Intermittent catheterization rather than urinary diversion in children with meningomyelocele. Fifteen girls more than 4 years old and with neuromuscular defects of meningomyelocele are maintaining adequate urinary continence through the use of intraurethral catheterization done by themselves or their parents. Urinary diversion has been necessary in only 1 child. The indwelling catheter has allowed heavily trabeculated bladders to become smooth enough for an antirflux operation to be successful, although the period of followup is only 2 years. Upper tract deterioration has not been observed and urine has been maintained sterile without the help of medication 50 per cent of the time when catheterizations have been done on a routine 3-hour schedule. For this method to be sucessful and replace conduit deversion, parents, child, nurse and physician must be a well-knit team. With the hope that a reliable artificial urinary sphincter will eventually provide contience for some children, one is further justified in pursuing urinary continence by use of the catheter, instead of resorting early to permanent conduit conversion.


Renal transplantation in cystinosis.

Renal transplantation in cystinosis. Three children from 6 1/2 to 10 years old received kidney allografts from their parents 2 1/2 to 4 1/2 years ago. Renal function has been stable and the patients have been doing well. Studies of renal tubular function as well as morphologic studies by light and electron microscopy, and microdissection of renal tubules fail to reveal evidence of recurrent disease in the allografted kidneys.


Hyperosmolar nonketotic syndrome and steroid diabetes. Occurrence after renal transplantation. So-called steroid (glucocorticoids) diabetes developed in 11 (5.5%) of 202 patients receiving 216 renal allografts between December 1963 and June 1974. In three of the 11 patients, hyperosmolar nonketotic syndrome was present at diagnosis; all of the three recovered. Eight of the 11 patients survived with functioning allografts, and only one of the eight requires insulin. Hyperglycemia has been detected in most transplant patients tested in the immediate postoperative period. Factors (including stress from surgery and treatment with drugs such as furosemide) predispose to this condition.


T rosettes in alcoholic cirrhosis of the liver. Thirty patients with alcoholic cirrhosis of the liver were studied for in vivo and in vitro correlates of cellular immunity. Seventy-seven percent failed to be sensitized to dinitrochlorobenzene, indicating impairment of the in vivo cellular immune response. A significant decrease in the number of T-rosette-forming cells was observed in this group of patients (.01 smaller than P smaller than .025). This finding suggests that the active T-rosette test is a valuable tool in detecting partial alterations in cell-mediated immunity in alcoholic cirrhosis of the liver. Our results also suggest that rosette formation is a more sensitive indicator of cell-mediated immunity than phytohemagglutinin-stimulated blastogenesis in patients with alcoholic cirrhosis of the liver.


Conventional coronary care unit monitoring. Nondetection of transient rhythm disturbances. Conventional electrocardiographic monitoring techniques depend on human observation of an oscilloscopic display for detection of transient rhythm disturbances such as premature ventricular contractions (PVCs). It is not surprising that such events are often missed. We have found that transient events are regularly identified only when they occur with a frequency exceeding one per minute. Rhythm disturbances such as coupled PVCs or PVCs in which R waves interrupt the preceding T wave ("R on T"), which constitute indications for antiarrhythmic therapy, may go undetected if they occur less frequently than this.


Shiga bacillus dysentery associated with marked leukocytosis and erythrocyte fragmentation. Granulocytic leukemoid reactions (white blood cell counts greater than 50,000 with myelocytes and promyelocytes in the peripheral blood) were documented in 15 per cent of 273 patients with dysentery due to Shigella dysenteriae, type 1 (Shiga bacillus) in Bangladesh. Peak granulocytosis occurred during the second week of illness, when the children were commonly afebrile and diarrhea had ceased or was subsiding. More than half of the patients with leukemoid reactions subsequently developed a fall in hematocrit associated with striking erythrocyte fragmentation on blood smears. Thrombocytopenia occurred during the period of hemolysis in most. Transient oliguric renal failure developed in several patients. Most made a complete recovery. The pathogenesis of the syndrome and the reason for its high incidence were not determined.


[Analysis of the structure of cardiac rhythm in auricular fibrillation with the aid of a specialized computer]. In 37 patients with atrial fibrillation of varying etiology the electron-computer technique was used in recording the cardiointervalogram and interval histogram and also in determining a number of indices characterizing distinctive features of the R-R intervals distribution. When analyzing the available data not was taken of a tendency towards appearance of definite types of the interval histograms, variations in the mean level of the cardiointervalogram, resembling the so-called slow waves observable in the sinus rhythm. During repeated investigations made in the same patients features of a single type in the distribution of the R-R intervals were apparent. In the course of conservative therapy of atrial fibrillation a certain stereotypy in the R-R intervals distribution was noted, it being indicative of an increased arrhythmicity in the work of the heart occurring simultaneously with the slowing down of the cardiac contractions.


[Results of perforating keratoplasty in hereditary corneal diseases (author's transl)]. Operation results of keratoplasty in 50 eyes having keratoconus are presented and discusses. Furthermore a report is made on keratoplasty in cases of keratotorus in reticulate, maculate, and granulate dystrophies as well as in congenital ichthyosis with corneal involvement. The prognosis and complications of this intervention are presented.


Saccular aneurysm of ascending aorta caused by granulomatous aortitis in a child. This report describes a 7-year-old boy who underwent successful surgical excision of a saccular aneurysm of the ascending aorta caused by giant cell aortitis. The aneurysm was removed by lateral aortorrhaphy without cardiopulmonary bypass. The clinical manifestations and appropriate surgical therapy of granulomatous aortitis in childhood are discussed.


Accumulation of 131I hippurate in rat heart allografts during rejection. The accumulation of 131I hippurate in heterotopic (abdominal) rat heart allografts (Brown-Norway to Lewis) in comparison with native (autologous) hearts 6 and 7 days after transplantation was studied by noninvasive scintigraphic imaging and by direct isotope counting of excised hearts. Six hours after intravenous isotope injection, isotope accumulation in the allografted heart was clearly identified by scintigraphic study in comparison with the background, kidneys, urinary bladder, and native heart. Six and 7 days after transplantation, excised allografted hearts were significantly increased in weight in comparison with native hearts. A significant increase in isotope accumulation in allografted hearts in comparison with native hearts was found both per heart and per gram of heart. The findings of this study suggests the potential usefulness of 131I hippurate in the immunoinflammatory monitoring of organ allograft rejection by direct counting as well as by noninvasive scintigraphic study if sufficient time is allowed to permit clearance of high concentrations of isotope from the background areas, kidneys, and urinary bladder.


Tracheal reconstruction with a prosthesis of marlex mesh and pericardium. Tracheal reconstruction with a new type of prosthesis made of heavy Marlex mesh and pericardium is described in 13 patients suffering from malignancy. Two patients had circumferential excision of the trachea, and the remaining 11 had partial circumferential excision and a patch graft. In 10 of them, tracheal excision was a part of block pulmonary resection. The early results are good enough to allow us to continue using the prosthesis in suitable cases.


Blunt injuries to branches of the aortic arch. Blunt injuries to branches of the aortic arch are not unusual and must be considered in any patient surviving deceleration or crush injury. Review of 36 case reports, including own own case, revealed 22 injuries to the innominate artery (4 with injuries to other arch branches), seven to the right subclavian, seven to the left subclavian, and eleven associated injuries to the thoracic aorta. Thirty patients (83 per cent) survived. Mediastinal widening (92 per cent) was the most frequent manifestation of vascular injury and is an indication for immediate aortography to delineate the entire thoracic aorta. Distal circulation was clinically decreased in less than 50 per cent, with symptomatic ischemia in only a few instances. Death was due to associated head injury in 3 of 6 cases. Earlier operation would have avoided exsanguination (one death) and late complications of false aneurysm or vascular insufficiency (10 patients).


Blood cultures: principles and techniques. Detecting the presence of microorganisms in blood is an important function of the clinical microbiology laboratory. With prompt isolation, identification, and antimicrobial susceptibility testing of bacterial isolates, the clinician can modify the selection and dosage of the antimicrobics used initially to treat a suspected septicemia. Principles and techniques for blood collection, culture, examination, and reporting are reviewed.


Focal sclerosing glomerulonephropathy: a clinicopathologic study. Forty cases of focal sclerosing glomerulonephropathy with nephrotic syndrome or proteinuria were studied retrospectively in regard to clinical presentation, response to steroid therapy and clinical course, and histopathology of the lesion.  Morphologically there was a focal segmental and global sclerosis with subendothelial hyaline deposits, collapse of the capillary loops, intracapillary hyaline material or foam cells, filling and widening of the mesangium with mesangial matrix, focal tubular atrophy, and focal interstitial fibrosis.  Thirty-four patients had been treated with prednisone; initial complete remission of the nephrotic syndrome occurred in only 4 patients and partial remission in 10.  Nine of these 14 patients had nephrotic relapse or became resistant to steroids.  Thirty-three percent of the patients progressed to end-stage renal failure and an additional 25 percent had impairment of renal function after a mean of 8 years from onset.  Three patients received kidney allografts, and in two the disease recurred in the transplanted kidney.  Focal sclerosing glomerulonephropathy associated with nephrotic syndrome or proteinuria appears to be a clinicopathologic entity characterized by resistance to steroid treatment, frequent progression to end-stage renal disease, and recurrence in the transplanted kidney.


Left ventricular function and myocardial contractility: analysis by roentgen videoangiographic techniques. Conventional attempts to derive indices of myocardial contractility from left ventricular pump function appear to be unsound in practice and theory, and the small number of dimensional measuremets on which these computations are based obscure the regional differences in ventricular myocardial function.  It is not surprising that these indices have not proved to be fully satisfactory, either in research or in clinical laboratory settings.  Both theoretical considerations and laboratory results support the need for more detailed measurements of regional myocardial function.  These can be obtained by use of multiplanar videoroentgenographic techniques for cross-sectional reconstructions of the epicardial and endocardial surfaces of the heart throughout the cardiac cycle and the application of computer-based sophisticated methods of analysis, such as the finiteelement technique, as a basis for more accurate assessment of myocardial function.


The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Several closely related disease entities make up the idiopathic hypereosinophilic syndrome (HES). The syndrome is manifest by persistent and prolonged eosinophilia with organ damage. A group of 14 patients had hematologic, cardiac, and neurologic abnormalities attributable to this disease. Patient survival and response to chemotherapy was significantly better in this group than in previously reported patients. The etiology of HES remains unknown, as does the mechanism of tissue damage.


