Study of female babies of women entering confinement with vaginal trichomoniasis. A series of 868 women in the last 4 weeks of pregnancy were examined for the presence of T. vaginalis by direct microscopy of freshly prepared wet films and by three culture methods; 32 (3-7 per cent.) were found to give positive results. Fourteen of the mothers with trichomoniasis at confinement had female babies, and these, together with a matching fourteen controls, were examined on three occasions by identical methods and within 21 days of birth. No baby gave positive results. On statistical examination it is very unlikely that with a much larger sample the number of positive findings could have been greater than 23 per cent. This is at variance with recent Polish work. These results suggest that neonatal infection in female babies, although a recognized clinical entity, is rare and unlikely to make any substantial contribution to the high incidence of trichomoniasis in women.


Rapidly transported proteins in sensory, motor and sympathetic nerves of the isolated frog nervous system. The synthesis and rapid axonal transport of [35S]methionine-labelled proteins has been studied using the isolated frog spinal cord and peripheral nervous system. Polyaerylamide gel electrophoresis in sodium dodecylsulfate of synthesized and transported proteins revealed similar labelling patterns of proteins transported in the sensory, motor and sympathetic systems. The relative labelling pattern of transported proteins which accumulated at ligatures in peripheral nerves was different from those obtained from ganglia or nerves and roots when they were incubated in labelled methionine. When compared with methionine-labelled protein profiles of rapid axonal transport in other species and systems, a common set of rapidly transported proteins emerges. The approximate molecular weights of these common proteins include (in 1000 daltons): 18,24-29, 34-36, 57, 65-68, 100 and 130. These proteins may represent fundamental macromolecules involved in the general maintenance of the function of nerve processes.


Myocardial infarction after aortocoronary bypass: etiologic factors. To ascertain the frequency and probable determinants of myocardial infarction after aortocoronary bypass, two groups of patients were studied: a group of 20 patients who underwent valve replacement of repair of congenital anomalies and a group of 24 patients who underwent aortocoronary bypass. Postoperative myocardial infarction was diagnosed by an increase in serum creatine phosphokinase concentration to a minimum of 1200 IU in two consecutive samples. The frequency of myocardial infarction differed between the groups, being only 5% in group 1 but 20.4% in group 2. In the patients undergoing coronary artery surgery, the duration of bypass, the aortic cross-clamp time and the vent site did not influence the rate of infarction. However, the incidence of myocardial necrosis did correlate with the number of vessels bypassed. In no case was the clinical course influenced by the infarction. Our results suggest that the frequency of perioperative infarction is higher in coronary artery surgery than in other adult cardiac surgery, and that the most important determining factor is the number of diseased vessels.


Prognostic significance of endocardial viability ratio in aortocoronary bypass surgery. Although aortocoronary bypass (ACB) for patients with stable angina carries a low mortality, some unexpected deaths do occur. Since in patients with normal coronary arteries the endocardial viability ratio (EVR) can be correlated with subendocardial perfusion, with a ratio of 0.7 or less indicating ischemia of the left ventricular subendocardium, and since the EVR postoperatively is useful in determining the need for intra-aortic balloon pump assist (IABPA), it was decided to ascertain whether the EVR might have prognostic value in patients with stable angina scheduled for standard ACB. Three groups of patients were studied: 50 with stable angina, 24 who had died after ACB, and 18 who required IABPA for cardiogenic shock after surgery for stable angina. No significant differences were found for cardiac index, left ventricular end-diastolic pressure, left ventricular ejection fraction and pre- and postoperative artery scores, but there were significant differences in the EVR between the first and second groups and between the first and third groups (P less than 0.01 in each instance). These findings suggest that the left ventricular EVR may indeed be of prognostic value in patients scheduled to undergo ACB and that use of IABPA, which produces an increase in EVR, may be useful in patients with EVRs of less than 0.7, even if other parameters of cardiac function are normal.


Triple-vessel coronary artery disease: Effect of revascularization on late survival. Of the first 600 patients to receive aortocoronary bypass grafts 383 had three diseased vessels, and of them 36 (9%) have died: 20 (5%) in hospital and 16 (4%) late. In 10 of those who died, ventricular function was normal, class I or class II and in the other 26 function was class III or class IV. For all ventricular classes except class IV, improvement in myocardial blood flow with operation was considerably lower than average in those who died. The leading cause of late death was congestive heart failure followed by myocardial infarction, and then by other cardiac complications. Of patients with good (normal, classes I or II) ventricular function, 3.5% died during a mean follow-up period of 27 months; and since, according to published reports, 1% of patients with triple-vessel disease without surgical intervention die each month, the data from this study suggest that survival in this group is improved by 23.5%. This study also shows that  in patients with triple-vessel disease and good ventricular function, adequate coronary artery bypass operations (i.e., placement of three grafts or more) improves survival.


Life tables as "predictors" of average longevity. Selected figures from Canadian life tables have been analysed to illustrate one potential use of routinely collected and published data. A plea is made for the inclusion of the fundamentals of demography in undergraduate medical education.


The effect of radiation therapy on lymphocyte subpopulations in cancer patients. The proportion of T and B lymphocytes in the peripheral blood was determined in patients with either mammary cancer or with various pelvic malignancies. In cancer patients studied prior to irradiation the level of cells forming either E-rosettes or EAC'-rosettes was similar to that found among healthy controls. Radiation therapy resulted in a striking lymphopenia. The level of cells with T-cell markers was diminished to a greater extent than the level of cells with B-cell markers. The relative proportion of T-cells forming high affinity E-rosettes was not reduced following radiation, so that it can be concluded that radiation affects predominantly the subpopulation of T-cells which do not form high affinity E-rosettes. Irradiation of the pelvic area resulted in a more rapid reduction of the level of T lymphocytes than irradiation of the mediastinum, although the final relative proportions of the cells were similar in both groups of patients. The results of the present study suggest that the reduction of the level of T lymphocytes following irradiation results from its effect on the lymphocytes in the major blood vessels, and that radiation of the thymus is not a prerequisite for this phenomenon.


Failure of leucovorin rescue to prevent reactivation of a solar burn after high dose methotrexate. A 21-year-old patient with metastatic osteosarcoma was receiving methotrexate with leucovorin rescue every 2 weeks. After the second (of four) infusions of methotrexate, a prior solar burn on an area of skin was reactivated in spite of leucovorin rescue. An area of skin treated 5 months previously by radiation was spared the effects of the reactivation phenomenon. No other toxicities appeared. The reactivation of the solar burn is an example of "false photosensitization" and this cutaneous toxicity is not ameliorated by leucovorin. Methotrexate therapy should be delayed until the effects of generalized solar burns have resolved (approximately 1 week).


Tumor cell characterization in mycosis fungoides. Five patients with tumor stage mycosis fungoides had tumor lesions excised and examined by light and electron microscopy. The tumor cells were also isolated and the percentages of E rosettes (T cells) and EAC rosettes (B cells) were determined and the rosettes examined by electron microscopy. The predominant cell type isolated from four of the five tumors was a T cell. Peripheral lymphocyte function measured by LTT to phytohemagglutinin and pokeweed mitogen was normal. Serum immunoglobulins gave variable results. The results support the concept that mycosis fungoides is primarily a T cell tumor involving the skin and morphologically similar to the Sézary cell.


T and B lymphocytes in non-Hodgkin's lymphoma: a comparison of tumor-derived cells and peripheral blood lymphocytes. T- and B-cell markers of lymphocytes in peripheral blood, involved node and spleen, PHA response of peripheral blood lymphocytes, serum immunoglobulin levels, and skin test reactivity to six common antigens were studied in 16 cases of untreated non-Hodgkin's lymphoma. Impaired response of peripheral lymphocytes to PHA was observed in 13 of 16 cases, regardless of the proportion of T lymphocytes. Of 12 cases in which skin tests were done, two were positive and had a normal PHA response, seven cases were positive in spite of low PHA response, and three were negative with low PHA response. In the lymph nodes from involved areas two cases showed monoclonal increase of B-cells, five showed "null" cell increase, and the remaining nine showed no increase or decrease of subpopulation of lymphocytes. No correlation with surface marker of lymphocytes to histologic classification was seen. From the above observations it was concluded: 1) a low PHA response in non-Hodgkin's lymphoma was not due to the decreased population of T-cells; 2) a low PHA response may not necessarily indicate impaired delayed hypersensitivity; and 3) non-Hodgkin's lymphoma can be classified in the following ways--B-cell proliferative type, "null" cell increase type, and normal T/B proportion type.


The accumulated effects of repeated systemic or local injections of low doses of Corynebacterium parvum in mice. The effects of 14 weekly injections, s.c. or i.v., of "human equivalent" doses (5.25 mg/sq m) of Corynebacterium parvum (CP) in mice have been compared. Both s.c. and i.v. CP caused significant splenomegaly and antibody to CP, but stimulation was considerably greater after i.v. CP. Delayed hypersensitivity levels to CP were similar after s.c. and i.v. injection. T-cell competence, as judged by phytohemagglutinin reactivity and delayed hypersensitivity to sheep cells, was unimpaired after s.c. CP and augmented by i.v. CP. Activated peritoneal macrophages capable of nonspecifically inhibiting tumor growth in vitro were detected only after i.v. CP, and in vivo resistance to tumor cell challenge was greater after CP administered i.v. than s.c.


Secondary in vitro lymphocyte-proliferative responses to syngeneic plasma cell tumors. Two characteristics of immune responses to weakly immunogenic plasma cell tumors were demonstrated in this study. (a) Elevated lymphoproliferative responses following in vivo inoculation of sublethal doses of plasma cell tumors were detected by a mixed lymphocyte-tumor interaction (MLTI) assay. Specificity of elevated MLTI responses correlated with resistance to in vivo tumor challenge. These responses were dependent upon the presence of thymus-derived cells. (b) Spleen and lymph node cells showed markedly different patterns of MLTI activity following plasma cell tumor immunization. Spleen cell responses were depressed for the first 30 days postimmunization, whereas lymph node cells showed augmented MLTI reactivity immediately after immunization. These observations indicated that lymphocyte populations from different lymphoid organs may show widely dissimilar responses in vitro at the same point in the in vivo development of tumor resistance.


