Studies on an acetate-fermenting strain of Methanosarcina. An acetate-fermenting strain of Methanosarcina was isolated from an acetate enrichment culture inoculated with anaerobic sludge from a waste treatment digestor. In pure culture, this organism fermented acetate in the absence of added hydrogen at rates comparable in magnitude to those found in digestor systems. This rate was significantly higher than previously obtained for pure cultures of this genus. Mineral components of yeast extract were highly stimulatory for cultures growing on methanol. Comparable stimulation was not observed for cultures growing on acetate. Labeling studies indicated that acetate was converted to methane and CO2 as predicted by previous studies on mixed cultures. Total oxidation or reduction of acetate was not the mechanism of conversion of acetate to methane by the pure culture. The ability of this strain to form colonies or to produce methane from acetate was apparently influenced by the choice of substrate and conditions used for growing the inoculum.


Methanogenesis from acetate: a nonmethanogenic bacterium from an anaerobic acetate enrichment. A methanogenic acetate enrichment was initiated by inoculation of an acetate-mineral salts medium with domestic anaerobic digestor sludge and maintained by weekly transfer for 2 years. The enrichment culture contained a Methanosarcina and several obligately anaerobic nonmethanogenic bacteria. These latter organisms formed varying degrees of association with the Methanosarcina, ranging from the nutritionally fastidious gram-negative rod called the satellite bacterium to the nutritionally nonfastidious Eubacterium limosum. The satellite bacterium had growth requirements for amino acids, a peptide, a purine base, vitamin B12, and other B vitamins. Glucose, mannitol, starch, pyruvate, cysteine, lysine, leucine, isoleucine, arginine, and asparagine stimulated growth and hydrogen production. Acetate was neither incorporated nor metabolized by the satellite organism. Since acetate was the sole organic carbon source in the enrichment culture, organism(s) which metabolize acetate (such as the Methanosarcina) must produce substrates and growth factors for associated organisms which do not metabolize acetate.


Rapid qualitative method for detecting staphylococcal nuclease in foods. A rapid method for the detection of heat-stable staphylococcal nuclease in foods is described. The procedure consists of an acid precipitation, boiling, and centrifugation followed by enzyme detection in an agar plate containing deoxyribonucleic acid. To test the efficacy of the procedure, purified Staphylococcus aureus nuclease was added to various foods and recovery experiments were performed. Additionally, foods were inoculated and incubated with S. aureus, and the staphylococcal counts were compared with nuclease activity. The results indicate that the procedure possesses merit for a rapid method that can be incorporated into quality control programs. The procedure requires approximately 2.5 h, and it will detect nuclease levels as low as 10 ng/g of food.


Isolation of an enteropathogenic, Kanagawa-positive strain of Vibrio parahaemolyticus from seafood implicated in acute gastroenteritis. A strain of Vibrio parahaemolyticus, serotype O4/K4, that was Kanagawa positive and reactive in the rabbit ileal loop test, was isolated in low numbers from raw oysters implicated in a case of acute gastroenteritis. To our knowledge, this is the first report of the isolation of a Kanagawa-positive strain from suspect food in the United States.


Long-range air transmission of bacteria. Bacterial spores from a sandstorm area north of the Black Sea were transmitted to Sweden by air, giving increased concentrations of viable bacterial spores at two air sampling stations in Sweden.


Comparison of selective media for coagulase-positive enterotoxigenic Staphylococcus aureus. Different culture media were used to detect enterotoxigenic Staphylococcus aureus strains from peptone salt solution and inoculated minced meat. When recovery, reactions, and counting mistakes were considered, it was concluded that Baird-Parker agar was the best medium.


Distribution of ribonucleic acid coliphages in south and east Asia. We investigated the distribution of ribonucleic acid (RNA) coliphages in the Philippines, Singapore, Indonesia, India, and Thailand by collecting sewage samples from domestic drainage in November 1976. Of the 221 samples collected from domestic drainage, 50 contained RNA phages (52 strains). By serological analysis, 46 of the 52 strains were found to belong to group III. It can thus be said that the most prevalent RNA phages in Southeast Asia (at least, in the Philippines, Singapore, and Indonesia) were group III phages. Investigations of sewage samples collected from domestic drainage in Japan indicate that the most prevalent RNA phages in mainland Japan (north of Kyushu) are group II phages, whereas group III phages are predominant in the southern part of Japan (south of Amamiohshima Island). We therefore propose a borderline between Kyushu and Amamiohshima Island for the geographical distribution of RNA coliphages in the domestic drainage of South and East Asia. Moreover, one strain (ID2) was inactivated to some extent with the antisera of four groups of RNA phages. This is thought to be significant from the evolutionary viewpoint.


Reticulate pigmented anomaly of the flexures. Dowing Degos disease, a new genodermatosis. Acquired reticulate pigmentation of the flexures developed in ten patients. Additional features in some cases were pitted scars near the angles of the mouth and scattered dark comedone-like lesions on the neck (dark dot follicles). The disease affects both sexes, usually develops in early adult life, and is slowly progressive. The abnormality is characterized by pigmented filiform epidermal downgrowths closely resembling an adenoid seborrheic wart, but similar proliferations also develop around the variably dilated pilosebaceous follicles. The occurence of the anomaly in siblings and in mother and daughter in two families suggests the condition in a new genodermatosis. Reticulate pigmented anomaly of the flexures bears a spurious clinical resemblance to acanthosis nigricans and, thus, the recognition of this new genodermatosis should spare patients undergoing unnecessary investigations to exclude visceral malignancy.


Cutaneous sinus tracts of dental origin. The most common etiologic factor responsible for the intermittently suppurating cutaneous sinus tract about the face and neck is the extension of chronic infection of dental origin. Complete healing invariably follows the eradication of this source of infection. The presence of a cutaneous sinus tract about the face and neck should alert members of the profession to the necessity of routine dental examination including roentgenographic surveys of the teeth and jaws.


Percutaneous absorption of topically applied triamcinolone in children. The real and potential problems associated with the percutaneous absorption of topically applied corticosteroids have been used as an argument against the prolonged administration of these drugs. Many pediatricians and dermatologists consider children to be more likely to absorb substantial quantities of topically applied corticosteroids than adults. This study examines the percutaneous absorption of 0.1% triamcinolone acetonide ointment applied four times a day for a period of six weeks to patients with severe atopic eczema. The results of 8 AM and 4 PM plasma cortisol and 24-hour urinary cortisol determinations do not indicate any notable adrenal suppression. No patient had an 8 AM cortisol value that would be considered in the abnormal range. These results indicate that the use of a medium-strength topical corticosteroid for this length of time probably poses no noteworthy hazard from percutaneous absorption.


Angiolymphoid hyperplasia with eosinophilia. Angiolymphoid hyperplasia with eosinophilia is manifested by benign vascular tumors that usually occur about the head in young adults. Clinical and histologic variation of this process has resulted in nosologic confusion, and the cases in the English literature were reviewed to characterize it within racial groups. Oriental patients tend to be younger at onset, usually male, and have marked blood eosinophilia; large, but relatively asymptomatic, tumors develop in these patients. White patients tend to be older at onset and have small, friable tumors. Large tumors that are painful or pruritic tend to develop in blacks and Middle Eastern patients.


Development of photosensitivity and an SLE-like syndrome in a patient with psoriasis. An unusual case of photosensitive psoriasis and systemic lupus erythematosus-related syndrome was characterized by erythroderma, chronic urticaria, angioneurotic edema, intermittent low-grade fever, and polyarthralgias. Investigation revealed no measurable total hemolytic complement and markedly diminished levels of C4, C2, and C3. Microscopic examination of three skin biopsy sections of sun-exposed skin showed psoriasis. Skin biopsy sections of sun-exposed psoriatic plaques and of non-sun-exposed, uninvolved skin (which were stained with fluorescein-tagged anti-IgG, anti-IgM, anti-IgA, and anti-C3) showed granular deposits of IgM and C3 at the dermal-epidermal junction in the sun-exposed plaques, and IgM alone in a granular pattern at the dermal-epidermal junction in uninvolved skin. Antibodies to single-stranded but not double-stranded DNA were detected in the patient's serum. In addition, serum immune complex-like material was detected by sucrose density-gradient ultracentrifugation, standard anticomplementary assays, and radioimmunoassays using both C1q and monoclonal rheumatoid factor.


Incontinentia pigmenti. Evidence for both neutrophil and lymphocyte dysfunction. A child with incontinentia pigmenti (Bloch-Sultzberger syndrome) had recurrent pneumococcal meningitis and pneumococcal bacteremia with associated subdural hematomas. Immunologic evaluation revealed defective neutrophil chemotaxis with normal neutrophil chemiluminescense. In addition, lymphocytes showed a depressed proliferative response to phytohemagglutinin stimulation. An immunologic defect may prove to be part of this syndrome.


Hydroa vacciniforme.

Hydroa vacciniforme. Two patients with hydroa vacciniforme, a rare photodermatosis of unknown etiology, demonstrated distinctive scarring and vesiculobullous skin lesions on light-exposed body areas. Results of blood and urine porphyrin studies were normal, and no systemic abnormalities were noted. A small bullous lesion was produced in normal skin in case 1 with 15 times the minimal erythema dose of ultraviolet energy. The conditions of both patients improved while they were taking beta carotene orally.


Isolated nodular cutaneous histoplasmosis. The initial manifestation of recurrent disseminated disease. Cutaneous manifestations of histoplasmosis may be divided into primary and secondary lesions. Primary cutaneous histoplasmosis is rare; to our knowledge, there are only three reported cases in the literature. Secondary cutaneous histoplasmosis develops during the course of disseminated disease. An isolated nodule of the hand was the initially appearing sign of recurrent disseminated disease in our patient. Because of the extreme rarity of primary cutaneous histoplasmosis, cutaneous lesions that are proven to be due to histoplasmosis should alert the physician to the presence of disseminated disease.


Mycetoma-like infection caused by previously undescribed bacterium. A 56-year-old man had a verrucous plaque with draining abscesses on the dorsum of hir foot for four years. Examination of cultures revealed a Gram-negative bacterium that, to our knowledge, has not been described in the literature. The infection was cured by treatment with co-trimoxazole (trimethoprim and sulfamethoxazole) and topical 10% lactic acid in hydrophylic emulsion base.