Management of mycosis fungoides--current status and future prospects. Current knowledge concerning the course of mycosis fungoides and recognized prognostic factors have been reviewed. Those factors with prognostic significance at the time of biopsy diagnosis include age and the clinical findings of skin tumors, ulceration or palpable lymphadenopathy. During the course of disease, the development of skin tumors, ulceration or palpable lymphadenopathy were each associated with a poor prognosis and median survival was only 12 months if all those clinical parameters were present. Patients who developed overt visceral mycosis fungoides rarely survived more than a few months. Lymphocytopenia and the presence of malignant lymphoma in biopsied lymph nodes were also poor prognostic findings. The various modalities of therapy for proven mycosis fungoides were reviewed. Topical therapy and external irradiation were generally of symptomatic benefit only, but two recent studies have shown that aggressive use of topical nitrogen mustard and electron beam therapy are associated with long-term responses in patients with disease confined to the skin. Single agent chemotherapy often resulted in transient responses in advanced and refractory mycosis fungoides. Future approaches to the management of mycosis fungoides have been suggested. These include a thorough review of the histological features, a thorough and systematic pretreatment evaluation and randomized studies of the various treatment modalities including combination therapy in appropriately staged patients.


Live attenuated versus killed virus vaccines. The discussion of the problems of production and use of killed and live virus vaccines shows that the theoretical, basic concepts of the alternative vaccination procedures are equivalent in regard to the ideals of calculable potency and safety. If one compares the present stages of development, then it becomes evident that the advantages of live viral vaccination are due to greater potency. However, killed virus vaccines are safer. Nevertheless, these differences are not without limits. In some vaccinating procedures, the live virus vaccine is the safer of the two.


[The influence of cardiogreen on the albumin binding of bilirubin in the neonatal period]. The albumin-binding of bilirubin may be disturbed by pharmacologically inert substances. This is true for Cardiogreen as used for dye dilution curves. The displacement of bilirubin from its albumin-bindung, examined in vitro by Sephadex filtration, is stronger for Cardiogreen than for Gantrisin known to cause kernicterus even in mild hyperbilirubinemia. However, from differences in dosage and the pharmacokinetics of the two substances it may be concluded, that the risk of possibly causing a kernicterus by Cardiogreen is limited to only extrem cases.


[Antibiotics in newborns and young infants]. Localized and generalized infections in newborns nowadays are mostly due to gram negative bacteria (E. coli, Klebsiella, Enterobacter, Pseudomonas pyocyanea, Serratia marcescens et al.). Unspecific treatment causes an increasing rate of resistance, as shown by an account of our own experiences. Tobramycin, Gentamycin, and Cefazolin appear to be particularly promising antibiotics to avoid the development of resistance though their pharmacokinetics in the newborn have to be considered carefully. Based on the determination of serum levels of Tobramycin and Amoxycillin in newborns general recommendations for the dosage of these new antibiotics are given.


Induction of base-pair substitution and frameshift mutations in wild-type and repair-deficient strains of Salmonella typhimurium by the photodynamic action of methylene blue. Induction of back mutations to prototrophy by methylene blue (MB)-sensitized photodynamic (PD) treatment has been studied in wild-type and repair-deficient strains of Salmonella typhimurium carrying either the base-pair substitution mutation hisG46 or the frameshift mutation hisD30529 We found that reversion of the hisG46 mutation was increased in a strain carrying a uvrB deletion and decreased in a strain carrying a recA-type mutation. Reversion of the hisD3052 (frameshift) mutation, on the other hand, was decreased in both uvrB deletion and recA-type strains. The former results are consistent with the hypothesis that the majority of MB-sensitized PD-INDUCED BASE-PAIR SUBSTITUTION MUTATIONS ARIse by a mechanism similar to that currently believed to be involved in UV mutagenesis. The latter results suggest that PD-induced frameshift mutations may arise in some other way, and two possible mechanisms involving sequential action of the excision repair and recombinational repair pathways are considered.


Test of recessive lethals in the mouse.

Test of recessive lethals in the mouse. The presence of spontaneous lethal mutations in inbred strains is discussed with special reference to their variation and influence on estimates of induced mutations. A model is presented that will facilitate classification of lethal-free and lethal heterozygotes. The model is used in classification of sons to lethal heterozygous males carrying a spontaneous mutation. The observed results are in good agreement with the model. From experience it is concluded that the most efficient way to use the facilities in lethal tests it to examine 10 or more full brothers to the P parents. By doing so pre-existing spontaneous lethals can be excluded by eliminating families in which any of the P parents were lethal heterozygous.  The observed total rate of recessive lethals gives slight over-estimation of the induced rate of mutations, as spontaneous mutations in the gametes forming the F1 cannot be excluded.


Spontaneous recessive lethal mutations in the mouse. The estimation of the load of recessive lethals in our inbred CBA strain is based on samples drawn from 1964 to 1971. 407 control F1 males were back-crossed to their daughters. The first examined females which for each F1  male gave 50 implants were included in the test. their rate of intra-uterine death was compared to that from lethal-free males. The distribution of the number of F1 males according to the number of dead in the first 50 implants were compared to a model of lüning. Three estimates of the proportion of lethal heterozygotes gave 4.2, 5.35 and 6.2% respectively. From the way the inbred strain was kept it was estimated that the mean load among F1 males was 11.5mu (mu equal to mutation rate per gamete). These data indicate that about 0.5% lethals occur per gamete with an upper limit of 1%. Comparisons are made with previous estimates of the spontaneous rate of lethal mutations per gamete. The low proportion of lethal mutations indicate that the number of loci giving lethal mutations is low. Both spontaneous and induced mutations give similar low numbers, more than one order of magnitude below the number commonly assumed. The uncertainties are stressed of estimating risk by multiplying mutation rate per locus and assumed number of loci.


Interactive mutagenicity of sodium nitrite, dimethylamine, methylurea and ethylurea. Groups of mice were treated per os with sodium nitrite either alone or in combination with nitrosatable amino compounds and tested in the host mediated assay. When mice were treated with sodium nitrite in combination with dimethylamine a small(4-fold) but significant increase in mutant frequency (MF) was observed. Ethylurea or methylurea in combination with sodium nitrite induced 10- or 850-fold increases in MF, respectively. The response to methylurea was dose-dependent with a 6- and 30-fold increase in MF at 5.4 and 11.5 mg/kg NaNO2 and a 6-fold increase at 108 mg/kg methylurea. That this response reflected gastric nitrosation was shown by the disappearance of the response if NaNO2 administration preceded methylurea treatment by 10 min. High MF's were observed if NaNO2 was administered 10 or 20 min after methylurea.


Quantitative relationship between carcinogenicity and mutagenicity of polyaromatic hydrocarbons in Salmonella typhimurium mutants. Mutagenic activities of various polyaromatic hydrocarbons (PAHs) in air pollutants, which are different in carcinogenic activities from each other, were examined with a set of four strains of Salmonella typhimurium (TAI535 series; deep rough strains without excision repair). All the compounds tested were converted to frameshift mutagens when they were metabolized by rat liver homogenate. There was a clear quantitative correlation between carcinogenicity and mutagenicity of PAHs tested in strain TAI538 using the rat liver enzyme induced with both dibenz(a,h)-anthracene and phenobarbital. On the other hand, such a correlation was not obvious in strain TAI537.


Zinc therapy of acrodermatitis enteropathica. The therapeutic effect of orally administered zinc was evaluated in an adult woman with acrodermatitis enteropathica. When she was off therapy and in clinical relapse the plasma zinc concentration (10 mug per 100 ml), serum alkaline phosphatase (3 1U per liter) and urine zinc excretion rate (39 mug per 24 hours) were extremely low. Di-iodohydroxyquin therapy was accompanied by a modest increase in plasma zinc concentrations. Oral zinc sulfate (220 mg three times a day or 50 mg twice a day) resulted in rapid and complete clinical remission, and in a return of plasma zinc, serum alkaline phosphatase and urinary zinc excretion to normal. These data are compatible with a severe zinc deficiency state and indicate that the inherited defect in this disease is either in or closely related to zinc metabolism. The beneficial effects of zinc therapy in this patient provide further confirmation of the efficacy of oral zinc in the treatment of acrodermatitis enteropathica.


Daily variations of FSH, LH and testosterone response to intravenous luteinizing hormone-releasing factor (LRF) in normal men. The responses of FSH, LH and testosterone to acute stimulation with synthetic LRF were studied in 6 healthy, fertile men aged 33.4 plus or minus 1.6 yr (X plus or minus SE). Fifty mug of LRF were given, iv at 0600 h, 1200 h, 1800 h and 0000 h, at 1-week intervals, to all 6 volunteers simultaneously. Blood samples were collected by venipuncture before (-5 and 0 min) and 8, 16, 32, 64 and 128 min after LRF injection. Plasma levels of FSH, LH and testosterone were determined by double antibody radioimmunoassay techniques. The responses of FSH and LH to LRF injection showed a clear difference at the times studied. Maximal values were obtained at 0600 h and 1800 h while the response at noon was not significant for LH and absent for FSH. Testosterone secretion showed a clear-cut response to LRF in all the subjects. At three of the four studied times (0600 h, 1800 h, 000 h) plasma testosterone was already increased at 8 min reaching its maximum at 16 min and persisted high until the end of the study. The noon response reached its maximum at the end of the test period. The daily variations of FSH and LH responses to acute LRF stimulation should be taken into consideration in clinical practive and the increment in testosterone secretion makes this test a useful indicator for androgenic testicular reserve.