Ultrastructural studies on neurophysine-containing vesicles of the neurosecretory system of vertebrates. A new method described in the present paper allows identification of neurophysine-containing (NP) vesicles of the magnocellular neurosecretory system of vertebrates. After oxidation of ultrathin sections, the content of NP vesicles can be dissolved specifically in an alkaline medium. This procedure marks NP vesicles selectively in all portions of the classical neurosecretory system.


Synthesis and intracellular transport of proteins in the exocrine pancreas of the frog (Rana esculenta). II. An in vitro study of the transport process and the influence of temperature. Frog pancreatic tissue was pulse-labelled in vitro with 3H-leucine and protein transport was studied in exocrine cells by electron microscope autoradiography. The proteins appeared to be synthesized in the RER and transported to the secretory granules along a similar route and with the same velocity as previously described under in vitro conditions. Evidence was obtained for the involvement of the vesicular and tubular elements at the periphery of the Golgi system in transferring protein from the RER to the Golgi cisternae. Kinetics of the release of newly synthesized proteins from the RER and their appearance in the condensing vacuoles are discussed and related to results reported from other tissues. The transport velocity in this poikilothermic system was studied in relation to the incubation temperature and compared with results reported from its mammalian counterpart. At temperatures between 20 and 30 degrees C intracellular protein transport occurs faster in the frog than in the Guinea pig pancreas. At higher temperature the transport process was severely disturbed in the frog.


A clinically useful coding system for normal coronary artery anatomy. Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50-70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: right coronary artery 100. 100. 0. LAD 100. 100. 100. intermediate artery 8.7 12.5 33.3 obtuse marginal artery 53.7 43.7 44.4 atrioventricular groove artery 0. 56.2 100. diagonal branch of the LAD 15. 6.3 11.1. This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.


An additional angiographic sign for determining coronary artery dominance in obstructive coronary artery disease. An additional angiographic sign for determining coronary artery dominance is proposed. This sign is based on the anatomic pattern of the infraventricular branches in the left anterior oblique view. It is especially helpful in patients in whom the right coronary and/or left circumflex coronary arteries are completely occluded and distal vessels are filled via collaterals.


Preoperative coronary angiographic prediction of bypass flow and short-term patency. A quantitative preoperative coronary angiographic index was defined in 148 patients undergoing coronary revascularization. Each diseased vessel was scored 0-3, for both diameter and quality of run-off. The sum of the scores for diameter and run-off constituted the numerical index for the diseased vessel. Correlations between the index and graft flow measured by electromagnetic flow meter at surgery were established in 259 bypassed vessels. The highest scores (5-6) were associated with higher flows, and the lower scores (0-4) with the lower flows (P less than 0.005). Repeat angiography performed 2 wk postoperatively in 110 patients demonstrated 174 graft patencies and 15 graft closures. Mean flow in open grafts was 82 +/- 41 ml/mn vs. 60 +/- 23ml/mn in closed grafts (P less than 0.005). It is concluded that graft flow is predictable from preoperative Coronary Angiographic Index and that higher flow and index scores are more likely to be associated with graft patency than low flows and index scores.


105 mm photofluorography: an adjunct to the study of coronary arterial and vascular disease. Obtaining high resolution static films through an image intensifier has been made possible by recent developments in radiographic equipment. Serial photofluorography 105 mm spot filming has been used successfully to complement cine coronary arteriography in approximately 700 patients. Many patients with coronary heart disease have diffuse peripheral atheromatous changes which are also suitable to study by serial 105 mm photofluorography. Aortic arch, abdominal aortography, and peripheral studies are easily and quickly performed in conjunction with coronary arteriography. Satisfactory results still depend upon skillful application by the angiographer of this imaging mode and proper processing of the film. Advantages of photofluorographic filming over conventional large film techniques include lower radiation exposure, reduction of costs, and easier film handling and storage. Most important is the facilitation of the performance of angiographic studies since constant television monitoring of the catheter and the contrast injections is possible. Disadvantages include restricted area of coverage and slight decrease in resolution. Our experience indicates that photofluorography may be relied upon in the study of vascular disease eliminating the need for large film changers in a laboratory used primarily for cardiac diagnosis.


Characteristics of pregnant women who report previous induced abortions. Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women.Women who reported abortions were less likely to be strict as regards religious observance and less likely to have had a previous stillbirth or child death, other variables being equal. They were more likely to be smokers or former smokers and to be delivered of their babies in certain obstetric units. They more often reported vomiting, bleeding, and medication in early pregnancy. On the other hand, there was no significant association with diabetes, anaemia, blood groups, or season of birth.The findings show that women reporting previous induced abortions differ significantly from other pregnant women in a wide range of demographic and health characteristics. Such women may also be biased for complications of pregnancy and outcome, particularly if selected from a clinic population. Observations that indicate a deleterious effect of induced abortions on subsequent pregnancy outcomes must therefore be interpreted with considerable caution.


The relationship of race, sex, and age to concentrations of serum immunoglobulins expressed in international units in healthy adults in the USA. Only a few investigations have been made to obtain human serum immunoglobulin values in units compatible with those used by the WHO International Reference Preparation for the Human Immunoglobulins IgG, IgA, and IgM. We report our summary statistics of serum IgG, IgA, and IgM, in international units (IU), for some 800 healthy American adults grouped by age, sex, and race. Our findings are in general agreement with some, but not with all, published data. We found that the mean IgG concentration is markedly higher and the mean IgA concentration is slightly higher in blacks than in whites. Except for white females, there was a significant increase in mean IgA with age for both races. In the younger adults of both races, mean IgM values were markedly higher in females than in males. Statistically significant interactions between race, age, and sex factors were seen for all three immunoglobulin classes. Although we have attempted to estimate the normal population means and variances for the serum concentration of IgG, IgA, and IgM the process we used to select specimens may have resulted in some bias; much larger, truly randomized, and fully documented studies in different geographic areas and in different socioeconomic and racial groups are needed to provide accurate acceptable limits for human immunoglobulins.


Specificity of the 48-hour reaction to Mitsuda antigen. Use of a soluble antigen from human and armadillo lepromin. Two antigens were tested and compared in relation to the 48-h Fernandez reaction. They were obtained from standard human and from standard armadillo lepromin. All the tests were negative in patients with lepromatous leprosy and highly positive in those with tuberculoid leprosy and in lepromin-positive contacts. There was total agreement in all tests done with the two types of antigen. The antigenic component has the following basic properties: it precipitates with 80% saturated ammonium sulfate; it is not destroyed by autoclaving or by treatment with 0.4% phenol; it is non-dialysable; and it is destroyed by treatment with trypsin.


Tests with three antigens in leprosy-endemic and non-endemic areas. A study comparing the 48-h and 30-day reactions produced by three antigens was made in areas of low and high leprosy endemicity in Venezuela and in areas of Chile, a non-endemic country. The antigens used for the intradermal tests were standard Mitsuda antigen, supernatant from standard Mitsuda antigen, and PPD. The results indicate that there is no difference in the Mitsuda reaction of persons living in areas of high or low endemicity, but they show a statistically significant difference between the reactions in persons who live in endemic areas and those of persons living in a country where the disease has not been described. The difference in the Fernandez reaction obtained with the supernatant was not statistically significant between the two population groups in the endemic country, but was highly significant when comparing the endemic and the non-endemic countries.


Immunopathology of nephropathies associated with malaria. Immune complexes play an important role in the pathogenesis of malaria-associated nephropathies. Two main types of lesion are demonstrable: (a) acute (transient-reversible) lesions typical of falciparum infections in man, with mild clinical symptoms developing a week or two after infection. Renal biopsies at that time show deposits of immunoglobulins, complement, and sometimes antigen. The lesions respond to antimalarials. (b) Chronic (progressive) lesions characteristic of quartan infections in man, developing slowly into a chronic stage with persistent proteinuria and gradually deteriorating renal function and hypertension. Renal biopsies at the onset of the disease show deposits of immunoglobulins, complement, and P. malariae antigens in glomerular capillary walls. Antimalarial therapy has no effect. Recent immunochemical findings confirm that these lesions are of the immune-complex type and are associated with malaria infection. However, several questions remain to be solved.


Determination of influenzavirus neuraminidase inhibition titres. Representatives of the WHO influenza programme recently proposed a standard method of determining neuraminidase activity and neuraminidase inhibition (NI) antibody titres. Logit transformation of the data obtained with the WHO method for the NI assay permits a more efficient performance of the test and easy calculation of titres with a computer programme.


The penetration of three simuliid species by the nematode Reesimermis nielseni. After 4 h of exposure to the preparasitic stage of R. nielseni first, second, and third instar Simulium venustum, S. decorum and S. vittatum were found to be harbouring the nematodes in the haemocoel and/or the gut. The possible use of R. nielseni in the biological control of simuliid species is discussed.


Prophylactic digitalization for coronary artery bypass surgery. One hundred and twenty patients undergoing aortocoronary bypass procedures were randomly placed into control and digitalized groups. All were initially in normal sinus rhythm and without evidence of congestive heart failure. Supraventricular arrhythmias occurred in 17 of 66 controls and in only three of 54 digitalized patients (P less than 0.01). There was no evidence of digitals toxicity. Based on this evidence we recommend prophylactic digitalization for patients having aortocoronary bypass operations.


Atherosclerotic narrowing of the left main coronary artery. A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing. Histologic sections of the left main (LM) and the other three major coronary arteries were studied in 152 patients. The lumen of the LM in 35 patients was greater than 75% narrowed; in thirty, 50-75%; and in 87, less than 50% narrowed. The patients with greater than 75% narrowing were younger. Angina pectoris and hyperlipoproteinemia, specifically type II, were more common (P less than 0.02) and acute transmural and healed subendocardial myocardial infarcts were less frequent (P less than 0.05) in the patients with greater 75% LM narrowing than in those with less than 50% narrowing. Of the three other major coronary arteries, the average number narrowed in the patients with greater than 75% LM narrowing was 2.9; in those with 50-75% LM narrowing 2.7, and in those with less than 50% LM narrowing, 2.4. Of the 35 patients with greater than 75% LM narrowing, 33 had greater than 75% luminal narrowing of each of the other three major coronary arteries. Narrowing of the LM, therefore, indicates severe narrowing of usually all major coronary arteries.


