Plasma heparin concentrations during subcutaneous heparin therapy. Plasma heparin concentrations were measured at two-hourly intervals following the subcutaneous injection of varying the doses of heparin. With doses of 5000 and 10,000 units, peak plasma concentrations were seen most commonly four hours after the injection. There was a wide range of peak values at both dose levels with considerable overlap and no correlation could be shown between plasma heparin concentration and the age, sex or weight of the individual. Traces only of heparin could be detected in the blood after a 1000 unit injection. Comparable results were obtained up to six hours after the injection with either the calcium or sodium salts of heparin.


Murray Valley encephalitis in Australia, 1974: antibody response in cases and community. Fifty-three patients accepted on clinical grounds as cases of Murray Valley encephalitis (MVE) in Australia in 1974 were examined for antibody to MVE virus. Only one (who died early in the disease and whose diagnosis was confirmed by virus isolation) did not develop antibody; 13 patients showed stationary or single convalescent titres not diagnostic of recent infection, but other evidence that infection was recent was obtained in eight; 39 showed significant rise or fall in titre confirming recent infection. Haemagglutination-inhibition (HI) was more effective in establishing a diagnosis than complement-fixation (CF) although both tests were of value. Patients varied widely in timing and magnitude of rise and fall of titre. Two showed late rises in antibody titre which raises the possibility of recrudescent persisting infection. CF titres were enhanced in some sera by increase in the number of units of antigen used and by inactivation at 56 degrees C rather than 60 degrees C. Five patients with clinically-acceptable diagnoses of MVE (and one with minor illness) showed higher HI titres to Kunjin than to MVE virus. The results in several cases suggest that Kunjin virus was the infecting agent. In others it is possible that MVE infection had occurred in patients with pre-existing Kunjin antibody. HI reactivity to MVE virus was found in IgM fractions of sera taken for at least 40 days and in some cases for over 100 days after onset of symptoms. IgM fractions gave similar titres to MVE and Alfuy virus but clearly distinguished MVE-Alfuy and Kunjin viruses. HI antibody to MVE virus was found in about 10% of sera from family contacts or neighbours of patients with encephalitis, and in a similar proportion of patients in Victoria with various febrile illnesses not accepted as MVE. One patient with minor illness had antibody response to Kunjin virus. 2589 sera from pathology laboratories in towns in the Murray Valley gave additional evidence of community immunity to flaviviruses and suggested some increase in the proportion reactive between January and May 1974. HI and plaque reduction tests on these sera also gave evidence of antibody to Kunjin virus in the Murray Valley.


Smooth muscle-associated contractile protein in human and experimental acute leukaemias. Cells from ten human myeloblastic leukaemias and from spontaneous rat myeloblastic and lymphoblastic leukaemias were examined by indirect immunofluorescence with human serum containing smooth muscle antibody. Strong positive cell outline staining of blast cells was seen in cryostat sections of rat leukaemic lymph nodes, spleen and liver. In cell smears of human and rat leukaemias, cell outline fluorescence was restricted to cells in close contact with each other. Membrane immunofluorescence tests of suspensions of viable leukaemic cells were negative. Specificity of the immunofluorescent staining reaction was established by failure to obtain staining with normal serum, or with smooth muscle antibody serum neutralized by homogenates of smooth muscle or extracts containing actin derived from smooth muscle. These observations suggest that smooth muscle-associated microfilaments are present in leukaemic blast cells and that expression of the antigen is dependent on cell-cell contact. The presence of this antigen may facilitate leukaemic infiltration of tissues.


Scleroderma (progressive systemic sclerosis) with severe bowel involvement. Treatment by extensive resection of the small intestine. A 48-year-old man with previously diagnosed scleroderma with bowel involvement was admitted to hospital with severe malnutrition attributed to malabsorption. Shortly after this, he developed features of intestinal obstruction followed by paralytic ileus. Due to failure to respond to medical treatment, operation was carried out. On two occasions adhesions were divided, but the bowel failed to function. At a third operation the proximal half of the small bowel below the duodeno-jejunal flexure was excised. Following this the patient made a good recovery. Small bowel involvement in scleroderma is discussed. Malabsorption is probably related to bacterial proliferaiton in the small bowel secondary to stasis and may be helped by antibiotic drugs. Other disturbances resulting in inability of the bowel to propel its contents may comprise syndromes of obstruction and paralytic ileus. Although management of scleroderma bowel involvement is usually medical, surgical treatment may be indicated under certain circumstances. It may be life-saving.


Chronic granulomatous hepatitis.

Chronic granulomatous hepatitis. Three cases are described in which a chronic relapsing febrile illness was associated with granulomas in the liver. None of the known causes of hepatic granulomas was present in these patients. In two cases there was clinical improvement after corticosteroid treatment and this was associated with resolution of the histological changes on liver biopsy. These three cases support the concept that chronic granulomatous hepatitis of unknown aetiology is a distinct entity.


Giardiasis following gastric surgery.

Giardiasis following gastric surgery. A patient is presented who developed acute life-threatening diarrhoea due to infestation with Giardia lamblia. We propose that the severity of the illness may have been related to hypochlorhydria following gastric surgery.


Intemittent obstruction of the upper airway during sleep causing profound hypoxaemia. A neglected mechanism exacerbating chronic respiratory failure. An obese patient with a ten year history of respiratory failure presented with insomnia and marked daytime somnolence. Respriatory failure had been attributed to obesity, respiratory centre insensitivity to carbon dioxide, and to diffuse airways obstruction. To investigate the possible role of episodic apnoea with frequent nocturnal arousals, continous recordings were obtained during sleep of arterial oxygen saturation, oesophageal pressure and the motions of the rib-cage and abdomen/diaphragm. Repeated episodes of hypoventilation and profound hypoxaemia were found which were due to intermittent obstruction of the upper airway rather than to cessation of breathing efforts. During the episodes of hypoxaemia, values of arterial O2 tension fell to as low as 24 mmHg. Episodic hypoxaemia was relieved but not abolished, by the use of a collar, designed to hold the mandible forward. Previous reports indicated that recognition of intermittent obstruction of the upper airway during sleep and treatment by a permanent tracheostomy, resulted in a significant long-term imporvement of pulmonary and cardiac function and relief of insomnia and day-time somnolence. When tracheostomy is inadvisable, as in the present patient, it is hoped that similar long-term benefits will result from a supportive collar.


Analgesic abuse and kidney disease.

Analgesic abuse and kidney disease. The analgesic syndrome, comprising renal disease, hypertension, peptic ulcer, anaemia and recurrent headache, accounts for wide-spread morbidity and mortality especially in Queensland and New South Wales. Epidemiological and clinical evidence gathered from many Western societies implicates unsupervised consumption of compound analgesic preparations, particularly those containing phenacetin, in the causation of the majority of cases. Laboratory experiments so far have failed to produce an entirely satisfactory model of clinical analgesic nephropathy. In small animals, papillary necrosis results from prolonged feeding with large doses of aspirin and a number of other anti-inflammatory agents more readily than when phenacetin, paracetamol or phenazone is given alone. The apparently conflicting deductive and experimental data may be reconciled if, as indicated by preliminary observations, salicylates enhance the toxicity of phenacetin derivatives. In planning a programme of prevention for the analgesic syndrome, the central aetiological role of non-narcotic drug dependency must be recognized. As the analgesics to which addiction commonly occurs are the compound powders and tablets, or those containing a stimulant, these preparations should be available only in circumstances where their use can be monitored. Suspected unsupervised and unwarranted consumption of analgesics should be checked by urinary testing for drug metabolites. Because the underlying problem of analgesic dependency is behavioural and environmental in origin rather than medical, the physician must combine forces with the social engineer to devise a definitive solution for this condition.


Extinction of globin gene expression in human fibroblast x mouse erythroleukemia cell hybrids. We have chosen human fibroblast x mouse erythroleukemia hybrid cells as a model system to examine regulation of unique genes. The globin genes were studied as a marker of erythroid differentiation. Three separate hybrid cell lines were incubated in 2% dimethylsulfoxide, an agent which induces erythroid differentiation of the parental erythroleukemia cells. Neither human nor mouse globin mRNA sequences could be detected by a sensitive molecular hybridization assay which utilized globin complementary D N A. However, td n a from one of the cell lines was shown to contain both the mouse and humand globin genes. Thus, loss of the genes by chromosomal segregation did not account for their failure to be expressed. Cocultivation of the mouse erythroleukemia cells with excess human fibroblasts did not prevent erythroid differentiation of the erythroleukemia cells in the presence of dimethylsulfoxide. Similarly globin gene expression was preserved in tetraploid cells generated by fusion of two erythroleukemia lines. Thus, extinction of globin geneated by fusion of two erythroleukemia lines. Thus, extinction of blobin gene expression in the human fibroblast x erythroleukemia hybrids occurred at the level of mRNA production and appeared to be due to the presence of the fibroblast genome within the hybrial cell.


