[Noise-induced hearing loss and the sisi test. on the assessment of noise-induced hearing loss (author's transl)]. In the assessment of noise-induced hearing loss problems arise mainly in those cases where the middle frequencies are involved in the hearing defects at a proportionally high degree, because this strongly impairs the speech discrimination and because such a hearing defect cannot be regarded as a typical case of noise-induced hearing loss. A recruitment test must be carried out in the middle or lower frequency range in order to diagnose any possible multifactorial genesis of the hearing defect. As concerns the widely used SISI test the result is shown to depend not only on the test intensity but also on the test frequency. Since the hearing threshold in the middle under discussion is usually better in the middle and lower frequency ranges than in the higher ones and since, as a consequence, the test intensity in the SISI test is lower, frequently lower SISI values can be observed here than in the case of higher frequencies. Since the test of the lower frequencies results in lower SISI values than for higher frequencies also in those cases where the hearing threshold in the lower frequency range is the same or even worse, we must assume that the results of the SISI test depend on the frequency. In the examination of patients with a hearing defect where the hearing threshold curve flattens obliquely, intensity dependence and frequency dependence are added in the lower frequency range; negative SISI values are not infrequent. It is not admissible to conclude from that a retrocochlear defect in the middle and lower frequency ranges in cases of noise-induced hearing loss in the high-tone range.


[Faults in medical opinions of noise deafness (author's transl)]. The expertise appraisal of noise deafness takes a great amount of experience for granted, since faulty interpretations are very numerous. Considering possible errors and false interpretations the following points will be discussed: anamnesis-elevation, interpretation of noise-measurements, audiometric examination including aggravation, execution of conversational speech hearing examination and its possible sources of error, tone audiogram, language audiogram and SISI-test, the coupling of the degree of deafness and the MdE (reduction of work capability), overassessment and underestimation, consideration of tinnitus and recruitment, separation of war-connected and skull-traumatic hearing loss, the "retroactive clause", substantial worsening as well as re-examination dates. Furthermore, some examples of typical faulty medical opinions will be reported upon.


[Advances in medical expert inquiries of noise deafness (author's transl)]. After a short description of the historical development the "Königsteiner Merkblatt" (Recommendations by the main union of trade associations for medical expert inquiries of professional noise deafness) in the edition of 1977 is presented. Some proposals for practice of medical inquiries are annexed as well as given indications to still unsolved problems of great practical importance.


[Presbycusis (author's transl)].

[Presbycusis (author's transl)]. This study is base on 438 patients (age 45-99), 250 women and 188 men, divided into decades from 45 to 95 years. Mean hearing levels were measured at 63 up to 12000 Hz using the atlas pure-tone audiometer. Statistical analyses helped estimating the influence of various anamnestic datas on sensorineural hearing loss. 65 patients with diabetes had no hearing loss related to their disease. In 115 noise-exposed patients 'correction for noise' was 5 to 7 dB at 2000 and 4000 Hz. There was no difference in men and women at any frequency and any age group. 'Average presbycusis' in the literature today is too positive. Starting age 20, a linear progressive hearing loss for all frequencies ranging from 6 to 18 dB per decade can be detected, being less for the lower than for the higher frequencies.


[Basal cell carcinoma developing in a preauricular fistula (author's transl)]. Malignant neoplasms in lateral cervical cysts and fistulae have been frequently described in the literature. In the following case, a tumor is reported which was found in the unusual localization of a preauricular fistula. The histologic diagnosis was basal cell carcinoma. In this 41-year-old male patient the tumor led to local recurrent inflammatory symptoms. Therapy consisted first of excision of the fistula. After final diagnosis was made, total parotidectomy and an additional excision of the skin were carried out.


[The clinical value of rhinomanometry. An analysis of the discrepancy between anamnesis, clinical state and rhinomanometry (author's transl)]. Anamnesis, clinical state according to inspection and Rhinomanometry result of 117 patients have been compared by means of a stardarized measuring unit. RM turns out to be indispensable for an exact functional analysis. Misjudgement of air conduction of the nose considering only anamnesis or clinical inspection is remarquable. The most frequent causes for misjudgement are listed. To estimate air conduction of the nose inspectionally a model based on physiological principles is indicated. A future uniform assessment of anamnesis clinical state and RM is indispensable to obtain finally comparable results.


[Examination of patency of ostium by measurement of air flow in the maxillary sinus (author's transl)]. The patency of the maxillary ostium can investigated by measurement of velocity and of presure difference with a new equipment of hot film anemometry and by strain gauges. This studies were performed during sinuscopy. The values are registered on a way-time recorder. The measurement of velocity in the maxillary sinus is more preferable than the measurement of pressure because we need no extraantal point of reference pressure: nose-sinus: difference pressure: sinus atmosphere. Both methods, the measurement of air flow and pressure difference, can proof the patency of the maxillary ostium. Examples are given from open partial patent ostium and from obstructed one.


[Measurement of sinus secretions viscosity (author's transl)]. Viscosity studies of the paranasal sinus secretions reflect the recovery of the damaged secretory mucosa. Effectful treatment leads to an increase associated with a wider range between maximal and minimal viscosity. The type of microorganism is less important.


[Cilia abnormalities in chronic maxillary sinusitis. a transmission (TEM) and scanning (SEM) electron microscopic investigation (author's transl)]. In the resistance of respiratory diseases the mucociliary clearance is a very important factor. Among them the cilia play a decisive role. The normal structure and some variations of the cilia in the maxillary sinus are described using transmission and scanning electron microscopy. The following cilia abnormalities were observed: cilia with a single axonema and excess cytoplasmic matrix; compound cilia and giant cilia with 2-4 and more complete or incomplete axonemata; development of cells, which have secretory granules like goblet cells and cilia like normal ciliated cells. Further the outgrowing of new cilia is shown in the SEM.


[Epipleural branchiogenic cervical cyst (author's transl)]. A case of a 71-year-old male patient with a branchiogenetic cervical cyst is presented. In addition to the clinical manifestation in the eight decade the speciality of this cyst was epipleural localisation. The longest diameter of the cyst was parallel to the right clavicule under the M. omohyoid. The cyst medially filled up the venous angle. Embryology, diagnosis, differential diagnosis as well as the therapy and prognosis are discussed in regard of cases of literature.


[Neurogenic tumor of the larynx (author's transl)]. The authors report a case of a 13-year old girl with a neurogenic tumor of the larynx. The tumor was localized in the submucosal region of the arytenoid and aryepiglottic area on the left side of the larynx. Histologically, it was classified as a neurinoma. As it was impossible to remove the tumor totally by endoscopic way, a lateral hypopharyngotomy had to be performed. Two years after this procedure, there are no functional defects or signs of recurrency.


[Results of treatment of the cancer of the larynx at the ENT-University-Clinic, Halle/Saale, 1940 to 1969 (author's transl)]. The treatment-surgery and irradiation- of 722 patients with cancer of the larynx in the years 1940-1969 are being statistically evaluated. The classification was done accordingly to localisation, stage (TNM-system) and the kind of therapy. The evaluation of the results only considers the 5-years-healing. Surgical therapy and primary irradiation were confronted. The irradiation ranks equally to surgery only at stages I and II of the carcinoma of the vocal cords. Tumors at other localisation or at a different stage (III and IV) can only be successfully treated by surgery.


[Laser surgery of the vocal cord. Clinical investigations with a view to treating small circumscribed carcinomas of the larynx (author's transl)]. It is reported on endolaryngel laser irradiation prior to operation, carried out, with varied dosage, on tumour-free areas of vocal cords of patients with larynx carcinoma. In these instances, the Nd:YAG-Laser MediLas (Messrs. MBB) with flexible light delivery, which we already used in earlier tests, was, for the first time, furnished with a laser endoscope--a special construction by Messrs. Karl Storz, Tuttlingen. The alterations caused on the vocal cords were investigated endoscopically and morphologically. It was proved that a laser induced lesion at a high dosage (55 W over 6 sec or 9 sec resp.) is capable to lead to a destruction of a carcinoma infiltrating into the vocal cord body.


[Laryngeal leukoplakias (author's transl)]. A histologic and cytologic classification of laryngeal dysplastic leukoplakias is described. The basic knowledge has been gained by the experience in the diagnosis of portio-carcinoma. Histologic and cytologic illustrations of different dysplastic stages are shown. The final classification including the clinical description is achieved by cytology and histology.


[Faults in operations as the nasal spine and the anterior parts of the septum (author's transl)]. The nasal spine and the anterior part of the septal cartilage are problematic parts for surgery. Technical faults in this region have not only poor functional results, they are also followed by dropping of the nasal tip and by unfavourable changes of the profile line of the face. This article shows some typical faults and their effects on the exterior picture of the nose. The principles for the reconstruction of the spine and the anterior septum are demonstrated.


[Histomorphology and resorption of longtime-implanted cartilage chips conserved in merthiolat in rhinoplasty (author's transl)]. A histological study is presented on 18 cartilage grafts, conserved in Merthiolat TM, which had been implanted for reconstruction of the caudal border of the nose for time periods of 1 month up to 11 years. These cartilage graft preparations were compared to non graft cartilage from patients died in an age of 37, 51 and 53 years respectively. Our findings show that cartilage grafts are eroded from the edge by resorption granulations of the host. Besides resorption one case showed purulent chondritis and another one osteoneogenesis. The extent of the erosion and the resorption rate seem to depend strongly on the original quality of the cartilage graft. This is possibly due to degenerative focuses which could be found in all of the natural cartilage preparations. After our opinion these focuses regarded like "loci minoris resistentiae". Therefore cartilage material to be used for rhinoplasty ought to be checked for such degenerative focuses.


[Frequency specific information retrieved from compound action potentials--model investigations and clinical results (author's transl)]. It is the aim of electrochleographic assessments to determine with sufficient accuracy the hearing threshold in the frequency range usually covered by subjective audiometric investigations. An optimal result would be an "objective" audiogram comparable to the subjective one. In the present paper, difficulties and limits which are arising during the retrieval of frequency specific information from compound action potentials are demonstrated on the basis of model experiments. In connection with these experiments a new approach is demonstrated which is based on the reverse process of the physiological formation of the compound action potential. As a result of this method, the excitation pattern at the level of primary auditory neurons is obtained. The efficiency of this technique is shown by means of model simulations as well as by processing derived action potentials recorded from normal hearing subjects.


