Cerebral carbohydrate metabolism during hypoglycemia and anoxia in newborn rats. The cerebral metabolic responses to perinatal hypoglycemia and anoxia were studied in newborn rats given regular insulin (30 units per kilogram of body weight). Animals were observed for up to 2 hours with no apparent ill effects in spite of blood glucose concentrations of 0.75 mmol per liter. When exposed to 100% nitrogen at 37 degrees C, hypoglycemic animals survived only one-tenth as long as littermate controls with normal blood glucose levels (4.7 mmol/L). Pretreatment of hypoglycemic rats with glucose (10 mmol/kg) 10 and 30 minutes prior to nitrogen exposure nearly completely reversed the anoxic vulnerability. Hypoglycemia led to progressive reductions in cerebral glycogen and glucose; however, only glucose reverted to normal levels 20 minutes after systemic glucose administration. The glycolytic intermediates glucose 6-phosphate and lactate were also lower during hypoglycemia. Brain glucose levels below 0.1 mmol per kilogram were associated with a disrupted cerebral energy state, reflected by declines in phosphocreatine (33%) and adenosine triphosphate (ATP) (10%). Cerebral energy utilization (metabolic rate) was minimally reduced (-7.2%) by hypoglycemia and returned to the control value (2.36 mmol approximately P/kg/min) with glucose treatment. The cerebral energy reserves ATP, adenosine diphosphate, and phosphocreatine declined more rapidly and to a lower level in hypoglycemic rats subjected to 2 1/2 minutes of anoxia than in normoglycemic animals rendered similarly hypoxic. The findings suggest that decreased anoxic resistance of hypoglycemic newborn rats is not primarily a function of reduced brain glycogen or altered cerebral metabolic rate. The presence of endogenous cerebral glucose stores combined with continued circulating glucose (cerebrovascular perfusion) appear to be critical factors for maintaining perinatal hypoxic survival.


Identification of speech lateralization by intracarotid injection of methohexital. Speech lateralization was assessed in 25 patients with epilepsy by direct carotid injection of carotid catheterization from a femoral approach. Hemispheric anesthesia was induced by intracarotid injection of the rapidly acting barbiturate methohexital. This technique allowed same-day study of both hemispheres, permitted repeated injection of either carotid artery without accumulation of methohexital sufficient to cause systemic effects, and added little to the total time required for three-vessel cerebral angiography. Unilateral seizures were induced by methohexital injection in 4 patients. No other complication secondary to the methohexital study was observed.


Unusual presentation of traumatic extracranial internal carotid artery aneurysm. A young man presented with apparent transient ischemic attacks following a motorcycle accident in which he sustained minor injuries only. Computerized axial tomography demonstrated a small right frontal infarct, and angiography revealed an aneurysm of the right internal carotid artery in its extracranial course. This was thought to be traumatic in origin.


[Increase in the oleandomycin distribution coefficient at the extraction stage by using electron carrier-acceptors]. A possibility of increasing the distribution coefficient of oleandomycin on its extraction from the aqueous solution into the organic phase containing an electron carrier-acceptor was shown. It was found that the level of the oleandomycin equilibrium shift into the organic phase depended on the carrier nature, i. e. the donor-acceptor interaction of the carrier and the antibiotic. It was shown that the oleandomycin fermentation broth contained non-identified admixtures, the interaction of which with the antibiotic was higher than its interaction with the acceptor-carriers tested.


[Chromatographic method on a thin sorbent layer for studying the purity and quality of the antitumor antibiotic, rubomycin]. A method for qualitative and quantitative investigation of rubomycin composition was developed. It was based on chromatographic separation of the antibiotic components in a thin layer of silicic acid followed by their elution and spectrophotometric determination. An additional component of rubomycin found in the therapeutic preparations and the conditions of its formation were studied. Fifteen different lots of rubomycin were assayed and the requirements for the limits of the admixtures in the antibiotic therapeutic preparations were determined.


[Effect of the chromosome markers of antibiotic resistance on the aggressiveness of Staph. epidermidis]. Elucidation of antibiotic resistance correlation with manifestation of the pathogenic properties and aggressiveness in particular is of definite importance. Because of a wide spread of antibiotic resistance among staphylococci and ever increasing in pathology the role of S. epidermidis, the changes in penetration of the internal organ tissues, activity and intensity of capture and digestion by phagocytes of S. epidermidis mutants D-5/240 carrying the chromosome markers of penicillin and erythromycin resistance were analyzed. It was shown that the chromosome markers of the antibiotic resistance in staphylococci promoted their more active penetration into the tissues of the internal organs, affected permeability of the cell membranes, changed the activity of the digestion enzymes in the phagocyting cells (lowering the number of the acid phosphatase), prevented phagocytosis completeness and decreased the microorganism immunogenic properties.


[Cephazolin and cephapirin circulation in the blood of rabbits]. Circulation of 2 semi-synthetic cephalosporins, i. e. cephazoline and cephapyrine in the blood of rabbits after their intramuscular administration in single doses of 5 and 20 mg/kg was studied. It was found that the antibiotics were well adsorbed into the blood. Their maximum blood levels were achieved 15--30 minutes after administration. Cephazoline provided a higher blood level persisting for longer periods of time as compared to cephapyrine. The value of the time of the two-fold decrease in the cephazoline blood level was higher. A four-fold increase in the dose of the cephalosporines resulted in an increase in their blood levels but did not induce any significant increase in the time of their circulation.


[Effect of levorin on the rat liver plasma membranes in experimental fatty dystrophy]. Activity of Na+, K+-ATP- ase and 5'-nucleotidase, the lipid composition of the liver plasmic membranes with toxic and alimentary-alcohol fat dystrophy were studied on rats exposed to water-soluble sodium levorin. It was found that the above forms of the liver fat dystrophy did not change the activity of the enzymes in the membranes but caused significant shifts in the composition of the membrane lipids. The shifts were evident from an increased level of phospholipids in the plasmic membranes. Administration of levorin at the very beginning of the development of both the toxic and the alimentary-alcohol liver fat dystrophy aggravated the increase in the phospholipid level in the membranes. It was supposed that the increase in the phospholipid level due to levorin in the membranes of the liver with fat dystrophy was one of the mechanisms of the drug therapeutic effect in case of such pathology type. Levorin increased the amount of phospholipids in the dystrophic membranes and thus changed the membrane permeability resulting in decreased accumulation of neutral lipids in the hepacytes and subsequently in decreased levels of the liver fat dystrophy.


[Action of carminomycin on leukemic cell proliferation and some problems of its use in the combined therapy of leukemias]. The effect of carminomycin on the mitotic cycle of the cells of the transplantable leukemia L-1210 and the therapeutic activity of other antitumor drugs, such as phopurine and cyclophosphane was studied on mice BDF1. It was found that the cells in phases S and G2 of the mitotic cycle were most sensitive to carminomycin. Transfer G1--S and phase G1 were characterized by resistance to the antibiotic effect. When carminomycin was used in combination with phopurine or cyclophosphane, clear dependence of the therapeutic efficacy on the treatment scheme was noted. Simultaneous administration of all the three drugs resulted in potentiation of the antileukemic effect. An analogous effect was observed when carminomycin was administered prior to phopurine or cyclophosphane. When the order of the drugs use was reverse, the efficacy of the combined therapy was significantly lower than the summation antileukemic effect of the drugs.


[Effect of microbial and tumor cell adaptation to rubomycin on their uptake of rubomycin and carminomycin]. Anthracycline antibiotics rubomycin (daunomycin) and carminomycin rapidly accumulated in the bacterial and ascitic tumor cells and their intracellular concentrations significantly exceeded the concentrations in the medium. The strains of Staph. aureus and Fisher mouse ascitic lymphadenosis L-5178/P resistant to rubomycin preserved sensitivity to carminomycin. The resistance of the bacterial and tumor strains to rubomycin was accompanied by a significant decrease in the accumulation of rubomycin in the cells. At the same time carminomycin also effectively accumulated in the cells of Staph. aureus and Fisher ascitic lymphadenosis adapted to rubomycin, the same as in the cells of the parent strains.


Carbon catabolite regulation of cephalosporin production in Streptomyces clavuligerus. Cephalosporin production by Streptomyces clavuligerus is regulated by some type of carbon catabolite control. Increasing concentrations of preferred carbon sources, such as glycerol and maltose, decreased production of the antibiotics. Poorer carbon sources, such as alpha-ketoglutarate and succinate, led to high specific production of cephalosporins and shifted the dynamics of fermentation to a greater degree of association with growth. The results support the concept that the phase in which a product is made by a microorganism is not a function of the particular molecule produced, but rather of the nutritional environment presented to the organism.


Pharmacokinetics of gentamicin administered intratracheally to rats. The pharmacokinetics of intratracheally instilled and intravenously injected gentamicin were compared in the rat and analyzed by a one-compartment open model. The maximum concentration of gentamicin in plasma occurred within 10 min after intratracheal instillation. Considerable amounts of gentamicin were absorbed from lungs after intratracheal instillation, as shown by its concentrations in plasma and elimination in urine. The data suggest that the absorption of gentamicin from the pulmonary system would be sufficient to maintain therapeutic levels of this agent in plasma.


Pharmacokinetics of cefaclor and cephalexin: dosage nomograms for impaired renal function. The pharmacokinetics of cefaclor and cephalexin were characterized in patients with creatinine clearances ranging from 0 to 147 ml/min. Each of 24 fasted subjects received a single 500-mg oral dose of cefaclor, and 13 of these subjects later received 500 mg of cephalexin. Serum and urine levels of the antibiotics were measured by bioassay. The serum half-lives were highly correlated with corrected creatinine clearance (cefaclor r = 0.92, cephalexin r = 0.94). Linear regression estimates of the half-life of cefaclor were 2.3 h in the anephric patient and 40 min in the patient with a corrected creatinine clearance of 100 ml/min. For cephalexin, corresponding half-lives were 15.4 h and 58 min. We present a dosage nomogram for calculating the appropriate adjustments to the loading dose based on patient weight and maintenence dose based on corrected creatinine clearance.