Profile analysis of blood proteins with a centrifugal analyzer. We describe a procedure for routine analysis of a profile composed of eight blood proteins with a GEMSAEC centrifugal analyzer. The end-point technique is used and four standards are included in each run in the immunochemical analysis of the individual proteins. Additional computer programs fit the absorbance readings from the samples to the (nonlinear) standard curve and store the results in a patient's file for a final printout, which also presents the patient's data and reference values. The proteins are analyzed in a given order, which allows common blank runs to be used. Antisera are used in suitably high concentrations, so that the "antigen in excess" problem only appears for analysis of IgA and IgM when sera contain high amounts of the M-components of these two classes. The capacity, accuracy, and precision of the method are satisfactory.


Vision screening in a national sample of 11-year-old children. This report describes the results of vision screening carried out by local health authorities on a national sample of 11-year-old schoolchildren using a standard Snellen chart. Of the 12 772 children tested, 78% had an unaided distant visual acuity of 6/6 or better in both eyes (optimal vision), 10% had a distant visual acuity of 6/9 in the worse or both eyes (near-optimal vision) and 12% had a visual acuity of 6/12 or worse in one or both eyes eyes (definite visual defect). In addition, near visual acuity was tested for 12 737 children and 5% were found to have defective near vision. Glasses had been prescribed for current use in 12% of children but a quarter of those prescribed glasses did not have them available at the time of the test. Testing revealed that 22% of children whose glasses were available had optimal or near-optimal unaided distant vision, the number increasing to 98% when retested wearing glasses. In contrast, 43% of the children who were without their glasses had optimal or near-optimal vision; 27% had a bilateral defect. Amongst the children for whom glasses had not been prescribed 4-6% had a visual defect. A higher proportion of children from non-manual family background than from manual family background had visual impairment and had been prescribed glasses, but there was no significant social class difference amongst the children with visual defects for whom no glasses had been prescribed. A defect of red/green colour vision was recorded in 6% of boys and 1% of girls. The proportion of children with poor visual acuity was similar in the group of children with defective colour vision and the group with normal colour vision.


Characterization of mononuclear effector cells in human blood. The effector cells responsible for cytotoxic activity induced by phytohaemagglutinin, (PHA) pokeweed mitogen (PWM) target cells complexes with IgG antibody has been investigated using cell separation techniques based on rosette formation and separation through Hypaque-Ficoll mixtures. It was shown the PHA-induced cytotoxicity is predominantly a function of T cells and that Fc receptor-bearing cells are not involved to any major extent. Antibody-dependent killing is conversely a function of Fc receptor-bearing cells among which two subtypes can be distinguished. One of these has receptors for activated complement while the other bears Fc receptors only and has no detectable receptors for complement. PWM appears to induce cytotoxicity in both T- and non-T-cell populations but the major cell type involved appears to be Fc receptor-bearing cells similar to those mediating antibody-dependent killing. It is concluded that PHA and antibody-dependent killing are the two most useful assays for discriminating between the cytotoxic activity of T and non-T cell in clinical studies.


Lymphocyte populations in peripheral blood in hyperthyroid and euthyroid subjects. Thymus-derived and non-thymus-derived peripheral blood lymphocytes were examined by means of E- and EAC-rosette tests. The frequency of these lymphocyte populations was the same in hyperthyroid and euthyroid individuals. It was also demonstrated that PHA responsiveness of lymphocytes from hyperthyroid patients was equal to that of lymphocytes from euthyroid controls and did not change after treatment with 131I.


B and T lymphocytes in Hodgkin's disease. Analysis at diagnosis and following therapy. B and T lymphocytes were studied in the blood and lymph nodes of fifty patients with Hodgkin's disease. At diagnosis, most patients (77%) had normal percentages of circulating B and T lymphocytes. Most patients (60%) also showed normal percentages of B and T lymphocytes in involved lymph nodes. Splenectomy had no effect on circulating B and T lymphocytes in four of five patients studied 2 weeks postoperatively. Seventeen patients were studied before and after treatment to determine the effect of therapy. Very high percentages of B lymphocytes were found in patients studied following radiotherapy. It appears that the known defects in cell-mediated immunity in Hodgkin's disease are not expressed as significant abnormalities in B-or T-lymphocyte ratios in blood or lymphoid tissues at diagnosis. The proliferation of B lymphocytes following radiotherapy could represent a compensatory mechanism to cell-mediated deficiency or a loss of normal suppressor activity of T lymphocytes.


Morphological, immunological and immunocytochemical identification of lymphocytes extracted from cutaneous infiltrates. The identification of mononuclear cells extracted from various skin disorders has been investigated and the relative amount of B and T cells determined according to various assays such as E-rosette test, FITC and peroxidase anti-immunoglobulin conjugates. It has been found that: (a) there were two different patterns of distribution of the cells in the infiltrates; one with a T/B ratio above 3 (closest to a delayed type reaction), the other with a T/B ratio below 2. (b) The morphological appearance of tissue lymphocytes differs from that of circulating lymphocytes by the presence of both membrane and cytoplasmic immunoglobulins.


Report of five children with Hemophilus influenzae pneumonia. Resistance to ampicillin must always be looked for. Five cases of Hemophilus influenzae pneumonia were observed in a 13-month period at Fairfax Hospital, Fairfax, Va. More aggressive diagnostic procedures may be required in order to diagnose this disease with greater frequency. This has become especially important in view of the growing recovery of ampicillin-resistant H. influenzae strains.


Marijuana and T lymphocyte rosettes.

Marijuana and T lymphocyte rosettes. The effect of marijuana smoking on sheep cell rosetting properties of both early (active) and total T lymphocytes was studied in vitro. Significantly fewer active rosettes were formed by T cells from a population of 35 who appeared to be chronic marijuana smokers than the 34 controls. The late, or cold-enhanced rosettes formed by smokers and nonsmokers were similar, suggesting that similar numbers of rosette-forming T cells were present in the peripheral blood of smokers. These data suggest that marijuana smoking may affect the function of a subpopulation of T lymphocytes, identified by their capacity to form early rosettes, possibly by affecting these cell membranes.


Percutaneous electrical stimulation for clinical tibial fracture repair. Observations on stress generated electrical currents in bone have stimulated interest in the possible osteogenetic effect of externally applied electrical energy to establish diaphyseal bone defects in animals and man. This report records the observed effects of pulsed electrical energy directed through a metal (Riordan pin) electrode placed in a large proximal tibial shaft dedect in a young man who sustained loss of bone from a gunshot wound. The fixation pin placed directly into the defect provided the cathode (-) electrode. The anode (+) electrode consisted of an aluminum foil band placed on the skin adjacent to the leg. The tibia had 282 consecutive days of electrical stimulation and provided X-ray and clinical evidence of enhanced osteogenetic activity. The degree of osteogenetic response attributable to the electrical stimulation is undetermined because other factors, including cast immobilization, time and minimal touchdown (25 pounds) weight-bearing in the cast during the period of observation, may also have had some influence on the healing response. Circumstantial clinical evidence indicates that the applied electrical energy was of primary importance in the healing process. This theoretically and technically acceptable source of osteogenetic activity merits continued, intensive investigation.


Alteration in the force and fatigability of skeletal muscle in quadriplegic humans following exercise induced by chronic electrical stimulation. The paralyzed forearm finger flexor muscles of 10 quadriplegic subjects were exercised via electrical stimulation to determine changes in the contractile force and fatigability of the muscle that could be externally induced. The force of contraction initially produced by most muscles was less than that required for functional activity. Following exercise, the strength of all muscles was increased above the level for functional use. In general, no correlation was noted between the amount of exercise and the force change. Two subjects had high contraction forces after prolonged periods before stimulation began, and 4 subjects who were followed after the stimulation program maintained near the contractile force achieved at the end of the program in the absence of stimulation. Fatigue of the muscle during the course of the exercise program was increased to above that recorded initially, although this was more variable and sometimes dropped to less than that recorded initially. Generally, no correlation was demonstrated between usage and fatigue. It is concluded that exercise induced by electrical stimulation alters the cantractile properties of the muscle toward a state usable for functional, tonic activation.


Massive gastrointestinal hemorrhage.

Massive gastrointestinal hemorrhage. Dissatisfaction with the high morbidity and mortality of traditional methods of handling massive gastrointestinal hemorrhage has led to the exploration of means other than surgical to attain hemostasis. Some, such as selective arterial infusion of surgical Pituitrin, have quickly won general acceptance in hospitals where facilities and interested personnel are available. Others, such as alkalinization, have become popular because of their inherent simplicity. Systemic hypothermia, requiring intensive patient care, has not been without considerable risk of significant complications. Iced saline lavage has never been subjected to critical evaluation. It is possible that the emptying of the stomach through mechanical destruction of the intragastric clot by repeated irrigations, reducing the antral stimulation by relief of distension, may be as important as the temperature of the solution in the stomach. Gastric irrigations with norepinephrine solutions have awaited the results of physiologic studies showing that the cardiovascular and renal effects of injected levarterenol are avoided, and that permanent damage to the gastrointestinal mucosa does not result. Trials have been confined largely to very poor-risk patients, and the hemostasis that has resulted has not been explainable, in all cases, on the basis of the physiologic activity of the agent (e.g., control of bleeding from tumor vessels). Evacuation of gastric content prior to introduction of the norepinephrine solution seems important. Lower gastrointestinal bleeding from benign disease has also responded to advances in applied pharmacology, with intra-arterial infusion of surgical Pituitrin again coming into progressively wider use. Intraperitoneal instillation of norepinephrine has also proved useful, even in patients who have adhesions from prior surgery or inflammatory disease, but closer monitoring of blood pressure and urine output are necessary because some of this solution is absorbed by the parietal peritoneum and not deactivated by the liver before entering the systemic circulation. Taken together, selective arterial infusion of vasopressin and topical application of norepinephrine can be considered complementary rather than competitive therapies. Because of the more extensive experience with selective angiographic infusion, it should be the first choice in institutions where it is readily available. For patients in whom arterial puncture is inadvisable, and where angiography is not readily available, topically applied norepinephrine becomes the treatment of preference. We have demonstrated effectiveness of intraperitoneal norepinephrine in a patient in whom selective arterial infusion of surgical Pituitrin had failed. And the reverse would probably also hold true on occasion. Pharmacologic techniques represent a therapeutic advance, reducing the frequency with which surgical intervention becomes mandatory. But they are not a substitute for surgery...


