Optometry and the underprivileged--an investigative report. In this essay I have taken the topic, "Optometry and the Underprivileged," and approached it as an investigative report. This investigation found me talking with people in all walks of life and visiting many institutions and health care facilities. Some of the people discussed in the report and their conditions represent composites of the real situations I encountered. Their names are fictitious and to the best of my knowledge these people do not exist. The report is intended to be informative, constructively critical, unboring, and positive. If I have accomplished this, then my purpose has been fulfilled.


Optometric manpower resources--1973. Part III. The Optometric Manpower Resources Project, funded under government contract since June of 1971, has completed its 1973 national census of licensed optometric manpower in the United States. The first article in this series of three reported on the distribution of optometrists by census region and the current ratios of practicing optometrists to civilian population. The second article reported on the principal forms of employment of active optometrists, the number of years in practice and practice size. This third article reports on the age and sex distributions of licensed optometrists, their racial/ethnic composition, their pattern of specialization, and the schools/colleges of optometry from which they graduated. The data indicate that almost 50% of active optometrists were over 50 years of age. Approximately 90% of male optometrists and only 58.5% of female optometrists were active. The data also indicate that one-third of all optometrists active in 1973 graduated from four schools/colleges of optometry.


The role of the technician in optometric practice. Members of the Indiana Optometric Association were asked to rate each of the duties which Indiana University optometric technician students are currently taught to perform. Rated on a four point scale from most desirable to undesirable, the duties deemed most important by respondents were those having to do with the dispensing of glasses and contact lenses as well as the usual receptionist and secretarial duties. The duties receiving the lowest ratings were keratometry and tonometry. However, there is good general agreement between the school and the profession concerning the content of the optometric technician program.


Leadership and interpersonal need compatibilities between optometrists and optometric assistants. A comparison of optometrists' leadership style and the preferred leadership style of their optometric assistants as well as both groups' interpersonal need orientations indicated: 1) optometrists' consideration and initiating structure orientations were lower than those preferred by their assistants, structure was significantly lower (p less than .01) while consideration approached significance (p = .08); 2) optometrists had significantly lower needs for expressing control than their assistants had for wanting to be controlled (p less than .01), assistants had significantly higher needs for expressing participation and inclusion than optometrists had for wanting to be included (p less than .05), and optometrists had significantly higher needs for wanting to be controlled and influenced than their assistants had to control and influence them (p less than .05). Implications for the optometrist-assistant working relationship are discussed.


An experiment in health careers recruitment: a summer program at Indiana University. During the summer of 1973, the Indiana University Division of Optometry, via a Special Project Grant from the National Institutes of Health, conducted its first Summer Institute in the Health Related Professions for High School and College Students. Twenty-seven high school students and twenty-nine college students were brought to Indiana University for intensive sessions in career awareness, curriculum and financial counseling, and academic coursework. Assisted by the staffs of Indiana Health Careers, Inc. and the Indiana University Coordinators for School Science, the Institute awakened new interests and goals, relative to the health career prospectus, within the trainees. As a direct consequence of the summer program, four participants in the college institute were matriculated into schools of medicine, pharmacy, and optometry during the semester following the culmination of the Institute; ten more are participating in the followup program for continued guidance and counseling, seeking 1974 entrance into health professions schools and colleges. This experiment in health professions recruitment for minority, disadvantaged, and low-income students proved to be a viable method of increasing the manpower pool of health professionals.


Health law in 1985--implications for the optometric profession. In conclusion, I believe that you should seek to expand the scope of optometry into areas now regarded as exclusively medical practice, and devote less time and effort to protecting your rear from the encroachment of the opticians. I suggest this because it follows a seemingly natural process of expanding upward that one finds in other professions and occupations in the health field. Second, I have suggested that, to achieve an expanded scope of optometry, there may have to be some sacrifice of the concept of the independent, entrepreneurial practitioner in optometry. Even the medical profession is recognizing that the individual entrepreneurial physician is becoming less of a factor than he was before, and the future is not particularly bright for him further down the road. Third, to the extent you can influence the forum where the struggle over the expanded practice of optometry takes place, you may increase the likelihood that the expanded role will be recognized by law sooner. I have already alluded to the idea that costs of health services and funding mechanisms are intimately tied to the law related to optometric practice in the future. As you know from the legislative struggles in many states over inclusion of optometric services within state Medicaid programs, and freedom of choice legislation that required an insurer to pay any legally recognized practitioner who could provide the service, rather than physicians exclusively, the optometric profession is well aware how closely the success of a profession is linked to access to third party payment.(ABSTRACT TRUNCATED AT 250 WORDS)


Understanding fluorescein contact lens photography: equipment and technique. A basic consideration of the utilization of close-up photography in the ophthalmic health care field is discussed. These principles can be applied to fluorescein contact lens photography using a hand-held camera. The discussion is divided into two areas: basic theory and equipment is reviewed, and a description of the clinical technique is described.


Orthokeratology: changes to the corneal curvature and the effect on refractive power due to the sagittal length change. Little has been published to date on orthokeratology which can explain what changes the eye actually goes through. Many professionals are waiting for this evidence before judging this controversial technique. With orthokeratology the corneal curves are changed and present a definite pattern. There are a number of changes which must occur when the cornea is flattened which reduce the power of the eye beyond that amount of flattening. This paper examines one of these unknowns.


The efficacy of frosted contact lenses in controlling flare. Improved techniques are rapidly increasing alternatives to the contact lens practitioner to aid in his efforts to afford maximum comfort and efficacy to the vision of his patients. The purpose of this research study was to determine if subjective symptoms of flare could be controlled, to a significant degree, with a frosted contact lens.


The influence of a high level of corn oil on rat serum lipoproteins. Although the stated requirement for linoleic acid in humans is less than 2% of the dietary calories, recently there has been considerable emphasis on the necessity to substitute dietary polyunsaturates for saturates in order to reduce serum cholesterol levels. In this study we have sought to determine the nutritional consequences of feeding a very high level of linoleate to rats. Three groups of thirty adult animals each were fed a semipurified diet consisting by weight of casein 17%; mineral mixture 5.5%; vitamin mixture in glucose 2.2%; cellulose fiber 3.0%; and corn oil 0% (group A), 10% (group B) or 40% (group C), which was provided at the expense of glucose. At the end of four weeks on the diets, blood was obtained in the fasting state from 16 rats in each group. The serum was ultracentrifugally fractionated into six classes of lipoproteins and analyzed for lipid composition and protein content. Disc gel electrophoresis using lipid and protein stains established that the various lipoprotein subclasses were reasonably free of adjacent density fractions. Although the total serum cholesterol levels were practically the same in the three groups, the cholesterol moiety of the major low density lipoproteins, LDL2 (d 1.019-1.050), but not of very low density lipoproteins, VLDL (d 1.006) or low density lipoproteins, LDL1 (d 1.006-1.019), was substantially and very significantly increased in rats fed the high level of corn oil as compared to the other groups. The concentration of the very low density lipoproteins was significantly lower in group C than in the groups A and B. The LDL2 concentration but not that of LDL1 was significantly greater in group C as compared to group A. The cholesterol/total lipid ratio was significantly greater in both LDL2 and LDL1 but not in VLDL of group C as compared with group A. The serum high density lipoproteins were relatively less influenced by the ingestion of an excessive level of corn oil at this time period. The serum lipoprotein levels as well as their lipid composition were generally similar in groups A and B and suggested that a moderate level (5%) of dietary linoleate did not cause any untoward changes in rats. On the basis of current information on the metabolism of lipoproteins, it has been proposed that the increase in rat serum LDL2 of group C reflects the status of the liver and that a large portion of the cholesterol moiety of LDL2 is perhaps derived from the liver while the protein and phospholipid portions may represent remnants of VLDL catabolism.(ABSTRACT TRUNCATED AT 400 WORDS)


Age-related interrelationships of blood pressure and arterial sterol accumulation in spontaneously atherosclerosis-susceptible and atherosclerosis-resistant pigeons. Interrelationships of arterial sterol accumulation and blood pressures were examined in age-matched White Carneau and Show Racer pigeons. It was found that the systolic blood pressure of White Carneaux changed from 155.0 mm Hg at nine months of age to 168.8 mm Hg at 17 months of age (P less than 0.005) while that of the Show Racers did not show any age-related increases. In White Carneaux, the total sterol content in the aorta increased by 43.6% from 9 months to 17 months of age (P less than 0.001) with major changes in the steryl ester fraction while no such changes were evident in the Show Racers. This indicates interrelationships of the arterial sterol content and blood pressure in the White Carneau pigeon.


ABO blood groups and age groups in surgical venous thromboembolism. In a series of cases of surgical thromboembolism there were significant age differences in the ratio of cases of blood group A to those of blood group O, the ratio being highest in the youngest age groups.


Familial and acquired type V hyperlipoproteinemia. The nature of Type V hyperlipoproteinemia including mode of presentation, prominent clinical and biochemical features, and genetics, was examined in 29 adults presenting with the Type V lipoprotein phenotype. Initially 23 of the 29 patients had various metabolic stimuli (diabetes out of control, estrogenic agents, pancreatitis, ethanolism) superposed on their acute hypertriglyceridemia. After metabolic stabilization, 17 of the 29 subjects were shown to have familial hypertriglyceridemia. In the 17 kindreds with familial hypertriglyceridemia, the lack of a specific, distinctive genetic marker for the Type V genotype and for the Type IV genotype restricts the conclusion that the pattern of inheritance was consistent with an autosomal dominant trait.


An analysis of arcuate staining with the B&L SOFLENS. Part I. A survey of 100 of our patients wearing Bausch & Lomb hydrophilic lenses shows that 38.5 per cent demonstrate corneal staining. The type of corneal staining that we are concerned with is epithelial, superficial, arcuate and usually located peripherally in an area between four and eight o'clock.


