kg was given. Either dose was more effective than no treatment. The greatest fall in temperature occurred after 4 or 5 hours. Rectal aspirin in a triglyceride base is effective in lowering postoperative temperature. It should also be of use in treating other fevers. A dose of 20--25 mg/kg is suggested.


Thrombocytosis in low birthweight infants: a physiological phenomenon in infancy. Prematurity has traditionally been connected with thrombocytopenia, although this is unlikely to be associated with prematurity itself but rather with serious illnesses in such infants. Platelet counts were measured in 117 healthy preterm infants with birthweights less than 2000 g, who were followed up from 2 weeks to 6 months. In this series the platelet counts were high compared with those in previous reports, and also compared with what is considered normal for term infants. The 95% range was between 160 and 675 X 10(9)/1, with a median value of 375 X 10(9)/1. The data suggest that thrombocytosis is a phenomenon related to prematurity.


Aortography in infantile coarctation: a simple and effective technique. A new and simple technique is described which clearly defines the aortic anatomy in infantile coarctation. The technique greatly helps to select those neonates whose lives can be salvaged by early surgery. There have been no serious adverse effects.


Frequency and weight of normal stools in infancy. These data give a guide to the range of stool weights and their frequency at different ages in infancy. The constancy of stool water content is emphasised.


Infantile hypertrophic pyloric stenosis--unusual familial incidence. A man, who had been treated for infantile hypertrophic pyloric stenosis (PS), was found to have 3 sons with the same condition. A genealogical table of his family showed that both his parents had relatives with PS. So far as it was known, none of his wife's relatives had the condition. It is suggested that the man's parents carried genes predisposing to PS and transmitted these to him in such quantity that he and all his children acquired the condition.


Pulmonary alterations in rats exposed to 0.2 and 0.1 ppm ozone: a correlated morphological and biochemical study. Weanling male Sprague-Dawley rats were fed either a synthetic diet supplemented with 11 mg vitamin E/kg body weight (to approximate average U.S. human dietary intake) or a commercial rat chow for 5 wk. At 2 months of age, rats were exposed to either 0.0, 0.1, or 0.2 ppm ozone continuously for 7 days. Morphological lesions were consistently present in centriacinar regions of lungs of both groups of rats at the 0.2 ppm level. At 0.1 ppm ozone, two of six rats fed the synthetic diet and two of five fed lab chow had minimal centriacinar lesions. Biochemical assays showeed that the activities of glutathione (GSH) peroxidase, GSH reductase, and G-6-P dehydrogenase and level of nonprotein sulfhydryls in the lungs of rats fed the synthetic diet and exposed to 0.1 ppm were elevated to about one-half the level that was produced by 0.2 ppm. The authors conclude that the level whereby there are no observable morphologic effects for short-term exposure to ozone in 2-month-old rats is less than, but close to, 0.1 ppm.


Biochemical and morphological correlation of oxidant-induced pulmonary injury: low dose exposure to paraquat, oxygen, and ozone. The authors compared the temporal pattern of low-dose oxidant-induced lung injury in rats after exposure to either 1 ppm ozone or 100% oxygen for 24 hr or from treatment with paraquat (20 mg/kg, intraperitoneally). Histological abnormalities in airways, parenchyma, and blood vessels were evaluated from coded and randomized sections and compared with appropriate controls. Drug metabolism by lung endoplasmic reticulum was studied in similarly treated rats as another index of lung injury. Exposure to oxygen caused no discernible morphological or biochemical abnormalities. Exposure to ozone caused histological lesions which appeared early and resolved by 7 to 14 days, whereas paraquat-induced lesions were first evident at about 7 to 14 days. Abnormalities in drug metabolism followed a similar pattern. Low-dose oxidant exposure from ozone and paraquat produce similar histological and biochemical lesions in rat lungs but with distinct temporal patterns.


