Hemodynamic effects of venous valves in aorto-coronary bypass grafts. Use of the saphenous vein in aorto-coronary bypass surgery for treatment of occlusive coronary artery disease is a well-established technique. Use of the mammary artery for the same purpose has also been favorably reported. This study was undertaken to determine whether a vein graft containing a valve would have an added advantage. A comparison of the effect of competent and incompetent valves in vein grafts on the hemodynamics of coronary circulation was made. In a group of 18 dogs, a 5 cm. portion of each dog's cephalic vein containing a valve was used in a single aorto-coronary bypass graft. Flow measurements were made between the valve and the anastomosis of the graft to the left anterior descending coronary artery (LAD). The valve was made temporarily incompetent by the insertion of a spring wire basket, 3.5 mm. in diameter, through the valve via a side branch. The flow of blood through the venous graft with the competent valve was 11.0 +/- 2.6 per cent higher than with the incompetent valve. An analysis of flow patterns showed that this increased flow could be attributed to a reduction of backflow during systole and an increase in forward diastolic flow. Results suggest that postoperative myocardial perfusion is enhanced by the presence of valves in aorto-coronary bypass vein grafts.


Alpha1-antitrypsin phenotypes in chronic active liver disease and primary biliary cirrhosis. Alpha1-antitrypsin concentrations and phenotypes were determined in groups of patients with chronic active liver disease and primary biliary cirrhosis. The concentrations of alpha1-antitrypsin were above normal values in both groups; the patients with primary biliary cirrhosis had higher concentrations than those with chronic active liver disease. The prevalence of common phenotypes in these two groups did not differ from that in a sample of healthy blood donors from this institution of from a large Norwegian sample. We interpret our data as disputing the view that alpha1-antitrypsin phenotypes, other than Z. significantly predispose adults to hepatic cirrhosis.


[Humoral and cell-bound immunological reactions in chronic hepatitis (author's transl)]. Various forms of chronic hepatitis can be differentiated on the basis of histological changes as well as of immunological findings. Humoral and cell-bound immune phenomena in chronic hepatitis are described; their significance for the pathogenesis and for establishing a diagnosis is discussed.


Arterial vasoconstrictor therapy for bleeding oesophageal varices. Upper gastrointestinal bleeding in patients with hepatic cirrhosis carries considerable mortality. Difficulties are encountered both in determining the source of bleeding and in controlling blood loss. The techniques of selective visceral angiography not only supply diagnostic information, but can be used to administer selective intra-arterial vasoconstrictor therapy to control blood loss. We report our experience with 28 patients in whom angiography was performed with particular reference to six patients treated with selective vasoconstrictor therapy. Although the precise role of the technique is not yet established, early experience is most promising. We believe it will play an important role in a difficult group of patients in the future and may well supplant present methods of controlling bleeding.


Comparative effectiveness of tetracycline, minocycline and doxycycline in treatment of acute-on-chronic bronchitis. A study based on sputum levels. After the administration of minocycline, doxycyline and tetracycline in recommended therapeutic doses to 11, 10 and 12 patients respectively, sputum levels of these antibiotics were determined. Only 20% of patients given doxcycline had a satisfactory sputum level and in the remainder levels were either low or absent. For patients receiving tetracycline and minocycline, 67% and 64% respectively had satisfactory sputum levels. Patients selected for this study had a history of chronic bronchitis and were producing copious amounts of purulent sputum. Minimum inhibitory concentrations of these three antibiotics were similar for 25 freshly isolated strains of Haemophilus influenzae, with minocycline being the most inhibitory and doxcycline the least inhibitory.


[Therapy of tuberculosis with Rifampicin in childhood (author's transl)]. Compared with the adults the child's bloodlevel after having taken Rifampicin is lower, therefore it is recommanded to take a higher dose of 15 mg/kg in the morning before having breakfasted. A combination of doses of 10 mg/kg INH and 20 mg/kg Ethambutol is possible without any doubt. If you consider the reaction which may arise, SGOT and SGPT values up to 21 mU are without any signification. If they depasse this limit a certain control is necessary and if they are still progressive the therapy must be changed. If you compare the experiences with the adults, secondary effects of Rifampicin in childhood are less, just so indigestibleness of the stomach or intestines tract or allergies.


The variable pattern of circulating lymphocyte subpopulations in chronic lymphocytic leukemia. The percentages of T and B lymphocytes in 13 patients with chronic lymphocytic leukemia were determined at two-week intervals. One patient with "B-cell predominant" disease showed a decrease from 77 to 49 in the percentage of circulating B cells, which bind heat aggregated immunoglobulin and anti-human immunoglobulin. This patient had a comparable increase in T cells, which form rosettes with sheep erythrocytes. The lymphocytes of three other patients, who originally had equal percentages of cells that bound heat-aggregated immunoglobulin and anti-human immunoglobulin, lost lg determinants from 47 to 63 per cent of cells without changing the proportion of cells with receptors for heat-aggregated immunoglobulin or for sheep erythrocytes. The characterization of lymphocytes in chronic lymphocytic leukemia should include sequential determination of cell-surface markers for both T and B cells, since the disease does not represent a proliferation of B cells alone.


Influenza: response of T-cell lymphopenia to thymosin. Eighteen volunteers in tow study groups were inoculated with influenza A (H3N2) and their peripheral blood T, B and null cells enumerated at subsequent intervals. Infection with wild-type virus or with a live, attenuated virus vaccine markedly reduced the proportion and absolute number of T-cell rosettes 24 hours after inoculation. T-Cell depression preceded the onset of clinical illness in symptomatic subjects, continued during illness, and returned to normal with recovery. T-cell lymphopenia was most pronounced in volunteers infected with wild-type virus and was accompanied by an increase in null cells. Lymphocytes from six wild-virus recipients with T-cell leukopenia were incubated in vitro with a calfthymus extract (thymosin), significantly increasing the percentage of T rosettes in all six subjects (P less than 0.0001). These data indicate that influenza is accompanied by pronounced quantitative and functional changes in T cells.


Liver disease in alpha1-antitrypsin deficiency detected by screening of 200,000 infants. We prosepctively studied 200,000 newborns to determine the frequency and clinical characteristics of alpha1-antitrypsin deficiency. One hundred and twenty Pi Z, 48 Pi SZ, two PI Z-and one Pi S-infants were identified and followed to the age of six months. Fourteen of 120 Pi Z infants had prolonged obstructive jaundice, nine with severe clinical and laboratory evidence of liver disease. Five had only laboratory evidence of liver disease. Eight other Pi Z infants had minimal abnormalities in serum bilirubin and hepatic enzyme activity and variable hepatosplenomegaly. All 22 Pi Z infants with hepatic abnormalities, two thirds of whom were made, appeared healthy at six months of age. Ninety-eight Pi Z infants did not have clinical liver disease, but liver-function tests gave abnormal results in 44 of 84 at three months, and in 36 of 60 at six months of age. The number of small-for-gestational-age infants was greater (P less than 0.001) among those with clinical liver disease. None of the 48 Pi SZ infants had clinical liver disease, but 10 of 42 at three months and one of 22 at six months of age had abnormal liver function. The Pi Z and Pi SZ phenotypes are associated with covert or readily apparent hepatic dysfunction in the first three months of life.


[Axonal composition of the marginal and basal optic tracts of the grass frog]. An electron-microscopy study of the marginal optic tracts (the medial and lateral divisions) and basal optic tract was performed for the frog Rana temporaria. The resemblance between the ultrastructure and composition of the marginal tracts is revealed. The basal tract is characterized by a relatively loose structure and considerable content of the myelinated large diameter fibres. The corresponding tract contains 3900 (4.7%), 4700, (4.9%), 700 (28%) of myelinated fibres and 79 800 (95.3%), 91500 (95.1%) and 1800 (72%) of unmyelinated ones. The spectra of the myelinated fibre diameters of the marginal tract are from 0.4 to 2.6 mum with the main peak at 1.0 mum and additional peak at 1.6 mum; the spectrum of the myelinated fibre diameters of the basal tract is from 0.4 to 4.0 mum with the main peak at 1.8 mum and the small additional peak at 3.2 mum. The spectra of the unmyelinated fibre diameters of all tracts are from 0.1 to 0.5 mum; 60% of them have a diameter of about 0.2 mum. 85 days after enucleation undegenerated myelinated fibres were not found in the basal tract of the frog kept at a temperature 18-20 degrees C. The medial and lateral marginal tracts contained a significant number of the undegenerated myelinated fibres, 33% and 13%, the diameter spectra being 0.6-1.4 mum and 0.6-1.0 mum, respectively. It is possible that these fibres participate in the organization of the ipsilateral visual projection on the tectum. Unmyelinated fibres remain unchanged in all the studied tracts.