780 SE: a new type of hypolipemic agent. Comparative assays in rats. The effect of 1-(m-trifluoromethylphenyl)-2-(beta-benzoyloxyethyl)-amino- propane hydrochloride (780 SE) on serum lipids, blood glucose and liver weight was studied in 4 experimental models, and compared with that of clofibrate and tiadenol. When rats were given a daily oral dose of 25 mg/kg or 50 mg/kg of 780 SE for 5 days a marked reduction of serum triglycerides and liver weight was observed. The decreases were more pronounced than those in rats treated with 50 mg/kg or 100 mg/kg of clofibrate or tiadenol. On the other hand, a reduction of serum cholesterol was only observed in the groups given clofibrate and tiadenol. These differences could be explained on the basis of the mechanism of action of the different drugs. Only 780 SE induced a decrease in blood sugar level, a reduction of plasma insulin concentration and restored the insulin sensitivity to a normal value in obese animals. There was a significant decrease in liver weight of 780 SE treated rats, whereas clofibrate and tiadenol cause hepatomegaly.


Variation in refractive error and corneal curvature after wearing hydrophilic contact lenses. Twenty-eight eyes of people who have successfully worn hydrophilic contact lenses were monitored during a period after removal of their contact lenses. The results are compared to similar studies of wearers of non-flexible contact lens. While both curvature and refractive changes in a number of eyes stabilized at about one week, others did not stabilize until three weeks or more.


Distribution of cholesterol and triglycerides among lipoprotein fractions in fat-fed rabbits at different levels of serum cholesterol. The serum lipoproteins of rabbits given semisynthetic cholesterol-free diets containing coconut oil or butter or a conventional rabbit chow supplemented with cholesterol, were studied by preparative ultracentrifugation and electrophoresis. (1) All three diets elevated the total cholesterol level but only the coconut oil diet markedly increased the triglyceride (TG) content in addition. All ultracentrifugation fractions showed elevated cholesterol/TG ratios, and this was especially evident for the cholesterol diet. In the hyperlipidemic rabbits cholesterol was therefore mainly transported in lipoproteins with a changed lipid composition. (2) The lipid levels of the "HDL" fraction were more or less unaffected by the lipid concentration in whole serum. In the total serum cholesterol ranges 150-500 (coconut oil diet) and 100-300 mg/100 ml (cholesterol diet), most cholesterol was transported as "LDL" cholesterol. This latter fraction reached maximum cholesterol concentrations of about 350 (coconut oil diet) and 400 mg/100 ml (cholesterol diet) at total cholesterol levels of approximately 600 and 1200 mg/100 ml serum, respectively. At still higher levels of total cholesterol, the whole increment was concentrated to the "VLDL" fraction. (3) With semisynthetic diets in the whole cholesterol range 250-400 mg/100 ml it was possible, with respect to cholesterol, to induce fairly similar concentrations and distributions to those seen in man, with about 60% transported as "LDL", 30% as "VLDL" and 10% as "HDL" cholesterol with the coconut oil diet and 65%, 20% and 15%, respectively, with the butter diet. Such experimental conditions seem to be suitable for testing the hypocholesterolemic action of drugs intended for human hyperlipidemia Type II. (4) Compared with earlier investigations on rabbits, the present distribution study suggests that the degree of aortic lipid infiltration in cholesterol-fed rabbits is better related to the levels of "LDL" than to "VLDL" cholesterol.


Power changes converting aphakics from hard contact lenses to the B&L SOFLENS. The authors refit 20 former hard lens aphakic eyes with the Bausch & Lomb SOFLENS. Ten patients required less soft lens power than the power of the hard contact lens formerly used; five patients required the same soft lenspower; and five patients required more power with the soft lens than with the previous hard lens used. These findings were different than what would have been expected on the basis of the Back-Vertex Power Chart distributed by Bausch & Lomb.


A comparison of corneal topographical changes induced by corneal lens wear and keratoconus. A distinction is made between keratoconus-like changes induced by physical pressures placed on the cornea by hard corneal lens wear and the simultaneous development of true keratoconus in contact lens wearers.


Cholesterol: blood and tears.

Cholesterol: blood and tears. The interrelationships of tear and blood cholesterol levels are explored with particular emphasis on the variables of age and obesity.


Soft contact lens identification.

Soft contact lens identification. Measuring procedures used for hydrogel contact lenses are sufficiently difficult to make identification of a given soft lens annoyingly time-consuming and sometimes impossible. Etching a number or letter on the lens when it is received from the laboratory allows the practitioner to tell whether the proper lens is being worn, even while the lens is still on the patient's eye. A sharp pointed tool on a dry hydrogel lens produces this identifying number.


Prepaid contact lens care for the hard lens patient. The author presents his views as to why prepaid care is the best method of after care for contact lens patients. Detailed procedures are presented as to how to implement such a program. Legal justification for the use of prepaid care plans by the optometrist is given.


Patient response to PMMA contact lenses. This study was designed to determine patient response to hard (PMMA) contact lenses and evaluate how lens modifications and refitting affect success. The subjects of this study were 178 randomly selected contact lens patients fitted at the University of California School of Optometry. Six to nine months after the patients were examined and fitted, their response to contact lenses was evaluated using the standard of Sarver and Harris. 44.4% of the patients were successful with the initial lenses while an additional 35.4% of the patients became successful after appropriate lens changes were made. The majority of the changes made were to eliminate ocular tissue changes. Our results indicate that lens modifications or refittings are often necessary to achieve a successful response to contact lenses.


Home humidifier thermophilic actinomycete isolates. Twenty-seven thermophilic actinomycete isolates obtained from humidification systems or living-bedroom areas of individuals with suspected but unproved home environment-related respiratory disease were characterized morphologically and biochemically. All isolates were demonstrated to be members of the Thermoactinomyces genus. Two previously misidentified isolates were reclassified as a Thermoacetinomyces sp. Thus, all of our thermophilic actinomycete humidifier isolates studied to date have been identified as either Thermoactinomyces vulgaris or Thermoactinomyces sp. Large numbers of unidentified thermotolerant bacteria have also been isolated from virtually all residual humidifier water samples and their possible role in production of "humidifier-associated" respiratory disease is unknown.


[Autoimmune mechanisms and post-anesthetic hepatitis]. After a brief review of clinical, biological and immunological features of post anesthesia hepatitis and hepatic auto-immunity, the authors attempt to determine whether certain forms of post-anesthesia hepatitis can be placed under the heading of autoimmune liver disorders, the mechanisms by which auto-immunity can be induced and modulated and the practical implications of these concepts, namely with regard to detection of subjects at risk.


Progesterone-receptor mediation of chromatin RNA transcription in a cell-free system. The chick oviduct progesterone receptor has been purified to homogeneity by affinity chromatography and its molecular action studied in vitro. The native receptor is a 200,000 MW dimer of two dissimilar 4S subunits with different intranuclear function. The receptors directly regulate RNA chain initiation sites in oviduct chromatin by interactions involving target tissue nuclear acceptor sites. There is a 1:1 correspondence between receptor "acceptor" sites and RNA sites. Only the dimer form of the receptor is active in vitro on chromatin templates. The study suggests a novel model for homone action that can be tested directly in this system.


[Chemically defined diets as a diagnostic and therapeutic measure in food hypersensitivities]. Vivasorb proved successful as a diagnostic and therapeutic agent in a 78-year-old patient who had suffered from food allergy for three years. The alimentation with Vivasorb not only freed the patient of all her complaints, but also allowed the testing for the responsible allergens despite complete oral nutrition.


[Myocardial infarct patients with and without intensive nutrition consultation over several years-- comparison of physiological and social variables]. After three years of experience with change of nutrition in 300 infarction patients of the Höhenried long-term study (150 patients with intensive change of nutrition and 150 patients serving as control group) and 50 randomized study participants from the control group, the following results could be found: 1. In infarction patients, who underwent rehabilitation and follow-up examinations (group with change of nutrition), the increase of the P/S quotient causes no serum cholesterol and serum triglyceride decrease compared with the control group. 2. Alcohol and nicotine consumption cannot be further decreased by intensive nutrition consultation compared with the lasting effect of the comprehensive care. 3. As well, no further weight reduction (no less than the patient obtained during the rehabilitation phase) can be attained in the "nutrition change" and the control group. 4. From the "nutrition change" group more patients took up work again after the infarction compared with the control group, although age and social status are identical in both groups. These results are contradictory to nearly all other studies. We explain this difference by the fact that both groups were under comprehensive care. The care of the patient is a very decisive factor, which is the reason for keeping low the mentioned risk factors.


Quantitative studies on gastric emptying of Vivasorb. The stomach clearance following the administration of 210 g Vivasorb in 700 ml water was ascertained in a 22-year-old healthy test subject. In the first hour, 50 g Vivasorb left the stomach, in the second hour 40 g and in the third and fourth hours, 30 g each. By doubling the dilution, the stomach clearance is not accelerated. An isocaloric glucose solution is cleared from the stomach just as rapidly as the Vivasorb solution.


[Comparison of medical and surgical treatment of infantile hypothalamic obesity]. The jejunoileal bypass is, of all the current therapeutic possibilities, the only permanent method for the successful treatment of a patient with hypothalamic obesity. Pre-operatively, it is advisable, however, to reduce the body weight by exclusive alimentation with Vivonex, in order to improve lung function and diminish the operation risks. Putting a smaller section of the bowel at rest will prevent major weight loss, as well as more severe complications. The disturbances of the calcium and potassium metabolism and of liver function, which frequently occur after jejunoileal bypass operation, were not observed, when on both sides of the immobilised bowel section a section of small bowel 23 to 38 cm long was maintained in normal function.


[Questioning of diabetic patients on their knowledge of nutrition and dietetics as well as on their smoking habits]. 100 diabetics were asked questions referring to the knowledge of nutrition to smoking habits. Most of the diabetics controlled their body weight regularly and were convinced that overweight may be dangerous to health. Despite this knowledge, more than half of the patients were overweight and did not know their individual ideal weight. Between the quality of dietary consultation and dietary behaviour of the patients a similar discrepancy existed: More than half of the questioned persons - especially males - had to be regarded as dietary failures. Patients with relatively low educational level came off worse. Fortunately, most of the patients were non-smokers. However, the dietary consultation practised at the moment seemed to have had no influence on the number of smokers. Consequently, for the training of the patients the following results: More than ever, the patients must be incited to normalize their body weight and they must be positively motivated in this regard as well as with regard to nicotine abuse. Behaviour therapy would certainly be desirable. Moreover, the patients should have a dietary consultation at least every second year. A dietary filled in for the patient personally must serve as the basis for the observance of the diet. Persons in whom diabetes mellitus was diagnosticated should receive consultation more quickly than up to now. Moreover, it would be useful to free the diet from the odium of an annoying and unimportant supplementation to medicamentous diabetes therapy. The study showed that continuous self-control of the own educational work is indispensable to guarantee a high standard of therapeutic efforts.


