Subacute sclerosing panencephalitis virus in immunosuppressed adult hamster. A hamster-adapted subacute sclerosing panencephalitis agent (HBS virus) produced a subclinical, nonlethal, and cell-associated encephalitis after intracerebral inoculation of adult hamsters. When adult hamsters were immunosuppressed by intraperitoneal injections of rabbit origin anti-hamster lymphocyte serum for varying periods of time before and after intracerebral challenge with HBS virus, more than 50 per cent died in all experiments. Large titers of cell-free virus developed acutely in all animals and were maintained in continuously immunosuppressed hamsters, all but one of which died within 21 days. When animals were given transient anti-hamster lymphocyte serum treatment, those surviving for 21 to 54 days always displayed serum measles antibodies, and, from such animals, highly cell-associated virus could often be isolated from the brain. In such animals and in some others from which no virus could be isolated, the presence of measles antigen or inclusion cell pathology was noted in the brain. The neuropathology was characterized early by focal necrosis; small, multinucleated, ependymal giant cells; and minimal inflammatory reactions. Chronically, it was represented by mild perivascular inflammation, plasma cell accumulations, and inclusion-bearing cells. These studies indicate that it is the host immune response, rather than intrinsic central nervous system resistance to virus infection, which changes with age and thereby increases the chance of survival. The results suggest that antibodies modify the virus, making it more cell-associated or defective and thus enhancing its persistence in the immune host.


Effect of beta-aminopropionitrile on in vitro bone lipid synthesis. The effect of beta-aminopropionitrile (BAPN) on lipid synthesis and 14CO2 production from 14C-acetate by rat calvariae in vitro was investigated by biochemical, histochemical, and autoradiographic techniques. Exposure of bones to 5 mM BAPN throughout a 5-hour incubation period resulted in little effect on lipid synthesis when compared with control bones. Higher BAPN concentrations, up to 100 mM, during this short incubation period resulted in enhanced lipid radioactivity for most of the identified lipid classes. Longer preincubation periods of 20 hours and low BAPN (20 mM) concentrations resulted in enhanced lipogenesis. As BAPN concentrations above 20 mM were employed, lipogenesis decreased to such a level that some lipid classes failed to become labeled with 14C-acetate. 14CO2 production from 14C-acetate by a rat calvariae was affected by BAPN concentration and incubation time in a pattern similar to that of lipid synthesis. Histochemistry demonstrated neutral fat in the osteogenic cells and phospholipids in osteoblasts and the osteoid matrix. Autoradiographic localization of 14C-acetate revealed that the radioactivity was in the osteogenic cells and that this activity was markedly increased after pretreatment of the calvariae with BAPN. This study shows that some concentrations of BAPN enhance lipogenesis by rat calvariae and supports the earlier suggestion that lipids play a role in biologic calcification.


[Biochemical changes in skeletal muscles during hypokinesia and possible means for counteracting them]. The changes in the metabolism of proteins, carbohydrates, fats, water and minerals as well as in the acitvity of enzymes of skeletal muscles during hypokinesia are discussed. The methods used to reverse metabolic disorders in skeletal muscles are recommended and evaluated. Among the suggested methods-the diet with predominant proteins, hypoxia, anabolic steroids and physical exercises-the latter seem to be most promising.


Immunoglobulin A glomerulonephritis: a clinicopathologic study. Renal biopsies from 10 patients staining predominantly for immunoglobulin A are reviewed. Historically, nine of 10 patients were less than 32 years of age; they all presented with either microscopic or gross hematuria. The initial creatinine clearances demonstrated good function in all patients; only one patient experienced a progressive decline in the creatinine clearance. Similarly, proteinuria was mild. The light and electron microscopic findings presented a variable pattern, including a group with changes confined to the mesangium, another group also having glomerular basement membrane changes, and one patient with severe, progressive glomerular sclerosis. Immunogluorescence demonstrated large amounts of IgA predominantly within the mesangium but occasionally involving the peripheral capillary loops. Serum IgA levels were elevated in six of eight patients tested, and two of five patients had elevated nasal IgA concentrations. These data suggest that there is an immunologic entity, IgA glomerulonephritis, characterized by the above clincial findings in association with elevated serum and occasionally nasal IgA levels, but that the pathologic findings are highly variable. Neither the mechanism nor the particular pathogenetic significance of the raised IgA levels is presently known. The similarities of this entity to the reported findings in anaphylactoid purpura are mentioned.


Cytoplasmic contractile apparatus in aortic endothelial cells of hypertensive rats. Hypertension was produced in male Wistar rats (150 gm. body weight) by complete ligature of the aorta between the renal arteries. Electron  microscopic examination revealed that 1 week later the amount of cytoplasmic microfilaments in the endothelial cells of the aortic segment above the coarctation (mean blood pressure 160 mm. Hg) was strikingly increased as compared with normal animals. The endothelial cells in the segment below the coarctation (mean blood pressure 25 mm. Hg) contained few filaments and were similar to the cells in the aortic endothelium in controls (mean blood pressure 105 mm. Hg). Microfilaments measured 40 to 70 angstrom in diameter and were mostly located close to the endothelial clefts, where they formed longitudinal bundles or a network. The bundles of microfilaments contained electron-dense areas similar to the "attachment sites" of the underlying smooth muscle. By using en face preparations of aortic endothelial cells treated with antiactin autoantibodies (AAA) followed by anti-human IgG, it was seen that in hypertensive animals the cells above the ligature were intensely fluorescent when compared with those of the aortic portion below the ligature or those of the controls. The fluorescence was abolished after incubation of the AAA sera with thrombosthenin A. The correlation between electron microscopic and immunologic findings suggests that the microfilaments present in the endothelial cells of hypertensive animals are composed, at least in part, of actin. Endothelial cells so modified may play a role in permeability or may be related to other phenomena such as electrotonic coupling and synchronized contraction of aortic cells during hypertension.


Experimental glomerulonephritis in the rat induced by antibodies directed against tubular antigens. II. Influence of medication with prednisone and azathioprine: a histologic and immunohistologic study at the light microscopic and the ultrastructural level. In this paper, the effect of the administration of prednisone and azathioprine on an experimental immune complex glomerulonephritis is studied. During the observation period of 3 months, it appeared that prednisone had no effect either on the morphology of glomerulonephritis or on the proteinuria caused by it. Azathioprine, especially when given 4 days before or simultaneously with the induction of the experimental immune complex glomerulonephritis, showed a clear effect on the morphology of the glomerulonephritis as well as on the proteinuria. The damage to the glomerular basement membrane as a result of deposition of immune complexes was less and the proteinuria was significantly lower. The effect of azathioprine was not present when given 10 days after the induction of glomerulonephritis, at a time when the autologous phase had already developed.


Extrathoracic bypass for stenosis of innominate artery. Stenosis of the innominate artery usually occurs in older patients in whom the risks of conventional, corrective procedures such as transthoracic endarterectomy or aorto-innominate arterial bypass grafting are quite high. An axillo-axillary bypass procedure was performed in a high-risk patient with innominate arterial stenosis who had repeated episodes of transient cerebral ischemia due to decreased blood flow through the right carotid artery and reversal of blood flow through the right vertebral artery. Postoperatively, he has had dramatic improvement in his symptoms. Because of its simplicity, avoidance of major thoracotomy, avoidance of temporary occlusion of the carotid artery, and excellent late results, axillo-axillary bypass grafting is being proposed as the procedure of choice for stenosis of the innominate artery.


Hemodynamic observations in the early period after human heart transplantation. Serial hemodynamic measurements, including determination of cardiac output by the Fick technique, were obtained in 10 human cardiac recipients for intervals up to 38 days after transplantation. Immediately postoperatively, donor cardiac output was severely depressed because of limitation of stroke volume. Spontaneous recovery of cardiac output and stroke volume then occurred gradually over the first 4 postoperative days to normal or nearly normal levels. Rate augmentation by arterial and/or ventricular pacing early after transplantation had little effect on donor heart performance, but isoproterenol caused significant enhancement of graft function and is now used routinely in postoperative management. Serial hemodynamic monitoring proved to be of little use in the prediction or confirmation of acute graft rejection episodes.


Surgical repair of total cleft sternum.

Surgical repair of total cleft sternum. There are two objectives in the surgical repair of congenital total cleft sternum:(1) to afford normal bony protection to the mediastinal structures and (2) to provide stability of the anterior thorax so that respiratory function and circulation can be maintained physiologically within normal pressure relationships. A case is presented, and a new method for repair of this life-threatening congenital anomaly is described.


Evaluation of an outpatient pediatric practice through the use of consumer questionnaires. Two questionnaires were given to parents accompanying children to an out-patient pediatric center. The first was given to all Ss directly after a care-receiving visit; the second was given one week after the visit only to Ss accompanying Ps receiving throat cultures. Care was judged extremely favorably in both instances. Quality of care measures intercorrelated very highly. No strong relationship was found between length of illness or illness versus absence and rated quality of care received.


The significance of positive margins in hemilaryngectomy specimens. This clinicopathologic study was undertaken to determine the meaning of surgical margins "involved" with carcinoma. The fate of hemilaryngectomy patients whose specimens had this finding was comparared with that of patients who had "uninvolved" margins. A consecutive series of 111 hemilaryngectomies performed for previously untreated invasive epidermoid carcinoma was analyzed. Serial step sections in a longitudinal plane were available for re-examination and re-evaluation of the surgical margins in each case. Clinical follow-up on every patient was current through 1972. Thirty-nine patients had cancer involvement of a margin in the hemilaryngectomy specimen. None of these patients received any immediate therapy but were followed only. Seven of these patients (18 percent) subsequently developed a biopsy proven local recurrence. Four of the 72 patients (6 percent) with uninvolved margins developed a local recurrence. The site of the positive margin in the specimen was compared with the clinical site of recurrence. The seven local recurrences in patients with positive margins were treated with full course irradiation or total laryngectomy. All of these patients are alive and free of cancer or have died of other causes without evidence of cancer. Of the four local recurrences in patients with negative margins one died of cancer; two are living and well, and one died of other causes. This study provides evidence to support the conservative management of those hemilaryngectomy patients who have involved margins in the resection specimen. No immediate treatment is required. Careful follow-up is indicated with 18 percent chance of clinical recurrence. These biopsy proven recurrences can then be successfully treated with total laryngectomy or full course irradiation. Utilizing this approach none of the 39 patients with involved margins died of cancer in the 5 to 12-year follow-up period.