Histiocytosis X of the cauda equina.

Histiocytosis X of the cauda equina. Laminectomy, performed on a 46-year-old woman because of weakness and paresthesias of the lower limbs, showed multiple discrete yellow nodules on the nerve roots of the cauda equina. One of these lesions was excised and proved to be a granuloma consistent with the diagnosis of histiocytosis X.


[Benzogammapirone in the treatment of digestive hemorrhages]. Given the difficulties of treating digestive haemorhages with normal coagulant methods, and considering that most haemorrhages are due to vascular factors, a vasoprotective substance was associated with common coagulant therapies. Benzogammapirone was used orally and by selective arterial infusion. The series is presented and the results discussed.


Chorioepithelioma presenting as a bleeding gingival mass. A case is reported in which a very malignant neoplasm appeared clinically to be a pregnancy tumor or a hemangioma. There was, of course, no question as to the cause of death in this particular case. It was of interest because of the rarity of the tumor, the metastasis to the oral cavity, and the fact that the final diagnosis was established from pathologic examination. The case demonstrates, with emphasis, the great importance of biopsy and routine pathologic examination of all tissue for accurate and correct diagnosis, regardless of its clinical appearance.


Aorta-circumflex coronary artery bypass through the transverse sinus. A new technique. Aorta-circumflex coronary artery bypass using a saphenous vein graft may present technical inadequacies with angulation, kinking, compression, tension and finally thrombosis and occlusion of the graft. As these problems are mainly secondary to incorrect length and direction of the vein graft, a new technique is described which allows the placement of a shorter graft in a more parallel direction to the physiologic aortocoronary flow. The transverse sinus of the heart is used as a natural protected channel whereby the graft passes behind the great vessels from the right posterior wall of the aorta to the circumflex coronary artery. Thus, redundancy, angulation and kinking are avoided and flow in the graft takes a more natural course.


Antinuclear antibodies and lupus-like syndromes in children receiving anticonvulsants. Drug-induced systemic lupus erythematosus (SLE)-like syndromes in children are most commonly associated with the administration of ethosuximide, diphenylhydantoin, and trimethadione. Five children receiving ethosuximide who presented with syndromes suggestive of SLE were studied. Each and fever, malar rash, arthritis, and lymphadenopathy. Two children had pleural effusions and another developed myocarditis and pericarditis. Three patients had anti-DNA antibodies associated with low serum C3. In four of five children symptoms disappeared with the discontinuation of ethosuximide; two of these continue to have antinuclear antibodies (ANA). One child continues to have active SLE with nephritis. A group of 101 children from a seizure clinic were tested for the presence of ANA. ANA were found in 14 of 70 children receiving ethosuximide and/or diphenylhydantoin; 2 of 14 had anti-DNA antibodies. Serum ANA titers in the drug-induced SLE group did not differ significantly from those of the asymptomatic seizure patients. ANA were also present in 5 of 23 children receiving phenobarbital only. The induction of ANA by phenobarbital is a possible hypothesis. Quantitative immunoglobulins and C3 were not significantly altered in the asymptomatic children with ANA. Follow-up studies at ten months showed no asymptomatic child with ANA to have developed clinical with ANA to have developed clinical evidence of SLE. This study suggests that asymptomatic children who develop ANA should have careful observation, but need not have their anticonvulsants discontinued.


Chloride transport in isolated frog (Rana temporaria) skin: changes in short-circuit currently, potential, resistance, and chloride flux elicited by furosemide. In a large number of isolated frog skins, with potential differences of from 20--92 mV (mean, 55.3 +/- 3.6 S.E.M.), the chloride influx was found to be slightly greater than chloride efflux under short-circuit conditions, but the difference was not statistically significant. However, if skins of low potential (less than 50 mV) were selected, chloride influx was significantly higher than chloride efflux (P less than 0.05). In this low potential group furosemide, (10(-3)M, applied to the solution bathing the mucosal surface) was found to produce a) a small increase in short-circuit current, which was generally apparent within 1 min, maximal in 5 min; and thereafter declined towards the control value; b) a marked increase in potential difference, apparent within 1 min and sustained for at least 30 min; c) a large and sustained increase in the calculated d.c. resistance of the skin and d) a decrease in the influx of chloride, such that influx and efflux were equalized.


[Obstructive pulmonary syndromes in children with alpha 1 antitrypsin deficiency. 3 cases]. During the last six years, the search for a deficiency in alpha-1-antitrypsin (AAT) was carried out in 106 children aged from 5 months to 14 years, having the obstructive pulmonary syndrome. Nine deficiencies were in this manner detected and phenotyped. These are the observations of three of these children which are reported here. Their age ranged between 4 years and a half for two of them and 8 years for the third one, having asthma. The phenotypes are respectively SS, MZ, and ZZ. Following these observations, the problems brought up by the association in AAT deficiency and the obstructive pulmonary syndrome in children are discussed: clinical symptomatology, interpretation of the basic design, pathogenic signification and possible connections with asthma and therapeutic influence. The functional respiratory disorders noted in these children involved a ventilatory asychronism, an overexpansion, and regional abnormalities of ventilation and perfusion. To answer these still outstanding questions, the need for a systematic prospective study carried out on a wide group of children is emphasized.


[Platelet anomaly in an eosinophilic myelophroliferative syndrome]. The authors report a case of chronic eosinophilic leukemia. Ristocetin did not aggregate patient's platelets in the absence of bleeding disorder. A possible relationship between arterial thrombosis observed in patients with eosinophilic leukemia and platelet abnormality is evoked.


Aortocoronary bypass surgery for ischemic heart disease: indications based on controlled trials. One- and two-year results of aortocoronary bypass for ischemic heart disease indicate that in stable angina pectoris, at least, the operation can be beneficial, ie, superior to intensive medical therapy, in achieving certain objectives. The operation is clearly a technical success, and prospects for very long-range patency of the grafts appear to be good. An observation of great interest is symptomatic improvement in some patients with occluded grafts. The greatest success of aortocoronary bypass is improvement in quality of life for certain patients.


A new look at diarrhoea, diverticulitis and 'colitis' after 25 years of clinical study. The clinical features of fat-intolerant bowel disturbance, which have been established by study, over a period of 25 years, of bowel disturbance seen in dyspeptic and other patients, are described. Excess dietary fat intake is an etiological factor in the irritable colon syndrome, spastic colon, diverticulosis, and diverticulitis of the colon and in ulcerative and non-ulcerative colitis. All these conditions are manifestations of intolerance to excess dietary fat intake, and are controlled, and their symptoms are cured, by adherence to the fat-free diet: i.e. a diet from which is excluded any fat derived from cow's milk, from the pig, any 'store' or 'depot' fat, and any vegetable fat concentrate.


B and T lymphocytes in viral hepatitis.

B and T lymphocytes in viral hepatitis. Peripheral blood lymphocytes were investigated in 20 patients with acute viral hepatitis. For assessment of B lymphocytes the rosette test was carried out using sheep erythrocytes coated with antibodies and murine complement. T lymphocytes were recognized by their ability of binding uncoated sheep erythrocytes. In 16 cases the results of EAC test in patients with viral hepatitis resembled those in healthy donors. In 3 cases a significant decrease was observed and in one case a significant rise was found in the number of cells forming EAC rosettes. The T lymphocyte count was within normal range in 19 investigated cases. The results suggest that impaired T lymphocyte reactivity to PHA in acute viral hepatitis is due to a disturbed function of T lymphocytes and not to a decrease in their number. In cases associated with significant hepatocellular damage a reduction in the number of circulating B lymphocytes was observed.