Ozone sensitivity in aging WI-38 cells based on acid phosphatase content. Young [16-19 population doubling level (PDL)] and senescing (50-53 PDL) WI-38 cell populations were exposed to 1 ppm ozone for 2 hr and the resultant extracellular and intracellular acid phosphatase concentration was measured. Dose-response curves were also determined for surviving populations of young and old cells after a 1 hr ozone exposure ranging in concentration from 0 to 1.00 ppm. Senescing cells released 8 times more acid phosphatase per million cells than the young cells. Both old and young cells showed a clear dose-response to the 1 hr ozone gradient exposure. However, the older cells demonstrated a consistent 17% average lower survival rate than the young cells. The higher acid hydrolase level in older WI-38 cells is probably related to the lower survival rate observed in the older cells in vitro.


The identification and elimination of a potential lead hazard in an urban park. During development of a park in Oakland, California, a potential public helath hazard due to lead in the soil (approximately 1,000 to 100,000 ppm) was identified through cooperative sampling and analysis efforts of the staffs at the county and state health departments. Analysis of samples collected at various locations and depths in the park, coupled with a three-dimensional model of the lead values obtained, indicated steps necessary to eliminate the hazard. The county undertook the abatement program, and with the elimination of the health hazard, the park development has been completed. Concomitant blood lead screening of neighborhood children failed to establish the park as a source of elevated lead in any of the children tested.


Selenium in the blood of South Dakotans. Determinations of blood selenium levels of the normal human population in and around the state of South Dakota were made and related to known seleniferous areas. With two exceptions, the highest mean values were obtained in regions where animal selenosis has been observed, but whether any of the samples contained enough selenium to indicate a chronic toxicosis cannot be stated. Data on blood, hair, and urine of four Rapid City residents showed no seasonal differences, and the average blood concentrations were consistent with previous findings. Urine concentrations were variable within limits. Hair was found to be unreliable in evaluating the selenium status of people because of the general use of antidandruff shampoos containing the element.


Visual processes of smokers and nonsmokers at different ages. Forty smokers and forty nonsmokers were matched for age over the range from 21 to 76 yr. The battery of tests included: optometric refraction for near vision, scotopic sensitivity, simple and choice reaction time, visually evoked cortical potentials to targets flashing at 1 and 16 times/sec, EEG, and a perimetric test of color detection. Roughly the same number of smokers and nonsmokers required spectacle corrections, but smokers tended to require more plus correction. The mean scotopic sensitivity of the smokers was significantly worse than that of the nonsmokers. Reaction time tended to be poorer for the smokers. There were no differences on the perimetry test and in the EEGs of the smokers and nonsmokers, and no significant changes in the visually evoked responses to either 1 or 16 flashes/sec. There was virtually no evidence of an increasing difference between the smokers and nonsmokers with increasing age.


The Tyler Asbestos Workers Program. I. A medical surveillance model and method. An asbestos-exposed worker who smokes cigarettes has a high risk of developing cancer of the lung. One thousand ninety-five former workers at a plant manufacturing asbestos (amosite) insulation products were exposed to high levels of asbestos dust concentrations in the atmosphere. The workers have been identified and located. A semi-annual medical surveillance program has been developed with National Cancer Institute support. Examination of the worker includes the following: history (questionnaire), physical examination, sputum cytopathology, chest roentgenogram, pulmonary function studies, and other tests. Emphasis has been placed on understanding the role of sputum cytopathology in a cancer control program in former asbestos workers.


Occupational lead exposure and renin release. Hypertension may result from chronic lead exposure. Lead poisoning arising from "moonshine whiskey" drinking has been associated with a rise in plasma renin activity. In the present study, plasma renin concentration following intravenous administration of frusemide was measured in eleven subjects with moderate or severe lead poisoning of industrial origin. The results were compared with those obtained for seven normal, control subjects. There was no significant difference in response obtained in the two groups. Industrial lead poisoning does not appear to affect renin release. The combined insult of lead and alcohol may explain the findings in the previous study.


Inhibition of follicle stimulating hormone binding to granulosa cells in vitro by human follicular fluid. Evidence for the existence of a low molecular weight (less than 10,000 daltons) factor in human follicular fluid that inhibits binding in vitro of FSH to ovarian granulosa cells is presented.