Measles in Port Moresby.

Measles in Port Moresby. To assess the importance and severity of measles in the Port Moresby area, 101 cases seen in hospital Out-Patients, and 26 cases seen in urban clinics during 1974, and 277 cases admitted during 1973-74, are analysed. The majority of cases were in children under 3 year of age. Of the 101 out-patients, only 19 had uncomplicated measles. 61 had pneumonia and 28 had gastro-enteritis. 19 needed admission to hospital. There were no deaths. Of the 277 admitted patients, 73% had pneumonia, 26% had gastro-enteritis and 22% were dehydrated. There were 6 deaths (a case mortality rate of 2.2%). All the children who died had pneumonia; 4 children developed tuberculosis. The disease appears to be more severe in Papua New Guinea than in most developed countries tough less severe than in many other developing countries. We estimate that the cost of treating measles is about K25,205 per annum. The introduction of measles vaccination might reduce the cost of measles to the community by K14,000 per annum, and would save children from an unpleasant and often serious disease.


An approach to the rehabilitation of the injured. Accidents and injuries account for an increasing number of patients admitted to hospitals throughout Papua New Guinea. The growing importance of this problem is stressed. The approach taken to treat injuries of the musculo-skeletal system at the Angau Memorial Hospital, Lae, is outlined with special emphasis on patient rehabilitation. Tables illustrating the relative frequency of fractures, the average period of incapacity following selected fractures and the prognosis of spinal cord injuries are included. It is emphasised that, provided an enthusiastic, knowledgable and co-operative approach is taken towards the treatment and rehabilitation of spinal cord and head injuries, the ultimate outlook can be greatly improved and a more optimistic outlook for these patients is justified.


A radiological study of urinary tract disease in Port Moresby 1972-74. During a 21/2 year period at Port Moresby, 852 patients had intravenous pyelograms. Two thirds of the patients were males and over half were Papua New Guineans. 34% of the patients had detectable urinary tract abnormalities of whom 38% had urinary calculi. Renal and ureteric calculi were particularly common in expatriate males, being found twice as commonly as in Papua New Guinean males. Although there were some Papua New Guinean male children with bladder calculi, the frequency appeared less than that found in some other developing countries. Other common findings included congenital urinary tract abnormalities, prostatomegaly and poor renal function. There were a few patients with malignant neoplasms including Wilms' tumours and carcinoma of the kidney.


Prevalence of toxoplasma antibodies in New Britain, Papua New Guinea. A seroepidemiological study of toxoplasmosis was conducted in four areas of New Britain (Papua New Guinea). The areas surveyed were of heterogeneous nature with regard to topography, soil, fauna, and the people's eating habits. The prevalence of human infection as measured by the presence of dye-test antibodies was high in Ewase area and Witu island with no cats, but not on Lolobau and Kilengi, where cats were present. Observations obtained from the investigation led to speculation that consumption of raw meat or other factors, individually or in combination, may have played an essential role in the transmission of Toxoplasma in the Ewase and Witu areas.


Melanin biosynthesis in skin. The redskinned' New Guinean. A distinctive unique red-toned skin colour found among New Guineans appears to be inherited in an autosomal recessive manner. The red skin colour is associated with red melanin granules within the epidermis, independent of hair bulbs, and described here for the first time. The red skin colour is also associated with smaller melanosome size and apparently diminished transfer of melanosomes from melanocytes to keratinocytes. The chemistry of this skin melanin cannot be elucidate without the availability of more substantial samples or the development of new technology. It does appear to be associated with variation of catechlolamine metabolism as well as a defect of gaze fixation.


Central hypotensive effects of angiotensin II in the rat. The floor of the fourth cerebral ventricle of urethane-anesthetized rats was exposed through the occipital foramen. Angiotensin II (10-1000 ng), applied onto the surface of the area postrema, induced a rapid lowering of the blood pressure. Pretreatment of the rats with reserpine abolished the hypotensive response to angiotensin II. It is concluded that the local application of angiotensin II induced in the vicinity of the area postrema a release of some biogenic amine, which has an inhibitory effect on the cardiovascular centres.


Site and mode of action of clonidine in the central nervous system. In urethane-anaesthetized rats clonidine was administered intravenously (i.v.), intracerebroventricularly (i.c.v.) or onto the surface of the area postrema which protrudes into the fourth cerebral ventricle. In each instance clonidine induced a dose-dependent lowering of the blood pressure. The region of the area postrema appears to be the most sensitive site for the action of clonidine so far studied. In order to obtain similar blood pressure effects, approximately 8 times higher amounts were needed i.c.v., and about 80 times higher amounts i.v., than onto the surface of the area postrema. A pretreatment of the rats with the specific histamine H2-receptor blocking drug, metiamide (4.5 micronmoles/rat i.c.v.) shifted the dose-response curve of clonidine (i.c.v.) to the right. The results suggest that clonidine exerts its hypotensive effect in the rat via a stimulation of histamine H2-receptors in, or in the vicinity of, the area postrema.


Severe arterial hypertension (grade III and IV). The aim of this study was to evaluate the number, outcome, survival time, and causes of death of patients with severe arterial hypertension who were admitted to the Department of Medicine at Landspitalinn (National Hospital) in Reykjavik during the years 1957 to 1971. During this period 117 patients were found to have severe arterial hypertension (12.6% of all cases of hypertension diagnosed) according to the grading of Keith and Wagener, 20 patients with grade IV retinopathy and 97 patients with grade III. The case histories were analysed according to age and sex distribution, blood urea, electrocardiographic changes, heart size by X-ray at the time of diagnosis and final outcome. The survival calculations were done by the decrement method (life tables) and aim taken from patient age 65 years and less. Relatively fewer patients with severe arterial hypertension were admitted during the last five year period (1967-1971) than during the two previous five year periods. The main causes of death were cerebrovascular accidents (26.6%), myocardial infarctions (22.8%), and renal failure (22.8%). Approximately 50% of the men and 60% of the women survived five years. Elevated blood urea values and signs of left ventricular hypertrophy on ECG at the time of diagnosis carried a more sinister prognosis.


The treatment of hypertension--an analysis of drug prescription data. This paper describes a study of the degree of continuity in the drug treatment of hypertension. An analysis of antihypertensive drugs dispensed to 916 individuals during 1970-74 revealed that 22% of the men and 27% of the women were without treatment for 20-50% of their observation time. A closer examination of 46 patients under 60 years of age showed that between 2 and 20 physicians had been involved in the antihypertensive treatment of the individual patient. The time without treatment in this group of unselected patients varied between 0 and 77% of the observation time, the degree of discontinuity being insignificantly correlated to the resulting blood pressure level. Non-compliance was the cause for discontinuing a drug in at least every fifth case.


Conn's syndrome. A follow-up of thirteen surgically treated cases. Thirteen patients were followed for 4-46 months after removal of an aldosterone producing adenoma. Normotension was achieved in all cases but two in whom moderate diastolic hypertension was easily managed on diuretic therapy. All were cured of hypokalemia and symptoms related to low plasm potassium. Persistaent selective hypoaldosteronism was seen in one patient. A gratifying regression of symptoms and signs related to arterial hypertension was seen. Medical treatment with aldosterone antagonists may "cure" the patient to the same extent as surgery. The present results encourage the use of surgical treatment in these young patients since a life-long drug therapy--with its attendant problems--is the only alternative.


Haemodynamics studies in young men with mild blood pressure elevation. The cardiac output at rest, and the intra-arterial blood pressure and hand blood flow at maximal vasodilation were determined in two groups of men aged 18-22 years. 44 patients were referred from a military enlistment centre because of mild blood pressure elevation, and 29 normotensive volunteers were mainly recruited from the same enlistment centre. In addition, in a majority of subjects in both groups the auscultatory blood pressure of both parents was determined. The patients were characterized by a significantly higher cardiac index at rest, and a significantly higher vascular resistance in the hand blood vessels at maximal vasodilation than the controls, indicating the presence of structural alterations in the resistance vessels of these subjects with only very mild blood pressure elevation. The tendency to increased vascular resistance in the hand blood vessels at maximal vasodilation was more prominent in patients with a normal cardiac index than in those with a high index. This suggests inclusion in the patient group of tense, anxious individuals with an elevated cardiac index but otherwise normal circulation, but does not exclude the possibility that these patients may develop structural vascular changes later on. The parents' blood pressure was higher in the group of patients, both for patients with a normal and those with a high cardiac index, compared to the parents of the controls.