Certain effects of adenoidectomy of Eustachian tube ventilatory function. In an effort to develop a simple and accurate method to identify children in whom adenoidectomy might prevent otitis media, the ventilatory function of the Eustachian tube was assessed by a manometric technique. Nasal pressures during swallowing were also determined in some. The study group consisted of 23 children with otitis media in whom tympanostomy tubes had been inserted. All were judged clinically and roentgenographically to have prominent adenoids. Inflation-deflation Eustachian tube ventilation studies were obtained in 36 ears that remained intubated, aerated and dry both before and eight weeks after adenoidectomy. Fifteen of the 36 (42 percent) ears had improvement in Eustachian tube ventilatory function postadenoidectomy which was attributed to relief of extrinsic mechanical obstruction of the tube. In the remaining 21 (58 percent) ears in which Eustachian tube function was not improved, mechanical obstruction was not apparent preoperatively. The effect of nasopharyngeal pressures on a pliant Eustachian tube (Toynbee phenomenon) due to obstruction of the posterior nasal choanae by the adenoid mass was suggested as a possible cause of functional Eustachian tube obstruction. In several instances in which preadenoidectomy mechanical obstruction of the Eustachian tube was not demonstrated, the tube appeared to have been made more pliant by the operation. This increase in compliance of the Eustachian tube was attributed to loss of adenoid support of the tube in the fossa of Rosenmuller. From this study, preliminary recommendations for selection of patients for adenoidectomy are the following: 1. Eustachian tube ventilation function tests in a dry, intubated middle ear; 2. if extrinsic mechanical obstruction of the Eustachian tube is present and chronic inflammation is absent, adenoidectomy will probably improve Eustachian tube function. The surgical technique should include adequate removal of the adenoid tissue in the fossa of Rosenmuller; 3. if the Eustachian tube does not appear to be mechanically obstructed, the adenoids should not be removed unless functional obstruction is suspected due to obstruction of the posterior nasal choanae. Adenoid tissue within the fossa of Rosenmuller should not be removed when such circumstances exist; and 4. in the abscence of obstructive adenoids to the nasal choanae or Eustachian tube, adenoidectomy probably will not improve Eustachian tube function and could make it worse. A more rational and effective approach to adenoidectomy for the prevention of otitis media in children may be possible through this type of preoperative evaluation.


The inverted Schneiderian papilloma: a clinical and pathological study. Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.


Failure of high dose 5-iodo-2'-deoxyuridine in the therapy of herpes simplex virus encephalitis. Evidence of unacceptable toxicity. Two placebo-controlled double-blind studies were initiated to evaluate the therapeutic efficacy of 5-iodo-2-deoxyuridine (idoxuridine) in biopsy-provedcases of herpes simplex virus encephalitis. Twelve patients who on clinical grounds were thought to have herepes simplex virus encephalitis underwent brain biopsy; six of these patients were proved to have this disease, three were considered probable cases,and three were considered doubtful. The patients with proved or probably herpes simplex virus encephalitis were treated with parenteral idoxuridine (or placebo) at a dose of 100 mg per kiogram per day for five days. The occurrence of unacceptable myelosupperssion and the failure of idoxuridine therapy to prevent death led to the premature termination of both studies.


Treatment of gallstones with chenodeoxycholic acid and phenobarbital. In a controlled trial, 36 patients with asymptomatic radiolucent gallstones were treated with chenodeoxycholic acid, 750 mg per day, phenobarbital, 180 mg per day, combination of both drugs, and placebo. After one year, chenodeoxycholic acid, phenobarbital and the combination, but not placebo, significantly decreased biliary cholesterol saturation. The effect was significantly greater with chenodeoxycholic acid and the combination than with phenobarbital. Gallstones size decreased more than 50 per cent in nine of 20 patients receiving chenodeoxycholic acid, either alone or combined with phenobarbital, but in no patient receiving only phenobarbital or placebo. Gallstones disappeared completely in tow patients. Abnormalities in liver-function tests in thriee of 36 patients and in five of 16 liver biopsies, occured with equal frequency in the four treatment groups. Thus, after one year, phenobarbital alone was ineffective in gallstone dissolution. Chenodeoxycholic acid alone or combined with phenobarbital, however, offered a partially effective and safe treatment for asymptomatic radiolucent gallstones.


Relation between quality assessment and utilization review in a functioning PSRO. The Utah State Medical Association, through its peer-review foundation, the Utah Professional Review Organization, has implemented an integrated system of utilization reveiw and quality assessment linked to a program of continuing education.  Nurse co-ordinators, employed by the Organization, screen all hospitalized patients covered by Titles XVIII, XIX and V as well as by subscribing private insurers. Approximately 10 per cent of hospitalized patients do not meet peer-generated criteria for admission review or length of stay and are screened out for peer review,  The nurse co-ordinators collect data for retrospective quality assessment, identifying targets for continuing medical education.  Preliminary data support the cost effectiveness of such a review program.  Continuing qualtiy audit will test the effectiveness of education programs.


Severe combined immunodeficiency and adenosine deaminase deficiency. Because others had described a lack of the enzyme adenosine deaminase as associated with severe combined immunodeficiency, we surveyed kindreds with infants affected with such an immunodeficiency. Three infants in two families with severe combined immunodeficiency were found to have no detectable erythrocyte adenosine deaminase. Eleven family members heterozygous for adenosine deaminase deficiency were encountered among the first-degree relatives; adenosine deaminase deficiency and severe combined immunodeficiency were associated and inherited as autosomal recessive traits in both kindreds. Successful bone-marrow transplantation was carried out in two of these infants. Normal immunologic function was established in both children, but the deficiency of adenosine deaminase persisted in their erythrocytes. The enzyme deficiency did not impair the successful establishment of normal humoral and cellular immunity by transplants of bone-marrow cells from siblings who were either normal or heterozygous for adenosine deaminase deficiency.


Value of early ambulation in patients with and without complications after acute myocardial infarction. A prospective, controlled, randomized study was done to compare the effect of early and late ambulation in hospitalized patients with acute myocardial infarction. All patients surviving longer than the first five days were studied; 64 patients were mobilized on day six and discharged on day 12, and 65 were mobilized on day 13 and discharged on day 19. Follow-up observation lasted from six to 52 weeks. Of patients without complications until day six, eight out of 32 in the early and 16 of 35 in the late groups manifested complications during the follow-up period (p smaller than 0.05). Of those who had complications before day six, seven of 32 and 26 of 30 still had or acquired new complications until last seen (p small than 0.0001). The number of serious complications in the two groups was eight and 24 respectively (p smaller than 0.001). We conclude that early ambulation is beneficial irrespective of complications on admission.


Filtration leukapheresis for granulocyte transfusion therapy. Clinical and laboratory studies. To study the clinical efficacy of granulocytes obtained by filtration leukapheresis, patients with clinically evident infection and granulocyte counts of smaller than 500 per cubic millimeter were randomly assigned to receive conventional therapy alone or with a granulocyte transfusion obtained from a single donor each day for four days. Five of 19 control patients survived to day 20, and 15 of 17 in the transfused group survived. Comparison of the two populations for variables such as age, disease, and severity and type of infection revealed no other factor that could account for the difference in survival. Outcome was not demonstrated to be related to HL-A match, post-transfusion counts, or presence of leukocyte antibodies. Functional studies of granulocytes obtained by filtration leukapheresis showed only minor differences although appearance was altered. Granulocytes so obtained can be used safely and efficaciously as adjunctive therapy for infection associated with granulocytopenia.


Immunopathogenesis of syphilitic glomerulonephritis. Elution of antitreponemal antibody from glomerular immune-complex deposits. A renal biopsy was performed on a patient with syphilitic glomerulonephritis characterized clinically by the acute onset of nephrosis that responded dramatically to penicillin therapy. Histologic, electron microscopical and immunohistochemical studies revealed an early membranous glomerulonephritis characterized by the presence of subepithelial basement-membrane deposits containing IgG and C3. The glomerular lesion, however, differed from that in the usual case of membranous nephropathy in that distinctive segmental lesions were present at the tubular poles of the glomeruli, and all the glomeruli exhibited mild proliferation of mesangial cells in association with the presence of IgM within mesangial areas. Antibody elution studies performed on the renal-biopsy specimen demonstrated the presence of antitreponemal antibody within the glomerular immune-complex deposits. This finding indicates that the glomerular injury occasionally complicating secondary syphilis is due to the deposition of treponemal antigen-antitreponemal antibody complexes.


Clinical genetics: some neglected facets. Like general medicine, clinical genetics has responsibilities to research, to dissemination and to service. Each exists at three broad levels. The elemental comprises acquisition of fact and development of technics. At the intermediate level coherence becomes a major concern: the discernment of relations among facts; the incorporation of data into ideas and insights; organization of clinical findings into a diagnosis; and the development of the rational management. The sophisticated level calls for theories and cosmologies at the scientific level, and cultivation of scholarship and of clinical wisdom. All nine compartments should be mutually correcting. If any of them is neglected or isolated from the rest, the whole will be impoverished-the student will suffocate in disconnected, empirical facts; fanciful theories will be spun from tenuous evidence; well established theory will be neglected by the practitioner; the best-intentioned schemes will have disastrous long-term consequences.


