Reversibility of effects of very hypotonic fluids on in vitro frog gastric mucosa: a functional and morphological study. Functional and morphological properties of the in vitro frog gastric mucosa were studied during and after exposure to very hypotonic (approximately 25 mOs M) solutions. Within 20 min the acid secretory rate decreased to zero, but it returned to normal levels after isotonic fluids had been restored. The potential difference (PD) dropped within the first minutes after the exposure to hypotonic solutions, and became inverted. Following the return of isotonic conditions the PD increased to levels higher than in the controls. The electrical resistance increased about 10-fold during the hypotonic period, but decreased to near normal values when isotonic conditions were restored. By light and electron microscopy the cells of the hypotonic mucosae appeared greatly swollen, and the alterations were assessed by morphometric methods. The gland lumina were almost obliterated, and the lamina propria was reduced to about 63% of its former volume. After the return to isotonic conditions normal morphology was restores. It is conceivable that the great increase in resistance duroing the hypotonic period was caused by the occlusion of the gland lumina. Quantitative analyses of the Na, K, and Cl tissue concentrations indicated a large loss of these ions during the hypotonic state. Presumably the epithelial cells in the hypotonic mucosae avoid bursting by rapidly letting large numbers of ions exit, which results in a celulular osmolarity close to that of the bathing fluids.


Follow-up catheterization of patients with myocardial infarction during coronary artery bypass surgery. Of 197 consecutive patients having aortocoronary bypass grafts over a 30 month period, 38 (19 per cent) had ECG evidence of myocardial infarction. The infarctions occurred more commonly in patients receiving multiple grafts. The infarctions were usually in areas supplied by grafted vessels. The infarctions occurred most often in the inferior wall, even when multiple vessels were grafted. Eleven patients with intraoperative infarction have had repeat postoperative coronary arteriograms. Seven had all grafts patent; three of these patients had hypokinesis of the infarcted wall. Four of the 11 patients had one or more occluded grafts; three of these patients had an area of hypokinesis. We conclude that intraoperative myocardial infarction is a common problem in aortocoronary bypass surgery and is not necessarily caused by graft occlusion.


The effect of massive doses of vitamin A on the signs of vitamin A deficiency in preschool children. Marked seasonal variation in the prevalence of signs of vitamin A deficiency was found in the 2nd year of a continuing study of children age 0 to 4-1/2 years in a village in West Bengal, confirming results of a previous 18-month study. Administration of 200,000 IU of vitamin A every 4 months completely eliminated night blindness and prevented the development of new cases of Bitot's spot in a statistically significant number of children. The effectiveness of massive doses of vitamin A, administered at intervals of 4 months, as a short-term measure to fight the problem, was confirmed in this village. The study yielded additional evidence of the complex etiology of Bitot's spot, since alternate day dose of vitamin A in addition to massive therapy failed to eliminate these spots.


Xerophthalmia and blindness in Northeast Brazil. Dietary and biochemical data have indicated that hypovitaminosis A is a public health problem in Northeast Brazil. However, there are few reports regarding clinical signs of hypovitaminosis A. Therefore, an epidemiological study was designed to study this problem. The study as done was primarily a review of hospital records of xerophthalmia in each state with attention paid to other nutrition factors. It was found that xerophthalmia is a problem in Northeast Brazil and a cause of blindness in certain areas. However, the number varied greatly from some states to others. Around 1,000 preschool-age children were recorded as blind from vitamin A deficiency in a 1-year period. It was also noted that the peak incidence of xerophthalmia and blindness was around 1 year of age. The government of Brazil is taking urgent measures to combat this deficiency with such measures as the supplementation of sugar with vitamin A and the distribution of massive doses of vitamin A.


SPLEEN/PATHOL.

SPLEEN/PATHOL. Lymphocyte subpopulations were studied in the peripheral blood, lymph nodes, and spleens in a group of 17 patients with untreated Hodgkin's disease. In 12 of 15 cases, diminished absolute levels of T-lymphocytes in the peripheral blood were found; however, this was correlated with total lymphopenia. No direct relationship between "T-lymphopenia" and diminished cellular immunity, as measured by phytohemagglutinin and pokeweed mitogen blast transformation, and delayed cutaneous hypersensitivity was demonstrated. In eight lymph nodes involved histologically by Hodgkin's disease, a preponderance of T-lymphocytes was found when compared with a group of seven hyperplastic nodes (78.2 +/- 8.9% versus 54.5 +/- 11.0%, P is less than 0.01). These latter data appear to be consistent with the hypothesis that the pathogenesis of Hodgkin's disease involves a cell-mediated immune response to a neoplastic (antigenic) element.


Ultrastructural aspects of interactions of platelets with microcrystalline collagen. Whole blood anticoagulated with EDTA was stirred with high concentrations of a microcrystalline bovine dermal collagen preparation in order to study the interactions of blood cells with collagen at the ultrastructural level. Blood from normal subjects and from patients congenitally deficient in Factors VIII or XII or with thrombasthenia or von Willebrands disease was used. In scanning and transmission electron microscopic studies with blood from normal subjects and patients, platelets were seen to adhere to collagen, develop cell surface undulations, form pseudopods, and undergo morphologic changes suggestive of the release reaction. Although thrombasthenic platelets adhered to collagen, pseudopods formed by these cells were remarkably angulated and nodular. Relatively few von Willebrands platelets adhered to collagen, but those platelets that did adhere underwent the usual sequence of morphologic changes.


The incidence of red-green colourblindness in the populations of Tripolitania, Cyrenaica and Fezzan in Libya, and of the Kikuyu, Kamba, Taita, Taveta and Luo tribes of Kenya. The results of surveys of colourblindness carried out using the Ishihara test cards in Libya and Kenya, involving 384 and 504 individuals respectively, are reported. The Libyan samples, drawn from three geographically distinct regions of the country, are relatively homogeneous. The Kenyan samples, on the other hand, are heterogeneous, but in toto they display a markedly lower colourblindness percentage than do the Libyans. The Kenyan data are in broad accord with the other data available for sub-Saharan African populations. There are very few sets of comparative data available for North African populations, but the Libyan material displays a lower incidence of colourblindness than the values reported in European populations.


Chloride balance in Rana pipiens.

Chloride balance in Rana pipiens. Frogs kept in dilute solutions of Cl- maintain a steady state with respect to this ion. Chloride is exchanged at a rate of about 15 mumol 100 g-1 h-1 (47 nmol cm-2 h-1). Over 90% of the efflux is integumentary of which about 50% is diffusion of the total influx. The rest is carrier mediated, half of which is exchange diffusion and half active transport. The chloride transport system displays saturation kinetics and is inhibited by acetazolamide. Uptake of Cl- is not dependent on concomitant uptake of cations. Salt-depleted frogs accumulate Cl- from dilute KCl or choline chloride in exchange for an endogenous base, probably HCO-3. High bath concentrations of NaCl (greater than 5 mM) abolish the active uptake of Cl- and increase the passive permeability of the skin to Cl-.


Chloride transport across isolated skin of Rana pipiens. The influx of Cl- across isolated frog skin bathed on the outside by 0.8 mM NaCl is about 100 nmol cm-2 h-1, which is approximately twice the Cl- influx in intact animals. The influx consists of diffusion (1%), exchange diffusion (38%), and active transport (60%). About 80% of the influx is independent of Na+ in the outer bath and is also independent of concomitant inward movement of cations. Chloride is exchanged for anions, probably HCO-3. The Cl- transport system is saturable; Vmax is about 200 nmol cm-2 h-1, and Ks is about 0.7 mM Cl-. High external concentrations of NaCl increase unidirectional fluxes of Cl- and urea, indicating a change in paracellular pathways. Active transport of Cl- is temperature sensitive (Q10 equals 2.68) and is inhibited by cyanide, dinitrophenol, iodoacetic acid, iodide, thiocyanate, and acetazolamide. The Na-independent component of JClin was unaffected by amiloride, ouabain, or eserine, all of which inhibit Na+ transport.


Contractile repriming of single muscle fibers: inactivation and tubular diffusion. Following  maximal potassium contractures of isolated single fibers from Rana pipiens, a brief recovery period is required to restore the ability to produce maximal tension by subsequent depolarization. At normal potassium concentration (2.5 mM), there is a minimal lag time of 5 s before any tension is produced by a second exposure to elevated K+; half-maximal tension can be produced in 13 s. The rate of repriming is directly related to the square of the fiber radius and is slowed by lowering external calcium concentration (1.5-0.4 mM). There is no significant difference in any of these respects between normal fibers and fibers dissected from semitendinosus muscles which had been chronically denervated for periods of up to 8 wk. Increased potassium concentration (5-20 mM) in the recovery solution decreased the steady-state repriming level, affecting denervated fibers more than controls. No repriming occurred at concentrations above 20 mM (-48 mV membrane potential.) At these intermediate concentrations, repriming was less complete in denervated muscle, reflecting the increased speed of delayed contractile inactivation. From the times to 50% repriming, which were proportional to the square of fiber radius, we estimated an upper limit for the diffusion coefficient for K+ in the transverse tubular system of 0.3 X 10(-6) cm2/s for both control and chronically denervated fibers.


Difference between endocardial and epicardial utilization of glycogen in the ischemic heart. In the nonischemic canine left ventricle, levels of glycogen, glucose-6-phosphate (G6P), and lactate, and phosphorylase activity in the endocardial layers were higher than those in the epicardial layers, but the phosphocreatine (PCr) level in the endocardial layers was lower than that in the epicardial layers, and there were no differences in the adenosine triphosphate (ATP) level between the endo- and epicardial layers. Upon ligation of a small branch of the left descending coronary artery, levels of glycogen and PCr decreased, while those of G6P and lactate increased, and the activity of phosphorylase increased. The level of ATP was not affected by the coronary ligation. Thus the coronary ligation accelerated the glycogenolysis and glycolysis in the myocardium without affecting ATP level, and the acceleration in metabolism in the endocardial layers was more rapid and marked than that in the epicardial layers.


The significance of the dural supply from the carotid siphon. The dural branches from the cavernous portion of the internal carotid consists of the meningophypopseal trunk, the inferior cavernous, and the capsular arteries. These vessels have extensive anastomoses in and around the sellar area. These arteries are not usually demonstrated angiographically; therefore, when they are enlarged, a pathological lesion should be suspected. There are numerous lesions other than meningiomas associated with hypertrophy of these dural branches and the corresponding vessels involved depends on the anatomic location of the associated lesion.