[Effect of immunosuppressive and cytostatic factors on the immune responses of the body. Communication II. Effect of hydrocortisone on immunologically competent cells (RFC cells and lymphocytes B) in immunized animals (author's transl)]. The effect of hydrocortisone on immunologically competent cells in peripheral blood (lymphocytes B and RFC cells) and on the level of humoral antibodies has been studied in rabbits immunized twice with 10per cent sheep erythrocytes. The animals were divided into two groups. The experimental group, numbering 14 rabbits, was administered 30 mg/kg body weight of hydrocortisone intramuscularly for three consecutive days before the first and second dose of antigen; the 10 rabbits of the control group were administered only the antigen. The results obtained showed that, after immunization and in the course of the normal immune response of the body, the numbers of RFC cells and of lymphocytes B increased in peripheral blood before the level of antibodies rose (Fig. 1, 3 and 4). The results in the group of experimental rabbits showed that hydrocortisone markedly suppressed the normal immune response of the body to the antigen administered. When the data obtained in both groups studied were compared, it was found that the amount of RFC cells and of lymphocytes B in peripheral blood was manifestly smaller in the group of experimental animals treated with hydrocortisone, than in the group of control animals, both after the first and the second dose of antigen (Fig. 1, 2 and 3). The difference concerning the humoral antibodies level between the two groups, however, appeared only after the second dose of the antigen (Fig. 4, Table I). That means that the investigation of immunologically competent cells in peripheral blood, such as lymphocytes B and RFC cells, enables to detect disturbances in the immune response of the body earlier than the investigation of humoral antibodies and supplies a more complete image of the changes occurring in the body during immunization.


Distribution of Ia-like molecules on the surface of normal and leukemic human cells. Antiserum to a glycoprotein antigen complex of 23,000 and 30,000 dalton subunits (p23,30), isolated and purified from a human lymphoblastoid B cell line, was shown to be highly specific for human bursal-equivalent-processed (B) cells, reactive with 15-20% of human Null cells, but completely unreactive with human thymus-processed (T) cells. The p23,30 antigen is widely distributed on chronic lymphatic leukemic cells, 85% of acute lymphatic leukemic cells, all acute myelogenous leukemic cells, but not on chronic myelogenous leukemic cells. A rabbit antiserum specific for normal human thymocytes has also been prepared; it is reactive only with precisely that subset of acute lymphatic leukemic cells (15%) whose members do not have p23,30 on their surfaces.


Antigen stimulation of prostaglandin synthesis and control of immune responses. Within 2 min following the intravenous injection of sheep erythrocytes (sRBC) there occurs 20 to 80-fold increase in prostaglandin (PG) F2alpha in the spleen. This burst of synthesis is followed by a slow decline to control levels over the next 1-4 hr. No increase in splenic PGF2alpha levels is observed between 24 and 72 hr after injection. Injection of colloidal carbon results in a small increase, approximately 20% of the increase in PGF2alpha observed with sRBC. The early increase in splenic PGF2alpha levels stimulated by sRBC is also dependent upon thymus-derived (T) cells, since the increase is small or nonexistent in athymic mice and NZB mice. Also, the elevation of splenic PGF2alpha levels is blocked by the administration of indomethacin or Ro 20-5720, both of which block the synthesis of prostglandin. A small increase (2-fold) in PGF2alpha levels occurs in the thymus. A soluble antigen, bovine gamma globulin, stimulated a bimodal increase in splenic PGF2alpha levels, the early peak occurring at 2 hr and the later increase occurring at 48 hr. Using inhibitors of prostaglandin synthesis, it is possible to enhance the appearance of cells forming 19S antibody against sRBC, both in vivo and in vitro. Furthermore, inhibition of prostaglandin synthesis enhances DNA synthesis induced in a two-way mixed-lymphocyte reaction only in whole spleen cell cultures and not in cultures of spleen cells purified by passage over glass wool. Based on this evidence, it is proposed that the prostaglandins represent a major soluble mediator in the control of T cell-T cell interactions and also play an important part in T-B (bone-marrow derived) cell interactions.


Molecular abnormality of human alpha1-antitrypsin variant (Pi-ZZ) associated with plasma activity deficiency. A human alpha1-antitrypsin variant protein was purified to homogeneity from homozygous variant subjects (Pi-ZZ) who had a deficiency of plasma trypsin inhibitory capacity. Molecular weight, specific trypsin inhibitory capacity, and immunologic activity of the variant protein were identical to those of normal. Amino acids, N-acetylglucosamine, and hexose contents were closely similar in the normal and variant proteins, but the sialic acid content in the variant protein was significantly lower than normal. The structural difference between the normal and the variant alpha1-antitrypsin was elucidated by fingerprinting of their tryptic peptides. Two amino acid substitutions, i.e., glutamic acid in the normal protein to lysine in the variant protein, and glutamic acid in the normal protein to glutamine in the variant protein, were found.


Müller cell function during spreading depression in frog retina. K+ potentials were investigated using K+ microelectrodes in frog (Rana pipiens) retinas conditioned for spreading depression (SD) by Cl--free Ringer's solution. A marked increase in outside K+ concentration, [K+]O, maximal in the inner plexiform layer, was observed during SD. This [K+]o change resembled the simultaneously recorded membrane potential change in Müller cells, suggesting that these cells act as K+ electrodes. Intracellular recording with K+ electrodes in Müller cells showed that upon SD the [K+]i (inside) of Müller cells increases and therefore immediately starts to cleanse the extracellular space of the excess of K+ which, evidence suggests, is mainly caused by pathologically enhanced synaptic activity in the inner plexiform layer.


Stimulation of antibody synthesizing lymphocytes in the rat by antigen reactive cells sensitized in vitro. Lymphocytes obtained from rat spleens were sensitized in vitro to sheep erythrocytes. The sensitized lymphocytes did not synthesize antibody but when injected into unimmunized rats did stimulate antibody production to sheep erythrocytes. Analysis of the location of 7 and 19 S plaque-forming cells in the recipient rats indicated that these two antibody synthesizing cell populations arise from different lymphocytes. It was also found that the sensitized lymphocytes could react only with a limited number of antibody synthesizing cells.


Sugar-induced potential difference and short circuit current in bullfrog small intestine: effect of UO22+. UO22+ 1.3 mM added as UO2(NO3)2 to the mucosal solution consistently inhibited the P.D. and ISC evoked by 11 mM glucose and 35 mM 3-O-methyl glucose across isolated strips of bullfrog small intestine bathed by symmetrical Ringer solutions in which SO42- was the major anion. The average degree of inhibition in the presence of glucose was 42 +/- 7(SEM) percent. P.D. and ISC in the absence of transported solutes were not significatnly altered by mucosal UO22+ at this concentration. Increasing the mucosal UO22+ concentration to 2.6 mM did not significantly increase its inhibitory action on glucose-evoked P.D. and ISC. Further increasing the UO22+ concentration to 13 mM completely inhibited glucose-induced P.D. and ISC but also markedly reduced these parameters in the absence of glucose. Serosal UO22+ (1.3mM) had no effect on the P.D. and ISC evoked by glucose and 3-O-methyl glucose. It is suggested that the inhibitory action of UO22+ involves binding of this ion to anionic sites located in the apical membrane of the absorptive cells. Mucosal or serosal UO22+ (1.3 mM) had no effect on the P.D. and ISC elicited by 20 mM valine, indicating that under the conditions of these experiments UO22+ selectively inhibits sugar-induced P.D. and ISC and, by implication mucosal sugar uptake.


Testosterone manipulations: effects on ranacide aggression and brain monoamines in the adult female rat. The effect of testosterone propionate on ranacide (frog-killing) behavior and brain norepinephrine (NE), dopamine (DA) and serotonin (5-HT) levels was determined in 40 female Wistar rats. Adult rats were screened for frog killing behavior on the basis of a single 30 min testing session. Aggressors were defined as animals which attacked or killed during this session while nonaggressors failed to do so. Using either aggressors or nonaggressors, testosterone and sesame oil equally increased aggresive behavior as measured in a second 30 min testing session. Biochemical analyses indicated that testosterone treated animals had significantly higher brain NE and NE/5-HT levels. Aggressors, testosterone or sesame treated had higher NE/5-HT ratios. Whole-brain levels of DA and 5-HT and the DA/5-HT ratios were unaffected. It is concluded that the elicitation of ranacide in the adult female rat is not androgen dependent nor is this behavior functionally related to the observed differences in brain noradrenergic/serotonergic levels. This study provides additional evidence that ranacide is a type of predatory aggression and yet presents data which may be at variance with the classic monoaminergic theory of aggressive behaviors.