Plasma renin activity and blood pressure during long term treatment with propranolol and diuretic. 19 primary hypertensive patients were treated in random succession with diuretic, propranolol and the combination of both. It was found that the diuretic gave a sustained increase in plasma renin activity (PRA). There was a negative correlation between PRA level attained and blood pressure reduction. Propranolol treatment gave a sustained reduction of PRA. There was no correlation between PRA reduction and blood pressure reduction. When diuretic was combined with propranolol, PRA was in average at control level, and there was no correlation between the PRA reduction from diuretic value to combination value and the corresponding additional blood pressure fall. It is concluded that propranolol treatment does not transform patients to "low renin hypertensives" specifically sensitive to diuretic treatment.


Macrophage mediated tumor cell cytotoxicity. The following evidence from our research has implicated the macrophage as an important effector cell in pyran and/or C. parvum induced host resistance to solid tumors: (1) Increased infiltration of tumors with histiocytes following systemic treatment with pyran;17 (2) activated peritoneal macrophages with tumoricidal activity have been recovered from the peritoneal cavity of normal or tumor bearing mice treated with pyran or C. parvum;17 (3) activated peritoneal macrophages mixed with tumor cells in vitro and transplanted into syngeneic recipients inhibited tumor growth; (4) trypan blue, an inhibitor of macrophage function, prevent C. parvum induced regression of methylcholanthrene tumors; and (5) direct intralesional injection of activated macrophages into the MCA 2182 tumor inhibited tumor growth and increased the MST.


Discussion paper: tumor-directed cellular hypersensitivity detected by leucocyte migration in patients with renal carcinoma. Leucocyte migration inhibition detected in vitro by the capillary tube technique (LMCT) has proved a useful tool for detection of tumor-specific cell-mediated hypersensitivity (TCMH) in man. Investigations in pateints with renal tumors are reported. It is shown that TCMH is a feature of hypernephroma in man, that the antigenic specificity is found in autologous as well as allogeneic tumor tissue and in fetal kidney tissue. The pattern of reactivity compared to postoperative survival and occurrence of metastases and postoperative clinical course shows a clear association between TCMH and tumor elimination. The capacity of hypernephroma patients to develop a cell-mediated immune response is generally not reduced. In allogeneic combinations, small noninvading tumors usually have a high antigenicity, whereas tumors with early dispersion show a low antigenicity. The development of TCMH and associated tumor elimination therefore may be depending preferably on the antigenicity of the tumor, less on the immune capacity of the tumor host.


Mediation of immune responses to tumor antigens in vitro by immune RNA. It was shown that normal nonimmune C3H mouse spleen cells became specifically cytotoxic to chemically-induced syngeneic C3H tumor cells by incubation with xenogeneic I-RNA extracted from the lymphoid organs of specifically immunized guinea pigs. This response was specific for the tumor used to immunize the I-RNA donor. In a totally syngeneic system, we showed that syngeneic I-RNA extracted from the spleens of tumor-bearing rats mediated cytotoxic immune reactions which were directed specifically against the tumor-associated antigens of syngeneic rat tumor target cells. Active antitumor I-RNA synthesis in the lymphoid organs of I-RNA donor animals reached a maximum between days 14 and 21, depending on the route of administration and the nature of the immunizing tumor. Active I-RNA preparations were insensitive to treatment with deoxyribonuclease or pronase, but were inactivated by ribonuclease treatment; thereby indicating that the active moiety was one or more species of RNA. The active fractions of the I-RNA preparations had sedimentation values in sucrose density gradients of 12-16S, and comprised only a small fraction of the total RNA present in the lymphoid cells. Active antitumor I-RNA appeared to be localized in the cytoplasm of sensitized lymphoid cells, rather than in the nucleus. Lymphocytes from normal human donors as well as from cancer patients, when incubated with xenogeneic or allogeneic I-RNA, became specifically cytotoxic for human tumor cells in vitro. Crossreactivity among tumors of the same histologic type was observed, but not crossreactivity with tumors of other histologic types. Xenogeneic I-RNA extracted from the lymphoid organs of donor animals immunized either iwth tumor cells or normal tissues, following incubation with normal allogeneic lymphocytes, mediated cytotoxic immune reactions which were directed both against tumor-associated antigens and normal transplantation antigens. However, when autologous lymphocytes were used as effector cells, only immune reactions directed against tumor-associated antigens were observed. Allogeneic I-RNA extracted from peripheral blood lymphocytes of human cancer patients mediated specific cytotoxic immune reactions that were directed against common tumor-associated antigens shared by human tumors of similar histologic type. I-RNA's directed against "self" normal cell surface antigens appear to be recognized as self by lymphocytes, and immune responses against these self antigens are not elicited. On the other hand, I-RNA's directed against "nonself" tumor-associated antigens induce lymphocytes to effect specific antitumor immune responses. Our data are consistent with the hypothesis that I-RNA is an information-containing ribonucleic acid molecule capable of mediating immune reactions in vitro which are specific for the tumor-associated antigens of the tumor used to immunize the I-RNA donor.


The complement system in tumor immunity: significance of elevated levels of complement in tumor bearing hosts. The elevation of complement level in the sera and depressed state of tuberculin reaction were observed in lung cancer patients. A clinical follow-up study demonstrated negative conversion of tuberculin reaction while keeping the complement at an elevated level during the observation period. This phenomenon can be explained; the complement system is elevated to compensate the depressed cell-mediated system to prevent the immunological surveillance system from invading agents in tumor bearing hosts. The immunological states of the patients with various diseases are classified into six stages according to the tuberculin reactivity, positive or negative, and complement level: elevated, normal, or depressed. A healthy control group is composed of the group of complement normal and tuberculin positive (Stage I). Most of acute inflammation falls into the elevated level of both complement and positive tuberculin reaction (Stage II). Sarcoidosis, leprosy, and Wegener's granulomatosis are divided into the elevated level of complement and depressed tuberculin reaction (Stage III). Systemic lupus erythematosus is in Stage V with the depressed state of both tuberculin reaction and complement level. A follow-up study of lung cancer patients showed a possible chronological sequence starting from Stage I through III, and finally to V, similar to the progression-of-disease process. The biological and medical significance related to the phenomenon is discussed, standing upon immunochemical, phylogenical, and immunogenetical standpoints of complement research.


Reversal of immunosuppression induced by murine leukemia viruses. BALB/c mice infected with Rowson-Parr virus, a lymphatic leukemia virus isolated from the Friend complex, undergo a rapid depression of antibody response. Spleen cells from these mice in culture show a similar deficit in the response to stimulation with sheep red cells and inhibit the reactivity of normal splenocytes. In an attempt to reverse this immunosuppression, near normal responses were obtained in vitro from infected splenocytes by increasing antigen dose, by adding E. coli lipopolysaccharide, or, more effectively, by cocultivating with small numbers of unfractionated or T cell-depleted peritoneal exudate cells (PC), whereas other manipulations proved ineffective. PC did not prevent the inhibition of normal splenocytes by infected spleen cells, but exhibited substantial restorative activity in vivo. In similar experiments, the immunosuppression exerted by the entire Friend complex could be reversed by PC in vitro but not in vivo. These results indicate that a functional deficit of macrophages may be partially responsible for the immunological impairment induced by leukemia viruses and suggest rational approaches to evaluate the relevance of this impairment to oncogenesis.


Subversive activity of syngeneic tumor cells as an escape mechanism from immune surveillance and the role of prostaglandins. Mice bearing a syngeneic tumor become increasingly immunodepressed during growth of the tumor, being unable to develop both cellular and humoral immunity to a histoincompatible tumor allograft and to reject the allograft. This failure to reject a strongly antigenic tumor allograft suggests that immunodepression associated with growth of a weakly antigenic syngeneic tumor provides the syngeneic tumor with an escape mechanism. This immunodepression is also manifest by the suppression of the response of spleen cells to mitogen stimulation by syngeneic tumor cells, both in vivo and in vitro. T cells that are stimulated by PHA, a T-cell mitogen, are the primary targets, and their suppression is the result of the direct subversive activity of the tumor cells. Subversion of T cells by tumor cells seems to be mediated through the prostaglandin pathway, because the prostaglandin PGE2 is itself suppressive, and an antagonist of PGE2 and an inhibitor of prostaglandin synthetases both inhibit the subversive activity of tumor cells. Several tumor cell lines tested, of different etiology and histologic type, all were subversive. This suggests that this subversive activity may be a general property of tumor cells and may be a key element in their ability to thwart the immunological system of the host. For this reason, any therapeutic regimen of cancer, based on immunostimulating drugs, should include drugs that can inhibit active subversion of the immune system by the tumor itself. Antagonists of prostaglandins and inhibitors of prostaglandin synthetases show promise in this regard.