[Results of therapy in cases of tumors of the nasal cavity and paranasal sinuses in relation to different tumor classifications (author's transl)]. The primary findings in 128 patients with malignancies of the nasal cavity and the paranasal sinuses were classified by 4 tumor classifications. The survival times and the rates of recurrences in relation to the stage of tumor were compared. Mostly cancers of advanced stages T3 and T4 with bad prognosis were treated: only 35% of the examined patients survived longer than 5 years. There was no obvious difference in the results of therapy in tumor cases T3 and T4 in relation to the different tumor classifications.


Multiple congenital hemangiopericytomas of the head and neck. Hemangiopericytoma is a vascular tumor arising from contractile cells, the pericyte of Zimmermann. The neoplasms most frequently involve deep musculature; however, 16% occur in the head and neck region. The case presented here represents the rare occurrence of multiple congenital hemangiopericytoma of the head and neck. In older patients, these rather poorly differentiated tumors recur locally after excision in 50%-80% of cases depending on the organ site involved. Distant metastasis to lung or bone may follow. Congenital hemangiopericytomas appear to follow a more benign clinical course, possibly due to a more superficial location and a tendency to transform into hemangioendotheliomas. Recommended treatment is wide local excision and long-term follow-up.


Carcinoma of the tonsillar region. Aspects on treatment modalities with reference to a study on patients treated by irradiation. Irradiation is the most common form of treatment of tonsillar region carcinomas in Scandinavia. During recent years, encouraging results have been reported when surgery has been performed. Therefore, an effort was made to compare different treatment principles on the basis of a study on patients treated by irradiation. This retrospective study comprised 37 patients over a 20-year period. The relative 5-year survival was 33%. Most of the patients died in the next two years after diagnosis. Seventy-three percent of the patients initially had signs of regional metastasis. Hardly 20% of these were still alive after 5 years, while patients without evidence of metastasis had a 5-year survival of 50%. Neither the size, nor the histopathological features of the primary tumor seemed to affect the incidence of regional metastasis. The duration of symptoms before diagnosis, however, seemed to influence prognosis. Surgical consideration alone, or in combination with irradiation, should be made in cases with large primary tumor with regional lymph node involvement. In other cases, however, there was no evidence suggesting surgery as a better form of therapy than irradiation alone.


Use of plastipore for ossicular chain reconstruction: an evaluation. With the exception of stapes prostheses, previous use of implantable alloplastic materials in reconstructing the sound conducting mechanism in middle ear surgery has been uniformly unsuccessful. A new material composed of ultra-high molecular weight polyethylene has been developed as a replacement for middle ear ossicles. This implant, called the Plastipore total ossicular replacement prosthesis (TORP), and the Plastipore drum to the stapes prosthesis were inserted in 87 patients, all of whom had a long history of extensive middle ear disease and/or surgery. One TORP patient was lost to follow-up. The overall average hearing gain was 14.8 db. The overall follow-up was 12.4 months with a range of from 3 to 25 months. Eleven of the 15 patients receiving the drum-to-stapes prosthesis had hearing gain; 55 of 71 patients receiving the TORP had hearing gain. Eight prostheses were extruded. Nine patients had no improvement in hearing. Eight patients had subsequent decrease in hearing after initial gains. All ears are now dry and aerated. Early evaluation appears to demonstrate that the Plastipore prosthesis shows promise for use in difficult reconstructive middle ear problems.


Neurorrhaphy of the recurrent laryngeal nerve. The authors have experimentally performed neurorrhaphy and its modifications and nerve grafting with end-to-end anastomosis of the recurrent laryngeal nerve in dogs. Recovery of a neurorrhaphy of the recurrent laryngeal nerve resulted in the bizarre and spasmodic movement of the vocal cords. These effects were recorded by means of electromyography and 16 mm cinematography to demonstrate restoration of nerve muscle function and vocal cord movements. From these results, it was concluded that these single modes were not adequate for restoration of laryngeal function, however, some specific attention is given to a few trophic changes of the affected muscles after a period of ten months postoperative.


Tympanoplasty: cartilage prostheses--a report of 564 cases. We reviewed 564 tympanoplasties operated upon over an eight year period at the Otologic Medical Group in which tragal cartilage was used to re-establish the sound pressure transfer mechanism. Eighty-six percent of the cases were revisions, and half of these were planned second stage procedures. In the majority of cases the stapes crural arch was missing. The conductive deficit in these cases was reduced to 20 db or less in 67% and 10 db or less in 40%. The commonest single cause of failure was a short prosthesis. There were no instances of cartilage resorption. Extrusion occurred in one case. Tragal cartilage has been more satisfactory than ossicular tissue in many situations. Recently we have been using plastic prosthesis (TORP and PORP) in combination with tragal cartilage and believe that the results will be even better.


Surgery of the skull base.

Surgery of the skull base. Tumors involving the base of the skull are often occult and may become quite large before detection is possible. Symptomology varies depending upon the nature of the tumor and its placement. These neoplasms have frequently been considered inoperable simply because of their location, but in recent years microsurgical technique and high speed air drills have allowed the modern temporal bone surgeon to gain improved access to the skull base. A wide variety of surgical approaches to tumors in this area have been described in the past 20 years: translabyrinthine, middle fossa, transcochlear, retrolabyrinthine, retrosigmoid, transpalatal-transclival, and through the jugular bulb. The purpose of this paper is to review the indications, complications, and results of each of these procedures in relation to specific tumors involving the skull base. Case reports illustrate the diagnosis and surgical management of a variety of unusual neoplasms, including an extradural meningioma of the temporal bone and clivus, a low grade squamous cell carcinoma on the tegmen in a radical cavity, a large primary cholesteatoma, an osteoblastoma of the temporal and occipital bones, an XIth nerve neuroma in the jugular bulb area, and an osseous hemangioma involving the facial nerve at the geniculate ganglion.


Acetylcholinesterase levels in nasal turbinate congestion. In a previous communication, one of the authors discussed prolonged congestion of the turbinates following nasal surgery. The clinical factors responsible were allergy or the traumatic effects of nasal packing on the turbinates. A study of turbinate function was done to find the factor responsible for this congestion. Biopsies of an inferior turbinate were obtained preoperatively and two weeks after surgery. The specimens were examined for the level of acetylcholinesterase by histochemical assay and were also studied by examining sections histologically. In the majority of cases, the level of acetylcholinesterase fell with the appearance of congestion and rose when the turbinates returned to normal. These results suggest a connection between turbinate congestion and levels of tissue acetylcholinesterase in the presence of inflammation or allergy.


What every otolaryngologist should know about hearing aids. The otolaryngologist does not have to fit hearing aids, but he does have to know with a broad encompassing view what is being done by the hearing aid dispenser and the audiologist in regards to hearing aid fitting and selection. The acquisition of a hearing aid is part of the general care for the hard of hearing. In this particular case, the otolaryngologist should always be the "Captain of the Ship." With him, as paramedical advisors and assistors, are the audiologist and the hearing aid dispenser. The ultimate responsibility of the members of this team to see that the patient is properly fitted and cared for is with the otolaryngologist. When problems exist with improper diagnosis or care, the medical-legal responsibility falls on the shoulders of the otolaryngologist. Having an audiologist work with the otolaryngologist is most desirable for the measurement and recommendations for the hearing aid. The new FDA regulations require an otolaryngologic examination prior to fitting hearing aids, except for personal and religious reasons. Children under 18 years of age require both a medical and audiologic examination. To simplify conversation with other members of this team, one should have some basic concepts clarified: 1) The nature of a hearing aid. 2) The concepts and nomenclature used in and for probably 90% of all descriptions regarding hearing aids. 3) Types of aids. 4) Coupling methods which involve ear molds, tubes, vents, and inserts. 5) Types of fittings, whether cross, bi-cross, monaural, etc. 6) Distortion. 7) Measurements. 8) Problems in fitting of hearing aids. It is reasonable to assume that adequate background in these simple basic concepts regarding hearing aids will permit the otolaryngologist to supervise and understand the nature of some of the complaints made by patients. It is totally desirable that a patient be seen by an otolaryngologist prior to being fit with a hearing aid. This can be accomplished by education of the public by the otolaryngologist.


Symposium on hearing loss--the otolaryngologist's responsibility. Medical management of hearing loss. Millions of Americans suffer hearing loss resulting in immense social and economic consequences. Hearing loss is merely a symptom or sign and the evaluation and management of afflicted individuals requires a thorough knowledge of etiologic factors and understanding of the underlying pathophysiology. Hearing loss is either conductive, sensorineural, or mixed. It may be congenital or delayed in onset, genetic or progressive or stable. Specific diagnosis should be sought in all cases with the objective being reversal of the hearing loss. Often definitive therapy is lacking yet prevention of progression, when possible; recognition of associated disorders, when present; compensation for disability, when applicable; epidemiologic study; genetic and psycho-social counseling; and habilitation and rehabilitation may still be initiated. A vigorous approach to the patient with hearing loss should be championed by the otolaryngologist.


Sympsium on hearing loss--the otolaryngologist's responsibility. Habilitation and rehabilitation of patients with sensorineural hearing losses. A philosophy of the (re)habilitation of patients with sensorineural hearing losses from a communication point of view is presented. Pediatric and adult populations are discussed separately. Topics of consideration for pediatric patients include the appropriate use of amplification, team management of the hearing handicap, educational placement and the importance of parent counseling. The discussion of the management of adult patients reviews some problems in hearing aid fitting, patient counseling and appropriate case follow-up. The guiding principle behind these (re)habilitation processes is the integration of the hearing-impaired patient into a hearing world.


Closure of tympanic membrane perforations by the use of fat. Otologists have attempted to close tympanic membrane perforations for 300 years. It has been in the past 25 years that closure with autograft materials has been consistently successful. Homografts have been successful for the past 10 years. One of the autograft materials, ear lobe fat, has been in use for the past 15 years. Over this period 65 patients have been reviewed. This report reviews the literature, explains the technique and summarizes the results as to hearing, graft mobility and graft survival.