[Diagnostic tests for hypersensitivity to halogen compounds]. The authors present a critical analysis of immunological tests used by some authors to establish the diagnosis of halothane-induced hepatitis. These tests include the lymphocyte transformation test (LTT), the leukocyte migration inhibition test (LMIT) and detection of auto-antibodies. It has not been possible for all investigators to reproduce the results of these tests. The inhibition of these tests is not specific for halothane since it is also observed after infectious and serum viral hepatitis.


Direct and indirect pulp capping.

Direct and indirect pulp capping. Cavity disinfection, indirect pulp capping, and direct pulp capping have been discussed in light of present day knowledge of the biology of the pulp. A format has been presented to the restorative dentist which has had long-standing clinical acceptance based on some scientific data and clinical evidence to substantiate the treatment radionale.


Some new studies of the wear behavior of ultrahigh molecular weight polyethylene. The wear rate of ultrahigh molecular weight (UHMW) polyethylene over a long campaign of sliding distance is not constant. Both unfilled and graphite filled polyethylene show a high rate early, which reduces to a low value. The graphite-filled product shows a late stage increase in wear rate. Increased molding temperature reduces the molecular weight and increases the wear rate. Titanium articulating with UHMW polyethylene develops frequently an abnormally high wear rate with the generation of a black wear product.


Identification and characterization of species of the family Bacteriodaceae by polyacrylamide gel electrophoresis. Polyacrylamide gel electrophoresis was used to compare protein profiles of members of the family Bacteriodacceae. Cell-free extracts were prepared and the protein components separated by multistage polyacrylamide gel electrophoresis. The profiles were distinct and reproducible thus allowing identification of species, subspecies, and minor strain differences. Lyophilization of the cell-free extracts did not alter the major protein components. The results indicate that the techniques used may be useful in conjunction with conventional tests in identification at the species level.


Sinus barotrauma in divers.

Sinus barotrauma in divers. Sinus barotrauma is a common occupational disease of divers, with the incidence of descent barotrauma approximately double that of ascent. Pain chronologically associated with the change of pressure is the most dominant symptom and is seen in 92% of the cases presented for treatment. The majority complain of a frontal distribution of pain, with ethmoidal and maxillary being much less significant. Epistaxis is the second commonest symptom, and may be the sole symptom in some ascent cases. A history of recent or past sinus barotrauma or upper respiratory tract pathology is very common. Clinical examination supports the evidence of upper respiratory tract pathology in many cases. The radiological signs of abnormality were present in over three quarters of the cases examined. Of these the maxillary sinus was affected in most cases, the frontal in approximately one quarter and the ethmoidal in less than a fifth. The pathology was more commonly that of mucosal thickening, but in 12% of cases there was a fluid level. It is noted that although symptoms were predominantly frontal, x-ray changes were most often present in the maxillary sinuses.


[Possibilities and limitations in the education of athe mentally handicapped (author's transl)]. The possibilities and limitations in the education of the mentally handicapped can today be defined in both medical and pedagogical terms. We think that the physician can create essential preconditions for optimal education of a mentally handicapped child by diagnostic retience, avoidance of negative suggestions, by observation of the possibilities which remain open, by concern for education as early as possible, by informing of special educational facilities and by emotional stabilization of the parents. This is the only way of attaining a successful upbringing with respect to a sufficient integration.


[Comments on the infraspecific taxonomy of Sergentomyia minuta (Rondani, 1843), S. africana]. The authors discuss the systematic value of the cibarial armature of three members of the genus Sergentomyia. Subspecies could not be differentiated by the number of teeth, nor could members of the antennata and africana complexes. Moreover, from this character, the minuta complex along the Mediterranean coast of Spain appears to represent a typical "cline".


Alternate-day prednisone therapy and human lymphocyte subpopulations. The mechanisms and kinetics of the immunosuppressive effects of alternate-day prednisone were investigated in a group of patients with a variety of inflammatory diseases receiving a range of alternate-day prednisone doses from 5 to 120 mg. Total circulating lymphocyte and monocyte counts, as well as proportions of lymphocyte subpopulations defined  both by surface markers and by in vitro functional capacities, were studied. At 8 a. m. of the day on prednisone, just before drug administration, lymphocyte and monocyte counts, proportions of lymphocyte subpopulations, as well as in vitro lymphocyte blastogenic responses to various mitogenic and antigenic stimuli were normal. 4 h after the administration of prednisone, there was a profound lymphocytopenia and monocytopenia, with a differential depletion of thymus-derived lymphocytes as well as various functionally defined lymphocyte subpopulations. Lymphocyte kinetic studies using a radioactive chromium-labeled autologous lymphocytes showed that the lymphocytopenia was due predominantly to a transient depletion of the recirculating portion of the intravascular lymphocytepool. All these parameters returned to normal by 8 a.m. of the following day (off prednisone) and remained normal throughout the day. This very transient lymphocytopenia and monocytopenia after prednisone, with normal cell numbers, proportions, and functions throughout the remainder of the 2-day cycle, was associated with suppression of disease activity, yet did not affect cutaneous delayed hypersensitivity in these patients nor increase the likelihood of infectious complications. This drug-associated cyclic and transient monocytopenia and selective lymphocytopenia is best explained by a redistribution of recirculating lymphocytes to other body compartments, particularly the bone marrow.


Immunoblastic lymphadenopathy. A hyperimmune entity resembling Hodgkin's disease. Immunoblastic lymphadenopathy, although it resembles Hodgkin's disease, is a distinct, hyperimmune disorder apparently of the B-cell system. In 32 cases, it was characterized by a morphologic triad: proliferation of arborizing small vessels; prominent immunoblastic proliferations; and amorphous acidophilic interstitial material. Clinically, it is manifested by fever, sweats, weight loss, occasionally a rash, generalized lymphadenopathy and often hepatosplenomegaly. There is a consistent polyclonal hyperglobulinemia and often hemolytic anemia. The course of the disease is usually progressive, with a median survival of 15 months in 18 fatal cases. The cellular proliferation appears benign morphologically in the pretherapy biopsies and in 10 of 12 available autopsy cases. In three cases the process evolved into a lymphoma of immunoblasts, immunoblastic sarcoma. The basic process appears to be a non-neoplastic hyperimmune proliferation of the B-cell system involving an exaggeration of lymphocyte transformation to immunoblasts and plasma cells that may be triggered by a hypersensitivity reaction to therapeutic agents.


Improvement of reduced left ventricular diastolic compliance in ischemic heart disease after successful coronary artery bypass surgery. To determine the effects of myocardial revascularization on decreased left ventricular diastolic compliance consequent to chronic stable coronary artery disease, 15 patients with patent coronary artery bypass grafts (Group I) were compared with 8 patients with occluded grafts (Group II) studied before and after operation. In addition, eight normal patients served as controls. Left ventricular diastolic compliance was assessed by: (1) total observed diastolic compliance: stroke volume (V) related to left ventricular diastolic pressure (P) change (deltaV/deltaP) normalized for end-systolic volume; (2) left ventricular stiffness index of passive elastic modulus (a equals slope of deltaP/deltaV related to mean left ventricular diastolic pressure); and (3) fractional pattern of left ventricular filling. All patients had normal sinus rhythm and none had preoperative or postoperative mitral regurgitation. The two groups with coronary disease were well matched preoperatively for ventricular function, volumes, mass, segmental contraction and compliance. Ejection fraction increased in Group I (0.56 preoperatively to 0.65 postoperatively, P less than 0.05) but was unchanged in Group II (0.63 To 0.61, P greater 0.05). Postoperative indexes of left ventricular compliance improved in Group I: (1) 0.110 to 0.150 (P less 0.05); (2) 0.030 TO 0.019 (P less 0.05); and (3) 37 to 30 percent filling during last one third of diastole (P less 0.05). These indexes were unchanged postoperatively in Group II: (1) 0.109 to 0.102 (P greater 0.05); (2) 0.033 to 0.039 (P greater than 0.05); and (3) 36 to 41 percent (P greater 0.05). Compliance indexes were not altered (P greater 0.05) in a subset of seven patients in Group I with preoperative or intercurrent myocardial infarction. Thus, this investigation demonstrates the relatively reversible nature of abnormal left ventricular compliance after successful coronary artery bypass surgery in certain patients with ischemic heart disease.


Thymosin activity in patients with cellular immunodeficiency. An extract of calf thymus, thymosin, induces an increase in percentage of T-cell rosettes when incubated in vitro with sheep erythrocytes and lymphocytes from patients with primary immunodeficiency diseases or viral illness. Precursor lymphocytes are required for this increase to occur. The percentage of T-cell rosettes, when they are normal, is not increased further upon incubation with thymosin. A patient with thymic hypoplasia and immunoglobulin synthesis was selected to receive thymosin in vivo when her T-cell rosettes had increased from 15 to 48 per cent after in vitro incubation with thymosin. During therapy, she clinically improved, the percentage of T-cell rosettes gradually increased to normal, and positive delayed hypersensitivity skin tests developed. Thymosin may be useful clinically for partial reconstitution of cellular immunity. An increased percentage of T-cell rosettes after incubation with thymosin in vitro may predict which patients will respond to thymosin therapy in vivo.


Oral manifestations of Crohn's disease without demonstrable gastrointestinal lesions. The literature relating to oral manifestations of Crohn's disease is reviewed and a case is reported in which clinical and histopathologic features of oral Crohn's disease are present without demonstrable gastrointestinal lesions. It is suggested that it is reasonable to make a firm diagnosis of the condition on this evidence alone and to monitor the patient for subsequent gastrointestinal symptoms, so that treatment can be instituted at an early stage.


Pancreatic disease.