Atrioventricular block (first of two parts). The development of His-bundle (H) electrocardiography and the concept of hemiblocks have prompted a re-examination of conventional thinking about the indications for treatment of atrioventricular (AV) block. The technic of treatment is not the issue; ventricular pacemaking is the only really effective and reliable method. The problem for this review is what these recent developments have contributed to deciding when and if a pacemaker should be installed.


Reversible hydronephrosis in the neonate with urinary sepsis. Hydroureteronephrosis without vesicoureteral reflux or lower-urinary-tract obstruction is uncommon in infants. There has been considerable interest in and controversy over the cause and management of this entity. We have cared for three neonates with severe hydroureteronephrosis after acute urinary tract infections, who were treated without operation.


A gene cluster in Aspergillus nidulans with an internally located cis-acting regulatory region. Work reported here on the fungus Aspergillus nidulans has provided the first definitive demonstration of operon-type organisation in an eukaryote genome. It has been shown that the prnA and prnB genes concerned with proline metabolism form a gene cluster with the regulatory region lying between the two putative structural genes prnA and prnB. Regulatory mutations (prnd) probably leading to relief of carbon catabolite repression, map in between prnA and prnB and are cis-dominant with respect to both. The properties of these regulatory mutations and other findings suggest that carbon catabolite repression may be mediated by a negative control system in A. nidulans. This gene cluster is particularly interesting in view of its divergent orientation (with the regulatory region located in the centre of the operon) and for the fact that unlike the divergent operons known in prokaryotes, the divergent orientation is related to the way in which this particular operon may be regulated.


Initiator constitutive mutation with an 'up-promoter' effect in Aspergillus nidulans. A mutation leading to strong constitutivity for a uric acid-xanthine permease in the lower eukaryote Aspergillus nidulans has been found to be tightly linked to the putative structural gene whose expression it controls in the cis configuration. In addition, it increases the maximal induced level of transport 2.5-fold. This is the first demonstration of an initiator or promoter mutation in an eukaryote.


Cerebrospinal fluid cytology: practical clinical usefulness. Sedimentation cytomorphology is a simple, inexpensive technique of collecting cells from cerebrospinal fluid and is of great clinical value. Important variables such as blood contamination, age of the patient, and general clincial condition must be considered. Specific conditions for which cerebrospinal fluid cytomorphology shows clinical usefulness include central nervous system leukemia, hemorrhage, immunopathies, infections, and brain tumors. Clinical examples of each of these conditions and their correlated cytograms are presented.


Serum clonazepam concentrations in children with absence seizures. Clonazepam, a chlorinated derivative of nitrazepam, was administered to 10 children with absence seizures. Serum concentrations were measured after 8 weeks of treatment, at steady state. Seizure frequency reports and the 12-hour telemetered electroencephalogram were studied before and after 8 weeks of treatment to determine the frequency and duration of generalized spike-wave paroxysms. The clonazepam dosage ranged from 0.028 to 0.111 mg per kilogram and was reflected in serum levels ranging from 13 to 72 ng per milliliter, with an excellent correlation between dose and serum level. Eight of the 10 patients showed a significant decrease in seizure frequency, with three experiencing no seizures at all. Six patients had side effects, predominantly drowsiness and ataxia. This preliminary study shows clonazepam to be useful in the treatment of absence seizures in children and to merit further study.


Abolition of electrically induced cortical seizures by stereotactic thalamic lesions. Evidence for descending thalamopontine medullar spinal connections in the centrencephalic epileptic system of the cat. In experiments on the mechanism of epilepsy in normal adult cats, seizure patterns were established by electrical cortical and subcortical stimulation. Repeated cortical stimulation after bilateral coagulation of the lateral posterior thalamic nucleus resulted in a marked reduction in seizures, including complete abolishment of seizures in some animals. Histologic studies of the lateral posterior thalamic nucleus showed degeneration to the ventral anterior thalamic nucleus, the H zone of Forel, the mesencephalic-pontine reticular formations, the trigeminal motor nucleus, the lateral vestibular nucleus, and the intermediate horn of the entire spinal cord. This establishes a role for the lateral posterior thalamic nucleus in the centrencephalic system for all components of a typical epileptic attack.


[Anesthesiological problems in renal transplantation]. The physiopathological changes observed in uraemia are briefly described and an account is given pharmacological considerations relevant to the induction and maintenance of anaesthesia and muscle relaxation, The anaesthesiological management of 20 kidneys transplants (17 from living donors and 3 from cadavers) is explained. Steps taken for intra-operative care and protection of the transplanted organ to aid its function recovery are explained.


[Hodgkin's disease in the malignant lymphoma category. Nosographic problems]. The classification of lymphoreticular tissue tumours is still confused. The tumours themselves take many forms and tissue reaction may be such as to preclude a clear distinction between neoplastic and inflammatory processes. This has led to what Willis called a chaos of definitions. The grouping proposed by Gall and Mallory in 1942 is still valid and includes Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma, and follicular lymphoma. Its basis is both clinical and histological, particularly the latter; vary slight differences between the respective histological pictures and the possibility of transition forms. True leukaemias, however, must be excluded.


[Hodgkin's disease in the malignant lymphoma category. Relations between its histopathological and clinical aspects]. The need for active collaboration on the part of the histopathologist and the clinician in the management of hodgkin's disease is stressed, with particular reference to diagnosis, histological classification, and evaluation of the clinical stage.


[Current chemotherapeutic trends in the treatment of malignant lymphomas with special reference to Hodgkin's disease]. Sequential or simulatineous use is made of four types of antiproliferative drugs in the modern treatment of malignant lymphoma: alkylating drugs, including procarbazine; Vinca rosea alkaloids; antibiotics; corticosteroids. The simulataneous employment of two or more drugs appears to give best results, though it cannot eradicate the disease; this is possible with radiation or surgery in the early stages. Chemotherapy is nevertheless without alternative in the more advanced stages. Long periods of even complete remission may thus be achieved.


[On a case of exlusively splenic Hodgkin's disease, with histological detection alone]. A case of Hodgkin's disease confined to the spleen is described. A picture of sepsis with rapidly progessive cachexia was present from the outset. Necrosy revealed no gross evidence of the disease and diagnosis was solely dependent on the histological evidence.


Gonadotropin responses following luteinizing hormone releasing hormone administration in normal subjects. Synthetic luteinizing hormone releasing hormone (LHRH), 100 mug, was administered intravenously to 29 normal individuals. In male subjects, both baseline and peak LH response values showed minimal variations between subjects. The FSH baseline and response were more variable. In normal females the FSH and LH baseline values and response to LHRH infusion showed greater variation than that seen in male subjects, and this variation correlated with the phase of the menstrual cycle. In perimenopausal women with elevated baseline gonadotropins, the absolute LH peak values were comparable to those seen during the periovulatory period of the menstrual cycle, while FSH baseline and peak values were unmistakably higher than those observed in the normally menstruating women. Three women under gonadotropic suppression by three different drugs were investigated; megestrol suppressed the LHRH response more effectively than either diethylstilbestrol or an oral contraceptive. The LHRH stimulation test reflects only the ability of the pituitary cell to release gonadotropins. In a normal individual, however, some justifiable assumptions can be made regarding the immediate past synthesis and release versus accumulation of pituitary LH.


Diagnostic use of luteinizing hormone releasing hormone in primary amenorrhea. Thirty-eight patients with primary amenorrhea were evaluated by the administration of luteinizing hormone releasing hormone (LHRH). The LHRH stimulation test was not helpful in differentiating those patients who will proceed to normal menses from those who will continue to have prolonged dysfunction. Similar responses were observed in patients with different pathology, which indicates that the LHRH test must be utilized in conjunction with a carefully planned evaluation if it is to be useful in differentiating a hypothalamic from a pituitary defect. The finding of a patient with hypergonadotropism by serum radioimmunoassay and negative gonadotropins by bioassay suggests that the radioimmunoassay may detect a biologically inactive molecule and indicates that both assays are essential in the evaluation of primary amenorrhea.


Gonadotropin response to luteinizing hormone releasing hormone administration in secondary amenorrhea and galactorrhea syndromes. Luteinizing hormone releasing hormone (LHRH), 100 mug, was administered to 60 patients with secondary amenorrhea. No side effects or adverse reactions occurred. Delayed FSH and LH peak outputs were observed in patients receiving LHRH subcutaneously rather than intravenously, but responses were otherwise comparable. The majority of patients with secondary amenorrhea had responses which fell into the 95% confidence limits of responses for normal ovulating women. Responses of patients with different forms of dysfunction may be similar, and patients with similar pathology may respond quite differently. The LHRH stimulation test may assist in the diagnosis of particular hypothalamic, pituitary, or gonadal dysfunction, but it must be used clinically in the context of a carefully integrated study.


Pituitary response to a new analog of luteinizing hormone releasing factor during the menstrual cycle. A new analog of luteinizing-hormone-releasing factor, (Des-Gly-NH-2-10, Pro-ethylamide-9)-LHRF, was tested in healthy women with regular menstrual cycles. This synthetic nonapeptide amide was injected intravenously in a dose of 200 mug into 15 normal female volunteers in the follicular, preovulatory, and luteal phases of the menstrual cycle, and the serum LH and FSH responses were compared with those to the same dose of the synthetic decapeptide LHRF in 15 controls. The new analog exhibited significantly higher activity than the synthetic decapeptide LHRF in the release of LH in the follicular (P smaller than 0.05), preovulatory (P smaller than 0.01), and luteal phases (P smaller than 0.05). In contrast, no statistical significance in the magnitude of FSH response was demonstrated in any phase of the menstrual cycle. The serum LH and FSH response to the nonapeptide amide suggested a longer physiologic half-life of the new LHRF analog. The results are similar to a previous report in men with normal gonadal function, and a clinical usefulness for the new analog is expected.