Acute epiglottitis: intubation versus tracheostomy. Acute epiglottitis is a disease with significant mortality. The patient, usually an otherwise healthy pre-school child, develops a sore throat and muffled voice from swollen supraglottic structures, and may progress rapidly to respiratory arrest. Early diagnosis and airway maintenance can prevent these fatalities. Whether to secure an airway by tracheostomy or endotracheal intubation is the subject of much discussion. Nineteen series totalling 738 cases of epiglottitis plus 11 new cases are reviewed. These patients were treated as follows: Tracheostomy = 348 (3 deaths - 0.86%); Endotracheal intubation = 216 (2 deaths - 0.92%); medical management with no artificial airway = 214 (13 deaths - 6.1%). The difference in morbidity and mortality between tracheostomy or nasotracheal intubation is so slight that the choice should be determined by local factors. Medical management with no artificial airway should not be used in children.


Antimicrobial agents from higher plants. An investigation of Hunnemannia fumariaefolia pseudoalcoholates of sanguinarine and chelerythrine. The antimicrobial activity seen in extracts of Hunnemmania fumariaefolia S. resides in the alkaloids. The activity seen in the non-polar fractions had been shown by chromatography, physicochemical measurements, and comparisons with authentic samples to be due to apparently artifactual formation of the pseudomethanolates and pseudoethanolates of the alkaloids sanguinarine and chelerythrine, which are abundant in the plant. The enhanced potency of the pseudoalcoholates of sanguinarine over the parent benzophenanthridine is discussed in comparison with the in vitro biopotencies of other analogs prepared for the purpose. It appears that the pseudoalcoholates may be useful prodrugs.


Antimicrobial activities of constituents of Uvaria chamae. The antimicrobial activities of a number of cytotoxic C-benzylated flavonoids from Uvaria chamae have been determined. The minimum inhibitory concentration values of these flavonoids and certain of their derivatives against Straphylococcus aureus, Bacillus subtilis, and Mycobacterium smegmatis compare favorably with those of streptomycin sulfate.


[Reproduction of the volume of biological objects by foreshortened roentgenograms]. The processing of a set of foreshortening roentgenograms by optico-holographic methods has been effected, its purpose being to obtain a three-dimensional image in a broad range of viewing angles. At the same time, the cross-sections of an object were synthetized by using an optical variant ofthe method providing for the synthesis of projecting functions and optical filtration of the synthetized image. The resolution power of the methods described is assessed.


[Automated complex for registering and analysing evoked potentials of the human auditory system]. A complex setup for diagnosing affections involving the auditory system of man is described. The algorhythm of the setup functioning is depicted in detail, its main task consisting in segregation of the signal produced by the potential from the noise--the background activity of the human brain cortex. The functioning of the complex setup in dynamics by following the given algorhythm is shown.


[Cryogenic technic in gynecological practice]. Two units with different refrigerants and cooling temperature are recommended for treating various gynecological affections by the method of cryodestruction of pathological changes in the cervical tissue and the uterine mucosa. In these liquid nitrogen, nitrous oxide and carbon dioxide are employed as refrigerants.


[Medical equipment at the Leipzig Fall Fair of 1977]. An analysis of the most interesting exponents of the Leipzig autumn fair of 1977 served as a groundwork for an attempt to outline the major orientation and trends in the development of the biomedical engineering. The advantages of the functional units method of designing are taken notice of on an example of some groups of devices manufactured both in the countries members of the Council for Economic Mutual Assistance and in western countries. Emphasis is placed on the good prospects offered by medical devices for ultrasonic location of the heart with the type M scanning, of the X-ray units intended for solving concrete diagnostic objectives within a narrow branch of medicine (apparatus for mammography, for use in urology, etc). Particular attention is paid to the medical equipment utilizing the elements of computer technique, in the form of built-in units and also in that of complex setups in which small computers ensure the most effective realization of the diagnosis and treatment.


[Microfluorimeter for biomedical research]. A new microfluorimeter built on the basis of the fluorescence microscope scheme is described. The study object is illuminated on the reading side. The device is highly sensitive and allows small amounts of fluorescent agents to be investigated. The microfluorimeter has been used to study the absorptive activity of the gastrointestinal tract.


[Pressure distribution on the surface of the cut-off elements of artificial heart valves]. With hydroaerodynamic investigations into pressure distribution on the surface of blocking components in artificial cardiac valves in the shape of a sphere, semisphere, lens and a disc opening at an angle serving as a basis a quantitative evaluation of the arrangement for the flow separation, evacuation peak regions and congestion zones is given. The highest velocity, greatest evacuation and shear stress occur in a flow-past of a valve having a shape of the lens. The disc valve opening at an angle, as concerns its hydrodynamic characteristics, is superior to the valves of all the other designs considered in the present work.


Plasma concentrations and tissue uptake of free amino acids in dogs in sepsis and starvation: effects of glucose infusion--some effects of low alimentation. The plasma concentrations of substrates, together with transhepatic and transgut balances, have been studied in six control and eight septic awake fasted dogs. Four severely ill septic dogs (typically fluid in chest and/or abdomen, extensive peritonitis, respiratory difficulties) had high concentrations of threonine, glycine, tyrosine, lysine, histidine, tryptophan, and triglycerides (p less than or equal to 0.05). The other septic dogs (less severely ill) showed fewer and less pronounced alterations in the plasma substrates (aspartate and tryptophan were elevated, p less than or equal to 0.05). The infusion of glucose increased the concentration of glucose, lactate, and pyruvate and depressed the concentrations of most amino acids in both normal and septic dogs. Threonine, asparagine, glutamine, leucine, isoleucine, alpha-aminobutyrate, and tyrosine were significantly depressed in the severely ill septic dogs (p less than or equal to 0.05). In the normal dogs most amino acids were removed by the liver, with alanine accounting for approximately 40% of the total. Glutamine removal was negligible. In the septic dogs hepatic removal of amino acids was variable; livers of two severely ill septic dogs did not remove amino acids. In the control dogs glucose infusion (0.015--0.017 g/kg/min) tended to lower hepatic removal of amino acids. Hepatic dye removal in the septic dogs was always very poor. In the gut glutamine was removed and alanine, glutamate, glycine, and ammonia produced, but the overall sum of amino acid uptake was negligible in both the control and septic dogs. The ratio of tryptophan to the sum of valine, isoleucine, leucine, tyrosine, and phenylalanine concentrations was greatly elevated in all septic dogs in which it was measured. The free concentrations of amino acids in the liver, heart, and muscle tissues were grossly elevated in the low intravenous alimented septic state relative to the fasted normal state, whereas the tissue concentrative ability as measured by nonmetabolizable amino acids, alpha-aminoisobutyrate and cycloleucine, was not similarly increased. Sepsis clearly alters plasma and tissue concentrations, and in some instances hepatic uptake of amino acids.


Initial splanchnic extraction of ingested glucose in normal man. Estimates of initial splanchnic uptake of ingested glucose and the concomitant suppression of endogenous glucose production were obtained in man by validated tracer techniques for non--steady-state turnover measurement. Nine normal volunteers (18--44 yr old) fasted overnight received intravenous infusions of tracer (3-3H-glucose or 1-14C-glucose) and a low (45 +/- 1 g) or high (96 +/- 5 g) oral load of glucose labeled with an alternative tracer (1-14C-glucose or 2-2H-glucose). A two-compartment model was used to derive rates of peripheral appearance (Ra) of glucose from all sources (total) and the Ra of ingested glucose. Ra (total glucose) and Ra (ingested glucose) were integrated from the first appearance of ingested glucose until the basal Ra (total glucose) or 116 +/- 6 (SEM) mg/min was reattained. The total amount of glucose reaching the systemic pool in this time was 95 +/- 4 g and 46 +/- 3 g with high and low doses, respectively. Of these quantities 86 +/- 4 g and 40 +/- 3 g originated in the oral glucose, representing 90% +/- 4% of the administered glucose. The remainder (11% +/- 2% of the total) represented endogenous production, suppressed by 66% +/- 6% relative to basal. Sequestration of ingested glucose and subsequent release did not take place during the study since identical results were obtained with ingested 1-14C-glucose or 2-3H-glucose. The latter label would have been lost if the glucose had entered the hexose--phosphate pool. Thus, in normal man approximately 90% of an ingested glucose load is absorbed and passes through the liver to appear in the systemic pool.


Cortisol metabolism in lymphocytes from cancer-bearing patients. A study was conducted to determine the pattern of cortisol metabolism by lymphocytes obtained from four groups of subjects: 27 male and female patients suffering from various types of malignancy other than malignancy of lymphatic tissues; and 26 healthy male and female controls. Known concentrations of cells were incubated with 1,2-3H-cortisol and the products were isolated by thin-layer and paper chromatography. Three metabolites were found to be produced by lymphocytes from both normal and cancer-bearing patients: 20alpha-hydroxycortisol, 20beta-hydroxycortisol, and tetrahydrocortisol. Cells from the female control group were found to be more active than those from the male controls, while cells from cancer-bearing patients were markedly more active than the normal cells, regardless of sex. It is suggested that this finding of increased metabolism of cortisol by lymphocytes from patients with different types of malignancy other than lymphoma may provide the basis for a new diagnostic aid.


Effect of 25-hydroxy-vitamin D3 on intestinal absorption of calcium in normal man and patients with renal failure. The effects of short-term treatment with 25-hydroxy-vitamin D3 (25(OH)D3) on intestinal absorption of 47Ca were examined in 18 studies of normal subjects and 16 studies of patients with advanced renal failure. Doses of 25(OH)D3 were 20, 100, 500, or 1000 microgram/day given orally for 7--10 days. There was an increase in 47Ca absorption and urinary calcium in normal subjects receiving 20 microgram/day, while doses of 500 or 1000 microgram/day were required to augment 47Ca absorption in renal failure patients. During treatment, plasma levels of 25(OH)D increased to similar levels in both normal and uremic subjects. A comparison of the dose-response curves found 25(OH)D3 to be 1/125 as potent as 1,25-(OH)2D3 in the normal subjects and 1/400 as potent as 1,25(OH)2D3 in patients with chronic renal failure. Thus, pharmacologic doses of 25(OH)D3 are active in both normal and uremic patients, although relatively greater quantities are necessary in uremia. This difference in relative potency of 1,25(OH)2D3 and 25(OH)D3 may be explained by some conversion of 25(OH)D3 to 1,25(OH)2D3 in normal compared to uremic subjects, while 25(OH)D3 may act in large part via mass action in uremic patients.