Cheilitis granulomatosa. Successful treatment with combined local triamcinolone injections and surgery. Cheilitis granulomatosa is a rare condition that has traditionally proved difficult to treat satisfactorily. Excellent results were obtained in our case with local triamcinolone acetonide injections and surgery. Histopathologic features of the classic, untreated condition were reviewed and compared to the histopathologic features of labial tissues after a seris of triamcinolone injections. It was found that the injected medication was effective in achieving some reduction of labial volume, apparently through a necrotizing effect of granulomas with subsequent replacement by fibrous scars. Discontinuation of local injections after initial surgery apparently contributed to an exacerbation, as shown by the histopathology of a second cheiloplastic procedure. We therefore recommended that patients with chelitis granulomatosa who are receiving combinaed triamcinolone-surgical therapy continue to receive local triamcinolone injections after surgery in order to minimize the tendency for recurrence.


Oral treatment of keratosis follicularis with a new aromatic retinoid. Four patients with extensive keratosis follicularis (Darler's disease) showed excellent clinical response to the oral administration of a new aromatic derivative of retinoic acid (RO 10-9359). Initial oral treatment with 50 to 75 mg of the drug was followed by substantial improvement in four to seven days and the lesions cleared completely after three to four weeks. Long-term treatment with 25 to 30 mg/day was sufficient to prevent recurrence. No serious side effects were seen with this dosage after several months. Some dryness of the lips and the nasal mucosa occurred and one patient experienced slight nausea. Histological investigations showed the gradual disappearance of acantholysis, dyskeratosis, and hyperkeratosis, in this order. The given therapeutic schedule is a reliable routine management for keratosis follicularis in adults.


Phenylketonuria and scleroderma.

Phenylketonuria and scleroderma. Two mentally retarded siblings, one with severe segmental scleroderma and the other with atrophoderma of Pasini and Pierini, were found at the ages of 6 and 10 years to have phenylketonuria (PKU). The belief that a common pathomechanism exists between morphea and atrophoderma of Pasini and Pierini is supported by the case of the two siblings. Disorders in tryptophan metabolism can occur in both PKU and scleroderma. For a low phenylalanine diet to be effective in PKU, it has to be instituted at an early age. Phenylketonuria should be considered in infants and children with sclerodermatous skin lesions.


Endrin and malathion toxicity to flagfish (Jordanella floridae). Endrin and malathion effects on survival, growth, and reproduction of flagfish were determined in a flow-through system. Endrin chronic effects on first-generation growth and reproduction occurred only at 0.3 microgram/L, the highest concentration tested. The mean endrin residues in the first-generation fish at 65 days were about 15,000 times the water concentration in all concentrations tested. Malathion concentrations of 31.5 microgram/L and 24.7 microgram/L, the highest concentrations tested, had detrimental effects on first-generation survival. During the same period malathion concentrations as low as 10.9 microgram/L significantly affected growth. Neither insecticide, at the concentrations tested, had any detectable effects on the second generation during a 30-day exposure period. Acute toxicities to juvenile fish were also determined in the same flo-through system. The 96-hr LC50's were 0.85 microgram/L for endrin and 349 microgram/L for malathion.


Arsenic in sediments, water and aquatic biota from lakes in the vicinity of Yellowknife, Northwest Territories, Canada. Arsenic concentrations were measured in aquatic invertebrates, macrophytes, sediments, and water of lakes in the vicinity of Yellowknife (N.W.T.), Canada. In arsenic-contaminated lakes the arsenic concentration ranged from 0.70 to 5.5 ppm in water, 6 to 3,500 ppm in bottom sediments, 150 to 3,700 ppm in macrophytes, 700 to 2,400 ppm in zooplankton, and less than 1 to 1,300 ppm in other invertebrates. The arsenic concentration in invertebrates varied with sampling time, place, and taxon. Arsenic concentration factors were calculated, and found to decrease with increasing concentration of arsenic in ecosystem components of the lake. No evidence was found for biomagnification of arsenic through ascending trophic levels. In high-arsenic lakes herbivores had the highest arsenic concentrations, and omnivores the lowest. Pelecypoda, Ephemeroptera, Amphipoda, and Hirudinea were conspicuously absent from high-arsenic lakes. These particular organisms may be more susceptible to the effects of arsenic than others.


The effect of malathion on the temperature selection response of the common shiner, Notropis cornutus (Mitchill). Warm- (17 degrees C) and cold-acclimated (8 degrees C) young-of-the-year, 1-year-old, and 2-year-old common shiners, Notropis cornutus (Mitchell) were exposed for 24 hr to sublethal doses (1.0, 0.25, and 0.05 microgram/L) of malathion to determine the effect of environmental concentrations of this compound on temperature selection. All three factors studied (acclimation temperature, age, and concentration) were found to affect the temperature selection response of malathion-treated fish. Malathion produced dose-dependent decreases in selected temperature (1.9 degrees to 4.3 degrees C below controls) in 17 degrees C-acclimated fish but not in 8 degrees C-acclimated fish. Two-year-olds treated with 1.0 microgram/L displayed the greatest lowering of selected temperature, followed by two-year-olds treated with 0.25 micrgram/L. One-year-olds treated with 1.0 microgram/L showed a slight lowering, while no downward shifts in selected temperature were found for young-of-the-year. Exposure to 0.05 microgram/L had no effect on any age group. Two-year-olds acclimated to 17 degrees C and exposed to 1.0 microgram/L malathion for 24 hr were placed in clean water and allowed to recover from the pesticide. It was found that the lowered selected temperature induced by malathion returned to that of the controls in 24 hr.


Distribution and elimination of naphthalene and 2-methylnaphthalene in rainbow trout during short- and long-term exposures. The accumulation and elimination of 14C in rainbow trout tissues following short- and long-term exposures to aqueous 14C-naphthalene or 14C-2-methylnaphthalene were studied. After exposure for eight hr to 0.005 mg/L or 0.023 mg/L of 14C-naphthalene most tissues of fingerling rainbow trout studied contained 14C at 20 to 100 times the water levels while fat and bile contained 14C at several hundred times water levels. The half-lives for elimination of 14C from all tissues except fat were less than 24 hr. Exposure of fingerling rainbow trout to 14C-naphthalene or 14C-2-methylnaphthalene for four weeks in a continuous-flow delivery system resulted in maximum tissue levels of these chemicals of from 40 to 300 times the water concentration. Maximum bile 14C levels were 13,000 and 23,500 times the water concentration for 14C-naphthalene and 14C-2-methylnaphthalene exposure, respectively. Elimination of 14C accumulated from 14C-naphthalene in this long-term exposure was much slower than after short-term exposures, while elimination of 14C accumulated from 14C-2-methylnaphthalene was biphasic. The presence of parent compounds and metabolites in acetone extracts of muscles was determined by TLC. The data suggest that the biphasic release of 14C from muscle of trout exposed to 14C-2-methylnaphthalene may be due to differential elimination of parent compound and metabolites.


Residues of atrazine and N-deethylated atrazine in water from five agricultural watersheds in Québec. Atrazine (2-chloro-4-ethylamino-6-isopropylamino-s-triazine) and N-deethylated atrazine (2-chloro-4-amino-6-isopropylamino-s-triazine) were monitored (1974 and 1975) in five rivers which drained agricultural areas in the Yamaska river basin of Québec. Water samples were collected frequently from April to December each year from sites near the outflow of each river. The water samples were extracted with benzene, chloroform, or ethyl acetate and the extracts were analyzed by gas chromatography using a Hall electrolytic conductivity detector and an alkali-flame detector. Atrazine and N-deethylated atrazine residues ranged in concentration from 0.01 to 26.6 microgram/L and less than 0.01 to 1.34 microgram/L, respectively, over the monitoring period. The highest levels of atrazine were observed in July each year and they coincided with the herbicide spraying season in this region and with occasional heavy rainfall events. Discharges (kg/yr) of atrazine from the five rivers were related to corn-growing area in each watershed. Losses of atrazine ranged from 0.1 to 2.9% of the atrazine that was estimated to have been applied in each watershed.


Dieldrin-14C elimination from turkeys.

Dieldrin-14C elimination from turkeys. A series of experiments were conducted to find ways of removing dieldrin2 residues from tissues of broiler-type turkeys (Meleagris gallopavo). The turkeys were contaminated with dieldrin and dieldrin-14C by oral dosing. Elimination was measured by assaying for 14C in the droppings. Carcass retention was measured by assaying the tissue for 14C, and in one experiment, dieldrin residues were measured by electron capture gas-liquid chromatography. Charcoal, Colestipol, and cholestyramine at dosages approximately equal to an intake of 5% of the diet were ineffective gastrointestinal adsorbants for removing dieldrin residues from the turkeys. Starvation accelerated the elimination of dieldrin from the turkeys, but only if the body lipids were reduced to approximately 10% or less of the carcass dry matter.


Relationship between theophylline-induced relaxation and excitation-contraction coupling in intestinal smooth muscle. The effects of 1.0 to 10.0 mM theophylline on excitation-contraction (E-C) coupling in the taenia coli of the guinea-pig were observed with the sucrose-gap technique. Theophylline at all concentrations simultaneously inhibited spontaneous, calcium-dependent action potentials and muscle contractions. At the higher doses, theophylline depolarized the membrane in spontaneously active preparations. In the presence of high potassium (60 mM) the spike activity was blocked only by 10.0 mM theophylline. High potassium made the spikes more resistant to the drug than were those in spontaneously active preparations. The phasic and tonic components of the potassium-contracture were progressively decreased by increasing concentrations of theophylline and were completely blocked by the 10.0 mM concentration. The drug had no effect on the potassium-induced membrane depolarization observed during the potassium-contracture. On the basis of these observations, it is proposed that theophylline inhibits spike and contractile activity in taenia coli by interfering with the availability of calcium which has been postulated to be necessary for maintenance of these functions.