Proplast in dental facial reconstruction. Successful clinical applications since early 1970 have occurred with the use of temporomandibular condylar prosthesis and endosseous blade-vent implants coated with porous proplast. Proplast as a bulk material has also been used to augment atropic mandibular alveolar ridges and deficient facial contours in the mental, mandibular border, and zygomatic areas.


Effect of various lysosomes and endotoxin on vascular permeability in frogs and mice. Blood-lymph permeability increasing effects of frog liver lysosomes, Escherichia coli 0111 endotoxin, bradykinin and serotonin were demonstrated in frogs with a method developed by the authors. These actions were expressed in a faster dye saturation in the lymph as compared to that of the controls. 2. The method is based on the determinations of concentration of Evans blue transported as protein-bound dye into the lymph. 3. Frog liver and polymorphonuclear leukocyte lysosomes had a capillary permeability increasing action tested by local skin response when injecting Evans blue intravenously in mice. 4. All these phenomena are similar to events described earlier in mammalian systems.


[The state of knowledge of the class of trematodes and the chief problems in studying them]. The paper deals with the current state of knowledge of Trematoda, trends and aims of further investigations. Up to now the classification system of trematodes has been unsatisfactory though for several large groups it is elaborated with due regard to the biology and ecology of these worms. The main deficiency of the present-day taxonomy of trematodes consists in the existence of two separate classifications, for adult worms and for their larvae (cercariae). Among the existing systems the classification suggested by Odening (1960-1963) is of the greatest interest. We do not agree with his division of the class into three subclasses (including Aspidogastrea) and Diginea into two subclasses, "Sporocystoinei" and "Redioinei", but follow the composition of orders established by him. Great difficulties arise in establishing the characters, taxonomic criteria of trematodes. However, a number of characters can be suggested for differentiation of species and genera at various developmental stages. Deficiency in the taxonomy of these worms is due to a wrong evaluation of their characters and to the lack of common collection and treatment techniques. On describing species one should proceed, if possible, from the whole complex of morphological and biological peculiarities of different ontogenetic stages of the forms under study. A study of the ultrafine structure, hysto- and biochemistry of trematodes will enable us to associate better the morphology and the function of organs and to go deeper into the functional morphology and functional biochemistry. The main task of further investigations is closely connected with the elaboration of a natural system of Trematoda, a study of diverse and deep interrelations in the "parasite-host" system and with the development of scientific methods of control of pathogenic species on the biological basis.


Oral-pharyngeal development and evaluation. The recognition and evaluation of deficits and abnormalities related to the development of feeding require comprehensive and systematic observation. This article describes both gross and fine motor coordination, as well as primitive reflexive movement, which influence eating. Oral-pharyngeal reflexes, the function of the tongue, oral hygiene, and the condition of the teeth are described relative to their influence on the feeding process. The development of eating behaviors of children are briefly outlined.


Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease. The incidence, pathology, etiology, clinical characteristics, differential diagnosis, and treatment of Legg-Calvé-Perthes disease are reviewed. Physical therapy and follow-up care are discussed, with emphasis on the relationship between orthopedic and physical therapy services.


The current use of prophylactic antibiotics in plastic and reconstructive surgery. A questionnaire distributed to plastic surgeons to determine their patterns of usage of systemic prophylactic antibacterial agents was answered by 1,025 respondents (73.7 percent). The patterns of usage among the respondents were determined for 29 circumstances and operations for the time of administration, and as influenced by 11 modifying factors. The data present the patterns of antibacterial use by plastic surgeons at this time.


Surgical problems in the excision and repair of radiated tissue. Surgical procedures for tissues damaged by radiation are fraught with the possibility of multiple and serious complications. A knowledge of the altered pathophysiology of such tissues (chiefly diminished blood supply, fibrosis, and direct cellular reparative potential) is necessary for the surgeon to make a proper judgment. Recognition of the pathognomic signs in the skin is important. The possibility of malignant change must be kept in mind. Surgical treatment must include the excision of radiated tissues back to good blood supply, and then proper and adequate coverage by the simplest and best means. If the surrounding local tissues are so altered that they are unsuitable for coverage, structures from a distance must be used. Prior planning of the coverage before the excision pays dividends by preventing disastrous complications.


Skin graft survival on avascular defects. Full-thickness skin grafts placed on bare rabbit ear cartilage were revascularized, whereas split-skin grafts on the same kinds of areas failed. The contrast is most likely due to differences in the skin graft thickness and the vascular patterns in the grafts. Full-thickness rat skin grafts placed over the same sized underlying silicone sheet implants did not survive. When the graft was made 3 mm larger on all sides than the implant, all or a portion of the graft over the implant survived. Quantitation of the area of graft survival is presented. Prepared grafts (replaced on their donor areas for 48 hours) on prepared beds and fresh grafts on prepared beds had slightly larger areas of graft surviving over an avascular defect. On the basis of this investigation, we suggest that a full-thickness skin graft placed on a prepared peripheral bed may make possible the greatest area of bridging over an avascular defect.


Marked prolongation of skin homograft survival with niridazole. A first report. Niridazole, a nitroheterocyclic drug used to treat helminth infections is reported for the first time to suppress cell-mediated immunity, as ascertained by multiple in vivo assays. Skin homograft survival time was significantly prolonged in mice, without loss of animals due to drug toxicity.


Stereology: methods for quantitative light and electron microscopy. There are available to the biologist sophisticated methods for the quantitative determination of many structural parameters of tissues; the methds are covered by the term stereology and are based on statistical sampling techniques introduced by geologists and materials scientists. Methods for determining the volume fractions of various compartments within a cell or tissue are presented, together with methods for determination of surface area, surface-to-volume ratio, and particle size and size distribution. The problems involved in applying these methods to tissue sections are discussed, together with the problems arising from anisotropy within the tissues. Sampling methods and test systems in common use are described and discussed in relation to available counting and recording systems, and the potentialities of automatic image analysing equipment in this field are assessed. A discussion of shape recognition follows, with a survey of recent stereological work.


Echocardiography in valvular heart disease. Echocardiography is a useful new technique that allows for the diagnosis and assessment of the severity of various forms of valvular heart disease. It is a safe and noninvasive procedure that can readily be used on the critically ill as well as the ambulatory patient. Since the examination can be easily repeated, echocardiography can be used to study a patient over an extended period of time to follow the severity of the disease. With proper care and experience in the performance and interpretation, the cardiologist can derive much useful information to aid in the initial evaluation and long-term follow-up of patients with various forms of valvular disease. With improvements in instrumentation and the use of newer techniques, the usefulness of ultrasound will be further enhanced.


The perception of speech signals.

The perception of speech signals. A brief outline of the mechanism of speech production is given. It is shown that the motion of the articulators is encoded in changes in the spectra of speech waveforms. Parameters derived from these spectra form the basis of a method of speech synthesis. The perception of speech is seen as a decoding of the acoustic features of the speech wave. The organs of the hearing system which are involved in this process are briefly described. An attempt is made to relate the results of auditory psychophysics to the physiology of the hearing mechanism. The acoustic features which are relevant for the perception of the various classes of speech sounds are described. These have mostly been obtained by experiments involving synthesized speech. Finally the results of some experiments in dichotic listening are presented which emphasize the differences in the perception of speech and other sounds.


Glucagon: role in the hyperglycemia of diabetes mellitus. Glucagon suppression by somatostatin reduces or abolishes hyperglycemia in dogs made insulin-deficient by somatostatin, alloxan, or total pancreatectomy. This suggests that the development of severe diabetic hyperglycemia requires the presence of glucagon, whether secreted by pancreatic or newly identified gastrointestinal A cells, as well as a lack of insulin. Glucagon suppression could improve therapeutic glucoregulation in diabetes.


Ventral medial hypothalamus: involvement in hypoglycemic convulsions. After the ventral medial hypothalamus of mice was lesioned with gold thioglucose, the dose of insulin required to produce convulsions in 50 percent of the animals was doubled compared to that in nonlesionad controls. No dose of insulin, up to 50 milliunits per gram, produced convulsions in more than 60 percent of the lesioned mice, even though blood glucose levels fell to approximately 24 milligram percent.


Yeast chromatin subunit structure.

Yeast chromatin subunit structure. Micrococcal nuclease digestion of in situ (intranuclear) and in vitro yeast chromatin produces distributions of DNA molecules of discrete sizes. In both cases, these molecules appear to be integral multiples of the smallest size on polyacrylamide gel electrophoresis. This result implies a widespread generic occurrence of the periodic organization of chromatin seen in mammalian systems.


The problem of the origin of fibroblasts in the postnatal ontogenesis of mammals. An analysis is made of the author's data and the literature information on the origin and patterns of differentiation of the fibroblasts of connective tissue during the postnatal ontogenesis of mammals. The hypothesis of the existence of two types of collagen-producing cells (fibroblasts) - protective-trophic (short-lived population) and supporting (long-lived population) - is substantiated. Hypotheses are advanced on the biological role of these types of fibroblasts and their origin in phylogenesis.


The possibility of using cytogenetic methods in the investigation of the origin of fibroblast-like cells of a focus of inflammation. An improved method of study of chromosome preparations of fibroblast-like cells of a focus of inflammation in mammals is described. The essence of the method consists of a supplementary brief culturing in vitro of cells of a focus of inflammation at its proliferative phase.


History of mental health services in South Africa. Part VI. The Transvaal. Weskoppies Hospital began life in 1892 under the South African Republic. The clinical head of this hospital is now the Professor of Psychiatry of Pretoria University, and it has close links with the H. F. Verwoerd Hospital. Sterkfontein Hospital was opened in 1943, and admits most of its patients from Johannesburg. It has now been placed under the clinical control of the Professor of Psychiatry of the University of the Witwatersrand, and is thus linked with the psychiatric departments of the Johannesburg General and Tara Hospitals.