Pancreatic disease. New tests and test methods aid in the diagnosis of pancreatic disorders. Pancreatic carcinoma, especially, may have an improved prognosis with earlier detection as a result of refinements in arteriography, cytology, pancreatic radioisotopic scanning, and endoscopic retrograde cholangiopancreatography. Acute pancreatitis results most commonly from alcoholism, biliary tract disease, and trauma. Management is directed primarily at decreasing pancreatic exocrine secretion. Surgery is usually best avoided in the acute phase. Chronic pancreatitis is most often a result of recurrent attacks of acute pancreatitis. Diabetes and malassimilation become manifest as pancreatic destruction progresses. Management consists of replacement of pancreatic enzymes and diet supplements. Once chronic pancreatitis is established, surgery can only be directed at complications of the disease. Pancreatic ascites is usually associated with a break in the pancreatic ductal system. Ascites caused by trauma responds well to surgical intervention, but the alcoholic type is less amenable to treatment.


The diagnosis and treatment of Raynaud's phenomenon. Twenty-five patients with Raynaud's phenomenon, including 20 with associated diseases and five with primary Raynaud's disease, were evaluated with sequential determinations of digital temperature recovery time after cold exposure and magnification hand arteriography before and after cold exposure and before and after intra-arterial reserpine. A variety of immunologic screening tests were performed, and the clinical response to oral guanethidine of phenoxybenzamine was determined. Temperature recovery time was prolonged in all but two patients with Raynaud's phenomenon before treatment. Arteriography revealed luminal obstruction of variable degree in all but two patients with Raynaud's phenomenon but not in those with Raynaud's disease. Radiographic vasospasm was noted in all patients. Patients with Raynaud's symptoms had a markedly greater vasospastic response to cold exposure than did three control patients without Raynaud's symptoms. Arteriography 48 hours after intra-arterial reserpine repeat revealed decreased vasospasm and a decreased vasospastic response to cold in most patients. A variety of serum protein and serologic aberrations were detected, with only eight patients being free of immunologic abnormalities, Nineteen patients were treated with guanethidine alone, three with guanethidine-phenoxybenzamine combination, and one with phenoxybenzamine alone. Good or excellent clinical results were noted in 19 of the 23 patients treated, with an average follow-up to date of 12 months.


Improvement of myocardial and other vital organ functions and metabolism with a simple method of pulsatile flow (IABP) during clinical cardiopulmonary bypass. A simple, safe, and effective method of producing pulsatile flow during cardiopulmonary bypass (CPB) with intra-aortic balloon pumping (IABP) was used in 56 patients. No complications were associated with IABP. Myocardial metabolic studies, including coronary sinus lactates, mycoardial venous-arterial lactate differences, myocardial lactate extraction, and "excess lactate" were determined serially during the first hour of CPB. Changes in myocardial metabolism were statistically less abnormal in pulsatile flow (PF) patients when contrasted with a comparable group of nonpulsatile flow (NPF) patients. The changes were probably myocardial in origin since alterations in arterial lactates and lactate/pyruvate ratios were similar in both groups. In a comparable group of coronary bypass NPF patients, the percentage of left ventricular ejection fractions fell during the immediate postoperative period, whereas it rose in the PF group. Over-all body tissue injury (lactic dehydrogenase) and probably hepatocellular injury (serum glutamic oxalacetic transaminase) were less apparent in the PF patients. Postoperative low-cardiac-output syndrome did not occur in the PF patients and supportive drugs and diuretics were not needed. PF does not produce excessive hemolysis. This procedure may improve mortality rates by improving myocardial and other vital organ perfusion and by sustaining their function during weaning from CPB. This technique may prove superior to other forms of PF and is indicated in patients with severe left ventricular or other vital organ dysfunction and/or prolonged CPB.


Application of visually evoked response near the threshold of vision to objective measurement of dark adaptation. The visually evoked response (VER) to dim lights with intensities within the scotopic or lower mesopic range increased in amplitude during the progressive dark adaptation. The VER amplitude vs. time curve resembled the psychophysical dark adaptation curve. The spectral sensitivity curve of the dark-adapted VER matched the C.I.E. scotopic sensitivity curve. The dark-adapted VER was abnormal in patients with retinitis pigmentosa and with congenital stationary night blindness and recordable in a patient with cone dysfunction. There was a close correlation between the VER threshold and subjective threshold of visual perception. The dark-adapted VER may be useful as an objective index of dark adaptation.


Association of an ultraviolet irradiation sensitive cytoplasmic localization with the future dorsal side of the amphibian egg. Drastic alterations in neural morphogenesis can be induced by ultraviolet irradiation of the amphibian egg. The target area of U.V. was determined either by direct irradiation of various regions of the egg or by comparing the area of the U.V. hit with the location of the dorsal lip. Axolotl eggs which displayed easily recognizable gray crescents were employed for the direct irradiation experiments and albino axolotl eggs were used for a comparison of the U.V. sensitivity of the animal and vegetal halves of the egg. Marked frog eggs were employed to determine the relationship between the sensitive area and the site of formation of the dorsal lip. It was concluded that the dorsal marginal zone of the fertilized, uncleaved egg was the most sensitive area of the egg. Ovarian homogenates provide a source of material for correcting, by microinjection, the effects of U.V.


Energy liberation and chemical change in frog skeletal muscle during single isometric tetanic contractions. Recent data obtained from Rana temporaria sartorius muscles during an isometric tetanus indicate that the time-course of phosphocreatine (PC) splitting cannot account for the total energy (heat + work) liberation (Gilbert et al. 1971. J. Physiol. (Lond.) 218:)63). As this conclusion is important to an understanding of the chemical energetics of contraction, similar experments were performed on unpoisoned, oxygenated Rana pipiens sartorius muscles. The muscles were tetanized (isometrically) at 0 degrees C for 0.6, 1, or 5 s; metabolism was rapidly arrested by freezing the muscles with a specially designed hammer apparatus, and the frozen muscles were chemically analyzed. Comparable myothermal measurments were made on frogs from the same batch. Results of these experiments indicate: (a) The energy liberation parallels the PC and ATP breakdown with a proportionality constant of 10.7 kcal/mol; (b) comparably designed experiments with sartorius muscles of R. temporaria revealed that the ratio of energy liberation to PC splitting was significantly greater than that observed in R. pipiens sartorius muscles; (c) there is no systematic difference between experiments in which metabolism was arrested by the hammer apparatus and others using a conventional immersion technique.


Longitudinal impedance of single frog muscle fibers. The longitudinal impedance of single skeletal muscle fibers has been measured from1 to 10,000 Hz in an oil gap apparatus which forces current to flow longitudinally down the fiber. The impedance observed is purely resistive in some fibers from the semitendinosus muscle and in two fibers from the sartorius muscle. In other fibers from the semitendinosus muscle a small phase shift is observed. The mean value of the maximum phase shift observed from all fibers is 1.07 degrees. The artifacts associated with the apparatus and method are examined theoretically and it is shown that one of the likely artifacts could account for the small phase observed. It is concluded that the longitudinal impedance of skeletal muscle fibers is essentially resistive and that little, if any, longitudinal current crosses the membranes of the sarcoplasmic reticulum.


An electrically evoked slow potential of the frog's retina. I. Properties of response. 1. Brief pulses of electrical current passed through the frog's eye cup from sclera to vitreous (inward current) evoked large, vitreous positive slow potentials of retinal origin. Brief pulses of outward current evoke no response. 2. This electrically evoked retinal response (EERG) increased sharply in amplitude as the strength of the stimulus was increased. 3. Strength-duration curves showed that the stimulating pulse was integrated with a time constant ranging from 14 to 36 ms. The time constant was a function of the amplitude chosen as a criterion. 4. The EERG was abolished by chemical agents which abolish the PII component of the ERG (KCl, NH3, aspartate). 5. The waveform of the EERG returned to the base line with exactly the same time course as the PII component of the ERG, both when the PII was evoked by flashes of light and when it was evoked by flashes of darkness. 6. These results can be explained in terms of the hypothesis that electrical stimuli act on the synaptic terminals of the photoreceptor cells.


An electrically evoked slow potential of the frog's retina. II. Identification with PII component of electroretinogram. 1. To show conclusively that the electrically evoked retinal response (EERG) is in fact an electrically evoked component of the usual ERG, it is necessary to show that the two responses have the same intraretinal pattern of current generators. A method for determining when two responses have the same origin has been developed. This method utilizes measurements from a single microelectrode penetrating the retina. 2. The method was sensitive enough to detect differences in the origins of two responses when they were present. 3. The EERG had the same intraretinal origin as the PII component of the ERG, and thus is the PII component evoked by electricity rather than by light. 4. The hypothesis that electrical stimuli act on the synaptic terminals of the photoreceptor cells predicts that electrical current will evoke components of the ERG. The fact that the EERG is an electrically evoked component of the ERG fulfills that prediction.


Modification of the frog's electroretinogram by transretinal direct current. 1. Transretinal direct current modifies the amplitude and waveform of the frog's electroretinogram (ERG). Outward current (that flowing from vitreous to sclera) depresses the ERG while inward current enhances it. Outward current causes an apparent reversal of the polarity of the positive off-response (d-wave) of the ERG. 2. A true reversal does not actually occur. Rather, the outward current unmasks a negative off-response by depressing the positive off-response. 3. The positive off-response and the b-wave can be completely abolished by strong outward current, but cannot be reversed. 4. Treatment with ammonia abolishes the negative off-response, leaving a positive off-response which is affected by current in exactly the same way as the normal positive off-response. 5. Two possible mechanisms by which the current could be affecting the amplitude of the positive off-response would require that its amplitude be reversed for strong outward current. The absence of such reversal rejects these mechanisms.


Neonatal craniopharyngioma. Case report. The authors report a case of craniopharyngioma in a newborn infant. Marked hydrocephalus of the fetal head was recognized in the pelvimetric roentgenograms of the mother and massive suprasellar calcification was seen in the plain skull films.


Alpha-1-antitrypsin deficiency, emphysema, cirrhosis, and intestinal mucosal atrophy. An elderly man with long-standing pulmonary emphysema was seen with recent onset of steatorrhea and ascites. He had very low levels of serum alpha1-antitrypsin, hepatic cirrhosis, and intestinal mucosal atrophy. We believe this this combination of findings did not occur by chance.