Postoperative reflux gastritis.

Postoperative reflux gastritis. The chief clinical features of forty-nine patients with the syndrome of reflux "alkaline" gastritis were epigastric pain, bilious vomiting, anemia, and the dumping syndrome. Separation of the symptoms of this syndrome from the symptoms of a multitude of other postgastrectomy syndromes is difficult, being complicated by a high incidence of emotional instability in these patients. Endoscopy remains the mainstay in diagnosis; among the characteristic endoscopic features are adherent mucus, edema, mucosal friability, and erosions, most severe on the gastric aspect of the stoma. The surgical treatment of choice is Roux-en-Y gastrojejunostomy accompanied by vagectomy.


Portal hypertension in infants and children with histiocytosis X. Histiocytosis X describes a disease characterized by histiocytic infiltration of the reticuloendothelial system, skin, bones, and pituitary gland. The disseminated form frequently occurs in infants and children. Chemotherapy has significantly improved the prognosis in this disorder. Sixty-three per cent of survivors, however, have some residual disability related to fibrosis of tissues previously infiltrated by histiocytes. In instances of liver involvement, healing by fibrosis may result in cirrhosis with portal hypertension and bleeding esophageal varices. Clinical findings include hepatosplenomegaly, jaundice, ascites, hypoalbuminemia, prolonged prothrombin time, and Bromsulphalein retention. Histologic examination of the liver shows a characteristic dense "macronodular" periportal  cirrhotic pattern. Three children with portal hypertension and bleeding varices due to healed histiocytosis X were sucessfully managed by portosystemic shunt procedures. Portacaval, mesocaval, and central splenorenal shunts were equally effective in relieving poral hypertension. These children had neither recurrence of bleeding nor evidence of encephalopathy. Two children remain well whereas in one patient a primary hepatoma developed fourteen years posthung and he died of pulmonary metastases. Portosystemic shunt procedures effectively relieve the threat of potentially fatal variceal hemorrhage and improve the opportunity for long-term survival in children with cirrhosis and portal hypertension due to healed histiocytosis X.


Vitrectomy-instrumentation-system MS 7.

Vitrectomy-instrumentation-system MS 7. An instrumentation-system (MS 7) for open-sky- as well as for pars-plana-vitrectomy is described. The intraocular canula is equipped with a special rotating cutting device. Suction is generated by a suction-pump in the power supply unit. Intraocular illumination is obtained by a detachable light pipe on the vitrectomy-canula or-for the bimanual technique-by a special hand-piece with infusion and fiber optic illumination. The infusion-canula in the hand-piece can be replaced by a micro-scissor with infusion-channel. Despite the motor the whole system can be easy cleaned and sterilized.


Vitreoretinal juncture; healing of experimental wounds. Healing of mechanically-induced, minimal wounds of vitreoretinal juncture in non-vascularized retina of rabbits was studied with electron microscopy at 1 and 3 days, and 1, 2, 6 and 10 weeks. Neuroectodermal scar was formed by two processes, each having a specific anatomical relationship to wound. Accessory gliocytosis, in which accessory glia adjacent to wound become phagocytic and proliferate; following this their progeny migrate to wound and progressively differentiate into fibrous astrocytes to fill in the wound proper. Plexiform gliosis, in which the Müller cell side branches proliferate to form a layer about the perimeter of wound. The retinal inner limiting lamina did not regenerate. The significance of these findings in relation to epiretinal membrane formation in man is discussed.


Provoked iris ischaemia in the rabbit. I. Clinical and histopathological examinations. Various surgical procedures were performed on albino rabbits, which impaired anterior segment blood circulation. Our early and late clinical observations showed a consequent development of anterior-segment ischaemia into anterior-segment necrosis. The significance of different surgical procedures for resulting complications is discussed. Histopathological observations showed ischaemic changes in the anterior segment: iris and ciliary body atrophy, cataract formation, rubeosis iridis. Even though changes in the anterior segment were not observed on biomicroscopic examination in the cases with ligation of one LPCA, histological studies revealed different degrees of sectoral iris atrophy with minor rubeosis.


An electron microscopic study on the blood-optic nerve and fluid-optic nerve barrier. Utilizing horseradish peroxidase as a tracer, electron microscopic studies were done on the blood-optic nerve and fluid-optic nerve barrier to the peroxidase diffusion. Following intravenous injection the peroxidase was observed to fill the lumen of the capillaries of the laminar, prelaminar and orbital portions of the optic nerve but there was no penetratation of the capillary walls. The obstruction of the tracer diffusion out of capillary walls was attributed to the tight junctions between the endothelial cells. Peroxidase penetration was also absent in the capillaries of the pia and dura mater, however, was observed in pinocytotic vesicles of the endothelial cells. Lateral diffusion from the surrounding choroid into the optic nerve was detected but diffusion from the prelaminar optic nerve into the juxta-optic nerve retina was prevented by the Kuhnt intermediary tissue. Tight junctions which prevented peroxidase diffusion were found between the glial cells of the Kuhnt tissue, and this tissue was the barrier between the prelaminar optic nerve and the juxta-optic nerve retina. Peroxidase which was given into the lateral ventricle of the brain appeared in the subarachnoidal space around the optic nerve and penetrated freely into the optic nerve. The pial surface of the optic nerve possess no barrier activity. Peroxidase could be traced along the intercellular space between glial cells and optic nerve fibers. The basal lamina of the optic nerve capillaries was filled with peroxidase but diffusion into the capillary lumen was obstructured by the tight junctions between the endothelial cells.


[The effect of repeated adrenaline application on intraocular pressure and pupil in the rabbit (author's transl)]. The effect of single and repeated topical application of adrenaline on the intraocular pressure and pupil in the rabbit eye was studied using a 2% adrenaline borate and a commercial preparation of 2% adrenaline hydrochloride. On the first day, the hydrochloride gave a more pronounced pressure reduction and pupil diladation than the borate. This was found to be due to the benzalkonium chloride in the chloride preparation causing a better permeability of the adrenaline into the eye. From the second to the fifth day of adrenaline treatment a marked pressure decrease was found from the previous application of the day before. The following adrenaline application gave a hypertensive phase of intraocular pressure lasting two or three hours and a subsequent hypotensive phase lasting more than 24 hrs. The pupil diladation on the second and following days of treatment was not essentially different from the first day considering the observation period of two hours. The hypertensive phase could not be influenced by intravenous or intramuscular propranolol, however, the topical application of propranolol inhibited it completely. Some aspects of adrenergic regulation of the intraocular pressure are discussed.


Intravitreal oxacillin in experimental staphylococcal endophthalmitis. We compared combined intravitreal and systemic oxacillin to combined subconjunctival and systemic oxacillin in the treatment of experimental staphylococcal endophthalmitis. Intravitreal injection of 500 mcg was nontoxic to all intraocular structures and produced concentrations in the vitreous bactericidal to all susceptible strains of Staphylococcus aureus for almost 24 hours. In eyes treated 8, 10, and 12 hours after intravitreal inoculation of 10000 to 20000 penicillinase-producing S. aureus organisms, intravitreal injection of 500 mcg of oxacillin was superior to subconjunctival injection of 100 mg when each was combined with seven days of intensive intramuscular oxacillin.


[Spectrophotometric studies for the demonstration of chromo-proteins and bilirubin in the eye (author's transl)]. Following intravenous injection we could demonstrate spectrophotometrically that in the rabbit chromo-proteins like hemoglobin and myoglobin as well as bilirubin are present in anterior chamber fluid, lens and vitreous body. We did not try yet to study the dynamics of these substances in relation to time and their quantitative distribution. Our findings, however, suggest a relationship between the concentration of these substances in the different parts of the eye and the serum. In lens, vitreous body and the anterior chamber fluid of patients dying with jaundice we also were able to demonstrate bilirubin spectrophotometrically.


[Dark adaptation in achromats (mathematical analysis) (author's transl)]. The integral dark adaptation curves of 10 complete acromats, 4 incomplete achromats and 11 normal subjects were compared using regression analysis. Neither in achromats nor in normal subjects a kink could be proven by this method. The final threshold of the mean dark adaptation curve of the complete achromats is slightly elevated. This may be explained by the fact that the group comprised 6 children.


[Transport of 131J-iodo-o-hippurate and 22Na out of the retroretinal space in experimental non rhegmatogenous detachment of the retina (author's transl)]. A model of an experimental arhegmatogenous retinal detachment is presented, to allow the measurement of the transport of radioactive labeled substances out of the subretinal space. Experiments were performed on 19 male cats. 131I-iodo-o-hippurate and 22Na were used as test substances. There was no significant difference between the rate of disappearance of 131I-hippurate  if injected retroretinally or intravitreally. The rate of disappearance of 131I-hippurate could be slowed down by intravenous infusion of penicillin-G. The rate of disappearance  of 22Na following retroretinal injection is not only slower than the rate of disappearance of 22Na injected intravitreally, but significantly slower than the rate of disappearance of 131I-hippurate. For graphic analysis ("curve peeling") of the terms embodied in the curves, more densly situated points of measurements will be necessary. Then the experimental model will serve well to analyze the components influencing the transport of labeled sodium out of the  subretinal space.


[Influence of occlusion of retinal vessels on the transport of 22Na and 131J-iodo-o-hippurate out of the subretinal space (experiments performed on cats) (author's transl)]. By means of microsurgical technique and under the control of the ophthalmoscope 300 mul of isotone solution of NaCl with 22Na or o-131J-iodo-hippuric acid were injected into the space between the retina and pigment epithelium of 28 narcotized tomcats after having closed the inferior retina vessels by photocoagulation about 1 hr before in an umber of the animals. With 22Na we could demonstrate that the retinal vessels influence the speed of the transport of substances out of the space between retina and pigment epithelium: When the retina vessels are closed, the transport is decelerated. The same experiments with o-131J-iodo-hippuric acid did not show any difference between the eyes with coagulated vessels and those with open ones. We cannot answer the question, whether sodium is transported in a mono-directional flux out of the space between retina and pigment epithelium (probably followed by water), or if there is simply an exchange between 22Na out of this space with 22Na of the blood.