A therapeutic response to a single diagnostic dose of luteinising hormone-releasing hormone. Luteinising hormone-releasing hormone (LH-RH) administration is a useful provocative test for the evaluation of the hypothalamic-pituitary-gonadal axis. Seven cases with oligomenorrhoea or amenorrhoea are reported, in which a single diagnostic injection of LH-RH produced an apparent therapeutic response. Six patients converted to a regular normal menstrual cycle, and 4 of these had evidence of ovulation. The seventh patient conceived. It is postulated that in some cases of hypothalamic menstrual dysfunction the gonadotrophic imbalance may be corrected by a single intravenous dose of LH-RH.


Influence of tetrahydro-aminacrine on muscle pains after suxamethonium. The incidence and severity of muscle pains were investigated in patients who had been given suxamethonium and thiopentone anesthesia for bronchoscopy. Group I patients received no other drugs. Groups II and III received d-tubocurarine and THA respectively before suxamethonium. Administration of these drugs resulted in a highly significant reduction in the incidence of severe and moderate pains. The use of d-tubocurarine necessitated a significantly greater amount of suxamethonium to maintain paralysis.


The present status of heart transplantation. Heart transplantation still remains the only form of treatment for patients suffering from terminal heart failure as the result of diffuse myocardial disease. The lack of enthusiasm for this operation has no scientific or moral basis. Our own limited experience and the much wider experience of other workers in this field show that with proper patient and donor selection and careful postoperative management, the results of this operation compare very favourably with those of any transplantation of other organs and in the surgical treatment of other types of terminal diseases.


Left ventricular bypass.

Left ventricular bypass. The removal of the patient's own diseased heart in order to perform a total cardiac transplantation has several disadvantages. A new technique for bypassing the patient's diseased left ventricle by using a cardiac allograft has been developed in our laboratory and applied clinically in 2 patients. This technique carried no direct surgical mortality, and no complications resulting from the patient's own heart being left in situ have been observed thus far. The presence of a second heart lying partly in the anterior mediastinum and partly in the right pleural space appeared to have no deleterious effects. Several advantages over the conventional transplant have been noted and are discussed.


History of the mental health services in South Africa. Part V. Natal. The early history of psychiatry in Natal is the history of Town Hill Hospital. A second hospital was opened at Fort Napier in 1927. They have, for clinical purposes, now been placed under the control of the Professor of Psychiatry at the medical school of Natal University, and it is planned to merge them into a single hospital.


Septic complications following endoscopic retrograde cholangiopancreatography. In four patients, septic complications developed following endoscopic retrograde cholangiopancreatography which required surgical intervention. The pathogenesis involves stasis in the pancreatic or biliary tree, but the source of infection is unclear. Prompt recognition and early surgical intervention should decrease the seriousness of these complications.


Cholecystokinin cholangiography and analysis of duodenal bile in the investigation of pain in the right upper quadrant of the abdomen without gallstones. Thirty-one patients with recurrent symptoms of the biliary tract and repeated normal oral cholecystograms were studied by a combination of cholecystokinin cholangiography and biliary drainage. Ten patients had reduplication of their symptons because of dyskinetic contractions or obstruction of the cystic duct, and seven patients had delayed gallbladder emptying without pain due to hypokinetic contractions. Five patients had abnormal duodenal bile characterized by supersaturation and the presence of crystals or bacteria. Based upon these studies, 22 patients had cholecystectomy and 20 were cured, while two showed improvement. There were no therapeutic failures. Cholecystokinin cholangiography capably detects the presence of neuromuscular disease of the gallbladder wall, whereas the oral cholecystogram tests for mucosal function or the presence of filling defects. An additional group of patients who have cholesterosis, cholecystitis, or cholelithiasis missed by the oral cholecystogram will not be diagnosed by cholecystokinin cholangiography unless the duodenal bile is also examined.


Subpopulations of thymus dependent and thymus independent lymphocytes in human gut associated lymphoid tissues. Human gut associated lymphoid tissues were studied in terms of the presence of subpopulations of thymus dependent and thymus independent lymphocytes. Both thymus dependent and thymus independent lymphocytes were present in substantial numbers, as judged from their ability to form spontaneous and complement mediated rosettes with sheep red blood cells and the presence of surface bound immunoglobulins. The relationship between this finding and the question of what is the lymphoid organ which may be the human equivalent of the avian bursa is discussed.


Has medical history importance for surgeons? Surgeons will do well to remember that the two most important contributions to the growth and extension of surgery came from two disciplines, not then regarded as the most innovative. Anesthesia came from dentistry, the work primarily of W.T.G. Morton of Boston; prophylactic surgical antisepsis originated with the obstetrician Semmelweis, who developed a scheme of prophylactic chemical antisepsis that still remains the core of surgical antisepsis. In the mid 1880's, largely as a result of the work of Chamberland and others of the Pasteur school, surgeons in France and Germany substituted thermal for chemical antisepsis, whenever applicable. Whereas Lister's influence was tremendous in fostering acceptance of antisepsis by surgeons, by the end of his professorial career he had begun his capitulation to prophylactic antisepsis, which was complete by 1896 to the very practices that Semmelweis had proved the value of almost five decades previously. These were 19th century innovations. The greatest boon to surgery's advance in this century has been control of cellulitic infections through chemotherapeutic agencies, the sulfonamides and antibiotics. The tremendous upsurge of interest in research at the end of World War II brought surgeons to a fuller realization of the significant part they could play in the advance of their discipline. Intimate alignment of surgeons with physiologists of the circulation begot intracardiac surgery, a significant innovation with consequences of tremendous import for greater medicine's advance. Today, surgeons attacking the problem of tissue transplantation are aligning themselves with biochemists, geneticists, immunologists, experimental pathologists, and pharmacologists in their broad approach to the phenomenon of allograft rejection. The great extension of vascular surgery since World War II has made jewelers of surgeons of small tubular structures. The technical phases of these demanding operative procedures have largely been overcome. Solution of the biologic rejection phenomenon is awaited eagerly by all investigators, a discovery that will greatly enhance predictable success of transfer of skin as well as of organs. When will surgery experience another great catalytic forward thrust like that achieved through anesthesia, prophylactic antisepsis, and the antibiotics? No discipline in medicine can exist alone without privation. For its continuing advancement, surgery is dependent upon close and intimate relationships with many other medical disciplines. Apart from the enlightenment provided by a searching examination of the origins of our surgical discipline, the earnest and persistent pursuer will discover a lively pleasure and satisfaction that accrues as a special dividend.


Cryostat microtomy of lung tissue in an expanded state. A technique is reported for cryostat sectioning of lung tissue in an expanded state for use in viral immunofluorescence studies. A 1:2 mixture of O.C.T. embedding compound and phosphate-buffered saline is injected intratracheally into fresh lung tissue. The lung tissue is frozen in liquid nitrogen and sectioned with a cryostat. Compared to other published reports of lung sectioning for immunofluorescence microscopy, this method has the advantages of being easy and quick, maintaining the lung sections in an expanded rather than collapsed state and avoiding contact with chemicals potentially capable of altering sensitive viral antigen.


[Differentiation of urinary bacteria in urological practice]. The value of a new differential diagnostic nutrient medium was tested on 360 urines from urological patients. Simultaneously every urine specimen was examined according to classical bacteriological differential methods and colony counting. In 137 sterile urines there was agreement between the two methods in approximately 93%. On the basis of colony counting 96% of the 223 urinary tract infections could be diagnosed with the new test. Differentiation of the infecting organisms was possible in 71% of the infections.


Renal artery aneurysm. Polyaneurysmal lesion of kidney. A case of innumerable renal artery aneurysms of probable congenital origin is reported. No other lesion could be found in any other abdominal organ studied. We think it unique as no similar case could be found in the medical literature. Except for right flank malaise, the patient was otherwise asymptomatic. The radiologic diagnostic methods are discussed, stressing the differential diagnosis of calcifications in the area of the kidney. The management of renal aneurysms is discussed in regard to the nephrectomy.


Scrotal pouch techniques. Adjunct to orchiopexy. Following orchiopexy, contraction of dartos and cremaster muscles may pull the testis toward the external inguinal ring. Fibrous tissue deposition resulting from testis mobilization and cord skeletonization may bind the testis in an unfavorably high scrotal position. The "scrotal pouch technique," utilizing both a subcutaneous scrotal pocket for the testis external to the dartos layer and a gentle testis traction regimen, serves to diminish the chances of testis retraction after orchiopexy.


Renal transplantation. Complications in patients with juvenile diabetes. Four cases of patients with juvenile diabetes who received kidney transplants are reported. Problems with selection and management are discussed, and the high mortality and morbidity rates in this group of patients is emphasized.


Renal transplantation. In adult patients with end stage polycystic kidney disease. Seventeen adult patients with end stage polycystic kidney disease underwent renal transplantation. Two groups were identified: (1) those transplanted with retained polycystic kidneys, (2) those prepared with preliminary bilateral nephrectomy. Although there was a shockingly higher incidence in the mortality rate in the non-nephrectomized group, no specific cause could be identified. The results do indicate, however, that bilateral nephrectomy is essential in all patients with a history of pyelonephritis or gross hematuria. Substantial benefit from retained kidneys was noted only during the initial period of hemodialysis.


Calculi complicating renal transplantation into ileal conduits. In 2 patients with renal transplants into ileal conduits renal calculi developed proximal to stenosis of the ureteral-ileal anastomosis, These are the only cases of urinary calculi in 600 consecutive transplants. The pathogenetic factors contributing to sepsis and stasis in such cases are reviewed and precautions suggested.