Influence of immune stimulators on viral leukemogenesis. Injection of RNA, extracted from statolon by the SDS-phenol method, into FLV-infected mice 24 hours before SRBC immunization restored the immune response to SRBC to normal levels. Leukemosuppression was observed in 50% of the RNA-treated FLV-infected mice. These RNA-treated mice were clinically normal 25 days after infection, whereas all untreated infected mice developed erythroleukemia. Furthermore, all RNA-treated mice with suppressed erythroleukemia produced antibody which was cytotoxic for Friend leukemia cells. Our studies, and studies by others, indicate that the immunostimulatory and leukemosuppressive principle in statolon appears to be a dsRNA.


Immunogenicity of modified tumor cells in syngenic hosts. Modified tumor cells were used to immunize three murine hosts against syngenic ascitic lymphomas: C3H-6C3HED, BALB/c-P1798, and DBA/2-L1210. When the host was capable of a significant immune response against the malignant cells during progressive tumor growth (e.g., C3H vs. 6C3HED), protective immunization against a larger challenge tumor dose was achieved after fewer vaccinations. Lipopolysaccharide (LPS) enhanced host response to iodoacetamide (IAd) modified P1798 and L1210 so as to confer resistance after fewer immunizations with these weakly antigenic tumors. Similarities among the three systems were also seen. Modified cells may be stored at 4 degrees C several weeks and are effective when 107-108 are given i.p.; resistance appears maximal about one week after vaccination. In immunotherapy trials, C3H mice implanted with 5 x 104 6C3HED cells and treated at least four times with IAd-6C3HED demonstrated a 25% cure rate. A model was presented for evaluating parameters of response to immunotherapy in conjunction with chemotherapy. Cell-mediated immunity in resistant mice was demonstrated by inhibition of DNA synthesis in cultures of lymphoma cells and sensitized peritoneal cells (PEC) compared to that with nonimmune PEC. This assay system may also provide an opportunity for examining the hypothesis of immunostimulation of tumor growth in vitro. Humoral response to modified cells was established by membrane immunofluorescence. Although anti-6C3HED and anti-L1210 appear specific, anti-P1798 antiserum reacts with BALB/c thymocytes and murine fetal antigen.


[Study of antihypoxic properties and toxicity of mexamine (5-methoxytryptamine)]. On its introduction to mongrel albino mice in doses of 1 to 200 mg/kg mexamine (5-methoxytryptamine) exerted a marked antihypoxic action in conditions of hypoxic hypoxia (a "rise" in the pressure chamber to an altitude of 8000 to 10 000 m) 5--180 minutes after administration of the drug. The possibility of reducing the toxicity of mexamine through preventive introduction of the agent in a dose of 1 mg/kg was established. With such a modification of the toxicity no mitigation of the antihypoxic effectiveness of the basic dose of the agent is observed.


Duovirus infection as a cause of infantile gastro-enteritis in Port Moresby. A preliminary study of nine children under five years of age admitted to Port Moresby General Hospital with acute gastro-enteritis showed that five (56%) were excreting duovirus in their stools as shown by electron microscopy. Duovirus was not demonstrated in the stools of any of eight children with gastro-enteritis seen at Kainantu Health Centre.


A radiological survey of upper gastrointestinal lesions in Port Moresby 1972-74. During  2 1/2 year period in Port Moresby General Hospital, 1023 patients had barium meals. Two-thirds of the patients were males and over half were expatriates. Positive findings were noted in  26% of Papua New Guineans but only 11% of expatriates. Over half of those with positive findings had peptic ulcer. Chronic duodenal ulcer, including deformed duodenal cap, was the commonest finding in both Papua New Guineans and expatriates but gastric ulcer was also common in Papua New Guinean males. The incidence of peptic ulcer is less than that reported in Goroka and in some other countries. The next commonest findings were carcinoma of the oesophagus and stomach in Papua New Guineans and hiatus hernia in expatriate males.


A study of human intestinal helminthiases on Kar Kar Island, Madang Province. This paper reports the results of an epidemiological survey of intestinal helminths in a village on Kar Kar Island, Madang Province. Samples of blood and faeces were collected from 320 people from all age-groups living in 51 houses in Kaul village. Three helminth species were recorded: Ascaris lumbricoides infections were highest and heaviest in childhood, and fell to low levels in adult life, the overall infection rate being 57%. More than 70% of the adult population were infected with Necator americanus, though almost all infections were light. 21% were infected with Trichuris trichiura, and all infections with this species were light. The parasitological findings were related to the haematological results, and the social and physical environmental factors affecting these findings are discussed. It is concluded that Ascaris infection is the principal cause of the high eosinophilia in the community.


A case of enteritis necroticans in pregnancy. This report describes a case of enteritis necroticans in pregnancy and comments on the surgical aspects of treatment.


Glanzmann's thrombasthenia in a Melanesian. A case of Glanzmann's thrombasthenia is documented in a Melanesian child, and the diagnosis and treatment of this disorder are discussed. This is the third inherited bleeding disorder to be reported in Papua New Guinea, haemophilia A (Factor VIII deficiency) and Factor XIII deficiency having been described previously.


[Methods for measurement and analysis of human dietary behavior]. Food intake in humans may be studied by the measurement of the quantity of food ingested, by the estimate of sensations evoked by food, and by recordings of the motor and secretory activities of the digestive tract. These methods may be used to study normal as well as pathologic food intake in humans.


A study of leukemic cell infiltration in the testis and ovary. The behavior of leukemic cell infiltration in the testis or ovary was examined on 99 autopsy cases of various leukemia, which were performed in the Department of Pathology, Tokyo Medical and Dental University, from 1964 to 1975. The incidence of leukemic cell infiltration was 48.5% in the testis and 58.1% in the ovary. The frequency of leukemic cell infiltration in the testis or ovary itself showed no significant increase in recent years, although median survival time became longer by a more aggressive combination chemotherapy. These findings show that the testis and ovary are essentially a preferred site of leukemic cell infiltration. Especially in acute monocytic leukemia, leukemic cell infiltration was revealed in all cases. In addition, short discussions were made on the role of sex hormones in the infiltration, proliferation, and persistence of leukemic cells of each type of leukemia in the testis or ovary.


Studies on medically important flies in Thailand. I. discovery of Calliphora species first in Thailand (Diptera: Calliphoridae). Species of flies, Calliphora vomitoria (Linné) and C. pattoni Aubertin, found for the first time in Thailand are reported, together with detailed illustrations of genitalia. These are known to be Palearctic species, which are commonly found in Europe or northern parts of Asia. These flies were found in Doi Inthanon, the highest mountain in Thailand, which belongs to the Oriental region.


Distant metastasis of carcinoma in the maxillo-facical region--relationship to the method of therapy and TNM system. Based upon the autopsy findings, the incidence of distant metastasis was studied to seek the relativity between the method of treatment and the TNM system at the time of initial examination on 31 cases with squamous cell carcinoma in the maxillo-facial region. The results are summarized as follows: 1) The incidence of distant metastasis among all of these cases was 58 per cent. 2) There was no significant difference in the incidence between the groups with radiation therapy and chemotherapy. 3) There was no relativity with the TNM system. 4) In the group with radiation therapy, the incidence at the "sites of the movable mucosa" was significantly higher than that at the "sites of the non-movable mucosa." 5) There was no relationship to the performance of radical neck dissection.


The aspect of ultrastructural changes of the osteoblasts and surface areas of alveolar bone appearing in experimental tooth movement. Molars of mature Wistar rats were moved experimentally by orthodontic elastic for four days. Then, the aspects of ultrastructural changes of the osteoblasts and structure of the alveolar bone surface which appeared in experimental tooth movement were studied. The following results were obtained. 1) These osteoblasts are classified into three groups according to their position. 2) The most active response to the orthodontic force is exhibited by the second group of cells with the ability of rapid production of abundant acid polysaccharide; i) Abundant rough surfaced endoplasmic reticulum with markedly dilated cisternae. ii) Well developed Golgi apparatus and electron opaque granules with a limiting membrane are found in the cytoplasm. Large granules are frequently seen to be secreted out of the cell. iii) The mitochondria are of large size and round shape with well developed cristae. 3) The surface of the new alveolar bone is covered with a belt-shaped structure consisting of small dense spherical-shaped structures. 4) Osteoclasts are rarely seen, but the original function of the cells appears to be almost inactive.