In vitro studies with Sch 21420 and Sch 22591: activity in comparison with six other aminoglycosides and synergy with penicillin against enterococci. In vitro tests were performed with Sch 21420 and Sch 22591 to determine (i) their activity in comparison to six other aminoglycosides against 343 clinical isolates, and (ii) whether synergy with penicillin G could be demonstrated with enterococci. In broth dilution tests, Sch 22591 was more active than the seven other aminoglycosides against Staphylococcus aureus, Enterobacteriaceae, and most nonfermenting gram-negative bacilli. Sch 22591 was as active as tobramycin against Pseudomonas aeruginosa. The activity of Sch 21420 was comparable to gentamicin, sisomicin, netilmicin, and tobramycin but greater than amikacin or kanamycin against S. aureus and most genera of Enterobacteriaceae. Sch 21420, amikacin, and kanamycin were (i) more active than the other five aminoglycosides against Proteus rettgeri and Providencia stuartii, but (ii) less active than the other five aminoglycosides against Neisseria gonorrhoeae, enterococci, most nonfermenting gram-negative bacilli, Proteus mirabilis, and Proteus morganii. Studies on the bactericidal activity of Sch 22591 with penicillin indicated a synergistic interaction against enterococci, including strains highly resistant to streptomycin and kanamycin. This could be demonstrated with combinations containing 3.0 to 6.0 mug of Sch 22591 per ml and was comparable to that observed with penicillin/gentamicin. Penicillin plus Sch 21420 (25 mug/ml) also demonstrated synergy against enterococci, including strains highly resistant to streptomycin. However, synergy did not occur against strains highly resistant to kanamycin. These latter results were similar to those obtained in tests with penicillin/kanamycin.


Activity of 5-episisomicin compared with that of other aminoglycosides. 5-Episisomicin, a semisynthetic aminoglycoside, has been shown to inhibit many members of the Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus. At a concentration of 3.1 mug/ml, more than 90% of Escherichia coli, Klebsiella pneumoniae, Enterobacter, Citrobacter, indole-positive Proteus, and Providencia were inhibited. 5-Episisomicin had activity against S. aureus, E. coli, Klebsiella, Enterobacter, and Citrobacter similar to gentamicin and netilmicin. It had activity similar to amikacin and netilmicin against many gentamicin-resistant bacteria. The activity of 5-episisomicin was greatest at an alkaline pH and in medium of low magnesium content. Synergy of 5-episisomicin and carbenicillin was found to occur most often against Pseudomonas.


In vitro susceptibility of Mycoplasma hyopneumoniae and Mycoplasma hyorhinis to fifty-one antimicrobial agents. By a tube dilution assay technique, 51 antimicrobial agents were singly tested against 9 strains of Mycoplasma hyopneumoniae and 1 strain of M. hyorhinis for the purpose of obtaining information useful for selecting an agent for testing in vivo against porcine mycoplasmal pneumonia. Based on determining minimal inhibitory concentrations and chemically grouping the agents into nine classes, all M. hyopneumoniae strains were found resistant to penicillins and peptides and susceptible to sulfonamides and tetracyclines, and, in other classes, were either susceptible or resistant depending on the particular agent being tested. Strains were susceptible to the same 33 of the 51 agents. Minimal inhibitory concentrations ranged from 0.06 to 9.20 mug/ml. M. hyorhinis was susceptible to 19 of the 33 agents that M. hyopneumoniae was susceptible to. Minimal inhibitory concentrations ranged from 0.03 to 8.10 mug/ml. All strains of M. hyopneumoniae differed from M. hyorhinis in that they were susceptible to cephaloglycin and nitrofurazone.


Effects of hydration on gentamicin excretion and renal accumulation in furosemide-treated rats. The effect of furosemide on gentamicin excretion and tissue accumulation was studied with clearance techniques in anesthetized rats, at two different infusion rates of saline or Ringer solution. Gentamicin ( approximately 20 mg/kg) was administered by constant intravenous infusion over a period of 3 h. With the low fluid infusion rate, furosemide (25 mg/kg intravenously) caused severe reduction in glomerular filtration rate and diminished urinary output of gentamicin. Serum and renal tissue levels of the antibiotic were significantly elevated. High fluid infusion prevented the decline of the glomerular filtration rate, with near normalization of all measurements. A fluid deficit incurred by furosemide was noted at both the low and high infusion rates. Complete correction of this fluid deficit by continuous adjustment of the infusion rate fully restored normal renal handling of gentamicin. These results suggest that furosemide had no direct effect on renal excretion of gentamicin. In comparison, renal handling of gentamicin in rats did not respond to changes in the rate of fluid infusion in the absence of furosemide therapy. It appears that gentamicin excretion and gentamicin accumulation in the renal cortex in furosemide-treated rats, in contrast with those in untreated rats, are influenced significantly by the rate of fluid infusion. Fluid administration sufficient to maintain the glomerular filtration rate was found to be necessary for appropriate gentamicin elimination, with consequent reduction in serum and renal tissue levels of the drug.


Ascitic fluid cephalosporin concentrations: influence of protein binding and serum pharmacokinetics. Mongrel dogs with ascites created by inferior vena cava ligation were given cephalothin, cephaloridine, cefazolin, and cefamandole to evaluate the effect of protein binding and serum pharmacokinetics on the distribution of cephalosporins into ascitic fluid. Antibiotics were given intramuscularly (15 mg/kg) every 4 h for a total of eight doses. Antibiotic binding to dog serum and ascitic fluid was measured by ultracentrifugation. Binding of the cephalosporins to dog serum ranged from 31% for cephaloridine to 46% for cephalothin, considerably lower than human serum binding for cefazolin, cephalothin, and cefamandole. Antibiotic binding to ascitic fluid was only slightly lower than that to serum. Ascitic fluid antibiotic concentrations, which approached equilibrium at 16 to 28 h, were significantly higher for cefazolin and cephaloridine than for cephalothin and cefamandole. However, serum concentrations were also higher for cefazolin and cephaloridine, and percent penetration (ratio of serum peak to ascites peak x 100) was not statistically different among the four drugs. Binding of these cephalosporins to extravascular fluid protein was an important factor that determined the total ascitic fluid antibiotic level achieved. A formula utilizing the log mean serum level and binding to serum and extravascular fluid protein was used to accurately predict ascitic fluid drug levels at equilibrium.


Vacuolization in cultured cells induced by amphotericin B. Amphotericin B induced vacuoles in one HeLa cell line and in some unrelated cell lines. Cell growth was not affected.


Erythropoietin concentration in amphotericin B-induced anemia. Amphotericin B was given to six patients with systemic fungal infections. A dose averaging 1.78 g, administered from 42 to 144 days, was associated with a fall in hematocrit to a mean value of 25.8%. Despite this degree of anemia, no elevation of erythropoietin concentrations in urine or serum could be detected. Thus, amphotericin appears to cause anemia by inhibiting erythropoietin production rather than by suppressing bone marrow activity directly.


In vitro activity of rosamicin and erythromycin against a group of nonfermenting gram-negative bacilli. The in vitro inhibitory activity of rosamicin and erythromycin against 283 strains of nonfermenting, gram-negative bacilli was determined by using a broth dilution procedure. Rosamicin demonstrated greater activity than erythromycin against most strains tested. A number of species demonstrated significantly lower minimum inhibitory concentrations to rosamicin and would fall within the therapeutic range of the drug based on current pharmacological data.


Kinetic parameters and relative turnovers of some important catabolic reactions in digesting sludge. The kinetics of propionate degradation, acetate splitting, and hydrogen consumption in digesting sludge were investigated in a lab-scale digester. At natural steady-state conditions, the acetate-splitting systems in well-digested sludge were about half saturated. Propionate-degrading systems were saturated to only 10 to 15%, and hydrogen removal was less than 1% of the maximum possible rate. It was concluded that acetate splitting rather than "methanogenesis from fatty acids" is the rate-limiting reaction in the anaerobic degradation of dissolved organic matter and that a methoanogenic anaerobic ecosystem is stabilized by its large unused capacity of hydrogen consumption which is "buffering" the partial pressure of dissolved hydrogen in the system at sufficiently low values to permit rapid fatty acid oxidation. A tentative scheme of the substrate flow in sludge digestion is presented. It suggests that acid formation coupled with hydrogen formation via pyridine dinucleotide oxidation yields the immediate substrates, namely acetate and hydrogen, for about 54% of the total methanogenesis.


Gastrointestinal microecology of BALB/c nude mice. The aerobic, facultative, and anaerobic microorganisms cultivable from the stomachs, ilea, ceca, and colons of BALB/c athymic (nu/nu) mice (normal and wasting), thymus-implanted normal nude mice, and their heterozygous (nu/+) littermates were investigated. Ninety-one species representing 23 genera of bacteria and yeasts were isolated from the 27 mice. The wasting nude mice showed significantly lower numbers of lactobacilli in their stomach microbiota than did mice from the other three groups. The littermate animals appeared unique among the four groups in having corynebacteria as a major constituent of their stomach and ileal flora. The normal nude mice appeared to have a more diverse anaerobic stomach flora than their heterozygous littermates. These minor differences are discussed with respect to possible immunological, physiological, and environmental factors as their cause. Because the gastrointestinal microfloras of the mice from the four groups were not radically divergent from each other, it was concluded that loss of T-cell function does not dramatically alter the makeup of the cultivable gastrointestinal microflora in these mice.


Methanogenesis from acetate: enrichment studies. An acetate enrichment culture was initiated by inoculating anaerobic sludge from a mesophilic methane digestor into a mineral salts medium with calcium acetate as the sole carbon and energy source. This enrichment was maintained indefinitely by weekly transfer into medium of the same composition. A study of this enrichment disclosed an unexpected age-dependent inhibition of methanogenesis by H2 and formate which apparently differed from the inhibition by chloroform and benzyl viologen. This age-dependent inhibition indicated that microbial interactions of the mixed enrichment population may play a regulatory role in methane formation. Futhermore, stimulation of methanogenesis in the acetate enrichment by addition of yeast extract showed a nutrient limitation which indicated that syntrophic interactions leading to formation of growth factors may also occur. A model is presented to illustrate the possible interrelationships between methanogenic and nonmethanogenic bacteria in their growth and formation of methane and carbon dioxide from acetate.


Effect of municipal refuse metals on cellulase production by Thermomonospora curvata. The high-concentration metals in municipal refuse compost were tested for effects on cellulase production and activity in Thermomonospora curvata. Although none altered cellulase reaction rates, both Al and Ca appeared to specifically inhibit cellulase production.


Extracellular endo-beta-1,4-glucanase in Cellvibrio vulgaris. Endo-beta-1,4-glucanase of the cellulolytic bacterium Cellvibrio vulgaris is an actively secreted, truly extracellular enzyme, as supported by growth and secretion studies using filter paper as the sole carbon source.