Effects of prostaglandins on avidin induction in the chick oviduct. Effects of exogenous prostaglandins (PGs) on avidin synthesis in the oviduct were studied in immature diethylstilboestrol-treated chicks. Among eight tested PGs only PGF-2alpha was effective when injected directly into the oviduct, but intraperitoneal and intravenous administration also caused avidin induction. 1 ng of PGF-2alpha/100 g B.W. injected into the oviduct caused avidin synthesis. The effect of PGF-2alpha on avidin induction occurred as early as 3 hr after intraoviductal administration. This study provides an additional evidence for the hypothesis that PGF-2alpha may be involved in the mechanism of avidin induction in the chick oviduct.


An analysis of action of nicotinic agents on adrenergic nerve terminals in rat isolated vas deferens. Nicotine and DMPP caused contraction of rat isolated vas deferens. The contractile response was antagonized by hexamethonium, phenoxybenzamine, phentolamine, guanethidine and bretylium, but not by atropine. The response was absent in tissues depleted of their norepinephrine content. Nicotine enhanced the outflow of tritium from tissues preloaded with 3H-norepinephrine. Only 50% of the nicotine-induced tritium outflow was due to unchanged norpinephrine, the rest were due to five metabolites of norepinephrine, chiefly glycol derivatives. As tissues, at the time of exposure to nicotine contained almost all of the tritium in the form of unchanged norepinephrine, it is likely that norepinephrine, only after being released from storage sites by nicotine was acted upon by the catabolizing enzymes to form various metabolites. Desensitization and cross desensitization phenomena were observed to both nicotine and DMPP. The tissues desensitized to nicotine were, however, responsive to norepinephrine, tyramine and transmural stimulation.


Oxotremorine neuromuscular blockade: effects of calcium and neostigmine and interactions with D-tubocurarine and decamethonium. The neuromuscular blocking effect of oxotremorine (OT) on the indirectly stimulated rat diaphragm preparation was compared with that of d-tubocurarine (TC) and decamethonium (C10). Approximate equieffective concentrations of these compounds were 20 micrometer for OT, 1.8 micrometer for TC, and 75 micrometer for C10. Increasing the Ca2+ concentration by 1 mM reduced the rate of onset of OT and C10 blockades whereas TC blockade was almost completely reversed. Neostigmine (NEO) antagonized TC blockade while OT and C10 blockades were enhanced. A facilitatory after-effect of NEO was suppressed in preparations previously exposed to OT but not in those previously exposed to TC or C10. C10 transitorily antagonized TC blockade but not OT blockade. OT did not antagonize TC blockade. A subreceptor effect may be involved in the action of OT and may explain its differences when compared to C10.


Paralytic action of manganese in the dog. Manganese is reported to interfere with transmitter release at a number of neuroeffector junctions. This effect is apparently related to competition between manganese and calcium for sites on the prejunctional terminals. Thus manganese can block the entry of calcium into the prejunctional terminals, an essential step in the excitation-secretion process. 5-Hydroxytryptamine, epinephrine, neostigmine, potassium chloride and calcium chloride have been investigated with respect to antagonism to partial paralysis induced with manganese chloride in canine peronealtibialis anterior, nerve-muscle preparations. Close intra-arterial injection of any of these substances manifested some degree of antagonism to manganese partial paralysis. Calcium was found to be the most effective antagonist. Post-tetanic facilitation was demonstrated during partial manganese block. Manganese was found to be seven times more effective than magnesium in producing paralysis.


A comparison of the effects of quinetholate, lidocaine and procainamide on ouabain-induced ventricular tachycardia and cardiac function. The antiarrhythmic effects of the quinoline derivative, quinetholate, on ouabain-induced tachycardia were compared with those of lidocaine and procainamide in dogs. In addition, the effects of these three agents on cardiac function were compared. Quabain was injected intravenously until ventricular ectopic beats accounted for at least 60% of the heart rate. Then one of the above antiarrhythmic agents was infused until sinus rhythm was reestablished for a minimum of 3 min or until it became evident that successful reversion would not occur. All three agents effectively reversed ouabain-induced ventricular tachycardia in most instances. Quinetholate was especially consistent, causing 16 reversions out of a total of 17 experiments. The relative molar antiarrhythmic potencies of the three agents in responding animals were as follows: lidocaine = 1.0, procainamide = 1.5, and quinetholate = 3.1. Quinetholate caused the longest lasting reversions, i.e. usually lasting at least 30 min after infusion was stopped. The degree of cardiac depression caused by the three agents at their mean effective antiarrhythmic doses was determined using the left ventricular function curve method. Lidocaine produced a significant depression of the ventricular function curve at the antiarrhythmic dose while procainamide and quinetholate did not.


The effect of purine bases and nucleotides on ethanol-induced fatty liver syndrome. Rats fed a special liquid fat diet had a higher level of liver triglycerides than rats fed a normal solid chow diet. The ingestion of ethanol induces a concomitant increase in hepatic triglycerides and a depression of ATP levels. Pure adenine base administered orally produces a significant reduction of hepatic triglycerdies and partially restores ATP levels in the chronic ethanol treated rat. Comparable doses of oral ATP are not effective. Pure guanine base and GTP failed to inhibit the ethanol-induced fatty liver and ATP depression.


Preservation of cellular integrity as a protective mechanism of dexamethasone in hemorrhagic shock in the cat. Anesthetized cats were hemorrhaged to a mean arterial blood pressure of 40 mm Hg for 120 minutes. Cats given dexamethasone (6 mg/kg, i.v.) at the time of hemorrhage and again (3 mg/kg, i.v.) at the time of reinfusion maintained post-reinfusion arterial blood pressure at a higher level than cats given the steroid vehicle. In addition, dexamethasone treated cats exhibited higher post-reinfusion liver blood flows than vehicle treated hemorrhaged cats. Dexamethasone significantly retarded the rise in plasma cathepsin D and amino-nitrogen activities during hemorrhage, and prevented the accumulation of a myocardial depressant factor (MDF) in the circulating blood. Dexamethasone had no significant effect on isolated cat papillary muscle or aortic strips. It appears that dexamethasone exerts its beneficial effect in hemorrhage shock primarily by stabilizing lysosomal membranes and the subsequent prevention of proteolysis and MDF formation rather than by a direct vasodilator or inotropic effect.


Central therapeutic effects of dihydroderivative of pralidoxime (pro-2-PAM) in organophosphate intoxication. Central actions of pro-2-PAM (dihydroderivative of 2-PAM) and 2-PAM in poisonings with DFP have been studied. It was shown that pro-2-PAM significantly increased activity of DFP inhibited acetylcholinesterase in the brain, quickly ceased the DFP-induced paralysis of respiration, partially normalized the DFP-induced abnormalities in electrocorticogram and increased the convulsive dosis of DFP. Effects of 2-PAM in these experiments were negligible.


Routine chest roentgenograms and electrocardiograms. Usefulness in the hypertensive workup. We reviewed the records of all patients entering the hypertension Clinic in 1974. One hundred sixteen met the criteria for hypertension and had a routine chest roentgenogram and/or ECG obtained for the evaluation of hypertension, Routine chest films and ECGs led to therapeutic or diagnostic interventions in only two instances, were not useful as baseline examinations, were never used for prognostic purposes, and not once influenced hypertensive management. We conclude that the value of routine chest roentgenograms and ECGs cannot be defended on the basis of their contribution to the workup of hypertension.


Upper gastrointestinal disease in chronic renal failure. A prospective evaluation. A prospective study was undertaken to determine the incidence of upper gastrointestinal disease in 85 chronic renal failure (CRF) patients on hemodialysis. Upper gastrointestinal x-rays were obtained for 83 patients, and enlarged gastric and duodenal folds were seen in 12% (10/83) and 42% (35/83) of the cases, respectively. Panendoscopy performed on 60 persons revealed gastritis in 22% (13/60), nodular duodenitis in 60% (35/60), and esophagitis in 13% (8/60). No peptic ulcers were identified either radiologically or endoscopically. Pathologic examination of mucosal biopsy specimens demonstrated gastritis in 46% (21/46) and duodenitis in 43% (22/51) of patients. A highly significant correlation was found between endoscopic and radiologic duodenitis (P less than .0001) and also between endoscopic and pathologic duodenitis. We have demonstrated a high incidence of mucosal inflammation but not ulcer disease in CRF patients. These lesions may predispose these individuals to gastrointestinal bleeding following renal transplantation.


Infusion intravenous pyelography and renal function. Effects in patients with chronic renal insufficiency. Acute renal failure (ARF) following infusion intravenous pyelography (IVP) has been reported in patients with chronic renal insufficiency, particularly diabetics. Renal function was evaluated before and after infusion IVP in 40 patients with chronic renal insufficiency. In 11 of 12 (92%) diabetics and 17 of 28 (61%) nondiabetics, a 25% or greater increase in serum creatinine values and/or decrease in creatinine clearance was noted after IVP despite adequate hydration in all patients. The maximum decrease in kidney function occurred within three days and usually returned to or near pre-IVP levels in seven to ten days. At least 70% of the patients had hypertension and/or evidence of vascular disease. The data suggest that preexisting vascular disease in the kidney, possibly associated with the known vasoconstricting effects of contrast media, may be an important factor in the ARF following infusion IVP.


Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons. We compared the prevalence of Gram-negative bacilli in the pharyngeal flora of two groups of patients with a known predilection for Gram-negative bacillary pneumonia (chronic alcoholics and diabetics), two other groups of aspiration-prone persons with no known predilection for Gram-negative bacillary pneumonia (epileptics and narcotic addicts), and normal control subjects. Quantitative cultures of saline gargles showed pharyngeal Gram-negative bacilli to be significantly (P less than .05) more prevalent among alcoholics (35%) and diabetics (36%) but not epileptics (17%) or  addicts (20%) than controls (18%). Counts of greater than or equal to 100 Gram-negative bacilli per milliliter were also significantly more common in alcoholics (14%) and diabetics (24%) than  controls (5%, P less than .05). Enterobacter sp, Klebsiella pneumoniae, and Escherichia coli were the most common Gram-negative bacilli isolated. Increased colonization by Gram-negative bacilli might be a factor contributing to the propensity of alcoholics and diabetics for Gram-negative pneumonia.