Gastro-intestinal bleeding in patients with rheumatoid arthritis: the effects of azapropazone treatment. A comparative study was carried out, using the Cr51 red blood cell labelling method, to assess the amount of gastro-intestinal blood loss in 20 rheumatoid arthritis patients taking either 600 mg. or 1200 mg. azapropazone daily. The results demonstrate that azapropazone does not produce greater than normal gastro-intestinal bleeding, that the volume of faecal blood loss is not dose-related, and there would not appear to be any correlation between blood loss and the occasional mild gastro-intestinal side-effects reported in a few patients. These results compared favourably with those obtained previously by the investigators in a similar group of patients taking 3 g. aspirin per day.


[Cytotoxic effect of antihuman thymocyte serum on T lymphocytes]. The rabbit human thymocyte serum had a selective cytotoxicity on human T lymphocytes.  In the presence of guinea pig complement, 23.8% of the otal blood leukocytes were killed by the heterologus antiserum and only 4.2 % were killed by normal rabbit serum.  On average 28.2% of the leukocyte preparation obtained by dextran sedmentation were lymphocytes.  According to the above figures, 72.3% of the circulating lymphocytes were identified as T cells.  The data were comparable to those obtained from other conventional methods used in laboratory animals.  The cytotoxicity test was found to be a reliable technique for identifying human T lymphocytes.


[Haemobilia as a special form of gastro-intestinal bleeding (author's transl)]. Nine patients with haemobilia were treated during a 17-year period (1958-1974), seven of them with postoperative haemobilia after operations on the biliary tract, and one with traumatic haemobilia. Three patients with intrahepatic injury after transhepatic drainage for inflammatory biliary-tract stricture or after extraction of intrahepatic biliary-tract stones with a Fogarty catheter were free of symptoms on conservative treatment alone. Of six operated patients one died from extensive hepatic necrosis after ligation of the main and right hepatic arteries, another two months after operation of septicaemia. The other patients have remained free of symptoms.


[Study of the effect of the enzyme hyaluronidase on the pathomorphological changes in certain internal organs in white mice infected intraperitoneally with Tr. vaginalis]. The authors injected daily a dose of 5 l hyaluronidase diluted in 0,5 ml of saline, in 25 out of 50 white mice, contaminated with tr. vaginalis intraperitonealy. The remaining 25 mice formed the control group and were injected only with saline. The administration was made intraperitonealy. An equal number of mice from both groups were killed on the 30th and 40th day of contamination and the macroscopic changes in the abdominal cavity were examined. Histological examinations of liver, spleen and kidneys were made as well. The obtained pathologic changes were characteristic of manifestations of chronice en pusforming inflammatory process, involving mostly liver. Substantially differences in character and gravity of the pathologic changes between mice treated with hyaluronidase and those of the control group were not found.


Effects of cytochalasin B on the electrical activity of frog muscle fibers. Cytochalasin B (50 mug/ml) markedly prolonged the falling phase of the action potential in frog sartorius muscle fibers without any effect on the rising phase and the amplitude of the action potential, nor on the resting potential. The maximum rate of fall of the action potential was reduced from 173 to 133 V/sec. The early depolarizing after-potential was increased in amplitude and lasted for as long as 1 sec. These changes in the falling phase of the action potential appear to be due to a slowing of sodium inactivation. Potassium conductance increase was not appreciably affected. The muscle treated with cytochalasin B responded to nerve stimulation with repetitive discharges which originated in presynaptic nerve elements.


[Unstable angina: observtions on 187 patients of whom 84 were operated on for aorto-coronary bypass (author's transl)]. Clinical data, EKG and coronary angiography of 187 patients with unstable angina are given. The patients are divided into 4 groups: spontancous angina, spontaneous angina Prinzmetal's variant, "in crescendo" agina, intermediate syndrome. 103 patients were treated with pharmacological therapy only and 84 underwent aortocoronary bypass; 2 of them were operated on for acute myocardial infarction. The clinical and pathologic peculiarities of two groups are not similar and therefore the results are not comparable. There was a mortality rate of 10.3% of patients with pharmacological treatment and the incidence of non fatal myocardial infarction was 10.4%. The mortality during operation was 14.2% and the incidence of non fatal myocardial infarction was 13.1%. The spontaneous angina and Prinzmetal's variant often had normal rest EKG and a very similar coronary angiographic pattern, with obstructive lesions often localized in the proximal part of a single vessel. In 9% of cases coronary arteries were normal. The incidence of serious arrhythmias was higher in Prinzmetal's variant than in other types of unstable angina. The mortality in patients with Prinzmetal's angina was particularly high during the first period of experience (1970-1973) when the operation was performed after a few days of unsatisfactory results with pharmacological treatment; it decreased after patients underwent operation in an attenuate phase of the disease. The rest EKG of "in crescendo" angina was almost always pathologic; these cases presented obstructive lesions of 2 or 3 coronary arteries, functional impairment of left ventricle, collateral circulation. The mortality in patients treated with pharmacological therapy was higher than in other types of unstable angina. The mortality during operation, fairly high in the first period of experience, decreased in this group of patients as well, during the second period of experience.


Symptomatic hepatic disease in cystic fibrosis: incidence, course, and outcome of portal systemic hunting. Fifteen (2.2%) of 693 patients with cystic fibrosis seen over an 18-year period developed clinical hepatic disease. In 13 patients all symptoms were secondary to portal hypertension. Ten had hypersplenism and 6 had variceal bleeding, including 3 who developed both conditions. All 5 patients who survived the initial episode of gastrointestinal bleeding underwent portal systemic shunting. A shunting procedure also was performed on 1 patients with hypersplenism but no variceal bleeding. No subsequent deterioration of intellectual function occurred in either the shunted or unshunted patients. Only 1 of the shunted patients showed progression of hepatic disease after surgery. These results suggest that portal systemic shunting is useful in the treatment of bleeding esophageal varices in cystic fibrosis. A sweat test to rule out cystic fibrosis should be included in the evaluation of any teenage or young adult patient with unexplained portal hypertension.


Relationship of splanchnic blood flow and portal venous resistance to elevated portal pressure in the dog. To determine the relationship of splanchnic blood flow and portal venous resistance to elevated portal pressure, in situ perfusion of the splanchnic circuit was carried out in 12 freshly killed dogs at varying perfusion rates and degrees of acute and chronic portal vein constriction. In six normal dogs before being killed, portal pressure averaged 8-8 +/- 1-2 mmHg and portal flow 658 +/- 81 ml/min. In the absence of portal vein constriction, increasing splanchnic perfusion to 1800 ml/min, minimally raised portal pressure (12-8 +/- 1-5 mmHg). With progressive acute constriction of the portal vein, however, comparable perfusion rates lead to progressively higher portal pressure levels and with greater than 90% constriction, portal pressure was greater than 30 mmHg with minimal elevation in splanchnic flow rate. In six other dogs before being killed but live to nine weeks after placement of an ameroid constrictor on the portal vein, portal pressure averaged 13-6 +/- 1-4 mmHg or slightly higher than in normal dogs (P greater than 0-02). Mesenteric venography and necropsy findings uniformly demonstrated 90% occlusion of the portal vein with extensive portasystemic collateralization. With increased perfusion of the splanchnic bed, portal pressure rose rapidly to approximately 35 mmHg with a flow rate of 1 800 ml/min.. These data suggest that, in disorders where resistance to transhepatic portal flow is marked, a small increment in splanchnic blood flow, which normally exerts little or no influence on portal pressure, promotes profound portal hypertension and may account for spontaneous 'rupture' of oesophageal varices. On the other hand, where resistance to transhepatic portal flow is mild but splanchnic blood flow is markedly hyperdynamic, reducing inflow may be sufficient to ameliorate extreme portal hypertension and its sequelae.


Hypersensitivity reactions in the small intestine. 2. Effects of allograft rejection on mucosal architecture and lymphoid cell infiltrate. Small intestinal mucosa contains both thymus dependent and thymus independent lymphoid cells and thus has the capacity to act via humoral and cellular mechanisms as a site of local immunity and local hypersensitivity. Allograft rejection of mouse small intestine is a model of a local cell mediated reaction. The effects of this clearly defined, immunologically mediated damage villi, crypts, enterocytes, and lymphoid cell infiltrate have been assessed by comparing the morphology of rejecting allografts with that of isografts and normal small intestine of the same age. In rejection there is infiltration of the lamina propria with lymphocytes, hyperplasia of the crypts of Lieberkuhn, and an eventual sloughing off of the mucosa. Usually, but not always, there is villous atrophy and increased numbers of intraepithelial lymphocytes. However, the morphology of individual enterocytes remains normal throughout rejection and neither plasma cells nor polymorphonuclear leucocytes infiltrate the lamina propria before mucosal ulceration. These results show unequivocally that a local T cell mediated immune response causes villous atrophy and crypt hyperplasia in this animal model, and since there is no evidence of local enterocyte cytotoxicity, a lymphokine may be the link between the activated T cell and the effects on mucosal architecture. We suggest that a local CMI reaction may be the cause of villous atrophy, crypt hyperplasia, and malabsorption in many clinical and experimental conditions, including coeliac disease, food allergy, and intestinal infections.