Effect of medium composition on the growth and asparaginase production of Vibrio succinogenes. Asparaginase synthesis by Vibrio succinogenes is induced by ammonium ions. Synthesis occurs throughout exponential phase, and in early stationary phase asparaginase accounts for about 5% of the total soluble protein. The organism grows best when fumarate is provided as the terminal electron acceptor of the formate-oxidizing cytochrome system. Yeast extract or enzyme-hydrolyzed proteins are effective nutrient sources. In an ammonium formate-sodium fumarate medium, where maximum growth and asparaginase synthesis occurs, the total enzyme yield (international units per liter of culture) is about one-tenth that obtainable with a good asparaginase-producing strain of Escherichia coli. The energetic inefficiency of V. succinogenes appears to cause a low yield of cells and therefore low total enzyme yield. However, the levels of asparaginase accumulated within cells raise questions about the organism's protein synthesizing system.


Progesterone biotransformation by plant cell suspension cultures. Progesterone was converted to 5alpha-pregnane-3alpha-ol-20-one, delta4-pregnene-20alpha-ol-3-one, delta4-pregnene-14alpha-ol-3,20-dione, delta4-pregnene-7beta,14alpha-diol-3,20-dione, and delta4-pregnene-6beta,11alpha-diol-3,20-dione by cell cultures of Lycopersicon esculentum. Cell cultures of Capsicum frutescens (green) metabolized progesterone to delta4-pregnene-20alpha-ol-3-one in very high yield, and Vinca rosea yielded delta4-pregnene-20beta-ol-3-one and delta4-pregnene-14alpha-ol-3,20-dione. A stereospecific reduction of the keto groups and a double bond and stereospecific introduction of hydroxyl groups at the 6, 11, and 14 positions have been observed. The mono- and dihydroxylated progesterones have not previously been reported as metabolic products of progesterone by plant cell systems and represent de novo hydroxylation of a nonglycosylated steroid.


Fungal contamination and mycotoxin detection of powdered herbal drugs. Forty-nine powdered herbal drugs were analyzed for their mold profile and for the potential presence of three mycotoxins (aflatoxin, sterigmatocystin, ochratoxin A). Aspergillus and Penicillium species were predominant, but Rhizopus, Mucor, Cladosporium, and Aureobasidium spp. were also found in a few samples. Mycotoxins were not detected in any samples, and only one isolated culture was found to be a mycotoxin producer on laboratory media.


Inhibition of aflatoxin biosynthesis by tolnaftate. Tolnaftate [2-napthyl-N-methyl-N-(m-tolyl)thionocarbamate], an antifungal drug, is widely used to control superficial fungal infections in humans and other animals. In this study the effect of tolnaftate on aflatoxin biosynthesis by Aspergillus parasiticus NRRL 3240 was investigated. Tolnaftate changed the morphology of A. parasiticus to yeastlike forms and inhibited aflatoxin formation. The formation of aflatoxin G was blocked considerably, indicating a metabolic block in the conversion of aflatoxin B to aflatoxin G. The incorporation of [1-14C]acetate into aflatoxin was significantly inhibited at a concentration of 1 mM tolnaftate. The presence of zinc in the resuspension buffer resulted in reversal of the tolnaftate-induced inhibition of aflatoxin G1 biosynthesis.


Factors related to the oxygen tolerance of anaerobic bacteria. The effect of atmospheric oxygen on the viability of 13 strains of anaerobic bacteria, two strains of facultative bacteria, and one aerobic organism was examined. There were great variations in oxygen tolerance among the bacteria. All facultative bacteria survived more than 72 h of exposure to atmospheric oxygen. The survival time for anaerobes ranged from less than 45 min for Peptostreptococcus anaerobius to more than 72 h for two Clostridium perfringens strains. An effort was made to relate the degree of oxygen tolerance to the activities of superoxide dismutase, catalase, and peroxidases in cell-free extracts of the bacteria. All facultative bacteria and a number of anaerobic bacteria possessed superoxide dismutase. There was a correlation between superoxide dismutase activity and oxygen tolerance, but there were notable exceptions. Polyacrylamide gel electropherograms stained for superoxide dismutase indicated that many of the anaerobic bacteria contained at least two electrophoretically distinct enzymes with superoxide dismutase activity. All facultative bacteria contained peroxidase, whereas none of the anaerobic bacteria possessed measurable amounts of this enzyme. Catalase activity was variable among the bacteria and showed no relationship to oxygen tolerance. The ability of the bacteria to reduce oxygen was also examined and related to enzyme content and oxygen tolerance. In general, organisms that survived for relatively long periods of time in the presence of oxygen but demonstrated little superoxide dismutase activity reduced little oxygen. The effects of medium composition and conditions of growth were examined for their influence on the level of the three enzymes. Bacteria grown on the surface of an enriched blood agar medium generally had more enzyme activity than bacteria grown in a liquid medium. The data indicate that superoxide dismutase activity and oxygen reduction rates are important determinants related to the tolerance of anaerobic bacteria to oxygen.


Occurrence of Yersinia enterocolitica in house rats. From July 1976 to May 1977, 270 rats (259 Rattus norvegicus and R. rattus) in Sapporo were examined for the presence of Yersinia enterocolitica in house rats. The organism was isolated in 55 rats (54 R. norvegicus and 1 R. rattus). Isolated strains were determined as O group (O)3, biovar 4; O4, biovar 1; O5A, biovar 1; and O6, biovar 1. The isolation of O3, biovar 4 strains from R. norvegicus is the first in the world, as far as we know. The organism was isolated from the duodenum in 3 rats, the jejunum in 7 rats, the ileum in 8 rats, the cecum in 34 rats, the colon in 23 rats, the rectum in 16 rats, and the mesenteric lymph nodes in 5 rats. The organism was not isolated from liver, spleen, and kidneys. Isolation of the organism from the mesenteric lymph nodes was made in 1 out of 2 O3-positive rats, 1 out of 7 O5A-positive ones, and 3 out of 29 O6-positive ones. A high agglutinin titer was recorded in the two O3-positive rats and in one O6-positive animal.


Rapid procedure for the detection of plasmids in Staphylococcus epidermidis. A rapid, reproducible, mini-volume assay capable of detecting staphylococcal plasmid DNA in the range of 0.8 to 32 megadaltons has been developed. The assay employs lysostaphin-mediated lysis of cells followed by a short, low-speed centrifugation and does not require treatment with ribonuclease or protease or deproteinization with phenol. A period of only 24 h may be required to detect the presence and size of a plasmid once an organism has been isolated. This method has been used to study the plasmid ecology of Staphylococcus epidermidis and to correlate the presence or absence of plasmids with tetracycline, chloramphenicol, neomycin, penicillin, and cadmium resistances.


Minimal water activity for enterotoxin A production and growth of Staphylococcus aureus. The minimal water activity (alphaw) for growth was correlated with enterotoxin A formation by two strains of Staphylococcus aureus in a salt mixture broth. Within 7 days at 30 degrees C both strains grew and formed enterotoxin A minimally between alphaw 0.864 and 0.867, but at 25 degrees C, the minimal alphaw for both activities was increased to between 0.870 and 0.887 after a 2-week incubation.


Depression of activity of intestinal mucosal alkaline phosphatase with gastrointestinal microorganisms. Depression of intestinal alkaline phosphatase activity can be caused by the formation of the microbial ecosystem with several kinds of viable microorganisms in rats.


Detection of bacterial nitrite production from nitrate by a nitrate-starch-iodide agar medium. A medium consisting of nitrate agar (Difco), modified by the addition of 1% starch and 1% KI, was used to detect the production of nitrite by a number of different bacterial species.


Staphylococcal enterotoxin A: a chromosomal gene product. Physical and genetic analysis of the plasmid make-up of Staphylococcus aureus strains S6 and FRI-100 has shown that staphylococcal enterotoxin A is a chromosomal gene product.


D-values of Bacillus pumilus spores on irradiated devices (inoculated product). The D-values of Bacillus pumilus spores on various devices ranged from 0.14 to 0.23 Mrads. The majority of devices displayed D-values equal to or less than the value obtained on filter paper. Increased resistivity was also encountered.


H2-producing bacteria in digesting sewage sludge isolated on simmple, defined media. Twenty percent of bacteria isolated on simple, defined anaerobic media produced H2. Eighty-four percent of these were isolated on glucose. All were Enterobacteriaceae, primarily Citrobacter.


[P. Metastasis of prostatic carcinoma to the epididymis]. When reviewing the bibliography of this rare metastatic location of cancer of the prostate gland, we have only been able to compile the observations published by HUMPHREY (1), BROTHERUS (2) and SMITH (3) wo describe cases with the same location and characteristics. All the observations of metastasis in the epididymis of cancer of the prostate gland constitute unexpected findings during the course of surgical castration operations. The morphology is always the same, small indurated nodules respecting the rest of the epididymis. On the other hand, metastases in the epididymis of extraurinary adenocarcinomas most of which were digestive, were not discovered until the increased size and pain in the testicle attracted the patient's attention and the exploration led to the identification of the tumour in the epidiymis (2, 4, 5). However, primitive malignant tumours of the epididymis constitute an infrequent lesion. In the literature there were found to be more primitive tumours in relation to the metastatic ones and it was difficult to establish the diagnosis of a primitive tumour of the epididymis without having previously ruled out the possibility of other distant neoplasias which are sometimes even asymptomatic.


[Xanthogranulomatous pyelonephritis. Our theory and discussion on the development of such an entity. Report of 9 cases]. The authors present 9 cases of xanthogranulomatous pyelonephritis observed in the "Juan XXIII" Hospital in Tarragona. They emphasize the relationship between lithiasis, chronic urinary infection and antigenic stimulation for the development of this entity, the progressive result of a lesion in the kidney tissue with immobilized infectious calcareous deposits. In the granulomatous lesion they find cells called antigen-antibody quartets, with foamy-type histiocytes, the nodular collections of which constitute the key to X.P. The formation of lymphocytic germinal centres is another antigenic stimulus in some parts of the kidney tissue. These structures are due to the storing of antibodies and therefore the immunoglobulins would not be released towards the blood stream, which would explain changes in the immunoglobulins in these patients' serum.


[Various aspects of renal pyramid collagen seen by scanning electron microscopy]. In apparently normal kidneys, viewed with a scanning electromicroscope, it has been observed that the renal pyramid has a collagen arranged in cells which cover vessels and tubules. These cells vary in arrangement and structure. In spite of the apparent normality, collagen variations are observed. Sometimes as a result of the increased intensity and other times because forms of neocollagen appear with accumulations of essential substances. This fact suggests that the said changes involve two circumstances. Either this tissue changes continuously or the said kidneys have some lesion in their collagen which leads to new forms of neocollagen appearing and to the great richness of essential substances.