Comparison between tamoxifen and clomiphene therapy in women with anovulation. Forty-eight women with various types of menstrual disorder were treated with tamoxifen: 30 of them ovulated as judged by serum progesterone concentrations and the basal body temperature (BBT) record. Serial determinations of serum FSH, LH, prolactin, and estradiol-17 beta showed that tamoxifen acts primarily on the hypothalamic-pituitary axis. Before or after the tamoxifen treatment cycles, 30 women received clomiphene. The ovulation rate in women with primary and secondary amenorrhea was similar, while women with oligomenorrhea tended to be more responsive to tamoxifen than to clomiphene. There was no difference between the drugs in the duration of the luteal phases nor in the pregnancy rate. The side effects during treatment with clomiphene were pronounced than during tamoxifen therapy.


Chromosome aberrations induced by occupational exposure to mercury. The incidence of chromosome aberrations was studied by peripheral blood incubation (52 hr, the last 4 hr in the presence of Colcemid) using a modification of the Evans' technique in twenty-two men exposed to either vapors of metallic mercury (Group I) or organic mercury (Group II). Mercury concentrations of the work areas frequently exceeded the Maximum Allowable Concentrations in the past. During the year proceding the investigation, mercury values ranged between 0.15 and 0.44 mg/m3. None of the investigated men were poisoned, but all had had repeated increased mercury absorption with urinary eliminations reaching 890 microgram/l and 896 microgram/l for subjects in Groups I and II, respectively. The incidence of chromosome aberrations was significantly higher (P less than .001) in subjects exposed to mercury as compared with a control group (ten subjects) of a similar mean age. There was no statistical difference in the incidence of chromosome aberrations between men belonging to Groups I and II. Although an increase of both chromatid gaps and breaks was noticed in exposed men, the incidence did not significantly differ from controls. No chromatid interchanges were recorded and no difference between exposed and control subjects was noticed concerning the frequency of aneuploid or polyploid cells.


Effect of near ambient exposures to sulfur dioxide and ferrous sulfate particles on murine pulmonary defense mechanisms. An infectivity model was used to test the safety margins for presently established air quality standards for sulfur dioxide and sulfate particles. Mice and rats were exposed to atmospheres of sulfur dioxide and mono-disperse ferrous sulfate particles from 3 to 6 times the standard for 17 hr prior to, or 4 hr after infection with aerosols of Staphylococcus aureus or Group C Streptococci. Exposure to these concentrations of pollutants did not impair the rodents' ability to ingest and inactivate the minimally virulent Straphylococcus or enhance the virulence of the Group C Streptococci. Insofar as these results can be extrapolated to man, the present air quality standards for sulfur dioxide and sulfate particles are protective in regard to respiratory bacterial infection.


The effect of combination chemotherapy on ovarian, hypothalamic and pituitary function in patients with breast cancer. Treatment of breast cancer by combination therapy induced luteal insufficiency, anovulatory cycles and sometimes hypergonadotropic amenorrhea in premenopausal women with previously normal mentrual cycles and ovarian function. In chemotherapy induced amenorrhea 17 beta-estradiol levels were those found in ovarectomised or postmenopausal women. Chemotherapy affected the ovary itself and not the hypothalamus or pituitary, the negative feedback mechanisms remaining intact. The ovary of perimenopausal patients was much more sensitive to cytotoxic drugs; following a short time chemotherapy hypergonadotropic amenorrhea invariably developed and the ovary seemed to be again the prime site of action. Postmenopausal patients continued to have physiologically high LH and FSH plasma concentrations and low plasma levels of prolactin and 17 beta-estradiol under cytotoxic treatment.