Distribution of alpha-1-antitrypsin phenotypes in two Dutch population groups. The alpha1-antitrypsin phenotypes of two Dutch population groups (consisting of 672 and 802 individuals) were determined by the isoelectric focusing technique, which due to its recent development, has been used for the first time in large-scale phenotyping. As in other population studies on the alpha1-antitrypsin phenotype distribution, Pi M is the most frequently occurring allele. The two investigated groups exhibit remarkable differences, both to other studied groups as well as to each other. The most interesting results are probably the high frequencies of the alleles Pi- and of the recently discovered Pi MN. Comparison with phenotype studies carried out in other populations is also presented.


The linkage relationships of HL-A with other genetic marker systems. Data on the linkage relationships of HL-A with 31 autosomal genetic markers are presented. Among 40 markers for which some information on the linkage relationship with HL-A is available, four (PGM3, GBG, Ch and Pg) have lod scores greater than +3. The most likely order for the polymorphic systems tentatively assigned to chromosome 6 is Kell: Pg:(HL-A,GBG):Ch:PGM3:P.


Utilization of uridine for RNA synthesis in the insect cell line CP-1268 derived from the codling moth, Laspeyresia pomonella. The utilization of [3H]-5-uridine by CP-1268 cells was studied. Uridine was rapidly transported into these cells by a concentration dependent, saturable process. Exogenous uridine rapidly equilibrated with cellular nucleotide pools and virtually all of the uridine transported into the cells was phosphorylated. Uridine incorporation into RNA was studied by continuous and pulse-labeling techniques in the prescence or absence of actinomycin D and cordycepin. These studies have shown that the pattern of unstable RNA precursor and relatively stable RNA product relationship known to exist in mammalian cells similarly exists in insect cells in vitro. This pattern varied markedly with pulse-labeling time and required the addition of RNA inhibitors to block reincorporation of intracellular labeled metabolites during the chase.


Effects of aprotinin on organ cultures of the rat's kidney. Fragments of adult renal tissue were maintained as organ cultures for 7 days in HEPES-buffered medium 199, supplemented with 10% calf serum and antibiotics. Addition of aprotinin (10,000 kallikrein inhibitor units per ml) to the medium resulted in improved survival of the cells of the glomeruli and tubules and preserved the integrity of the glomerular, capsular and tubular basement membranes. Optimal results were obtained when aprotinin was present throughout the period of culturing. Inclusion of aprotinin in the medium for only the first 3 days in vitro slightly increased the numbers of surviving glomerular and tubular cells, but also promoted the growth of connective tissue in the explants and was detrimental to the basement membranes of the tubules. It is suggested that both the antiproteolytic and the carbohydrate-binding properties of aprotinin are involved in the mediation of the observed effects.


The detection of F(ab')2-related surface antigens on the thymocytes of children. A Fowl antiserum to human polyclonal F(ab')2 with specificities for variable region antigens of both light and heavy chains and for the constant portion of the Fd fragment bound to about 20 per cent of thymocytes from three children. Binding was completely inhibited by purified human polyclonal IgG and only partly by L chains. The fowl anti-F(ab')2 also bound to a subpopulation of peripheral blood lymphocytes which was somewhat larger than the B-cell population identified with other anti-immunoglobulin sera. Binding was detected by autoradiography and the amount of radiolabel seen on thymocytes was nearly as great as that on peripheral blood lymphocytes. As no binding to thymocytes was seen with other anti-immunoglobulin sera we propose that the fowl anti-F(ab')2 recognizes immunoglobulin or material with structural similarities which is synthesized by thymocytes but of which predominantly V region determinants are exposed on the membrane surface.


Restoration of delayed hypersensitivity to sheep erythrocytes by thymosin treatment of T-cell-depleted mice. Calf thymosin was injected subcutaneously in daily doses of 0.1 to 3 mg for 12 to 15 days into adult thymectomized, irradiated, bone marrow-reconstituted (THXB) mice. Thymosin partially restored the ability of the T-cell-depleted host to develop delayed-type hypersensitivity to sheep erythrocytes. The degree of restoration varied from 50 to 75% of control values. Thymosin treatment of normal mice potentiated the footpad responsiveness to sheep erythrocytes by as much as 50% over that of untreated controls. The optimum dosage of thymosin seemed to be in the 200- to 500-mug range, and multiple injections were essential for a significant response. Tweleve daily injections of 100 to 500 mug of thymosin restored T-cell reactivity to the THXB mouse, but the responsiveness decayed relatively rapidly once the treatment was stopped. The restoration of immune responsiveness to sheep erythrocytes in T-cell-depleted mice provides a convenient means of demonstrating activity in thymosin preparations in vivo.


Synthesis and release of polyribophosphate by Haemophilus influenzae type b in vitro. Polyribophosphate, the capsular polysaccharide antigen of Haemophilus influenzae type b, can be assayed in crude bacterial extracts by a combination of immunoprecipitation, hot-acid extraction, and colorimetry. In vitro, the antigen is synthesized during growth and, in well-buffered media, in early stationary phase as well. It is shed from the cell throughout the course of synthesis, and at 37 C almost all the extractable antigen has been released spontaneously within several hours after synthesis. Various strains are similar in extent of synthesis and gross composition of the antigen; however, strains differ in the rate of release during exponential phase. The antigen is released as (or as part of) a very large structure, although under certain culture conditions much smaller antigenic units are found.


Defective repair of gamma-ray induced DNA damage in xeroderma pigmentosum cells. We used the bromouracil-photolysis technique to estimate the sizes of the repaired regions in normal human and xeroderma pigmentosum (XP) cells irradiated by gamma-rays aerobically or anoxically. After 1 1/2 hours of incubation, single-strand breaks were repaired and the repaired regions were small--one to two BrUra residues--for cells irradiated aerobically or anoxically. After a 20-hour incubation, the repaired region in normal cells showed a component mimicking U.V.-repair. There were large patches (approximately 30 BrUra residues) in the approximate ratios of one per six chain breaks for aerobic irradiation and one per three chain breaks for anoxic irradiation. XP cells, however, only showed large patches at 20 hours if they had been irradiated aerobically. We could not detect such regions in XP cells irradiated anoxically. These results indicate (1) that some part of ionizing damage mimics excision of U.V. damage in that the repair patches are large and the repair takes an appreciable time; (2) the types of such damage depend on whether the irradiation is done aerobically or anoxically; and (3) XP cells are defective in repairing a component of anoxic damage.


Effect of 60Co gamma-irradiation on the reaction of mixed disulphides of mercaptoethylguanidine with enzymes of rat-liver cytoplasm. A theoretical assumption of Eldjarn and Pihl suggests that mixed disulphides formed by radioprotective aminothiols and protein SH-groups can be broken down by enzymes in the organism, and the native structure of the macromolecules restored. Irradiation should enhance this effect. In our experiments, mixed disulphides of mercaptoethylguanidine (MEG) and albumin/haemoglobin were split by the soluble enzyme fraction of rat-liver homogenate (cytosol). The liberation of the radioprotector MEG is brought about by small molecules; dialysed cytosol has no effect, nor has the suspension of particles of mitochondria. On irradiation with doses in the 0-1--5-0 Mrad range, the mixed disulphide bridge is stabilized and made more resistant to splitting. Increased resistance up to 700 per cent with albumin-MEG and 160 per cent with haemoglobin (Hb)-MEG mixed disulphide was observed compared with the unirradiated control.


Effects of 60Co irradiation of the early developmental stages of an ixodid tick, Hyalomma anatolicum. Various developmental stages of Hyalomma anatolicum were subjected to a range of doses of 60Co radiation from 0-10 000 R, and their subsequent development was observed. Some of these ticks were infected with Theileria annulata. Doses of 2000 R and over prevented all but a very limited development of ticks. After 1000 R a proportion of exposed individuals continued development in a near-normal manner. Lower doses had proportionately less effect. 1000 R to ticks infected with T. annulata failed to prevent transmission of typical theileriasis to calves.


Chromosome aberrations induced in human lymphocytes by neutron irradiation. In vitro dose--response curves of unstable chromosome aberrations in human lymphocytes have been obtained for neutron spectra of mean energies 0-7, 0-9, 7-6 and 14-7 MeV. The aberration yields have been fitted to the quadratic function Y = alphaD + betaD2, which is consistent with the single-track and two-track model of aberration formation. However with high-LET radiation, the linear component of yield, corresponding to damage caused by single tracks, predominants, and this term becomes more dominant with increasing LET, so that for fission spectrum neutrons the relationship is linear, Y = alphaD. At low doses, such as those recieved by radiation workers, limiting r.b.e. values between 13 and 47 are obtained relative to 60Co gamma-radiation. At higher doses, as used in radiotherapy, the values are much lower; ranging from 2-7 to 8 at 200 rad of equivalent gamma-radiation. Both sets of r.b.e. values correlate well with track-averaged LET but not with dose-averaged LET. When the numbers of cells without aberrations are plotted against radiation dose, curves are obtained which are similar in shape to those for conventional cell-survival experiments with comparable neutron spectra. The Do values obtained in the present study are close to those from other cell system.


Nucleoside phosphotransferase from Erwinia herbicola, a new membrane-bound enzyme. A nucleoside phosphotransferase, which catalyzes the phosphorylation of nucleosides to nucleotides by low energy phosphate esters, has been isolated and purified 500-fold from the membrane fraction of Erwinia herbicola. Its most noteworthy difference from other enzymes of this class is that it is membrane bound and can be isolated and handled only in the presence of a detergent. With a ribonucleoside acceptor, adenosine, the reaction product is exclusively 5'-AMP; with deoxyadenosine, 5'- and 3'-nucleotide products appear in the approximate ratio of 2:1, respectively. The enzyme has no detectable phosphatase activity with the best phosphate donors, 5'-dAMP and 5'-dTMP, and very little with less active donors, such as p-nitrophenyl phosphate. This phosphotransferase should be a useful agent for preparing 5'-nucleotides from unusual synthetic bases.


The current status of angiography in gastrointestinal bleeding. Endoscopy, barium studies and angiography are all valuable diagnostic procedures in gastrointestinal bleeding. They are not mutually exclusive procedures but the correct sequence of investigation varies. Correct localization can be achieved in 84% of cases of massive gastrointestinal bleeding by their combined use. Vasoconstrictive therapy is also possible in severely ill patients and other poor surgical risk candidates.