[Solitary pedunculated polyp of the posterior urethra in a child]. We present a case of polyps in the prostatic urethra in a 21-month old child. The clinical picture and the diagnosis are discussed with particular attention being paid to the mictional urethrocystography. The most suitable surgical approach is indicated as the basis for treatment and finally the etiology is established.


[Scrotal appendicocele in an infant (clinical note)]. The authors present the case of a 7-month old suckling baby with scrotal appendicocele which simulated a para-testicular tumour. They comment upon the difficulty involved in a preoperative diagnosis and analyse the factors which favour the emigration of the appendix to the scrotum at an early age (persistence of the peritoneo-vaginal duct, non-joining of the peritoneal membrane, the insertion of the appendix into the end of the caecum and increases in the intraabdominal pressure). They point out the need for surgery which will be of a diagnostic-therapeutic nature.


[Clinical study of a phytosterol extract of Prunus arborea and 3 amino acids: glycine, alanine and glutamic acid]. We have carried out a therapeutic study on "Tebetane compuesto", by applying it to one hundred patients, whose pathologies, prostatic adenoma, prostatitis and postadenomectomy sequelas, come within the field of action of the product, as shown by other authors. The particular feature of "Tebetane compuesto" is that it is a non-hormonal product, which contributes to the fact that it may be used in high doses without producing harmful effects on the patient. We have found no cases of intolerance or side effects, which we feel makes it superior to other similar products. To be specific, in the case of prostatitis, "Tebetane compuesto" has proved to be effective in 94 per 100 of the patients treated, making it a highly reliable product for use by the specialist or general practitioner. We feel, on the other hand, that the inclusion in the formula of "Tebetane compuesto" of the three aminoacids has led to a considerable reduction in the duration of the treatments of these patients, with the resulting financial saving involved.


[Ultramicroscopic study of the mucosa of the lower 3d of the ureter]. A study has been made, using an electronic microscope, of the mucosa of the lower third of the ureter of rats, including a description of three kinds of cells with their own ultrastructural characteristics. One may emphasize the presence of intraepithelial nerve endings and chromaffin type granular formations. In some cells, adjacent to the basal membrane, there is also a perinuclear structure described, consisting of tonofilaments (perinuclear crown of tonofilaments) which it is thought could affect the genesis of distension stimuli.


[Sonographic study of hydronephrosis].

[Sonographic study of hydronephrosis]. The authors present the experience acquired by the Urology Department of "La Paz" Hospital in the sonographic diagnosis of hydronephrosis over a period of one year. In 47 patients, the percentage of successful diagnoses reached 93.7%, including 32 cases with a silent kidney in the intravenous urography. They discuss the different sonographic patterns of hydronephrosis, in relation to its degree of evolutionary development and its differential diagnosis with other kidney disorders.


[Ureteral injuries following translumbar aortography]. In the already scarce traumatic ureter pathology, beyond the scope of Gynaecology, we present a case, also iatrogenic, which although it is described as a possible complication in the performing of a translumbar aortography, is of unquestionable interest by virtue of its origin and subsequent evolution.


[Temporary urinary derivations: use of the Kehr T tube]. The authors present 10 cases of obstructive uropathy, 8 caused by lithiasis and 2 by retroperitoneal tumours, in which, due to the chronic nature of the processes and to the intense periureteral fibrosclerosis in the place of the stone, temporary derivation of the urine was advisable. After having used several kinds of derivations (nephrostomies, pyelostomies, free ureteral probes), they use Kehr's T tube and comment upon the advantages and benefits obtained with this kind of derivation.


[Subcapsular renal hematoma: report of a case of unusual etiology]. The authors present a case of myeloproliferative syndrome with an exceptional clinical picture of pain in the right hypochondrium and right iliac fossa, with no mictional syndrome or hematuria, caused by the appearance of a spontaneous subcapsular hematoma. They discuss the frequency of the different kinds of kidney hematomas and their causes. They also describe the typical radiological signs of the subcapsular hematoma in comparison with the other forms of kidney hematomas.


Effect of selective proximal vagotomy and truncal vagotomy on gastric acid and serum gastrin responses to a meal in duodenal ulcer patients. To assess the effectiveness of selective proximal vagotomy (SPV) in reducing the acid response to food, we have compared pre- and postoperative gastric acid and serum gastrin responses to a meal in 11 duodenal ulcer patients with intractable pain treated by SPV, with those of seven ulcer patients with gastric outlet obstruction treated by truncal vagotomy and drainage (TV + D). Acid secretion was measured by an intragastric titration method which measures acid response to food within the stomach (5% amino acid meal) adjusted to various pH levels (5.5, 2.5, and 1.5). Studies were performed before and two to six weeks after operation. The preoperative intragastric acid output (IGAO) was about 50% of maximal acid response to Histalog. The mean preoperative IGAO at pH 5.5 For 11 SPV patients was 17.4 +/- 3.1 mEq/hour; this was decreased by 72% to 4.3 +/- 1.1 mEq/hour after operation. The mean IGAO at pH 5.5 in nine patients treated by TV + D was 21.6 +/- 3.4 mEq/hour; this was decreased by 67% to 7.3 +/- 2.1 mEq/hour. Gastrin levels were significantly higher in postop than in preop SPV PATIENTS EVEN THOUGH PH values were constant. Gastrin levels were higher in postop TV + D patients than in postop SPV patients. This study demonstrates that acid reduction achieved by SPV is reliable and at least comparable with that achieved by turncal vagotomy. Postoperative elevation of gastrin in the SPV patients suggests that the vagus may release a humoral inhibitor of gastrin release from the gastric fundus; there may also be a further direct vagal inhibitor of antral gastrin release.


[Surgery of ureterocele with lithiasis]. We present 7 cases of ureterocele with secondary lithiasis, which constitute 15% of all our cases of ureterocele. From the clinical point of view, the symptoms are not different from those of these two separate pathologies. Nephroureteral colics associated with a low ureteral syndrome were the most frequent cause of the patients' visiting the doctor. Obstruction of the vesical neck is characteristic of ectopic or large ureteroceles. The diagnostic is radiographic and endoscopic. The results of the surgical treatment are much more superior with the transvesical approach followed by antireflux plastia to the transureteral approach, in which postoperative reflux is common, although it is usually well tolerated by adult patients.


[Carcinoma of the penis: review of our cases]. A review is made of 36 carcinomas of the penis treated in the Urology Department of the "La Fe" Hospital. The most frequent decade for their appearance is the fifties. We establish their link with restricted hygiene and with fimosis, Queyrat's erythroplasia, leukoplasia and accuminated condyloma. The treatment given depends essentially on the clinical stage. We feel that within stage A, with minimum prepuce lesions, the ideal treatment is local excision and circumcision plus radiotherapy; in the case of minimal gland lesions radiotherapy; in the rest and when the former forms of therapy fail, partial amputation of the penis. We currently treat this stage with cryosurgery although we cannot give any results because of the limited period of development of the same. In stage B, we indicate amputation plus bilateral, ilio-inguinal lymphadenectomy plus radiotherapy. In stages C and D the treatment is palliative, on the basis of polychemotherapy.


Relief of acute, persistent postvagotomy atony by metoclopramide. Seventeen patients with acute, persistent postvagotomy atony after vagotomy with antrectomy or pyrloroplasty for peptic ulcer underwent a doubleblind study of the relief of postvagotomy atony by metoclopramide. All patients had complete, functional gastric obstruction for at least three weeks postoperatively, precluding oral alimentation. Contrast studies and gastroscopy ruled out mechanical obstruction in each patient. Gastric outlet obstruction was confirmed by radioisotope assessment of gastric emptying of a special solid meal labeled with Technetium 99m DTPA. A gamma camera over the epigastrium precisely quantitated the emptying rate of the labeled meals. After baseline scanning an intravenous placebo was given to each patient and all 17 showed gastric retention of the meal after 90 minutes. Gastric emptying rates were restudied 24 hours later after intravenous metoclopramide and all 17 patients then immediately emptied the labeled meals. These patients then received standard postgastrectomy diets. Eight patients received metoclopramide tablets (10 mg 30 minutes a.c., q.i.d.) and nine received placebo tablets. Each of the eight patients receiving metoclopramide ate normally immediately after treatment with no further evidence of gastric atony. The nine patients receiving the placebo were unable to retain any oral feedings and were then given oral metoclopramide which promptly relieved gastric atony. All 17 patients received metoclopramide for one month without side effects after which the drug was discontinued with no recurrence of gastric symptoms during follow-up periods ranging from three to 27 months. Metoclopramide safely and effectively relieves acute, nonmechanical gastric atony when this occurs after surgical treatment of peptic ulcer.


[Tumors of the testicle: various comments of their etiological and evolutive aspects, and therapeutic results in a review of 360 cases]. Out of a total of 360 cases compiled of testicle tumours obtained from numerous Spanish urologists, the authors analyse their distribution according to the age at the onset, in decades, in the 232 patients in which it became known to them, observing the greatest incidence between 21 and 50 years of age. They then compare the age-type of tumour parameters, in 115 of the cases of which they received the data. In the second part of the study, they make a brief study of the methods of therapy: orchidectomy, with or without lymphadenectomy, radio or cobaltotherapy, antiblastic chemotherapy or the combination of several means of treatment, summing up in the form of a general chart, the results obtained in the 275 observations known to this end and they conclude with another diagram comparing the cases of survival (117 out of the above-mentioned 275) with those obtained by other foreign observers.


[Comparative study of ureteral displacements]. A study ia mde of 15 patients with a known neoplasia: 2 retroperitoneal tumours, 5 lymphomas, 3 prostate neoplasias, 3 seminomas and 2 uterus neoplasias; with displacement of the ureter and in some cases ectasia of the excretion system. The displacement was always one-sided and most frequently found in the lower third of the ureter. Ectasia was found in two patients; we have never found this in any patients without a known neoplasia. Adenopathies were the most frequent cause of inferior ureter deviation but in only one case did they infiltrate into the wall and they were more constant on the right side. These cases are compared with other patients suffering from different pathologies, some of which are also neoplastic but in which no displacement or ectasia appeared even when the retroperitoneum was affected, and with another group of patients in whom there was found to be ureteral displacement or ectasia without any retro- or intraperitoneal pathology.