The influence of bretylium tosylate on the intraocular pressure of the rabbit. Bretylium tosylate was applied topically and intravitreously to rabbit eyes. The topical application of 1, 2, 5 and 10% bretylium tosylate gave a small but significant decrease of the intraocular pressure 6 hrs after treatment. The effects had disappeared, when the eyes were re-examined after 24 hrs. The intravitreous injection of 200 mug of bretylium tosylate caused a more pronounced and prolonged pressure decrease. The results are interpreted in the light of chemical sympathectomy.


[Questions concerning the effect by diazepam (Faustan) in the EOG (author's transl)]. After oral medication of Faustan the EOG curve demonstrates: 1. a potential reduction throughout all 25 min of investigation; 2. an abnormal curve during dark time in several cases; 3. an inverse reaction in 7 persons.


[Acquired and congenital monocular pendular nystagmus. A comparative electronystagmographic study of two cases (author's transl)]. Comparative analysis of two cases of monocular pendular nystagmus (MPN). The nystagmus was acquired in one case of multiple sclerosis, and congenital in the other patient who had achromatopsia. A postsaccadic inhibition of 0.6-1 sec duration was seen only in the case of acquired MPN. All the other characteristics of the acquired and congenital monocular nystagmus were identical. The waveform of the nystagmus was sinusoidal, triangular or mixed. There was no modification of the MPN by eye position or by smooth pursuit. The nustagmus was inhibited by lid closure. Oscillopsia was reported by both patients. A peculiar disturbance of the sensorimotor feedback loop of the visual system is discussed as the possible common pathogenesis of acquired and congenital pendular nystagmus.


[Posttraumatic unilateral aphakia and contact lens -binocular functions of grown-ups]. The binocular results are only subnormal and comparable to former squinting patients. The results are better if one succeeds in reaching a visual acuity of at least 1.0. One can try to prevent a divergence by prescribing a contact lens as early as possible. Presbyopic patients have better binocular functions because the lost accommodation is the most interfering component (factor). It has disadvantageous effects especially on those patients who are yet presbyopic. The aniseikonia is in contrary to this not an as important interfering factor.


[Fixation disparity under various test-conditions (author's transl)]. Measurements of fixation disparity and Panum areas were performed with a special device of the phase-difference haploscope in normal persons. There was a reproduceable influence on fixation disparity and size of Panum areas, when the conditions of examination were changed (position of the binocular fusion-pattern, brightness and contrast of the targets for sensory fusion and time of prism wearing). There found we found only under comparable conditions a quantitative relationship between the two phenomenons.


[Beginning atrophy of the eye bulb. An echographic-histologic comparative study (author's transl)]. In 21 cases of beginning atrophy of the eye bulb, ultrasongraphy revealed abnormal echoes reflected by equatorial and preequatorial parts of the bulbar shell. In addition, ultrasonography revealed a shortening of the bulbar axis by 0.88 mm and a thickening of the retroequatorial sclera up to 2.1 mm on an average. By correlation of the echogram and microscopic sections the presumption of an edema of the peripheral choroid and the ciliary body could be verified in 6 cases. Thus echography makes possible an earlier diagnosis of beginning bulbar atrophy than does the clinical symtomatology. In such cases surgical procedures for improvement of hypotony are useless or even detrimental.


[Clinical, light- and electron-microscopic investigations on the effect of 5-ethyl-2-deoxyuridine (EDU) in herpes simplex keratitis in rabbits (author's transl)]. Morphologic changes in rabbit cornea accompanying herpes simplex keratitis especially under the treatment of ethyldeoxyuridine (EDU) are summarized in regard to clinical aspects, light microscopy and electron microscopy. Untreated eyes show virus-dependent characteristic changes of the cell structure: peripheral migration of the cell chromatin, swelling of the nucleus, and disappearance of the nucleolus are persistent. In the nucleus as well as in the cytoplasm mature and immature virus particles are visible which demonstrate the normal virus-replication course. In the EDU treated cornea these particular changes are observed only in the primary stage. After prolonged treatment in the nucleus of the infected cells there are only immature virus particles with optically empty center. This can be evaluated as a sign of inhibition of the normal replication. No virus formation was detected in the cytoplasm. After 7 day treatment of EDU, the corneal epithelium is almost of normal structural appearance. Accordingly, the present results on the rabbit seem to correlate well with the reported therapeutic antiherpetic studies in the human cornea.


Ring-shaped alkali burns of the rabbit cornea. Epithelial and endothelial changes. Rabbit corneas were burned by touching their surfaces with rings of Whatman No. 1 chromatographic paper soaked in 1N NaOH. The corneal epithelium and endothelium were studied by impregnating flat sections with McGovern's and Jabonero's silver stains. Immediate destruction as well as regeneration of both cellular layers is described.


[Experimental study of the problem of retinal ischemia (author's transl)]. Survival and revival time of the retina in animal experiments are essentially dependent upon whether total ischemia occurs or not. Using the so-called barbiturate effect in the electroretinogram as a functional criterion, complete ischemia can be shown to take place in rabbit and cat at intraocular pressures of 100 mm Hg. At somewhat lower pressures, which already cause alterations of the ERG a remarked barbiturate effect can be observed, indicating the persistance of a certain amount of remaining blood flow. Possible mechanisms of the barbiturate effect in the retina are discussed.


[Experimental chorioretinitis in rabbits induced by homologous and heterologous photoreceptor outer segments (author's transl)]. Experiments with 73 GrCh rabbits showed, that both homologous and heterologous (bovine) photoreceptor outer segments (ROS) induce chorioretinitic diseases of the same kind. The findings refer to questions of localization and efficiency of homologous and heterologous (bovine) pathogenic ROS antigens.


[Structure of the vitreous body over areas with lattice degeneration of the retina (author's transl)]. The clinical examination of the vitreous in the extreme fundus periphery is difficult; therefore only very little was known up to now about the relations of the posterior limiting membrane of the vitreous and the preretinal tract to retinal lattice degenerations arranged parallel to the ora serrata in several rows. There will be reports of new findings gained by depression biomicroscopy.


[Problem of scattered light in the localized stimulation of the retina (author's transl)]. In attempting local retinal stimulation of an intact eye the generation of scattered light cannot be prevented, but it can be sufficiently reduced by a suitable selection of stimulus parameters, especially of stimulus luminance and facial field luminance, of stimulus size and exposition time. By investigating the most important sources of scattered light, e.g. inhomogenities in the dioptric media, reflections at refracting surfaces, diffraction at the pupil borders, and the distribution of scattered light in the retina it becomes possible to develop indications for the construction of a focal optical stimulator.


[Lesion of the retinal fatty acids following intravitreal injection of iron. An experimental study on the retinal lesions in cases of siderosis bulbi (author's transl)]. In this study the alterations of the pattern of the fatty acids of the retinal phosphatides after intravitreal injection of ferrous ammonium sulphate are treated. In vitro and in vivo a significant decrease of the highly unsaturated fatty acids of the C22 type occurs. This lesion spreads from the region of direct contact between iron and retina towards the periphery within 24 hs. The reliability of the experiment is ensured by the proof of analogous changes in human globes affected with siderosis. Finally, the production of lipid peroxides as a cause of the breakdown of the retinal function is discussed.


An analysis of muscle weight variations in the hindlimbs of Rana esculenta. Dry weights of 24 muscles of the left and of the right hindlimbs in 63 frogs (Rana esculenta) are determined. By means of factor analysis is calculated which part of the variance in a muscle's weight can be accounted for by common factors and which part by the characteristics of the muscle itself. The main results are: 1. Body size (factor 1) accounts for more than 90% of the variance in all the heavier muscles and more than 64% in the eight lighter muscles. 2. Since only one single common factor is found, no separate groups of highly correlated muscle weights are present in the frog's hindlimb. 3. A decrease in the number of fibers is coupled with an increase in the residual variance of a muscle. 4. Left and right identic muscles follow the same variation-pattern. Two models for muscle development are discussed: 1. A model in which the innervation of the muscle determines the number of fibers. 2. A model in which clumping play an important role.


Agammaglobulinemia in a horse with evidence of functional T lymphocytes. Agammaglobulinemia was diagnosed in a 1-year-old Thoroughbred horse on the basis of the following observations: (1) absence of serum immunoglobulins M, A, and G(T); (2) small amounts of serum immunoglobulin G (16 mg/100 ml); (3) absence of specific antibody in the serum of the horse following immunization and challenge exposure to 2 antigens; (4) absence of plasma cells, primary follicles, and germinal centers in a lymph node removed after antigenic stimulation; (5) absence of "natural" serum antibodies to rabbit-erythrocytes which were easily detectable in age-matched control horse serums; and (6) increased susceptibility to infections. There was evidence of functional cell-mediated immunity which included a skin response to injected phytolectins, skin response to antigen challenge following sensitization, and in vitro proliferative response of lymph node cells to phytohemagglutinin. An intact cell-mediated immune response was also supported by the observation that the horse lived to 17 months of age without antibody production, whereas horses with an absence of both antibody production and cell-mediated immunity (combined immunodeficiency) die by 4 months of age without immunologic intervention. The known features of agammaglobulinemia in this horse are similar to those in sex-linked agammaglobulinemia in persons and are unique among the immunodeficiences described in other animals.


Distributions of immunoglobulin-containing cells in alimentary tract, spleen, and mesenteric lymph node of the pig demonstrated by peroxidase-conjugated antiserums to porcine immunoglobulins G, A, and M. Peroxidase-conjugated antibody to porcine immunoglobulins A, G, and M were used in a light microscope study of the distribution of immunoglobulins and immunoglobulin-containing cells in alimentary tract, spleen, and mesenteric lymph node of the pig. Largest populations of plasma cells staining for each of the 3 immunoglobulin classes were demonstrated in the lamina propria of the intestinal tract. Immunoglobulin A cells were most numerous, and immunoglobulin A and M cells each outnumbered immunoglobulin G cells which were, however, present in considerable numbers. Both immunoglobulins A and M were demonstrated in intestinal crypt epithelial cells, indicating they have similar intracellular secretion pathways. Porcine spleen and mesenteric lymph node seem to have a minor role in immunoglobulin synthesis.