The response of pituitary gonadotropes to synthetic LRF in children with glucocorticoid-treated congenital adrenal hyperplasia: lack of effect of intrauterine and neonatal androgen excess. Previous studies have demonstrated that the secretory reserve of the pituitary gland during childhood and adolescence is characterized by an age-related increase in LH secretion and a sex dichotomy of FSH secretion evoked by LRF. To determine if prenatal and neonatal androgen excess alters hypothalamic-pituitary-gonadal function, as in the neonatally androgenized rodent, we assessed pituitary sensitivity to 100 mug synthetic LRF in 9 girls and 2 boys with glucorticoid-treated congenital virilizing adrenal hyperplasia (CAH). In the 7 prepubertal girls with CAH, plasma LH following LRF rose to 2.0 plus or minus 0.4 (SE) ng/ml (LER 960) and did not differ from normal prepubertal children (1.7 plus or minus 0.1) and was lower (P less than 0.002) than in normal pubertal children (4.9 plus or minus 0.3). The 2 pubertal girls had LH rises in the pubertal range. In the 2 boys with CAH, the one with the more advanced bone age, 11-6/12 yr, developed true precocious puberty following initiation of cortisone treatment and had a pubertal LRF-evoked LH release on 3 occasions; the more immature boy, bone age 10, had a prepubertal LH rise. In the 7 prepubertal girls with CAH, plasma FSH rose to 8.1 plus or minus 1.6 (SE) ng/ml (LER 869), which did not differ from normal prepubertal girls (5.3 plus or minus 1.9), but was significantly (P less than 0.001) greater than in normal prepubertal boys (2.9 plus or minus 0.4). In these girls with CAH, basal plasma T (27.4 plus or minus 4.0 (SE) ng/dl) and 17-OHP (2703 plus or minus 1143 (SE) ng/dl) were greater than in prepubertal children, but plasma E1 and E2 were in the normal range. The pubertal boy had plasma T, E1, and E2 levels appropriate for his degree of sexual maturation. The results suggest: (1) age-related LH secretion evoked by LRF in glucocorticoid-treated CAH is appropriate for skeletal maturation; (2) the sex dichotomy of FSH secretion following LRF is preserved in CAH despite intrauterine and variable postnatal exposure to excess androgen and continuing slightly elevated plasma T during childhood; and (3) precocious puberty may follow initiation of cortisone treatment in a child with CAH whose bone age and secretory reserve of pituitary gonadotropins are in the pubertal range.


Bacterial behaviour.

Bacterial behaviour. Bacteria swim by rotating their flagella. They back up or choose new directions at random by changing the direction of the rotation. The probability of such changes is biased by sensory reception. The bias depends on the way in which the intensity ofthe stimulus changes with time, so that the bacteria tend to swim up a gradient of attractant and down a gradient of repellent chemicals.


Chemical structure and biological activity of endotoxins (lipopolysaccharides) and lipid A. Lipopolysaccharides (endotoxins) of gram-negative bacteria consist of two components with distinct physico-chemical character: a heteropolysaccharide and a covalently linked lipid, termed lipid A.  Chemically, lipid A is made up of acylated glucosamine disaccharides, which are interlinked by pyrophosphate bridges.  Lipid A represents the toxic center of lipopolysaccharides.  In rabbits, lipid A also induces pyrogen tolerance as well as pyrogen cross-tolerance.  Fever tolerance can be passively transferred with serum from rabbits immunized with lipid A.  The protective power of lipid A antiserum, however, is only expressed in amimals which have been pretreated with lipid A or lipopolysaccharide, indicating that other than humoral factors, perhaps cellular, also participate in endotoxin tolerance.  Lipid A antiserum also prevents the local Shwartzman reaction in rabbits.  The possible potency of lipid A antiserum to prevent other endotoxin effects such as lethal shock is presently investigated.


[Prevention and treatment of edema due to arterial revascularization]. Mean daily doses of 4-800,000 units iant. Cal. Trasylol administered i.v. for about 7 days prevented oedema and improved circulation after revascularisation surgery of the lower extremities involving the femoropopliteal axis in a large number of clinical cases.


Pelvic exenteration for vaginal embryonal rhabdomyosarcoma: a review. The English language literature for the years 1935-1972 was reviewed to assess the effect of pelvic exenteration on vaginal embryonal rhabdomyosarcoma. Twenty-one cases were determined eligible for review. Tumor was confined to the vagina in 8 cases and extended beyond the vagina in 13 cases. Treatment by pelvic exenteration was found to be relatively ineffective means of curing patients with tumor extending beyond the limits of the vagina. Recent evidence from the literature indicates that better results can be obtained by coordinated treatment, ie, surgery, radiation therapy, and/or chemotherapy, than by surgery alone.


Long-range effects of Ivalon sponge containing isobutyl cyanoacrylates on rat tissue. A quantitative planimetric study. This study on seventy rats was undertaken to determine the long-range effects of Ivalon sponge containing isobutyl cyanoacrylates (IBC). Histologic examination revealed that IBC sponge was well tolerated by the connective tissue. IBC sponge was most effective during the first 2 weeks of healing. At observation periods of 1 and 2 weeks, the percentage values for connective tissue formed in IBC-treated animals were 2.02 and 1.58 times higher than those in the untreated animals.


A rare and complex case of multifocal mucocutaneous lupus tuberculosis with isolated lesion of the tongue. We have described a case of plurifocal tuberculous lupus with a localization limited to the tongue. This finding is remarkable because of its rarity. The weakly positive tuberculin reaction and the discovery of a concomitant myeloproliferative syndrome add interest and complexity to the case.


Evaluation of root canal preparation with two automated endodontic handpieces. An evaluation of automated low-speed handpiece preparation of canals was made by a silicone injection technique. These preparations were compared and rated with canals prepared by conventional hand instrumentation. Canals were graded on the criteria of shape, smoothness, elimation of morphologic aberrations, and apical preparations. Conventional hand istrumentation proved to be superior and required approximately the same amount of time as automated ins-rumentation in this vitro study.


Nonspecific stomatitis-a presenting sign in pernicious anemia. Recurrent nonspecific stomatitis may be an oral sign of pernicious anemia. Repeated examinations and blood studies are important when the cause of stomatitis is not clear on initial evaluation of a complaint of sore mouth. Three cases of pernicious anemia are presented to illustrate the similarities and differences in oral signs of pernicious anemia.


Symposium on sensorineural hearing loss in children: early detection and intervention. Delivery systems in the management of hearing impaired children. The management of a hearing impaired child involves the family as well as the child himself, especially when the child is very young. Delivery systems therefore must include the parents as an integral part of the delivery chain and be sensitive to the parents' need to understand the treatment or therapy and, when appropriate, to sustain it in the home. Health care services that have educational implications have been termed eduhealth, which in the case of the hearing impaired child, refers to such services as the early detection of hearing loss, the proper fitting of hearing aids, the prompt treatment of upper respiratory infections that might lead to further hearing loss, and vision screening. The otolaryngologist, audiologist, and parent all have eduhealth responsibilities. Professionals in medicine and allied fields, although well trained and experienced in their specialities, are rarely prepared to meet all the needs of the young hearing impaired child and his parents with appropriate services and in the manner most appropriate for them. Some agencies, however, have demonstrated comprehensive capabilities in this area. In referring a family to a delivery system, the otolaryngologist should establish to his own satisfaction that the requisite skills are present. Common complaints of parents of hearing impaired children are the lack of communication with the physician and clinician, which is frequently the result of the vocabulary used by the specialist and the limited time spent with the parents during visits. The result can be parental failure to follow instructions and possibly irreversible damage to the child's development of listening, language, and speech skills. The eduhealth delivery service index is a new attempt to measure the effectiveness of systems for the delivery of education and health care services to young hearing impaired children and their parents. It has been demonstrated in a limited population and may prove useful in the comparison of delivery systems. The otolaryngologist is urged to become better acquainted with the various elements of delivery systems and to be cautious in accepting claims of comprehensive quality services until verified by his own experience or the reports of actual consumers of the services offered.


Symposium on sensorineural hearing loss in children: early detection and intervention. Genetic factors in deafness of early life. One half of all cases of childhood deafness are genetically caused, and this proportion will become increasingly larger as other causes come under control. The mode of transmission of hereditary hearing loss may be dominant, recessive, or X linked. Many varieties of childhood deafness can be distinguished by their accompanying anomalies. Other types of hereditary deafness occur, without associated abnormalities. Certain of these types may be delineated by the mode of transmission, age of onset, stability or progression, and audiometric findings. Further research on delineation of nonsyndromic hearing loss in necessary if treatment of specific kinds is to become a reality. Research also is needed to detect the carrier state in recessive and X linked types of hearing loss. In the absence of means of prevention and treatment for most cases of hereditary deafness, genetic counseling remains the most valuable course.


Symposium on sensorineural hearing loss in children: early detection and intervention. Classifications of auditory impairment. Over the past 25 years there has been a consistently growing interest in the identification of hearing disorders in children. Basic to the identification of hearing loss are the degree of hearing loss, the age of onset, the etiology, and the site of the lesion. In this modern era, hearing loss should not go undetected, and a child with a hearing loss no longer has to wait until he is six years of age before he can be treated and educated. Very young children can be successfully tested for auditory problems, and every effort should be taken to detect and identify such children with hearing problems. The audiometric tests devised for adults have been adapted, in part, for the measurement of hearing in children. The threshold values derived from standard audiometry and play audiometry are equivalent to those in adults. If some consistency is used in classifying children with auditory impairment, future research will be enhanced in the areas of prevention and social and educational management of children with auditory impairment.


Responsivity of pituitary gonadotropes to luteinizing hormone-releasing factor in idiopathic precocious puberty, precocious thelarche, precocious adrenarche, and in patients treated with medroxyprogesterone acetate. One hundred micrograms synthetic luteinizing hormone-releasing factor (LRF) were administered to 13 girls and 2 boys with idiopathic precocious puberty, 3 girls with precocious thelarche, 2 girls with precocious adrenarche, and 5 children treated with medroxyprogesterone acetate (MPA). Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sex steroid responses were assessed. The mean readily releasable LH rose to a peak of 8.4 plus or minus 1. 8 ng/ml (LER 960) in the children with idiopathic precocious puberty and was significantly greater than in normal prepubertal (1.8 plus or minus 0.14) or pubertal children (4.9 ng/ml) (LER 869) was higher in precocious puberty but not significantly greater than in normal prepubertal (5.3 plus or minus 1.9) or pubertal girls (6.0 plus or minus 1.2). The mean concentration of plasma estradiol rose significantly above resting levels after LRF in the girls with idiopathic precocious puberty. The LH response in girls with precocious the larche was in the prepubertal range. In 4 of 5 children with sexual precocity treated with MPA, the LH release evoked by LRF was diminished.