Surgical correction of congenital heart disease in the adult: experience with 139 patients. Patients over 18 years of age who have undergone a surgical correction of a congenital cardiac malformation during the period 1968 through 1977 have been reviewed. Those patients with calcific aortic stenosis which was thought, but not proved, to have arisen in a congenitally malformed aortic valve, were excluded from the review. Patients with cystic medial necrosis of the aorta were similarly excluded. There were 139 patients in the series (age range from 18 years to 67 years). The most common defects were those involving the intra-atrial septum and the related great veins, 50%. Abnormalities involving the great arteries including patent ductus arteriosus and coarctation of the aorta accounted for 19%. Common defects of conal development including ventricular septal defects and Tetralogy of Fallot malformations accounted for 15%. Valvular abnormalities including pulmonic stenosis, aortic valve abnormalities and Ebstein's malformation of tricuspid valve accounted for 11.5%. Complex congenital malformations were relatively uncommon, 4%. There were two patients with a combination of acquired and congenital heart disease. There were two operative deaths in the series, both occurring in patients with complex forms of congenital heart disease (multiple ventricular septal defects, double outlet right ventricle). There were two additional postoperative hospital deaths, one occurring following repair of an atrial septal defect from massive pulmonary embolus, and another occurring six weeks following a Fontan procedure performed for tricuspid atresia. Thus, the hospital mortality for the series was 2.9%. This reviewed series reveals the incidence of operable congenital heart defects appearing in an adult cardiac surgical practice and demonstrates that surgical repair can be accomplished with a satisfactory low mortality rate.


[Renal cortical rest pseudotumor].

[Renal cortical rest pseudotumor]. The authors present a case of kidney pseudotumour and stress the difficulty of reaching a final diagnosis in relation to the course of therapy.


[Chyluria].

[Chyluria]. The authors present two cases of non-parasitic chyluries, with views of the right intrarenal fistula in one case, by means of lymphography and another which was more exceptional in its appearance, linked with sleeping and postural, apparently with a lymphographic blockage. Conservative treatment, based mainly on the diet, with the omission of long-chain triglcerides and poor in fats, produced good results.


Management of external gastrointestinal fistulas. We analyzed the course of 186 patients with external gastrointestinal fistulas treated at the University of California Medical Center, San Francisco from 1968 to 1977. There were 82 patients in the earlier group (1968-1971) and 104 patients in the later group (1972-1977). The groups differed in that 35% of patients in the earlier group received TPN, but 71% of patients in the later group received TPN. Of the patients who did not receive TPN, 93% had been adequately nourished using tube feeding methods. The two groups were otherwise similar. The fistula-related mortality (11%) and the spontaneous closure rate of the fistulas (32%) was unchanged over the ten year period. Thus, the principal impact of TPN was to simplify the nutritional management rather than to alter the outcome. When malignancy, previous abdominal irradiation, Crohn's disease, or a short (<2 cm) fistula tract were present, spontaneous closure was less likely than when none of these factors were present (20% versus 47%). Sixty-eight per cent of the deaths occurred in patients with uncontrolled sepsis. Fifty per cent of the deaths were due to the primary disease and were unrelated to the fistula. Spontaneous closure could not be expected to start until sepsis was controlled. Because over 90% of patients whose fistulas closed spontaneously did so within one month after infection was eradicated, we recommend operative closure for most fistulas that persist beyond that time. The most reliable operation is excision of the bowel from which the fistula arises with end-to-end anastomosis. Fistulas not amenable to excision should be managed by bypass.


Failure of low dose heparin to prevent pulmonary embolism after hip surgery or above the knee amputation. In a randomized, double-blind trial, 5,000 USP units of sodium heparin or saline were give subcutaneously at least two hours before surgery and at 12 hour intervals thereafter to patients requiring total hip replacement, surgical correction of hip fracture, or major lower extremity amputation for vascular insufficiency. Lung perfusion scans were performed before surgery and at weekly intervals during the postoperative period. Pulmonary arteriograms were requested in patients developing new perfusion defects on serial scans. Two hundred twelve patient hospitalizations were analyzed. We diagnosed acute pulmonary embolism by serial lung perfusion scans or at autopsy in 37 patients. The incidence of pulmonary embolism in 40 patients with below the knee amputation was too low to warrant conclusions. The incidence of acute pulmonary embolism in 94 patients undergoing above the knee amputation was 25% in patients receiving heparin and 27% in patients receiving saline. The incidence of acute pulmonary embolism in 78 patients undergoing hip surgery was 13% in patients receiving heparin and 12% in patients receiving saline. We conclude that the regimen used had no significant effect on the incidence of acute pulmonary embolism in patients undergoing hip surgery or above the knee amputation.


Abdominosacral resection for carcinoma of the midrectum: ten years experience. Abdominosacral resection allows curative resection of midrectal cancer with excellent preservation of sphincter function. In the last ten years 427 patients underwent resection for rectal carcinoma at University Hospital by one surgeon. (SAL) The operation, selected by preoperative sigmoidoscopic measurement, was anterior resection (AR) in 239, abdominosacral resection (ASR) in 100, and abdominoperineal resection (APR) in 88. Operative mortality was 1.7% for AR, 2% for ASR and 2.3% for APR. All patients were completely continent of stool and flatus after AR and ASR. Follow-up is complete in 194 of 195 patients treated five to ten years ago. Five year survival for curative resection (no distant metastases) was 67.3% after AR (66/98), 58.3% after ASR (21/36), and 50% after APR (15/30). For patients without tumor in lymph nodes, survival rates were 78.3% for AR, 64.3% for ASR and 63.2% for APR. With involvement of regional nodes, survival fell to 41.4% for AR, 37.5% for ASR and 27.3% for APR. For lesions at 5-8.5 cm, five year survival was 61.1% for ASR and 58.3% for APR. No statistical difference in survival time was noted when patients were matched for age, sex, level of lesion and extent of spread. Pelvic recurrences were detected in 16.7% after ASR, 15.3% after AR and 33.3% after APR. All of the pelvic recurrences after ASR and the majority of those after AR and APR occurred in patients with tumor invasion of perirectal fat. These data strongly support the applicability of ASR as an important advance in the treatment of midrectal cancer. Although technically demanding, ASR has permitted preservation of anal continence without sacrifice of long-term cure in approximately 50% of patients who would otherwise have required APR.


Use of CEA as an indicator of early recurrence and as a guide to a selected second-look procedure in patients with colorectal cancer. The usefulness of the CEA as an indicator of recurrence and a guide to selected second-look surgery was evaluated from a retrospective analysis of 358 patients with colorectal cancer and from a prospective experience with 16 patients all of whom had been admitted for second-look surgery because of postoperative elevations of CEA only. Our previous experience had shown that after curative resection the CEA usually returned to normal levels (less than 5 ng/ml) within one month, but became elevated at time of clinically obvious recurrence being very high in patients with liver metastases, but only moderately elevated or normal in patients with local recurrence. All 16 patients had previously had curative resection of colorectal cancer; 13 in the rectum or rectosigmoid and three in the right colon. There were 13 Dukes' C and three Dukes' B cancers. All had been followed clinically and by CEA testing at three monthly intervals and were considered free of disease (NED) at time of CEA elevation. The median disease free interval was 13 months (range 4-57 months) and the median CEA prompting admission for second-look operation was 21 ng/ml (range 10-56 ng/ml). The sites of recurrence were liver in six, lung in two and localized disease in six. Two patients had negative exploration for recurrence and were found to have cholelithiasis only (one of these later died of metastases). Resection for cure was done in seven and palliative resection or biopsy only was done in nine patients. At this time, four patients are NED (12-37 months), five are living with disease (10-16 months) and seven have died of disease (2-12 months). The CEA test provides a method of early detection of recurrence and may permit surgical retrieval in selected patients and earlier initiation of palliation in other patients. The longterm effects in patient salvage remain to be defined.


The relationship between transfusion and hypoxemia in combat casualties. The relationship between transfusion and subsequent hypoxemia was examined retrospectively in the records of combat casualties studied by the first three U.S. Army Surgical Research Teams in Vietnam. There was no evident relationship in 425 casualties studied before anesthesia and operation. In 199 casualties studied preoperatively and on at least two of the first three postoperative days, there was no evident relationship in those with injuries not involving the chest or abdomen. Eighteen such casualties received over ten units of blood each (average 24.5) and exhibited subsequent changes in arterial oxygen tension (PaO2) which were indistinguishable from those transfused lesser amounts or not all. Similar observations were made in casualties with injuries to the abdomen, although there was a tendency to lower PaO2 two days after injury in those heavily transfused. In those with thoracic injury, there was statistically significantly lower PaO2 on the first two postoperative days in those heavily transfused. Two possible interpretations are considered, one that blood transfusion contributed to hypoxemia, and alternatively, that a greater magnitude of the injuries accounted for both the worsened hypoxemia and the need for more transfusions. The latter was thought more likely. The differences in PaO2 related to the type of injury exceeded the differences associated with transfusion.


Treatment of Budd-Chiari syndrome by side-to-side portacaval shunt: experimental and clinical results. The Budd-Chiari syndrome caused by occlusion of the major hepatic veins, often of unknown etiology, is typically characterized by massive ascites, hepatomegaly and abdominal pain due to intense congestion of the liver. The outcome has almost always been fatal. This report describes an evaluation of side-to-side portacaval shunt in dogs with experimental Budd-Chiari syndrome and in six patients with hepatic vein thrombosis. In the animal studies, side-to-side portacaval shunt was very effective in relieving massive ascites, hepatomegaly, hepatic congestion and portal hypertension produced by ligation of the hepatic veins. Only one of 24 dogs with side-to-side anastomosis reformed ascites, 67% of the animals survived until the study was concluded after one year, and liver biopsies showed reversal of the severe pathologic abnormalities. In contrast, all 20 control dogs subjected to a sham laparotomy, and all 20 dogs that underwent end-to-side portacaval shunt reformed massive ascites and died within six months with continued hepatic congestion and necrosis. All six patients with the Budd-Chiari syndrome due to hepatic vein occlusion had massive ascites (4.4-15.9 l), hepatomegaly, abdominal pain and disturbed liver function. In all six, angiography demonstrated occlusion of the hepatic veins with a patent inferior vena cava (IVC) and a normal IVC pressure, and liver biopsy showed intense centrilobular congestion and necrosis. The most valuable diagnostic study was angiography of the IVC and hepatic veins with pressure measurements. Side-to-side portacaval shunt was performed from four to 14 weeks after the onset of symptoms, and produced dramatic and sustained relief of ascites in five of the six patients during follow-up periods of from eight months to seven years. Liver function returned to normal, hepatosplenomegaly disappeared, none of the survivors developed portal-systemic encephalopathy, and follow-up liver biopsies showed disappearance of congestion and necrosis, but mild to moderate fibrosis. One patient died following an emergency IVC thrombectomy and portacaval shunt, which was undertaken when, during the course of his workup, his condition deteriorated suddenly because the thrombotic process extended from the hepatic veins into the IVC. The everpresent risk of this complication, and the dangers associated with delaying operation were emphasized by this case. It is concluded that side-to-side portacaval shunt, which decompresses the liver by converting the portal vein into an outflow tract, provides effective treatment of the Budd-Chiari syndrome when the occlusive process is confined to the hepatic veins.