A clinical method for detecting subendocardial ischemia after cardiopulmonary bypass. Subendocardial ischemia with consequent subendocardial necrosis is a frequent cause of death after cardiopulmonary bypass. The problem is caused by an inequity in the oxygen requirements of the subendocardium and the available blood supply. We have developed a means of detecting ischemia early in the postperfusion period. Using an analogue computer, we determine the endocardial viability ratio (EVR). This value may decrease before either systemic or central venous pressure changes. Thus the ratio can reflect early the danger of subendocardial ischemia. Another advantage is that equipment now common in coronary care units can be used to determine the EVR.


Direct selective myocardial revascularization by internal mammary artery-coronary vein anastomosis. In this report, we shall describe our work with retrograde coronary perfusion, first in mongrel dogs and then in 6 patients. The left internal mammary artery (LIMA) is anastomosed to the left anterior descending coronary vein (LADV)  to provide myocardial perfusion. This procedure may be of great value in the treatment of patients who are not suitable candidates for direct coronary bypass grafting, i.e., those who have diffuse atherosclerosis, with poor or no runoff of the left anterior descending coronary artery (LADA),but who have satisfactory left ventricular contraction.


The rationale for surgery in preinfarction angina. Of 123 patients with identical clinical criteria for preinfarction angina, 35 were treated medically and 88 surgically in a nonrandomized manner. There was no statistical difference between these two therapeutic groups in regard to age range, average age, sex distribution, number and distribution of prior myocardial infarction, and duration of chronic and acute anginal symptoms. With medical therapy, 32 sustained a myocardial infarction, and 14 (40 per cent) of these died within 1 month of hospital admission. Thirteen of 21 survivors or 37 per cent of the original group are asmptomatic on continuing medical therapy an average of 15 months after discharge. The surgical patients were studied by catherization and anigiography and underwent an early operation. Eight (9.4 per cent) demonstrated evidence of postoperative infarction, and 3 (3.4 per cent) died after the operation. Seventy-one (84 per cent) are completely asymptomatic and 6 are less symptomatic an average of 17 months after the operation. Actuarial analysis of the follow-up data reveals that the initial significant difference in survival between the two groups is maintained through the first 36 months. On the basis of this experience, we suggest that surgical intervention is the therapy of choice in patients with preinfarction angina.


Suppression of lymphocyte transformation after aspirin ingestion. To learn whether in vitro blastogenesis of lymphocytes is affected by in vivo salicylate ingestion, blood samples were obtained from 19 normal volunteers before and after therapeutic doses of aspirin. Lymphocyte transformation studies performed on these blood samples showed marked and statistically significant suppression of blastogenesis. Maximum suppression was observed in blood samples obtained 12 hours after the last aspirin ingestion. As compared to controls, samples obtained at this time showed mean blastogenic responses to phytohemagglutinin and pokeweed mitogens of 49 and 56 per cent respectively. No correlation could be demonstrated between the plasma salicylic acid level and the degree of suppression of blastogenesis. Aspirin ingestion altered neither the proportions of circulating T and B cells nor the viability of lymphocytes in culture.


Quantitative determination of antibody in idiopathic thrombocytopenic purpura. Correlation of serum and platelet-bound antibody with clinical response. We studied the clinical applicability of a recently developed technic that determines antiplatelet antibody directly on the platelet surface or in serum. The technic is a quantitative complement lysis-inhibition assay. Normal platelets have less than 0.4 pg of surface IgG. All patients with idiopathic thrombocytopenic purpura who were studied had greater than that value. Surface IgG was increased in inverse proportion to the platelet count. Surface levels of greater than 1.1 pg correlated with failure to respond to prednisone therapy. Incubation of normal serums with normal platelets did not increase surface IgG of such platelets, but the incubation with thrombocytopenic serums increased their surface IgG 0.5 to 100 times. The degree of increase did not predict response to treatment. However, quantitation of surface IgG of thrombocytopenic platelets was useful in predicting response to treatment.


A community study of the relation of alpha1-antitrypsin levels to obstructive lung diseases. Since it is still uncertain whether moderate degrees of alpha1-antitrypsin deficiency predispose to the development of lung disease, data obtained from a stratified random sample of white households in Tucson, Arizona, consisting of 2586 subjects over five years of age, were analyzed. No relation was found between serum alpha1-antitrypsin levels, measured as trypsin inhibitory capacity, and ventilatory function, respiratory symptomatology, or frequency of diagnosed pulmonary diseases even among cigarette smokers. The data indicate that an intermediate level of alpha1-antitrypsin deficiency (i.e., inhibitory capacity between 20 and 62 per cent of the population's mean value) is not an important risk factor for the development of chronic obstructive lung diseases. The data militate strongly against the use of any quantitative determination of alpha1-antitrypsin as a test to identify subjects with moderate deficiency for the purpose of predicting later development of chronic respiratory disorders. The rate of severe deficiency is so low as to make population screening for such subjects impractical.


Partial purification and characterization of a lymphotoxic factor from multiple sclerosis serum. A factor found in the serums of some patients with multiple sclerosis has been shown to have a toxic effect on the normal, mature lymphocyte. This lymphotoxic factor is a protein that is stable to heating at 56 degrees C for 3 hours. It is a nondialyzable material, with recovery of lymphotoxic activity following 30 days of dialysis. Elution of lymphotoxic serum through Sepadex G-100 demonstrates toxic activity closely associated with albumin. Purification by elution through DEAE-cellulose yielded lymphotoxic activity. The lymphotoxic factor was inactivated by standard ammonium sulfate precipitation. Analysis of the effect on distinctive cell types within the total lymphocyte population demonstrated that the T lymphocyte was particularly sensitive.


Use of potassium sorbate for treatment of fungal infections. One hundred and twenty-two cases of vaginal fungal infections treated with potassium sorbate are presented. A new method of follow-up home application by means of vaginal tampons is tried. Relief of symptoms is prompt, and yeast organism disappear; the safety and superior efficacy of a strengthened (3%) solution is established. Treatment of fungal infections in males is also discussed.


Meningitis due to an unusual type of Haemophilus influenzae. An infant was admitted to hospital with suspected meningitis. Haemophilus influenzae type 'a' was isolated from cerebrospinal fluid (C.S.F.) and blood. Haemophilus meningitis due to types other than type 'b' is rare, and only a few due to type 'a' have so far been recorded. Investigations of the family are included together with a discussion of the implications for the diagnostic bacteriologist.


Unilateral ventricular obstruction due to infection. A 14 year old male was hospitalized with pansinusitis complicated by intracranial spread of the infection. He developed a unilateral obstruction of the ventricular system of the foramen of Monro and a secondary mass effect revealed by radiological investigation.


The use of hypnosis in hemophilia dental care. The influence of emotional stress on the onset and control of bleeding episodes is a well-known fact. Oral surgical procedures are a common cause of severe states of anxiety in hemophiliacs. Anxiety has been shown to trigger and/or complicate an existing hemorrhagic episode in hemophiliacs. This is true in adults as well as children. Hypnosis, when applicable, has been found to be an excellent adjunct for the control of anxiety. It has been observed that in a relaxed and tranquil hemophiliac, his hemorrhagic tendency during and after surgery is considerably decreased. Induction to a hypnotic state depends on each individual's susceptibility, and therefore different approaches are used depending on the patient's knowledge of hypnosis. In addition to the control of fear, salivary secretions, pain, and capillary bleeding can well be brought under control during surgery and postoperatively by means of posthypnotic suggestions. Good oral hygiene habits such as daily brushing and flossing, so important as preventive measures for the prevention of caries and periodontal disease, can be reinforced through hypnotic suggestions. Preventive dentistry in hemophiliacs is of paramount importance.


The therapeutic role of epsilon-aminocaproic acid (EACA) for dental extractions in hemophiliacs. The results of a double-blind controlled trial, previously reported, showed that EACA is a useful adjunct to preoperative therapeutic concentrates of factor VIII or IX for dental extractions in hemophilia and Christmas disease. To estimate the amount of factor VIII and IX conserved in hemophiliacs receiving EACA for dental surgery compared with those not receiving EACA we have surveyed the usage of therapeutic materials in ten hemophilia centers in the U.S. and at Oxford. The amount of postoperative factor-VIII containing materials given to 20 U.S. hemophiliacs not receiving EACA averaged 11 062 units of factor-VIII activity per patient; 4,146 units for each of 22 U.S. patients receiving EACA; and 717 units for each of 56 patients at Oxford receiving EACA. Conservation of factor-IX-containing material was not as great. At Oxford 62.5% of patients receiving preoperative factor-VIII or -IX concentrates sufficient to raise the deficient factor to 50% of normal together with EACA, 24 g per day for ten days, required no postoperative therapeutic materials to control bleeding. The remainder required an average of two postoperative doses to control bleeding.


Benign small bowel tumor.

Benign small bowel tumor. The clinical record and histologic sections of 84 cases of benign small bowel tumor are reviewed. Manifestations of systemic diseases, congenital anomalies, and lesions of either the ileocecal valve or periampullary region were excluded. In the same time span there were 96 small bowel malignancies. Clinical presentation, pathologic findings, management and result are compared to the collected published experience of about 2000 cases. There were 36 leiomyomas, 22 lipomas, 9 angiomas, 6 neurofibromas and 4 fibromas. Thirty-six men and 48 women were affected; the majority in their fifth and sixth decade. Seventy-eight were operative and 6 autopsy diagnoses. The most common symptom was obstruction (42%) followed by hemorrhage (34%) and pain (22%), relative frequency differing for the various specific tumors. There were rarely significant physical findings. A diagnosis of small bowel tumor was made radiologically in 30 patients. Because of the nonspecificity of other signs and symptoms, an acute awareness of the possibility of small bowel tumor is mandatory for preoperative anticipation of the diagnosis. Local resection was performed in all with no deaths or significant postoperative complications.


Labyrinthitis ossificans due to chronic otitis media. Histopathology of two cases of unilateral labyrinthitis ossificans in the presence of bilateral chronic suppurative otitis media is presented. In both cases, ossification and fibrosis were limited to the scala tympani of the lower basal turn, apparently due to inflammation entering through the round window membrane. The round window was occluded by new bone and fibrous tissue presumably resulting in a conductive hearing loss in addition to the conductive loss due to middle ear lesions. Degeneration of the hair cells of the organ of Corti was limited to the lower basal turn where ossification and fibrosis occurred.