A new deficient variant of alpha1-antitrypsin (MDUARTE). Inability to detect the heterozygous state by antitrypsin phenotyping. A new molecular variant of alpha1-antitrypsin was discovered in the family of a woman with severe antitrypsin deficiency and bullous emphysema. The variant resembles the Z variant in most respects in that it results in severe antitrypsin deficiency with the homozygous state and intermediate deficiency with the heterozygous state, and is associated with diastase-resistant, periodic acid-Schiff-positive globules in the liver cells. It differs from the usual Z variant, however, by having normal mobility on acid-starch electrophoresis so that the heterozygous state with the normal M form cannot be distinguished by phenotyping procedures on either acid-starch or alkaline-agarose electrophoresis. The variant has been labeled MDUARTE. A review of phenotype patterns in all patients previously classified as having a homozygous ZZ phenotype reveals extra, fast-moving bands on acid-starch suggestive of an MDUARTEZ heterozygous state in 7.9 per cent of such cases. When intermediate antitrypsin deficiency occurs in the presence of a normal phenotype pattern, one must consider that the patient has inherited either a null gene for antitrypsin synthesis or an MDUARTE variant.


Classification of bronchial lymphocytes from nonsmokers and smokers. The population of lymphocytes obtained by endobronchial lavage is significantly different from the distribution of lymphocytes in the peripheral blood. Both B and T lymphocytes are found in fluids lavaged from the normal human lung. Of the lymphocytes that can be classified, the T cell population is larger than the B cell population in both nonsmokers and cigarette smokers, whereas a further increment in T cells is noted in smokers. A third population of unclassified lymphocytes, the "null" cells, also comprise a large portion of the lymphocyte population in both smokers and nonsmokers. Their significance has yet to be determined.


Aortocoronary bypass in Jehovah's Witnesses: review of 46 patients. The hemodilution technique for cardiopulmonary bypass using blood substitutes for priming has permitted open heart operations in Jehovah's Witnesses who refuse to accept blood, and has reduced the need for massive blood transfusion in certain procedures including aortocoronary bypass. A series of 46 Jehovah's Witness patients underwent aortocoronary bypass procedures. Of these, two patients died, representing a mortality of 4.3 per cent. Neither patient's death was related to lack of blood transfusions. The hospital stay and recovery time of all the other patients was not affected by failure to transfuse blood. The excellent short- and long-term results of this particular group paralleled those observed in our larger series of over 2700 other patients who have undergone coronary bypass surgery since 1969. Among these patients not of the Jehovah's Witness religion, blood transfusion was not necessary in about 30 per cent, while the remainder averaged less than two units per patient. Our results with Jehovah's Witness patients encourage our policy of avoiding blood transfusions whenever possible in all operations. Further justification for our conservative attitude is provided by the current shortage of blood in relation to a projected continuous increase of aortocoronary bypass procedures in the future.


Diagnosis and management of occult gastrointestinal bleeding: visualization of the small bowel lumen by fiberoptic colonoscope. In 95 per cent of patients, the source of gastrointestinal bleeding can be determined by the usual roentgenographic and endoscopic methods. In the remaining five per cent of patients, the source of bleeding is obscure and special diagnostic procedures will be necessary. Among the special procedures that have been reported are the fluorescein string test, stepwise aspiration of intestinal contents, detection of radioactive red blood cells by stepwise aspiration, Geiger counter or scanning, and selective visceral angiography. An additional procedure, reported here, combines exploratory celiotomy with total endoscopic examination of the bowel.


Fleck (Mouchetée) dystrophy of the cornea. Five families, four Caucasian and one Negro (14 patients) with fleck (speckled or Mouchetée) dystrophy of the cornea are presented. In each, the typical presentation of fine scattered fleck-like dystrophic lesions was found throughout all layers of the central and peripheral corneal stroma but not affecting the epithelium, Bowman's membrane, Descemet's membrane or the endothelium. Clear stroma was noted between each lesion. Visual acuity in all patients was normal or only slightly affected. Except for an occasional patient with minor photophobia, almost all patients found affected with this dystrophy were asymptomatic in regard to their corneal condition. There was no decrease in corneal sensitivity noted in any patient. All families displayed evidence of an autosomal dominant hereditary pattern and progression of the dystrophy is slow and benign in character.  With the exception of one family with atopic disease, no systemic organic illness was noted by histroy in all of the families. Laboratory screening of 2 of the 5 families showed no abnormalities of any systemic metabolic disorders. The characteristic clinical picture and favorable prognosis of this condition enables one to easily differentiate this condition from other known parenchymatous corneal dystrophies. The incidence of this condition is probably much more common than the reported cases in the literature might indicate.


Diagnostic and therapeutic vitrectomy for endophthalmitis. The introduction of a compact portable vitreous suction cutter enables the aspiration and resection of infected ocular tissues for diagnostic and therapeutic purposes. Four cases of postoperative bacterial endophthalmitis are presented in which mechanical anterior vitrectomy was performed in addition to conventional antimicrobial therapy. Three of these eyes were saved and 2 retained the possibility of useful vision. A rationale for the aggressive managements of endophthalmitis is presented.


Haemophilus influenzae as a cause of salpingitis. A case is reported of acute unilateral salpingitis, the cause of which was Haemophilus influenzae cultured from a pus sample taken from the infected Fallopian tube during laparotomy. The significance of the findings is discussed with reference to the literature.


Microdilution technique for antimicrobial susceptibility testing of Haemophilus influenzae. A microdilution method incorporating the use of color-defined growth end points was compared with a conventional broth tube dilution procedure for susceptibility testing of Haemophilus influenzae with ampicillin and chloramphenicol. The microdilution method allowed rapid performance of dilution susceptibility tests with easily defined end points.


The relationship between the T-helper cell and the T-cell involved in the delayed hypersensitivity. The common cell type involved in the humoral and cellular responses is the T-cell. Functionally the T-cell, active in the humoral response, is known as Thelper (Th), the T-cell active in the cellular response as Tcellular (Tc). The present experiments are used to study the relationship between Tc and Th. IP immunization, with suboptimal doses of antigen, did not result in antibody formation but induced both a DH (equals Tc) and a Th population. Th and Tc activity changed in a similar way with increasing doses of antigen. Spleen cells taken from mice, which were immunized under conditions which only invoke cellular activity, were able to function even in small numbers as Th in transfer experiments. Educated thymus cells and cells obtained from cortisone or CY treated donor mice had an increased Th and Tc activity when transferred into irradiated recipients. Education in the presence of a high antigen dose reduced both activities below control levels. Cross reactivity between HRBC and SRBC in the hormoral response is known to be at the Th level. It was demonstrated that this cross reactivity also exists at the Tc level. Induction of DH with one antigen acted as pre-immunization, for the humoral response, on the cross reactive antigen too. These results suggest a correlation between the T-cells involved in DH and the Th for antibody formation.


Influences of media and inocula on the in vitro susceptibility of Haemophilus influenzae to co-trimoxazole, ampicillin, penicillin, and chloramphenicol. The effects of inocula and media on the activities of ampicillin, penicillin, chloramphenicol and co-trimoxazole against Haemophilus influenzae were examined in vitro. Two inocula and four media were tested by the disk diffusion, broth dilution, and agar dilution methods. Chloramphenicol activity versus H. influenzae was least affected by changes in inocula and media, whereas co-trimoxazole was most susceptible to these effects. Filde's and Levinthal's agar dilution tests were most satisfactory for ampicillin. Penicillin was less active on Levinthal's than on Filde's agar. Both ampicillin and penicillin were less active when tested against the higher inoculum. Co-trimoxazole was most active (<1% H. influenzae was resistant) when tested at an inoculum of 10(6) colony-forming units/ml on diagnostic susceptibility test agar with 5% lysed horse blood added. The majority of H. influenzae appeared resistant to co-trimoxazole with increases in the test inocula and/or when tested on brain heart infusion with Filde's, Levinthal's or "low-thymidine" Mueller-Hinton medium.


Effect of stimulation with bacterial lipopolysaccharide on the surface-charge of mouse B-lymphocytes. Nude spleen (B) cells were cultivated in vitro in a serum-free medium, without or with lipopolysaccharide (LPS) and their surface-charge was measured by cell electrophoresis. In the absence of LPS, surface-charge did not vary significantly with time, whereas, in the presence of LPS a biphasic modification was observed. Thus, after 4 hours of culture with LPS, surface-charge was diminished by 14%. Subsequently, when DNA synthesis and blast formation were activated, it increased by up to 19-23% over control value, whether LPS was present continuously in the medium or had been eliminated by washing after 4 hours of incubation.


Migration of intramediastinally injected thymocytes in draining nodes. The present study investigated the migration, in the lymph node, of cells entering the organ via the subcapsular sinus. Thymocytes of rats were labelled with 3H-thymidine and injected into the mediastinal cavity of syngeneic recipients. These animals were sacrificed at various intervals after injection. Five minutes after injection, labelled cells were found in the subcapsular sinus, and even in the peripheral cortex, of the draining mediastinal lymph nodes. The overall of the radioautographic observations reveals a migration of cells from the peripheral cortex towards the deep cortex, and into the medullary cords. The observations indicate that such migration can occur in less than 12 hours. Nevertheless, six hours after the injection, some labelled cells had escaped already the draining nodes and migrated into the other lymphoid organs. It is a fact that some of our results suggest that cells may pass directly from the subcapsular into the medullary sinuses without previously migrating into the nodal parenchyma. As to folliculo-nodules and pseudo-follicles, they exhibited relatively few labelled cells. Moreover, some of our findings indicated that cell migration was much slower in the pseudo-follicles than in the extrafollicular zone.


The degradation of paracetamol (4-hydroxyacetanilide) and other substituted acetanilides by a Penicillium species. A mould which was isolated from a solution of paracetamol was identified as a Penicillium species and was found to possess the ability to utilise a series of substituted acetanilides, including paracetamol (4-hydroxyacetanilide), phenacetin (4-ethoxyacetanilide) and metacetamol (3-hydroxyacetanilide) as sole carbon sources for growth. Studies with washed-cell suspensions indicated that growth of the Penicillium isolate in the presence of paracetamol induced the respective enzyme systems for the degradation of this compound. Manometric studies measuring oxygen uptake rates, indicated that the mould was capable of degrading paracetamol to acetate and 4-aminophenol. Acetate was further metabolised whilst 4-aminophenol accumulated in the growth medium and was subsequently i-entified by UV spectroscopy and thin-layer chromatography. Similar experiments with phenacetin indicated metabolism by the mould to acetate and 4-ethoxyaniline which was isolated and identified by subsequent analysis of the growth medium. However, unlike 4-aminophenol and 4-ethoxyaniline, the degradation product (3-aminophenol) from metacetamol metabolism was further degraded by the mould.