Pharmacologic manipulation of human erythrocyte 2,3-diphosphoglycerate levels by prednisone administration. Erythrocyte 2,3-diphosphoglycerate (2,3-DPG) concentrations in 10 patients with acute lymphoblastic leukemia rose 21.3%(P smaller than 0.02) after 3 weeks of prednisone and vincristine therapy, and returned to pretreatment level 2 weeks after therapy had been discontinued. The mean 2,3-DPG level of three patients on vincristine alone did not vary significantly from the control level of the leukemia patients on prednisone and vincristine. No significant change in serum inorganic phosphate level was observed. The mean erythrocyte 2,3-DPG concentration of 17 nephrotic syndrome patients being treated with chronic prednisone therapy was 14.0% higher than a control group of 20 nephrotic syndrome patients not being treated with prednisone (P small than 0.01). A significant positive correlation was observed between the dose of prednisone and 2,3-DPG level.


T and B lymphocyte subpopulations in children. T and B lymphocyte subpopulations were examined in the peripheral blood of children using the E and EAC rosette assays. Children under 18 months of age were found to have a decreased percentage of E-binding (T) lymphocytes and an increased percentage of EAC-binding (B) lymphocytes compared to older children (18 months to 10 years) and adults. The absolute number of E-binding and EAC-binding lymphocytes was increased in children under 18 months of age.


Transcutaneous oxygen tension measurements in newborn infants. Attention is called in this brief review article to the development and clinical uses of a new technique for monitoring blood oxygen tensions in newborn infants. This technique uses an electrode recently developed by Huch et al. in Germany to measure arterial oxygen tensions directly through the skin. This device allows for continuous monitoring with a non-invasive technique. The method is now in use in European hospitals. Clinical experiences are cited to document its usefulness.


Suprarenal abscess in the neonate: a case report and review of diagnosis and management. A case of unilateral suprarenal abscess is reported. This is the third such reported case, and the first reported case successfully treated with preservation of the kidney. Diagnosis and treatment were aided significantly by a thorough preoperative radiological evaluation, including angiography.


The use of indwelling radial artery catheters in neonates. Indwelling radial artery catheterization was performed on 20 infants. In only one patient was it unsuccessful. Mean duration of indwelling catheterization was 44.1 hours. Advantages of this procedure include constant availability of arterial blood gas sampling and blood pressure monitoring. It is a relatively safe procedure offering a low incidence of clinical infection and serious vascular complications. Further experience will delineate its exact role in the care of the acutely ill neonate.


The efficacy of group therapy by nurses for hospitalized patients. To investigate the effect of group therapy by nurses on chronic psychiatric patients, 100 chronic psychiatric patients between the ages of 30 and 59, hospitalized on two regressed, continued care wards and one community care preparation ward at the Veterans Administration Hospital, Augusta, Georgia, were paired, using the variables of age, diagnosis, and number and duration of hospitalizations, and assigned to five control and five experimental groups (ten patients per group). Experimental subjects attended group therapy sessions, led by two nurses, twice a week; control subjects did not. All subjects were evaluated by two nursing assistants on the NOSIE-30 scale prior to group therapy, after ten sessions, and at the end of 20 sessions. Paired t-tests were computed on pre- and postdata for six factors. Data from an evaluation scale of the most regressed ward indicated leader-patient interaction. Sociogram evaluation revealed 79 percent positive interactions. Topics most frequently mentioned were nature in regard to delusional systems and interpersonal relations in the hospital and home. Findings supported the use of group therapy with chronic regressed psychiatric patients.


T4-induced RNA ligase joins single-stranded oligoribonucleotides. RNA ligase isolated from Escherichia coli infected with bacteriophage T4 will catalyze the formation of an intermolecular 3' leads to 5' phosphodiester linkage between an oligoribonucleotide with a free 3'-hydroxyl and another oligoribonucleotide with a 5'-phosphate. Upon reaction with (Ap)5C, nearly quantitative conversion of the hexamer [5'-32P]p(Up)5U to the dodecamer (Ap)5C[3' leads to 5'-32P]p(Up)5U was observed. The product was identified by its mobility on RPC-5 column chromatography, its resistance to alkaline phosphatase, and the appearance of the expected radiolabeled products on hydrolysis with alkali, ribonuclease A, snake venom phosphodiesterase, and spleen phosphodiesterase. The coupling of other pairs of single-stranded oligoribonucleotides has also been demonstrated. The intermolecular joining reaction is probably mechanistically similar to the intramolecular cyclization activity previously reported for Tr RNA ligase. It is expected that this enzyme will be useful for the synthesis of RNA fragments of defined sequence.


Microbial production of ammonium ion from nitrogen. Genetic manipulation of nitrogenase and key glutamate-forming enzymes can provide mutants that excrete fixed N2 as NH4+. A derepressed N2 fxation mutant (SK-24) has been isolated , which excretes up to 20.2 mumol of fixed N2 as NH4+ per mg of cell protein in 24 hr at room temperature. Biochemical analysis shows that this mutant, which requires glutamate for growth, releases fixed N2 as NH4+ into the environment because of (i) constitutive synthesis of nitrogenase and (ii) genetic blocks resulting in losses of glutamate synthase [L-glutamine:2-oxoglutarate aminotransferase (NADPH oxidizing), EC 2.6.1.53] and glutamate dehydrogenase [L-glutamate:NADP oxidoreductase (deaminating), EC 1.4.1.4] activities, enzymes essential for NH4+ assimilation into cell material. The parent strain (asm-1), missing only glutamate synthase activity, also actively excretes NH4+ during early phases of its growth but eventually reutilizes the NN4+. A miximum yield of 4.0 mumol of NH4+/ml per 24 hr has been noted for asm-1 only during the growth period. Biosynthesis of NH4+ PROCEEDS AT THE EXPENSE OF A Variety of fermentable sugars, such as sucrose or glucose, with a maximum energy conversion efficiency of about 5 glucose degraded per NH4+ formed. The use of microbes for production of NH4+ fertilizer is discussed.


Proteolytic cleavage of bacteriophage lambda repressor in induction. The bacteriophage lambda repressor, a protein that maintains the lysogenic state of a bacterium containing a lambda prophage, is cleaved when the lysogen is induced by mitomycin C or ultraviolet light. This cleavage does not occur when induction is prevented by mutational alteration either of the phage repressor or of the host recA gene product. Proteolytic cleavage may be the primary mechanism of repressor inactivation in this induction pathway, or it may follow a different event which causes the initial inactivation.


DNA strand breaks measured within 100 milliseconds of irradiation of Escherichia coli by 4 MeV electrons. A method was developed in which E. coli cells were irradiated with four MeV electrons and transferred to alkaline detergent within a fraction of a second. This technique minimizes the amount of repair of radiation damage before analysis without the necessity of using physical or chemical treatments to inhibit repair and alter the physiological condition of the cells. The yield of DNA strans breaks formed in covalent circular superhelical lambda DNA molecules superinfecting E. coli lysogens was about 4-fold greater when the cells were irradiated in oxygen than when they were irradiated under nitrogen anoxia. The same yields were obtained in phosphate buffer at 3 degrees and 22 degrees as well as in growth medium at 37 degrees, and the yields were not altered by the polA1 mutation. When E. coli lysogenic cells superinfected with lambda were irradiated with doses sufficient to introduce at least seven breaks in the phage DNA, the chromosomal DNA and the superinfecting phage DNA sedimented similarly in alkaline sucrose gradients, indicating that both DNAs were broken to a similar extent during irradiation. However, the yield of breaks calculated for chromosomal DNA in similar experiments was greater than the yield calculated from the first break introduced into covalent circular lambda DNA molecules. These apparently contradictory results are explicable either if the initial break in a superhelical molecule occurs with an efficiency different from that for subsequent breaks, or if the pulsed electron radiation produces a high proportion of double-strand breaks.


Chromatin as a template for RNA synthesis in vitro. RNA transcribed in vitro from myeloblast chromatin by exogenously added RNA polymerase B predominantly consists of short chains that remain in hybrid structure with the template; the remainder of the product is free RNA of heterogeneous size. Addition of polyanions during synthesis caused an increase in the size and amount of free RNA with a concomitant decrease in the proportion of small RNA. The large molecular weight RNA is derived from the short RNA chains, which are synthesized de novo during the reaction in vitro. The effect of polyanions on the size and nature of the product may be related to structural changes induced in the template rather than to an inhibition of nuclease activity.


A new chemical procedure for 32P-labeling of ribonucleic acids at their 5'-ends after isolation. A new technique, which utilizes the chemical reaction between [32P]diimidazolidate of orthophosphate and the cetyltrimethylammonium salt of high-molecular-weight RNA in nonaqueous dimethyl formamide, has been developed for the 32P-labeling of RNAs after isolation. The radioactive label of high specific activity is introduced onto a phosphorylated 5'-end of the RNA and renders it suitable for 5'-terminal group analysis. When the labeling reaction was applied to the 70S RNA of avian myeloblastosis virus, a labeled 35S RNA was isolated on sucrose-dimethyl sulfoxide gradients without apparent degradation.


Temperature-sensitive cell mutations that inhibit adenovirus 2 replication. Five temperature-sensitive growth mutants of the hamster cell line BHK-21 were tested for the ability to support adenovirus 2 multiplication at 39 degrees and 33 degrees. Wild-type BHK-21 and mutants ts 422E and ts BCH yielded comparable amounts of virus at 33 degrees and 39 degrees, whereas in three other mutants, ts T22, ts T23, and ts AF8, virus production at 39 degrees was reduced to about 1% of that at 33 degrees. Virus yield in the three mutants was not reduced because of a delay in virus production; for all cells tested maximal virus yield at 39 degrees was obtained by 40-50 hr after infection. Normal yields of infectious virus were not obtained from ts AF8 even with a very high multiplicity of infection. In contrast, the virus yield from ts T22 and ts T23 was multiplicity-dependent. Shiftup experiments demonstrated that in ts AF8, a cell cycle mutant which at 39 degrees becomes arrested in G1, virus multiplication was thermosensitive for the first 40 hr of infection. In ts T22 and ts T23, the thermosensitivity was only for the first 3-4 hr of the infection. In all three mutants viral DNA synthesis was reduced by at least 95% at the higher temperature. The cell function specified by the ts AF8 mutation seems to be required for the early period of adenovirus 2 replication, after virus entry into the cell but before the onset of viral DNA replication.