Time-dependent results of amino acid uptake studies of learning in frogs. Myelencephalic grass frogs were trained to elevate the right forelimb to avoid a shock plate at several times in relation to administration of 3H-leucine and sacrifice. Total radioactivity (excluding 3H2O) and radioactivity in the soluble pool were significantly greater in the trained animals. The differences between trained and yoked animals decreased with increasing time, up to 30 min after training. The opposite trend was apparent in TCA insoluble material; differences between trained and yoked animals increased with increasing time after training. Similar experiments with 3H-inulin provide evidence that the effects were not due to generalized permeability increases or circulatory alterations.


Simultaneous efflux of K+ and Na+ from frog sartorius muscle freed of extracellular fluids: evidence for rapidly exchanging Na+ from the cells. After removal of radioactivity trapped in the extracellular space and correcting for the contribution of connective tissue elements, the K+ -efflux curve of frog sartorius muscles becomes a perfect straight line in a semilogarithmic plot. The simultaneously recorded Na+-efflux curve from the same muscles remains strongly curved, and can be resolved into a slow fraction (which conventionally has been regarded as representing the entire cell Na+) and at least one fast fraction. The fast fraction of Na+ could not have originated from a sarcoplasmic reticulum or any other extracellular space extensions; otherwise a similar fast fraction should exist for K+. The data agree with the interpretation that it is the fast fraction that is rate limiting by cell permeability and the slow fraction by desorption from intracellular adsorption sites.


Intracellular resistance and conduction in bullfrog atrium. The present study was undertaken to study the mechanism of transmission across the junctions between cells of cardiac muscle. Two cases, one with high resistance junction and the second with low resistance junctions, were modeled mathematically and each model was analyzed to predict the ratio of the transverse to longitudinal threshold field strengths. This ratio was measured experimentally for atrial trabeculae from Rana catesbiana and agreed well with the value predicted by the model in which the resistance of the membranes at the junctions is low. It can be inferred, therefore, that the resistance at the junctions between cells of bullfrog atrial muscle is low enough to permit the flow of sufficient current from the pre- to postjunctional cell to cause excitation of the latter. One parameter required in the analysis was the space constant, lambda. This was measured with the trabecula in a volume conductor using a large planar external electrode to produce a change in the transmembrane potential and a microelectrode to measure the spatial decrement of the electrotonic potential. The measurements of electrotonic decrement in 16 trabeculae are pooled to provide an estimate of the value of the space constant in frog atrial trabeculae: lambda= 0.863 +/- 0.041 mm, s.d., n=96.


The anti-inflammatory agents used in rheumatic disorders. The objectives of nonspecific anti-inflammatory therapy are, for the most part, to relieve symptoms. In selected patients such therapy may also slow, prevent, or reverse the destructive effects of the inflammatory process. It is well to remember that none of the wide variety of anti-inflammatory agents is without some inherent toxicity, although some agents are obviously much more toxic than others. The physician prescribing these agents must keep in mind both the potential benefits and the potential risks attendant to their use. In this way he can balance potential benefit against potential risk and arrive at the most rational drug therapy for any given rheumatic disorder.


[Indications for surgical and medical treatment of coronary artery disease (author's transl)]. The following effects in treatment of coronary artery disease are desired: 1. Elimination or improvement of angina. 2. Improvement of physical capacity. 3. Prevention of imminent complications (myocardial infarct, cardiac arrhythmias, heart failure, embolism). 4. Elimination or diminuation of risk factors. 5. Prolongation of life. - In a critical survey concerning long-term studies of patients with aorto-coronary bypass or medical treatment in the literature subtile lists of indications for surgical and conservative treatment are put up (Table II and III), illustrated by case reports. - Useful criteria for diagnosis, follow-up, and prognosis are selective coronary angiography, ventriculography as well as determination of the coronary reserve (Argon Method). Indication for aorto-coronary bypass and resection of myocardial aneurysms are presented. Principles of medical treatment are: 1. Diminuation of myocardial oxygen requirement (release of pressure, economisation of work load, recompensation, regulation of arrhythmias) and 2. improvement of myocardial oxygen supply (Diminuation of coronary perfusion resistance including prevention and treatment of atherosclerosis). Indication for various medications are discussed (nitrites, beta-adrenergic blocking agents and antihypertensive drugs, glycosides, medication for arrhythmias, coronary dilatators, anticoagulants, and lipotropic substances). Their mode of action is debated and documented by own results. Present possibilities and limits in treatment of coronary artery disease are presented.


[Surgical treatment of occlusive coronary artery disease. Methods and results (author's transl)]. A brief history of the development of coronary heart surgery is presented. Modern methods include the aorto-coronary bypass using saphenous vein graft or the thoracic internal artery, and the resection of ventricular aneurysm. The own experience with a group of 262 patients revealed a total mortality of 11,4%. Selected indication, improved surgical technique and postoperative care changed coronary surgery during the recent years into a routine method. The operative risk is characterized by the anatomical location of the occlusive artery disease as well as by the left ventricular function. But even in the group with high surgical risk the operative treatment is justified since life expectancy under conservative therapy is limited. In a group with 17 late death the main cause was due to cardiac insufficiency. In the group of survivors approximately 84% of the bypass were patent after an average period of 18 months.


Evaluation of pediatric hydrocephalus by computed tomography. Computed tomography (CT) is a safe and reliable technique for the study of children with increased head circumference. Hydrocephalic children requiring drainage of cerebrospinal fluid may be shunted on the basis of the CT scan alone and their postsurgical course followed by serial CT scans thereafter. Any additional pneumographic studies required may be performed via the existing shunt tube, eliminating transcerebral catheterization and its attendant complications.


Diagnosis of epidermoid tumor by computed tomography. Analysis and evaluation of findings. Primary intracranial intradural extraventricular epidermoid tumor may be suggested by the findings on computed tomography (CT), which is also useful during the follow-up period. Epidermoid tumors may exhibit minimal symptoms and have usually spread far beyond their original site by the time they are found. Early detection, delineation, and characterization are possible with CT.


The anterior inferior cerebellar artery in mass lesions. Preliminary findings with emphasis on the lateral projection. Analysis of abnormalities of the configuration of the anterior inferior cerebellar artery in lateral projection facilitates diagnosis of posterior fossa masses. Cerebellopontomedullary angle lesions frequently cause arcuate posterior-inferior displacements of the rostrolateral artery or reversal of curvature of the ascending segment of the meatal loop. Vermian, hemispheric, intra-fourth ventricular, and suitably situated extra-axial masses alter the plane of the lateral loop of the caudomedial artery. Tonsillar herniation may be detected in patients with hypoplastic or absent posterior inferior cerebellar arteries by analyzing the relationship of the biventral segment of the descending or caudomedial artery to the foramen magnum.


Abnormal pulmonary gallium accumulation in P. carinii pneumonia. The potentially fatal interstitial pneumonia of Pneumocystis carinii is a frequent opportunistic invader of patients treated for malignancy with immunosuppressive and cytotoxic agents. Generalized Ga-67 pulmonary localization which is markedly disproportionate to the clinical and radiographic findings has led to earlier diagnoses by open lung biopsy in this setting. The potential usefulness of gallium scintigraphy in patients with suspected P. Carini pneumonia is presented.


Alterations in the cellular-mediated immune responsiveness of chronic marihuana smokers. Chronic marihuana smokers and matched nonsmokers were compared with respect to several aspects of both their humoral and cellular immune system. Immunoglobulin and complement levels, SMA 12 and hematologic values from marihuana smokers did not differ significantly from those obtained from nonsmokers. However, the number of T-lymphocytes with respect to the ratio of T and B-lymphocytes in the peripheral blood was lowered in marihuana smokers. In addition, phytohemagglutinin stimulation of lymphocytes was apparently less effective in smokers. The polymorphonuclear leukocytes (PNM) from the blood of smokers contained fewer cells capable of phagocytizing yeast cells than did PMN from nonsmokers. While marihuana smoking does appear to affect immune mechanisms at no time in these studies were any deleterious physiological effects that could be directly associated with the alterations in the immune system observed in the marihuana smokers.