RNA synthesis during zoospore germination in the water mold Allomyces arbuscula. The major classes of RNA (rRNA, mRNA, tRNA) start to be synthesized simultaneously in the zoospore of Allomyces soon after the onset of germination. Especially during cyst formation and germ tube emergence, the synthesis of mRNA and tRNA is prominent whereas that of rRNA proceeds slowly. The transcription products of these early stages are needed for the subsequent initiation of hypha formation.


Improvements of the membrane filter method for DNA:rRNA hybridization. We describe and recommend the following improvements of DNA:rRNA membrane filter hybridization methods. One of our aims was to avoid DNA release from filter discs during hybridization. 1. Our hybridization conditions are 2 SSC in aq. dest., with 20% formamide, 50 C, overnight for 16 hr. 2. Duplexing is over in 8-10 hr. 3. Formamide has to be very pure (O.D. less than or equal to 0.2/cm light path at 270 nm). 4. RNAase treatment: 250 mug/5 ml 2 SSC/filter at 37 C for 1 hr. 5. Our conditions for stepwise thermal denaturation are: 5 degrees C steps from 50 C to 90 C in 1.5 SSC in 20% formamide. 6. Single-stranded DNA, fixed on membrane filters, and stored in vacuo at 4C can be used reliably for hybridization for up to 20 months. 7. Concentrated DNA in 0.1 SSC, quick-frozen at -50 C and stored at -90 C for up to 2 years can be used for hybridization without much change. 8. A CsCl gradient purification step yields much purer DNA, but increases the release of DNA from filters by about 20%. Filters with 20% more DAN is a compensation. 9. rRNA can be stored for 20 months in SSC or 2 SSC at -12 C without changing the hybridization results.


A genetic study of tolerance and resistance to colicin A in Citrobacter freundii. Colicin A-insensitive mutants of Citrobacter freundii were isolated and grouped into six phenotypic classes characterized by sensitivity, insensitivity or partial insensitivity to the bacteriocins S6, DF 13 and colicin A, and sensitivity or insensitivity to deoxycholate (DOC) and ampicillin. Mapping by the gradient-of-transmission method revealed the chromosomal regions in which the responsible genes are situated. Res-3 mapped near pur between pur and thr; Tol-5 mapped between aro and ilv and Tol-4 between gal and pur; Tol-1, Tol-2 and Tol-3 are situated close to gal. All the mutations that mapped near gal rendered the bacteria more sensitive to DOC and ampicillin. Complementation analysis with E. coli plasmids showed that the three phenotypic groups that map near gal were complemented by E. coli plasmids and fall into three complementation groups. Two of these are quivalent with the tol A and tol B genes in E. coli.


Halteromyces, a new genus in the Mucorales. Halteromyces radiatus is described as a new genus and species in the order Mucorales. The genus is referred to the family Mucoracease and has close affinities to the genus Absidia. The fungus grows readily in pure culture. The asexual structures are described; no sexual structures have been found despite extensive contrasts with members of the genus Absidia and Gongronella.


Additional notes on species of Aspergillus, Eurotium and Emericella from Egyptian desert soil. Aspergillus floriformis, A. pseudodeflectus, Eurotium xerophilum (st. con. A. xerophilus) and Emericella purpurea (st. con. A. purpureus) are described and illustrated as new species. In addition the morphology of strains identified as Aspergillus melleus, A. caespitosus and A. versicolor is discussed.


On the subdivision of the genus Ceratocystis. The desirability is discussed of a subdivison of the genus Ceratocystis into a group characterized by the presence of a phialidic conidial state, and a group in which the conidia are usually produced exogenously. Corroborative evidence for this arrangement is found in the carbohydrate constitution of the cells: in all examined species of the former group (Ceratocystis s. str.) rhamnose and cellulose are absent, whereas in the latter both components are present (Ophiostoma H. et P. Sydow).


Trichosporon terrestre sp. nov.

Trichosporon terrestre sp. nov. A single strain representative of an undescribed Trichosporon species, was recovered from soil. The cell wall of the strain corresponds in structure to cell walls of the ascomycetous yeasts. On the ground of X-ray inactivation data the strain is assumed to be diploid. A description of the new species is given.


Gastrointestinal hemorrhage from adhesion-related mesenteric varices. As a result of this retrospective analysis of hemorrhage from a porta-systemic venous shunt occurring within the small intestine, we believe that the early diagnosis of the syndrome is strongly suggested by the presence of varices in unusual locations demonstrated by the venous phase of mesenteric arteriography. In all patients portal hypertension was present, and in all the affected bowel was adherent to postoperative adhesions on old suture lines. The syndrome was treated variously with lysis of adhesions, bowel resection, or portal-systemic shunt. Those patients with excellent hepatic reserve survived and had no further gastrointestinal bleeding.


Mesocaval "H" graft using antogenous vein graft. A group of 22 patients with bleeding esophageal varices were treated by creating mesocaval "H" shunts using autogenous veins as the "H" graft. The right external iliac vein was selected as the graft because of its appropriate size in diameter and length, its strength and elasticity. Details in operative technique are outlined. The age of our patients ranged from 24 to 75 years (average age 49), 19 patients had preoperative endoscopy, 10 patients received intraarterial pitressin drip to control hemorrhage, and surgery was done within 10 days of admission in 18 patients. There were two postoperative deaths (both patients Childs Class C), and very few postoperative problems. Right leg edema was a temporary and minimal problem. Encephalopathy was a major problem in only three patients, all of whom had poor hepatic reserve preoperatively. There has been no recurrent variceal bleeding in any of these patients. Our previous experimental data in dogs indicated that the long term patency of these shunts could be assured.


Peripheral vascular anastomotic aneurysms: a fifteen-year experience. A 15-year experience with anastomotic aneurysms resulting from peripheral vascular reconstruction is presented. The analysis is divided into three 5-year periods. It is obvious from this presentation that the etiology is probably caused by suture material, end-to-side anastomosis, proximity of the anastomosis to a joint and intimectomy of the recipient artery at the original operative procedure. None of the lesions reported herein were associated with graft or wound sepsis. Anastomotic aneurysms at the proximal aortic suture line resulted in aortoenteric fistulae in 6 of 8 cases. There were no survivors  in these 6 cases despite successful graft replacement. It is to be emphasized that the complication of anastomotic aneurysm still remains a significant complication in peripheral vascular surgery with a 1.9% incidence noted in 320 operations performed from 1970-1974.


A controlled surgical approach to annulo-aortic ectasia. Annulo-aortic ectasia has attracted much surgical attention in the last 20 years. Replacement of the aortic valve and ascending aorta from the valve ring to just proximal to the innominate artery eliminates most, if not all, the pathologically involved tissue. Composite valve-Dacron tube grafting, plus elective saphenous vein grafts from the coronary orifices to the Dacron tube or distal aortic wall, provide a safe systematic approach to this entity. A review of surgical techniques and a description of a successful case employing this method are presented.


Coronary artery grafting with the saphenous vein or internal mammary artery. Comparison of late results in two consecutive series of patients. In two series of consecutive patients who underwent coronary artery grafting with the saphenous vein or the internal mammary artery (IMA), angiographic studies were conducted two weeks and one year after operation. The early patency rate was 91.8% in 184 vein grafts and 97.4% in 38 IMA grafts. Late patency was 93.1% in 143 vein grafts and 90.9% in 33 IMA grafts. Thus, the cumulative patency rate at one year was 84.9% for vein grafts and 88.3% for IMA grafts. The incidence of severe narrowing at the site of anastomosis was 2.2% in vein grafts and 7.9% in IMA grafts; the rate of occlusion of the distal limb of the recipient coronary artery was, respectively, 4.3 and 7.9%. Diffuse reduction in the caliber of grafts at one year was less frequent with IMA grafts (12.7 versus 6.6%). On the other hand, blood flow was significantly higher in vein grafts: 67.4 versus 45.2 ml per minute (p less than 0.001). Blood flow in IMA grafts whose caliber was larger than that of the recipient coronary artery was significantly higher than flow in IMA grafts with a caliber equal or inferior to that of the coronary artery: 63.1 versus 32.7 ml per minute (p less than 0.001). Although cumulative patency rates at one year were comparable in both series, because only one-third of the IMAs were larger than their recipient coronary arteries, flow was somewhat restricted in the other two-thirds. This suggests that the IMA does not constitute the better bypass conduit and, unless it is of large caliber, preferably should be used in the grafting of small coronary arteries or those with limited runoff.


Comparative hemodynamic properties of vein and mammary artery in coronary bypass operations. To understand better the observed differences in bypass flows between vein and internal mammary artery (IMA) grafts, a technique was devised for anastomosing both vein and IMA to the same anterior descending coronary artery in 14 patients. In the stable postperfusion state, flows in the two bypass conduits were simultaneously recorded as well as pressure relationships in both grafts and the left ventricle. The supply/demand ratio for left ventricular performance was calculated with respect to the diastolic pressure-time index/tension-time index (DPTI/TTI) for each bypass independently and simultaneously and then compared. The DPTI/TTI ratio was nearly two times greater with the vein bypass than with the IMA. This difference was further confirmed by the flow studies, in which blood flow through the vein ranged 2 to 3 times higher than IMA flow to the same coronary bed. By present criteria the DPTI/TTI ratio for IMA grafts to the left ventricle was inadequate in the majority of patients studied, and atrial pacing markedly lowered the DPTI/TTI ratio of the IMA. The choice of vein or IMA as a bypass is a critical determinant of the resultant bypass-left ventricular DPTI/TTI ratio. Vein bypasses exhibited far superior hemodynamic capability in the resting state, and the effect of atrial pacing on the DPTI/TTI ratio in IMA-vein-left ventricle bypasses confirms this point.


Intimal hyperplasia. A cause of radial artery aortocoronary bypass graft failure. Autogenous radial artery grafts have been advocated for those situations in which adequate saphenous vein is not available for aortocoronary bypass procedures. It was anticipated that autogenous artery would demonstrate less predilection to develop the intimal proliferative changes seen with vein grafts in the arterial system. Early clinical experience with 79 patients receiving one or more radial artery grafts has shown that the radial artery is not spared occlusive intimal proliferative changes. Although early restudy of 6 patients was encouraging, late restudy in 29 patients showed 22 of 34 radial artery grafts (64.7%) to be unsatisfactory. Recovered grafts from 3 patients who required a second operation revealed severe generalized intimal hyperplasia. On the basis of this experience we no longer consider the radial artery an alternative conduit for aortocoronary bypass.