Complementation in cytoplasmic petite mutants of yeast to form respiratory competent cells. Complementation has been observed in cytoplasmic respiratory deficient yeast cells (petites) to yield respiratory competent diploids. This successful demonstration depended on the use of spontaneous petites of recent origin and on crosses involving all possible apirwise combinations between the many different petite isolates of opposite mating type. The possibility of deletion of a single unique region of yeast mitochondrial DNA as the initial lesion in petite formation has been eliminated by using strains isogenic for their mitochondrial DNA.


Regulation of proline catabolism by leucyl,phenylalanyl-tRNA-protein transferase. A mutant of Escherichia coli lacking leucyl,phenylalanyl-tRNA:protein leucyltransferase, EC 2.3.2.6) exhibited several abnormal growth characteristics relative to the wild type or a revertant when grown with glycerol as a carbon source. All three strains were auxotrophic for proline. The mutant required higher levels of this amino acid than did the other strains to attain a normal growth yield and metabolized exogenous [14C]proline more rapidly. The greater rate of proline utilization was associated with a 4-fold increase in specific activity of proline oxidase. When glucose rather than glycerol was employed as a carbon source, proline oxidase activity was reduced by catabolite repression and the growth ccharacteristics of the mutant were similar to those of the parental and revertant strains. These results suggest that the mutant growth phenotype is due to an altered rate of proline catabolism and constitue evidence for regulation of a specific metabolic pathway by leucyl,phenylalanyl-tRNA-protein transferase.


Specialized transducing phages for ribosomal protein genes of Escherichia coli. Specialized lambda transducing phages have been isolated carrying approximately half the ribosomal protein genes of E. coli. These phages carry regions of the bacterial chromosome between aroE and fus. The ribosomal protein genes on these phages have been identified by the stimulation of ribosomal protein synthesis in ultraviolet-irradiated bacteria following infection by the transducing phage, and by the in vitro synthesis of ribosomal proteins in a DNA-dependent protein synthesizing system. The results indicate lambdadspcl probably carries at least 22 ribosomal protein genes and lambdadspc2 at least 26 genes. All these genes are clustered between trkA and strA. At least 13 of them have not been previously mapped.


The deltopectoral flap: an anatomical and hemodynamic approach. An anatomical and hemodynamic study of the deltopectoral flap in cadaver dissections and clinical cases is described. Anatomically, the deltopectoral flap represents a fusion of 3 vascular regions supplied by 3 different sets of vessels. Hemodynamically, the flap consists of a lateral cutaneous flap nourished by a medial arterial pedicle. The method of choice for delay of a deltopectoral flap is discussed.


Large Indian forehead rhinoplasty. Case report. The classic Indian rhinoplasty, with a midline forehead flap, was performed on 4 young adult patients with "cut noses". The rather large flaps survived in all cases, without a delay procedure, and the results were surprisingly good. The appearance of the donor area is, however, a problem-especially in patients with pigmented skins. The method is relatively simple and we believe it to be of value in selected cases.


Scalping injury.

Scalping injury. The history of scalp avulsions is presented, and one case is reported. A treatment plan for scalped patients is outlined.


Use of parieto-occipital flaps in the surgical treatment of baldness. I present a surgical procedure for the treatment of baldness, using parieto-occipital and occipito-parietal flaps. I believe these flaps are somewhat different from those advocated earlier by others, 1,3-5. We have treated about 400 cases (Tables I, II), and the overall results have been excellent with this method. The only complications have been dehiscences of the donor wound when the wound was under tension (15) and necrosis of the distal two cm of the flap (10).


The effect of commonly used antiseptics on wound healing. Acetic acid, hydrogen peroxide, and povidone-iodine solutions were applied to experimental wounds in rats and to human donor sites to test their effects on wound healing. Control donor sites were treated with saline or dry Owens gauze. The acetic acid and povidone-iodine solutions had no significant gross or microscopic effect on the wounds. The hydrogen peroxide solution seemed to hasten the separation of the scab and to shorten the healing time, though characteristic bullae and ulceration appeared if the hydrogen peroxide treatment was applied after the crust had separated, when new epithelium was visible. We believe that the use of hydrogen peroxide should be avoided after crust separation. When only dry Owens gauze was used to treat split-skin graft donor areas, the result was a 3-day prolongation of the scab separation (compared to the saline controls) and greater subepidermal reactive and inflammatory changes.


Autotransplant of omentum to cover large denudation of the scalp. Case report. Omentum was transplanted and covered with a split-skin graft, for repair of a denuding injury of the scalp in a 5-year-old girl. With the many successful recent reports of free skin flaps, the indications for omental transplantation have decreased somewhat, but some peculiar situations may require it.


Double-blind procedure: an assessment in a study of lithium prophylaxis. Fifty-seven patients with primary affective disorder who were in a double-blind outpatient study to evaluate the prophylaxis of lithium were questioned as to whether they believed they were receiving lithium or placebo. Research nurses who were 'blind' to the patients' medication and a close relative living with each patient were also questioned. Nearly all patients (96%) said they beleived they were receiving lithium, ascribing this belief in 63% of the cases to a perceived improvement in condition. In only 14% of the cases on lithium was the presence of side-effects implicated in the patients' beliefs. One of the three nurses had a correct guess rate in excess of chance expectancy. All nurses tended to be more accurate in their guesses in the cases of patients who had been in prophylactic trials of over 15 months' duration than for patients with briefer periods in the study. Patients' relatives were, as a group, extremely accurate, their correct guess rate exceeding chance expectancy at the 0-001 level.


Melorheostosis with linear sclerodermatous skin changes. A case of melorheostosis with overlying linear skin changes is reported. The radiographic appearance is that of a linear hyperostosis which appears to flow along the cortex of the bone. This is believed to be the twelfth such case in the literature.


Gastric pseudo-ulcers: membrana angularis and pyloric torus defects. The membrana angularis and pyloric torus defects are two physiologic bulges which can simulate ulcerations along the lesser curvature of the stomach. The muscular anatomy of the stomach and the mechanism which produces these pseudo-ulcers are discussed. Both pseudoniches can be seen transiently in normal individuals but occasionally are such prominence as to become diagnostic pitfalls. The features and significance of each pseudo-ulcer are reviewed in an attempt to facilitate recognition on the upper gastrointestinal barium examination.


Angiography of renal transplant using ipsilateral femoral artery compression. A technique is described for performing pelvic renal transplant arteriography using compression of the common femoral artery on the same side as the transplant. This method is an alternative to selective catherization.


Radiological concepts of cholecystokinin cholecystography. Cholecystokinin-cholecystography originated in Stockholm in 1955. At the present time the radiological procedure is conducted under supervision of medical research teams in the United States. The cholecystokininpancreozymin preparation is imported for clinical investigation under "Investigational Drug" regulations. Dr. Donald Hanscom, gastroenterologist, who is conducting clinical investigations in the Midwest, submitted radiographs, publications and evaluations from his files for this manuscript. This gastrointestinal hormone "squeezes out a diagnosis" as it is observed fluoroscopically. Dr. LeRoy B. Garbe, radiologist, evaluates these findings in the cases presented. The effects of cholecystokinin on the contrast-filled gall bladder give enhanced diagnostic information for the patient suffering with chronic cholecystitis and cystic ductitis.


Where we stand on proficiency testing.

Where we stand on proficiency testing. Because of the lack of comprehensive information in radiologic technology publications on the history, purpose and future implications of a process technologists hear talked about as "proficiency testing," and because of a lack of understanding of the role The American Society of Radiologic Technologists is playing in the project, the authors responded to a request by the editor to prepare this article.  Since evaluation of the proficiency testing concept is still going on, this article is only a beginning and cannot be conclusive as to possible implementation, but it serves to provide substantial understanding through which the reader can evaluate future information.


Arteriographic bleeding: a new sign.

Arteriographic bleeding: a new sign. A new sign of arteriographic bleeding, diastolic clearance of angiographic contrast medium selectively from the bleeding vessel, is described. The use of this sign must be confined to rapidly bleeding end-vessel distributions or when nonopacified collateral circulation is not a consideration. It should not be confused with the normal washout of contrast substance in areas of multiple parent vessel collateral circulation where intermittent opacification is a normal feature.


Ultrasonographic determination of the splenic size and its clinical usefulness in various liver diseases. Contact ultrasonic tomography was employed to obtain the size of the spleen in vivo. The scanning was done parallel to the ribs, and the splenotomograms obtained by this method showed three basic patterns of enlargement: a soft, bulging spleen, splenic congestion, or a firm spleen. Of the 96 patients with liver disease studied by this technique, 95% gave evidence of splenic enlargement. Useful information on prognosis may be obtained by observing the changes in the sectional areas of the spleen.


Detection of canine kidney allograft rejection with 51Cr-labeled lymphocytes. Mongrel dogs received transplanted kidneys following total nephrectomy. The whole blood was centrifuged to separate out the lymphocytic fraction, which was tagged with 51Cr. Renal accumulation of 51Cr was followed using imaging detectors. All allograft rejections were accompanied by a simultaneous rise in the count rate. Labeled lymphocytes can be used to detect canine renal rejection, and the authors feel that this technique can be applied to man.


The effect of contrast media on patient motion during cerebral angiography. Conray, Renografin-60, and Reno-M-60 were compared in 40 patients undergoing cerebral angiography. Pain during injection, as evidenced by head motion, was documented using subtraction. Conray produced less had head motion and therefore a superior subtraction study than either Renografin-60 or Reno-M-60 and was also subjectively the least painful of the three.


The effect of glucagon on barium-enema examination. Fifty barium-enema studies were performed with glucagon and 50 with a placebo to compare their effect on colonic spasm, patient discomfort, and diagnostic quality. Each drug was administered in a randomized double-blind fashion and was injected intramuscularly 10 minutes before beginning the enema. Bowel relaxation during fluoroscopy was graded. Patients were questioned about discomfort during and immediately after the enema, and radiographs were reviewed blindly for diagnostic quality and degree of spasm. Studies done with glucagon produced significantly less spasm and discomfort and better diagnostic quality compared to the placebo (p less than 0.01).