Frequency dependence of the frog skin impedance. At frequencies between 20 Hz and 1 kHz the impedance locus of the isolated frog skin is circular; below 20 Hz the resistive component of the impedance is frequently greater than would be expected from extrapolation of the high-frequency locus. At frequencies greater than twice the highest frequency at which there are deviations from the circular locus the variation of impedance Z with angular frequency omega is closely described by the equation Z equals r1 plus r o/[1 plus (j omega tau)1-alpha], where j is square root--1, r 1 and r 0 are resistances, tau is a time constant and alpha a constant in the range 0.02-0.14.


Electro-optical property of extremely stretched skinned muscle fibers. Skinned fibers of frog semitendinosus muscle could easily be stretched up to 8 mum or more in sarcomere length. Such extremely stretched fibers gave quite sharp optical diffraction patterns. The intensities of all observable diffraction lines were found to increase on application of electric field (10 similar to 100 V/cm) parallel to the fiber axis, provided that there was no overlap between thin and thick filaments. By use of a polarizing microscope, it was concluded that I-bands were mainly responsible for this intensity increase. By application of square pulses, the time course of the intensity increase and decay was followed. The analysis based on a simple model suggests: (a) Each thin filament has a permanent dipole movement and the movement directs from Z-bands to the free end of the thin filament. (b) The flexural rigidity of thin filaments is estimated to be similar to 3 with 10-17 dyn with cm-2. The present fibers will provide various applications in physiochemical studies of in vivo thin and thick filaments.


[Detection of longitudinal electric currents in frog nerves]. The data on transversal potential difference (V-x) in the sciatic nerve of a frog under the influence of the magnetic field are presented. The amplitude of the registered signal has a linear rise with an increase of the magnetic field tension. (H), while a change of (H) direction leads to a change of polarity of the signal (V-x). The presence of (V-x) is connected with the existence of the longitudinal directed stream of the light charged particles in the nerve.


Serotonin-sensitive adenylate cyclase activity of immature rat brain. Cell-free preparations from superior and inferior colliculi of very young rats (1-3 days old) contained adenylate cyclase systems which were highly responsive to serotonin. The response to serotonin declined markedly during early development and was very low at maturity. Adenylate cyclase activity in the 10,000 times g particulate fraction from colliculi of newborn rats was significantly stimulated by 0.05 muM serotonin. Half-maximal activation was produced with less than 1 muM serotonin. Maximal stimulation of collicular adenylate cyclase was about 80% above basal enzyme activity and occurred with approximately 50 muM serotonin. Tryptamine and several derivatives of serotonin produced responses which were comparable to that obtained with serotonin; 5-methoxytryptamine was uniformly the most active compound tested. Norepinephrine or dopamine produced much smaller increases in adenylate cyclase activity. Stimulation of collicular adenylate cyclase by serotonin was significantly but incompletely blocked by serotonin antagonists, including d-lysergic acid diethylamide (d-LSD), 2-bromo-d-lysergic acid diethylamide, methysergide, 1-methyl-8 beta-carbobenzyloxy-aminomethyl-10 alpha-ergoline and cyproheptadine. Chlorpromazine also produced partial blockade. In contrast, l-lysergic acid diethylamide, haloperidol, propranolol, phenoxybenzamine and morphine were ineffective as serotonin blocking agents. Of the compounds which produced a partial blockage of serotonin action, d-LSD, cyproheptadine and chlorpromazine were themselves capable of stimulating adenylate cyclase activity. These results are consisent with the existence of multiple receptors in rat brain which are capable of interacting with indoleamines.


Further observations of Fc receptors in human malignant tissue and normal lymphoid tissue. Twenty human malignant solid tumors of various histologic types were tested for the presence of Fc receptor using cryostat sections or single cell suspensions of fresh tissue. Sheep erythrocytes sensitized by various amounts of rabbit IgG antibodies served as indicator cells (EA). All tumors possessed Fc receptor, but to varying degrees; eight reacted more strongly than normal spleen without any relation to histologic type. The tumors which gave the strongest reactions in sections also formed the highest percent of EA rosettes in suspensions, thus indicating surface localization of receptors. The reactions with spleen sections localized to the B cell and monocytic areas; the latter also showed high avidity in reactions with uncomplexed IgG. Rabbit antisera to tumors, spleen, and peripheral lymphocytes (polyvalent ALS) in inhibited the reactions, while a T-cell-specific ALS did not. Absorptions of the antisera with lymphocytes or tissue sediments of spleen and tumors removed the inhibiting activity, tissue sediments of muscle and kidney only reduced the titers. Again, results with spleen sections paralleled those obtained with tumor sections. Apparently, the tumor Fc receptor is very similar to the Fc receptors present in normal lymphoreticular tissues.


The management of pulmonary metastases in children with osteogenic sarcoma with surgical resection combined with chemotherapy. This report concerns a consecutive group of 10 children with metastatic osteogenic sarcoma treated with combined surgery and chemotherapy. Eight of 10 patients had thoracotomy prior to chemotherapy, and 2 after an initial trial of chemotherapy. Sequential chemotherapy was given to all patients and consisted of vincristine, high-dose methotrexate with citrovorum factor rescue, cyclophosphamide, and Adriamycin. Chemotherapy was continuously recycled for 1 year. The encouraging results obtained with these 10 patients are demonstrated with emphasis on the value of aggressive multidisciplinary therapy in salvaging patients with advanced metastatic osteogenic sarcoma.


Combination chemotherapy and radiation therapy in the treatment of metastatic osteogenic sarcoma. Fourteen patients with 16 metastatic ostogenic sarcoma lesions were treated with high-dose methotrexate (HDMTX) with citrovorum factor rescue (CFR), adriamycin, and pulse high-dose cyclophosphamide combined with radiation therapy. Thirteen of 16 lesions responded. Responses consisted of relief of pain (6/6 patients) in bone lesions, roentgenographic and clinical evidence of decrease in the size of the bone lesions (6/7 patients), and a decrease in the size of pulmonary metastases (2/4 patients). The 2 patients whose pulmonary metastases responded to combined therapy developed pulmonary fibrosis and pneumonitis in the treated areas 3 months after radiation therapy (RT) (1400 and 1600 rads respectively). Of two bulky primary tumors that appeared to respond, both were ultimately found to contain viable tumor; a third less bulky primary tumor appeared to respond more completely. Three smaller metastatic bone lesions that were ultimately biopsied showed no evidence of active tumor. It is concluded that: 1) combination therapy (particularly HDMTX and RT) has an additive effect in controlling osteogenic sarcoma bone lesions, but bulky primary tumors cannot be completely eradicated; 2) although synergistic in treating osteogenic sarcoma, combination therapy can produce enhanced toxicity in surrounding normal lung tissue; and 3) combination therapy is of value in the palliative treatment of metastatic lesions other than that of lung, and in the treatment of small primary bone lesions. However, experience to date does not justify the delay in surgical ablation of a primary lesion in a child who presents without metastatic disease.


Prolonged depression of cellular immunity in cured laryngopharyngeal cancer patients treated with radiation therapy. Immune competence was evaluated in cured patients who had been treated by irradiation for carcinoma of the laryngopharynx, and compared with that of similar patients treated by surgery alone, and normal controls. Cellular immunity was determined by quantitation of in vitro phytohemagglutinin (PHA)-induced lymphocyte reactivity and peripheral blood thymus-dependent lymphocyte (T cell) levels. Humoral immunity was assessed by measurement of serum immunoglobulin levels and by the effect of serum on in vitro normal lymphocyte reactivity to PHA. In 21 patients who were studied for 4-23 years (mean 8.4) after surgical treatment alone for laryngopharyngeal carcinoma, neither cellular nor humoral immunity differed from that of 44 controls. In contrast, 14 patients who had been irradiated and subsequently cured for 4-15 years (mean 9.0) prior to evaluation displayed significantly impaired cellular immune competence when compared to normals and patients treated by surgery alone. Since previous determinations of the effects of radiation therapy have been in patients who received irratiation to the thymic region or large area of bone marrow, this study indicates that radiation therapy for cancer administered via portals that encompass a minimal area of the immune system may be associated with prolonged impairment of cellular immunity.


The rationale for multiple drug chemotherapy in the treatment of osteogenic sarcoma. Based on our prior experience in treating children with metastatic osteogenic sarcoma, a multidrug regimen was developed. Nine children with evaluable osteogenic sarcoma were treated with vincristine 1.5 mg/m2 on day 1, highdose methotrexate 200-300 mg/kg i.v. on day 2, with p.o. citrovorum factor "rescue" 9 mg every 6 hours x 12, followed in 2 weeks by cyclophosphamide 40 mg/kg i.v., then 2 weeks later Adriamycin 1.5 mg/kg/day x 2; in 2 weeks cyclophosphamide was repeated. After a 2-week rest, the 56-day cycle was repeated for a total period of 1 year. Oropharyngeal mucositis was the most frequent severe manifestation of gastrointestinal toxicity. Hematologic depression was mild to severe. Nine patients with clinically evaluable osteogenic sarcoma and no previous chemotherapeutic treatment were treated with this regimen. One patient had only a transient shrinkage in tumor mass, and one patient had no progression of multiple pulmonary and bone metastases for 16 months while on therapy. Of the remaining seven patients, all had clinically significant responses with tumor regression demonstrated for from 5 to 20+ months. Four of these patients (three presenting with primary tumor and pulmonary metastases) demonstrated regression of their primary tumor. In an attempt to increase the cure rate in osteogenic sarcoma, chemotherapy that has proven to be effective against metastatic osteogenic sarcoma should now be employed as prophylactic therapy, after amputation, at cancer treatment centers where it can be safely and effectively administered.


Some important pitfalls in the diagnosis and treatment of bacterial meningitis in children. Some of the common errors and problems of the physician who cares for the child with bacterial meningitis are: 1) misdiagnosis; 2) inappropriate handling of cerebrospinal fluid; 3) inadequate assessment of therapeutic responses; 4) inappropriate drug therapy; 5) improper treatment of seizures; 6) inadequate care of increased intracranial pressure; 7) inappropriate evaluation of persistent fever; 8) inappropriate fluid therapy; 9) inadequate investigation of persistent  neurologic deficit; 10) overvigorous treatment of subdural effusion; 11) inadequate assessment of neurologic or psychologic impairment; and 12) inadequate consideration of possible underlying defects.