[The salivary glands during rheumatoid arthritis]. Salivary gland lesions were studied in 65 non-selected, confirmed rheumatoid polyarthritis patients. The investigations included a careful clinical study, the Schirmer test, sialography, sequential scintigraphy with Technetium 99, and a histological study of the sublingual glands. Tests were also made for salivary gland anti-epithelium antibodies. The frequency of sialography and scintigraphy anomalies is emphasized. In different degrees, two of of three patients presented anatomical or functional anomalies of the salivary glands. These disturbances were not related to the duration, the functional severity, or the treatment of the disease or to the presence of anti-salivary gland antibodies. On the other hand, there was a clear relation with both the presence of anti-nuclear antibodies and an increase in the serum gammaglobulin levels. The limits of the Gougerot syndrome are discussed and it is proposed that there is a need for a second nosological class grouping the minor scintigraphic and sialographic anomalies related to rheumatoid arthritis that has been suggested by several authors.


[Intermittent rheumatism revealing a familial syndrome. Arthritis--urticarian eruptions--deafness: Muckle-Wells syndrome without kidney amylosis]. At a consultation with a 31-year-old man, motivated by painful episodes of joint pain that had started considerably earlier, a familial disease entity was discovered that included the three clinical signs of the Muckle and Wells syndrome : urticarial eruption, intermittent pain in the limbs originating in the joints, and bilateral deafness of perception. In spite of the absnece of renal amylosis, the similarity of the characteristics of these three elements, as well as the nature of the biochemical disturbances, and the mode of transmission, led the authors to consider these observations in the contest of this syndrome. The joint manifestations being indicative, the signs of this intermittent rheumatism are described, as well as the characteristics of the other disorders.


Genetic control of B-cell responses. II. Identification of the spleen B-cell defect in C3H/HeJ mice. The responsiveness of spleen cells from C3H/HeJ and C3H/Tif mice to lipopolysaccharide (LPS) was compared. Around 1,000-fold higher concentration of LPS were required to minimally activate HeJ cells, as compared with Tif high-responder cells, to both proliferation and polyclonal antibody secretion. However, HeJ cells did respond to higher LPS concentrations (100 and 1000 mug/ml). This selective pattern of responsiveness to LPS was also observed in the polyclonal responses of strains to LPS in vivo. Furthermore, the unresponsiveness of HeJ spleen cells was found to depend on a pure B-cell defect in the capacity to interact and/or generate triggering signals on interaction with LPS. Thus, adherent cells, thymus-derived lymphocytes, serum factors, and other non-specific conditions inherent in spleen cell suspensions of low-responder mice were not responsible for suppressing a putative B-cell response to LPS. The present findings are compatible with the possibility that the defect in C3H/HeJ B cells reflects the absence of a structure on the cell surface membrane that is functionally responsible for mediating LPS triggering.


Demonstration of T lymphocytes in cerebrospinal fluid. Cerebrospinal fluid (CSF) was allowed to drop straight into Hanks's balanced salt solution. After centrifugation the pellet was resuspended and mixed with sheep erythrocytes. The mixture was further handled as in the E-rosette test with peripheral blood lymphocytes. CSF from 20 individuals were investigated, and rosette-forming cells (RFC) were found in all. Six patients with normal fluid had between 46% and 83% RFC. Four patients with multiple sclerosis had increased numbers of RFC (94%-96%). Low numbers of RFC were found in one patient with cerebellar ataxia and in one of two patients with acute viral meningitis. With this technique RFC can be counted even in normal CSF with a 3-ml sample.


Amyloid-related serum protein (SAA) in patients with inherited amyloidosis and certain viral conditions. Amyloid-related serum protein (SAA) was studied with a double immunodiffusion method. Only 2 of 21 patients with inherited systemic amyloidosis and lattice corneal dystrophy had elevated SAA levels in their sera. Several pseudoexfoliation patients had elevated levels of SAA, but it was not possible to differentiate an age-related elevation of SAA from that associated with this disease. In addition, SAA was found in the sera of many groups of patients with acute viral infections, including 10 of 11 patients with measles and 7 of 11 persons vaccinated against rubella. Elevation of SAA protein appeared in the serum before the 6th day after the vaccination, had its peak value between days 6 and 12, but was absent already on the 20th day. In this relation the SAA protein appears to behave as an acute-phase reactant.


Mitogenic properties of polyene antibiotics for murine B cells. Two polyene antibiotics, nystatin and amphotericin B, were found to be mitogenic for mouse spleen cells as measured by induction of DNA synthesis and polyclonal antibody production. This effect was demonstrated on spleen cells from nude mice and anti-theta-treated spleen cells from normal mice. No effect was found on cortisone-resistant thymocytes or on spleen cells treated with anti-mouse bone marrow-derived lymphocyte antigen antiserum. Nor was there any effect on spleen cells passed through a nylon fiber column. Thus we conclude that nystatin and amphotericin B are murine B-cell mitogens.


Heterogeneity of B cells: direct evidence of selective triggering of distinct subpopulations by polyclonal activators. This investigation was undertaken to assess directly the previous postulate that distinct subsets of B cells in the adult mouse spleen are selectivity triggered by different polyclonal B-cell activators (PBA). Several strains of mice and lipopolysaccharide (LPS), purified protein derivative of tuberculin (PPD), and dextran sulphate (DS) were used in this study. Two experimental approaches were used: stimulation after addition of two PBAs simultaneously to cell cultures and eliminating the responding population to one PBA, by a hot pulse of radioactive thymidine, on a later response to another PBA. The results of these experiments indicated that DS stimulated a cell population completely different from that stimulated by the LPS- and PPD-sensitive cells. When LPS and PPD stimulations were compared, it was found that the cells responding to these PBAs were largely distinct, although some cells were sensitive to both these PBAs. The extension of the overlaps in these subsets (the number of cells that could be activated by either PBA) was found to vary from one strain to another. These experiments gave direct evidence of the existence of subsets that can be activated by different PBAs. The present results also provided indications of the functional performance of distinct subsets of B cells on activation.


Assessment of Peroheme-40 for the presence of occult blood in the faeces. Peroheme 40, a chemical test for occult blood in faeces, has been assessed by comparing it with results obtained using 51Cr labelled red cells. The study was carried out in two parts. Initially testing was carried out on 75 stool samples from 20 patients on a restricted diet, and in the second part, testing was performed on 40 samples from 10 patients on a normal ward diet. All patients were suspected of losing blood from the gastrointestinal tract. On the restricted diet there were 29 per cent false positive and 13 per cent false negative results, while on the normal diet, there were 86 per cent false positive and 8 per cent false negative results. Peroheme-40 has therefore been shown, on a restricted diet, to compare favourably with previously available chemical tests.


Quantitative evaluation of left ventricular bypass in reducing myocardial ischemia. A controlled study was undertaken to evaluate the relationship between myocardial oxygen consumption (MVO2) and epicardial S-T segment improvement in an ischemic heart preparation during left ventricular (LV) bypass. Twelve mongrel dogs were prepared with left ventricular-aortic bypass, coronary sinus cannulation, and a multiple point epicardial electrocardiographic technique. The left anterior descending coronary artery was ligated low (Group I) or high (Group II) after baseline studies. After ischemic baseline studies, increasing degrees of LV bypass were performed at a constant mean aortic pressure and heart rate. The final infarct size was determined by the nitroblue tetrazolium staining technique. Group I--a significant reduction in the average (S-T) segment elevation occurred during 50 to 59 percent of LV bypass during which MVO2 was reduced 10.9 percent from controls. A maximum S-T reduction of 75 percent occurred during LV decompression during which MVO2 was reduced 52.8 percent from controls. The final infarct size for Group I was 9.8 +/- 0.9 Gm. per 100 Gm. of LV. Group II--a significant reduction in S-T segment elevation occurred only after 90 to 99 percent LV bypass was achieved during which MVO2 was reduced 28.1 percent from controls. LV decompression produced a maximum S-T reduction of 63 percent during which MVO2 was reduced 50.2 percent from controls. The final infarct size for Group II was 21.1 +/- 0.4 Gm. per 100 Gm of LV. This study indicates that larger degrees of bypass are required to decrease the ischemic areas encountered in larger infarctions. LV decompression is most beneficial in reducing ischemic myocardium surrounding large infarctions.


Aluminium localization in amphibian skin with the electron microprobe and ion microanalyzer. EMP and IMA studies show the presence of A1 in the epidermis of larvae and young adults of Discoglossus pictus and Rana esculenta, which disappears during later stages of development. A1 is practically absent in the epidermis of Xenopus laevis and Pleurodeles waltlii. The localization of A1 with EMP and IMA supports the biochemical results. The function of A1 in the epidermis is not known at present.