Response to corticosteroids in the hypereosinophilic syndrome. Association with increased serum IgE levels. Severe blood eosinophilia (16,500/cu mm and 6,500/cu mm) accompanied by involvement of the lungs, pleura, heart, pericardium, liver, gastrointestinal tract, peripheral nerves, or skin developed in two patients with bronchial asthma. Associated with the eosinophilia were elevated serum IgE levels (1,400 IU/ml and 10,500 IU/ml), depressed serum C4 complement levels (13 mg/100 ml and 6 mg/100 ml), and high titers of rheumatoid factor (1:2560 and 1:640). Symptoms improved after treatment with prednisone and the eosinophil counts and serum IgE and C4 complement levels returned to normal.


Association between acute pancreatitis and malignant hypertension with renal failure. Of 42 patients with malignant hypertension seen in five years in our institutions, seven (17%) had acute pancreatitis. All patients with pancreatitis were black, all had renal failure, and six received dialysis. No particular drug was received by all patients, gallstones were excluded in the majority, and alcoholism was not a factor. Clinical acute pancreatitis persisted for several weeks and five patients died, three of them with pancreatic pseudocyts. Among 259 patients on long-term hemodialysis programs in the same time period, only two additional cases of acute pancreatitis were observed and related to chronic alcoholism. Acute pancreatitis is a frequent complication of malignant hypertension, and when it happens it is severe and commonly fatal.


Cimetidine. H2-receptor blockade in gastrointestinal disease. Cimetidine is an H2-receptor antagonist that is capable of marked suppression of gastric acid and pepsin secretion. Patients with active duodenal ulcer disease treated with cimetidine show improved rates of healing and symptom relief compared with placebo-treated controls. Peptic ulcer and diarrhea of Zollinger-Ellison syndrome and other acid hypersecretory states respond to cimetidine treatment, as may stress ulcers and steatorrhea of patients with pancreatic insuffficiency who have a suboptimol response to oral pancreatin. Effectiveness with gastric ulcer has been less convincing than with duodenal ulcer. In duodenal ulcer disease, cimetidine need not replace less expensive antacid therapy in most cases and is unlikely to replace definitive surgery for suitable candidates.


Acute interstitial nephritis associated with carbenicillin therapy. Although acute interstitial nephritis has been documented during therapy with many antibiotics of the penicillin class, it has not previously been reported in association with carbenicillin therapy. We report here the case of a patient who developed the characteristic clinical features of this form of injury while receiving prolonged large doses of carbenicillin. Histologic examination confirmed the presence of a striking interstitial nephritis. Carbenicillin should be considered a potential cause of renal damage in patients who develop rash, eosinophilia, and microscopic hematuria in association with deterioration of renal function.


Chronic renal insufficiency from cortical necrosis induced by arsenic poisoning. A 39-year-old man had anuria and azotemia and was found to be suffering from acute arsenic poisoning. After two peritoneal dialyses, partial renal function returned, and the patient has survived for five years without dialysis. Renal cortical necrosis was demonstrated by renal biopsy and renal calcification. We suggest that arsenic be added to the list of substances capable of causing renal cortical necrosis and recommend consideration of this complication in cases of arsenical poisoning.


Partial hypopituitarism following septic peritonitis with shock. A 46-year-old man had a prolonged septic peritonitis with shock that resulted from a perforated appendix at the age of 29, followed, six months later, by the gradual development of partial hypopituitarism. Radiographic studies, including a pneumoencephalogram, did not reveal any evidence of sellar or surprasellar masses. Endocrine studies revealed growth hormone and gonadotropic deficiency and possible adrenocorticotropic hormone deficiency and possible adrenocorticotropic hormone deficiency. The nature of the disease course yielded much speculation in regard to pathogenesis of the condition.


Evidence for a hypothalamic defect in septo-optic dysplasia. A 21-year-old man demonstrated septo-optic dysplasia. Optic and retinal colobomas were present and panhypopituitarism was documented. Releasing hormone studies showed partial luteinizing hormone (LH) response and no follicle-stimulating hormone response to administration of gonadorelin (LH-releasing hormone); thyroid-stimulating hormone (TSH) and prolactin levels were increased normally after administration of protirelin (thyrotropin-releasing hormone). The LH, TSH, and  prolactin responses are believed to be evidence of intact pituitary function and suggest that a hypothalamic defect accounts for the hypopituitarism.


Renal artery stenosis and polycystic kidney disease. A patient had unilateral renal artery stenosis and, at the same time, bilateral polycystic kidney disease. The renal venous renin ratio of 151:40, together with a high peripheral plasma renin activity, indicated that the hypertension was partially caused by renopressor mechanism. Correction of the obstructive lesion permitted a better control of hypertension with antihypertensive drugs, and the peripheral and renal venous renin activity returned to normal. The success in detecting one pathogenic mechanism responsible for arterial hypertension should not deter further diagnostic efforts.


Familial myopathy. Exacerbation by hypokalemia associated with colonic polyp. A patient with Charcot-Marie-Tooth disease developed profuse mucinous diarrhea and severe potassium depletion. After two weeks, her muscle weakness grew worse, rhabdomyolysis occurred, and kaliopenic nephropathy was suspected. The patient's diarrhea ended abruptly after a single tubular adenomatous polyp was removed from her colon. Her metabolic status became normal and remained normal six weeks after transcolonic polypectomy.


Hypophosphatemia in thyrotoxic periodic paralysis. A patient with thyrotoxicosis from Graves' disease had concomitant muscular paralysis, hypophosphatemia, and severe hypokalemia. The parallel depression and return to normal of these electrolyte abnormalities and his neurologic status suggested that cellular ion influx was related to the paralysis.


Aortic atherosclerosis in Laënnec's cirrhosis. A comparative study using a planimeter. A postmortem comparison of atherosclerotic lesions of the aorta was made between 107 cirrhotic and 168 control subjects with mean ages of 61 and 64, respectively. The cause of death in 93 of the control subjects was malignant neoplasms. Individuals with a history of hypercholesterolemia, diabetes, hypertension, ischemic arterial disease, cerebral vascular accidents, or myocardial infarction were eliminated from this study. The entire aorta was removed during necropsy, and the ratio between the total aortic surface and the surface areas of fibrous, calcified, and ulcerated lesions was determined, using a planimeter. Statistical analysis disclosed no difference between the cirrhotic or control groups in either the extent or type of atherosclerotic lesions.


Ectopic parathyroid hormone syndrome. Occurrence in a case undifferentiated lymphoma with bone marrow involvement. A patient with hypercalcemia, hypophosphatemia, and an undifferentiated lymphoma involving only the bone marrow was treated by us. The finding of an elevated serum parathyroid hormone (PTH) level in the presence of normal parathyroid glands and increased metabolic bone activity on bone biopsy suggests an ectopic PTH syndrome. To our knowledge, no previous case of ectopic PTH syndrome associated with a lymphoma with bone marrow involvement only has been reported.


[Tolerance of the fetus with congenital anemia to induced uterine contractions]. A study of the fetal cardiac rate was made during uterine contractility induced by Pose's test in a group of 22 isoimmunized women carrying fetuses with variable degrees of hemolytic anemia. A high percentage of "positive tests" and other alterations in the fetal cardiac rate recordings were found. The risks of delivery and the need to examine the clinical value of different anomalies in the fetal cardiac rate are noted.


Utilization and cooxidation of chlorinated phenols by Pseudomonas sp. B 13. Pseudomonas sp. B13 was grown in continuous culture on 4-chlorophenol as the only carbon source. Maximum growth rate of 0.4 h(-1) was observed at a substrate concentration of greater than 0.01 mM and less than 0.15 mM. In addition to the enzymes of phenol catabolism, high specific 1,2-dioxygenase activities with chlorocatechols as substrates were found. The isomeric monochlorinated phenols were also totally degraded by 4-chlorophenol grown cells. (+)-2,5-Dihydro-4-methyl- and (+)-2,5-dihydro-2-methyl-5-oxo-furan-2-acetic acid were formed in high yield as dead-end catabolites from cooxidation of cresoles. Several dichlorophenols except 2,6-dichlorophenol were removed from the culture fluid by chlorophenol grown cells. Ring cleavage of chlorinated catechols were shown to be one of the critical steps in chlorophenol catabolism. A catabolic pathway for isomeric chlorophenols is discussed.


L-Aspartate fermentation by a free-living Campylobacter species. In the fermentation of L-aspartate by a free-living Campylobacter spec., the products formed were acetate, succinate, carbon dioxide and ammonia. The oxidative part of the fermentation pathway yielded acetate, succinate, carbon dioxide and ammonia, and the reductive part gave rise to the formation of succinate and ammonia. When grown anaerobically with aspartate, cells contained cytochromes b and c as well as menaquinone. Reduced cytochrome b, but not reduced cytochrome c could be reoxidized by fumarate. In the presence of nitrate, 90% of the available electrons were transferred to nitrate, which was reduced to nitrite; the remainder was transported via the fumarate reductase system. Cells grown with aspartate and excess of formate converted aspartate quantitatively to succinate.


[Accident or planned self mutilation? Probability of accidental injuries during chopping]. The results of 200 chopping experiments with a big axe and a smaller cleaver on two different chopping-block levels were presented. Objects were beech-billets with relatively big cross-section areas. In 66 per cent of all experiments the holding hand was put partially or completely upon the surface of the billet, in a principally endangering position. The lateral deviations from the intended impact place were in 62 per cent not more than +/- 1.5 cm; 7.5 per cent hit closer to the holding hand, in the utmost case 3.7 cm, the angle with the aspired sagittal impact plane in most cases not transgressing 5 degrees in the direction of the holding hand and never more than 15 degrees. It can be deduced, that unwilled forefinger injuries from axe stroke are not to be expected on the base phalanx very probably; those in a right angle to the finger axis are not possible, however. For the thumb these rules do not hold in like manner.


Regulatory properties of the nitrogenase from Rhodopseudomonas palustris. Ammonium salts, glutamine, asparagine, and urea cause an immediate inactivation (switch-off) of light-dependent acetylene reduction in intact cells of the photosynthetic bacterium Rhodopseudomonas palustris. This effect is reversible showing the same kinetic pattern of inactivation and reactivation with all effector compounds. Its duration depends on the amount of effector added to the cells. Both nitrogenase components are found catalytically active in a cell-free preparation after enzyme switch-off in vivo. Involvement of the ammonia assimilating system in this regulatory mechanism is indicated by the following observations: ammonia uptake during the switch-off period, resumption of acetylene reduction after disappearance of ammonia from the outer medium, and persistence of enzyme switch-off with dihydrogen and thiosulfate as electron donors in the absence of an additional carbon source. Nitrogenase activity in crude extracts is non-linear with time and is stimulated by manganese ions. After resolution of nitrogenase into its MoFe--protein and Fe--protein these properties are lost, indicating the presence of an activating factor. Nitrogenase of R. palustris cross reacts reciprocally with the complementary proteins of Azotobacter vinelandii, but not with those of Clostridium pasteurianum.