Absolute alkaline phosphatase positive and negative neutrophil counts in chronic granulocytic leukemia. Absolute counts for the alkaline phosphatase positive (AP+) fraction of potentially AP+ neutrophils were measured cytochemically during the course of chronic granulocytic leukaemia (CGL), from the clinical onset of the disease. In a previous study of different kinds of severe granulocytopenia, the AP positivity of circulating neutrophils appeared to indicate a kinetic parameter. Early release of mature, non-stored bone marrow granulocytes apparently furnished more AP+ neutrophils, whereas release of stored cells furnished more AP- cells. If we consider enzyme activity to indicate a kinetic parameter, its differential diagnostic usefulness would be less than generally supposed. One hundred and forty eight determinations in 74 CGL patients showed that low AP values are valid for CGL statistically, especially between the 2nd to 5th years of clinical disease, but normal or higher counts of circulating AP+ fraction of mature neutrophils could be found in one fourth of advanced cases (blastic metamorphosis excluded), and even more (17/37) in the earliest period of the CGL process. A similar tendency appears to be detectable in the absolute counts for circulating AP- cells.


Erythropoietin level in patients with acute leukaemia. Erythropoietin level in the serum and urine of adult patients with acute leukaemia (AML, ALL, MML) was estimated by polycythaemic mouse bioassay in order to obtain more information about the associated anaemia. In AML and ALL patients the serum erythropoietin level as found to be increased and in a negative correlation with the blood haemoglobin concentration. In ALL patients erythropoietin in urine was increased regularly while in AML patients it was not. No correlation between the serum level and the urinary excretion of ESF, or between the blood Hb and the serum ESF, was found in MML patients. The results show that anaemia in leukaemia is not due to the low ESF level.


Prazosin in the treatment of patients with hypertension and renal functional impairment. Prazosin was used as an additional antihypertensive agent for treating 16 patients with hypertension and significant renal functional impairment. The drug was effective in 13 patients at a mean daily dose of 7.9 mg. The most important side effect of prazosin treatment was dizziness which occurred on standing or following exertion, and was seen either after the first dose or following a large increase in dose. This could be prevented by giving the very first dose of 0.5 mg late in the evening. Five patients complained of palpitations. In no patient was there a deterioration in renal function which could be attributed to prazosin. Five women had a significant improvement in renal function.


Thyroid function following intravenous pyelography. Thyroid function was assessed by total serum thyroxine, free thyroxine index and serum triiodothyronine immediately prior to intravenous pyelography in 105 female outpatients. The thyroid function tests were repeated two months later. Although all three parameters showed a statistically significant mean rise, the changes were small and not clinically significant. Two patients from the study population with a past history of thyrotoxicosis had a transient elevation in serum triiodothyronine but neither patient developed clinical features of hyperthyroidism.


Some perceived postgraduate education needs of house surgeons. Registrars and specialists. In December 1974 questionnaires concerning postgraduate education were sent to all New Zealand medical practitioners. This paper refers to the replies from house-surgeons/registrars and from specialists. Fifty-seven percent of the house surgeons/registrars replied to their questionnaire. Nearly 70 percent of those who chose general practice expected to train vocationally for this discipline wholly in New Zealand, compared with nearly 60 percent of pathology/radiology and undecided candidates, and 20 to 35 percent of medical surgical and O and G candidates. On the average the house officers will expect full-time continuing medical education (CME) for about three weeks every one to three years and local CME for about three hours each week. Seventy percent of GP candidates and 30 percent of specialist candidates expected and full-time CME to be in New Zealand. Fifty-six percent of the specialists gave information. Only 14 percent had trained solely in New Zealand and 80 to 90 percent of physician and surgeon groups had trained beyond Australasia. Full-time CME amounted to about five days each year and local CME to about two hours each week. New Zealand CME was not rated highly, but visiting overseas specialists were regarded as essential by most respondents, as was travel overseas for vocational training and CME. Learning methods most preferred were reading, lectures followed by small group discussions and plenary sessions, and small groups using member expertise. Television, tapes and films were poorly regarded.


Imported methicillin-resistant Staphylococcus aureus infection: a case report. The first isolate of a methicillin-resistant strain of Staphylococcus aureus at the Wellington Hospital was made on 31 March 1976, from a man who had emigrated from the United Kingdom in 1973. The infection was successfully treated with co-trimoxazole and fucidin. The epidemiological implications of this infection are discussed.


Primary amoebic mengingoencephalitis contracted in a thermal tributary of the Waikato River--Taupo: a case report. The case history and identification of the aetiological agent of a case of primary amoebic meningoencephalitis contracted from a natural thermal steam is presented. The diagnosis and treatment of suspected cases is discussed.


Hypercalcaemia in acute renal failure.

Hypercalcaemia in acute renal failure. A case of myoglobinuric acute renal failure complicated by hypercalcaemia is reported. Data on 13 other such cases published in the English literature since 1964 are summarised. Hypercalcaemia appears to be uniquely confined to rhabdomyolysis-myoglobinuric acute renal failure. Serum calcium concentrations should be monitored in such patients.


Psychological treatment of self-injury.

Psychological treatment of self-injury. Behavioural treatment techniques were used for eliminating self-injurious behaviours of two mentally retarded patients. During treatment, each self-injurious response resulted in punishment followed by a timeout period and then differential reinforcement of other behaviours incompatible with self-injury. This procedure was effective in rapidly eliminating self-injury.


Alcoholism, life events, and psychiatric impairmant. A sample of 122 DPs was compared to a "normative" sample of CSRs. The presentation of psychiatric disorder scores and numbers and kind of stressful life events was detailed. Results of this comparative analysis suggest that research that focuses on high psychiatric disorder-controlling for life events is in order. Furthermore, therapeutic intervention must obviously take into account the iterative nature of alcohol and stressful life events. Also, these findings suggest and support the role of life stress in the possible formation of alcoholism.


Alcoholism and the child molester.

Alcoholism and the child molester. This study shows a high association among drinking, alcoholism, and child molestation. Forty-nine percent of the child molesters were drinking at the time of commission of the offense, and 34% were drinking heavily, defined as 10 or more beers or the equivalent. The alcoholism rate for the group was 52% based on the MAST or 33% based on the more stringent Pokorny shortened version of it. An interesting and unexpected finding was a statistically significantly lower incidence of drinking at the time of commission of the offense in male-child molesters compared with female-child molesters. In addition, the male-child molesters had a definitely lower alcoholism rate compared with female-child molesters. The importance of these findings for treatment programs is emphasized.


Changing perceptions of self and spouse from sober to intoxicated state: implications for research into family factors that maintain alcohol abuse. This paper has concentrated on reporting changes along eight dimensions of the Leary ICL in perception of self and of spouse between sober, as if intoxicated, and intoxicated conditions for couples with an alcoholic member. Major findings were that of a pilot sample of four couples, three couples showed significant changes in the responsible-hypernormal dimension, though not always in the same direction, that, otherwise, there were highly individualized patterns of change along the eight dimensions both for each couple and for each separate member of a couple, and that the ability of an individual to predict his or her experience of the intoxicated condition is highly variable, not only from couple to couple but also between husband and wife and even between one dimension and another for a given individual. Changes in congruence of these perceptions between husband and wife and their potential utility were also discussed. Advantages of conceptualizing alcoholism in interactional terms and the importance of developing research techniques that address the interactional variables were also discussed.


Behavioral disorders in children with parental alcoholism. The influence of parental alcoholism on the personalities of the children was studied by use of the Devereux Rating Scales to delineate problem behavior patterns. The subjects for the investigation were identified as a result of their parents being in treatment for alcoholism, and a control group matched for age, sex, race, family size, and socioeconomic status was utilized. The findings suggest that the presence of parental alcoholism acts as a serious deterrent to healthy personality development in the children, and the degree of disturbance in these individuals might be greater than previously suspected. Several implications of these observations are discussed, including the importance of considering alcohol abuse as a total family problem.