[Natural variability of Bacillus diastaticus, a thermophilic bacterium that forms amylase]. Natural variability of the thermophilic culture of Bacillus diastaticus was studied, and the population of its cells was found to be genetically heterogeneous. The bulk (75.5%) of the cells had a high activity of amylase biosynthesis; 21.5% of the cells had a low activity; 2.94% of the cells had no activity. One inactive variant and two variants whose activity was higher that that of the parent culture with respect to amylase biosynthesis have been selected.


[Phosphoenolpyruvate carboxylase in the carboyxdobacterium, Pseudomonas gazotropha]. The activity of phosphoenolpyruvate carboxylase (orthophosphate: oxalacetate-carboxy-lyase phosphorylating, E. C. 4.1.1.31) in the cell extracts of the carboxydobacterium Pseudomonas gazotropha Z-1156 depends on the presence of bivalent metal ions, Mn2+ ions being more effective than Mg2+ ions. The value of apparent KM for phosphoenolpyruvate in a freshly prepared extract is 7.1 mM. The affinity of the enzyme to phosphoenolpyruvate increases after storage of the extract in ice in the presence of dithiothreitol: KM=0.42 mM at low concentrations of the substrate, and 2.5 mm, at high concentrations of the substrate. The calculated maximum rate is 18.1 mE per 1 mg of protein of the extract, and changes only slightly upon storage in the presence of a stabilizer of sulphydryl groups. The activity of the enzyme reaches its maximum at the phase of deceleration of growth. Nucleotide triphosphates inhibit the activity of the enzyme more than the corresponding nucleotide diphosphates. The properties of PEP-carboxylase are discussed from the viewpoint of comparative biochemistry.


[Photosynthesizing bacteria from the Wanda Lake (Antarctica)]. Photoautotrophic bacteria growing under anaerobic conditions in the light at 28 degrees C with carbon dioxide as a sole source of carbon were isolated from the ooze of the Vanda Lake at a depth of 68 m. The cells are rounded gram-negative rods, and form a dark-red pigment. The morphology and physiology of the cells were studied as well as absorption spectra of the cells and isolated pigments. The main maxima of absorption were found to be shifted to a short-wavelength region of the spectrum. This fact and peculiar conditions of their habitat as well as some other characteristics are the reasons why these bacteria are classed as a new species Chomatium vanda. As far as we know, this is the first description of photosynthetic bacteria inhabiting the Vanda Lake in the Antarctic.


[Thermophillic sulfate-reducing bacteria from oil-bearing strata]. The paper describes pure cultures (strains 435 and 781) of thermophilic spore-forming sulphate-reducing bacteria isolated from oil strata. The strain 435 was classed as a new subspecies Desulfotomaculum nigrificnas subsp. salinus according to its morphological, physiological, and biochemical characteristics. The cells of the culture are rod-like, 2-5 mcm long and 0.9-1.3 mcm thick. Some cells are spindle-shaped. The cells have peritrichously arranged flagella. Spores are oval, located terminally or subterminally, slightly widening the cells. The culture is an obligate anaerobe. It grows in media containing sulphates and assimilates sodium salts of lactic, pyruvic, malic and formic acids, ethanol, and butanol. The cuture assimilates pyruvate in the absence of sulphates. Sulphate, sulphite and thiosulphate are electron acceptors when the culture grows on lactate. The organism can grow at 40-70 degrees C, the optimum temperature being 60 degrees C. It requires NaCl for growth, and can grow even in the presence of 4% NaCl in the medium. The optimum should contain 1% NaCl and microelements. Desulfoviridin is absent. The cells contain a cytochrome of the protoheme class. The content of G + C base pairs in DNA is 57.0 +/- 0.5 mol. %.


[Systematic position of an autotrophic actinomycete isolated from a floodplain marsh near Moscow]. A hydrogen-oxidizing actinomycete (Z-1046) was isolated from a flood-plain marsh in the Moscow Region. Its taxonomy was compared with that of similar cultures belonging to international special standards of actinomycetes (ISP). The strain Z-1046 was found to be identical with Streptomyces autotrophicus ISP-5011 (RIA-1008, ATCC-19727, CBS-466.68, IFO-12743). It has been also shown that the generic identification of the standard culture ISP-5011 is erroneous: as Hirsch (1960) holds, the culture belongs to the genus of Nocardia (Proactinomyces). Thus, the culture Streptomyces (Actinomyces) autotrophicus ISP-5011 must be eliminated from the international special standards of the genera Streptomyces and Streptoverticillium. The autotrophous actinomycete that we have isolated is classed as Proactinomyces autotrophicus comb. nov. (=Streptomyces autotrophicus Takamiya et Tubaki, 1956, ISP-5011, RIA-1008, ATCC-19727, CBS-466.68, IFO-12743, =Nocardia autotrophica, Hirsch, 1960).


[Autotrophic methanol metabolism in Microcyclus aquaticus]. Metabolism of methanol was studied in Microcyclus aquaticus Z-238 in enzymological experiments. This facultative methylotroph was found to assimilate the carbon of methanol after oxidation to CO2 via the reductive pentose phosphate cycle. Dehydrogenases of methanol, formaldehyde and formate as well as ribulose-1,5-diphosphate carboxylase were induced during the methylotrophic growth of the bacterium. The serine pathway and the hexulose phosphate cycle were not involved in methanol metabolism owing to the absence of serine-glyoxylate aminotransferase and hexulose phosphate synthase, respectively.


[Increased reliability of the legal protection of Soviet inventions in the field of microbiology]. The reliability of juridical protection of microbiological inventions which may result in the production of a commercial product is discussed in the paper. If the structure of an invention is strain-method-product, then juridical protection of each of the objects is possible. Protection of a product would be most reliable, but this is not always possible. Protection of a microbial strain is less typical of an invention, and is not reliable. Protection of a microbiological method of production has advantages over protection of a microbial strain since, in this case, the theory of equivalents can be applied.


[Development of bacteria and their activity in an aqueous surface film under experimental conditions]. The formation and number of bacteria in the surface film of water depend on the content of organic substances in water. In flasks containing distilled water after 1-2 days, a bacterial film 5-7 mcm thick is formed at the surface; in flasks with water taken from reservoirs, the film is 5-15 mcm thick; in flasks with water containing organic substances, the film is 15-50 mcm thick. A distinct bacterial band of growth is formed on glasses semisubmerged in water in this layer. At the beginning, bacterial rodshaped cells are oriented by their side surface to the surface layer of water. Judging by the assimilation of protein labeled hydrolysate, the total activity of bacterial population in a film is much higher than in deep water layers. In the course of time, the number of bacteria changes, they begin to die off, and their species are substituted by other bacterial species. Numerous motile forms and various Caulobacterial forms are found in the surface layer of water. The dimensions of bacterial cells growing on glass are much larger than in dry preparations obtained from this film on membrane filters.


[3,4-dichloroaniline cometabolism by representatives of the genus Pseudomonas]. The effect of propanide, linuron and 3,4-dichloroaniline on soil organisms was studied. Two strains of Pseudomonas aurantiaca 1 and 7, were isolated from soil; they decomposed propanide yielding 3,4-dichloroaniline. These strains, as well as a number of collection cultures belonging to the Pseudomonas genus, could transform 3,4-dichloroaniline at a rate of 0-100 per cent during 48 hours. A certain correlation existed between this transformation ability and the level of total oxidase activity. All the strains of Pseudomonas studied in this work were characterized by a low peroxidase activity, and no strict correlation was detected between its level and the ability to transform 3,4-dichloroaniline.


[Composition of Actinomyces hygroscopicus membranes]. The composition of membranes was studied in four strains of Actinomyces hygroscopicus differing in their morphologo-cultural characteristics and synthesis of antibiotic hygromycin and enzyme hygrolytin. The composition of the membranes was not the same and varied in the course of growth and development. The content of proteins and carbohydrates increased in the membranes, particularly in the strains producing enzymes. In the process of growth, the content of phospholipids increased in the lipid component of the membranes, and the ratio between the main phospholipids, i. e. phosphatidyl ethanolamine and cardiolipine, changed. The spectrum of fatty acids of phospholipids did not change in the course of growth.


[Fine structure of the outer sheath of the aerial mycelium in Actinomyces levoris]. The outer sheath of the aerial mycelium of Actinomyces levoris 64 bears groove-like and granular submicroscopic structures. They are very susceptible to a short-term treatment of the aerial mycelium with aqueous acetone which causes their disintegration. Under specified conditions, submicroscopic structures, viz. granules and threads, assemble from the acetone extract of the aerial mycelium of Actinomyces levoris. These structures possess the anti-yeast activity. The granular structures reorganized from the acetone extract of the aerial mycelium of Actinomyces levoris somewhat resemble in morphology the structures seen in the outer sheath of the aerial mycelium of this actinomycete. The results obtained are discussed within the framework of the hypothesis on a possible participation of polyene antibiotics in the formation of the outer sheath of the aerial mycelium of actinomycetes which produce these antibiotics.


[Candida mogii and Debaryomyces hansenii yeast development in the presence of metal chlorides]. The yeasts Candida mogii 2 and Debaryomyces hansenii 8 isolated from salted fish spawn in the process of its storage were found to be capable of growth in 4 M KCl, 3 M MgCl2, 2.5 M NaCl, 1.5 BaCl2 and 1 M CaCl2. The activity of water (aw) in these solutions varied from 0.983 to 0.719; the maximum osmotic pressure was 380 atm. The cultures grew also in a 3 M sucrose solution, at low concentrations of osmotically active substances and without them. Therefore, they can be regarded as osmotolerant microorganisms. The osmotolerance of the cultures decreased with temperature of solutions. The absence of growth or weak growth in solutions of certain other chlorides should be attributed to toxicity of cations.


[Characteristics of Pseudomonas putida plasmid DNAs]. Physico-chemical characteristics of plasmid DNAs isoalted from Pseudomonas putida G7 were studied as well as the behavior of these DNAs in th eourse of chromatography on columns with Sepharose 4B and kieselguhr with methylated albumin (MAC). This strain was found to contain several plasmid DNAs having molecular weights of 33-36X10(6), 15-18X10(6), and 3-5X10(6) dalton. The plasmid DNAs of biodegradation are supposed to be located in the vicinity of chromosomes, and only a small part of them is characterized by extrachromosomal localization.