The nature of the cells generating B-lymphocyte colonies in vitro. B-lymphocyte colonies are grown in semi-solid agar from mouse spleen or lymph node cells in the presence of mercaptoethanol with or without added sheep red cells. High levels of colony-forming cells were present in the spleen or normal mice and nu/nu (athymic) mice but colony-forming cells were rare in the thymus and not detected in activated T-lymphocyte populations. Colony-forming cells were theta-negative and most exhibited Fc receptors. Most colony-forming cells had the sedimentation velocity of small lymphocytes, were non-adherent and had a buoyant density similar to B-lymphocytes. Colony-forming cells were radiosensitive (Do60 rads) and sensitive to cortisone. Colony formation was potentiated by the addition of adherent spleen cells or peritoneal macrophages. It is concluded that most cells forming B-lymphocyte colonies are themselves characterisable as B-lymphocytes.


1,25-Dihydroxycholecalciferol deficiency: the probable cause of hypocalcemia and metabolic bone disease in pseudohypoparathyroidism. Pseudohypoparathyroidism (PsH) is a genetic disease characterized by hypocalcemia, hyperphosphatemia, and metabolic unresponsiveness to parathyroid hormone (PTH). The administration of PTH elicits neither a significant rise in serum calcium (calcemic response) nor a decrease in the renal tubule reabsorption of phosphorus (phosphaturic response). The diminished phosphaturic response is due to an inability of PTH to generate cyclic AMP in renal tubule cells. We investigated the question of whether hypocalcemia and deficient calcemic response to PTH are due to a similar cyclic AMP defect in bone or to an acquired vitamin D deficiency. Four patients were studied. The active form of vitamin D (1,25-dihydroxycholecalciferol) was measured in 3 and was low. Treatment with vitamin D2 restored the serum calcium and the calcemic response to PTH to normal without changing the impaired renal response. Bone biopsy was performed in 2 patients and showed morphologic evidence of increased osteoclastic activity and osteomalacia. The data indicate that the hypocalcemia and bone disease in PsH are due to active vitamin D deficiency, possibly resulting from the genetic renal lesion.


Emergency coronary surgery: Evolving indications. Between December 1970 and October 1973, 74 patients underwent emergency myocardial revascularization for the relief of acute coronary insufficiency. Through our experience in this area, we have established three categories for which we perform emergency surgery. The first of these is cardiogenic shock complicating acute myocardial infarction for which 14 patients underwent emergency saphenous vein grafting. Seven of these patients expired during operation and one died three months after operation. The second category is acute unstable myocardial infarction for which 25 patients received surgery. There were no operative deaths in this group, but two patients died at six weeks and four months after operation. Thrity-five patients were classified as pre-infarctional angina, the third category for which we perform surgery on an emergency basis. There was one operative death and two late deaths at four and ten months in this group of patients. Our experience suggests that immediate coronary angiography and revascularization will improve survival in the three above-named categories.


Limits of coronary artery surgery. Clinical and postmortem findings. In the first series of 90 continuous patients with coronary artery disease 9 patients died after aorto-coronary bypass procedures (10%). There were 7 operative deaths, and 2 postoperative deaths (respiratory failure after bronchopneumonia and bleeding duodenal ulcer; acute necrosis of the liver following hepatitis). The study of the deceased patients made evident that postoperative impairment of left ventricular function is caused by ventricular aneurysms. This fact can be shown by the poor ventricular function with an elevated left ventricular enddiastolic pressure (LVEDP) of more than 18 mm Hg. The results in patients with congestive heart failure could not be improved by multiple bypass-grafts. Probably the prolonged surgical intervention may cause additional stress to the predamaged myocardium. So, in our group the indication for using multiple grafts in cases with ventricular aneurysm is confirmed with great caution.


Mechanisms responsible for defective human T-lymphocyte sheep erythrocyte rosette function associated with hepatitis B virus infections. The expression of selected lymphocyte surface-membrane markers was evaluated in 37 patients with acute viral hepatitis B, 10 of whom were studied serially through the resolving and convalescent phases of disease. Bone marrow-derived (B) lymphocytes were identified by reference to surface immunoglobulin, whereas normal thymus-derived (T) lymphocytes were assayed by their capacity to form spontaneous nonimmune rosettes with sheep erythrocytes (E rosettes, ER). During the acute and resolving phases of viral hepatitis B, the relative and absolute number of ER-positive lymphocytes was significantly reduced, whereas the number of surface immunoglobulin-positive lymphocytes and the absolute lymphocyte count remained normal. This resulted in the appearance of a third population of cells, deficient in respect to both surface immunoglobulin and ER markers. Such cells accounted for nearly 25% of peripheral blood lymphocytes, approximately 5 x 105ml blood. Depression of the number of ER-positive lymphocytes occurred at least once during the course of disease in every patient studied serially, and was observed in 55 of 67 individual assays of the 37 cases of acute viral hepatitis B. Lymphocytes from some patients reacquired ER function when cultured in fetal calf serum but not in the presence of autologous serum. Such autologous serum was capable of suppressing ER function of lymphocytes from normal donors. The extrinsic suppression of er function by a serum factor (designated as the Rosette Inhibitory Factor), was found to be time dependent, characterized by a 4-h latent period and requiring approximately 18 h for maximum attenuation of ER function. The Serum Rosette Inhibitory Factor was: (a) heat and freeze-thaw stable, (b) nondialyzable, (c) physically separable from hepatitis B surface antigen, (d) not a lymphocytotoxic antibody, and (e) had the buoyant density of a lipoprotein. This extrinsic mechanism was observed in 41.8% of patients with reduced numbers of ER-positive lymphocytes. The Rosette Inhibitory Factor was not detectable in the serum of the remaining 58.2% of the cases of acute and resolving viral hepatitis B despite the presence of reduced numbers of ER-positive lymphocytes. The lymphocytes from these cases did not reacquire ER function when cultured in the absence of autologous serum. The mechanisms responsible for the suppression of normal ER function in these cases appears to be intrinsic to the lymphocytes and not the result of a humoral factor. The T lymphocyte lineage of cells deficient in respect to ER function, whether of intrinsic or extrinsic type, was demonstrated by their capacity to form spontaneous rosettes with neuraminidase-treated sheep erythrocytes. Both intrinsic and extrinsic suppression of T lymphocyte ER function commonly occurred during the first 4 wk of acute viral hepatitis B.9 of the 10 patients followed serially continued to manifest defective ER function at 12 wk...


Failure of heavy chain glycosylation of IgG in some patients with common, variable agammaglobulinemia. Four patients with common, variable agammaglobulinemia were preveiously reported to have normal numbers of circulating B lymphocytes which synthesized normal amounts of IgG in tissue culture but failed to secrete the newly synthesized IgG. The B lymphocytes of these patients fail to incorporate [3H]mannose and/or [3H]glucosamine into newly synthesized IgG, whereas such incorporation appears to occur just before IgG secretion in cultures of normal B lymphocytes.


Perfusion therapy for skin cancer.

Perfusion therapy for skin cancer. Surgical techniques for the selective administration of anti-cancer drugs is presented. These isolated-perfusion or intra-arterial infusion procedures have achieved significant palliation for many patients with advanced cancer. When used in conjunction with surgical excision of certain early skin cancers, such as aggressive forms of malignant melanoma of the extremities, improved cure rates may be achieved.


Host factors and antibody response Haemophilus influenza type b meningitis and epiglottitis. Levels of antibody in serum after infection with Haemophilus influenza type b or challenge with polysaccharide vaccine are highly variable. Convalescent-phase serum antibody to the capsular polysaccharide of H. influenzae type b was measured in two groups of patients with pathophysiologically distinct diseases, meningitis and acute epiglottitis. Antibody response after H. influenzae meningitis was subnormal. Mean levels of antibody, the distribution of antibody levels by age, and erythrocyte and genetic marker lymphocyte antigens were studied; all results suggested that these two groups of patients were genetically and immunologically different from each other. Evidence suggested that the magnitude of the important host immunologic response was under host genetic control.


Stimulation of lymphocytes by purified protein derivative: suppression by cells from human vaccinated with Bacille Calmette-Guérin. Specific stimulation of thymus-derived cells by purified protein derivative or tetanus toxoid was inhibited by autologous lymphocytes. The lymphocytes, which were collected from healthy humans who had been vaccinated with bacille Calmette-Guérin were purified on nylon columns after removal of cells that form rosettes with sheep erythrocytes. The degree of purification of the lymphocytes was controlled by appropriate techniques.


Cell surface immunoglobulin. XVIII. Functional differences of B lymphocytes bearing different surface immunoglobulin isotypes. Three populations of murine splenic B lymphocytes have been characterized previously (6, 7, 9) as those bearing only IgM, those bearing only IgD, and a population bearing both isotopes. These studies were designed to test the response of the IgM+ cells (IgM-only or IgM plus IgD) vs. the IgD-only cells to the B-cell mitogen, lipopolysaccharide. Results that after 1-4 days of culture, in the presence of mitogen, the IgM+ cells enlarge and elaborate an IgM polyclonal response. The IgD-only cells, in contrast, do not exhibit an IgM polyclonal response, but instead undergo blastogenesis and proliferation.


The class of surface immunoglobulin on cells carrying IgG memory in rat thoracic duct lymph: the size of the subpopulation mediating IgG memory. The fluorescence activated cell sorter was used to determine the class of immunoglobulin on the thoracic duct lymphocytes (TDL) which carried IgG memory. Although only about 3% of all TDL carried membrane IgG these cells accounted for most, if not all, of the adoptive IgG anti-DNP response. It is concluded that both CR+ and CR- cells mediating IgG memory in rat TDL bear the same class of membrane immunoglobulin as that secreted by their differentiated progeny. The class of membrane immunoglobulin on CR+ and CR- rat TDL was also examined. It was found that IgM+ cells, which made up over 80% of all Ig+ cells, were virtually all CR+. In contrast, the few percent of IgG+ and IgA+ cells present were to be found in both subpopulations. There was no evidence of a large population of B cells bearing exclusively heavy chains other than IgA, IgG, of IgM. The observation that some IgG+ cells as well as IgM+ cells possess a receptor for C3 appears to rule out the hypothesis that this receptor is involved in blocking a switch from IgM to IgG synthesis.