Treatment outcome for earlier-phase alcoholics. Employed alcoholics treated in a traditional inpatient alcoholism treatment program were classified by their alcoholism counselors as being in either the chronic phase or in earlier phases of alcoholism. Three-month follow-up data indicated that a significantly smaller proportion (41%) of the earlier-phase alcoholics than of the chronics (59%) were maintaining abstinence. Given abstinence as the primary success criterion, it must be concluded that earlier-phase alcoholics treated in this program were less successful than chronics. However, follow-up data also indicated that earlier-phase alcoholics were more likely than chronics to be controlling their drinking. These findings are discussed in light of the newly emerging paradigm of alcohol problems as a multidimensional rather than a unidimensional problem; it is suggested that success criteria be relaxed to include controlled or responsible drinking as acceptable treatment objectives and that experimental treatment programs, specifically for earlier-phase alcoholics, be initiated.


Alcohol consumption during pregnancy as reported to the obstetrician and to an independent interviewer. Data on the 67 women asked by this study and by their physician about their drinking indicate that most of them reported "occasional" consumption to the physician, no matter what their drinking behavior appeared to be as estimated by personal interview. That is, heavy drinkers (by the estimates of this study) underestimated and infrequent drinkers overestimated alcohol consumption relative to the personal interview when reporting to their physician. Becuase of the difficulty in classifying responses, a rather loose criterion of "disagreement" of the two estimates was established. About 10% of the women gave conflicting reports to the study interviewer and the physician by this criterion. In most cases of conflict, the report to the physician was lower. These data suggest that the reports of drinking to the physician were of limited usefulness, becuase all women tended to declare similar quantities. Furthermore, physician interrogation failed to detect almost all the heavier drinkers found by an independent interview.


Methadone and alcohol.

Methadone and alcohol. We have demonstrated the dangers of alcoholism that complicate methadone treatment of heroin addiction. In future papers, we will attempt to identify contributory factors and suggest interventionist techniques. In the final analysis, however, rehabilitation programs, vocational programs, and, above all, alleviation of the dreadful socioeconomic deprivations related to, among other factors, the racial bias under which most of these people have been born and have suffered during their lives will, in the long run, prove the most satisfactory means of reducing the heroin problem, except for a minority whose psychologic problems will then provide the irreducible minimum from which the majority of the addicts will come. As has so often been stated, the great drug problem in this country is alcoholism. We know that legal prohibition does not prevent the rise of alcoholism, and we know to our sorrow that not only does it give rise to enormous wealth and power to criminals and criminal gangs but that some of them are now also profiting from the great wealth to be made by dealing in heroin.


Secondary prevention of alcoholism using a population of offenders arrested for driving while intoxicated. The paper describes a comprehensive and objective evaluation of 2358 persons arrested in Philadelphia for driving while intoxicated. It was demonstrated that 63.8% of this population was involved with alcohol to an extent that a diagnosis of alcoholism was evident, and it is suggested that these persons are in need of intensive treatment to prevent further dependency on alcohol. It is significant that these persons were diagnosed as suffering from alcoholism because they had been arrested for DWI and referred for evaluation. They are considered to offer an excellent opportunity for early intervention of what might be a progressive disease process. The study utilizes four parameters on which a diagnosis of serious alcohol impairment is established. They are the blood alcohol concentration at the time of arrest, the quantity and frequency of alcohol intake, the behavior associated with the drinking, and the Eysenck Personality Inventory, which measures the degree of neuroticism found in these subjects. Problems in the establishment of a diagnosis of alcoholism in this particular population are presented, and the need for measurement with several instruments is emphasized. Through use of the techniques described, it is possible that specific treatment directions can be established based on particular patterns of alcoholism.


Rural alcohol abuse.

Rural alcohol abuse. One hundred and forty-eight rural males between the ages of 18 and 60 volunteered to be tested and were interviewed with a series of scales and background information items that were selected to predict alcohol abuse or nonabuse. The subjects were classified as Black abusers, Black nonabusers, White abusers, and White nonabusers. Major sections of the test and interview format included measures of achievement need, alienation, tolerance of deviance, leisure time, religious fundamentalism, general deviation, mobility, age, family size, and education. Criteria of abuse and nonabuse were based on interview information related to quantity consumed, circumstances for drinking, problems related to drinking, and a community estimate from references. Field research data across 32 Texas villages were used to develop recommendations for education, information, and treatment for strictly rural American areas. Analysis of variance methods identified significant differences between abusers and nonabusers on measures of tolerance of deviance, religious fundamentalism, general deviation, mobility, age, and education.


Occlusive mesenteric infarction. A retrospective study of 83 cases. Acute mesenteric infarction was diagnosed clinically or post mortem in 83 patients over a 10 years period in 4 surgical departments. The present study is concerned with 56 of these patients who suffered occlusive disease of the mesenteric vessels and on whom sufficient data were available. Of these 17, patients had presented at least one symptom of chronic intestinal ischemia before the fatal exacerbation. Of 42 patients treated surgically 14 had operations with curative intend and 3 patients, all with venous thrombosis, survived after small bowel resection. Only 19 percent of the patients who underwent surgery were treated within 24 hours after onset of symptoms. Early diagnosis promptly followed by surgery might save some patients. A radical improvement of survival rate can however no be expected for the acute cases. More attention should be paid to the syndrome of abdominal angina, as elective arterial reconstruction in patients with chronic intestinal ischemia carries a low mortality and renders satisfactory results.


Acute mesenteric infarction caused by small vessel disease. A case of acute mesenteric infarction caused by small vessel disease is reported. The patient recovered after 2 operations by which extensive bowel-resections were performed. The resected bowel showed intimal hyperplasia and atherosclerosis of the small mesenteric arteries. Since also thrombocytosis and increased platelet aggregation was demonstrated the main cause of thrombosis however is supposed to be hypercoagulability.


Arterial embolism in the upper limb.

Arterial embolism in the upper limb. Upper extremity embolectomy was carried out in 20 patients. Two patients died postoperatively of their primary disease. Of the remaining 18 patients 10 had embolectomy performed within 12 hours after the onset of symptoms, 8 of these had excellent results and 2 had fair results. Eight patients were embolectomized after 12 hours, 2 had excellent results, 2 had fair results, 2 poor results and 2 had the forearm amputated.


High occlusion of the abdominal aorta.

High occlusion of the abdominal aorta. In the period 1969-1976 27 patients have been operated for high occlusion of the abdominal aorta. The patients had a high frequency of concomitant arteriosclerotic involvement of other parts of the cardiovascular system. The over all mortality was 11 per cent, the 3 deaths were all related to simultaneous operation on the renal arteries. The renal arteries were not operated upon in the other 24 cases. The operative morbidity was low and the prognosis is good as there have been no late death, and 83 per cent of the patients are free of recurrence throughout the follow-up period (mean 2.1 years, range 3 months-7 years).


Rehabilitation after arterial reconstruction of the lower limbs. A four to six years follow-up study. The social fate of 105 patients was followed 4 to 6 years after arterial reconstruction of the arteries of the lower limbs. At the time of operation half of the patients had ischemic symptoms at rest. None died, and none were amputated as a result of the arterial reconstruction. In 84 per cent the operation aimed at restoring the working-capacity including the ability to do housework. In 11 per cent the aim was preservation of personal independence. Five per cent had non-disabling claudication. In 60 per cent the working-capacity was restored, and only 5 per cent were confined to nursing care. At the end of the follow-up period 74 per cent of the patients were alive, and of these 50 per cent had retained their working-capacity. Forty-five per cent were personal independent pensioners and 5 per cent were confined to nursing care. The majority of senescent patients, threatened by amputation of the lower limbs, will retain their personal independence after arterial reconstruction. The socioeconomic importance of this fact is stressed.


Cardiovascular effects of induced hypercarbia during halothane-nitrous oxide anaesthesia. The effect of induced hypercarbia on the cardiovascular system during steady-state halothane-nitrous oxide anaesthesia was investigated in 4 male patients without cardiac disease. Heart rate, cardiac index, systemic and pulmonary blood pressures rose as pCO2 was increased. Stroke volume, systemic and pulmonary vascular resistance remained unchanged. Oxygen consumption decreased and oxygen saturation of mixed venous blood increased. In conclusion the primary effect of hypercarbia was an increased heart rate and a resultant increase of cardiac output. The pressure changes merely reflect the effect on cardiac output. Under these circumstances a regulatory role of mixed venous pO2 on cardiac output is highly unlikely.