[Cell morphology, nucleus distribution and DNA content in haploid and diploid Aspergillus niger strains]. The cells of haploid Aspergillus niger strains contain, on the average, 7-9 nuclei, a fragment of a thin hypha 100 me long comprising 11-19 nuclei. The cells of a diploid strain are 1.5-2.6 times larger in volume. The diploid cells contain less nuclei and more cytoplasm per nucleus as compared to the haploid strains. The primary sterigmae of Aspergillus niger comprise 3-13 nuclei, the secondary sterigmae and conidia, one nucleus. The conidia of the diploid strains are 1.8-2.0 times larger in volume and contain twice as much DNA as compared to the haploid strains.


Congenital toxoplasmosis in Tasmania.

Congenital toxoplasmosis in Tasmania. In a prospective study, 9037 cord sera from Tasmanian children were tested using the Toxoplasma indirect fluorescent antibody test (IFAT). There were 494 positive reactors at the screening titre of 1:64. These reacting sera were titrated out and were also tested in the immunoglobulin M (IgM) Toxoplasma IFAT. No specific IgM antibodies were detected, but, even so, 33 of the sera had titres of 1:512 or greater. Repeat samples from 20 of the children with high titres revealed a substantial decline in titre. It is believed that these results indicate that congenital toxoplasmosis is not an important cause of perinatal morbidity in Tasmania.


Electronic communication system for the disabled. This paper outlines the need for and describes a communication system which enables immobile patients suffering from speech loss to communicate effectively.


The clumsy child: observations in cases referred to the gymnasium of the Adelaide Children's Hospital over a three-year period. Group treatment of clumsy children is one part of a multidisciplinary management programme which is provided at The Adelaide Children's Hospital for children who have multiple handicaps. This study reviews 176 children who were referred for treatment. Clumsiness was the most common reason for referral. Not all children benefited from group treatment, and those who had significant degrees of mental retardation, or mild spasticity worsening on effort, needed individual handling. Movement training aims mainly to reduce physical clumsiness, and it is hoped that certain nonspecific benefits may result. The greatest improvement occurred in the ability to mix with others. Group counselling of parents, with a social worker as leader, is considered to have played an essential part in the management of these children's problems.


Sporting activities and exercise habits of the 1975 Busselton population. Studies of the sporting activities and exercise habits of the 1975 Busselton population indicated that two out of three subjects exercised either not at all, or less than once a week, and only 7% stated they tried to get out of breath during their exertions. Those in sedentary occupations undertook more leisure exercise than those in non-sedentary occupations, with men exercising more frequently than women. Comparisons of body weights, blood pressures, serum levels of cholesterol and triglycerides, glucose levels, uric acid levels, lung function tests and electrocardiogram tracings between those who exercised four or more times per week and those who exercised less than four times per week revealed significant differences only in relation to lung function tests, which favoured the higher exercise group. This evidence suggested that the levels of activity involved in the Busselton population's sport and exercise habits were failing to provide additional protection against future coronary heart disease.


The dangers of surgery: an Aboriginal view. The prospect of surgery occasions great anxiety among the people of Aboriginal communities in northern Australia. Several of the fears are similar to those of patients of other cultures. Others are intimately linked to traditional beliefs about healing, and attitudes towards the body, the shedding of blood and the activities of malevolent human beings or sorcerers. Successful rapprochement between medical staff members, the patient in need of surgery, and the members of his family depends on sensitivity to these fears, detailed consultation with all concerned, and the involvement of Aboriginal community members, particularly local Aboriginal health workers.


Environmental chemical carcinogenesis.

Environmental chemical carcinogenesis. The methodology of revealing and studying chemical carcinogens in the environment is based on epidemiology, animal testing, and short-term laboratory studies. The techniques and limitations of these respective investigations are described. From evidence of carcinogenicity, extrapolation must be made to assess whether a particular substance is a cause of cancer in humans. This inference depends upon the type of evidence for carcinogenicity. In particular, parameters limiting extrapolation of all laboratory assays include species' specificity and dose response. Control of the environmental distribution of punative carcinogens poses difficulty, both in the selection of substances, and in legislative design. Certain personal habits still constitute the major established carcinogenic hazards for the community-at-large.


Parvovirus gastroenteritis--a new entity for Australia. An outbreak of acute gastroenteritis occurred in a primary school southwest of Sydney in August, 1977. Two hundred and eight pupils and nine teachers were affected over a one-month period. Electron microscopy revealed parvovirus-like particles in faecal extracts of 14 of 23 persons tested during the acute phase of illness. The virus was still present in the faeces of four individuals six weeks later. The appearance of specific antibodies was demonstrated by immune electron microscopy in five persons. No other cause for the outbreak could be found despite exhaustive investigations.


The dental health revolution: The dramatic improvement in dental health of school children in the northern metropolitan region of New South Wales. There has been a dramatic improvement in the dental health of school children in the past 15 years. The proportion of children aged five to 12 years who have never experienced any dental decay increased nearly ten-fold from 3.8% in 1961 to over 35% in 1974. The proportion of children with active dental decay at routine school examinations has fallen from 92% to 22%. These improvements are probably due to improved oral hygiene and diet in combination with the usage of fluoride. Almost certainly, the availability of fluoride both in tablet form and delivered through town water supplies has been the predominant factor. These very large reductions in the incidence of dental decay amont children represent a modern triumph of preventive health care. Further improvements in dental health may be effected by the topical application of fluoride and reduced intake of refined sugar.


Choledochoscopy: a comparison of a rigid and a flexible fibreoptic instrument. A comparison of choledochoscopy using a Storz rigid choledochoscope and a flexible Olympus instrument has been made. After using both instruments during a 12-month period, it is felt that the rigid instrument has practical advantages for general use, while the flexible instrument offers additional benefits, but requires more skill and care in its use.


How safe is isoniazid?

How safe is isoniazid? The complications of isoniazid (INH) were studied in 1033 patients, who had received INH for at least 18 months, with or without other drugs. Hepatitis developed in 25 patients; this was attributed to rifampicin, (15 cases); infectious hepatitis (three cases); INH alone, (three cases); IHN possibly exacerbating chronic liver disease, (two cases); and multiple drug treatment, (two cases). Central nervous system disorders (mainly peripheral neuropathy) due to INH occurred in 12 patients, all of whom were over the age of 40 years. Hypersensitivity to INH developed in 12 patients. Some difficulties in distinguishing hepatitis due to rifampicin from that due to INH are discussed. When the risk of hepatitis was compared with the risks of developing, or dying from, tuberculosis, it was found that the benefits of INH chemoprophylaxis outweighed the risks, particularly in patients who were less than 50 years of age.


Sarcoidosis in an Australia Aboriginal.

Sarcoidosis in an Australia Aboriginal. A case of sarcoidosis in a fullblood Aboriginal woman is reported. This condition appears not to have been recognized in Australian Aboriginals hitherto and some implications of this are discussed.


Diving injury resulting in tetraplegia.

Diving injury resulting in tetraplegia. This paper reviews the medical records of 100 consecutive patients with tetraplegia owing to diving injury. Their high survival characteristics, plus youth on presentation, create the problem of an expanding population of chronically disabled patients.


Nursing training in intensive care in a country hospital. Experiences with a training programme in intensive care in a country hospital are described. Difficulties in getting adequate numbers of trained persons to act as instructors can be partially overcome by the use of recorded tapes and manikins. The benefits of such a programme make it a worth-while venture for any similar unit.


Herpes simplex encephalitis: treatment with adenine arabinoside and cytosine arabinoside. A series of three infants with herpes simplex encephalitis is reported, together with details of treatment with adenine arabinoside and cytosine arabinoside. The former appears to be the most effective treatment available. A more aggressive approach is urged in the diagnosis and treatment of this serious infantile disorder.


Spontaneous pneumothorax. A review of 210 consecutive admissions to Royal Perth Hospital. A series of the 210 consecutive admissions of patients with spontaneous pneumothorax to a large teaching hospital over a five-year period, was reviewed and analysed with regard to age and sex of the patient, side of involvement, family history, association with exertion, association with respiratory tract disease, incidence of recurrence, method of management, duration of pleural cavity drainage, duration of hospitalization, and pattern of unit admission. Spontaneous pneumothorax was a disease of young males, with a peak incidence at 16 to 25 years of age. For the majority of patients it was an isolated event, with left-sided predominance. It was neither familial nor fatal, and most commonly occurred in the absence of a history of exertion or of clinical evidence of concurrent respiratory disease. The usual method of definitive treatment involved the insertion of an intercostal catheter and resulted in hospitalization for a period of up to ten days.


Acute myocardial infarction in women. The influence of age on complications and mortality. The prognostic implications of a past history of ischaemic heart disease, site of infarction, ectopic ventricular dysrhythmias (ventricular premature beats (VPB) more than one in 10 sinus beats, and/or ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular blocks (AVB), bundle branch blocks (BBB)) and the occurrence of electrical and/or mechanical complications during stay in the Coronary Care Unit (CCU) were analysed in 154 women with definte (WHO Class 1) acute myocardial infarction, admitted sequentially to the CCU over a four-year period. The prognosis in these women was then compared with the prognosis in a group which represented the general male population in the CCU and an age-matched group of men. The results showed that the long-term prognosis in women with acute myocardial infarction is remarkably similar to age-matched groups of men.


Roadside resuscitation: a simple kit.

Roadside resuscitation: a simple kit. Of the many car accident victims who die at the scene of the accident or during transit to hospital from anoxia or blood volume depletion, 20% need not do so. The resuscitative facilities of the casualty department can, to a considerable extent, be made available at the roadside by doctors who carry in the boots of their cars simple, well-organized equipment. This is invaluable too for other emergencies, such as cardiac arrest and drowning. A study has been made of the most useful, basic lifesaving equipment which can be readily available. The items which are recommended are simple and familiar and are contained in a case with a pliable, polyurethane insert which is designed to hold the components in accurate recesses.


Suburbia: a small obstetric hospital in Brisbane. In a small suburban obstetric hospital, during the period from July 1, 1963 to December 31, 1970, 3760 private and intermediate patients were delivered by suburban general practitioners. The number of perinatal deaths in hospital were nine deaths per 1000 births, both live and still. During the same period, 4873 private and intermediate patients were delivered by suburban general practitioners in the private/intermediate section of a large centrally sited obstetric teaching hospital. The number of perinatal deaths in hospital were 18.9 per 1000 births, live and still. The reason for, and the implications of, these results are discussed.