Purification of human MM and ZZ alpha 1-antitrypsin. Alpha -1-antitrypsin is the main protease inhibitor in human serum. Certain variants or phenotypes of this protein are associated with diseases of the liver and lung. The availability of purified alpha-1-antitrypsin of various phenotypes would be useful in studies exploring these associations. A two-step purification procedure is presented which involves affinity chromatography on isolubilized conconavalin A followed by preparative starch gel electrophoresis. This simple and rapid method has provided both MM and ZZ alpha-1-antitrypsin in highly pure and active form.


[Immunosuppressive therapy in pure red cell aplasia]. Acquired erythroblastic aplasia of adults is a rare disease characterised by the absence of red cell precursors in the bone marrow. In a 34-year-old female patient the disease has been known for seven years. A partial remission had at first been achieved with glucocorticoids but regular transfusions had been necessary since 1971. Treatment with cyclophosphamide produced a remission which has lasted for over twelve months up to now. Histology of the bone marrow biopsy shows the appearance of active erythropoiesis after cyclophosphamide treatment which reflects well the clinical course.


[The effect of aneurysm resection on left ventricular function]. The effect of successful aortocoronary artery bypass surgery on left ventricular (LV) function was studied by angiography in 13 patients with coronary-artery disease and resection of a ventricular aneurysm. The following were calculated from single-plane right anterior oblique LV cine-angiograms: LV end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), percentage shortening of the medial perpendicular short axis (deltaM), mean velocity shortening of the circumferential fibres (VCF). The changes in the five hemi-axes of the anterior LV wall, and five of the inferior wall were averaged to give a value for relative anterior wall motion (SMV) and inferior wall motion (SMH). Changes in apical motion (SMS) were calculated from the percentage changes in the base-to-apex axis. The following mean values (x plus or minus s) were obtained four months before and 11 months after aneurysmectomy: EDVI (ml/m2) 154 plus or minus 27 (126 plus or minus 23), ESVI (ml/m2) 107 plus or minus 28 (56 plus or minus 15), SVI (ML/M2) 46.5 plus or minus 12.7 (69.9 plus or minus 23.1), EF (%) 32.6 plus or minus 8.0 (54.6 plus or minus 12.0), SMV (%) 6.1 plus or minus 10.0 (25.0 plus or minus 13.4), SMH (%) 25.9 plus or minus 13.1 (31.2 plus or minus 11.1), SMS (%) 5.1 PLus or minus 3.4 (13.1 plus or minus 4.2). These results indicated significant improvement in ventricular pumping action and wall motion after aneurysm resection and aortacoronary bypass surgery in patients with coronary-artery disease and severe cardiac failure.


Melanophore stimulating hormone (MSH) release: inhibition by cytochalasin B and "stimulation" by dimethyl sulfoxide. Incubation of rat or frog pituitaries in cytochalasin B (10-4 minus 10-8 g/ml) for 2, 4 or 6 hr produces a time-dependent inhibition of MSH release. This inhibition is reversible and, again, time-dependent since longer incubations of pituitaries returned to normal media result in greater hormone secretion. Cytochalasin B inhibits MSH release even at a high concentration (10%) of dimethylsulfoxide (DMSO) which, itself, is "stimulatory" to hormone release. MSH release in high DMSO concentration is also inhibited by ouabain or by the absence of Ca2+ from the medium. In amphibian Ringer enriched with glucose, and in Medium 199, cytochalasin B fails to inhibit the release of MSH from the frog pituitary. Colchicine, vinblastine, and vincristine (10-3 minus 10-6 g/ml) were without effect on MSH release. These data suggest a possible role for microfilaments in the control of MSH release but fail to provide information on the exact nature of the mechanisms involved.


A serum melatonin rhythm in chickens and its abolition by pinealectomy. Melatonin, a suspected hormone of the pineal organ, was extracted from chicken serum and quantified by the Rana pipiens bioassay. When chickens were housed in an alternating light-dark photoperiod, serum melatonin was usually not detected during the light phase. Serum melatonin rose within 1 hr after the lights were extinguished, plateaued around midnight and fell before the lights were turned on. Serum melatonin was not detected at any time of day in pinealectomized chickens, suggesting that the pineal is neccessary for, and may be the source of, circulating melatonin.


Kinetic studies on the phosphorolysis of polynucleotides by polynucleotide phosphorylase. The kinetics of the phosphorolysis of polynucleotide (as differentiated from oligonucleotide) by polynucleotide phosphorylase of Micrococcus luteus has been investigated. Double reciprocal plots of initial velocity against either inorganic phosphate or polynucleotide concentration are linear, and furthermore, the affinity of the enzyme for either substrate is unaffected by the presence of the other. dADP, an analogue of ADP product, is a competitive inhibitor with respect to Pi and polynucleotidy. (Ap)tA-cyclic-p is a competitive inhibitor with respect to Pi. The results are almost identical with both primer-independent (Form-I) and primer-dependent (Form-T) enzymes, although the various kinetic constants differ. On the vasis of these data a rapid equilibrium random Bi Bi mechanism is proposed. The demonstration of two different inhibitor constants for dADP and the difference between the Michaelis and the inhibitor constant for polyadenylic acid in polynucleotide phosphorolysis indicate at least two binding sites for polyadenylic acid and dADP on M. luteus polynucleotide phosphorylase. Its is suggested that in the phosphorolysis of long chain polymers the second binding site permits the polynucleotide to snap right back into position after removal of I mononucleotide unit and thus leads to the observed processive degradation. A general discussion of oligonucleotide and polynucleotide phosphorolysis and the differences between Form-I and Form-T enzymes in de novo synthesis and degradation of polynucleotides is presented.


Surgical therapy in acute ischemic syndromes. Despite increasing enthusiasm about the treatment of symptomatic angina pectoris by direct revascularization surgery, there appropriately continues to be concern about the effects of such therapy. While it is generally accepted that surgery is effective in relieving anginal pain in upwards of 80% of patients undergoing aortocoronary bypass, reservations focus on the possibilities that such therapy may increase the incidence of infarction (postoperative), accelerate the atherosclerotic process, and shorten longevity, primarily because of the increased early operative mortality. While these contentions may or may not be true for the majority of patients who undergo such therapy, there is accumulating experience that in certain well-defined subsets, surgery does favorably affect the prognosis of the disease. Patients with preinfarction angina constitute one such subset of patients with coronary atherosclerosis. The all-inclusive surgical mortality for 106 consecutive cases was 3.8%, and 86% of the survivors are asymptomatic. Actuarial analysis of follow-up data reveals that this survival rate is essentially constant through the first 36 months after surgery. On the basis of this experience we feel that patients with preinfarction angina present a therapeutic opportunity in which the ideal goal of preventive medical care can be achieved by early identification, study and surgery.


Distribution of microtubules and microfilaments in developing vestibular sensory epithelium of mouse otocysts grown in vitro. Otocysts explanted from 12th-gestation-day mice and maintained in organ culture under went a series of developmental changes which paralleled those that occurred in vivo and which resulted in the formation of a sensory epithelium of the vestibular type. At the time of explantation presumptive vestibular sensory epithelium consisted of cells that were undifferentiated, pseudostratified and rapidly proliferating. The only microtubules present were those of the mitotic apparatus. After 4 days of in vitro development cells comprising the presumptive vestibular sensory epithelium were less pseudostratified and more elongate; their nuclei had assumed a basal orientation and there was a clear maginal velum. Longitudinally oriented cytoplasmic microtubules were present at the apices of some cells; they were often grouped around a centriole which may have served as a nucleation centre for their assembly. After 7 days of in vitro development mitosis had ceased and supporting cells had innervated hair cells were present: both types of cells were always longer than they were broad and were often highly asymmetrical. Hair cells were flask- or columnar-shaped, with a nucleus situated in the basal third of the cell. Most mitochondria in hair cells were located in the apical third of the cell. The same distribution of mitochondria and nuclei was evident in supporting cells. Microtubules occurred throughout the length of the supporting cell and were always parallel to its longitudinal axis. In hair cells microtubules were more frequent than in supporting cells: the majority were parallel to the longitudinal axis of the cell but there were two exceptions. First, at the apex of hair cells some microtubules were oriented transversely and diagnonally: these were probably involved in the development and maintenance of the constricted apex of these cells. Secondly, microtubules appeared to be randomly arranged in the narrow region of the cytoplasm between the ventral surface of the nucleus and the base of the hair cells. Microfilaments were confined to the basal third of hair cells where their orientation paralleled that of microtubules. The possible functions of microtubules and microfilaments in the development of hair cells and supporting cells of the mouse vestibular epithelium are discussed.


Revascularization via healthy myocardial arteriolar networks compared with that through diseased surface coronary arteries. Myocardial mammary artery implants revascularize via the undiseased coronary microcirculation. Such implants, followed for up to 20 years, showed no atherosclerosis, while the coronary arteries of the patients became totally occluded. Implant patency with collateralization was 80%; some patients were living entirely on blood supplied by mammary implants. Operative mortality was 2%. There was improvement in anginal pain in 85% of the cases and in left ventricular failure, in 67%. Studies of 43 patients with single implants, followed for up to 20 years, showed that 54% survived for an average of eight years and 46% have survived for an average of 12 years, and are still living. Double-ventricular implants in 42 patients with triple coronary artery disease showed that 90.5% survived for an average of five years, compared with 53% for medically treated patients. The technique of mammary implants is described and the procedure is compared to aortocoronary bypass grafts.