The structural study of the saphenous vein. From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency. This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.


Ascending aorta insertion of the dual-chambered intraaortic balloon for counterpulsation during cardiac operations. A patient with left ventricular power failure after aortocoronary saphenous vein bypass was successfully managed by intraaortic dual-chambered balloon counterpulsation through the ascending aorta. This insertion route reverses the orientation of the spherical distal chamber, which inflates early in diastole and partially occludes the aorta. This position achieved an effective augmentation pressure during left ventricular diastole and reduced arterial end-diastolic pressure considerably. The technique of insertion and events at operation and postoperatively are discussed.


The lesser saphenous vein. An alternative graft for coronary revascularization. In patients with surgically removed or varicose greater saphenous veins and atherosclerotic or small internal mammary arteries, or in patients requiring three or more coronary bypasses, the lesser saphenous vein can be considered for aortocoronary revascularization procedures. Its suitability can be demonstrated preoperatively by careful clinical examination and by venography. This report describes the successful use of the lesser saphenous vein in 3 patients, with long-term follow-up.


Improvement in forward coronary blood flow by using a reversed saphenous vein with a competent valve. Reversed segments of saphenous vein have been the grafts of choice for aortocoronary bypass (ACB). Internal mammary arteries and free radial autografts have recently been shown to have a higher ppatency rate, but flow is usually lower. Normally forward coronary blood flow ceases and retrograde flow occurs during cardiac systole. Prevention of retrograde flow with a rapidly acting valve proximal to the coronary artery anastomosis should improve forward coronary blood flow. Thirty-nine reversed saphenous veins containing a competent valve were implanted in 32 patients undergoing ACB. After accurate zero flow was determined and a resting state achieved, mean (22 veins) and pulsatile (17 veins) flows were measured distal to the valve with the valve competent and temporarily incompetent. A competent valve in 10 right coronary artery vein grafts increased mean flow by 29.7% (+41 ml/min; p less than 0.005) and pulsatile flow in 6 veins by 17.7% (p less than 0.001). A competent valve in 12 left coronary artery vein grafts increased mean flow by 31.3% (+34 ml/min; p less than 0.01) and pulsatile flow in 11 veins by 13.7% (p less than 0.001). This study suggests that a portion of reversed saphenous vein containing a competent valve provides greater coronary artery blood flow than veins without valves and may be the conduit of choice for coronary artery revascularization.


A useful instrument for aortocoronary bypass operations. A punch biopsy forceps is described that is used to make openings in the aorta for anastomosing one end of a saphenous vein graft to the ascending aorta. It can be very successful in myocardial revascularization when there is severe calcification of the aortic wall.


Coexistent lymphoid interstitial pneumonia, pernicious anemia, and agammaglobulinemia. Immunologic factors have been incriminated in the pathogenesis of lymphoid interstitial pneumonia. The discovery of a patient with coexistent lymphoid interestitial pneumonia, pernicious anemia, and common variable hypogammaglobulinemia focused attention on the possible autoimmune nature of this pulmonary disease. Extensive immunologic studies demonstrated a noticeably impaired bonemarrow-dependent (B cell) system and intact thymus-dependent (T cell) system. No evidence of humoral or cellular hypersensitivity to homologous lung determinants was found.


[Plasminogen activator and other trypsin-like proteases in the uterus wall and their participation on the tissue bleeding (author's transl)]. In the myometrium and endometrium a content of plasminogen activator and non-specific trypsin-like proteases was determined. It was ascertained that there was a higher level of plasminogen activator in the endometrium during the menstruation in the contrary to the first and second phase of the menstrual cycle and that both plasminogen activator and non-specific trypsin-like proteases were relative higher in Corpusmyometrium than those Cervixmyometrium. The proteases present in the fractions of myometriumeluate were able to split casein and partially fibrin, too. These activities were not inhibited by epsilon aminocaproic acid and aprotinin. The importance of these findings for gynaecological bleeding was suggested.


Infection of human and rhesus lymphoblastoid cells with Herpesvirus macaca. The interaction between Herpesvirus macaca and lymphoblastoid cells grown in continuous culture, or purified from rhesus blood, was studied as a model for latent or chronic herpesvirus infection of leukocytes. Continuous lymphoblastoid cell lines infected in vitro were PA3, a human cell line with bone-marrow derived (B)-lymphocyte characteristics; LM/DM, a rhesus cell line with B-lymphocyte characteristics; and MOLT-4, a human cell line with thymus-derived (T)-lymphocyte characteristics. A distinct pattern of interaction was found for each lymphoblastoid cell line. A small but stable fraction of cells continued to express virus-specific antigens for more than three weeks following infection of the B-type lymphoblastoid cell lines of rhesus and human origin. Herpesvirus macaca replicated only in PA3 cells. Viral replication did not occur and viral antigens were not detected in either peripheral lymphocytes or MOLT-4 cells. The observations suggest that Herpesvirus macaca interacts in distinct patterns with different lymphoid cell lines in vitro, and that within a given culture, subpopulations of lymphoid cells are present at a given time which respond to the virus differently.


Malignant fibrous xanthoma with metastasis to cerebellopontine angle. Malignant fibrous xanthoma is an uncommon tumor of histiocytic origin. It is a difficult tumor to diagnose, and may have an unpredictable and confusing clinical course. The malignant fibrous xanthoma described herein probably represents the first reported case of metastasis to the cerebellopontine angle. When properly diagnosed, the preferred treatment is wide excision. Metastases are usually to the lungs and regional lymph nodes, and portend a poor prognosis. Radiotherapy appears to be of little value.


The results of diagnostic colonoscopy in the management of unexplained bleeding from the rectum. A consecutive series of 71 colonoscopies performed for unexplained bleeding per rectum is reported. All patients had had previous barium enema examinations reported as normal. In 26 colonoscopies lesions were detected; there were 12 cancers and 11 polyps. Twenty-five of these lesions were in the left colon. These findings illustrate the value of colonoscopy in supplementing the available radiological findings. The sighting of blood at sigmoidoscopy was associated with a lesion found on colonoscopy in most instances, whereas the presence of occult blood was associated with a lesion in very few. Colonoscopy should be considered prior to laparotomy in every case of unexplained blood in the stools.


Vestibular-ocular accommodation reflex in man. Stimulation of the vestibular system by angular acceleration produces widespread sensory and motor effects. The present study was designed to study a motor effect which has not been reported in the literature, i.e., the influence of rotary acceleration of the body on ocular accommodation. The accommodation of 10 young men was recorded before and after a high-level deceleration to zero velocity following 30 s of rotation. Accommodation was recorded continuously on an infrared optometer for 110 s under two conditions; while the subjects observed a target set at the far point, and while they viewed the same target through a 0.3-mm pinhole. Stimulation by high-level rotary deceleration produced positive accommodation or a pseudomyopia under both conditions, but the positive accommodation was substantially greater and lasted much longer during fixation through the pinhole. It is hypothesized that this increase in accommodation is a result of a vestibular-ocular accommodation reflex.


Animal experimental studies on chronic granulomatous inflammation and T-lymphocyte-system. The presence of lymphocytes in chronic granulomatous inflammations is frequently thought to indicate that thymus-dependent cellular immune mechanisms are involved in the pathogenesis of such processes. Therefore, in the present studies, a model of a granulomatous heaptitis (induced by heat-inactivated group A streptococci) was used to determine whether liver granulomata, consisting of macrophages and lymphocytes, could also be evoked in neonatally thymectomized or in congenitally thymus-deficient nude mice. The morphological (light and electron microscopical, immunohistological) investigations were supplemented with selective determination of T- and B-lymphocyte function. The thymus-deficient mice, after injection of streptococci, developed liver granulomata that did differ neither quanlitatively nor quantitatively from those of control animals with thymus. Lymphocytes were found within the granulomata in both animal groups. There was no evidence for functional disorder of the RES in thymus-deficient mice; on the contrary, RES-activity seemed to be increased. Phagocytosis of streptococci, their intracellular breakdown and streptococcal antigen-degradation occurred as fast or faster in such animals. PHA- and LPS-stimulation of spleen lymphocytes indicated a considerable depletion of T-cells in neonatally thymectomized mice and a complete absence of T-cells in congenitally thymus-deficient nude mice. However, radioimmunological determination of antibodies to group A streptococcal carbohydrate revealed that both groups of experimental animals possessed functionally active B-cells. Therefore, the granulomatous hepatitis described here can be defined as a focal reaction of the liver RES with "B-lymphocyte trapping". Cellular immune mechanisms are not involved in the pathogenesis of these lesions.


Studies on the humoral regulation of granulopoiesis in leukaemic RFM mice. Intraperitoneal diffusion chambers have been used to investigate changes in humoral factors during the development of myeloid leukaemia in mice. Normal mouse bone marrow cells form colonies of granulocytes and macrophages when cultured in semi-solid agar medium within intraperitoneal diffusion chambers. The use of mice bearing transplanted myeloid leukaemia as Agar Diffusion Chamber (ADC) hosts enhances colony formation from normal marrow. The humoral basis for this stimulation has been shown by the colony stimulating activity of the fluid entering the diffusion chambers when assayed against normal mouse bone marrow cells in agar culture in vitro. The stimulus to colony growth in ADCs and the in vitro colony stimulating activity depend on the phase in the development of the leukaemia investigated, and the stimulation was abolished by splenectomy. There was no apparent relationship between the growth of the leukaemic cell population in vivo and the level of the stimulating factor detected in leukaemic mice.


[Prospective study of patients with prolonged fever]. A prospective study was made in 283 patients who attended IMAN's Children's Hospital, with fever the main symptom. A clinical and paraclinical procedure was designed for the study of each patient. 112 patients were eliminated because they did not follow the established criteria. All patients had acute infectious diseases considered trivial; 85% were 3 weeks to 2 years of age. They all had an antibacterial treatment without precise diagnosis. It was considered that on admission the patients showed a normal course in the natural history of the basic disease. The study group included 171 patients 2 months to 13 years of age; 62.5% had fever due to infection, 12.2% to collagenopathies, 7% to neoplasias 5.2% to miscellaneous causes and 12.8% were not diagnosed. The most common infectious causes for prolonged fever were tuberculosis, upper respiratory infections, amoebic liver abscess, typhoid fever and malaria. Careful questioning and clinical examination were enough to enlighten diagnosis in more than 80% of the patients.