Experimental hydronephrosis. An electrophysiologic investigation before and after release of obstruction. Pelvi-ureteric function was studied in pigs with experimental urinary tract obstruction, and again, 5 weeks after relief of the obstruction. Study parameters comprised EMG records taken from pelvis and ureter, measurements of intrapelvic pressure and urine flow, and some supplementary studies of renal function. Total obstruction of 5 and 6 weeks duration induced by cuffing the proximal ureter occasioned severe hydronephrosis and renal failure. Pelvic peristaltic activity was of low frequency, and abnormality was clearly more marked after the longer period of obstruction. There was, for example, some preservation of pelvi-ureteric synergism at 5 weeks, but at 6 weeks ureteric activity was wholly autonomous. Pelvic function was similarly isolated, and non productive. Inspection 5 weeks after reconstruction by pelvis resection and neo-anastomosis of the ureter showed continued absence of renal function and no restitution of normal peristaltic patterns. Partial obstruction, effected by implantation of the ureter in the psoas muscle, induced mild pelvic dilatation and impaired renal function, but there were only minor signs of disruption of normal anterograde pelvi-ureteric activity - irregularities, pauses in activity, and double activity complexes. When the ureter was freed functional patterns returned to normal. Both during obstruction and after relief, pelvic pressure increases during forced diuresis were the equivalent of or lower than the pre-determined norm. Cautery at the pelvi-ureteric junction destroyed the musculature and induced a progressive (fibrous stenosis. There was progressive dissociation of pelvi-ureteric activity, total when obstruction was total in which case ureteric activity was only autonomous, and partial when obstruction was partial in which case varying degrees of synergism and autonomous activity were seen. Successful reconstruction (pelvic resection and neo-anastomosis of the ureter) restored an apparent synergism in pelvi-ureteric function.


Morphology of the upper urinary tract in experimental hydronephrosis in pigs. In the light of electrophysiologic findings in obstructions of the upper urinary tract in pigs, the morphological changes in kidneys, pelvices and ureters were evaluated. Gross anatomical and light and electron microscopical studies were undertaken. In total obstructions severe damage to the parenchyma was seen after 5 to 6 weeks independent of the way the obstruction was obtained. Pelvic musculature was rapidly destructed. After reconstruction performed as dismembered pyeloplasty no regeneration was registered neither in the parenchyma, in pelvic musculature or at the site of the anastomosis. In partial obstruction there were minimal to moderate changes both in parenchyma and in musculature and no signs of regression after reconstruction or relief of the obstruction. Also in these cases there were no muscular regeneration at the site of the anastomosis. When morphology was compared to electrophysiological findings a good correlation was found.


Predictive value of renography and i.v. urography  for the outcome of reconstructive surgery in patients with hydronephrosis. Intravenous urography and isotope renography studies were made in 54 patients with hydronephrosis. Thirty six of these patients underwent reconstructive surgery and were also studied postoperatively. Both studies gave more or less consistent results - that is to say evaluations of renal function and drainage from each individual study were similar - but no individual parameter was of any specific significance in the selection of patients for therapy. Points were allocated to each parameter, and after summing these points for each individual patient, 3 groupings became apparent: a low count group - patients with pelvectasia but normal renal function:a middle count group - patients with certain hydronephrosis; and a high count group with severe hydronephrosis, and markedly impaired renal function. Post-operatively, renal function was unaltered or mildly reduced in group 1, and improved in groups 2 and 3, though the differences were not statistically significant. It was hoped that the studied would allow differentiation between patients of the low count group, but the conundrum remains - which of them can be categorized as normal variants, and which were in fact displaying early pathological signs of essentially progressive disease.


Percutaneous intrapelvic pressure registration in hydronephrosis during diuresis. Percutaneous registration of renal pelvis pressure was undertaken successfully in 17 of 22 patients with unilateral hydronephrosis. Intrapelvic pressure was registered continuously during diuresis induced by mannitol and Urografin. In 10 cases additional increase in urine flow was induced by administration of furosemide. Ureteric urine flow was recorded through a cystoscopically introduced catheter on the side under investigation in 7 cases. The basic pressure was on average 12 mmHg and more than 20 mmHg in 2 cases only. No correlation was found between baseline pressure and degree of hydronephrosis. The intrapelvic pressure rose during forced diuresis with a few exceptions within normal limits. No correlation was demonstrated between pressure rise and renographically estimated kidney function. Pelvic peristaltic activity was detectable in only 3 cases. It is concluded that preoperative registration of renal pelvic pressure during diuresis as performed in this study is of no value in selection of the method of treatment in patients with hydronephrosis.


Dynamics of upper urinary tract in man. Peroperative electrophysiological findings in patients with manifest or suspected hydronephrosis. In 31 patients undergoing surgery in treatment of hydronephrosis, peroperative pelvic pressure measurements were made. EMG records were taken from pelvis and ureter, and occasional measurements of urine flow were made. In 6 instances these studies were also made in the contralateral "normal" kidney, but in 2 of these patients the diseased kidney was not studied. Pelvic pressure during antidiuresis in these 6 "normal" kidneys was about 5 mmHg, and pelvic activity of frequency 5/min. Pelvi-ureteric impulse transmission was anterograde and conduction times were constant. Conduction ratios varied. During forced diuresis mild pelvic pressure rises were seen together with transient increase in pelvic activity over the period of pressure increase. In the studies of hydronephrotic kidneys no significant differences were seen in pelvic pressure of frequency of pelvic activity compared with the "normal" kidney studies, but impulse transmission was markedly disturbed, manifest by varying conduction times, and, on occasion, total dissociation of activity within the pelvis, and between the pelvis and ureter. The more severe the degree of hydronephrosis, the more marked the disturbance. The findings are similar to those made in experiments with pigs after establishment of varying degrees of urine flow obstruction.


Renal pelvic function following total alloplastic replacement of ureter in pigs. Electrophysiology, renal function and morphology. Total replacement of one ureter was under-taken in pigs. After an observation period of 2-3 months further studies were made. Pelvic peristaltic activity as reflected by pelvic pressure waves and electrical activity was indistinguishable from that in normal pigs. In particular, retrograde activity was not observed. It appears that ureteric peristalsis is not a prerequisite of normal pelvic function. Providing only that the calibre is sufficient, function of a ureteric prosthesis is satisfactory, and no changes in kidney or pelvis function and morphology are apparent.


Late results from mucosal denudation for urinary bladder papillomatosis. The study comprises 16 patients who during the period 1965-1972 underwent mucosal denudation (stripping) for multiple, highly differentiated, non-invasive bladder papillomas. No major complications to the operation were seen. In 3 of the 16 patients histological examination of the operative specimen revealed a more malignant tumour than found on preoperative biopsy. During the observation period, which averaged 4 years, the disease recurred in 10 of the 16 patients. In 4 of them, repeated biopsy showed a more malignant tumour than did the operative specimen. The study moreover demonstrated that following mucosal stripping, pronounced bladder contracture occurred in all the patients and dilatation of the upper urinary tracts in half of them. These serious complications mean that even if the disease does not recur, a reasonably normal life for the patient is unattainable. The method, consequently, cannot be recommended.


Total cystectomy and cutaneous uretero-ileostomy following supervoltage radiotherapy for bladder carcinoma. Cutaneous uretero-ileostomy was performed on 59 patients previously given irradiation at a dose of 6000 rads as a curative treatment. In 47 patients the urinary diversion was combined with total cystectomy. The indication for operation was residual tumour and/or subjective symptoms. It is concluded that radical surgery following super-voltage radiotherapy is possible, but implies a high lethality and severe complications. The prognosis is especially poor in patients who at the time of surgery have invasive malignant tumours. In our opinion, the operation should be done only if necessitated by severe subjective symptoms and not on the sole indication of residual tumour.


Anaesthesia for cystoscopy. A comparative study of 3 methods of intravenous anaesthesia: diazepam-fentanyl, thiomebumal and althesin. Three different methods of anaesthesia for diagnostic cystoscopy are compared in randomly divided series of 100 males each. Group I received diazepam-fentanyl supplemented with Althesin in case of therapeutic transurethral procedures. Group II had thiomebumalnatrium-N2O-O2 and group III had althesin-N2O-O2. Group I had no premedication while the two others were premedicated with morphine-scopolamine mixture. The period during and after anaesthesia was observed independently by the urologist, the anaesthetist, the nurses on the ward and by interviewing the patient the day after the cystoscopy. The anaesthetist was the only one who knew the method to be used. Diazepam-fentanyl proved to give sufficient analgesia. This combination offered the shortest and most uncomplicated period of recovery. Five patients given diazepam-fentanyl remembered the cystoscopy as being painful. All these cases could be related to insufficient coordination of anaesthesia and cystoscopy, which seems to be of major importance for this method.