Gastric candidiasis.

Gastric candidiasis. A male, aged 60 with rheumatoid arthritis which was treated with prednisone, developed a severe symptomatic stomal gastritis at the site of a previous Polya partial gastrectomy. The endoscopic appearance of the lesion was similar to that of Candida infection, which is more frequently seen in the oesophagus. Candida albicans was cultured from biopsy specimens, and prompt resolution of the lesion and the patient's symptoms occurred with orally administered antifungal therapy. Primary gastric candidiasis should be considered in compromised patients with symptoms of infection of the upper part of gastrointestinal tract.


Behavioural sciences in medicine at the University of Sydney. The two-year preclinical course in Behavioural Sciences in Medicine at the University of Sydney is described. A brief history of the development of the department is followed by a description of the course objectives, and the way that these objectives are translated into course content. The supervision of assignment work in the community is considered to be an essential part of the department's work. Ongoing evaluation of the course contributes to its development and refinement.


[The concurrence of bronchial carcinoma and anthracosilicosis in the lung (concomitantly a contribution to "silicotic carcinoma in scar tissue of the lung")]. Among 4608 evaluated post mortem records (3452 miners with silicosis and 1156 miners without silicosis or nonminers resp.) 501 cases had developed a bronchial carcinoma. 425 of these observed cases showed a bronchial carcinoma together with silicosis, 76 cases were without anthracosilicosis. The occurrence of the bronchial carcinoma in case of anthracosilicosis did not depend on the time of employment in the underground mining industry. Neither was there a correlation between the determined grade of anthracosilicosis and the frequency of bronchial carcinoma. The diagnosis for 2,8% of these combined cases of anthracosilicosis and bronchial carcinoma was silicotic carcinoma of scar tissue. Statistically no signficant differences could be detected between the two groups of bronchial carcinomata with and without silicosis regarding age structure, kind of propagation and histological type of the bronchial carcinoma.


[Successful haemodialysis treatment of acute renal failure in a patient with multiple myeloma (author's transl)]. A case of multiple myeloma with severe osteolytic destructions and myeloma kidney is presented, in whom a rapidly progressive renal insufficiency because of hyponatraemia and dehydration developed. After 5 months of regular dialysis treatment diuresis increased and a sufficient global kidney function recurred. Aetiological factors and the pathomechanisms of acute renal failure in multiple myeloma are discussed. We assume that acute renal insufficiency is - in rare cases - at least partly reversible. Therefore patients with acute renal failure and multiple myeloma should not be excluded from haemodialysis treatment because even complete rehabilitation can be achieved.


[Correlations between metabolisms of magnesium, calcium and parathormon (author's transl)]. Serum- or plasma levels of 102 healthy individuals as well as 78 patients with chronic renal insufficiency of various degrees were tested for parathormon (PTH), calcium, magnesium, anorganic phosphate, alkaline phosphatase, kreatinin, total protein as well as magnesium concentrations of the erythrocytes; attempts were made to correlate these parameters with each other. As most important finding in healthy individuals a significant negative correlation could be observed between serum PTH and magnesium of erythrocytes, whereas patients with renal insufficiency had a marked elevation and significant positive correlation between these two parameters. Since all other correlations were not as striking, if compared to these findings, we concluded that a feedback regulation system may exist in the intracellular magnesium concentration and PTH metabolism, so that an increase of the intracellular magnesium stimulates the PTH secretion, whereas elevated PTH activity causes a decrease of the intracellular magnesium together with a depression of the PTH release.


[Coagulation factors and thrombocytes after application of Reptilase in the course of gynecologic operations (author's transl)]. Hemostasiologic effects of intravenous application of Reptilase were investigated in a randomized double blind study in the course of normal abdominal and vaginal hysterectomies. Coagulation factors and thrombocytes were checked before, after, 40 minutes after as well as 24 hours after the operation. Significant shortening of the clot observation time resulted 40 minutes after the injection of 1 ml Reptilase. A small but highly significant decrease of thrombocytes was observed 40 minutes after the end of the operation when Reptilase was injected. Further coagulation screening tests: Quick test, PTT and thrombin time were without statistically differences in both patients groups from the beginning till 24 hours after the operation. A significant decrease in Factor V concentrations resulted 40 minutes after the injection of Reptilase, whereas no changes were seen in the placebo patient group. Too, Factor XIII values and Antithrombin 3 concentrations decreased after the administration of Reptilase. There was no abnormal raise of fibrin-monomers in both groups. Enhanced fibrinolysis with elevated FDP-levels were measured in none of the cases. The administration of Reptilase induced a short lasting augmentation of blood coagulation but without any signs of disseminated intravascular coagulation.


[Mycoplasms in vagina and cervix in non-gonorrhoeal inflammatory disease of the pelvis (author's transl)]. Over a period of four years 110 patients with chronic recurrent inflammatory disease of the pelvis were treated in our special clinic of micrbiology. In 59 patients (53,6%) mycoplasms were isolated from vagina and cervix. In patients without inflammatory pelvic disease only in 21% of all cases mycoplasms could be detected. It is pointed out that mycoplasms may play a role in the etiology of chronic recurrent inflammatory disease of the pelvis.


[Diagnosis of candidiasis by means of Microstix-Candida]. The incidence of candidiasis was study in 115 mothers (vaginal) and their newborn infants (throat and fecal). Comparison studies employing Microstix-Candida and conventional Nickerson's media indicate a higher detection rate with the former. The detection of candida albicans in the newborn was obtained at an earlier time point and somewhat more frequently with Nickerson's medium.


[Diagnosis of yeast contamination in urine especially of patients with indwelling catheters (authors transl)]. Mycologic investigations of female patients with permanent catheters have shown that the yeast contamination detected in the urine depends on the time of catheterizing. Yeast from the genital and anal regions are the main sources of infection. Prophylactic therapy with antimycotic agents is recommended.


[Treatment of chronic arterial occlusive disease. Clinical study with a new galenic preparation of Pentoxifyllin (Trental 400) (author's transl)]. 26 patients suffering from arterial occlusive disease in the legs, stages IIa to IV according to Fontaine classification, and 7 patients with serious vascular disorders in the arm, were treated with daily 3- to 4 X 1 tablet Trental 400 (400 mg Pentoxifylline per tablet) over extended periods. In order to establish the therapeutic efficacy of the drug, influence on microcirculation (133Xenon-muscle clearance), poststenotic blood pressure (Doppler ultrasonic technique), oscillography, walking distance and alteration of clinical stage (following Fontaine classification) were studied. The medication resulted in a significant increase in muscular capillary flow whereby more affected legs showed better response than those initially less impaired. The poststenotic pressure increased significantly in initially more affected arteries and elevation of oscillographic amplitudes was found, too. The walking distance increased markedly, rest pain was removed and the clinical stage according to Fontaine classification changed on a linear scale from the more severe to the light stages of impairment. The patients with vascular disorders in the arms showed good improvement of their condition.


[Thrombotic arterial and venous obstructions under ancrod (Arwin) therapy (author's transl)]. 44 patients were treated with subcutaneous ancrod (Arwin) for peripheral arterial occlusive disease (Fontaine stage III). An acute fulminating arterial occlusion occurred in two patients on the 10th and 23rd days respectively, and in a third patient a deep venous thrombosis developed in the leg on the 45th day after beginning treatment. Accordingly, vascular occlusion must be expected during defibrination in the presence of poor peripheral drainage conditions and if the serum fibrinogen can no longer be maintained below 1.0 g/1 in spite of increasing the ancrod dosage. Under these circumstances the treatment must be terminated.


[Influence of dihydroergotamine and leg compression on the blood volume in different regions of the body (author's transl)]. After intravenous injection of 99mTc labelled autologous erythrocytes the radioactivity of a definite body-region is proportional to the local blood volume. By whole body scintigraphy it is possible to assess simultaneous changes of blood volume in different interesting regions. By this method the influence of 1 mg dihydroergotamine i.v. was investigated in 10 patients and of compression of both legs by inflatable leg cuffs (Jobst) with pressures of 25 and 40 mmHg (3,3 and 5,3 kPa) in 7 patients. After dihydroergotamine statistically significant decreases of blood volume were found in the legs and arms and increases in the thorax and liver. Over the abdominal region there was a statistically not significant decrease of blood volume. After leg compression a statistically significant decrease of blood volume in the legs and an increase in thorax, liver and abdomen were found. The arms showed a statistically not significant blood volume increase. The blood volume diminishing effect of dihydroergotamine in the legs was 20,4% in average, of a leg compression (25 mmHg=3,3 kPa) 33,4%. Contrary to the general opinion a reduction of blood volume was also found in legs with severe varicosis. The diminution of blood volume is even more intense in such cases than in normal legs. The results after dihydroergotamine are explained by its well known constrictor effect on the capacitance vessels in the extremities.


Changes in the liver lactate dehydrogenase isozyme profile after induced glycogenolysis. Treatment with cystamine, phlorrhizin or nicotinic acid, which induced liver glycogenolysis, resulted in the increase of liver lactate dehydrogenase activity. This increase was counteracted by the administration of cycloheximide or actinomycin D and coincided with the increase os isozymes 4 and 3 and the decrease of isozyme 5. The enhancement of liver lactate dehydrogenase activity and the changes observed in the isozyme profile were similar to those observed after starvation. These results suggest that the changes in the lactate dehydrogenase isozyme profile found after cystamine, phlorrhizin or nicotinic acid administration may be related to the glycogenolytic effect of these compounds. These result in an adaptation of the liver lactate dehydrogenase to gluconeogenesis.


[Photosynthesis as a prototype of solar energetics of new type. I. Chlorophyll apparatus of photosynthesis]. The hybridization of double-stranded regions of pre-mRNA from mouse Ehrlich ascites carcinoma cells, rabbit bone marrow cells and primary culture of rabbit kidney cells with an excess of total poly(A)+-mRNA of mouse or rabbit globin mRNA respectively was studied. The hybrids were detected as RNAase-stable acid precipitable material or by adsorbtion of the hybrid complexes of poly(U)-sepharose. The sizes of the hybrid complementary sequences and their thermal stability were estimated.