Opsonic alpha2 surface binding glycoprotein therapy during sepsis. A pronounced depletion of an opsonic protein for hepatic reticuloendothelial (RE) phagocytosis has been demonstrated in critically ill trauma patients. This opsonic alpha(2) surface binding (SB) glycoprotein has immunologic identity and a similar amino acid composition to cold insoluble globulin (CIg). Since CIg can be concentrated in cryoprecipitate, it was utilized as a readily available source of opsonic alpha(2)SB glycoprotein for replacement therapy after injury with documented hypoopsonemia. Six septic patients (2 multiple trauma, 2 thermal burn, and 2 intra-abdominal abscess) were studied to test whether cryoprecipitate infusion would restore this humoral component. Pre- and posttherapy opsonin levels were determined by bioassay and electroimmunoassay. In all patients, severe opsonin depletion was reversed following cryoprecipitate infusion. All patients had a rapid improvement in febrile state, normalization of leukocyte levels, and improvement in pulmonary function as evidenced by decreasing requirements for end expiratory pressure at lowered levels of inspired oxygen. One patient was studied more extensively and demonstrated an increase in cardiac output, limb blood flow, total body and limb oxygen delivery, total body and limb oxygen consumption and a progressive decrease in pulmonary shunt fraction. Thus, opsonic alpha(2)SB glycoprotein deficiency can be reversed by cryoprecipitate infusion in critically ill septic injured patients. Replacement of this humoral factor may be an important therapeutic modality in prevention of multiple organ failure, but it should be administered only after documentation of hypoopsonemia in traumatized patients.


The use of silastic transhepatic stents in benign and malignant biliary strictures. Between 1969 and 1978, 45 patients with biliary strictures have been managed surgically utilizing silastic transhepatic stents. In 25 patients the strictures were benign. After resection or dilatation of the benign stricture, an hepaticojejunostomy was performed to a Roux-en-Y loop. The anastomosis was stented with a large bore silastic tube with multiple side holes passed through the biliary tree, out the anterior surface of the liver, and then out through the abdominal wall. There was one hospital death. Most stents were left in place for one year. Of the 15 patients with long-term follow-up, all have had excellent results. In 20 patients the strictures were malignant and involved the common hepatic duct in 10 patients or its bifuraction in 10 patients. In 14 patients the tumor was thought to be primary in the biliary tree, and in six patients the tumor was felt to represent a metastasis or direct extension from another site. In three patients the tumors were resected, and in the remaining they were dilated or bypassed. After positioning a silastic transhepatic stent, a hepaticojejunostomy was carried out. There were two hospital deaths. Serum bilirubin on admission average 17.1 mg%, and after decompression 1.8 mg%. Five patients have survived over one year, and two over two years. Postoperative radiotherapy and a primary biliary tumor favored longer survival.


One per cent incidence of recurrent gallstones six to eight years after manometric cholangiography. The national incidence of retained and recurrent common duct stones is between 2 and 7%. A prospective comparison of operative common duct pressure flow rates as opposed to operative cholangiography was commenced in 1968 to assay another diagnostic technique to assist in the reduction of this rather high incidence of recurrence. We are now reporting the 6-8 year follow-up data on the first 200 patients, 190 (95%) of whom were reevaluated in 1977. In our inital reports we were surprised to find that our accuracy with flow and pressure studies was 93%, not significantly different from that found with operative cholangiography (92%). The measurements of flow, resting pressure, and opening pressure in the patients with stones or strictures at the lower end of the bile duct were each significantly different from those found in normal ducts (p < 0.001). We considered normal flow to be 10 ml/min saline at 30 cm of pressure and normal intrabiliary pressure to be less than 16 cm of saline was measured through the cystic duct. To date only one individual has had to undergo reoperation for stones and another for recurrent biliary obstruction. A third individual is suspected of, but not proven, to have a retained stone. No patient who had a normal operative cholangiogram, flow and pressure studies, has had a late recurrence of stones. We have presented the specifications of a new catheter for performing flow and pressure x-ray studies, which we feel may be used to primarily evaluate the distal duct with greater accuracy and clarity. We think that this inexpensive but reliable method has an important place in biliary surgery, particularly where operative cholangiography may not be available, or, for one reason or, another, is not reliable.


Epidemic of cutaneous leishmaniasis in Northern Sudan. This paper describes the first epidemic of cutaneous leishmaniasis to be reported from the Sudan. The epidemic occurred in villages in an area extending for about 100 km along the banks of the Nile between Shendi and Atbara. The disease affected people of all ages and the skin lesions, which were nodular or nodulo-ulcerative, were usually multiple.


Thyroid function in hepatic schistosomiasis. Serum thyroxine (T4), serum tri-iodothyronine (T3-uptake) and the free thyroxine index in 17 men suffering from hepatosplenic schistosomiasis did not differ significantly from those of ten healthy male controls. There was no correlation between these values and serum protein levels or liver function tests.


The nephrotic syndrome in the Sudan with special reference to schistosomal nephropathy. A preliminary morphological study. The morphology of 68 renal biopsies from the Sudan is analysed. Schistosomal infection was more common among the nephrotic patients than in the average population (32% against less than 1%). In the schistosomal group the high incidence of focal sclerosing glomerulonephritis (28%) and of secondary amyloidosis (38%) was remarkable. The history is described of a boy in whom repeated biopsies showed the decrease of glomerular amyloid depositions accompanied by mesangial cell proliferation following treatment for schistosomiasis.


Human Ancylostoma infections in Nigeria. An estimate of the proportion of infections with Ancylostoma duodenale and Necator americanus by the examination of larvae collected from the stools of 220 persons infected with hookworm was made. Fifty-nine per cent of the infections were due to N. americanus only: A. duodenale always occurred in association with N. americanus. In 12% of the infections it is suggested that there were approximately three female A. duodenale to 95 female N. americanus. The highest numbers of A. duodenale in mixed infections (28 female A. duodenale with 45 female N. americanus) occurred in only 1% of the infections. Evidence is given that egg size can be important in the differentiation of the two species. A method of calculating the proportion of the two hookworms, and hence of other intestinal nematodes, in mixed infections in an individual as well as in the general population, is also described.


A survey of Anopheles gambiae (species A) and An. arabiensis (species B) of the An. gambiae Giles complex in the Kisumu area of Kenya following insecticidal spraying with OMS-43 (Fenitrothion). After village huts in the Kisumu area of Kenya had been sprayed with a nominal 2 g/m2 of OMS-43 (fenitrothion) as part of an insecticidal evaluation programme 964 adults of the Anopheles gambiae complex collected from huts were identified cytogenetically as either An. gambiae (species A) or An. arabiensis (species B). Similarly, cytogenetic methods were used to identify 349 adults collected from granaries and artificial pit-shelters. In addition, 2203 larvae of the gambiae complex collected from different types of habitats were specifically identified cytogenetically. As in a previous survey made prior to insecticidal spraying, adults of An. arabiensis predominated in outdoor collections while An. gambiae was highly endophilic. However, it appeared that spraying with fenitrothion had resulted in an increase in both the degree of exophily in An. arabiensis and also its relative numbers in respect to An. gambiae, although the overall pooulation of both species was greatly reduced by spraying. Insecticidal spraying may have diverted both species from feeding on man to cattle. Except for one village, where larvae of An. arabiensis were commoner than expected in cattle hoof-prints, there was little difference between the selection of different types of larval habitats by the two sibling species. Chromosomal inversions were more common in adults of An. arabiensis than in An. gambiae.


[Electrocardiography of high frequency and pneumopathies]. High frequency electrocardiograms were studied in 19 patients with chronic neumopathies, pulmonary arterial hypertension and respiratory failure in the great majority. Studies were made of: a) the significance of conduction disorders in the right ventricle either at the fasciculary branch or within the mass of the ventricle with regard to the time of appearance and the length of the intrinsicoid deflection and its components. b) The duration of the electrical sistole of each ventricle in relation with hyperatrophy that results in sistolic over loading. c) An attempt was made to correlate the number of high frequency deflections (discontinuity of activity) with the prognosis.


[Analysis of empyrical factors for the determination of cardiac output]. With a method by which no recirculation was possible the area of a dilution curve was obtained. On this basis it was searched what percentage represents the forward triangle of the total surface of the curve. The rôle of the V/F of the sampling system on this portion of the curve was studied, surface from which the empirical constants for the estimation of the cardiac output derivates. The data obtained suggest that the forward surface triangle was V/F dependent V/F less than 1 gave smaller forward triangles, the opposite was true with V/F greater than 1. It was also found that V/F greater than 1 subestimate the total surface of the dye curve, which means cardiac outputs higher than the real. The forward surface of the curve was reduced to a minimal percentage of the total curve when a V/F less than 1 was used. Situation that makes this area non useful to obtain from them empirical factors. If an empirical factor is use in order to measure cardiac output it had to be accepted that an important grade of error is introduced.


[Precordial heart beats in myocardial infarct (clinical and electrocardiographic study in 40 cases)]. The precordial K1 to K6 cinetocardiograms in 40 patients with Myocardial Infarction (10 recent and 30 old) were studied. These were compared with the findings of the precordial palpetion, electrocardiograms, and the radiologic studies. In the recent infarcts, all the patients presented abnormal systolic "annoyances", 50% of which were palpable. In the old infarcts, 90% had abnormal cinetocardiograms and 63% had pathological precordial beats. The anterior infarcts tend to present "sounds" more to the right of the precordium than the posterior-inferiors. The diffuse cardiac hypokinesia may give normal cinetocardiograms. The severity of the myocardial disturbance is directly related to the precordial extension occupied by the abnormal systolic "annoyances". An aneurismectomy may cause the disappearance of the pathogenesis of these phenomena.