Diagnosis and management of onyalai.

Diagnosis and management of onyalai. Onyalai is diagnosed by finding the combination of haemorrhagic blisters in the mouth and severe thrombocytopenia, and by excluding other possible causes of thrombocytopenia. Patients improve rapidly with appropriate therapy. Haemorrhagic shock should be corrected with intravenous fluid and blood transfusion. Corticosteroids should be given in large doses initially, then tapered off and stopped over a period of several weeks. Occasional patients may require more prolonged steroid therapy.


Selection of patients with urinary incontinence for application of functional electrical stimulation. Contradictory data from the literature along with our own experience using functional electrical stimulation (FES) have facilitated the determination of objective criteria for the application of FES in correcting urinary incontinence. Simultaneous urodynamic, neurophysiological, and radiological examinations employed during our studies enabled us to determine changes in these parameters due to FEX. Among a large number of patients with urinary incontinence (for example: paraplegics, patients with spina bifida, stress incontinence following prostate operations, or resistant enuresis) we have determined that FES is appropriate if applied to properly selected patients. FES is indicated on the basis of the following criteria: the degree of morphological lesion of the urinary tract, the peripheral denervation of the muscles of the pelvic floor, the condition of the spinal center for miction, and, above all the quality of response to FES. FES not only activates the closing muscles of the bladder, but also inhibits the reflex contractions of the detrusor. Here, it should be noted that FES is indicated for cases of reflex incontinence. During FES of the pelvic floor muscles intravesical pressure normally diminishes and the reflex contractions of the detrusor subside. Sometimes, however, the reflex of miction occurs. In such a case, two reflex mechanisms are engaged. Their equilibrium, i.e. controlled miction, can be achieved with an afferent in flow which inhibits the reflex of miction. The use of FES for the correction of urinary incontinence can be a very good method if the FES parameters are individually chosen and patients properly selected.


A critical look at incontinence radio-implants. Indwelling electrical stimulation of the pelvic floor by a radio-implant benefits some cases of problem or recurrent urinary incontinence. It is not possible to predict success or failure with a given patient. The only worthwhile criterion for selection is the presence of contraction of pelvic floor musculature in response to voluntary effort or trial electrical stimulation. The results are not simply explained by postulating electrically induced closure of the urethra. There may be conscious enhancement of the urinary sphincter mechanism. Re-education of voluntary sphincter muscles by electrophysiotherapy may occur. Reflex inhibition of the detrusor may occur. The surgery involved in inserting an implant restores continence in some patients.


Maximum perineal stimulation for urinary incontinence. Maximum stimulation of the pelvic floor has been advocated for the treatment of urinary incontinence associated with defective urethral closure mechanisms. Information in the literature was imprecise as to what constitutes a maximum stimulation. With one exception, published results are not encouraging when analysed. None of our 19 patients showed improvement. One had enhanced contraction when using an anal plug electrode following maximum stimulation, and this effect may warrant further study.


Electrical stimulation for incontinence. Technique, selection, and results. Incontinence due to hyperreflexic bladder and/or pelvic floor weakness can be corrected by chronic functional electrical stimulation (FES). Cystometry, electromyography of pelvic floor muscles, and anal sphincter pressure measurements with and without electrical stimulation determines if chronic FES will be successful. Post-acute stimulation improvement occurred in patients with incontinence due to hyperreflexic bladder and/or pelvic floor weakness. A success rate of 92 per cent was achieved with chronic FES in incontinent patients with this method of selection.


Lymphocyte functions in the rat spleen at various times after urethan administration. The effect of urethan on various spleen-lymphocyte functions was studied in the rat for 45 days after administration of the carcinogen. For 3 days following the last injection of urethan, the total cell number and LPS reactivity were greatly reduced. Certain reactivities, probably T-cell dependent functions, such as responsiveness to the in vitro mitogenic effect of PHA, Con A, and primary stimulation by histocompatibility alloantigens in the one-way reaction, were selectively enriched during the first 2 days. Thereafter several dissociations of these lymphocyte functions can be observed: i.e., various intervals succeed during which one function may be enriched and other(s) diminished. It seems that the kinetics of enrichment, decay and recovery of the T-cell subsets involved in the reactions investigated follow a distinctive profile for each one of them. It is suggested, as a working hypothesis, that the unbalanced situations derived from the time-course discordance of the quantitative changes in the various lymphocyte functions may allow, or even enhance, tumor development.


Suppressor T cells in the pathogenesis of hypogammaglobulinemia associated with a thymoma. The nature of the immunological defect in patients with hypogammaglobulinemia associated with a thymoma was investigated using a technique established to study the differentiation of lymphocytes into immunoglobulin synthesizing and secreting cells. Exhaustively washed peripheral blood lymphocytes were cultured for 7 days in RPMI-1640 medium supplemented with fetal calf serum in the presence of the lectin, pokeweed mitogen. The IgG, IgA, and IgM synthesized and secreted into the medium were measured by competitive double antibody radio-immunoassays. Twenty-two normal individuals synthesized 1625 ng of IgG, 1270 ng of IgA, and 4910 ng of IgM per 2 million lymphocytes in culture. In contrast, the three patients with hypogammaglobulinemia and a thymoma synthesized less than 100 ng of each class of immunoglobulin. When lymphocytes from 2 of the 3 patients studied were cocultured with normal lymphocytes and pokeweed mitogen, the synthesis of immunoglobulin by normal lymphocytes was depressed by a factor of 66 to 97%. Co-cultue of purified T cells from the hypogammaglobulinemic patients with normal lymphocytes resulted in an 87% suppression of immunoglobulin synthesis by the normal cells. However, no suppression of immunoglobulin synthesis was observed when preparations of B cells and macrophages depleted of T cells from the hypogammaglobulinemic patients were co-cultured with normal lymphocytes. In addition, in control studies no such suppression of immunoglobulin synthesis was seen when normal cells were co-cultured with lymphocytes from unrelated normals, patients with isolated IgA deficiency, patients with chronic lymphocytic leukemia or patients with the Sezary syndrome, a T cell leukemia nor were they inhibited when incubated with T cells from unrelated normals. These observations suggest that in some patients the hypogammaglobulinemia associated with a thymoma may be caused or perpetuated by an abnormality of regulatory T cells which suppress the maturation of lymphocytes into antibody producing cells.


[Histological and immunological study of patients with lung and digestive tract tumors. Analysis of T and B lymphocytes from the peripheral blood and from the lymph nodes draining the tumor (author's transl)]. The nature of the immune response to the tumor cell is complex and has yet to be clearly defined. Although past research has foscused on the cytotoxic effect of T lymphocytes versus tumor cells, it has been shown in animal studies that B lymphocytes may also be implicated. Lymphocytes from patients with respiratory and digestive tract tumors were studied. B and T lymphocytes of peripheral blood and of draining lymph node tumors were studied using the following techniques: E rosettes (marker for T cells); membrane Ig, EAC rosettes, aggregated-Ig (marker for B lymphocytes); PHA and PKW in vitro response of lymphocytes using tritiated thymidine incorporation. It was observed that both groups of patients had normal or depressed B and T populations. PHA response was depressed in the majority of the cases with lung tumor. No difference was observed between lymphocytes from peripheral blood and from lymph node suspensions. As in normal lymph nodes the EAC rosettes were constantly observed in the cortical area of lymph node draining tumors. The immune defect observed in part of these cases is discussed in relation to the local and general immunological factors probably responsible for this defect.


[Esophageal-gastric hemorrhage in patients with portal hypertension treated by splenectomy]. The authors report their observations over 336 patients previously subjected to splenectomy for the portal hypertension syndrome. Prior to surgery 66.4% of patients showed esophageal varices, 43.7% - bleeding. After the operation venous varices were noted in 48.2% of patients, bleeding - in 34% of all patients. The causes of hemorrhage occurred in later terms after splenectomy are analysed. A conclusion is made concerning the way how to minimize a probability of hemorrhage recurrence following splenectomy.


[Complications in the use of proteinase inhibitors]. It is well known that the use of proteolysis inhibitors of animal origin can result in complications of an allergic character up to anaphylactic shock. More frequently such complications according to the authors' data occurred in intraarticular or paraarticular injection of drugs in patients suffering non-specific infectious arthritis. Some useful recommendations are given.