[Structure of DNA complexes with regular polypeptides]. The conformation of some regular polypeptides: (Lys-Ala)50, (Lys-Ala2)37, (Lys-Ala2)26, (Lys-Ala3)18, (Lys3-Pro)29, (Orn3-Gly)28 was studied by means of CD. The complexes of these polypeptides with DNA were obtained by the methods of jump-dilution of a two-components mixture from 2 M NaCl to 0.05 M NaCl. The extent of DNA covering by the polypeptides was compared using binding isoterms of ethidium on DNA and DNA-polypeptide complex. The length, L, which polypeptides cover on DNA was estimated by means of energy transfer between the dyes absorbed on the complexes. The CD spectra of the complexes revealed a high sensitivity to changes of the environmental conditions. Small variations in the temperature and ionic strength produces marked changes in the CD spectra of the complexes. It was suggested that observed CD changes are due to both the structural relaxation of the complexes and the existence of liquid-crystal domains in solution.


[Intracellular structures of influenza virus]. The intracellular influenza virus-containing structures involved in RNA synthesis in the cytoplasm and in the nucleoplasm of infected chicken fibroblasts were studied. Two approaches were used: (1) short pulse labeling of infected cell with [3H]uridine; (2) determination in vitro of polymerase activity of intracellular virus-specific structures. Both methods revealed functionally active virus-specific structures in the nucleoplasm and showed that a functionally active virus-specific structure was localized in the nucleoplasm of infected cells. This structure contained proteins of the viral ribonucleoprotein, but sedimented somewhat faster (at 60--90S in velocity sucrose and glycerol gradients). Meanwhile, polymerase-containing structures in the cytoplasm of infected cells sedimented in the position of viral ribonucleoproteins (25--60S).


[Structure of nuclear pre-mRNA. IX. Hybridization of double-stranded portions of pre-mRNA with excess mRNA]. The hybridization of double-stranded regions of pre-mRNA from mouse Ehrlich ascites carcinoma cells, rabbit bone marrow cells and primary culture of rabbit kidney cells with an excess of total poly(A)+-mRNA of mouse or rabbit globin mRNA respectively was studied. The hybrids were detected as RNAase-stable acid precipitable material or by adsorbtion of the hybrid complexes of poly(U)-sepharose. The sizes of the hybrid complementary sequences and their thermal stability were estimated.


[Reaction between calcium and different protein S-100 fractions]. The interaction between various fractions of neurospecific S-100 protein and calcium was studied by means of differential spectrophotometry. Fractions demonstrating "blue" and "red" shifts of the spectrum were detected. The change of conformation, occurring when calcium is bound, results in a redistribution of the protein in the double-phase system (polyetylenglycol-dextran), and the fractions, demonstrating the "blue" shift are transferred to the more hydrophobic phase (PEG), while fractions with the "red" shift move to the less hydrophobic phase (dextran). The existence of fractions with different reaction to calcium binding is discussed considering their participation in controling ionic permeability of neuronal membranes.


[Compact form of synthetic polynucleotides. Relationship between secondary structure and circular dichroism spectra]. The formation of compact particles from synthetic double- and triplestranded polynucleotides in water-salt solutions, containing poly(ethylene glycol) (PEG) has been investigated. CD spectra of compact particles are characterized by intense bands (positive or negative) in the region of 270 nm, compact particles being divided into two families--psi- and psi+--according to the CD band sign. The amplitude of the CD band at 270 nm increases with the increase of CPEG. Heating of a solution, containing compact particles, results in a disappearance of the CD band, the "melting" of compact particles as revealed by the CD method occuring prior to the melting of the secondary structure of the corresponding polynucleotide. It is concluded that intense CD bands, which are characteristic of the compact form of synthetic polynucleotides, arise (similar to the case of DNA or dsRNA) from regular arrangement of polynucleotide chains in compact particles. The question, concerning the relation between parameters of the secondary structure of polynucleotides and their belonging either to psi- or to psi+ family is discussed. The factors, which could account for the appearance of intense bands in CD spectra of compact particles are also considered.


[Several properties of complexes of polynucleotides with aromatic amino acid amides of oligonucleotides]. Residues of Phe, Tyr and Trp in the complexes of their oligonucleotide amidates and polynucleotides of A-U of G-C nucleotide composition are most likely localized in the minor groove of the Watson--Crick part of the triple helix where they interact with bases but do not intercalate into the helix. Formation of the complexes is accompanied with a change in the relative localization of amino acids and bases. The major geometrical parameters of the triple helices of the complexes are not changed by the residues of aromatic amino acids (according to CD data). A slight violation of stacking interactions between bases is observed along with an increase of the cooperativity of melting of the complexes of A-U composition (according to UV absorption data). The effect of the residues of aromatic amino acids on the stability of triple helices is determined by the nucleotide composition of the latter, i.e. complexes of A-U composition are destabilized with the Phe, Tyr and Trp residues, whereas the Trp residue does not affect the stability of the complexes of G-C composition. The hydrophobic character of aromatic amino acids and their different affinity for bases of different structure seem to account for this difference in stability. The dependence of the thermal stability of RNH-dp(An).2poly(U)-complexes on the structure of the amide radical (residues of glycin, aromatic amino acids, alkyl- and arylalkyl amines) testifies the ability of the radical to "regulate" the interaction between the oligomer and the complementary polynucleotide. This capacity for "regulation" is not observed in the system of G-C composition.


[Possible mechanism of cooperative control in polyenzyme systems]. A mathematical model of an anabolic multienzyme system and its function mechanism is considered. The first substrate in this kind of biochemical system may be binded to its active site, provided the last product was released out of the system. The functional control is assumed to be exercised by cooperative rearrangement of the protein structure. Any intermediate or product molecule if present within the system, induces conformational changes in the entrance center of the multienzyme system, preventing the initial substrate binding. The steady-state product synthesis rate in such a system is determined by joint influence of rate constants at all stages of the reaction chain. The model corresponds closely to the multienzyme system of chlorophyll biosynthesis in higher plants. Essential advantages of cooperative controlled multienzyme systems in regulation of biochemical processes are discussed.


[Oligonucleotides and their analogs. III. Circular dichroism and conformation of analogs cytidylyl-(3'--5')-adenosine]. The CD spectra of 11 analogues of CpA, containing modified carbohydrate residue, achiral hydroxyalkyl- and optically active hydroxymethylene substituents have been studied. On the basis of the dependence of the CD spectra on temperature, the constants of U in equilibrium S equilibria and thermodynamic parameters in the approximation of dilute solution was calculated. The calculation was carried out on a computer in the terms of a two-state model. The influence of the modifications of the carbohydrate on the stability of the S-conformation is discussed. The CD spectra of S-conformation was calculated and the assumption of the origin of oligonucleotides CD is considered. Possible mechanisms of how water participates in the stabilization of the S-conformation of dinucleoside phosphate are analyzed.


[Physico-chemical study of the nucleic acid of bacteriophage phiB]. A study of physico-chemical properties of the nucleic acid of phage Brevibacterium flavum was made. It was found that the phage nucleic acid is a double-stranded DNA. The content of GC pairs was determined by the temperature of DNA melting and by the chromatographic method. In both cases it was (52 +/- 2) mole %. It has been shown that endonuclease Eco RI treatment of phiB DNA forms 12 fragments. The molecular weight of phiB DNA has been determined by two independent methods: by measuring the contous length of DNA and by the sum of molecular weights of DNA restricts obtained after hydrolysis by endonuclease Eco RI and was found to be (30 +/- 1) . 10(6) dalton. Electron microscopy investigations detected rod and circular DNA in either monomeric or dimeric forms. The polarity of DNA arrangement in the phiB phage particle was determined by using the partial denaturation maps.


[Irreversible secondary structure changes in concentrated aqueous solutions of DNA]. "Aqueous" and "electrolytic" solutions of DNA from chicken erythrocytes different concentrations of NH4Cl have been investigated. Solutions of the first type were prepared from concentrated aqueous solutions of DNA and the second type solutions by solving a solid DNA in a supporting electrolyte. Studies of the melting curves showed that even the concentrated aqueous solutions of DNA were not completely native. The changes of the secondary structure of DNA caused by solving in deionized water are irreversible. This is confirmed by the abnormal dependence of melting temperatures of DNA on the ionic strength of aqueous solutions that is not characteristic for electrolytic solutions, that is not characteristic for electrolytic solutions. It has been shown that the type of dependence of the melting temperatures on the ionic strength is a more precise test of the secondary structure of DNA than a molar extinction or hyperchromic koefficient.


[Helix-globule transitions of polypeptides selectively reacting with the interface]. An analytical theory of helix-coil transitions for polypeptides in a solution near a flat and homogeneous interface is given. The following cases were considered: a) only the helical parts are absorbtively active; b) only the coiled sections of the chain are active in adsorption. It has been shown that the binding of the polymer chain to the surface is a result of a phase transition of a second order, moreover in case a) the presence of a secondary structure abruptly increases the ability of the macromolecules to bind to the interface. This largely increases the stability of the helical structure of the chain and leads to a practically complete spiralization of the macromolecule. The profile of the conformational transitions was strictly asymmetrical which is typical for the phase transitions. In case b) the process of binding resembles the adsorbtion of the Gaussian coils. In this case the rate of spiralization of the chain decreases in the course of binding and the degradation of the secondary structure is significant even if the helical state in volume is stable. The profile of the transition remains qualitatively similar to the helix-coil transition in volume but is displaced to the region of larger equilibrium constants.


[Acrodermatitis enteropathica (author's transl)]. In connection with the clinical observation of their five patients suffering from AE the authors summarize current questions related to this disease. They examined the function of the cellular immunity in this disease. They call attention to dangers of oxychinoline treatment, and to benefits of zinc administration. They established that the introduction of zinc therapy indicates a progress in the treatment of AE.


[A case of cobalamin-dependent methylmalonic acidemia. Biochemical aspects, diagnosis and possible treatment (author's transl)]. A case of methylmalonic acidemia with intermittend homocystinuria is described. Special attention is given to the early symptoms of this inborn error of metabolism, like lethargy, muscular hypotony, poor feeding, ketoacidosis, and recurrent vomiting. Furthermore, the necessary diagnostic steps, the pertinent differential diagnosis (septicemia, duodenal stenosis, other inborn errors of metabolism), and the possible treatment are discussed.