[The diastolic function of the left ventricle. I. The ventricular suction]. The paper describes the normal and pathological characteristics of left ventricular filling. There are described some of the most sophisticated methods of assessing left ventricular function: The volume-time curve, the rate of change of left ventricular volume (dV/dt) and the pressure-volume loop. It is discussed the phenomenon of ventricular diastolic suction as an accessory mechanism of filling in some restrictive disorders.


[Disorders of the right intraventricular conduction in chronic pulmonary hypertensive cardiopathy]. Disorders of the right intraventricular conduction were analyzed in cases of chronic pulmonary hypertensive cardiopathy (C.P.H.C.), diagnosed on basis of the anatomic data. The series studied here (40 cases) was obtained from the review of 3,000 reports of autopsies at the Instituto Nacional de Cardiología de México. Thickness of the free right ventricular wall, thickness of the interventricular septum at three levels, thickness of Wolf's spur and the circumference of the 4 valvular rings, were determined in each heart. Haemodynamic studies and respiratory function tests were revised in those cases in which they had been practiced. Electrocardiographic study essentially analyzes the time of onset of intrinsicoid deflection as well as the morphology of ventricular complexes in the unipolar leads. In 37 cases (92.5%), a disturbance of the right intraventricular conduction was present. R.B.B.B. was observed in 29 cases (72.5%): 12 of minor degree, 19 of intermediate and 1 of advanced degree. Right peripheral block was diagnosed in 8 cases (20%): anterior type in 2 cases (5%); posterior type in 6 cases (15%). In the cases with R.B.B.B., the anatomic data of right ventricular hypertrophy were predominant; in those with R.A.S.B., anatomical data suggested right ventricular enlargement. The facts exposed here permit the following conclusions: 1) Diagnosis of right fascicular block can be suggested even in the presence of hypertrophy of the corresponding ventricle. 2) Hypertrophy of the right ventricle appears more directly related to the homolateral bundle branch block than to distal or segmentary blocks. 3) Topographic diagnosis of delay in the right ventricle activation process can be established by an electrocardiographic thoracic mapping that permits to explore the ventricular structures at different levels.


[Double outlet of the right ventricle with anterior aorta to the left of the pulmonary artery in situs solitus]. Two cases of double outlet of the right ventricle with an anterior aorta to the left of the pulmonary artery are described. Both in situs solitus. One had an anterior interventricular communication, and other had a middle posterior communication. The importance of the aortic component of the second sound is analyzed with regard to its localization and intensity. An analysis is also made of the morphology of the cardiac silhouette and the peculiarities of the electrocardiogram as diagnostic aides in the malformation. Considerations are made of the distinct theories which explain the malformation. It is clearly shown that a correct diagnosis is necessary since this cardiopathy may be treated surgically.


[Creatine phosphokinase (CPK) and isoenzymes. Correlation with myocardial damage]. 1). The MB electrophoretic fraction of the serum CPK is specific in the diagnosis old acute myocardial infarction. 2). It allows us to differentiate ischaemia from myocardial necrosis. 3). The absence of this fraction, when found out during a period of 12 to 24 hours after the start of the angina attack allows us to deny the presence of acute myocardial infarction with a high index of precision. 4). Our results show that the serum sample should be obtained between 12 and 24 hours after starting the clinical case, in order to get a higher sensibility and specificity. 5). The quantification of MB fraction might be useful in the calculation of the amount of cardial muscle destroyed. When calculating the amount of cardial muscle destroyed of 125 cases (12.5%) with positive diagnosis of reinfarction and among the same 125, 12 were found occurring for the third time. Is possible that the real frequency of the iterative infarction is even higher, because many cases were dismissed (27.7%) for lack of electrocardiographic data, clearly pointing to myocardial transmural infarction. 6). Investigations were conduced about the evolutative condition of the danger factors.


[Prevention of recurrence of rheumatic cardiopathy in 564 patients]. In a group of 564 patients with rheumatic heart disease seen in the period from 1971 to 1975, who were under benzatinic prophylaxis, 23% were seen in the clinic and 77% at home. The object of this revision is to analyze the latter group in order to obtain the frequency of pharyngoamigdaline infections, and of relapses. 1. During the observation, those patients who did not present pharyngeal infections had no relapses. On the other hand, all relapses were observed in those patients who presented infections. 2. Those patients who carried out the prophylaxis incorrectly and who also presented pharyngeal infections, had almost twice the percentage of relapses as those who carried out the prophylaxis correctly. 3. In the group with effective prophylaxis, including those cases with or without pharyngeal infection, 5% had recurrences. In the group with ineffective prophylaxis, 16% had relapses. 4. Those patients with subsequent attacks doubled the percentage of relapses in comparison with those with initial attacks. 5. The plurivalvular patients have a higher frequency of recurrences than the univalvular patients. 6. During the first year of post-attack prophylaxis, the incidence of relapses is only 1.7%, in comparison with the following years in which there is a higher incidence of around 10%. 7. The total number of recurrences in 564 patients was 8%.


[Myocardial reinfarction in male and female]. 1). In 1001 patients with acute myocardial infarction 403 cases were found (40.2%) showing possible relapse. A study was made of 125 cases (12.5%) with positive diagnosis of acute myocardial infarction relapse, and among them, 12 were found to be occurring for the third time. Is possible for the real frequency of the iterative infarction to be even higher, because many cases were dismissed (27.7%) for lacking of conclusive electrocardiographic data pointing to myocardial transmural infarction. 2). Investigations were conducted about the evolutive condition of the danger factors in the coronary profile as well in the male as in the female group. Besides, a comparative study was made about symptoms, complications, morbidity and mortality. Clinical, enzimatic and electrocardiographic proofs were found, in every case, of a new myocardial transmural necrosis which was in evolution, with waves of injury and ischemia. Thirty eight deaths were registered in hospitals (30.4%) and in 25 of these, a necropsic study was conducted. 3). This illness is more frequent among men than among women, in a 3.5 to 1 proportion. The recurrent myocardial necrosis tends to be more frequently present during the first year following the first episode. In women, the first myocardial infarction as well as the iterative infarction occur at an older age than in men. 4). The influence of personality and stress is a very important factor of danger in the iterative infarction. Familiar antecedents of ischemic cardiopathy constitute a danger factor in patients presenting a single episode of myocardial infarction; nevertheless they don't seem to have a determining influence in this group of relapsing infarction. Although this study confirms with statistics that smoking has a decisive influence in the first myocardial infarction, neither frequency nor mortality of the relapsing infarction are in any way modified by the diminishing or suppression of the smoking habit.


[Duplication of the mitral and tricuspid valvular orifice. Study of 10 cases]. Ten patients with duplication of the atrioventricular valves were studied, nine of them with the double orifice located in the mitral valve and the other one in the tricuspid. In two cases the diameter of the secondary valve was the same as that of the normal valve, and in the other 8 cases, it was smaller; each had its own valvular apparatus with chordae tendinae attached to papillary muscles located in different sites. The principal malformation in nine was ostium primum. One of the cases with mitral duplication had pulmonary atresia, an association which has never before been published. In five patients regurgitation of the secondary orifice was present; the diagnosis was made during surgery in nine cases and at necropsy in one. The orifice was sutured in three cases because of regurgitation. Four patients died in the immediate post-operative period, including the one with pulmonary atresia. The other three had pulmonary hypertension. These findings agree with the literature. The etiological hypotheses are discussed and emphasis is given to the importance of the finding of a narrow jet of contrast material directed upward and to the right in the left angiocardiogram in frontal plane. The authors believe that this may be an important sign in diagnosing cases with ostium primum septal defect; taking into account the fact that double mitral orifice is the cause of valvular insufficiency, this can be the site of bacterial endocarditis and usually needs to be surgically closed.


[Value of echocardiography in the diagnosis of myxoma of the left auricle]. We have been able to differentiate the right pre-operatory diagnosis of mixoma in the left auricle versus "tumor" caused by hypertrophy and fusion of the papillary muscles of the left ventricle in a severe mitral stenosis. In the mixoma we find the echoes only in the ventricular diastole and not in the sistole; there is a place without echoes in the protodiastole--which has a diagnosis value, and sometimes in the telediastole. When it is a "tumor" in the fusioned papillary muscles of the left ventricle, echoes can be found in ventricular diastole and sistole and there are not spaces without echoes in the protodiastole as it is usual in the pedicled tumors of the left auricle. We have found a new sign to predict the existence of a tumor in the left auricle instead of a mitral stenosis; if we find echoes in the left auricle during the ventricular sistole, we will observe that the front edges of the waves form a capital W, and the back ones form a small w. In the central portions of both ws, the waves go forward as it should happen in the mitral valve when existing a real mitral stenosis. Nevertheless, as this central portion is surrounded by a space without echoes, it means that the tumor is a pedicled one, constitutes an obstruction and is causing similar signs to those pertaining to the mitral stenosis.


[Pulmonary arterial hypertension in disorders of oxygen diffusion]. Twenty three cases with impairment of greater than 40% of DLCO were studied in a search of frequency, severity and pathophysiological mechanisms of PAH. Hemodinamic studies, pulmonary angiography (PA), lung scan (LS), lung biopsies (LB) were performed. The venous admixture was estimated and expressed as percentage ratio of the cardiac output (Qva/Qt x 100). Anatomical pulmonary artery to vein shunt (Qs/Qt) was estimated breathing pure O2. Ninety one percent of cases had PAH; mild to moderate in 76% of cases. Cardiac index (CI) was less than 2.8 in 26% and greater than 4.2 in 39%. The right ventricular work index (RVWI) was greater than 1.25 in 86%. The alveolar arterial oxygen tension gradient (A-aDO2) was abnormal in all cases (greater than 18 mmHg) with a Qva/Qt of greater than 30% in 78% of these cases. The Qs/Qt was found 6% in 39% of cases. PAH was mild to moderate in DL impairment. The RVWI was usually increased with a normal or high CI. Increase in Qva/Qt that result from V/Q abnormalities and extreme impairment of DL is to be considered as the major factor functional features in the genesis of PAH. Reduction of the cross sectional area of the pulmonary vascular bed and lung function abnormalities are equally important relevants features in the genesis of PAH.


[Formation of the cell wall during the formation of Entamoeba invadens cysts]. The presence of chitin in the walls of E. invadens cysts has provided a new way to study the process of encystation, since chitin stains intensely in the presence of Calcofluor white M2R, a fluroescent dye. With this technique we have observed various stages in the differentiation of trophozoite membrane, then the cyst is formed inside the trophozoite and finally the cyst leaves the trophozoite after partial degradation of trophozoite body.