Separation of helper and suppressor T lymphocytes on a ficoll velocity sedimentation gradient. A 5-20% Ficoll velocity sedimentation gradient has been successfully applied to separate concanavalin A (Con A)-induced helper; and suppressor T cells. When titrated into a constant number of fresh normal spleen cells responding to sheep erythrocytes, cells from the top pool show stimulatory effects while those from the bottom pool show inhibitory activity. Both activities are found to be Con A dependent and anti-theta sensitive. We conclude that Con A-induced helper and suppressor T cells are distinct subpopulations and such separation will allow further characterization of these cell types.


Suppressor cells: dependence on assay conditions for functional activity. Spleen cells educated in vitro with sheep red blood cells (SRBC) suppressed the plaque-forming cell response of Mishell-Dutton assay cultures challenged with optimal doses of SRBC. Changing conditions in the assay cultures changed the effect educated cells had on the assay culture responses. For example, educated cells helped rather than suppressed assay cultures of suboptimal numbers of spleen cells. Similarly, augmentation resulted upon addition of educated cells to assay cultures challenged with suboptimal doses of SRBC. Such a reversal of regulatory effects was not observed when assay cultures were challenged with supraoptimal antigen doses. Educated cells helped assay cultures of B spleen cells, and the addition of normal T cells reinstated suppression. Furthermore, maintenance of assay cultures under stationary rather than the usual rocking conditions allowed educated cells to help rather than suppress the antibody response of assay cultures. These results show that when the response of the target population (assay cultures) is low, the regulator (educated) cells augment the response, and vice versa, supporting the hypothesis that the effect regulator cells produce depends on the activity of the cells they regulate.


Growth of B-lymphocytes clones in semisolid culture is mitogen dependent. A substance which was mitogenic for murine B lymphocytes in the presence of 2-mercaptoethanol was isolated from agar. Stimulating activity of this material was stable to proteolysis or protein denaturants but was destroyed by periodate treatment. Agar-derived mitogen stimulation was distinct from that obtained with dextran sulfate or lipopolysaccharide and may define different populations of B lymphocytes.


Cross-priming for a secondary cytotoxic response to minor H antigens with H-2 congenic cells which do not cross-react in the cytotoxic assay. Cytotoxic effector T cells of F1 (BALB/c X BALB.B) (H-2d/b) mice immunized against the minor histocompatibility differences of C57BL/10 (H-2b) can lyse targets from C57BL/10, but cannot lyse B10.D2 (H-2d) targets. Despite this lack of cross-reaction in the cytotoxic assay, C57BL/10 cells do prime F1 (BALB/c X BALB.B) mice for a secondary cytotoxic response to B10.D2. C57BL/10-primed, B10.D2-boosted cytotoxic cells lyse B10.D2 targets but not C57BL/10 targets. DBA/2 (H-2d) spleen cells or thymocytes prime F1 mice for a secondary response to DBA/2, B10.D2, and C57BL/10 cells, but DBA/2 mastocytes, P815, do not prime for a response to C57BL/10. Whether H-2 congenic lymphoid cells express minor histocompatibility determinants which cross-react at the cytotoxic T-cell level or the helper T-cell level is discussed.


An improved vaseline gap voltage clamp for skeletal muscle fibers. A Vaseline gap potentiometric recording and voltage clamp method is developed for frog skeletal muscle fibers. The method is based on the Frankenhaeuser-Dodge voltage clamp for myelinated nerve with modifications to improve the frequency response, to compensate for external series resistance, and to compensate for the complex impedance of the current-passing pathway. Fragments of single muscle fibers are plucked from the semitendinosus muscle and mounted while depolarized by a solution like CsF. After Vaseline seals are formed between fluid pools, the fiber ends are cut once again, the central region is rinsed with Ringer solution, and the feedback amplifiers are turned on. Errors in the potential and current records are assessed by direct measurements with microelectrodes. The passive properties of the preparation are simulated by the "disk" equivalent circuit for the transverse tubular system and the derived parameters are similar to previous measurements with microelectrodes. Action potentials at 5 degrees C are long because of the absence of delayed rectification. Their shape is approximately simulated by solving the disk model with sodium permeability in the surface and tubular membranes. Voltage clamp currents consist primarily of capacity currents and sodium currents. The peak inward sodium current density at 5 degrees C is 3.7 mA/cm2. At 5 degrees C the sodium currents are smoothly graded with increasing depolarization and free of notches suggesting good control of the surface membrane. At higher temperatures a small, late extra inward current appears for small depolarizations that has the properties expected for excitation in the transverse tubular system. Comparison of recorded currents with simulations shows that while the transverse tubular system has regenerative sodium currents, they are too small to make important errors in the total current recorded at the surface under voltage clamp at low temperature. The tubules are definitely not under voltage clamp control.


Orbicularis oculi reflex and facial muscle electromyography. Pre- and postoperative evaluation of posterior fossa space-occupying lesions. The electrically evoked orbicularis oculi reflex was analyzed in 26 patients with proven posterior fossa space-occupying lesions (11 cerebellopontine angle and 15 cerebellar hemispheric masses). In the former group, although only six had clinical evidence of trigeminal or facial involvement, the reflex analysis showed both nerves to be involved in all. Electromyography (EMG) of the orbicularis oculi showed profound denervation of this muscle while only minimal abnormalities of the masseter were seen. The sensory component of the trigeminal nerve was always more involved than its motor component and this was a reliable guide as to the upward and medial extension of the tumor, especially in the absence of clinical localizing signs. In the 15 patients with cerebellar masses, six with masses located posteriorly and entirely within the confines of the cerebellum had normal studies. In eight, the mass was located anteriorly, and fifth nerve involvement could be detected in all by EMG, although only two patients had clinical evidence of such involvement. One patient with dysfunction of the central reflex arc had EMG evidence of an intraventricular dermoid tumor abutting the pons, later confirmed at surgery. Thus, an invaluable body of diagnostic and prognostic data can be obtained by this nontraumatic and simple electrodiagnostic procedure.


Characteristics of the entry process for sodium in transporting epithelia as revealed with amiloride. 1. The permeation of sodium ions trhough the mucosal surface of frog skin epithelium at different transepithelial potentials has been investigated using the blocking drug amiloride. 2. An increase in serosal negativity in voltage-clamped skins was associated with an increase in the absolute amount of inhibition caused by a fixed concentration of amiloride. Hyperpolarizing or depolarizing skins with respect to the short-circuited condition did not affect the apparent affinity of amiloride for the entry sites. 3. When skins were voltage clamped at -50 mV (serosa negative) the specific binding of amiloride to sodium entry sites was increased by 77% compared to the short-circuited condition. Skins clamped at +50 mV had only 72% of the specific binding found in short-circuited skins. Experiments with a second blocking drug, triamterene, indicated that the extra binding sites appearing at -50mV were similar to those found under short-circuit conditions. The appearance and disappearance of binding sites may reflect changes in cell volume. 4. The findings suggest that the increased sodium current which flows when skins are clamped at -50 mV results from an increase in the number of entry sites, and perhaps also to a voltage sensitive increase in flux through each entry site.


Separation of two voltage-sensitive potassium currents, and demonstration of a tetrodotoxin-resistant calcium current in frog motoneurones. 1. Depolarization-induced voltage and conductance changes were studied in frog montoneurones in isolated, perfused spinal cord slices. Two types of afterhyperpolarization are observed following action potentials in normal Ringer, a fast afterhyperpolarization lastin 5-10 msec and a slow afterhyperpolarization lasting 60-200 msec. Both afterhyperpolarizations are mediated by an increased K+ conductance. 2. The slow afterhyperpolarization and conductance increase underlying it are selectively and reversibly inhibited by perfusion with solutions containing low [Ca2+] (less than or equal to 0-2 nM) or the Ca2+ antagonists Mn2+ (1mM) or Co2+ (5 mM), and are enhanced by perfusion with high [Ca2+]. 3. Addition of 2-5 mM tetraethylammonium ion (TEA+) to the perfusing solution prolongs the falling phase of the action potential and abolishes the fast afterhyperpolarization, but does not inhibit the slow afterhyperolarization. 4. When the voltage-dependent Na+ current is blocked by perfusion with TTX (10-5 M), intracellularly applied depolarizing current steps evoke fast and slow hyperpolarizations with kinetics and pharmacological sensitivities similar to those of the fast and slow afterhyperpolarizations, respectively. The fast hyperpolarization is maximally activated by brief, intense depolarizations, the slow hyperpolarization by prolonged, less intense depolarizations. 5. These pharmacological and kinetic data demonstrate that in frog motoneurones the repolarization-fast afterhyperpolarization sequence and the slow afterhyperpolarization are produced by different K+ conductance systems. The fast K+ conductance activates rapidly on depolarization, decays rapidly on repolarization, and is TEA+ sensitive, while the slow K+ conducatance activates and decays more slowly and is Ca2+-dependent. 6. Motoneurones perfused with TEA+ and TEA often show a slow, regenerative depolarizing response to applied depolarizing currents. These regenerative depolarizations are probably produced by an influx of Ca2+, because they persist in isotonic CaCl2 and are blocked by Mn2+ or low [Ca2+]. The Ca2+-dependence of the slow afterhyperpolarization and the increase in slow afterhyperpolarization magnitude observed following the slow Ca2+ potentials suggest that a depolarization-evoked Ca2+ influx activates the K+ conductance underlying the slow afterhyperpolarization. 7. Motoneurones in which the slow Ca2+ and K+ conductance systems have been enhanced by high [Ca2+] or blocked by Mn2+ show altered discharge patterns in response to intracellularly applied depolarizing current steps. Perfusion with twice normal [Ca2+] (4 mM) causes montoneurones to discharge more slowly at all current intensities, and reduces the slope of the 'steady-state' frequency-current relationship. Mn2+-perfused motoneurones exhibit fairly normal high-frequency discharge at the onset of the current step, but unlike normal motoneurones, do not discharge at frequencies below 60/sec...