[Incidence of iron deficiency in a sample-population of Frankfurt children (author's transl)]. Using customary hematological and biochemical criteria, peripheral iron deficiency was observed, depending on age, in 12-51% and anemia in up to 6%, in a sample of 337 children (age: 4 4 months to 10 years). The majority of children were well nourished. Since iron deficiency occurs even in these children, it appears to be important to study this situation in underpriviledged German children as well. Even after peripheral iron deficiency was excluded, hemoglobin concentration varied significantly with age. This has to be considered in order to avoid unnecessary iron medication, that, according to recent findings, could cause adverse effects. The data presented here, do not as yet justify a general iron fortification program for all infants in Germany. Iron research should be directed toward the relationship of iron nutrition and iron-related blood chemistry of children on the one hand, and general criteria of functional capacity, morbidity, and longivity on the other. It will only be possible to give rational definitions of what are normal iron and hemoglobin concentrations in childhood, when we know more about these relationships.


[Radiotelemetric studies on heart rates of 10 year old boys and girls during a 3000 m-run on the sports field and on the treadmill (author's transl)]. The behaviour of heart rates of 25 untrained boys and 25 untrained girls between 9.5 and 10.5 years of age was registered telemetrically before, during and after a 3000m-run with a finish on the sportsfield and during a run over the same distance with the equivalent but constant speed on a treadmill. Additionally an exhausting spiroergometric test on a bicycle in a sitting position (method: W/kg body weight) was carried out. With a self-determined intensity the boys passed the 3000 m-distance in a shorter time than the girls. During the run the girls' heart rates remained relatively constant between 190 and 204 per min, whereas the boys' heart rates were significantly lower (about 10/min). Children with a higher relative oxygen capacity (56 ml O2/kg) run faster and revealed lower heart rates than children with less relative oxygen capacity (39.8 ml O2/kg). The same results were obtained when children with lower body weight were compared to heavier children of the same size.


[Diabetes insipidus, diabetes mellitus, optic nerve atrophy, and deafness--an autosomal recessive syndrome (didmoad-syndrome) (author's transl)]. By reporting a further case attention is drawn to the autosomal recessive inherited DIDMOAD-syndrome. While diabetes mellitus and optic atrophy are easy to recognize, one often has specifically to look for deafness, diabetes insipidus and the frequently associated dilatation of the urinary tract. Awareness of this condition is important for genetic counselling and vocational guidance, and allows to avoid invasive neuroradiological investigations.


[Treatment of abdominal liposarcoma in children (author's transl)]. A patient with abdominal liposarcoma is described, and the treatment of this in children extremely uncommon tumor is discussed. After complete surgical excision, local irradion with 5000-6000 rad should be considered only if no vital organs are irradiated. Because of the high tendency for local recurrence and for distant metastases of this tumor a primary polychemotherapy beginning immediately after surgical excision is proposed as in cases of other solid tumors in children for instance rhabdomyosarcoma or fibrosarcoma. 18 months after the surgical excision and after the beginning of polychemotherapy our patient is clinically well without demonstrable tumor growth.


[Waardenburg's syndrome. Four cases in an Iranian family (author's transl)]. 4 cases of Waardenburg's syndrome in an Iranian family are presented and discussed. The patients, a 34-year-old father with his 6-month-old and 3-year-old sons and 2-year-old daughter, show symptoms of this syndrome in varying degrees of expression except for deafness.


Repair of UV-induced damage in wild-type and mutant strains of Schizophyllum commune. The basidiomycete fungus Schizophyllum commune was found to have both photo-repair and dark-repair systems for UV-induced damage. Three UV-sensitive mutants were isolated and characterized for ability to repair UV-induced damage in light and dark, and for cross-sensitivity to caffeine and methyl methanesulfonate. Two of the mutants were damaged, to different extents, in their capacity for excision repair; one of these mutants was also probably damaged in post-replication repair. The third mutant was damaged only in post-replication repair.


Mutation in continuous cultures of Schizosaccharomyces pombe II. Effect of amino acid starvation on mutational response and DNA concentration. In agreement with the results obtained in Escherichia coli by other workers and our own previous data, the kinetics with which spontaneous mutations to resistance to the 12,13-epoxytrichothecene trichodermin accumulate in a lysine auxotroph of Schizosaccharomyces pombe are dependent upon the nutrilite used to limit the growth of the population. Under conditions of glucose-limitation mutation accumulation is proportional to generation time, while under lysine-limitation it becomes proportional to chronological time. In contrast to observations made in bacterial system, however, no significant change in the DNA content per cell is noted in slow growing cultures grown under amino acid starvation. These findings help to eliminate some of the theories put forward to explain the differential mutational responses observed under different growth limiting regimes.


Inhibition of post-replication repair by isonicotinic acid hydrazide. In the presence of the alkylating mutagen N-methyl-N-nitrosourea (MNU), the well-known tuberculostatic ionicotinic acid hydrazide (INH), even in otherwise ineffective doses, depressed cell number and mitotic index in peripheral human lymphocytes and inhibited the post-replication repair process in Chinese hamster cells (CHO). INH had no influence on unscheduled DNA synthesis (cut-and-patch repair), which was negligible in CHO cells under our conditions.


Caffeine-inhibited DNA repair in 7-bromomethylbenz (a)-anthracene-treated Chinease hamster cells: formation of breaks in parental DNA and inhibition of ligation of nascent DNA as a mechanism for enhancement of lethality and chromosome damage. The cytotoxic and clastogenic effects of 7-bromomethylbenz(a)anthracene (7-BMBA) are potentiated by post-treatment incubation of cells in the presence of an non-toxic concentration of caffeine. Under these conditions caffeine inhibits the rate of ligation of newly-synthesised DNA and induces breaks in the template strand of DNA. It is proposed that endonucleolytic attack occurs at the site of lesions in the template strand of DNA and that a later step(s) of excision-repair is (are) inhibited by the presence of caffeine-induced 'gap' in the nascent DNA opposite these lesions.


The detection of mutation in human diploid fibroblasts after mutagen treatment using non-selective cloning and enzyme electrophoresis. In an attempt to study mutagenesis in human diploid fibroblasts, clones derived from mass cultures treated with mutagen have been examined by starch-gel electrophoresis for 43 different enzyme loci. A technique of mutagen treatment was devised which facilitated the cloning and which enabled the cells to be exposed to very high doses of EMS and MNNG. Two alterations in phenotype, presumably the result of mutation, were observed, one involving peptidase D (PEPD) and the other phosphoglucomutase (PGM1).


Lidocaine kinetics predicted by indocyanine green clearance. To evaluate the importance of hepatic blood flow in lidocaine kinetics, we compared indocyanine green clearance, an estimate of hepatic plasma flow, to lidocaine clearance in 26 patients, half with and half without congestive heart failure, who received a lidocaine infusion for 24 hours as clinically indicated. The results demonstrated that patients with congestive heart failure had significantly higher steady-state lidocaine levels (6.8 +/- 3.6(S.D.) vs. 2.9 +/- 0.9 microgram per milliliter, P less than 0.005) and reduced lidocaine clearance (3.8 +/- 1.4 vs. 10.9 +/- 3.1 ml per minute per kilogram, P less than 0.005) than patients without heart failure. Potentially subtherapeutic or toxic lidocaine levels were found in 10 patients. The regression line (y = 0.3 + 1.07 x) relating clearance of lidocaine to that of indocyanine green was linear (r = 0.95, P less than 0.001). Since indocyanine green clearance can be determined rapidly and noninvasively, it offers the potential of predicting lidocaine dosage requirements with avoidance of toxicity or suboptimum therapy.


Extreme insulin resistance in ataxia telangiectasia: defect in affinity of insulin receptors. The syndrome of ataxia telangiectasia is associated with glucose intolerance and insulin resistance. We examined the status of insulin receptors on circulating monocytes and on cultured fibroblasts from two siblings with ataxia telangiectasia and severe insulin resistance. 125I-insulin binding to monocytes of the two patients consistently demonstrated an 80 to 85 per cent decrease in receptor affinity. In contrast, the defect in receptor affinity was not expressed on the patients' cultured fibroblasts or on monocytes or fibroblasts obtained from unaffected family members. Whole plasma and immunoglobulin-enriched fractions of plasma from the patients inhibited the normal binding of insulin to its receptors on cultured human lymphocytes (IM -9 line) and on human placental membranes. We conclude that the insulin resistance in the two siblings with ataxia telangiectasia was associated with defects in the affinity of the receptors for insulin, probably caused by circulating inhibitors of insulin binding.


A follow-up study of vascular disease in growth-hormone-deficient dwarfs with diabetes. Thirty-one growth-hormone-deficient dwarfs were re-examined after a period of 10 to 12 years. These subjects had initially shown glucose intolerance, insulinopenia and hyperlipidemia comparable to those of diabetic patients matched for age and sex, but vascular complications were not present in dwarfs. After 10 years glucose tolerance became progessively more abnormal in dwarfs than could be accounted for by expected deterioration with age, and hyperglycemia after mixed meals remained greater than in control subjects. Serum lipid and serum lipoprotein concentrations were abnormal in over one third of the dwarfs. Despite the metabolic similarity to the diabetic patients, clinical complications of diabetes were absent in dwarfs: retinopathy did not occur, and the prevalence of hypertension and arteriosclerosis was considerably lower in dwarfs than in the diabetic subjects in both study periods. The follow-up data support the hypothesis that growth hormone has at least a supportive role in the pathogenesis of vascular disease in the diabetic state.


The relation between estrogen receptors and response rate to cytotoxic chemotherapy in metastatic breast cancer. In a retrospective study we determined the relation between estrogen receptors and the response rate to cytotoxic chemotherapy in 70 patients with metastatic breast cancer. Thirty-four of 45 patients with low or absent estrogen-receptor values (less than 10 fmol per milligram of cytoplasmic protein) had objective responses to chemotherapy, whereas only three of 25 patients with higher values (greater than 10 fmol per milligram of cytoplasmic protein) responded (P less than 0.0001). There were no statistically significant differences between the two groups in age, menopausal status, disease-free interval, Karnofsky index or prior therapy. Differences in sites of involvement or type of chemotherapy did not account for the increased response rate in receptor-negative patients. We conclude that estrogen-receptor values are an important predictor of response to cytotoxic chemotherapy in metastatic breast cancer.