Acetate assimilation and the synthesis of alanine, aspartate and glutamate in Methanobacterium thermoautotrophicum. Cultures of the autotrophic bacterium Methanobacterium thermoautotrophicum were shown to assimilate acetate when grown on CO2 and H2 in the presence of acetate. At 1 mM acetate 10% of the cell carbon came from acetate, the rest from CO2. At higher concentrations the percentage increased to reach a maximum of 65% at acetate concentrations higher than 20 mM. The data suggest that acetate may be an important carbon source under physiological conditions. The incorporation of acetate into alanine, aspartate and glutamate was studied in more detail. The cells were grown on CO2 and H2 in the presence of 1 mM U-14C-acetate. The three amino acids were isolated from the labelled cells by a simplified procedure. Alanine, aspartate and glutamate were found to have the same specific radioactivity. Degradation studies showed that C1 of alanine, C1 and C4 of aspartate, and C1 and C5 of glutamate were exclusively derived from CO2, whereas C2 and C3 of alanine and aspartate, and C3 and C4 of glutamate were partially derived from acetate. These findings and the presence of pyruvate synthase, phosphoenolpyruvate carboxylase and alpha-ketoglutarate synthase in M. thermoautotrophicum indicate that CO2 is assimilated into the three amino acids via acetyl CoA carboxylation to pyruvate, phosphoenolpyruvate carboxylation to oxaloacetate, and succinyl CoA carboxylation to alpha-ketoglutarate.


Degradation of microbodies in relation to activities of alcohol oxidase and catalase in Candida boidinii. Degradation of microbodies in the methanol-utilizing yeast Candida boidinii was mainly studied by electron microscopical observation. The yeast cells precultured on methanol medium contained five to six  microbodies per section and showed high activities of alcohol oxidase, catalase, formaldehyde dehydrogenase and formate dehydrogenase. When the precultured cells were transferred into an ethanol medium the number of microbodies and concomitantly the activities of alcohol oxidase and catalase decreased. After 6 h of cultivation microbodies were hardly detected. Also the activity of alcohol oxidase was not measurable and catalase activity was reduced to one tenth, whereas the activities of formaldehyde dehydrogenase and formate dehydrogenase decreased only to about 70%. Experiments with methanol-grown cells transferred into an ethanol medium without nitrogen source indicated that the inactivation of alcohol oxidase and catalase does not require protein synthesis. However, the reappearance of these enzymes is presumably due to de novo protein synthesis as shown by experiments with cycloheximide.


Inhibition of methanogenesis by sulphate reducing bacteria competing for transferred hydrogen. A methanogenic bacterial consortium was obtained after inoculation of benzoate medium under N2/CO2 atmosphere with intertidal sediment. A hydrogen donating organotroph and Methanococcus mazei were isolated from this enrichment. H2-utilising sulphate reducing bacteria were isolated under H2/CO2 in the absence of organic electron donors. The Methanococcus was able to produce methane in yeast extract medium under N2/CO2 if the H2 donating organism was present, and sulphate reduction occurred if the hydrogen utilising sulphate reducing bacteria were grown with the H2 donating organism. The ability of the H2 utilising sulphate reducing bacteria to inhibit Methanococcus competitively was shown in clutures containing both of these H2 utilising bacteria.


Hydrogen as a substrate for methanogenesis and sulphate reduction in anaerobic saltmarsh sediment. Hydrogen gas stimulated sulphate reduction in a saltmarsh sediment and the importance of H2 transferred from organotrophic bacteria to the sulphate-reducers is discussed. beta-fluorolactate inhibited sulphate reduction whether lactate, ethanol or hydrogen was being used as growth substrate. When added to sediment beta-fluorolactate inhibited sulphate reduction with a consequent increase in methane production. Addition of H2 stimulated methanogenesis in sediment and this stimulation was greater if CO2 was also present. Hydrogen availability was the primary limitation of methanogenesis but the low concentration of dissolved CO2 in seawater may limit methane production even if H2 is available. The removal of inhibition of methanogenesis by the use of fluorolactate to suppress sulphate reduction or by the provision of hydrogen indicates competitive inhibition of methanogens by sulphate reducers utilizing transferred hydrogen.


The role of enoyl-coa hydratase in the metabolism of isoleucine by Pseudomonas putida. The purpose of the present study was to determine if the enoyl coenzyme A hydratase formed by Pseudomonas putida during growth on isoleucine was a unique enzyme specific for isoleucine metabolism. The highest levels of the hydratase were formed during growth on isoleucine intermediates and the lowest levels during growth on glutamate and glucose. Data from growth experiments revealed that 2-methyl-3-hydroxybutyryl coenzyme A hydratase, an enzyme unique to isoleucine metabolism and enoyl coenzyme A hydratase were coordinately induced, but that 3-hydroxyacyl coenzyme A dehydrogenase was under separate control. The hydratase was purified 180-fold from isoleucine cells, and its physical and catalytic properties reported. The highest activity was with crotonyl coenzyme A,Vmax = 1100 x 10(3) moles/min mole enzyme, next was tiglyl coenzyme A, Vmax = 61 x 10(3) moles/min mole enzyme, and last was 3-methyl-crotonyl coenzyme A, Vmax = 2.3 x 10(3) moles/min mole enzyme. Enzyme purified from butyrate cells had the same elution patterns during column chromatography and catalytic properties as the enzyme from isoleucine cells. These data support the conclusion that a single enzyme in P. putida is responsible for the hydration of both tiglyl coenzyme A and crotonyl coenzyme A.


Growth of a photosynthetic bacterium anaerobically in darkness, supported by "oxidant-dependent" sugar fermentation. Rhodopseudomonas capsulata can obtain energy for growth from light (anaerobically) and can also grow heterotrophically in darkness using alternative energy conversion modes, namely, aerobic respiration or an unusual type of anaerobic catabolism of sugars. Dark anaerobic growth with fructose as sole carbon and energy source is dependent on the presence of an "accessory" oxidant such as trimethylamine-N-oxide, is accompanied by production of lactate and other classical fermentation products, and yields cells with a high content of photosynthetic pigments and polyhydroxybutyrate.


Mutants of Alcaligenes eutrophus defective in autotrophic metabolism. Forty-four mutants of Alcaligenes eutrophus H 16 were isolated which grew poorly or not at all under autotrophic conditions. Four types were characterized with respect to their defects and their physiological properties. One mutant lacked both enzymes specific for autotrophic CO2 fixation, another one lacked both hydrogenases, and two mutants lacked either the membrane-bound or the soluble hydrogenase. Comparing the results of studies on these mutant types, the following conclusions were drawn: the lack of each hydrogenase enzyme could be partially compensated by the other one; the lack of membrane-bound hydrogenase did not affect autotrophic growth, whereas the lack of the soluble hydrogenase resulted in a decreased autotrophic growth rate. When pyruvate as well as hydrogen were supplied to the wild-type, the cell yield was higher than in the presence of pyruvate alone. Mutant experiments under these conditions indicated that either of both hydrogenases was able to add to the energy supply of the cell. Only the soluble hydrogenase was involved in the control of the rate of hydrogen oxidation by carbon dioxide; the mutant lacking this enzyme did not respond to the presence or absence of CO2. The suppression of growth on fructose by hydrogen could be mediated by either of both hydrogenases alone.


Fungal transformation of naphthalene.

Fungal transformation of naphthalene. Eighty-six species of fungi belonging to sixty-four genera were examined for their ability to metabolize naphthalene. Analysis by thin-layer and high pressure liquid chromatography revealed that naphthalene metabolism occurred in forty-seven species belonging to thirty-four genera from the major fungal taxa. All organisms tested from the order Mucorales oxidized naphthalene with species of Cunninghamella, Syncephalastrum and Mucor showing the greatest activity. Significant metabolism was also observed with Neurospora crassa, Claviceps paspali and four species of Psilocybe. The predominant metabolite formed by most organisms was 1-naphthol. Other products identified were, 4-hydroxy-1-tetralone, trans-1,2-dihydroxy-1,2-dihydronaphthalene, 2-naphthol, 1,2-and 1,4-naphthoquinone.


The pathway of formation of acetate and succinate from pyruvate by Bacteroides succinogenes. Bacteroides succinogenes produces acetate and succinate as major products of carbohydrate fermentation. An investigation of the enzymes involved indicated that pyruvate is oxidized by a flavin-dependent pyruvate cleavage enzyme to acetyl-CoA and CO2. Active CO2 exchange is associated with the pyruvate oxidation system. Reduction of flavin nucleotides is CoASH-dependent and does not require ferredoxin. Acetyl-CoA is further metabolized via acetyl phosphate to acetate and ATP. Reduced flavin nucleotide is used to reduce fumarate to succinate by a particulate flavin-specific fumarate reductase reaction which may involve cytochrome b. Phosphoenolpyruvate (PEP) is carboxylated to oxalacetate by a GDP- specific PEP carboxykinase. Oxalacetate, in turn, is converted to malate by a pyridine nucleotide-dependent malate dehydrogenase. The organism has a NAD-dependent glyceraldehyde-3-phosphate dehydrogenase. The data suggest that reduced pyridine nucleotides generated during glycolysis are oxidized in malate formation and that the electrons generated during pyruvate oxidation are used to reduce fumarate to succinate.


Deoxyribonucleic acid reassociation in the classification of coagulase-positive staphylococci. DNA-DNA reassociation studies were performed with coagulase-positive staphylococci belonging to the biotypes A, B, C, D, E and F. These studies present genetic evidence for the existence of at least two distinct species within this group of organisms. The common Staphylococcus aureus strains were represented by organisms from biotypes A to D, and their DNA revealed over 80% nucleotide sequence homology under restrictive conditions. Less than 15% DNA homology was detected between strains from biotypes A to D (S. aureus) and those from biotypes E and F. The DNA of organisms from either the biotypes E or F displayed over 70% homology. Together, both biotypes are considered to represent the species S. intermedius. However, DNA homology values dropped to 50--65% between strains from different biotypes. This may justify the separation of S. intermedius biotypes E and F on a subspecies level.