Mathematical, clinical, and laboratory study of hemodynamic changes in the placental circulation. Various rheological properties of blood were investigated in pregnant and non-pregnant women of similar age. The results from 27 women with abnormal pregnancies were compared to those obtained from 17 non-pregnant women. In abnormal pregnancies we found a reduction of the erythrocyte filtration and a pathological use in red cell aggregation and in the shear resistance of the aggregates. Fractional light transmission (T7/T0) was higher than 1.0, suggesting that pressure gradients in the capillary circulation are not sufficient to disperse red cell aggregates. Thus, rheological factors may be partly responsible for the clinical consequences of pre-eclampsia. Pathological red blood cell aggregation and stagnation are consequences of the changed flow properties in the microcirculation. Even a small decrease of the local pressure gradients in the microcirculation of patients with pre-eclampsia would impair the dispersal of red blood cells and lead to their increased aggregation. Complete occlusion of the placental circulation by these aggregates would impair oxygen transfer at a speed that has been calculated from a diffusion equation based on the concept of the placenta as a hollow cylinder.


Purification and characterization of pregnancy associated plasma protein A (PAPP-A). Pregnancy Associated Plasma Protein A (PAPP-A) has been isolated from late pregnancy plasma using ammonium sulphate precipitation, ion exchange chromatography, affinity chromatography on Concanavalin-A, gel filtration and negative affinity chromatography. It was found that PAPP-A is an alpha 2-glycoprotein of 750-820 000 MW, probably a dimer with each monomer being composed of 2 polypeptide chains of 218 000 MW. The amino acid composition as well as other physicochemical characteristics are similar to human alpha 2-macroglobulin. PAPP-A exhibits in vitro an inhibition of the activity of the complement system, of the caseinolytic activity of plasmin and possibly of the urokinase activation of plasminogen. The hypothesis that PAPP-A plays a role in the regulation of fibrinolysis during pregnancy is put forward.


Antagonistic effects of zinc and aluminum on lead inhibition of delta-aminolevulinic acid dehydratase. In vitro and in vivo studies regarding the influence of metals on delta-aminolevulinic acid dehydratase activity in erythrocytes indicate that a lead concentration of 4 micrometer/l completely inhibits the enzyme. Zinc activates the enzyme both in vitro and in vivo at concentrations greater than 76 micrometer/l. Aluminum has an inhibitory effect at all concentrations in vitro whereas it activates the enzyme in vivo. Zinc and aluminum together activate the enzyme in vivo. The in vitro activation of zinc is inhibited by increasing concentrations of aluminum. Aluminum and lead together depress the enzyme activity in an additive way that can be reactivated by the addition of zinc.


An ozone-generating system and chamber for testing injury to cultured cells. A system was constructed which alternately exposed cultured cells to specific concentrations of ozone in the gas phase and then to cell culture medium. It was designed to produce a constant mass transfer between the gas phase and the exposed cell phase. Monolayers of neonatal rat lung fibroblasts cultured in miniature glass dishes were used to test for ozone toxicity. The cells were alternately exposed to ozone (0.05, 0.15, 0.45, 1.35, and 4.05 ppm) for 30 sec and then to culture medium for 30 sec over a 1-hr period. Toxicity was measured as inhibition of cell growth 4 days after exposure to ozone. Growth was significantly inhibited at all concentrations with a 50% inhibitory concentration of 0.8 ppm. The system described was effective for quantifying ozone toxicity for cultured lung cells.


The results of isotope renography and intravenous pyelography in 420 patients with carcinoma of the uterine cervix. A group of women with carcinoma of the cervix was studied by renography and i.v. pyelography. The incidence of renal and urinary tract disorders detected by these tests increased as did the stage of the disease, being 17.1% with Stage I carcinoma of the cervix, 27.8% with Stage II carcinoma of the cervix, 47% with Stage III carcinoma of the cervix, and 83.3% in Stage IV carcinoma of the cervix. In patients with Stage I and Stage II carcinoma of the cervix, those selected for radiotherapy had twice the incidence of abnormal renograms as those selected for surgery. This difference probably reflected a higher incidence of medical disorders affecting renal and urinary tract function in those considered unfit for surgery. We believe that renograms should be used routinely as a screening test in patients with carcinoma of the cervix.