Releif of severe fecal impactions with water-soluble contrast enemas. High fecal impaction resulted in complete bowel obstruction in 2 children following renal transplantation and in one adult on chemotherapy and narcotics. The usual methods of relief failed, and water-soluble contrast enemas with a high osmolality were employed. Fluoroscopic control assured placement of the enema fluid at the site of obstruction, where it was very effective in relieving the impaction. It is suggested that such high-osmolality enemas be considered in patients with severe high fecal impactions before surgery is contemplated.


The effect of bithionol sulphoxide on Echinococcus granulosus and Taenia hydatigena infections in dogs. Double Thiry-Vella loops in calves were used to show that when heat stable E coli enterotoxin was in contact with only one of the loops, a net increase in water secretion occured in both. It was concluded that either enterotoxin itself or a mediator substance was absorbed and acted via the systemic circulation.


The effects of Escherichia coli endotoxin on the concentrations of mineral elements in the plasma of the domestic fowl. The intravenous injection of E coli endotoxin (serogroup 0111 : B4) into eight to nine week old disease-free fowls (0-025-3-0 mg/kg) produced successive falls in the plasma potassium and calcium levels during the 9 h following the injection. This change in the potassium concentration was accompanied by a slight rise in that of sodium, and in some cases a slight rise in that of sodium, and in some cases a slight reduction in the magnesium concentration was detected when that of calcium was reduced. No effect was observed 24 h after the injection. The metal-binding properties of endotoxin, its affinity for membranes and its effect on the secretion of adrenocortical hormones may be involved in the production of these responses. Their pathophysiological significance is also discussed.


Studies on the development of chloramphenicol resistance in Salmonella typhimurium. Chloramphenicol therapy of acute and chronic Salmonella typhimurium infection in mice did not lead to the development of chloramphenicol resistant mutants of this organism. However, chloramphenicol resistant organisms were readily produced in vitro. Transfer of chloramphenicol resistance from a donor strain of Escherichia coli X12 to a suitable recipient strain of S typhimurium 5235 occurred readily in the intestine of 15 out of 20 conventional mice, following oral administration of large doses of these strains supplemented by chloramphenicol therapy. When a similar system was used in untreated animals, only a small number of chloramphenicol resistant S typhimurium were isolated from three out of 18 mice. The virulence of chloramphenicol resistant S typhimurium produced in vitro and in vivo was similar to that of the sensitive parent strain.


Respiratory and cough mechanics in antitussive trials. Responsivity of objective indices to the treatment of acute upper respiratory tract infections. The relative responsitivy of nine expirographic and airway indices to antitussive therapy was studied in a randomized double-blind trial in which 60 adults without bronchopulmonary disorders, but suffering from common colds, were given oral doses of five drug formulations or placebo during their initial 48 h of symptoms. Thoracic gas volume (Vtg), nasal (Rn), lower (Ra), total t[Rn + Ra]) and specific (sRa) airway resistances were determined plethysmographically; forced vital capacity (FVC), forced expiratory volume for the first second (FEV1.0) and maximal mid-expiratory flow rate (MMEFR) were recorded spirometrically. Cough pressure at peak flow furnished an index of cough (CI). The measurements were made at baseline and for 4 h after drug; medication was continued for two additional doses and the indices determined again the following morning. Abnormal control means were noted for Rn and [Rn + Ra] (90.8%), cough resistance (83.3%), MMEFR (58.3%), Ra and sRa (30.0%), but less ofter for FEV1.0, Vtg and FVC (6.6, 5.1 and 0.0%, respectively). Nasal and total airways flow resistance means were as sensitive to active therapy and in discriminating the relative worth of medication as direct CI values, Ra and sRa were less reliable, and the three spirometric functions were the lease responsive. This ranking was consistent with the common central airways location of subepithelial receptors responsible for cough and the associated reflex bronchoconstriction. The greatest changes in cough resistance followed treatment with the most significant activity in the nasal, as well as the lower tract, component of total airway resistance.


Aerosol chemotherapy in bronchopulmonary candidiasis. One of the most frequent complications encountered in non-specific respiratory pathology of recent years is overinfection by Candida albicans. An important contributive factor is the recent massive antibiotherapy, above all with tetracyclines, favouring this overinfection. Since at present the treatment of bronchopulmonary processes is difficult owing to the lack of an effective oral or parenteral therapy, a study was carried out of 33 patients treated with nystatin and amphotericin B in aerosol form, with 3-4 sessions of treatment per day, during a minimum of 10 days. At each session either 50,000 U of nystatin or 5 mg of amphotericin B were administered. The results obtained showed that after treatment, C. albicans was no longer present in the sputum of 84% of cases treated. In view of these results it is considered that - at present - the two most suitable substances for the treatment of pulmonary candidiases are nystatin and amphotericin B in aerosol form.


Regional distribution of pulmonary blood flow in normal high-altitude dwellers at 3,650 m (12,200 ft). Simultaneous isotope dilution curves were recorded from the right upper (QRUZ) and right lower lung zones (QRLZ) by surface scanning in the sitting and recumbent positions in 15 normal high-altitude-born (HAD) males and in 1 HAD female as well as from 3 male newcomers, using 10 muCi of 131I-HSA as a bolus injection into the right ventricle. Similar information was also obtained at sea level from 5 normal males. The mean percent distribution of total pulmonary blood flow (Q) to RUZ and RLZ in the two body postures indicate (1) that in the vertical position RUZ in males receives about 17% of Q regardless of altitude and elevation in mean pulmonary artery pressure (MPAP) in HAD of 8.6 mm Hg above that extant at sea level; (2) recumbency at high altitude showed QRUZ also to be lower than at sea level; (3) elevation in MPAP at altitude has no significant effect on changing the sea-level distribution pattern of pulmonary blood flow.


Blood volume.

Blood volume. During the past decade the diagnostic use of blood volume determinations has declined as a result of the generation of largely inaccurate results and inappropriate normalization and interpretation. After historical development of more than 50 years, current methodology employs 125I-labeled human serum albumin and 51Cr-labeled red blood cells to determine plasma volume and red cell volume, respectively. Accurate blood volume determinations require (1) abandoning the use of the mean body hematocrit:venous hematocrit ratio and using simultaneous independent measurements of both volumes; (2) delaying multiple postinjection patient samples until complete mixing and equilibration are complete; (3) backextrapolation of plasma concentrations of 125I to account for albumin loss from the plasma, and, rarely, back-extrapolation of red cell concentrations to account for dilution by red cells transfused during the procedure; (4) normalization of volumes by adjusting patient weight to normal correspondence with lean tissue mass, whenever necessary. A rapid, routine method that fulfills these four requirements is presented. A number of surgical and medical conditions in which blood volume determinations are very useful in diagnosis and therapy are discussed. Recently developed techniques for blood volume measurements include neutron acativation analysis and fluorescent excitation analysis. Correct normalization of accurate blood volume measurements will provide a valuable service to the entire medical community.


Use of radioisotope techniques in the clinical evaluation of patients with megaloblastic anemia. Because virtually all cases of vitamin B12 deficiency seen in this country are due to malabsorption, the availability of radioactive vitamin B12 for direct measurement of absorption of this essential nutrient has proved to be of great clinical value. These tests are useful not only in demonstrating vitamin B12  malabsorption but also often in defining the pathophysiological mechanism responsible for this abnormality. The urinary excretion test of Schilling remains the most useful test for vitamin B12 absorption. Minor precautions and modifications in technique make the test results more reliable and easier to interpret. The 8-hr plasma test for vitamin B12 absorption can no longer be considered acceptable. Some patients with vitamin B12 malabsorption have results in the normal range when studied by this method. Serum vitamin B12 assays utilizing radioactive vitamin B12 and the isotope dilution principle are not widely used and are useful screening tests. Low normal or borderline results observed in patients with clinical evidence suggestive of vitamin B12 deficiency should be interpreted with caution or confirmed by radioactive vitamin B12 absorption studies. Radioactive vitamin B12 can also be used for rapid, reliable assay of gastric intrinsic factor, antibody to intrinsic factor and unsaturated vitamin B12 serum. Methods using radioactive folate compounds for similar in vivo and in vitro studies are not yet applicable for routine use in nuclear medicine laboratories.


Colestipol hydrochloride, a new hypolipidemic drug: a two-year study. Colestipol hydrochloride is an insoluble, nonabsorbable copolymer with bile-acid-binding capacity. It prevents reabsorption of cholates from the intestinal tract into the enterohepatic circulation causing a net loss of bile acids, and therefore of cholesterol. Sixty subjects with cholesterol levels over 250 mg/100 ml were studied for 104 weeks. Patients with normal phenotypes, types 2,3, and 4, were given 5 gm three times daily and experienced an average drop of 40 mg/100 ml (14%). While patients with types 2,3, and 4 hyperlipidemia responded effectively, cholesterol levels in type 2 patients dropped earliest and most consistently with an average decrease of 58 mg/100 ml (19%). A comparable group of patients with hyperlipidemia taking placebo showed on average no change in serum cholesterol. Serum triglyceride values were not altered significantly. The resin is not absorbed from the gastrointestinal tract and produces a slight increase in fecal volume. Results of chemistries, enzyme assays, prothrombin times, hematology, and urinalysis and body weights wer unaltered. There was no evidence of lithogenic bile production. Colestipol is a tasteless and ordorless copolymer with high acceptability. Side effects were limited to occasional bloating, gas, and constipation. The drug is a safe, effective, palatable hypolipedmic agent.


Primary prevention of atherosclerosis: a challenge to the physician caring for children. This review article stresses the importance of prevention in the reduction of the incidence of artherosclerotic disease, especially coronary heart disease. Evidence accumulated from autopsy studies, animal experimentation, and long-term epidemiologic studies supports the concept that atherosclerosis has its inception in childhood. Adult programs designed to change life styles and attitudes or reverse morphologic changes appear doomed to failure. Therefore, if nutritional, physical activity, and smoking habits are to be altered, it is essential to begin these efforts in infancy and childhood.


Primary prevention of atherosclerosis: nutritional aspects. The changes suggested for reducing consumption of calories, cholesterol, and sodium are not radical but sensible. These modifications are nutritionally sound suggestions which will lead to the development of good dietary habits which may be continued throughout life. Hopefully, this will prevent the child from entering adulthood with habits inappropriate for longevity and subsequently having to face the extremely difficult task of changing well-established habits.