[Histiocytosis. Clinical aspects in childhood]. The clinical and pathologic features in 11 cases of histiocytosis were reviewed. The were 6 cases of Hand-Schüller-Christian, disease 4 cases of Letterer-Siwe and 1 case of eosinophilic granuloma. The clinical differences among those diseases are outlined. We agree with other authors that the symptoms are related in great measure to the moment of embryonic differentation in which the proliferation occurred. When proliferation is present at an early stage of development of macrophage (promonocyte), a more malignant disease appears than when it occurs at a later stage (macrophage). The treatment of histiocytosis is briefly outlined.


Factors influencing prognosis in adults with acute myelogenous leukaemia. A study of the thymidine labelling index (TLI) of bone marrow blast cells in 58 untreated patients with acute myelogenous leukemia showed no correlation with remission rate but there was a strong correlation between labelling index and remission length in the 21 patients who achieved remission. The median remission length of the patients was 33 weeks. Of the 12 patients with initial labelling indices greater than 10%, only 2 had remissions longer than 33 weeks whereas 8 of the 9 patients with labelling indices less than 10% had remissions longer than 33 weeks. No correlation could be found between the degree of cytological differentiation and remission induction, remission length or survival. No correlation was found between the TLI and the degree of cytological differentiation. Age and initial platelet count were confirmed to be important factors influencing complete remission rate, but these factors did not correlate with remission length. Sixteen patients had their pretreatment sera assayed for mouse marrow colony stimulating activity and inhibitor levels but there was no correlation with subsequent response to treatment, although the number of patients examined was clearly too small for any definite conclusions to be drawn.


Active specific immunotherapy of mouse methylcholanthrene induced tumours with Corynebacterium parvum and irradiated tumour cells. The relative efficiency of active nonspecific or specific immunotherapy of developing methylcholanthrene induced fibrosarcomata with C. parvum was compared. For nonspecific immunotherapy, mice were challenged with tumour cells s.c. or i.v., and 2 days later injected i.v. with dilutions of C. parvum. The only significant effect was a retardation of s.c. tumour growth by the highest concentration of C. parvum (350 mug). However, active specific immunotherapy, using mixtures of C. parvum and irradiated or living tumour cells in the footpads, suppressed tumour growth when given at 2 or 6, but not 10, days after tumour challenge. Successful therapy required: sufficient tumour cells (greater than or equal to 5 X 10(4)); an optimal dose of C. parvum (5-120 mug, increasing with the number of tumour cells); an intact T cell system; the same tumour cells for challenge and treatment. The specificity was confirmed in a protection system in which treatment was given 7 days before tumour challenge. No protective immunity could be achieved with mixtures of C. parvum and foetal cells. Thus in this system C. parvum potentiates protective immunity only to the tumour unique TSTA.


Human leukocyte granule elastase: rapid isolation and characterization. Human granulocytic elastases have been purified by a two-step procedure involving affinity chromatography of crude extracts of leukocytic granules on Sepharose-Trasylol, followed by ion-exchange chromatography on CM-cellulose to resolve the isoelastases. All of these enzymes were found to be glycoproteins with the carbohydrate content of the major form being composed essentially of only neutral sugars. The molecular weight of this form was found to be near 30 000 daltons with the other forms being slightly higher. Preliminary structural analyses indicate that all of the elastase isozymes have identical NH2-terminal sequences suggesting that the differences in mobility of the four proteins are not due to different degrees of activation from a common zymogen but, more likely, from minor changes in carbohydrate content. Human granulocytic elastases are less active on ligament elastin than porcine pancreatic elastase, but both are inhibited by synthetic elastase active-site directed low molecular weight compounds (Tuhy, P. M., and Powers, J. C. (1975), FEBS Lett. 50, 359) as well as by plasma alpha-1-proteinase inhibitor (formerly called alpha-1-antitrypsin). In the latter case a stable complex with mol wt of 78 000 daltons is formed indicating the formation of a 1:1 complex.


The action of cordycepin on nascent nuclear RNA and poly(A) synthesis in regenerating liver. Following a 5 min pulse of [5- 3H]orotic acid via the protal vein, the specific radioactivity of non-poly(A)heterogeneous nuclear RNA (HnRNA) reaches a peak at 12 h after partial hepatectomy. In contrast, poly(A)-HnRNA was maximally elevated only at 2 h after operation. After intraportal injection of cordycepin (3'-deoxyadenosine) 1 min before [5-3H]orotic acid, a dose-dependent inhibition of nuclear HnRNA and rRNA occurred. Fractionation of HnRNA on poly(U)-Sepharose following 20 mg/kg of cordycepin revealed that a 65% reduction occurred in the labeling of poly(A)-HnRNA while non-polyactivity of UTP in control and cordycepin-treated animals indicated no significant alterations in these parameters. Assessment of poly(A) size using poly(A)-HnRNA annealed with oligo(dT)10 as template primer for Escherichia coli DNA polymerase I, showed that 20 mg/kg of cordycepin inhibited nuclear polyadenylylation by 43%; no alteration in the binding of poly(A)-HnRNA to Millipore filters occurred at this dose of cordycepin. These results indicate that cordycepin is a non-selective inhibitor of nuclear RNA and poly(A)synthesis in regenerating rat liver.


Deviations from the flux ratio equation for chloride ions in ouabain- and acetazolamide-treated frog skin. In order to establish whether or not chloride ions behave as freely moving particles in "passive", i.e. ouabain- and acetazolamide-treated, frog skin, tracer fluxes of 36Cl-have been measured while a voltage (generally +40 mV, serosal side positive) across the skin was applied. Ussing's flux ratio equation has been used as a criterion for this type of transport. One group of skin samples exhibited significant exchange diffusion phenomena. Most samples in a second group either behaved according to the flux ratio equation of showed significant and extreme exchange diffusion. From flux ratios obtained at two different voltages across various skin samples, showing extreme exchange diffusion, it appeared that the simple form of Kedem and Essig's law derived from irreversible thermodynamics, which is valid for homogeneous systems, does not apply to the type of exchange diffusion found. The system can, however, be described by a 1:1 exchange mechanism working in parallel with a diffusional pathway. The ratio exchange flux/observed efflux must then have a constant value (0.83) at the voltages appled, which implies that the exchange flux is voltage dependent. By comparison with iodide flux experiments as carried out by Ussing, it is shown that iodide exhibits the same type of exchange diffusion. A carrier, possibly responsible for the observed behaviour, is described.


The influence of glutamine, its decomposition products, and glutaminase on the transformation of human and mouse lymphocytes. The extent of blast transformation for human and BALB/c mouse lymphocytes has been examined over a wide range of glutamine concentrations with several agents which initiate blastogenesis. Maximum [3H] thymidine incorporation was seen at 0.5 mM glutamine for lymphoid tissues stimulated in the following manner: human and BALB/c splenic and peripheral blood lymphocytes with phytohemagglutinin, BALB/c splenic lymphocytes with lipopolysaccharide, and BALB/c vs C3H/HeJ two-way mixed lymphocyte cultures. The inhibition of blastogenesis exerted by glutamine concentrations greater than 0.5 mM could not be reversed by washing and reculturing the cells at 0.5 mM glutamine. To elucidate the reason for inhibition by higher glutamine concentrations, the products of spontaneous glutamine decomposition, L-2-pyrrolidone-5-carboxylic acid and ammonia were tested for their in vitro influence on BALB/c splenocyte blastogenesis. Pyrrolidone-carboxylic acid, in concentrations up to 5 mM, was without effect. In contrast, ammonia concentrations exceeding 1 mM became increasingly more inhibitory. The genesis of inhibitory levels of ammonia in culture medium was confirmed and has been considered as primarily responsible for inhibiton by high glutamine. Addition of Escherichia coli glutaminase (pH optimum 4.9) to cultures of BALB/c splenocytes or human peripheral blood lymphocytes had no effect on either the extent of blastogenesis of these tissues or the glutamine levels in their culture medium.


Effects of cycloheximide on protein degradation and gluconeogenesis in the perfused rat liver. Cycloheximide at concentrations above 18 muM produced a 93% inhibition of total protein synthesis measured by valine incorporation in the perfused rat liver. Rates of protein degradation were estimated by perfusing livers prelabeled in vivo with L-[1-14C]valine with medium containing 15 mM L-valine. Thus labeled valine released from liver protein during perfusion was greatly diluted and reincorporation of label was minimized. Cycloheximide at 18 muM inhibited protein degradation by over 60%, after a delay of 15-20 min. Associated with these effects were dose-dependent increases in the rates of glucose and urea production. Glucose production increased 3 fold, from 0.54 +/- 0.07  in control to 1.85 +/- 0.24 mumol/min/100 g rat in cycloheximide-treated livers. Urea production increased from 0.24 +/- 0.02 to 0.62 +/- 0.06 mumol/min/100 g rat. No changes in liver glycogen or cyclic AMP content were seen. The data suggest that inhibition of protein synthesis provides an increased availability of intra-cellular amino acids and that many of these are rapidly degraded, yielding urea and glucose. This is supported by the fact that intracellular alanine levels were significantly increased following cycloheximide treatment. It is possible that the inhibition of protein degradation by cycloheximide is due to altered intra-cellular pools of amino acids or their metabolites.


Restoration of cellular immune response by levamisole in patients with Hodgkin's disease. Cellular responses were studied in patients with Hodgkin's disease before and after levamisole treatment "in vivo" by measuring delayed skin reactivity to various antigens (PPD, Mumps, Candida and SK-SD), and "in vitro" by evaluating lymphocyte capacity to form spontaneous rosettes and to react to the T-cell mitogen PHA. Levamisole was found to significantly increase both the delayed skin reactivity and the number of T-rosette forming lymphocytes. Patients within two years from irradiation had reduced reactivity to PHA and in them levamisole significantly increased this reactivity. On the other hand, patients who had been irradiated more than two years prior to the study had normal reactivity to PHA which tended to decrease under levamisole treatment. It is concluded that levamisole restores the depressed cellular immunity in patients with Hodgkin's disease and its administration might be indicated in patients, especially in the immediate post-irradiation period.