Studies with clonidine (dixarit) in menopausal women. Eleven women with menopausal symptoms were treated with 150 micrograms Clonidine (dixarit) daily. Before and during therapy, plasma estradiol-17 beta, LH, FSH and prolactin levels were measured by specific radio-immunoassays. In addition, each patient recorded the number of hot flushes a day and symptoms were monitored by the Kupperman-index. A highly significant fall in the number of hot flushes by day and night occurred during therapy (p less than 0.001) and the Kupperman-index similarly improved. Significant pulse and blood pressure changes were not noted and plasma hormone concentrations remained unaltered. Medication was well tolerated. Clonidine therapy would appear to be the treatment of choice for menopausal symptoms if estrogens are contraindicated.


Investigations of gestation-induced metabolic changes in the rat liver. I. Glycogen metabolism. The activities of alpha-glucan-phosphorylase and phosphoglucomutase and the concentration of glycogen were measured in the liver of pregnant and non-pregnant rats. There were no significant differences between normal non-pregnant and pregnant animals nor was there any change of enzyme activities during pregnancy. Our results lend support to the idea that glycogen metabolism is not changed during normal pregnancy.


[Clinical significance of arteriovenous shunt malformations in the uterine and adnexal region (author's transl)]. This case report describes and discusses the entity of arteriovenous shunt malformations in the uterine and adnexal region. The diagnostic measurements and clinical importance of this disease is also outlined. The condition is rare, but should be considered in cases of severe hemorrhage when routine investigations have been normal. For the first time bloodgas-analytic measurements showing the extent of the shunting have been performed with such a disease.


Hypercalcaemia in rheumatoid arthritis: investigation of its causes and implications. When correction was made for hypoalbuminaemia, 23 of 50 ambulant patients with definite or classical rheumatoid arthritis were found to have hypercalcaemia. When these 23 patients were studied 6 months later, 7 had hypercalcaemia as defined by the correction factor for a low serum albumin level, and 6 of these patients had raised serum ionised calcium concentrations. Biochemical studies in the 23 patients indicated evidence of hyperparathyroidism, namely, hypophosphataemia, increased serum alkaline phosphatase, hyperchloraemia, and reduced tubular reabsorption of calcium. However, serum immunoreactive parathyroid hormone concentrations were normal. Only one patient had an abnormally low serum 25-hydroxy-vitamin D result: this patient had a high level of urinary D-glucaric acid and was receiving phenobarbitone for treatment of epilepsy. The biochemical features suggestive of parathyroid overactivity were particularly found in patients with raised serum calcium levels. The cause of hypercalcaemia in rheumatoid arthritis remains to be explained.


Clinical and radiological features of osteonecrosis in systemic lupus erythematosus. Symptomatic osteonecrosis occurred in 8 out of 68 patients with systemic lupus erythematosus. Multiple joints were involved in 3 patients, and weight-bearing joints were most frequently affected. Osteonecrosis tended to occur early in the disease, and the patients had all received corticosteroids. Symptoms tended to occur when the disease had progressed from an active phase into one of clinical and serological quiescence. In weight-bearing joints classical radiological changes were often absent at the onset of symptoms.


Another look at osteoarthritis.

Another look at osteoarthritis. One hundred consecutive cases of osteoarthritis seen in a medical clinic have been reviewed and contrasted with 100 patients with rheumatoid disease. Osteoarthritis was usually a polyarticular disease and as symmetrical in distribution as rheumatoid; the knees and hands were the most commonly involved sites. Evidence of inflammation was often found in patients with osteoarthritis and included morning stiffness, redness of distal interphalangeal joints, warmth, and effusions in the knees. In many cases there was either radiological or electron microscopical evidence of deposition of calcium salts. These findings do not support the concept of osteoarthritis as a mechanical, noninflammatory 'wear and tear' condition. An active metabolic abnormality of articular cartilage resulting in cartilage destruction, calcification, and inflammation is suggested as being more compatible with the findings.