Duplication of the inferior vena cava in retrocaval ureter. A case of peroperative urodynamic investigation. A patient with partial duplication of the inferior vena cava and a retrocaval ureter was preoperatively studied by uro-cavography and renography. Peroperatively intrapelvic pressure measurements were made, and simultaneous EMG recordings were taken from the pelvis, and from the ureter proximal and distal to the retrocaval segment. The electrophysiological activity was normal with normal anterograde impulse transmission. Renal pelvic pressure and pressure increase during forced diuresis was within a normal range.


Right ovarian vein syndrome. A case with pre- and peroperative electromyographic registration of ureteral activity. Electrophysiological studies of ureteral function in a patient with right ovarian vein syndrome demonstrated intermittent antiperistalsis as reflected from pre-operative endoureteral activity recordings. The antiperistalsis was related to the patient intermittent right flank pain. Per-operative EMG and pressure measurements revealed that the antiperistalsis apparently arose from the area of obstruction and caused pressure waves of higher amplitude than those seen during normal anterograde peristaltic activity. After section of the vein, exclusively anterograde peristalsis was observed, and at 3 month follow-up, the patient was free of right side colics.


Appendico-vesical fistula. A new case and a brief review of the literature. A new case of appendico-vesical fistula is submitted. After a brief review of the literature, it is concluded that these fistulas usually manifest themselves clinically in recurrent urinary infections without gastro-intestinal symptoms. The best aids in the difficult diagnosis are cystography and cystoscopy. Treatment is by appendectomy and excision of the fistular opening.


Complete sagittal septum of the bladder. A case report. A case of complete sagittal septum of the bladder, successfully treated by resection of the septum is reported. The literature of this rare malformation is reviewed and alternate surgical procedures are discussed with regards to bladder function and continence.


Renal vein renin ratio. Predictive value in renal and renovascular hypertension. Renal vein renin ratios were determined in hypertensive patients, 19 with renal artery stenosis, 7 with renal artery occlusion and 13 with unilateral renal hypoplasia. Twenty-one of these patients were treated surgically. Renal vein renin ratios of greater than or equal to 1.5 were associated with high frequency of operative success, but ratios less than 1.5 by no means excluded good surgical results.


[The socio-medical significance of chronic rheumatoid arthritis (proceedings)]. The last figures, portraying to the cost complex concerning rheumatism, have been released by the Austrian Health Insurance Organisation. Attention is called to the problem of unauthorized sick leave and to the cooperation of all pertinently concerned, with regards controlling cost inflation.


Transovarial transmission of LaCrosse virus in Aedes triseriatus. As part of a continuing investigation on the ecology of LaCrosse virus in Wisconsin, field and laboratory studies were conducted to explore the possibility that the virus is transmitted transovarially in A. triseriatus mosquitoes. In laboratory experiments, A. triseriatus mosquitoes were infected by ingesting LaCrosse virus in defibrinated blood. LaCrosse virus was recovered from F1 eggs, larvae, and adults that originated from the infected parent mosquitoes. In a subsequent field study aimed at determining if transovarial transmission accounted for the survival of LaCrosse virus during the winter season, larvae that originated from overwintering A. triseriatus eggs were collected from a LaCrosse virus enzootic area in southwestern Wisconsin. LaCrosse virus was isolated from these larvae and from adult A. triseriatus that were reared from field-collected larvae. These findings strongly imply that A. triseriatus is the reservoir of LaCrosse virus and that transovarial transmission is the mechanism responsible for the maintenance of the virus during the winter season in the north central region of the United States.


Symbiosis and attenuation.

Symbiosis and attenuation. Parasitic protozoa and bacteria transmitted by vector insects and ticks resist destruction in the intermediate host, possibly through the possession of antigens similar to those of the host. There is no evidence that symbiotic microorganisms have evolved similar eclipsed antigens. Symbiotes are protected from destruction by the natural lytic agents in the host, because they remain for the most part inside special cells that have lost the ability to recognize the symbiotes as "nonself." Metallic ions may play an important role in attenuation through their effect on cell membranes and on the release of lytic agents. The symbiotes of insects are useful and interesting subjects for studying attenuation.


In vivo behavior of a Sindbis virus mutant isolated from persistently infected Aedes aegypti cell cultures. A mutant of the Sindbis virus SV-S was found to interfere with the regular course of infection by the wild strain of the virus SV-W in A. aegypti mosquitoes and in suckling mice. In mosquitoes, this result was manifested by a reduced titer of SV-W in the presence of SV-S and by a failure of the mosquitoes to transmit SV-W. In the brains of suckling mice, in the presence of SV-S, the growth of sc inoculated SV-W was suppressed, and as a result, the usually lethal course of infection by this virus was converted into a nonlethal one.


Arbovirus infection of vertebrate and insect cell cultures, with special emphasis on Mokola, Obodhiang, and kotonkan viruses of the rabies serogroup. Multiplication of rabies serogroup viruses, Obodhiang and kotonkan (two presumptive arboviruses), was induced in vertebrate cell cultures with Singh's A. albopictus cell cultures used as "helper cells" in cocultivation experiments. Plaque formation without prior in vitro adaptation was induced in Vero cell cultures with eight rabies serogroup viruses: in all five instances by cocultivation of either infected BHK-21 or A. albopictus cells with Vero cells under agar overlay and in three of eight instances by direct plaque assay of infected mouse brain suspensions. In cross-plaque reduction neutralization tests with cloned viruses that represented human pathogens, rabies, Duvenhage, and Mokola, on the one hand, and the presumptive arboviruses Obodhiang and kotonkan, on the other hand, Mokola virus shared common antigenic components with both the nonarboviruses and the arboviruses. Biologically, Mokola virus was different from the other two human pathogens, rabies and Duvenhage, in that it multiplied in both vertebrate and invertebrate cell cultures. Mokola virus thus appears to be the biologic and serologic bridging agent.


Neutralization of a togavirus by antivector antisera. An A. aegypti-propagated togavirus (Sindbis) is neutralized by antisera to both whole-body extracts and to salivary fluid of the vector mosquito. Virus propagated in Vero cells is not neutralized by such antisera. Neutralizing activity resides in the immune globulin fraction of sera. Sera from animals injected with adjuvant neutralized neither virus propagated in mosquitoes nor virus obtained from Vero cells. Although neutralizing titers were low, such activity may protect, to some degree, vertebrate hosts normally exposed to vector antigens.


Genetic studies of pathologic conditions and susceptibility to infection in Biomphalaria glabrata. During studies on the genetics of variation in susceptibility of B. galbrata to infection with S. mansoni, four types of proliferative amoebocytic accumulations have been observed. They occur in four different clonal stocks of B. glabrata, beginning as amoebocytic aggregations, namely, in the atrial cavity, pericardial cavity, periaortic space, and hemocoel between the stomach and intestine. Persistent amoebocytic accumulations involve the sinuses around the stomach, intestine, and hepatopancreas. In these snails, nests of undifferentiated cells occur in the anterior pericardial wall, which is considered to be a hemopoietic area. Crossing experiments indicate the involvement of genetic factors, possibly in combination with infectious agents.


[Myelomonocytic chloroleukemia. Histochemical evaluation of two observations]. A myelosarcoma was diagnosed in the bioptic excision of an eight year old boy's middle ear. An autopsy of this case as well as that of a 47 year old man revealed the presence of tumoriform chloroleukaemia. The histochemical positivity of naphthol AS-D-chloracetate-esterase and NaF-sensitive non-specific esterase showed the simultaneous double differentiation of tumour cells thus serving as evidence of their myelomonocytic nature. The first observation also revealed the presence of atypical eosinophil leucocytes with PAS-positive, naftol AS-D-chloracetate-esterase-negative granules. Both observations brought evidence of the reticular as well as tumour cells showing signs of erythrocytophagia which may have a share in the development of the tumour tissue green coloration.


The stiff man syndrome: a psychiatric disease? Although the Stiff Man Syndrome has been traditionally viewed as a neurologic disorder, a number of recent articles have documented a pattern of familial, interpersonal, and intrapsychic stress which suggests that this disease may be, to a considerable degree, psychosomatic in origin. The present paper reviews several recent articles and focuses on a single case study. Although the medical diagnosis was earlier confirmed, an in-depth psychiatric evaluation and extensive psychological assessment showed many psychopathological concomitants associated with the severe muscle spasm and stiffness. A follow-up after about a year of group and individual psychotherapy showed that the symptoms were still in remission, and that the patient was functioning personally and occupationally on a significantly improved level.