A comparative analysis of extreme thermophilic bacteria belonging to the genus Thermus. Several extreme thermophilic Gram negative bacteria found in a thermally polluted river in Belgium have been compared with Thermus strains isolated from widely distant geographical areas. This analysis has become possible after the design of a new culture medium (162). All strains examined (including the isolate successively denominated Flavobacterium thermophilum and Thermus thermophilus) were found to be morphologically identical with strain YT-1 of Thermus aquaticus. The cells are immotile, rod-like, strictly aerobic, catalase and oxidase positive. They produce amylase, hydrolyze gelatin and are confirmed to be highly sensitive towards penicillin. The nutritional pattern of all strains has been analysed extensively, by testing a broad spectrum of possible substrates. The strains display a uniform response to the microbiological tests applied and most probably belong to the same species: Thermus aquaticus.


[Severe hyperthermia in children].

[Severe hyperthermia in children]. In some children severe hyperthermia may be the result of fever that causes cellular damage. This can be seen histologically as cell necrosis. When hyperthermia occurs with collapse or with neurological symptoms it should lead to a search for other lesions (renal, hepatic and/or coagulation disorders). Treatment of these conditions may, in some cases, lead to improvement. Simple prophylactic measures and close supervision of febrile children should prevent this serious syndrome.


[Late diagnosis of cystinosis in 2 brothers: histological and ultrastructural renal study]. Cystinosis was discovered by chance in two adolescent boys who had proteinuria with minor tubular abnormalities. Renal biopsies were examined by light microscopy, electron microscopy and immunofluorescence. There were few histological changes but crystals were present in the epithelial cells of the glomerulus and occasionally in the tubules. A further unusual feature was the detection of IgA deposits in the mesangium.


[Electroencephalographic approach to lateralization in children]. Electroencephalograms were recorded in 76 normal children between 10-12 years of age and several parameters were calculated from the results of spectral analysis. Sections of recordings which were free of artefacts, taken under different conditions (eyes open, eyes closed and during tests of mental arithmetic and vocabulary with the eyes closed were analysed. In these normal children, there was significant asymmetry of the alpha 1, beta 1, theta rhythms, and related parameters at rest, but the asymmetry was not necessarily found to correlate with the laterality of hand, eye, foot or all three. Vocabulary, and to a greater extent arithmetic significantly decreased alpha rhythms. Arithmetic affected both hemispheres equally but vocabulary depressed the alpha rhythms more obviously on the left.


[A new family with mutation of the structural gene of human ornithine carbamoyltransferase]. Studies of a child with hyperammonemia have demonstrated a deficiency in OCTase. The kinetic properties of the enzyme were studied and it could be shown that we have to deal with a new mutation which is different from the ones previously known. It is a mutation of the structural gene. The detection of a heterozygote is possible when the urinary orotic acid excretion is studied after a loading meal (2g of proteines per kilo of weight). A child with hyperammonaemia due to ornithine transcarbamylase deficiency is described. A new structural gene mutation is probable because the kinetic properties of the enzyme are different to previously described variants. The heterozygote could be detected by the measurement of the excretion of orotic acid in the urine following a protein load of 2 g/Kg.


[Disseminated osseous angiomatosis in children]. The authors review 54 cases of diffuse bone angiomatosis (one new case and 53 from the literature) and describe the major clinical, radiological and anatomical features. The difficulties of distinguishing between haemagiomata and lymphangiomata are emphasised. The diagnosis is often helped by the presence of visceral or cutaneous lesions and when such lesions are found, a skeletal survey should always be done. These conditions, which may be classified under the general heading of angiodysplasias of bone, are hamartomata and must be distinguished from other bone lesions of vascular origin.


[Measurements of the sella turcica in idiopathic hypophyseal nanism]. The size of the sella turcica was measured in 66 cases of so-called idiopathic hypopituitary dwarfism, and compared to Silverman's standards. In 55 % of patients the sella was abnormally small for age, and in 45 % abnormally small for height. No significant differences were found from male to female patients nor from isolated somatotropic deficiencies to multiple tropic hormones deficiencies.


[Malignant adrenal carcinoma with metastases: exeresis and treatment with op'DD followed by cure]. A 6 years old child with a malignant adrenal tumour with metastasis was treated with radical surgery followed by long term therapy with op'DDD. After a 12 year follow up without recurrence it is likely that the child has been cured.


[Mucocutaneous lymph node syndrome: case report]. The muco-cutaneous lymphonode syndrome affecting babies and infants has recently been described in Japan. The children present with sub-maxilliary glands, fever and a characteristic desquamating rash. It is important to make the diagnosis because of the rare but dangerous cardiac complications. The aetiology is unknown but the condition may be related to infantile polyarteritis nodosa.


[Cerebral trauma - psychological trauma? Study of 47 children with medulloblastoma and their follow-up]. 47 Children with medulloblastoma who were treated between 1954 and 1974 were studied. The parents and children were interviewed regularly with their medical attendants to estimate the contribution of the organic disease, the psychological factors and the environment on their intellectual performance and their personalities. In the assessment, allowance was made for their age, clinical history, and social and scholastic background. The analysis helped in the choice of the most appropriate psychological support. The difficulties of social re-adjustment cannot be solely due to the brain tumour or its sequelae. The parents have to forget their idealised image of their child, who never existed and who never will, so that they can give the child a new start and enjoy life without fear of death. In this distressing exercise, the extent of the emotional trauma becomes obvious.


A diagnostic interview: the schedule for affective disorders and schizophrenia. The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episodes of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.


Concurrent diagnostic validity of a structured psychiatric interview. In order to estimate the concurrent validity of a structured psychiatric interview, we compared interview diagnoses obtained for 101 psychiatric inpatients to those recorded in the same patients' hospital charts. For most diagnoses considered, concordance was found to be high. For those in which concordance was low, we examined the reasons for the diagnostic discrepancy. Diagnostic errors that were judged to have occurred on the basis of the structural interview often seemed to have resulted from a lack of longitudinal clinical observation. However, more errors were judged to have occurred in the hospital charts, apparently because of physician oversight. We conclude that the concurrent validity of this structured interview is high and that such examinations might be useful not only for research but also for the routine initial evaluation of psychiatric patients.


Genetic strategies in biological psychiatry. Studies of the etiology of schizophrenia and other psychiatric illnesses may be executed by using a genetic framework in the experimental design. This article describes research strategies for identifying the genetic factors that produce a vulnerability to a psychiatric illness. The proposed strategies evaluate the role of a given genetic factor by comparing the transmission of this factor within pedigrees to the transmission of that illness. In a biologically heterogeneous disorder, these strategies can be used to identify homogeneous subgroups. This report also describes a strategy for identification of the environmental events that promote the development of a psychiatric illness, either independently or in conjunction with the genetic diathesis.


Prior psychiatric treatment and the development of breast cancer. Computerized records of a large university hospital were searched to identify all women from 1967 to 1976 whose conditions had been diagnosed as breast cancer or primary cancer of another site. The records for those women with diagnoses of cancer were then examined to identify any prior psychiatric diagnoses. The rationale was that most patients treated in this hospital setting for psychiatric disorders received neuroleptic drugs, and patients with a diagnosis of schizophrenia are almost certain to be treated with major neuroleptic drugs over a prolonged period of time. No substantial difference in the relative frequency of prior psychiatric treatment was observed between breast cancer and other cancer groups.


A three-year follow-up study of the elimination of the internship. A comparative study of internship- and noninternship-trained residents in a psychiatric outpatient setting. The American Board of Psychiatry and Neurology eliminated the internship as a requirement for certification in psychiatry in 1970. Preliminary study on a psychiatric inpatient service of internship-trained first-year residents with that of a matched group of residents who entered the same program without the internship disclosed differences in patient care practices. The same group of residents in their subsequent years of training in a psychiatric outpatient service were compared. A chart review comparison disclosed differences in areas of management in psychiatric outpatient treatment, referral patterns, and use of medication. Supervisory ratings of the residents were found to differ substantially in nine of the 15 measured categories.


Research designs for the study of gene-environment interactions in psychiatric disorders. Report of a Foundations Fund for Research in Psychiatry Panel. Understanding the genetic and environmental contributions (and their interactions, which are likely to be complex) to the etiology of psychiatric disorders requires research designs incorporating many basic principles of genetics. Genetic variation is likely to contribute to psychiatric disorders and genetic heterogeneity is likely to exist for any single disorder, ie, completely different genetic variants may each be capable of increasing an individual's susceptibility to the disorder. Thus, it is important to define phenotypes that may more closely reflect each individual genetic variant rather than to rely solely on the psychiatric diagnosis. Research should be undertaken with the goal of testing specific hypotheses that can be excluded. Research designs can include studies of unrelated individuals, twins, separated relatives, nuclear families, or extended pedigrees. Not all hypotheses can be tested on one type of data, and appropriate analytic methods vary. Because genetic hypotheses cannot be tested on studies of unrelated individuals, it is important that data be collected on families instead of unrelated individual patients and/or controls. Studies should include traits that bridge the gap between the genotype and the diagnostic phenotype. Such studies should be multidisciplinary, and the best statistical-genetics methodology should be used for data analysis.


Primary affective disorder, aggression, and criminality. A review and clinical study. Aggressive and criminal behavior among patients with manic and depressive conditions has been in need of greater delineation, particularly since the advent of current pharmacotherapies. This report reviews the literature on aggression and criminality among bipolar and unipolar patients and the nature and occurrence of these conditions among criminal and unprosecuted offender populations, and presents a study of 100 consecutive prisoners (89 women, 11 men) referred for psychiatric evaluation. It is hypothesized that manic and depressive states are underdiagnosed in prison populations, particularly among female prisoners. A comparatively high incidence (10%) of primary affective disorder was found in this study; possible causes of the hypothesized underdiagnosis are discussed.