Quantitative urine culture by reagent strip incubation. The filter paper culture-tetrazolium test ressults have been compared with routine hospital streak plate cultures in 400 random urine specimens. Pseudomonas cultures tended to impart a color change to the test pads which rendered interpretation difficult. While a consistently accurate quantitative interpretation of these cultures did emerge during the course of the trial studies, some degree of observer accommodation and bias, in terms of the manufacturer's instructions and description, was necessary to achieve an appropriate reading. When the hospital laboratory results and culture strip test results are compared in terms of colony counts greater than 10-4 bacteria per milliliter and less than 10-4 bacteria per milliliter, the method was found to be 93% sensitive for the total count and 83% sensitive for the gram-negative count with a specificity correlation of 96% for the total and gram-negative counts, respectively.


Sexual function of males before and after renal transplantation. In an attempt to define changes in sexual function before and after renal transplantation, a questionnaire was distributed to adult male patients with functioning kidney transplants. Significant changes in sexual performance were shown during the transition from the healthy state to end-stage renal failure and, finally, to the post-transplant state. Both potency and libido showed marked parallel impairment with the development of end-stage renal failure, followed by moderate recovery after renal transplantation. This study indicates that the majority of men with functioning kidneys can look forward to a return of sexual activity comparable to pre-illness level. However, sexual impairment may persist in some patients after transplantation, emphasizing the need for further evaluation in this group of patients.


Urinary incontinence. Treatment with electrical stimulation of the pelvic floor. Electrical pelvic floor stimulation may be administered either externally by the transrectal tampon or internally with the implantable pelvic floor stimulator. This treatment modality requires intact pelvic floor innervation and therefore is unsuccessful in patients with pelvic floor denervation. Pelvic floor stimulation has been successful in patients with stress and with congenital, iatrogenic, and postoperative urinary incontinence.


Ureteral replacements.

Ureteral replacements. The clinical necessities of replacing all or part of the diseased or destroyed ureter have plagued surgeons for many years. In the past seventy years more than 100 surgical techniques have been described for ureteral replacement. Methods of replacement have fallen into four categories; nonbiologic substitutes, pedicle grafts, free grafts, and implantation and diversion. This review discusses the history and present status, and presents a look to the future in the surgery of ureteral replacement.


Urinary tract calculi associated with enteritis and intestinal bypass. There is a definite increased incidence of calculi associated with extensive small bowel disease or resection. Hyperoxaluria appears to play a major role and may be due to increased intestinal oxalate absorption. Forced fluids and dietary discretion are mainstays of stone prophylaxis.


Live donor nephrectomy.

Live donor nephrectomy. Donor nephrectomy was performed on 39 living related renal donors. The preoperative evaluation, surgical technique, and postoperative follow-up are presented. Major or minor complications developed in 23 per cent of the patients and included acute myocardial infarction, brachial plexus injury, acute glomerulonephritis, ileus, pneumonia, and urinary tract infection. All complications had resolved by six months postoperatively.


Urologic complications in renal transplantation. Our ten-year experience with 141 kidney transplants is reported. Fifty per cent of the grafts are presently functioning, and 22 patients have been followed more than five years. A urologic complication rate of 13 per cent occurred, but 84 per cent of those patients retained their grafts. Only 1.3 per cent of patients with urologic complications died. Improved results can be achieved by good operative technique and aggressive management of complications.


Testicular lymphoma.

Testicular lymphoma. Testicular tumor in the sixty- to eighty-year age group is mostly lymphoma. It is usually a manifestation of a generalized lymphoma, even though it may appear localized. Prognosis is uniformly poor. A combined approach of radiation and chemotherapy gives the best results. Chemotherapy is used sequentially in multiple doses. Two cases are reported.


Nephrogenic adenoma of bladder in immunosuppressed renal transplantation. A case of nephrogenic adenoma is reported in an immunosuppressed renal transplant recipient. The nature of the lesion is discussed, and a possible relationship between benign tumors and impaired immunologic surveillance is considered.


The induction, persistence and loss of framycetin sulphate resistance in enteric E coli of pigs. When framycetin sulphate was fed at prophylactic levels to pigs, resistance to this antibiotic was induced within days in the enteric E coli. The E coli of the gut did not become fully susceptible again until six to seven weeks after the anitbiotic was withdrawn from the diet.


Effects of domestication on animal behaviour. Centuries of domestication of animals by civilised man have had many measurable effects on the various species involved, but only in relatively recent history has scientific curiosity been directed to assessing their extent. The process of domestication is analysed and its known effects on animals reviewed through observations of and experiments with various species of domesticated animals conducted by researchers into animal psychology and biology. The known facts on the effects of domestication in animals are extrapolated in an attempt to determine to what extent modern man himself has been domesticated in the urban environment.


Serological classification of anti-I sera. Twelve anti-I sera were examined by means of broad panel of cells: OI, BI, OhI, Oicord, Oiadult, BI-F. Titration, fixation-elution, and haemagglutination-inhibition tests, and comparison of agglutination of untreated and neuraminidase-treated erythrocytes allowed to establish the specificity of the sera. For some sera the serological heterogeneity was revealed, which consisted in the following combinations of two or more kinds of specificity: anti-I-D plus anti-I-F, anti-I-D plus anti-i, anti-I-D plus anti-I-S, anti-I-D plus anti-I-F plus anti-I-S. Methodical problems of classification of anti-I sera are discussed.


Hans Schaefer's asystole: two case reports. Two cases of myocardial infarction are reported with transient (case 1) or permanent (Case 2) recovery of an R wave in anterior chest leads in the acute epsiode. This observation confirms H. Schaefer's hypothesis of asystole of the affected area, i.e. electrical inexcitability without necrosis. This phase precedes necrosis in any acute infarction; in the large majority of cases, myocardial infarction ultimately develops; therefore, demonstration in a clinical follow-up is quite rare.


[Availability of cryo-solutions for use in a thermodilution method]. A simple device was developed allowing the storage of cooled injectate at constant temperature. Cardiac output determinations by the thermodilution technique are simplified considerably.


LH and FSH in serum after intramuscular administration of LH/FSH-releasing hormone in normal and hypogonadal men. The increase in serum concentrations of LH and FSH after intramuscular administration of LH/FSH-RH was investigated in normal and hypogonadotrophic hypogonadal males. LH and FSH were measured by specific radio-immunoassays. To evaluate the appropriate dose of LH/FSH-RH for intramuscular administration different doses were administered and with 200 mu g an increase in LH and FSH was found comparable to the results obtained by other investigators using intravenous administration. After the initial studies a simple test including two determinations before LH/FSH-RH administration and one 60 min and 120 min after administration was developed and used in all cases. In 12 normal males a significant increase in the serum concentration of both LH and FSH was found averaging 381% and 148% respectively 60 min after 200 mu g LH/FSH-RH with a slight decrease in LH but not in FSH after 120 min. A positive response similar to that in normal men was observed in 11 hypogonadotrophic hypogonadal patients presenting different clinical pictures. This indicates that in all these patients the hypogonadotrophic state was due to a hypothalamic defect and not to a hypophyseal disorder.


Hypothalamic-pituitary function in anorexia nervosa. Hypothalamic-pituitary function was studied in 4 patients with anorexia nervosa of different degree of severity before and after refeeding. Gonadotrophin secretion was low in all subjects and improved in two after a prolonged period of feeding. In one subject there was a failure of pituitary gonadotrophin secretion after the administration of hypothalamic gonadotrophin-releasing hormone but the response was restored to normal after treatment. Thyroid function was reduced in one patient only but returned to normal after intravenous therapy for 6 days. Growth hormone and cortisol levels were elevated in all patients, and in one severe case the growth hormone values were extremely high. There was also a disturbance of the hypothalamic control of growth hormone and pituitary-adrenal function, which returned to normal after refeeding. One patient with severe hypothermia was resistant to the administration of a pyrogen, but developed a normal febrile response after treatment.


Further studies on the nature of the immunoreactive luteinizing hormone-releasing hormone (LH-RH)-like peptide in human urine. The chemical nature of the immunoreactive LH-RH-like peptide found in human urine has been investigated using ion-exchange chromatography on carboxymethyl (CM)-cellulose and a radioimmunoassay for LH-RH. A single immunoreactive substance was found in urine after LH-RH administration and in urine samples from untreated subjects. This substance did not have the mobility of either the synthetic decapeptide nor the 3-10 octapeptide on CM-cellulose and the evidence suggests that it may be the 2-10 nonapeptide of LH-RH.


The postnatal occurrence of biogenic monoamines in pancreatic islets of golden hamsters. Fluorescence histochemical studies in newborn and young golden hamster have revealed that some cells in the islets of Langerhans contain monoamine. These cells can be seen in newborns and up to ten day old animals, at least in three to five days old animals in the amine behaves like dopamine and is mostly stored in the A2-cells.


A double-blind trial with baclofen (Lioresal) and diazepam in spasticity due to multiple sclerosis. In 17 in-patients suffering from spasticity due to multiple sclerosis, the effect and tolerability periods were 4 weeks each. As to efficacy, the variables: spasticity, clonus, flexor spasms, gait and bladder function were evaluated clinically. No significant difference was found between the two drugs. As far as side-effects are concerned, sedation was specifically inquired about. Apart from that, spontaneoulsy reported side-effects were recorded. Sedation was more often seen during treatment with diazepam, while the side-effects during baclofen treatment were more varied. The total number and severity of side-effects were equal in the two treatment groups. A preference for one of the two treatment periods was stated by the investigator before the code was broken. A significant difference (p less than 0.001) in favor of Lioresal was found. This is discussed in the light of the fact that no significant difference was found for the individual symptoms or side-effects.


Successfully treated pneumopericardium in a newborn infant during IPPV. The successful treatment of pneumopericardium and cardiac tamponade in a newborn infant is presented in this case report. Alert recognition of this complication in newborn infants on intermittent positive pressure ventilation (IPPV) is of the utmost importance as prompt and adequate treatment is life-saving.