[Correlation between findings of exertion ECG with 12 derivations and coronoriography]. A coronary angiography was taken to 80 patients whose twelve leads exercise ECG had been found positive. This group included 38 patients with old myocardial infarction and 42 with coronary insuficiency. When looking for a relation between: 1. The amount of positivity in the exercise ECG and the number on injured vessels, and 2. the ischemia located in the effort test and the blocked vessels shown by the angiography. We found a reasonable relation between the exercise ECG and the severity of the injuries. This co-relation is of 100% between the old infarction area and the severe or total obstruction of the corresponding vessel. It was observed then, that a close relation exists between the ischemia area and the obstructive injuries. In a second group of 15 patients we failed to find atero sclerotic injuries in the corresponding vessel, but observed some vascular anomalies which explained the ischemia. The effort test with twelve leads exercise ECG makes easier the localization of obstructions, single or multiple, on the area supposedly affected.


[Rupture of the teflon cover of valvular prosthesis in aortic position. Severe postoperative complication]. Fourteen patients (18.5%) are presented from a total of 78 patients who received a Starr-Edwards prosthesis Model No. 2320 with a Telfon covering, in an aortic position. In the late post-operative period these patients developed complications which merited a surgical reintervention. Twelve of these were operated on to substitute this prosthesis for a distinct type and model. In the other two the teflon covering on the cage of the prosthesis was dried thoroughly. The most frequent complication which made it necessary to reoperate was hemolysis, which would not cede to intense medical treatment. The hemolysis appeared at an average of 20 months post-operatively. In all of the cases we found a rupture due to erosion of the telfon material. This is undoubtably an etiological factor of the hemolysis. Eleven of the 14 cases (78.5%) survived. Ten of which were possible to follow up on a long term basis. Seven of these (70%) are asymptomatic and the remaining 3 (30%) are evolving with data suggestive of peri-prosthetic aortic insuficiency. A review is made of the evolution of Starr-Edwards prosthesis and the causes of the post-operative hemolysis in valvular surgery.


[Determination of the alternative complement pathway in patients with amebic liver abscess]. The activation of the alternative pathway of complement in the sera of patients with amebic liver abscess was studied. Of 11 sera examined, only six showed an activation of the alternative pathway. However, all sera showed diminished levels of complement (CH50) and C3, in spite of normal levels of C1q. The results suggest that the sera of patients with invasive amebiasis have a substance capable of activating the properdin pathway. The significance of these observations is not completely clear at the present time.


[Levels of total hemolytic complement, C3, C4 and antibodies against the myocardium in rheumatic fever]. The levels of the hemolytic complement (UH 50%), C3, C4 and the antibodies against myocardium and against the antigenic fractions of myocardium precipitated with ammonium sulphate were studied in 8 patients with active rehumatic fever (ARF), 28 with inactive rheumatic fever (IRF) and 26 people without cardiopaties (NI). The UH 50% was low in 2 out of 36 patients with rheumatic fever (RF). C3 was normal and C4 low in 12.5% of the ARF patients. C3 had subnormal values in 25% and C4 in 33% of IRF patients, this last value had a stadistic significant decrease with respect to the values of C4  in normal people. The 36 patients with RF had antibodies against the myocardium and also against the heart antigenic fractions precipitated with 10% ammonium sulphate. 11.5% of the normal group had anti-myocardial antibodies and none had antibodies against the fractions. The levels of anti-streptolysin-O and C-reactive protein were higher in the ARF group than in the patients with IRF or the normal people. The participation of the hemolytic complement, the anti-myocardium antibodies, the anti-streptococcus antibodies and the cytophilic activity in the etiopathogeny of rheumatic fever is discussed.


[Aldosteronism after hypokalemia in diuretic therapy of systemic arterial hypertension]. Twenty-two cases with essential arterial hypertension were studied in the final part of a chronic period of treatment with Chlortalidona and in the first 30 days after treatment. Measurements of the following parameters were made: 1) Change in the excretion of urinary aldosterone (aldo). 2) Change in the arterial pressure (delta P). 3) Transtherapeutic serum potassium (delta K). 4) Change in the Q-T (delta QT) in the electrocardiogram. The measurements were made 3 days after the suppression of the drug and afterwards every 3 to 6 days for a month. The correlation of the K and QT was significant (r = 0.63). The P did not correlate with the K nor with the aldo (r = 0.14). The aldo was -5.92 +/- 3.1 ug./24 hs (p = 0.01) in those cases responsive to the drug. The disappearance of the antihypertensive effect occurred at 9.61 +/- 3.7 days and correlated with the normalization of the QT (r = 0.83) and the serum potassium. The delta aldo correlated with K (r = 0.56) and normalized 6.7 days after the suspension of the drug. The secondary aldosteronism participates in the parogenia of the transtherapeutic hypokalemia although with a slightly significant correlation. The important correlation between the disappearances of the antihypertensive effects and the electrocardiographic signs of hypokalemia may dwell in changes which directly or indirectly exercise the diuretic in the intracellular metabolism of K without necessarily cousing an antihypertensive effect additive of the same hypokalemia.


[The electrical mass; a new electrocardiographic index to calculate the muscular mass of the left ventricle]. We have developed an empirical mathematic formula which allows us to measure the muscular mass of the left ventricle. It expresses, in grams/square meter of corporal surface, the result of the correlation (r = 0.865) between the mass calculated by echocardiography and an index we call "Electric Mass of the Left Ventricle" (E.M.L.V.) and which equals the intrinsic deflection of V6 multiplied by R height in V6, cubed and divided by the corporal surface. The developing of a corrective factor (a factor of correction) allows us to express in grams/square meter the muscular mass measured by the electrocardiogram. The final formula is E.V. = Log. (1 + Nat. Log of the electric mass) + 56.66(3). The values obtained through this formula give us a correlation of r = 0.834.


[Pulmonary thromboembolism in heart disease]. In heart disease (HD) pulmonary emboli (PE) is seen with same frequency at necropsy as in the general hospital population. There is more mortality in patients with HD than in those without it. The patient with HD rarely is asymptomatic during the pulmonary embolization. Symptoms, signs and laboratory abnormalities occurs with the same frequency in both groups of patients with PE, but some symptoms and clinical signs, and also laboratory abnormalities could pre exist in the patients with HD, situation that dificulties the clinical diagnosis of PE. Particular value should be given to the symptoms and signs for the diagnosis in the patients with HD when they progress. In patients with HD the arrithmias were more common and also the pulmonary infection, for these reasons monitorization and the use on antibiotics should be routenely.


Serologic responses in amebiasis.

Serologic responses in amebiasis. Serologic tests for amebiasis, utilizing antigens prepared from Entamoeba histolytica HK-9, axenic culture in Diamond's media, have demonstrated reproducible results with good clinical correlation. The indirect hemagglutination test was positive in 100 per cent of all cases with hepatic abscess, in 99 per cent of cases of amebic dysentery and in 60 per cent of asymptomatic carriers. A population of uninfected subjects yielded less than 1 per cent of individuals with demonstrable amebic antibodies. Similarly, the complement fixation test was 100 per cent positive for the liver abscess, 91 per cent positive for patients with amebic dysentery, 23 per cent positive for asymptomatic carriers, and 0 per cent positive for the uninfected control group. The antibody responses to amebic antigens are discussed.


[Intestinal amebiasis in children II. Evaluation of various diagnostic technics and different therapeutic regimens]. The diagnostic usefulness of different laboratory tests was evaluated in 20 cases of invasive intestinal amebiasis: the direct coproparasitoscopic exam in mucus obtained by rectoscopy was positive in 90.0 per cent of cases; the same exam done in mucus obtained by the spoon technique was positive in 40.0 per cent. The serum antibodies investigated by the counterimmunoelectrophoresis technique were found in 40.0 per cent of the cases in the first blood sample obtained at the hospital admisssion, and 15 days later this percentage increased to 66.6 percent. The fecal antigen studied by the ELISA technique was positive in 70.0 per cent of the cases. Simultaneously, the therapeutic effectiveness of emetine and metronidazol was evaluated, and with both therapeutic programs total recovery was obtained in 100.0 per cent of the cases; there were no significative differences in the symptoms duration after the start of therapy, and side effects were not observed. The results must be considered preliminary, because the calculated full sample has not been concluded.


[Composition of the cell wall of Entamoeba invadens cysts]. Cyst walls isolated from Entamoeba invadens have a microfibrillar structure. The main sugars detected in acid hydrolysates from walls were hexosamines. X-ray diffraction analysis of the cyst walls demonstrated that the only crystalline polymer present was chitin.


Nitrate and nitrite reductase negative mutants of N2-fixing Azospirillum spp. Chlorate resistant spontaneous mutants of Azospirillum spp. (syn. Spirillum lipoferum) were selected in oxygen limited, deep agar tubes with chlorate. Among 20 mutants from A. brasilense and 13 from A. lipoferum all retained their functional nitrogenase and 11 from each species were nitrate reductase negative (nr-). Most of the mutants were also nitrite reductase negative (nir-), only 3 remaining nir+. Two mutants from nr+ nir+ parent strains lost only nir and became like the nr+ nir- parent strain of A. brasilense. No parent strain or nr+ mutant showed any nitrogenase activity with 10 mM NO3-. In all nr- mutants, nitrogenase was unaffected by 10 mM NO3-. Nitrite inhibited nitrogenase activity of all parent strains and mutants including those which were nir-. It seems therefore, that inhibition of nitrogenase by nitrate is dependent on nitrate reduction. Under aerobic conditions, where nitrogenase activity is inhibited by oxygen, nitrate could be used as sole nitrogen source for growth of the parent strains and one mutant (nr- nir-) and nitritite of the parent strains and 10 mutants (all types). This indicates the loss of both assimilatory and dissimilatory nitrate reduction but only dissimilatory nitrite reduction in the mutants selected with chlorate.


Investigations of the pigments from Cytophaga johnsonae Cy jl. New flexirubin-type pigments. Besides carotenoids a complex of flexirubin-type pigments was isolated from the gliding bacterium Cytophaga johnsonae Cy jl and separated into 6 components, which partly containe chlorine. In spite of the fact that these components still consist of pigment mixtures, the gross structures of 18 new flexirubin-type pigments could be deduced by spectroscopic and chemical investigations. The results open insights into biosynthesis and structural variety of the flexirubins, the novel non-isoprenoid pigments recently found in Flexibacter elegans.