The action of acetylcholine antagonists on amino acid responses in the frog spinal cord in vitro. 1 The isolated hemisected frog spinal cord has been used to study the action of acetylcholine antagonists on amino acid responses by means of sucrose gap recording. 2 Primary afferents and motoneurones were shown to contain few, if any, cholinoceptors, since acetylcholine and carbachol responses were essentially abolished when synaptic transmission was blocked with magnesium ions or when action potentials were blocked by tetrodotoxin. 3 Curare antagonized the gamma-aminobutyric acid (GABA) and beta-alanine depolarizations of primary afferents and hyperpolarizing action of these amino acids on motoneurones. Nicotine also antagonized beta-alanine depolarizations and to a small extent GABA depolarizations of primary afferents. These actions are similar to but weaker than those obtained previously with picrotoxin. 4 Atropine selectively antagonized beta-alanine depolarizations of primary afferents and blocked beta-alanine and glycine hyperpolarizations of motoneurones. GABA responses were entirely resistant to the action of atropine. These actions are similar to but 50 times weaker than those obtained previously with strychnine. 5 Dihydro-beta-erythroidine, tetraethylammonium, and gallamine were entirely ineffective in antagonizing amino acid responses. Since these agents are known to block the dorsal root potential elicited by ventral root stimulation but have no effect on the amino acid responses of primary afferents, it is evident that a cholinergic step is involved in this pathway.


Thyroid and other autoantibodies in British and Japanese women: an epidemiological study of breast cancer. To define the role of asymptomatic autoimmune thyroiditis in the cause of breast cancer, the presence of circulating thyroid autoantibodies was studied in two populations, one with a high risk of breast cancer (British women) and one with a low risk (Japanese women). Ostensibly healthy women and patients with breast cancer from both countries were studied. There was no difference in the incidence of thyroid autoantibodies between women with breast cancer and healthy women in either race. The incidence of thyroid autoantibodies in healthy British women, however, was two to three times that in healthy Japanese women. The incidence of reticulin antibodies, was considerably higher in both groups of Japanese women. No remarkable differences in the incidence of antinuclear, smooth-muscle, antimitochondrial, gastric parietal cell, or liver-kidney microsomal antibodies were found between women with breast cancer and healthy women or between the two races. Only the incidence of antinuclear antibodies was marginally higher in Japanese patients with advanced cancer. These results indicate that asymptomatic autoimmune thyroid disease is more prevalent among British than among Japanese women, but they fail to provide direct evidence that autoimmune thyroid disease is associated with breast cancer. Prospective studies of women with autoimmune thyroiditis and studies of young women from low-risk and high-risk populations are needed.


Radiology and endoscopy in acute upper gastrointestinal bleeding. Of 112 patients admitted with acute upper gastrointestinal bleeding, the presumed bleeding site was detected in 61-5% of cases by radiology and in 57% of cases on endoscopy. Thirty-one patients who had barium-meal examination were operated on and the surgical and radiological findings agreed in 26 (84%). Twenty-three patients who had endoscopy were operated on and the surgical and endoscopic findings agreed in 15 (65%). In 10 cases radiology detected a lesion not identified on endoscopy and in nine endoscopy detected a lesion not seen at radiology. We suggest that when there are two potential sources of bleeding radiology as well as endoscopy can detect the actively bleeding lesion. The supplementary nature of radiology and endoscopy is emphasised and we conclude that both methods should be used if there is any doubt at the initial radiological or endoscopic examination about the source of the bleeding.


Efferent projections of the superior olivary nucleus in the frog, Rana catesbeiana. Following electrolytic lesions of the superior olivary nucleus (SO) of the bullfrog, Rana catesbeiana, the efferent pathways of this nucleus were studied with silver impregnation methods. The major projection was to the ipsilateral principal nucleus of the torus semicircularis. Less conspicuous degeneration was traced to the nuclei magnocellularis and commissuralis of the torus. No contribution was made to the tectum or nucleus isthmi. Other projections of the SO include a sma-ler contralateral projection to these same nuclei and to the ipsilateral nucleus lateralis profundus mesencephali. A system of connections between the acoustic nuclei was invariably interrupted with these lesions and the degeneration seen in the more dorsal acoustic areas was not entirely due to the destruction of SO neurons.


The risk of iridocyclitis in juvenile rheumatoid arthritis. A retrospective study comparing 14 patients with juvenile rheumatoid arthritis (JRA) complicated by chronic iridocyclitis (Group I) with an equal number of JRA patients without this complication (Group II) was conducted to determine which factors might aid in the earlier diagnosis of chronic iridocyclitis. Eleven patients in Group I had oligoarticular disease compared to 5 in Group II. Antinuclear antibody was found in 13 patients in Group I compared to only 2 in Group II. Only one of nine patients tested in Group I for the histocompatibility antigen W-27 was positive. The patient with oligoarticular disease and a positive ANA test should be followed closely by the ophthalmologist for the development of chronic iridocyclitis.


Chemotherapy, en bloc resection, and prosthetic bone replacement in the treatment of osteogenic sarcoma. In an attempt to shrink primary osteogenic sarcoma and allow complete surgical removal of the primary tumor, without amputating the involved limb, intensive preoperative chemotherapy with high dose methotrexate (HDMTX) with citrovorum factor rescue (CFR) and adriamycin (ADR) was initiated in 20 patients with biopsy-proven primary osteogenic sarcoma of the distal femur (15 patients) and proximal tibia (five patients). Following intensive chemotherapy, en bloc resection of the primary tumor with prosthetic replacement of the involved bone was planned. After surgery, adjuvant chemotherapy, consisting of HDMTX with CFR, ADR, and high dose cyclophosphamide was given sequentially for 1 year. Of 20 patients with primary osteogenic sarcoma (two with evidence of pulmonary metastases), 18 had primary tumors that could be clinically measured. Of these 18, 17 demonstrated a decrease in the size of primary tumor prior to surgery, while on chemotherapy. To date, 12 of these patients with osteogenic sarcoma of the distal femur have had total femur and knee joint replacement, and three patients with osteogenic sarcoma of the proximal tibia have had total knee replacement. In all 15 patients, surgical margins were grossly and microscopically free of tumor. There has been no evidence of soft tissue recurrence in any of the 15 patients who have undergone surgery for from 2 to 15 months postoperatively. These preliminary results indicate that with the use of aggressive chemotherapy, it is possible to demonstrate objective tumor regression in primary osteogenic sarcoma, allowing the surgeon to perform en bloc resection of tumor and prosthetic replacement of the involved bone. Although the limb is preserved, it is important to stress that extensive surgery yielding tumor-free margins is performed. The ultimate evaluation of this approach to the treatment of primary osteogenic sarcoma awaits longer observation, to determine limb function and the continued disease-free status, once adjuvant chemotherapy is discontinued.


An attempt at synchronization of marrow cells in acute leukemia: relationship to therapeutic response. The relationship between changes in the bone marrow labeling index and the patient's subsequent response to cycle-specific agents was studied by the South-eastern Cancer Study Group in adults with acute leukemia. Ninety-eight patients were randomized to one of two treatment regimens. Schedule 1 consisted of a single intravenous (i.v.) push of cytosine arabinoside followed in 48 hours by a large dose of oral methotrexate distributed over 24 hours and i.v. vincristine. Leucovorin rescue was employed to control the toxic effects of the high dose methotrexate and the cycle was repeated every 7 days. Schedule 2 differed only in that there were three daily injections of cytosine arabinoside preceding vincristine and methotrexate injections and each cycle was given every 10 days. Cell kinetic studies were performed in 30 patients and revealed that the majority of patients who had a response to therapy had some increase in the marrow labeling index 48 hours after cytosine arabinoside injection. In general, those patients who had no response to therapy had little change. There was no significant difference between schedules in the ability to induce an increase in labeling index 48 hours after cytosine arabinoside or in the increment achieved by the responders. However, there was a significant difference in the response rate seen with these schedules. Schedule 1 achieved only a 24% remission rate in acute nonlymphocytic leukemia (ANLL) while schedule 2 was associated with a 52% remission rate. In acute lymphoblastic leukemia (ALL) both schedules induced a 60% remission rate while none of the four patients with blast crisis of chronic granulocytic leukemia (CGL) responded. Analysis of the characteristics associated with remission revealed that more females achieved a remission than males and that the presence of pretreatment infection was the greatest contributing cause of early death and thus severely limited the ability to achieve a remission. As opposed to the current regimens used in ANLL, schedule 2 did not require significant bone marrow hypoplasia (as judged by the degree of hematological toxicity) to achieve a remission and there was no decrease in response seen with increasing age. The data suggest that increased efficiency of cycle-specific, antitumor agents may occur by increasing the proportion of human leukemic cells in DNA synthesis.


The effect of thymosin on human T-cells from cancer patients. The effect of thymosin on in vitro reactivity of peripheral lymphocytes to phytohemagglutinin, concanavalin A, and the formation of spontaneous E-rosettes in 54 patients with metastatic carcinomas has been studied. Thymosin increased lymphocyte responses to PHA and Con A in only 10 patients, with predominant effect seen with Con A. Twenty patients showed depressed baseline levels of E-rosettes which were increased to normal or subnormal levels after incubation with thymosin. No distinct correlation was noted between the clinical stage of the disease and the ability of lymphocytes to form E-rosettes. Although the exact mechanism by which the thymus exerts its influence on host resistance is not clearly defined, present evidence supports the concept that the thymic hormone, thymosin, may be an important addition in treatment of cancer patients by increasing cell-mediated immunity.


The role of upper gastrointestinal endoscopy in patients with cancer. The last decade has seen considerable advance in the application of fiberoptic endoscopy to the diagnosis and management of patients with cancer. Forward and side-viewing instruments have been developed that have complete tip control, potential for obtaining directed biopsies, brush and lavage cytology, and for aspiration of material for assay of enzymes and tumor-associated antigens. These features have provided a high degree of diagnostic capability in the esophagus, stomach, and duodenum. Accurate histologic diagnoses require multiple biopsies and brush cytology from each lesion. Lavage cytology has been useful in selected patients, especially those with diffusely infiltrating lesions. Brush cytology has been especially helpful in patients with stenotic esophageal cancer. These techniques have also provided a diagnosis in a high percentage of patients with lymphoma involving the stomach. Endoscopy has also been very useful in patients with nongastrointestinal cancer who have major gastrointestinal problems such as bleeding stress ulcers or monilial esophagitis.