Treatment of meningitis and septicemia in infancy with a sulphamethoxazole/trimethorpim combination. Ten infants, 8 days to 10 months old, with meningitis and/or septicemia were considered therapeutic failures after conventional antibiotic treatment (i.e. kanamycin, ampicillin and sulfonamides) and given sulphamethoxazole and trimethoprim parenterally. Nine patients recovered, 8 of them rapidly, and one after prolonged treatment for 34 days when kanamycin was added to the combination. One infant improved but later died of complications not related to the treatment. High concentrations in serum and cerebrospinal fluid were achieved with a daily dose of 30-40 mg sulphamethoxazole and 6-8 mg trimethoprim per kg without signs of accumulation. No change in resistance of the bacteria isolated was seen. A hemolytic reaction, probably due to the propylene glycol in the solution, was seen in one case. Other possible side-effects in this age-group are discussed. The antibiotic combination used seems to be a good alternative in the therapy of bacterial meningitis of infants caused by gram-negative bacteria. However it should still not be given to icteric or very immature infants and probably not during the first week of life.


Pulmonary mechanics in infants surviving severe neonatal respiratory insufficiency. Pulmonary mechanics was studied in 24 survivors of severe neonatal ventilatory insufficiency, 15 infants had idiopathic respiratory distress syndrome (IRDS), 6 recurrent severe apnoeic spells, and 3 postasphyxia syndrome. Of the infants with IRDS, 5 were treated with intermittent positive pressure ventilation (IPPV), 3 with continuous positive airway pressure (CPAP) via an endotracheal tube and 7 with CPAP applied via a face chamber. The other infants were all treated with IPPV. IPPV-treated infants generally had lower than expected values of dynamic compliance and pulmonary conductance, particularly after prolonged treatment. All infants treated with CPAP via a face chamber had normal mechanics, but a trend towards obstruction of the airways after varying periods of time was observed in most infants, irrespective of diagnosis or treatment. One infant treated with CPAP via an endotracheal tube and given pure oxygen for a long time had gross abnormalities suggesting bronchopulmonary dysplasia. Measurement of pulmonary conductance appears to be a reliable prognostic tool as concerns pulmonary symptoms later in infancy.


The immune response to urinary tract infections in childhood. I. Serological diagnosis of primary symptomatic infection in girls by indirect hemagglutination. Determination of antibodies to E. Coli O antigen by indirect hemagglutination for detection of acute pyelonephritis was investigated in sequences of sera from 94 girls with their first known attack of symptomatic urinary tract infection. Using O antigen from the infecting bacterial strain or a standard strain increased antibody titres were found among pyelonephritis patients in 89% in unreduced sera (mainly 19 S antibodies) and in 81% in reduced sera (mainly 7 S antibodies) compared to a control material of 643 healthy children. Significant changes of these antibody titres occurred in 74 and 39% respectively. Analysis of maximal titres as well as titre changes in both unreduced and reduced sera showed diagnostically significant changes in two or more of these four parameters in 89% of patients with pyelonephritis. In contrast one parameter with such changes was found among the cystitis patients in only 5%. Employing a pool of 8 common O antigens, increased antibody titres were detected in 76% of patients with pyelonephritis. A larger pool of 68 antigens was no better and had a low capacity to detect 7 S antibodies. Optimal time for blood sampling was 2 to 3 weeks after onset of symptoms.


Ribonucleic acid synthesis after adsorption of the bacteriophage lambda on Escherichia coli minicells. Lambda bacteriophage adsorbs on the chromosome-less small bodies (minicells) produced by aberrant cell division of Escherichia coli P678-54. The plasmid-less minicells, as well as the minicells harbouring the colicinogenic factor E1, reveal a considerable inhibition of total RNA synthesis after phage adsorption. Both kinds of minicells synthesize RNA hybridizable to lambda DNA, but in the plasmid-harbouring minicells lambda RNA synthesis is much more intensive.


A search for Saccharomyces cerevisiae mutants with an increased sensitivity to nitrous acid. Six strains with an increased nitrous acid sensitivity were isolated (Fig. 1). The putative HNO2-sensitive mutants, as well as the parental strain 55R5 behaved abnormally in crosses, so that studies on the segregation of the sensitivity were difficult and unreliable. During 1.5 years the oversensitivity of the mutants gradually decreased to disappear completely (Tab. V). The differences in HNO2 sensitivity between respiratory-sufficient and cytoplasmic respiratory-deficient strains (Tab. I), as well as between different respiratory-sufficient strains (Tab. II-IV) are analysed.


Observations on the serologic changes in the recombinants in Shigella flexneri Serotype 4a. Studies on the antigenic composition of 84 diagnostic strains of S. flexneri serotype 4a and their Lac+ recombinants from a cross with E. coli HfrC were carried out. Considerable differentiation of agglutination reaction was found both in original material and in recombinants. An interesting group included recombinants which completely lost their capability to agglutinate with sera specific for type and group antigens and preserved only the capability to agglutinate in the polyvalent serum of S. flexneri subgroup. One of them (recombinant 140 Lac+) had been subject to detailed serological analysis and was shown to acquire as a result of recombination a new antigen appearing neither in any flexneri subgroup serotype, nor in dysenteriae and boydii subgroups. This antigen is of thermostable character.


Effects of disintegration of incorporated 35S on mutation frequency. The reverse mutation to the wild type of lambda sus 9 and T4 AM B17 bacteriophages, grown in bacteria prelabeled with 35S and stored at--196 degrees, was studied. No mutagenic effect of 35S was observed in both, lambda and T4 bacteriophages. It is suggested that there is no influence of 35S disintegrations on the properties of DNA polymerase to which the mutagenic activity could be attributed.


Comparison of the mutagenic effects of 35S decay in Escherichia coli strains WP-2 and WP-2S. Comparison was made of the lethal and mutagenic efficiency of 35S yields 35Cl transmutation of incorporated 35S in cells of Escherichia coli strain WP-2 and WP-2S (UV-sensitive). Bacteria were stored at minus 196 degrees. 35S yields 35Cl transmutation induced a higher lethal effect in strain WP-2 than in the UV-sensitive strain WP-2S. Reversions try yields try+ were induced with an approximately similar efficiency in both strains compared.


The supra-additive natriuretic effect addition of bendroflumethiazide and bumetanide in congestive heart failure. Permutation trial tests in patients in long-term treatment with bumetanide. The additive natriuretic effect of a single dose of bendroflumethiazide, 5 mg., has been studied in patients with advanced congestive heart failure in long-term treatment with bumetanide, 4 mg., daily. Three permutation trial tests were performed including six patients each. In the first trial, the response to supplementary bendroflumethiazide, 5 mg., was definitely superior to that of additional bumetanide, 4 mg., in terms of renal output of sodium, chloride, potassium, water, and osmolar clearance. In the second trial, a similar pattern was found in patients receiving a combination of bumetanide, 4 mg., and spironolactone, 100 mg., daily. The third trial compared the effects of bendroflumethiazide, 5 mg., plus bumetanide, 4 mg.; of bendroflumethiazide, 5 mg.; and of bumetanide, 4 mg. In terms of natriuresis and chloruresis, the response to the combination of two drugs was significantly larger than the sum of the effects of other treatments. It is concluded that the combined effects of the drugs represent a supra-additive effect addition for sodium and chloride. A tentative explanation of the mechanism of interaction in terms of inhibition of renal tubular supplementary spironolactone, involve a tendency to development of hypokalemia, hypochloremia, and alkalosis, it is recommended that supplementary use of bendroflumethiazide in this setting is combined with the administration of potassium chloride or potassium-saving diuretics.


Inotropic effects of tolbutamide in man. The hemodynamic responses of normal subjects to intravenous injections of tolbutamide, 250 mg., and 1,000 mg., were assessed by measurements of serial systolic time intervals. Analysis of results, compared to saline control, revealed evidence of minor inotropic effects during the period five to 10 minutes after infusion. Small but statistically significant (p less than 0.05) decreases in pre-ejection phase and electromechanical systole were noted. The time response of these changes did not correlate with dose of blood level of tolbutamide, and appeared to coincide with peak insulin levels. No inotropic or chronotropic effects were seen during the first four minutes after infusion, suggesting that the myocardial adenyl cyclase-stimulating properties of the drug, previously demonstrated in vitro, are not significant in intact man. The minor late inotropic effects are of doubtful clinical significance, and cannot be invoked to explain the reported increased cardiovascular mortality of patients treated with tolbutamide.


The use of echocardiography to measure isometric contraction time. The current methods for estimating isometric contraction time were discussed. Ultrasonically derived isometric contraction time, using external carotid pulse tracing, phonocardiogram, and the B-point of the mitral echogram was also measured. Recordings were performed in 10 normal subjects, and 15 patients. Hypertrophic cardiomyopathy (5), congestive cardiomyopathy (6), and ischemic heart disease (4). In 11 patients, the results were correlated with the internal isometric contraction time. The ultrasound isometric contraction time showed good correlation with the internal isometric contraction time (r equals 0.92, P less than 0.01). The external isometric contraction time showed less correlation with the internal isometric contraction time and was significantly shorter (P less than 0.01). The ultrasound isometric contraction time showed a superior discriminating value to the external isometric contraction time for differentiation the normal subjects from the patients' group.


Relationship of pulmonary artery diastolic and pulmonary artery wedge pressures in mitral stenosis. Resting and exercise hemodynamic studies were performed in 22 patients with mitral stenosis (14 men and 19 women; average age, 25 years) in normal sinus rhythm with normal pulmonary vascular resistances. A normal pulmonary vascular resistance was assumed when the resting pressure gradient between the pulmonary artery diastolic and mean pulmonary artery wedge pressures was 5 mm. Hg or less. A satisfactory correlation existed between the pulmonary artery wedge and pulmonary artery diastolic pressures at rest (r equals 0.9017) and during exercise (r equals 0.8670). A method of predicting pulmonary artery wedge pressure from pulmonary artery diastolic pressure during exercise was formulated. The correlation between the predicted and measured exercise pulmonary artery wedge pressures was very close (r equals 0.9561). It is suggested that during exercise the pulmonary artery diastolic pressure can be modified as above and substituted for mean pulmonary artery wedge pressure if the resting gradient between pulmonary artery wedge and pulmonary artery diastolic pressure is known.