Maintenance dose of penicillamine in rheumatoid arthritis: a comparison between a standard and a response-related flexible regimen. There is much individual variation in the response of rheumatoid arthritis (RA) to penicillamine, some patients deriving benefit from very small doses. A dose of 750 mg daily is widely regarded as standard, and, while their RA commonly responds, many patients discontinue treatment because of adverse reactions to penicillamine. A more flexible prescribing policy might be more successful in the long term and was tested in 1 group of 20 patients, another receiving a 'standard' regimen, each beginning treatment at a low dose level. Of those who were given increases of dose only if response was poor 17 completed 1 year of treatment on an average maintenance dose of 308 mg daily, but only 11 of the other group on an average dose 613 mg daily. Proteinuria, which was found only in the latter group accounted for 6 withdrawals, all at doses of 625 mg daily or above. The reduction in rheumatoid activity appeared to be of about the same degree among the members of both groups who completed 12 months of treatment. Penicillamine should be given initially in a low dose and this should be raised only if there is lack of response after at least 4 weeks.


An evaluation of criteria for polymyalgia rheumatica. There has been little basis on which to standardise a diagnosis of polymyalgia rheumatica (PMR), and so 11 rheumatology units in the south and west of Great Britain have collaborated in a study to evaluate possible criteria. Symptoms and laboratory findings claimed to be of diagnostic value in PMR were included in an analysis of the features of 236 patients considered to have unequivocal PMR and 70 patients thought to have possible PMR. The results were compared with similar information from 253 patients with conditions that mimic PMR and from 201 consecutive new presentations to outpatients. The 7 most valuable criteria for differentiation were bilateral shoulder pain or stiffness, onset of illness of less than 2 weeks' duration, initial ESR greater than 40 mm/h, duration of morning stiffness exceeding 1 hour, age 65 years or more, depression and/or weight loss, and bilateral tenderness in the upper arms. We suggest that a patient might be regarded as having probable PMR if any 3 or more of these criteria are fulfilled, or if at least 1 criterion coexists with a clinical or pathological abnormality of the temporal artery. A standardised therapeutic test with prednisolone has value in making the diagnosis of PMR more certain.


Effects of corticosteroids and local anaesthetics applied directly to the synovial vascular bed. The effects of intra-articular injection of triamcinolone hexacetonide on the rate of clearance of radioactive xenon (133Xe) was studied in 11 patients with rheumatoid arthritis. No effect of the corticosteroid injection was observed, which suggests that the drug has no immediate effect on synovial blood vessels.


Metabolic alterations in human synovial lining cells in pigmented villonodular synovitis. Synovial tissue from 3 patients with villonodular synovitis has been examined by quantitative cytochemistry. Considerable changes in the metabolism of the synoviocytes have been observed. These included a massive rise in the activity of glucose 6-phosphate dehydrogenase to levels even greater than those found in rheumatoid arthritis, and a significant rise in the activity of 2 glycolytic enzymes, glyceraldehyde 3-phosphate and lactate dehydrogenase. Lysosomal napthhylamidase showed raised activity with no latency. The sulphydryl content in the synoviocytes was raised, as was the amount of available phospholipid. This pattern of metabolic alterations is similar to that found in human rheumatoid synoviocytes.


Enhancement of urate solubility by connective tissue. II. Inhibition of sodium urate crystallisation by cation exchange. The urate concentration of the supernatant was greater after supersaturated solutions of sodium urate were incubated in a suspension of CM-Sephadex C-25 than in one of Sephadex G-25. The supernatant urate concentration was greater when the CM-Sephadex had been equilibrated with potassium than with sodium. The results are analogous with those obtained in studies of urate solubility in proteoglycan solutions. They are consistent with the Donnan effect and the hypothesis that the glycosaminoglycans within the proteoglycan molecule function as cation exchangers which, when charged with potassium, exchange with the sodium of the urate molecule, leading to formation of highly soluble potassium urate.