[Indices of cellular and humoral immunity following surgery intervention for malignant bone tumors]. The immunity indices were studied in 35 patients, operated upon for various types of osteosarcomas, as well as the nonspecific reactivity of T-and B-lymphocytes and the specific immune response of lymphocytes. The system of peripheral T-lymphocytes in these patients is being inhibited with the primary tumor progression and an unfavourable postoperative course. In a continuous (from 1 to 15 years) favourable course of the disease postoperatively a persistent restoration of T-lymphocytes reactivity was noted. The specific antitumor immunity was found at every stage of the disease, but its suppression with serum (a blocking effect) seemed to be an unfavourable factor from the prognostic point of view, it was more frequently observed in patients with a progressive tumor growth. The operation proper after a provisional nonspecific suppression resulted in enhancement of the immune reactivity.


[Revascularization of the ischemic heart muscle in disseminated coronary sclerosis]. The author presents his own experience in bypass operations performed on 123 patients suffering from ischaemic heart disease. The paper covers the period from October 1969 to April 1974. The total mortality in this group of 123 patients was 7%. Post-operative myocardial infarction took place in 11% of the cases. The control examination made 6 months after operation showed the patency of bypass in 75% of patients. Proliferative changes were found in 10% of the cases with venous bypass. Arterialisation of the cardiac veins was performed on 21 patients because of disseminated occlusion disease of the coronary arteries. Early results are very encouraging. However, a longer observation period is needed.


[Permeation-increasing activity of puncture-fluids: 2. Chromatographic and immunoelectrophoretic studies]. A human pleural effusion was separated by gel chromatography, DEAE-chromatography, disk-electrophoresis and immunoelectrophoresis. The fractions obtained were tested for the permeation-increasing activity. IgA, IgM, IgG, transferrin and haptoglobin are not responsible for a permeation-increasing effect. Albumin, alpha1-antitrypsin, acid alpha1-glycoprotein and alpha2-macroglobulin appear only in permeation-active fractions. Of these proteins, however, no direct effect on the permeability of animal membranes is known. It is discussed, whether proteolytic enzymes, which may be bound to these proteins are responsible for the increase of permeation.


[Experiences and results in the surgical management of bleeding esophageal varices using fundectomy]. 1966, 1967, and 1971 we published the good results with the "Transsectionsligature" of bleeding esophageal varices. The bleeding segment is nearly in all cases the angiomusculare strech closure segment in the terminal portion. In the last 27 patients we used the fundektomie of the stomach together with a splenektomie to stop the bleeding. Fundektomie abolished ulcusdisposition and splenektomie diminished the development of anaemia. Encephalopathy does not occur after these operations. All patients with a healthy liver remained alive. Cirrhotic patients come to death through their poor liver function. The selection of patients is the remaining problem.


[Ectopic pregnancy near term (case-report) (author's transl)]. Description of a case of ectopic pregnancy during the last 3 months with a living, malformed and underdeveloped neonate. Possible treatment is discussed: where as in our case there is a secondary ectopic pregnancy (i.e.a pregnancy started primarily in the tube and still in vascular contact with it but secondarily ectopic) removal of placenta following ligation of the main vessels arising from the tube is possible and recommended. In the much rarer primary ectopic pregnancy with primary nidus in the abdomen, removal of the placenta is dangerous and not advised because of the danger of diffuse hemorrhage.


Acute radiological investigation of oesophagus and stomach in the event of massive upper gastro-intestinal tract bleeding. Acute radiological investigation of the oesophagus, stomach and duodenum is a routine in patients admitted to the first surgical department of Kommunehospitalet, Copenhagen, with upper gastro-intestinal tract hemorrhage. In the period 1969-1972, 294 patients were admitted with hematemesis and/or melena. The acute radiological study was undertaken in 190 of these patients (65%). Whenever possible, confirmation of the acute primary radiological diagnosis was sought at acute operation, subsequent elective operation, by repeated radiological study, by gastroscopy, or at post mortem. 19 acute investigations were inadequate, and in a further 20 patients no studies subsequent to the acute study were made. There remain 151 patients, and the primary diagnosis could be confirmed in 111 (74%). 45 patients underwent acute operation, and primary diagnosis was confirmed in 66%. The most frequent primary diagnosis was duodenal ulcer (78 of 151 patients), which was verified in 63 instances (81%). In 8% of these patients subsequent definitive diagnosis of gastric ulcer was made, and in 11% no cause of bleeding could be demonstrated. Primary diagnosis of gastric ulcer in 28 patients could be confirmed in 85%. Primary diagnosis of oesophageal varices was made in 9 patients and confirmed in 7 (78%). One patient had a carcinoma of the stomach, and this was also the acute radiological diagnosis. In one patient primary diagnosis of oesophageal ulcer was made, but this could not be confirmed. In 34 patients the acute study failed to point the cause of bleeding, and in 50% of these patients subsequent examination was also non-productive. 26% subsequently evidenced duodenal ulcer; 11% gastric ulcer; 6% carcinoma of the stomach; 3% oesophageal varices; and 3%--one patient--a bleeding vessel in the fundus of the stomach. The acute radiological study was complication free. The place of the study in acute diagnosis of the patient with upper gastro-intestinal tract bleeding is discussed.


[EA rosettes in patients with progressive chronic polyarthritis]. One subpopulation of human lymphocytes contains Fc-receptors that form rosettes with antibody (IgG) coated human erythrocytes (EA-rosettes). On the average 8.9% of the lymphocytes from patients with rheumatoid arthritis (RA) form EA-rosettes compared with 5.3% in controls. When the lymphocytes were washed three times the EA-rosettes increased to 21.2% for RA patients and 9.5% for controls. This procedure thus reveals more Fc-receptors on the lymphocytes from RA patients than on those from healthy controls. The number of T-lymphocytes was normal in RA patients and controls, no matter how many times the lymphocytes were washed.


["Side effects" in cortisone therapy].

["Side effects" in cortisone therapy]. Glucocorticosteroids are comprehensively acting agents and their therapeutically used derivatives - the cortisonoids - accordingly also have unwanted effects. In addition every pharmacodynamically active medication of these drugs in due time, induces adrenal atrophy and leads to the patient's dependence upon an adequate exogenous supply. This condition is then called "cortisonism". Such a development represents one of the most important risks of cortisone therapy in rheumatic disorders.


[Autoimmune phenomena in D-penicillamine therapy]. In two patients with rheumatoid arthritis, immunoglobuline deposits in the skin were detected during D-penicillamine treatment. One patient presented with drug induced exanthema, the other with pemphigus erythematosus which was confirmed by clinical, histological, and immunofluorescent findings. During the development of the specific side-effect in one patient, an increase of ANA-titre and antibody-binding-capacity versus denaturated DNA was observed. Therefore in a prospective study of another ten patients during four months after onset of treatment with D-penicillamine, antinuclear antibodies and antibody-binding-capacity versus native and denaturated DNA were examined. The latter group of patients - without skin lesions - did not show any changes in the above mentioned parameters.


Nerve excitation generated by the action potential of muscle. The effect of the electrical activity of muscle on the nerve in contact with it was investigated. The results obtained on isolated nerve-muscle preparations and on whole leg preparations of frog revealed that, under certain conditions, the action potential of the muscle is capable of producing excitation of the nerve adjacent to the muscle. These results suggest the hypothesis that the muscle activity could have an additional function in the excitatory processes by means of the electrical effect exerted on the nerve.


The significance of a crossed extensor hallucis response in neurologic disorders: a comparison with the Babinski sign. The significance of a crossed extensor hallucis response on active flexion of the hip was analysed in various neurological disorders. It is concluded that this sign, not formerly described, is a pathological reflex or synkinesia. In the cooperative patient the crossed extensor response is a more sensitive indicator of a minor disturbance within the cortico-spinal motor pathways than the Babinski sign. With lesions above the foramen magnum a crossed extensor hallucis response is observed more frequently than the Babinski sign.


Plantar response during infancy.

Plantar response during infancy. Cross-sectional as well as longitudinal studies on full-term urban and rural infants demonstrated that the initial extensor plantar response present in the first half of the infancy changed to a flexor plantar response in the later half. The urban infants receiving nutritional supplements showed an advance of 4 weeks over the rural infants. This process of change-over of plantar response was delayed in pre-term infants. However, two pairs of twins showed plantar response almost identical to full-term urban infants.