Salmonella empyema and Hodgkin's disease. Bilateral Salmonella empyema was diagnosed in a 34-year old woman with active stage IV-B Hodgkin's disease and marked depression of immunologic function. Factors which might have predisposed to her infectious complication are discussed. The patient's dramatic response to treatment is stressed.


Modern approach to the diagnosis of anaerobic surgical sepsis. Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina, and the colon are the areas of the human body where the obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of these endogenous bacteria during the course of the operative procedure. To enable the isolation and successful identification of most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques have been reviewed in this paper. All of these techniques minimize the exposure of the clinical specimen to atmospheric oxygen during collection and transfer. The modern equipment used in sophisticated anaerobic bacteriologic workup has been discussed. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis, or associated gas formation. The importance and value of the gram-stain in the early identification of surgical sepsis has been stressed.


Platelet heparin-neutralizing factor (platelet factor 4). The heparin-neutralizing platelet factor (PF4) is released from platelets under the influence of inducers of aggregation and nucleotide-release in the form of a high-molecular weight complex. The heparin-neutralizing activity is carried by a basic protein of molecular weight 29,700, four of which combine with a proteoglycan carrier, which in turn consists of 4 chondroitin sulfate A residues and a peptide moiety.


A direct visualisation of helicoidal architecture in Carcinus maenas and Halocynthia papillosa by scanning electron microscopy. The test of the Tunicate Halocynthia papillosa is shown to have a laminate organization. Three properties of a helicoidal model can be directly observed: (1) Fibres in each lamina run parallel. (2) Fibres in adjacent laminae run at an angle. (3) In oblique section, discontinuous parabolic arcs made up of straight lengths of fibre from succeeding laminae are observed. These properties are confirmed in the cuticle of Carcinus maenas and the relationship of the pore canals to the laminar organization is discussed. It is shown by matching light and electron micrographs that the 'macrofibres' of recent workers are displaced pore canal tubules.


On the ultrastructure and permeability of taste buds of the marine teleost Ciliata mustela. The abundant taste buds of the barbels and free fin rays of the five bearded rockling, Ciliata mustela contain an average of 100-150 cells, falling into two types. Tubule-containing cells ('t-cells'), tentatively identified as receptor cells, and each surrounded by fibril-containing cells ('f-cells') in the central part of the bud. t-Cells also occur in two concentric shells separated by indifferent epithelial cells at the periphery of the bud. f-Cells are characterized by their concentrations of fine fibrils, and by granules or vesicles of 180-190 mmu diameter. The 100 or so receptor cells in a taste bud are innervated by some 250 axons. Lanthanum penetrates more deeply into the extracellular space of taste buds than into the extracellular space of the general epithelium, perhaps indicating that a greater area than the mere protruding tip of receptor cells may be accessible to chemical stimulation. Degenerating cells may provide an important route of entry for such external agents.


A computerized system for the selection of organ transplant recipients. The Southeastern Regional Organ Procurement Program has developed a computerized system for the selection of organ transplant recipients.  This system has proven to be a useful method for the rapid selection of histocompatible recipients for organ transplants from a large pool of potential recipients in a wide geographical area.  In addition, the system provides a readily accessible source of data that can be used to analyze the relationship between histocompatibility and transplant survival.


Detergent solubilisation of baboon histocompatibility antigens and their use in prolonging liver allograft survival. Histocompatibility antigens have been solubilised from baboon spleen cell membranes by brief exposure to sodium deoxycholate (DOC).  Preparations contained a high molecular weight species (DOCH-Ag) excluded by Sephadex G-200, and a low molecular weight species (DOCL-Ag) which eluted in the included fraction (molecular weight 46,000).  The low molecular weight antigen was stable and was not sedimented by high speed centrifugation even after dialysis against a low molar salt solution.  It elicited a delayed-type hypersensitivity response in sensitised baboons but not in normal animals.  DOCL-Ag cultured in vitro with sensitised allogeneic lymphocytes produced a 1.3- to 24.9-fold stimulation, whereas when cultured with normal lymphocytes the maximum stimulation index was 2.  Intravenous administration of donor DOCL-Ag (2 mg/kg) at the time of transplantation and without additional immunosuppression significantly prolonged the mean survival time of baboon liver allografts.  The same treatment with donor DOCH-Ag did not prolong graft survival.


Prolongation of liver allograft survival by donor-specific soluble transplantation antigens and antigen-antibody complexes. Soluble transplantation antigens were prepared from chacma baboon spleen cell membranes by a modified 3 M KCl technique.  The extracts were soluble according to usually accepted criteria.  Molecular weight was 37,700 daltons.  Antigenicity was confirmed by inhibition of cytotoxicity of alloantibody.  The antigens stimulated sensitized lymphocytes in culture but failed to stimulate unsensitized lymphocytes.  Antigen-antibody complexes were assembled in vitro in the regions of equivalence and marked antigen excess.  Administration of a single dose of soluble donor antigen at the time of orthotopic liver allotransplantation prolonged graft survival significantly.  Concomitant administration of a polyspecific alloantibody, previously shown to prolong baboon liver allograft survival, abrogated the graft prolongation produced by the antigen or antibody given alone.  When the administration of the soluble antigen was preceded by a dose of cyclophosphamide (20 mg/kg), graft prolongation was slightly curtailed. Antecedent administration of azathioprine and prednisolone for 3 days seemed to render the antigen immunogenic in that liver allograft rejection was accelerated.  Antigen-antibody complexes at equivalence prolonged liver allograft survival beyond that seen with antigen alone, but complexes in marked antigen excess were immunogenic, inasmuch as graft survival was not prolonged and the histological features were those of accelerated rejection.


The renal effect of intravenous adenine in humans. The purine base, adenine, improves the posttransfusion viability of liquid stored blood. However, adenine in high doses may cause kidney damage becuase of the precipitation in renal tubules of its incoluble metabolite, 2,8-dioxyadenine. Adenine is not licensed for use in the United States because it may be nephrotoxic. In a controlled, randomized, double-blind study, eight human subjects received 10 mg/kg of adenine infused intravenously over one hour, four subjects received 5 mg/kg, and four subjects received no adenine. Renal function tests were performed on each subject before adenine infusion and one day and one week following the infusion. Tests included an assessment of glomerular function (serum creatinine, creatinine clearance, protein excretion), proximal tubular function (amino acid and glucose excretion), and distal tubular function (maximal acidifying and concentrating ability). Plasma and urine levels of adenine and 2,8-dioxyadenine were measured. Renal function tests showed no evidence of kidney damage secondary to adenine.


Evidence of cytotoxic T and B immunoblasts in the thoracic duct of rats bearing tumour grafts. Wistar rats were immunised with allogeneic or xenogeneic tumour before collection of their thoracic duct lymph. Specifically cytotoxic effector cells were found in the lymph between 3 and 8 days after immunisation, and their occurrence coincided with an increased number of immunoblasts in the lymphocyte population. The immune response in lymph to allogeneic cells appeared to be affected solely by radiosensitive thymus-dependent lymphocytes; no complement-dependent killing was evident and cytotoxic cells failed to appear when immunised animals were deprived of thymus-dependent lymphocytes. In contrast, the response to immunisation with xenogeneic cells elicited both complement-dependent and complement-independent cytotoxicity, but only the former could be detected in animals deprived of thymus-dependent lymphocytes. In normal animals and in animals deprived of thymus-dependent cells, the cytotoxic cells in the thoracic duct lymph appeared to be large lymphocytes or immunoblasts.


Studies on the specific suppression of renal allograft rejection in presensitised rats. Theoretical and clinical implications. DA and Lewis rats were sensitised by two (DA times Lewis)F1 skin allografts 6 weeks apart and were given a (DA times Lewis)F1 renal allograft 4 weeks after the second skin allograft. Passive enhancement was tbsted in both strain combinations, the (DA times Lewis)F1 to DA model representing the weaker histocompatibility barrier as judged by renal allograft rejection. Passive enhancemnt was much less effective in the sensitised weaker model and was sometimes virtually ineffective in the sensitised stronger model. The powerful combination of antilymphocyte serum and enhancing serum could only delay but not prevent rejection in the latter model. Thus, the avoidance of sensitisation might be of critical importance for the clinical applicability of passive enhancement. Furthermore, it was shown that a sensitised cellular immune system is susceptible to specific immunosuppression, but the result depends on the strain combination used and whether the test graft is skin or kidney. A hypothesis is presented to explain the basis for the difference in strength of different histocompatibility barriers and also the differences between skin and kidney allograft rejection, based on the affinity of surface receptors of lymphocytes for histocompatibility antigens. It was also shown that sensitisation to minor histocompatibility antigens in the Ag-B-compatible AS to Lewis combination led to fierce rejection of a subsequent renal allograft, which was not rejected by the nonsensitised recipient.


Prolongation of allogeneic heart graft survival in the rat after implantation on portal vein. In rats, heart allografts with venous drainage via the portal vein were performed and compared with similar grafts draining into the inferior vena cava. A new technique was developed using the complete thoracic descending aorta and ligation of all its branches. The descending thoracic aorta was anastomosed to the recipient's abdominal aorta below the left renal vein. The pulmonary artery was implanted on the portal vein in an end to side fashion. In two rat strain combinations the allograft survival time was significantly prolonged when compared to that of the control grafts with pulmonary-caval anastomosis. The presumed mechanism for this prolonged graft survival might be the sequestration or degradation of transplantation antigens in the liver during their first passage through this organ. In this way only a small amount of antigen reaches the systemic circulation.


Cardiac heterotransplantation. Morphological and immunohistological studies. A vascularized heterograft model using outbred strains of animals was developed by transplanting mouse hearts heterotopically into rats. With this species desparity rapid but not immediate graft rejection was observed, with a predictably narrow range of graft survival times. Morphological and immunohistological studies showed early deposition of fibrinogen and vascular and myocardial inflammation without prominent or consistent localization of either IgG or C3. Later more extensive changes were observed, and deposition of IgG and C3 were more prominent in the grafts. Pretreatment of the recipient with cyclophosphamide alone or cyclophosphamide plus antigen prolonged graft survival; however, no statistically significant difference was noted between these groups. Morphological and immunohistological alterations preceded clinical rejection, and tissue injury appeared to be mediated by humoral and cellular immune mechanisms and by the coagulation system. This model is potentially useful for the study of heterotransplantation.