A scanning electron microscopic study of the morphology and geometry of neural surfaces and structures associated with the vestibular apparatus of the pigeon. The scanning electron microscope (SEM) was used to investigate the morphology of the neuroepithelial regions of the vestibular ampullary structures in 47 White King pigeons. The specific neural surfaces studied were (1) the cristae ampullares of the vertical and lateral membranous ampullae, (2) the hair cells lining the cristae, (3) the ampullary nerve fibers, and (4) the bipolar cells of the vestibular (Scarpa's) ganglion. Additionally, some observations of the gross anatomical structures of the bony labyrinth are given. Arguments are advanced which show that if the surface area of a given semicircular canal can be projected onto one of the three normal head planes, then that canal can be made to respond to motion in the appropriate plane, provided that the projected area is sufficiently large to achieve a threshold pressure as determined by a generalized form of Groen's equation ('57). With regard to the cristae ampullares, it is hypothesized that their surface areas can be described by means of a revolved catenary, i.e., a catenoid of revolution. (The catenary is found in nature as the approximate shape taken by a flexible cable when it is suspended at two points). The surface area of a catenoid provides a minimum surface of revolution. In the context of a crista, this implies that the given number of hair cells could not be fitted onto a smaller surface area. One advantage of this is that nature is able to utilize a thinner cupula than would be possible with other configurations and therefore an increased sensitivity to cupular motion can be realized. A second important factor is that all hair cells must revolve (by way of cupular motion) about the same centre of rotation in response to angular acceleration. Thus, all of the orthogonally-positioned hair cell tufts on the cristae surface may be stimulated simultaneously by way of a tangential shear. Other arguments show that the classical "swing door" type of cupular motion is not consistent with SEM and other recent observations. Two alternate modes of cupular motion are presented, each of which requires far less energy expenditure than does the "swing door" cupula. The suggestion is then made that, during normal head movements, the cupula behaves as a drum much like the tympanic membrane and that only for large, non-physiological motions does the "swinging door" mode of cupular motion take place. It must be remembered, however, that cupular motions during normal physiological head movements are infinitesimally small (Oman and Young, '72).


Idiopathic thrombocytopenic purpura: report of case. A patient with classic symptoms of blood dyscrasia, specifically idiopathic thrombocytopenic purpura, failed to receive laboratory tests because the condition had gone undetected by a dentist and a physician. However, after the patient was given a provisional diagnosis supported by laboratory test results, one of the general treatment procedures for idiopathic thrombocytopenic purpura that consisted of a regimen of corticosteroids was instituted and was proved successful. More radical procedures, such as transfusions of fresh whole blood or of fresh platelets, or a splenectomy, were unnecessary. The responsibility of a dentist to detect oral changes that are not of dental origin is emphasized.


Serious postextraction hemorrhage into the submandibular space: report of case. A 47-year-old woman had a swelling in the floor of the mouth and in the submandibular area on the left side. About four hours earlier, a dentist had extracted the mandibular left second premolar and first molar. The rate and degree of the distension were alarming; the floor of the mouth was at a level with the incisal edges of the mandibular incisors. Five hours later, the floor of the mouth was elevated about 1 1/2 cm above the incisal edges of the teeth. Treatment of the patient and her unusual sensitivity to meperidine and promethazine that caused a depression into Cheyne-Stokes respiration and hypotension are described.


Spontaneous and methylcholanthrene-enhanced thyroiditis in BUF rats. I. The incidence and severity of the disease, and the genetics of susceptibility. Virgin female Buffalo strain (BUF) rats that were treated with methylcholanthrene (MC) had a higher incidence of lymphocytic thyroiditis than untreated BUF rats. The degree of infiltration was also greater in MC-treated rats. The incidence of thyroiditis in retired breeder female BUF rats approached that found in MC-treated rats. The susceptibility to the effect of MC was not expressed in most F-1 hybrids of BUF and Lewis (LEW), a strain of rat that does not develop thyroiditis after treatment with MC.


Relation of DNA synthesis and suppression to development of memory by T cells. Parental thymocytes, inoculated into lethally irradiated F-1 mice, synthesize DNA in response to the histocompatibility antigens of the reciprocal parent in the F-1 cross. The DNA synthetic response is characterized by 1 to 3 day latent period and a 1-to-2-day period of peak activity which is followed by a sharp decline. Cells transferred to secondary recipients at the time of peak activity in the primary hosts respond only minimally in the spleens of the secondary hosts. Cells transferred 1 day later, when DNA synthetic activity in the primary hosts is sharply curtailed, exhibit striking secondary responsiveness. Thus, the decline in activity in the primary host is not due to the loss of potentially reactive cells from the spleens. It seems more likely that the preceding response creates a suppressive milieu in the primary host. The inability to transfer significant secondary responsiveness with cells harvested at the time of peak activity in primary hosts suggests that the acquistion of memory by these cells requires more than their colonal expansion. The occurrence of an additional differentiational event is suggested by the correlation of a marked increase in memory with the sharp cessation of the primary DNA synthetic response.


Capacity of sensitized thymus-derived lymphocytes to induce fatal lymphocytic choriomeningitis is restricted by the H-2 gene complex. Adoptive immunization of syngeneic, immunosuppressed recipients infected with lymphocytic choriomeningitis (LCM) virus causes fatal neurologic disease within 2 to 4 days of cell transfer, providing that donors are sampled when the in vitro 51-Cr release assay shows maximal specific activity of sensitized thymus-derived lymphocytes (T cells). Prior treatment of immune spleen cells with AKR anti-omicron ascitic fluid and complement causes total abrogation of this in vivo activity. Fatal neurologic disease is induced only when donor and recipient share at least one set of H-2 antigenic specificities. Parent yields F1 and F1 yields parent combinations are as effective as syngeneic systems, but mice given allogeneic immune cells survive as long as controlsmdifferences at the M-locus in H-2 compatible mice do not inhibit effector activity. Homing of transferred lymphocytes to spleen is similar in syngeneic or allogeneic recipients, but only syngeneic immune cells cross the blood-cerebrospinal fluid (CSF) barrier and cause choriomeningitis. Fatal LCM, is, therefore, apparently induced by a specifically sensitized omicron-bearing cell population, activity of which is restricted by the H-2 gene complex.


The selective action of poly A:U on the electrophoretic mobility and surface charge of a subpopulation of B cells. Electrophoretic mobility (E.P.M.) of lymphoid cells has been determined in three species. In chicks, the E.P.M. of bursa cells was 0.47 plus or minus 0.07 and of thymocytes 0.64 plus or minus 0.10 mum/sec/volt/cm. On the basis of the E.P.M. profile of the Ficoll gradient purified lymphocytes from the rat spleen, two populations of cells present in the proportion of 65 and 35% were identifiable. The former had a mobility of 1.06 plus or minus 0.08 and the latter 1.24 plus or minus 0.09. The E.P.M. of lymphocytes prepared from athymic nude mice was 0.86 plus or minus 0.06 with a Gaussian distribution profile. On incubation of these cells with poly adenylate-poly uridylate (poly A:U) for 30 min at 38 degrees C followed by extensive washings, the E.P.M. of thymocytes from the chick and rat as well as the thymus-derived cells in rat spleen remained essentially unchanged. On the other hand, poly A:U increased the E.P.M. of avian bursa cells and of a subpopulation of B cells in rat spleen and of splenocytes from nude mice. The proportion of cells markedly affected by poly A:U was 70 to 83% of the total B cells in these species.


Relationship of cloning inhibition factor, "lymphotoxin" factor, and proliferation inhibition factor release in vitro by mitogen-activated human lymphoctes. Human lymphocytes were stimulated in vitro with mitogens, phytohemagglutinin and concanavalin A to secrete proliferation inhibitory factor (PIF), cloning inhibitory factor (CIF), and lymphotoxin (LT). These three activities were demonstrable in the same supernatant, moreover, the particular effect observed was shown to depend on the concentration of the medium and the type of target cell employed. In general, the medium effects on target cells were: a) cytotoxic at high concentrations, b) growth inhibitory at intermediate concentrations, and c) only temporarily growth inhibitory at low concentrations. The absolute concentration producing a certain effect varied, depending on the target cell type employed. In addition, the sensitivity of the target cells to LT parallels the sensitivity of the cell to each of the other activities, PIF and CIF, and no species specificity was observed.


Anti-Ig-triggered movements of lymphocytes-specificity and lack of evidence for directional migration. Interaction of anti-immunoglobulin antibodies with the surface Ig of B lymphocytes leads to capping and endocytosis of the immune complexes and to a brief stimulation of translational motility. Lymphocytes are not stimulated to move by interaction with other ligands, such as antibodies to the theta isoantigen, to H2 determinants, or to determinants recognized by heterologous anti-lymphocyte antibodies. Furthermore, anti-lymphocyte antibodies block the motility produced by anti-Ig. This effect was not seen in cells treated with colchicine, suggesting that the anti-lymphocyte effect may be associated with hyperstabilization of microtubules. Finally, we report on preliminary experiments using chemotactic chambers which show that anti-Ig stimulates random but not directional movement.


Ly-4.2: a cell membrane alloantigen of murine B lymphocytes. I. Population studies. The Ly-4 locus defines an alloantigenic specificity present on the surface of lymphocytes of some mouse strains and detected in lymphocytotoxicity tests by an antiserum (BALB/c times SWR)F1 anti-B10.D2. In this paper are presented results which indicate that Ly-4.2 is predominantly represented on B cells and not T cells. In cytotoxicity tests with rabbit complement, the distribution of Ly-4.2 is restricted: thymus 5%, TDL 12%, spleen 60%, lymph node 30%, bone marrow 36%, Peyer's patches 55%, peritoneal exudate cells 35%, and peripheral lymphocytes 35%. This distribution is the reciprocal of that obtained with anti-Thy-1 antiserum. Further, when both reagents were used together, almost all cells in these tissues were lysed, excepting those with bone marrow. When anti-Ly-4.2 and anti-Thy-1.2 were used sequentially, it was apparent that these specificities were present on different cell populations. As Thy-1 is a marker for T cells, Ly-4 is therefore, presumably, a marker for B cells. This conclusion was confirmed by testing mice depleted of T cells ("nude"; thymectomy + anti-lymphocyte serum treatment; thymectomy, irradiation + reconstitution with bone marrow) where the majority of lymphocytes were Ly-4.2+, Thy-1.2-; and by testing tumors, where, for the most part, this reciprocal relationship held true. Appropriate studies indicate that the Ly-4.2 antibody does not detect a surface immunoglobulin allotype. Anti-Ly-4.2 anti-serum may provide a useful alloantigenic marker distinct from immunoglobulin, mouse-specific bone marrow-derived lymphocyte anti;en, and "beta" for detecting some or all, B cells.