Relationship between Monro's foramen and cranial breadth: a method for a more accurate echo-encephalographic examination. A pneumoencephalographic study to localize the position of Monro's foramen in the skull cavity is reported. This has to be done by evaluating the place of Monro's foramen in both vertical and horizontal plane. A method to perform more accurate ultrasonic examinations is described.


[Tetanic fatigue and proximate post-tetanic recuperation in sartorius and flexor carpi radialis muscles of the male frog. Effects of iodoacetic acid (author's transl)]. The time-course of the isometric tension output, at 20 degrees C, during a long tetanus and after a short period of rest, was investigated in two isolated frog muscles : the sartorius and flexor carpi radialis muscles. To prevent aerobie and glycolytic recovery processes, some muscles were poisoned with 0,4 mM iodoacetic acid (IAA) and nitrogen, for 20 or 40 min. 1. For the unpoisoned sartorius muscle, tetanic tension declined quickly, but after a 0,8 sec period of rest, the muscle was able to develop high tension. Poisoning with IAA-N2 increased fatigue without suppressing the property of a proximate post-tetanic recuperation. 2. In the flexor carpi radialis muscle resistance to fatigue was very large before poisoning and diminished after poisoning. Proximate recuperation was very weak. 3. The results show that the recovery processes are not a primary factor of the development of the short-term fatigue ; they enhance the hypothesis that a failure of the electromechanical coupling can explain the rate of the tension fall in tetanized sartorius muscles.


Introducing quality assurance and medical audit into the UCSF medical center curriculum. The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.


Rickets in Nigerian children--response to vitamin D. The findings in 20 cases of nutritional rickets treated on an out-patient basis with oral calciferol and calcium gluconate are reported. Attention was paid to their clinical, biochemical and radiological responses. If was noted that presentation at the hospital out-patient department was always delayed until there were obvious and sometimes severe deformities in  the children. Biochemical changes noted during the early phase of treatment showed an initial fall in the level of serum calcium and plasma phosohorus and a rise in the serum alkaline phosphatase. About three months after initiating treatment, calcium and phosphorus reverted to normal levels but serum alkaline phosphatase still remained high. Twelve of our cases (60 per cent) suffered from protein calorie malnutrition of the marasmic type and showed an apparent resistance to vitamin D therapy in what may be regarded as normal dosages. Response was however, achieved with substantial increase in the amount of vitamin given. There was a striking sex difference in the ratio of 15 males to five females indicating that males are more likely to develop nutritional rickets than females when subjected to predisposing environmental conditions. Vitamin D resistant type of rickets was not encountered in this study.


Carcinogenesis in tissue culture 25: reduced tumorigenicity of alkaline phosphatase-constitutive variants from Chinese hamster ovary cells. Several subclones with high alkaline phosphatase (ALP) activity were isolated from ALP-negative Chinese hamster ovary cells (CHO-K1). When inoculated into cheek pouch membranes of Syrian golden hamsters treated with anti-hamster thymocyte serum (ATS), ALP-negative CHO-K1 cells produced progressively growing tumors, whereas the cells of ALP-positive subclones did not, although small nodules were formed temporarily. The animals injected CHO-K1 cells died of tumor by 35 days after grafting, and metastases in liver and lung were revealed on autopsy. The histological features of the resultant neoplasms were consistent with fibrosarcoma. In animals transplanted with the cells of ALP-positive subclones, neither tumor death, nor metastasis formation was observed.


Hepatitis B antigen and systemic lupus erythematosus. False positive complement fixation due to anti-antibodies. Sera from 22 patients with systemic lupus erythematosus (SLE) were examined for the presence of hepatitis B antigen (HBsAG) by a complement fixation (CF) test, by an immunoelectrophoretic method (counterelectrophoresis-CEP), and by radioimmunoassay (RIA). The sera from 8 patients gave positive results using CF. However, the same sera and sera from 28 additional SLE patients, when tested with CEP and RIA, were not shown to contain HBsAG.


Studies of receptors on normal and malignant tissue from man. Receptor studies on normal and malignant human tissues were carried out. Erythrocyte receptor studies failed to show differences between malignant and normal tissues; both apparently have a receptor for rat erythrocytes, a hemolysin for monkey erythrocytes, and an agglutinin for rabbit erythrocytes. Fc receptors were found in several malignant tissues and only an occasional normal tissue, except for a patient who died of sepsis.


Coronary collateral circulation during stress and the effects of aorta-coronary bypass grafts. The ability of coronary collateral vessels to supply an adequate volume of blood to the subendocardium during the resting state and during periods of stress was studied. Regional myocardial blood flow was determined by the radioactive microsphere technique. Ameroid constricting devices were placed around the left circumflex coronary artery in 22 adult mongrel dogs. Three months later, regional myocardial blood flow was measured in a normal area of the left ventricle as well as in the area supplied entirely by coronary collateral vessels. Collateral blood flow was sufficient in the resting state to prevent myocardial ischemia distal to a gradually occluded coronary artery. However, in 10 animals (Group I) without aorta-coronary bypass grafts (ACBG), a selective underperfusion of the collateralized subendocardium occurred during periods of stress. In 12 animals (Group II), this selective underperfusion of the collateralized subendocardium with stress was abolished by placing ACBG's distal to the site of the coronary artery occlusion.


Operative flow measurements and coronary bypass graft patency. Early (one week) and late (one year) postoperative angiography was performed in 142 patients having 310 grafts (117 right coronary artery [RCA], 134 left anterior descending [LAD], and 59 circumflex coronary artery [CCA]) to assess the factors responsible for failure of aorta-coronary artery saphenous vein grafts. Early catheterization revealed an 85.5 per cent patency rate with similar rates for each artery (RCA 88 per cent, LAD 85 per cent, and CCA 81 per cent). At one year 238 grafts remained patent, for a cumulative patency rate of 76.8 per cent with a similar distribution for each vessel (RCA 75 per cent, LAD 78 per cent, and CCA 76 per cent). Intraoperative flow measurements were correlated with early and late patency. Grafts with a basal flow less than 20 ml. per minute have a 42 per cent early closure rate and a 21 per cent late closure rate (cumulative 63 per cent). A basal flow of less than 40 ml. per minute was associated with a 25 per cent early failure and an 11 per cent late failure rate (cumulative 36 per cent). Basal flow at levels greater than 40 ml. per minute was not associated with an increased probability of graft closure. Absence of reactive hyperemia (30 second graft occlusion) was associated with a 19 per cent probability of early closure and a 31 per cent probability of cumulative thrombosis. A papaverine-induced flow increase (15 mg. given into the graft) of less than 100 per cent over basal flow gave a 20 per cent probability of early failure and 30 per cent probability of cumulative closure. Thus intraoperative basal flow measurements are of predictive value in determining the fate of aorta-coronary artery vein bypass grafts, and vasodilatory maneuvers provide little additional information.


Infrarenal mycotic pseudoaneurysm. A late complication of coronary bypass surgery with proximal aortic dissection. A 62-year-old man developed a mycotic infrarenal pseudoaneurysm at the re-entry site of a previous aortic dissection. The aortic dissection had occurred one year earlier while he was undergoing coronary bypass surgery. The patient was successfully treated with a Dacron bifurcation graft after the mycotic aneurysm had been sterilized. Causes and relationships of the mycotic pseudoaneurysm to aortic dissection and aortic balloon support are discussed.


Distribution and severity of atherosclerosis in the coronary arteries. A postmortem study of 93 human hearts was undertaken. Gross inspection was used to determine the degree of atherosclerosis and postmortem coronary angiography to estimate the degree of luminal narrowing. The findings indicate the following: (1) There is high correlation between the estimates of luminal narrowing in the gross specimen and the presence of significant atherosclerosis. (2) Approximately 30 per cent of vessels with significant proximal disease will have significant distal coronary artery disease. (3) When one coronary artery is involved with severe proximal atherosclerosis, either of the other two vessels are likely to be involved, with a frequency of 75 per cent ormore. (4) When significant distal disease is present the proximal vessel is nearly always involved. (5) Patient selection prior to referral to surgery may be partly responsible for the over 90 per cent operability rate in patients undergoing coronary artery bypass grafting.


Scanning electron microscope study of human veins and aorta-coronary artery vein grafts. Scanning electron microscope study of two vein grafts which were removed after 50 months of implantation as aorta-coronary artery vein grafts showed considerable subendothelial thickening, which consisted of relatively cell-poor fibrous layer. In one of the grafts the endothelial surface was intact; the second graft showed focal loss of endothelial cells. Sections of two fresh human veins, studied prior to their insertion as aorta-coronary artery vein grafts, have shown that they retained an intact endothelial layer. A third fresh vein, however, showed focal damage with missing endothelial cells and adherent fibrin.


Myocardial revascularization. Early and late results after reoperation. In a series of 4,522 consecutive patients who underwent aorta-coronary bypass (ACB) with the saphenous vein at the Texas Heart Institute, 32 had a second revascularization procedure. All patients were reoperated upon because of recurrence of incapacitating angina. Reappearance of angina was related to obstruction of the grafts alone in 6 patients, to the disease of other arteries alone in 16, and to both sources in the remaining 10 patients. In 9 patients progression of the native coronary disease was found, in 16 significant coronary obstructions had been left unbypassed at the time of initial operation, and in the remaining 7 patients inadequate indication and/or performance of revascularization was considered responsible for the failure. Of the 31 survivors, 61 per cent experienced complete relief of angina or were improved, whereas 39 per cent were unimproved. Reoperation was more successful in relieving angina when performed in patients with new lesions or with previously unbypassed lisions than when done in patients with graft occlusion. Incidence of myocardial infarction after the first and second procedure was similar (3 per cent). Reoperation was performed with a mortality rate of 3 per cent, comparable to that of the original procedure, but relief of angina was not achieved so consistently.