Immunological enhancement of skin allografts in the rat. Role of vascular and lymphatic reconstitution. Four skin graft models are created which vary in the rates of lymphatic and vascular reconstitution. Rat allografts (Brown Norway or (L times BN)F1 hybrid) transplanted to Lewis recipients by conventional (immediate lymphatic, delayed vascular), surgical anastomosis (immediate lymphatic, immediate vascular) or isolated anastomosis (delayed lymphatic, immediate vascular) techniques have similar mean survival times (7.8 days). Grafts placed on an isolated recipient pedicle (delayed lymphatic, delayed vascular) double the mean survival time to 15.6 days. Treatment with alloimmune serum, able to indefinitely prolong survival of similarly mismatched renal grafts, prolongs only isolated anastomosed grafts. In contrast, cyclophosphamide treatment prolongs survival of all groups. These results suggest, first, that both vascular and lymphatic routes of sensitization are equally effective and, second, that immunological enhancement requires either prompt vascular continuity or a persistent lack of lymphatic reconstitution.


A modified rosette inhibition test in renal allotransplantation. The rosette inhibition test, with a modification of the technique which enables highly accurate marking of T lymphocytes, has been employed in the followup of 55 renal transplant patients. The minimal inhibitory concentration of antilymphocyte globulin (that is, that concentration of antilymphocyte globulin causing 25% inhibition of rosette formation) was higher than 1:16,000 in 63 (97%) of 65 separate determinations made during acute rejection episodes, and lower than 1:16,000 in 377 (92%) of 410 determinations after which no clinical evidence of rejection developed. The results presented in this paper indicate that this modified test is a useful tool either to predict the occurrence of or to confirm the diagnosis of rejection.


Characteristics of histocompatibility barriers in congenic strains of mice. III. Passive enhancement of skin allografts in X-irradiated hosts. Passive immunological enhancement of skin allografts was investigated in three donor-host combinations of congenic mice disparate at non-H-2 loci. Serum against the graft donor was derived from mice that had received donor strain lymphoid cells as neonates, and thereby were rendered specifically tolerant of a skin allograft. We refer to this serum as "allograft-tolerant" serum. Each strain combination was chosen to provide only two non-H-2 histoincompatibilities present in the donor and absent in the host. The differences are categorized as immunogenetically strong, moderate, or weak, on the basis of skin allograft survival times. With passively administered allograft-tolerant serum significantly prolonged graft survivals were noted for the weakest combination only. Combined treatment with sublethal X-irradiation and allograft-tolerant serum signigicantly prolonged graft survivals were noted for the weakest combination only. Combined treatment with sublethal X-irradiation and allograft-tolerant serum significantly prolonged graft survival in both the moderate and weak combinations, with the largest effect present in the weakest disparity. A hyperimmune alloantiserum (produced in adults) directed against the graft donor prolonged allograft survival in the strongest disparity when given in combination with irradiation. In this combination, graft survival time was increased in hosts exposed to X-ray alone, but joint treatment with X-ray and the alloantiserum gave the largest increment. In contrast, combined treatment with the serum and an antithymocyte alloantiserum did not affect graft survival times. Treatment with both radiation and antithymocyte serum did not prolong graft survival beyond that in mice given only X-radiation. Immunological enhancement with central inhibition is assumed as the mechanism underlying prolonged graft survival, and it is suggested that a population of thymus-derived "killer" cells, sensitive to X-irradiation, is required for normal graft rejection.


Corticosteroids in organ preservation.

Corticosteroids in organ preservation. 1. Glucocorticoids have been empirically employed during perfusion preservation of transplantable organs. 2. Use of corticosteroids in organ preservation is based on their pharmocologic binding of released lysosomal enzymes, as membrane stabilizers, peripheral vasodilators, and inhibitors of the inflammatory response. 3. The incidence post-transplant of ATN in cadaveric kidney preservation by pulsa-tile perfusion has been reduced from 57% to 18% when the donor was protected with large doses of M-P. 4. There is sufficient clinical and laboratory evidence to substantiate the use of large doses of M-P given to the prospective donor as a protective agent against ischemic injury in organ recovery.


Corticosteroids in clinical and experimental lung transplantation. Lung allograft rejection can usually be diagnosed by the appearance of infiltrates on plain chest roentgenograms when these are interpreted in the light of other clinical and bacteriologic information. Large pulsed intravenous doses of methylprednisolone were usually effective in reversing lung allograft rejection that occurred in immunosuppressed dogs. In 10 of 15 animals the presence of moderate to severe rejection and its effective reversal with treatment were documented with roentgenograms and histologic sections. This ability to reverse the manifestations of lung allograft rejection, when they occur, has helped in the management of human lung allograft recipients.


[Apparatus for automatic recording of the intensity of ultraviolet fluorescence from individual cells]. The device enables to examine about 40 000--60 000 cells per min. The results are presented by the distribution curves of the ultraviolet fluorescence intensity.


Case study using simultaneous bladder pressure and urine loss measurements. Using an "electronic nappy" of improved design and a miniature pressure manometer of the strain-gauge type mounted at the tip of a catheter, the case of a patient with spina bifida and a large lipoma has been investigated. Some retention exists, but areas on the lipoma surface can be touched lightly, causing an increase in bladder pressure with subsequent voiding as measured by the nappy. Investigations of the same area by electrical stimulation produced rises in bladder pressure sustained for only a few seconds, as in the case of manual stimulation. Local anaesthetic in the "trigger" area prevented bladder pressure changes and urine loss, but triggering returned as the anaesthetic wore off.


[Congenital bulbular urethral constrictures. Pathogenesis and treatment of diseases of the bladder neck and urogenital border regions(author's transl)]. This paper is a survey of the literature concerning diseases of the bladder neck, posterior urethra and the urogenital border region. Urethrographic, uroflowmetric and urethrocystoscopic examinations of more than 200 patients ranging in age from one day to over 70 years demonstrated a clear-cut bulbular urethral constricture in this broad-spectrum disease picture. Its a congenital appearance is explained embryologically. A case analysis allows for classification based on the functional value of the urethral constricture. Diseases of as yet unexplained etiology such as Marion's disease, bladder neck sclerosis, urethral valves and chronic prostatitis-prostatopathy are clarified, based on the demonstrated urodynamics.


Late ureteropelvic necrosis after transplantation. Total ureteropelvic necrosis of the transplanted kidney occurred more than one month after transplantation in 5 of 575 consecutive renal transplants performed at the University of Minnesota Hospital since 1963. Necrosis became evident long after normal renal function had been established. Histologic signs of rejection were minimal, but perinephric or periureteral hematomas were found in 3 of 5 patients: post-transplant acute tubular necorsis requiring hemodialysis occurred in all. The pathogenesis of this complication probably involves (1) a primary deficit of blood supply from the renal vessels to the pelvis and ureter, (2) a failure to develop a new ureteral blood supply because of surrounding hematoma, (3) early swelling of the ischemic ureter resulting in oliguria interpreted as acute tubular necrosis, (4) resolution of edema resulting in diuresis, and (5) late patchy ureteral necrosis and fistula formation due to ureteral ischemia.


Use of procine zenografts in treatment of Fournier's gangrene. The use of procine xenografts as a biologic dressing has become increasingly popular, particularly in cases of extensive tissue loss, as in severe thermal injuries. It not only minimizes protein and fluid loss, acts as a barrier to infection, but also prevents conversion of second-degree burns through its ability to control existing infection. In this case, it was used successfully to treat Fournier's gangrene. We believe it significantly eased and shortened the patient's hospital stay and enabled us to apply autogenous split thickness skin grafts sooner than with conventional modes of wound care.


Complete duplication of urethra.

Complete duplication of urethra. Complete duplication of the urethra with a single bladder is an exceptional finding. The anomalous urethral canal originates from the bladder separately, runs parallel and usually dorsal to the normally situated urethra, and opens on the dorsum of the penis. To our knowledge there are 41 reported cases of this anomaly. We present 2 cases of complete urethral duplication originating from a single bladder, one in a male patient and the other in a female. It is concluded that conservative therapy is the treatment of choice, and that surgery should be reserved for incontinent patients only. The complications of surgery have been emphasized.


[Comprative evaluation of the immediate results of gastrectomy with different types of esophago-intestinal anastomosis]. Using the experience with 207 gastrectomies the author presents an analysis of a dependence of incompetency of enteroesophageal anastomosis sutures on the operative approach, extent of surgery, method of enteroesophagostomy, number of suture rows. The author's data evidence that incompetency of anastomosis sutures in gastrectomy is the principal cause of mortality in the postoperative period. The mortality due to suture incompetency while using a thoracoabdominal access is considerably higher than in transabdominal approach. The Sapozhnikov-Judin technic yields the least per cent of anastomotic suture incompetency (2%), whereas the Gilyarovich method--the highest (18.7%). The use of three-row sutures in formation of the anastomosis decreases twice the percent of suture incompetency. Extension of gastrectomy to a combined one does not increase the percentage of suture incompetency. Constant improvement of the Sapozhnikov-Judin method might permit to reduce to a minimum the anastomosis suture incompetency in gastrectomy.


[Selection of pancreato-intestinal anastomosis in pancreatoduodenal resection]. 41 pancreatoduodenal resections with 11 lethal issues (26.8 plus or minus 7%) were analysed. In 21 cases an end-to-end pancreatointestinal anastomosis was employed, in 12 cases an end-to-side one with peritonization of a suture line with the jejunal wall after the A. A. Shalimov technic, but in 8 cases- the technic of pancreatojejunostomy elaborated by the author, an end-to-end side type enveloping the anastomosis with a cecal segment of the jejunum. This method of peritonization does not impede passage of the intestinal content, thus rendering unnecessary the production of enteroenterostomy. Suture divergency of the end-to-end pancreatointestinal anastomosis was noted postoperatively in 6 of 21 patients (28.6 plus or minus 10%). Whereas, among 20 pancreatojejunostomies with peritonization of sutures by the jejunal wall after the A. A. Shalimov technic or in the author's modification this complication was noted only in 2 cases (10 plus or minus 7%).