Measurement of right ventricular volumes using 131I-MAA. A method has been presented for determining the right ventricular residual ratio, that is, the ratio of the end-systolic volume to the end-diastolic volume during each cardiac cycle. 131I-MAA was injected as a bolus into the right ventricle, and the ratio of isotope remaining in the chamber during the succeeding cardiac cycles was determined with a collimated scintillation counter placed over the right ventricle. Since the counter detected the radioactivity from the entire right ventricular cavity, potential errors from incomplete mixing were minimized. The washout curve from the ventricle was distorted somewhat by the accumulation of isotope in intervening lung tissue. This distortion was eliminated by subtracting the build-up curve of radioactivity in the lung recorded simultaneously with a second scintillation counter positioned over the lateral chest wall. In 14 dogs anesthetized with chloralose, the right ventricular residual ratio was relatively constant at 40.4 plus or minus 3.1 per cent. Duplicate measurements differed by less than 3 per cent indicating the good reproducibility of the method. Right ventricular stroke volume was determined from cardiac output (dye dilution) and heart rate. With this and the simultaneously determined residual ratio (131I-MAA), end-diastolic volume could be calculated. Stroke volume and stroke work were highly correlated with end-diastolic volume, in keeping with the Frank-Starling mechanism.


Direct and reflex cardiac bradydysrhythmias from small vagal nerve stiumaltions. Alterations in cardiac pacemaker location, its rate of discharge, and A-V conduction patterns were induced in anesthetized adult dogs by electrical stimulation of the thoracic vagi and their small cardiac branches before and after cervical vagotomy. Electrical activity from small, contiguous bipolar silver electrodes was amplified and recorded by an optical oscillograph. The electrodes were located over the SA node, the three internodal pathways, the left atrium, and ventricular epicardium. A hoffman-type plaque electrode was placed over the A-V node to record a His bundle electrogram simultaneously with a Lead II electrocardiogram. Electrical stimulation of the intact left recurrent laryngeal nerve and its cardiac branches before and after vagotomy induced both direct and reflex effects on SA nodal cycle length. Efferent dromotropic effects on the A-V node varied from first- to third-degree heart block during stimulation of individual left recurrent cardiac branches. Stimulation of the right recurrent cardiac nerve induced atrial bradycardia with heart block above the His bundle. Stimulation of individual right vagal branches near the heart induced bradycardia, cardiac asystole, shifts in atrial pacemaker location, or activation of His pacemakers. Establishment of the His rhythm probably indicates selective inhibition of supraventricular but not of the His bundle. Asystole and His rhythms induced during stimulation of the more caudal branches of the right cardiac vagal nerves were generally reflexly mediated and were abolished by cervical vagotomy.


Myocardial imaging with indium- 113m- and technetium-99m-macroaggregated albumin. New procedure for identification of stress-induced regional ischemia. Regional coronary blood flow distribution was studied by myocardial imaging after intracoronary injection of technetium-99m- and indium-113m-macroaggregated albumin at rest and during coronary hyperemia induced by intracoronary injection of Hypaque-M, 75 percent. The four- to five-fold increase in coronary flow after injection of radiographic contrast material was similar in magnitude to that occurring with maximal exercise stress. Experimentally, resting coronary blood flow and regional distribution of radioactive particles remains normal in spite of coronary stenosis of up to 85 percent. Less severe stenosis causes flow and distribution abnormalities only during periods of increased flow, and the degree of maldistribution is directly related to the physiologic severity of the stenosis. Of 49 patients with suspected coronary artery disease, 10 had no significant lesions by coronary arteriography and all had normal images at rest and during coronary hyperemia. Thirty-seven of 39 patients with significant obstructive coronary artery disease had abnormal images at rest or during contrast agent-induced hyperemia, or both. Patients with significant coronary artery disease without previous infarction usually demonstrated abnormalities in flow distribution only during coronary hyperemia. Patients with previous infarction demonstrated resting perfusion abnormalities that often became more abnormal during hyperemia. This technique provides a new method for assessing the physiologic effects of coronary stenosis in conjuntion with coronary arteriography.


Scanning electron microscopy of cardiac endothelium of the dog. Tissue obtained from young dogs was fixed in buffered aldehydes by vascular perfusion or direct immersion. Selected hearts were maintained in modified mammalian Ringer's solution for three to five minutes prior to fixation. The chambers of the heart and related valves were exposed by dissection and prepared by routine techniques for observation by scanning electron microscopy (SEM). Subsequent to SEM studies, selected specimens were embedded in Epon 812 and sectioned for transmission electron microscopy (TEM). The cardiac endothelium, when fixed immediately in buffered aldehydes, presents an essentially invariable surface throughout the interior of the heart. The predominant nuclear bulges and attenuated peripheral plasmatemma are consistently smooth, with occasional marginal ruffles, scattered microvilli and small blebs. Apart from the higher population of nuclear bulges on valvular surfaces, local variations in SEM of endocardium occur in response to the various stages of systole and diastole encountered. These physiological changes do not produce microappendages. Immersion for three to five minutes in (Chenoweth's) Ringer's solution, prior to fixation, produces a substantial population of microappendages. The cellular surface acquires a swirled appearance erupting in microvilli, blebs and ruffles. These exhibit considerable pleomorphism. There is great lability of the endocardial surface in response to a classic "holding solution" widely used in preparatory techniques. In preparing soft tissues for SEM caution must be used if physiological "holding solutions" are used prior to fixation.


Embedding brain specimens in transparent plastic. A simple, reliable and practical technic for permanently embedding brain specimens in plastic is discussed. The anatomic details, including the natural colors, are so well preserved that they give a real picture of the morphologic details, such as preservation of anatomic landmarks and pathologic alterations. The specimen can be observed from different angles, enhancing the student's opportunity for visual examination. Clearing of the specimen with visualization of the vascular tree after injection with opaque dyes may be accomplished. The procedure is recommended for museums and laboratory teaching.


IgD deposition in glomerulonephritis. An immunopathologic study. Diffuse deposits of IgD were found in glomerular basement membranes in eight of 263 consecutive renal biopsies by the direct immunofluorescent technic. In five biopsies a granular staining pattern was found and in three a linear pattern was found. IgG and beta1C were present in glomeruli of all eight patients, and IgM in four. Two patients had elevated titers of antithyroglobulin antibodies in the serum, and one patient had anti-glomerular basement membrane antibodies of the IgG class in both serum and renal eluate. This study suggests that IgD may play a role in immunologically mediated glomerular disease. (Key words: IgD; Glomerular deposits; Nephritis.)


Acute glomerulonephritis. Immunofluorescent and electron-microscopic observations in sporadic cases. The authors studied by immunofluorescent and electron microscopy renal biopsy specimens from 29 patients with various glomerular diseases. Poststreptococcal glomerulonephritis was characterized by the presence of complement (beta1C) in the mesangium and/or on the basement membrane in all cases. Immunoglobulin G (IgG) was also present in less than half of the cases in the same distribution. Electron microscopy, carried out in six cases, revealed no uniform ultrastructural change: minimal subepi helial deposits were observed in three cases, intramembranous deposits were seen in two cases, and the basement membrane was normal in one case. Glomerular abnormalities during the courses of some systemic diseases were similar. Mild renal involvement was characterized by only beta1C deposition. This finding raises the question whether a mechanism other than or in addition to that involving immune complexes is operative in the pathogenesis of acute glomerulonephritis. There is circumstantial experimental evidence that an alternate pathway of complement activation and deposition may be operative in acute glomerulonephritis.


Immunofluorescence of soft-tissue tumors with anti-smooth-muscle and anti-skeletal-muscle antibodies. One hundred thirteen soft-tissue tumors were studied by immunofluorescence using anti-smooth-muscle (SMA) and anti-skeletal-muscle antibodies (MGA). Of the classic leiomyomas examined, 94% manifested bright fluorescence with SMA, whereas cellular leiomyomas and leiomyosarcomas failed to stain. Of the rhabdomyosarcomas studied, 21% showed fluorescent cross-striations or fluorescent granules after incubation with MGA. None of 48 control tumors fluoresced with either antibody. No tumor vessel seen showed smooth-muscle fluorescence in its walls. Although of little diagnostic value, immunofluorescence utilizing specific human antibodies is a valuable tool with which to study some of the antigenic components of these neoplasms.


Pulmonary granulomatous pneumocystosis following renal transplantation. Report of a case. Pulmonary granulomas of sarcoid type in a patient who was on long-term immunosuppressive therapy following renal transplantation are described. Pneumocystis carinii was identified within the lesions. This is believed to be the first description of this type of reaction to Pneumocystis in the adult patient on immunosuppressive therapy.


Selective hypogammaglobulinemia with persistence of IgE, malabsorption and a nutritionally dependent, reversible defect in cell-mediated immunity. A 46 year old man presented with selective hypogammaglobulinemia, malabsorption and long-standing secondary malnutrition. Although the patient had essentially unmeasurable levels of immunoglobulins G (IgG), M (IgA), he had normal levels of immunoglobulin E (IgE). He was found to be anergic when tested for the delayed cutaneous hypersensitivity reaction. Evaluation of his cell-mediated immunity in vivo and in vitro suggested one discrete lesion, a defective production of the lymphocyte mediator macrophage migration inhibitory factor. With improved nutrition the patient "repaired" this defect in the "efferent" limb of cellular immunity and was no longer anergic.