Abnormalities of cerebral lateralization in schizophrenia patients. Initial lateral eye movements (LEMs) have been shown to be associated with activation of the contralateral frontal lobes. Using LEM as a criterion measure of activation, schizophrenics were compared to normals with respect to the processing of four types of stimuli: verbal nonemotional (VNE), verbal emotional (VE), spatial nonemotional (SNE), and spatial emotional (SE). Our results indicate that schizophrenics initiate thought in their left hemisphere significantly more often than controls when one compares all test conditions and on VNE, VE, and SE material. Neither medication nor level of education had an appreciable effect on LEM in either group. However, sex was a significant variable; women irrespective of diagnosis consistently used the left hemisphere more often than men. The inappropriate initiation of thought on SE material as well as the overall increase in left hemisphere activity suggest left hemisphere disorder. This is consistent with other findings that suggest a left hemisphere locus of disturbance in schizophrenia.


Chromosomes in patients receiving methadone and methadyl acetate. Chromosomes of peripheral leukocytes were examined in 28 addicts participating in a Veterans Administration-Special Action Office for Drug Abuse Prevention (SAODAP) cooperative study of methadyl acetate vs methadone. Blood samples for 72-hour leukocyte cultures were drawn after nearly 40 weeks of maintenance therapy while subjects were receiving active medication. For comparison, ten nondrug users were also studied. The frequency of chromosome damage was not greater in subjects maintained on methadyl acetate or methadone than in nondrug users.


Abrupt withdrawal from therapeutically administered diazepam. Report of a case. Subjective, behavioral, and physiologic changes followed abrupt withdrawal of diazepam (Valium) in a patient who had been treated with 30 to 45 mg of diazepam daily for 20 months. Precipitous weight loss and orthostatic pulse rate increase were a part of the abstinence syndrome, which occurred between the fifth and ninth days of withdrawal. Accompanying these changes in physiologic measures were discomforting symptoms and dysphoria that were aversive and reinforcing to drug taking since the patient sought diazepam administration. These observations suggest that changes in mood, feeling states, and behavior may be the most prominent characteristics of the abstinence syndrome associated with physical dependence on this dose level of diazepam.


[Prognosis of anorexia nervosa in adolescence]. A group of 28 patients with anorexia nervosa, who had fallen ill at the age of 15 (14 to 18) and were examined for the first time at the age of 17 (14 to 23), were all examined again 10 (5 to 20) years later. In the vast majority (25 cases), the anorexia syndrome sensu stricto had completely, or very nearly, disappeared. While weight and menstruation had returned to normal, nutrition behavior was sometimes still disturbed, although to a lesser extent than before. The course of the disease in the long term generally leads to disappearance of the symptoms; fatal issues and psychotic manifestations are extremely rare. In half of these 28 cases, however, there are other neurotic symptoms (depression, anxiety, obsession), indicating the underlying neurotic disturbance. In the matter of social integration (separation from original family, successful education, professional activity), positive developments predominate. More than one-third of the patients have married. The results are compared with those of some other investigations in this field.


[Cerebral toxoplasmosis complicating Hodgkin's disease in the adult. Light and electron-microscopic findings (author's transl)]. A male patient with a history of Hodgkin's disease of 11 years duration died at age 41 with signs of progressive cerebral involvement. The blastomatous process had been treated with X-rays, cytostatic agents, and corticosteroids. Autopsy revealed isolated lymphogranulomatous lesions in the chest walls and multiple foci of necrosis in the brain. In the latter, Toxoplasma could be detected by light and electron microscopy. The inflammatory response elicited by the protozoan parasite was strikingly slight. This indicated that the patient had had some immunologic impairment. Pathomorphologic and clinical aspects of cerebral toxoplasmosis in the adult are discussed. It is emphasized that patients suffering from chronic malignant disorders, particularly Hodgkin's disease, are preferentially affected by toxoplasmosis of the brain.


Laser-spectrographic analysis of the cation content in Fahr's syndrome. The cation content and composition of mineral deposits in cerebral vessels in a case of Fahr's syndrome was studied by laser-spectrographic analysis. It was shown that in addition to Ca and Fe, other minerals such as Mg, Al, and Zn accumulated in pathologic deposits. The occurrence of cations other than Ca and Fe in these deposits had not been previously reported. The observations made in this study may contribute to a better understanding of the etiopathogenesis of Fahr's syndrome.


[Modification and improvement of the diagnosis of cerebral damage (DCS) for clinical use (author's transl)]. The purpose of this study was to determine whether Weidlich's DCS Test (Diagnostikum für Cerebralschädigung) (Weidlich, 1969) which is very burdensome when applied to brain-damaged patients, could be simplified by means of multivariate error analysis without loss of its great diagnostic value. The results of 40 brain-damaged patients and 47 clinical control patients were examined by multivariate analysis. In order to establish a comparative learning-function value, a random sample of 20 nonclinical persons was tested, as well. Results showed that within a discriminant function the error variables could differentiate clinical groups just as well as Weidlich's global criterium, while a diagnosis could be established after only about half the test time. Applicability of the multivariate methods to the diagnosis of single clinical cases was confirmed by means of positive cross validation.


Histocompatibility antigens in primary affective disorders. We determined 27 histocompatibility antigens of A, B, and C locus with a standard lymphocyte cytotoxicity test in 125 patients suffering from primary affective disorders, 77 of bipolar type, 24 of unipolar type, and 24 with schizo-affective psychosis. Comparison with a normal control group showed significant increases in the frequencies of antigens Bw40 and Cw4 in unipolar patients and a significantly decreased frequency of antigen Cw3 in bipolar patients. The statistical significances which were at the 5% level, disappeared when the P values were corrected for the number of antigens investigated. Our results failed to confirm previous findings of significantly altered antigen frequencies among patients with primary affective disorders.


[Long-term follow-up study of the absorption of gas after encephalography in dilated intracranial cerebrospinal fluid spaces (author's transl)]. The absorption of gas after encephalography in different groups of patients was investigated in a long-term follow-up study. Group I (11 patients) showed no pathological findings in the encephalogram. Group II (8 patients) had encephalographic signs of diffuse cerebral atrophy. Group III (7 patients) demonstrated in the encephalogram characteristics of normal pressure hydrocephalus with variously located blocks of air in the subarachnoid space. In group I the gas located in the subarachnoid space had usually disappeared after 24 h, in some cases after 72 h. In group II the pattern of resorption was basically similar, although in one case cortical air could be seen at 96 h. In group III the absorption of air from the subarachnoid space began after 72 h in radiological relevant amounts. In none of the cases of group III could similar short times of resorption be seen in comparison to group I. It is considered that these two groups can be clearly distinguished from each other in the duration of resorption of air from the subarachnoid space. The importance of encephalography as a pathophysiological tool for investigation of both the disturbed resorption and circulation of the cerebrospinal fluid in normal pressure hydrocephalus is stressed.


The influence of sleep deprivation on the duration of endogenous depressive episodes. Out of 102 patients suffering from endogenous depression, it was possible to ascertain the duration of episodes in the case of 60 patients. Intraindividual comparisons among patients with unipolar depression show that sleep deprivation therapy causes a tendency to shorter depressive episodes. This tendency is related to the time of application of sleep deprivation: the sooner sleep deprivation is applied within an episode, the better the effect. Younger patients react better than older ones.


[One chronobiological aspect of sterotyped behaviour (author's transl)]. The stereotyped behaviours of six institutionalized handicapped children were continuously observed during several days. Each child showed at least two forms of stereotyped behaviour. Using spectra of variance and cross-correlation analysis, the data were analysed with respect to underlying periodicities. A 2.5-hour cycle was found in all observed stereotypies. Furthermore, stable phase relationships were found between the periodic variations of different stereotypies in one and the same child. The temporal courses of hand and oral stereotypies were synchronous but head and whole-body stereotypies were delayed by half a phase with respect to sterotypic handwaving. A possible relationship is discussed between the 2.5-hour periodicity of stereotyped behaviour and Kleitman's "Basic Rest Activity Cycle."


Photic EEG-driving responses in thalamotomized and medicated cases of Parkinson's disease. EEG-driving responses to visual stimulation were studied using EEG Interval Spectrum Analysis (EISA) before and after stereotaxic thalamotomy and Nacom (L--Carbidopa and Levodopa) treatment of 67 Parkinson patients. Five types of photic-driving responses were distinguished in the EISA results: (1) all-band response, (2) Beta-dominant, (3) Alpha-Beta-dominant, (4) Alpha-Theta-dominant, (5) non-response. Twenty patients received a daily dose of 750--1000 mg of Nacom orally, and 47 patients 1000--1500 mg for a period of 3 to 4 weeks. In most cases the medication produced no change in photic-driving and EEG patterns. The photic-driving response showed no significant correlation with clinical signs and background EEG. Unilateral thalamotomy was performed in ten Parkinson patients. In two of these patients the EEG-driving response diminished in the first post-operative week for low frequency stimuli but increased after the second week.


Diarrhea and colitis in clindamycin-treated surgical patients. Responding to reports that diarrhea and pseudomenbranous colitis occurred relatively frequently among patients who received clindamycin, we initiated a program of surveillance in clindamycin-treated patients, including direct examination of the colon mucosa for inflammation or pseudomembranes and a patient follow-up by a nurse-epidemiologist. Observation of 145 patients having 161 consecutive clindamycin treatment episodes determined that unexplained diarrhea (two or more stools per day) occurred in 30 patients (21%), and more severe diarrhea (five or more stools per day) occurred in 12 patients (8%). Colitis was not identified at all. The absence of pseudomembranes was confirmed by direct examination of colon mucosa in 114 patients. Development of disabling diarrhea or colitis in association with clindamycin therapy is not a universal phenomenon.


Fat necrosis of the breast.

Fat necrosis of the breast. Fat necrosis of the breast is an uncommon entity but may mimic malignancy on both mammographic and clinical examination. Seven patients had recent excisional breast biopsy specimens that showed fat necrosis. The mammographic appearance is a reflection of the reparative phase of the lesion, with a cystic appearance representing early or incomplete healing. Progression to connective tissue invasion appears as an irregular, dense, spiculated mass. Clinically, these tumors may be firm, fixed, and produce overlying skin or nipple retraction. No matter how strong the clinical suspicion that a breast lesion represents fat necrosis, an excisional biopsy is necessary for confirmation in all cases.