Patients' expectations in relation to outcome of total hip replacment surgery. The importance of expectations has been assessed by giving 88 patients who had undergone total hip replacement surgery a series of visual analogue scales to provide a pain score, a 5-point rating scale to assess their remembered expectations, and an interview to establish clinical, functional, social, and psychological data. Patients generally had high expectations, but only 55% had their expectations fulfilled. Despite this, 86% claimed the operation to be successful, though when questioned more closely patients noted a certain amount of displeasure about the outcome. Further analysis revealed that, when the sample was split into 2 groups of fulfilled and unfulfilled expectations, significant differences were noted in that the quality of life enjoyed by the former group was greater than that enjoyed by the latter group. This finding suggests that the notion of 'success' is not as effective as the notion of 'expectations' as a measure of the outcome of total hip replacement surgery.


Yellow nail syndrome in rheumatoid arthritis: report of three cases. We report the occurrence of the yellow nail syndrome in 3 patients with rheumatoid arthritis. In 2 patients the development of the syndrome was related to severe chest infections, and there was evidence of immunodeficiency, consisting in 1 case of a persistently low serum IgA level and in the other of a generalised marrow suppression. The third patient gave a history of recurrent sinusitis and showed evidence of previous chest infections and pulmonary fibrosis, but has no gross evidence of immunodeficiency. We have found only 1 previous brief mention of a patient with the yellow nail syndrome and rheumatoid arthritis.


Juxta-articular adiposis dolorosa: what is it? Report of 2 cases. Juxta-articular adiposis dolorosa may be defined as the localised accumulation of painful fat near joints, most commonly the knee. It exists as a separate entity that must be distinguished from other causes of knee pain. We present 2 patients with this condition and review the literature. Various approaches to therapy are discussed. A classification of painful fat near joints is proposed.


Successful valve replacement for aortic incompetence in rheumatoid arthritis with vasculitis. A patient with rheumatoid arthritis (RA), vasculitis, and aortic valve incompetence of the histologically nonspecific type is described. Valve replacement was undertaken, and an excellent haemodynamic result was achieved. Both arthritis and vasculitis subsequently remitted. Valve replacement can be successfully performed in RA despite active vasculitis.


[Regional conference on measles vaccination. Intervention in discussion]. A short account is given on the reasons for which it is esteemed appropriate the age of 13-15 months suggested by the Regional Consulting Committee as the best period for the extensive voluntary vaccination against measles. At the same time, the practical organization of the campaign can be obstaculated by the miss of sanitary operators.


Morphology, anatomic distribution and cancer potential of colonic polyps. The concept of a polyp-cancer sequence is assuming increasing credibility as a factor in the development of colorectal cancer. Colonoscopy permits most colonic polyps to be endoscopically removed and studied pathologically. Of various polyp types encountered in the colon only neoplastic polyps are regarded as having malignant potential. Neoplastic polyps include tubular adenomas (formerly, adenomatous polyps), villous adenomas and villotubular adenomas (formerly, mixed or tuboglandular polyps). Cancerous changes must penetrate the muscularis mucosae for a polyp to be regarded as clinically malignant. The present report analyzes a series of 5,786 adenomas from over 7,000 polyp endoscopically removed. The largest number of each type of adenoma presented in the sigmoid colon, followed by the descending colon in terms of frequency. In all zones tubular adenomas were most common, villous least. Abnormal cellular change, from dysplasia to carcinoma in situ to invasive cancer was most frequently found in the sigmoid colon and, in all colon sectors, increased as the villous componency of the polyp increased. However, all categories of neoplastic polyps showed malignant changes. Polyp size, long recognized as a factor, was shown to be importantly related to malignant change, but invasive cancer was found even in polyps less than 1 cm in diameter. In addition, the incidence of malignancy rose parallel to the frequency of synchronous and metachronous polyps. A vigorous program for detection and endoscopic removal of colorectal polyps is recommended as a means of reducing the incidence of colorectal cancer.


A comparative study of Japanese and American gastric dimensions. A comparative study between Japanese and Americans was carried out to determine gastric characteristics of the two groups, since Japanese appear to allow easier gastric transposition to the neck. Japanese were found to have a longer and more mobile stomach, but in the vast majority of Americans an esophagogastric anastomosis in the neck is possible following an extensive Kocher maneuver.