Thromboembolic risk of postsplenectomy thrombocytosis. Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Thrombocytosis developed in 75% of the patients. No substantial increase in the incidence of thromboembolism was detected in patients with thrombocytosis.


Nonspecific peritesticular fibrosis manifested as testicular enlargement. Nine cases of peritesticular fibrosis initially appeared to be enlargement of the testes. Seven patients under went orchiectomy and two had biopsy specimens taken of the grossly thickened  tunica albuginea. In six patients, a hydrocele was present with intramural fibrosis and minimal chronic inflammation. Active epididymitis and chronic interstitial orchitis were present in two patients, with some spread of the inflammation into the fibrotic peritesticular tissues. One case, without associated hydrocele or epididymitis, showed dense fibrosis of the peritesticular tissues with focal edema, lymphangiectasis, and minimal perivascular round cell infiltration. This clinicopathological entity of diffuse peritesticular fibrosis is an unrecognized cause of benign testicular enlargement. The hypothesis is advanced that the primary process is a congenital hypoplasia of the peritesticular lymphatics progressing at various speeds into a state of chronic lymphedema and end stage noninflammatory fibrosis.


Resection of postinfarction left ventricular aneurysm with and without revascularization. Twenty-four patients had resection of their ventricular aneurysm and 29 had resection plus revascularization. Sixty percent of the patients received no blood in the heart lung machine during surgery or at any time during hospitalization. One of 24 patients with ventricular resection and two of 29 patients with resection plus revascularization died during hospitalization, for an overall mortality of 5.7%. Fifty of the 53 patients had an ejection fraction of 0.4 or less and 23 of these had an ejection fraction of 0.2 or less. Survival rate was 75.5% at four years for all 53 patients compared to only 12% of patients alive at five years with medical treatment. For the patient with a large ventricular aneurysm, resection and myocardial revascularization can be performed with a low risk even for the patient with poorly functioning residual myocardium.


Surface cooling (20 degrees C) and circulatory arrest in infants undergoing cardiac surgery. Results in ventricular septal defect, complete atrioventricular canal, and total anomalous pulmonary venous connection. During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 degrees C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 degrees C, before repair and at 37 degrees C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 degrees C. Systemic vascualr resistance was increased at 21 degrees C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients  were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.


Retained intrahepatic stones. Use of the U tube during repeated nonoperative stone extractions. Of 355 patients undergoing nonoperative extraction procedures for retained bile duct stones, 61 patients had intrahepatic calculi. In seven of these patients with multiple intrahepatic stones and two of them with additional hepatic duct strictures.trahepatic stones, a U tube was placed. Insertion of a U tube is particularly useful if multiple sittings are required for intrahepatic stone removal. The U tube can be inserted postoperatively and permits ease of operation from two sides, particulary if stricture dilation is required before stone removal. With the use of the U tube, inadvertent removal has not occurred and patients are able to work and shower between extraction procedures. Indwelling U tubes are readily replaced over a guide wire. This technique was used with good success and for long periods of time in seven patients, all with multiple intrahepatic stones and two of them with additional hepatic duct strictures.


Severe chest trauma. Morbidity implication. Patients who sustain fracture of either the first or second rib have severe injuries usually involving multiple systems. In comparing 71 patients with first rib fractures and 49 patients with second rib fractures, we found morbidity and mortality to be similar. A multidisciplinary approach to management of these patients is described and vigorous diagnostic and therapeutic measures are warranted to promptly determine the extent of injury and minimize the frequency of missed diagnosis.


Surgical treatment of the thoracic outlet compression syndrome. Narrowing of the thoracic outlet may give rises to symptoms in the arm from compression of the nerves, the subclavian artery, and the subclavian vein. Anatomic studies show that nerve compression may affect fibers from T-1, C-8, and not infrequently C-7, providing an explanation for the diffuse nature of the nerve symptoms in the arm. Relief from this compression at the thoracic outlet is readily accomplished by transaxillary resection of the first rib together with any associated cervical rib, fibrous cervical rib analogues, or other fibrous bands encroaching on the neurovascular structures. A study of 40 patients with the syndrome who were treated in this way and followed up after an interval of three to ten years shows that those with nerve and vein symptoms can expect a good result but the results of treatment in those with arterial symptoms is less satisfactory.


Expanded microporous polytetrafluoroethylene as canine arterial bypass or replacement graft. Expanded microporous polytetrafluoroethylene (PTFE) has been used experimentally and clinically for small-vessel bypass or replacement grafting; the results vary widely. This study  assessed short (4--cm) femoral and carotid artery replacement PTFE grafts and longer (12--cm) femoral artery bypass PTFE grafts that crossed a flexion crease. Pore size at the blood-graft interface ranged from 10 to 30 mu. At the end of three months, overall patency rate was 22%. No long bypass grafts remained patent. The pore size and type of anastomosis did not affect patency. The occlusion was always thrombotic, associated with fibrin at the suture line. Nine of the 20 short carotid grafts (45%) and five of 22 short femoral grafts (22%) remained patent. These poor results indicate that further experimental studies are needed before PTFE is used clinically when an alternative exists.


Primary liposarcoma of the omentum.

Primary liposarcoma of the omentum. Liposarcomas are common soft tissue tumors of the mediastinum and the retroperitoneum. Although they are rarely found in the greater omentum, when they occur in that area they can become enormous and be mistaken for pancreatic pseudocysts or ascitic distension. Recently, successful resection of a 10--kg liposarcoma of the omentum was performed at our institution. A description of the clinical presentation, preoperative assessment, and characteristics of this tumor are reported and the literature is surveyed. The use of adjuvant chemotherapy for these tumors is also discussed.


Intrahepatic bile duct rupture following blunt abdominal trauma. The natural history of intrahepatic bile duct rupture secondary to blunt trauma is not known. A unique case of bilateral hepatic lobar duct rupture is presented to demonstrate the clinical features and potential complications of this injury. Operative intervention is not always indicated and treatment should be dictated by the specific lesion.


Ultrasound and false normal oral cholecystogram. Although oral cholecystography is a highly accurate investigation for the diagnosis of gallbladder disease, false normal examinations do occur. In other patients, the presence of jaundice, nausea, or vomiting may preclude oral cholecystography. When there is clinical suspicion of gallbladder disease with a normal or equivocal oral cholecystogram, ultrasound examination is a highly accurate alternative imaging procedure. We describe in this article three patients with apparently normal oral cholecystography who were found to have obvious gallstones on ultrasound examination and at surgery. The relative accuracy of these diagnostic procedures is reviewed and their place in the diagnosis of biliary tract disease is discussed.


Breast carcinoma in a young man.

Breast carcinoma in a young man. Breast carcinoma occurred in a 25-year-old man. This is to our knowledge, the seventh reported instance of this extremely rare cancer. Despite its infrequent occurrence, high cure rates can be obtained if it is detected and treated early. Breast masses in young men must not be ignored.


Adverse effects of calcium administration. Report of two cases. Calcium chloride, 7 mg/kg, and calcium gluconate, 20 mg/kg, were administered to patients with low or low-normal levels of serum ionized calcium. Both patients had low blood pressure and cardiac index, and did not respond to digitalis, volume expansion, and beta-adrenergic stimulation with dopamine. Administration of calcium rapid increase of serum ionized calcium levels, decrease of serum potassium levels, and development of severe cardiac arrhythmias. Atrioventricular dissociation and further fall of cardiac index and blood pressure were common features of both cases. Administration of exogenous calcium can cause severe complications, even when theoretically indicated.


Reconstruction of a large chest wall defect using greater omentum. A 56-year-old woman was admitted for treatment of a large carcinoma that involved the chest wall. Fourteen years earlier, she had undergone a radical mastectomy, which was followed by chemotherapy and radiation therapy. The carcinoma was excised and the large anterior chest wall defect reconstructed using Marlex mesh, an omental pedicle flap, and a split-thickness skin graft.


High intramuscular anorectal abscess.

High intramuscular anorectal abscess. Six percent of the anorectal abscesses drained last year at the Naval Regional Medical Center, Portsmouth, Va, were of the high intramuscular variety. High intramuscular perianal abscesses may be difficult to diagnose because of the lack of external signs. It is important that a patient with unexplained anal pain be examined, under anesthesia if necessary. When a high intramuscular abscess is found, it is best drained into the anal canal rather than through a perianal skin incision.


Severe complications of intralesional BCG therapy in an unsensitized patient. Case report and clinical implications. Since the introduction of BCG intralesional immunotherapy for melanoma, severe complications, including death, have been reported after treatment in hypersensitized individuals. This is a case report of BCG dissemination with ulceration, skin necrosis, lymphadenitis, and abscess formation following the first intralesional injection of a minimal dose of BCG in a PPD-negative patient. The case demonstrates that severe complications can occur in patients who are not hypersensitized, anergic, or debilitated or who have been treated multiple times. This patient's complication further suggests that migration of BCG after intralesional therapy may play a role in the regression of uninjected nodules seen in some patients.


Lipoma of the colon.

Lipoma of the colon. Lipoma, an uncommon tumor in the gastrointestinal tract, occurs most often in the colon. The majority are asymptomatic but may cause abdominal pain, obstruction, or bleeding. The diagnosis can be made roentgenographically but is usually not made until operation is performed. Small lipomas may be removed by colonoscopy or followed conservatively after biopsy via colonoscopy. The treatment for symptomatic or large lipomas is surgical excision.


[Zinc anabolism during pregnancy].

[Zinc anabolism during pregnancy]. In the livers of pregnant rats an anabolic effect was found for zinc which, however, developed analogously to the enlargement of the organ. Femur and muscle did not reveal any super-retention of zinc during pregnancy. In the whole organism, a 10% increased zinc storage was found being attributable to stronger accumulation in the reproductive organs (3%) and in the liver (1%) and in other organs (6%) that were not under study. Higher Zn supply did not allow to increase this additional zinc storage during pregnancy. After lactation, the anabolic effect in the livers had declined, the Zn values of the lactating rats remaining, on the whole, at the same level as those of the pregnant animals. The Zn-serum concentrations as well as the alkaline phosphatase and carboxy peptidase A activities of the pancreatic gland were reduced during pregnancy, whilst the alkaline phosphatase activity in the femur increased. This finding is discussed in relation to Zn-supply and Zn-mobilisation.