Central cloudy corneal dystrophy of François. A family is reported with central cloudy dystrophy of the cornea, as described by François in 1956. The lesion consists of a grey zone deep in the stroma, made up of polygonal or rounded areas with indistinct margins, separated by apparently clear, normal stroma. No deposits are visible in the slit lamp. The anterior and posterior boundary layers appear normal. The corneal thickness is normal. Open angle glaucoma was present in the family. The pathogenesis of the dystrophy is unknown, and histopathological examination has not been described. The differential diagnosis is briefly discussed. The family tree is suggestive of a dominant mode of transmission.


An unusual case of histiocytosis X in the spine. A case of spontaneously healing histiocytosis X followed over 9 years is presented. The lesion was located in the cervical and dorsal spine and had unusual radiological features such as soft tissue swelling, involvement of the pedicles and recovery with fusion between adjacent vertebra.


Angular velocity of the slow phase in experimental and clinical lesions of the vestibular apparatus. The authors present the results of their experimental and clinical observations on the occurrence of regularity in the course of angular velocity of the slow phase of nystagmus. They have found that the regularity is rather distinctly pronounced in peripheral lesions of the vestibular apparatus. This observation may be complementary to the interpretation of electronystagmographic recordings.


Surface structures influencing the migration in vivo ecotaxis of murine thymocytes, T- and B-cells. The effect of protease and neuraminidase treatment on the ecotaxis of radioactively labelled thymocytes, T- and B-cells was studied by scintillation counting and autoradiography. Each enzyme had a similar effect on all cell types. Both protease and neuraminidase treatment strongly reduced the migration to the lymph nodes while the distribution to the spleen was more profoundly reduced by neuraminidase than by protease. In contrast, a similar and less pronounced effect of the enzymatic treatments on the circulation to the Peyers patches was found. The possible structure of the surface "receptors" involved is discussed in view of the known effects of these enzymes on the cell membranes.


Transfer factor, sarcoidosis and cellular immunity. A 27-year-old man with disseminated sarcoidosis was treated with repeated injections of Transfer Factor. Grossly abnormal immunological in vitro parameters were normalized, but in spite of these changes the clinical condition deteriorated.


[A biochemical and cytological explanation of cochlear otospongiosis]. In a study of 250 otosclerotic perilymphatic fluids, it was found statistically that in the presence of developing inner ear deafness, 90% of cases will demonstrate increased trypsin activity. Conversely, elevated antitrypsin levels are found in the absence of developing inner ear deafness.


Posterior fossa meningiomas. A report of 30 cases. The clinical symptoms of thirty patients with surgically treated posterior fossa meningiomas were reviewed. These included 16 cerebellopontine (CPA), 7 cerebellar, 4 carrefour-falco-tentorial (CFT), 2 foramen magnum, and 1 clivus meningiomas. Careful attention to clinical findings is necessary in diagnosing these tumors. With rare exception they have an insidious onset and even after having reached considerable size, the ensuing neurological abnormalities might not be revealing. On occasion there are false localizing neurological findings. Neuroradiological localization is essential to obtain accurate diagnosis and to plan the best operative approach. Radioactive brain scanning offers the best screening method. Although air studies remain useful, angiography of vessels of the posterior foss is assuming a dominant role in diagnosis and surgical planning.


Nonspecific esterase activity in T cells. Acid alpha-naphthyl acetate esterase activity characterizes the majority of peripheral T cells in mice. In addition to the simplicity of the cyto- or histochemical demonstration of esterase activity and the fact that this method may be applied to tissue sections and smears, the present study indicates that combination with lymphocyte surface markers may offer an important approach to the examination of differentiation pathways of peripheral T cells.


In vitro proliferative reactions by lymphocytes from both responder and "low" responder mice to (T,G)-A--L. In summary (T,G)-A--L can induce specific in vitro lymphoproliferative reactions in LNC from immunized mice. From 3-8 weeks after immunization lymphocytes from responder mice react to a much greater degree than from low responders. These proliferative reactions are not specifically enhanced by supernatants of "educated" T cells. However, 2 to 3 months after immunization the lymphoproliferative response of the low responders rises to the same level as that of responder mice.


Bursa of Fabricus: uptake of radioactive particles and radiotoxic "sealing" of bursal follicles. Making use of the fact that the avian bursa is uniquely equiped for uptake, degradation and storage of particulate matter from the cloacal lumen, we administered 239Pu(IV) perorally or via the cloaca to cause radiotoxic damage to the bursal tissue.  This resulted in a involution of the follicles, reduction of the lymphocyte mass, predominance of smaller lymphoid cells in the medulla as compared to controls, disappearance of tuft epithelia, formation of a sub-epithelial fibrous layer in many follicles and impairment or an almost complete loss of the capacity of the bursa to take up particulate matter. Concomitant with these changes was a reduction in the concentration of serum IgG. These findings are discussed in relation to the immunologic contact role of the bursa.


The need for transcription and translation for differentiation of bone marrow cells by thymic factors in man. 1. Two small populations of human marrow cells are differentiated to cells bearing T-cell markers by Thymosin F3 or F5. 2. Analysis with metabolic inhibitors indicates that transcription and translation of RNA are needed for induction of T cell markers (layer III). 3. a) At 4 hours incubation RNA synthesis is enhanced in layers III, IV and V and inhibited in layers I + II. b) At 20 hours incubation RNA synthesis is markedly enhanced in all cell layers. 4. a) At 5 hours incubation protein synthesis is suppressed in layers I + II and III, but not in IV and V. b) At 20 hours incubation protein synthesis is markedly increased only in layer III.


Studies on suppressor T cells in tolerance. (1) Evidence is provided that tolerance induced in mice to HSA depends on a suppressive mechanism which inhibits the responsiveness of potentially competent cells. (2) the suppression is apparently the function of suppressor T cells which are comparatively radiosensitive and are resistant to cortisone. (3) The cortisone resistant suppressor cells are apparently the progeny of cortisone-sensitive precursors, the differentiation of which into mature suppressors seems to be signalled by antigen. (4) The precursor lymphocytes are comparatively short functioning cells (about 14 days), while the mature suppressor T cells function for at least two months.


Depletion of suppressor T cells in syngeneic chimeric mice. The present results suggest that some T-cell activities of syngeneic chimeric mice such as T-cells involved in the antibody response to SRBC and MLC reaction are intact. On the other hand, suppressor T-cells involved in the regulation of the immune response to PVP and enhancement of 3LL tumor growth, and cells mediating CML reaction are damaged.


Interference with antibody-feedback by irradiation, thymus cells, the allogeneic effect, and serum factors. Low doses of irradiation, increased number of T cells, increased T cell activity as in the allogeneic effect, or early activation of an in vitro cell-mediated immune response all confer resistance to antibody feedback. In some of these systems, the resistance is directed against immunosuppression by intact IgG antibody whereas suppression by F(ab')2 antibody is either not changed or increased. These forms of interference with immunosuppression by antibody, are explained in terms of an Fc-dependent model for antibody-feedback regulation.


Augmentation of cell mediated lysis (CML) by THF. The in-vitro model of cell mediated lysis (CML) was used to study whether a thymic hormone (THF) participates in the processes which lead to generation of effector cells. It was found that THF increases the capacity of effector cells from spleens of intact mice in the CML assay. This effect of THF on generation of effector cells was manifested when THF was present during the mixed lymphocyte culture. On the other hand, addition of THF to the effector (CML) phase did not elevate the lytic capacity of killer cells. Moreover, THF compensated the impaired lytic capacity of effector cells from adult thymectomized mice and raised it to the level of intact mice. The results are compatible with the hypothesis that THF acts on the generation of CML effector cells of both intact and adult thymectomized mice.


Lymphocyte surface-attached immunoglobulins in some clinical conditions. The TEAG rosette test was not devised as an immediate diagnostic indicator, but in order to detect gross differences over a period of time between the lymphocytes of patients with conditions where immune complexes may be formed, and those of normal people. In summary these results indicate that:- 1. Percentage TEAG rosettes were highly significantly increased in patients with SLE, active chronic hepatitis and carcinoma of lung compared with normal controls, when the tests were performed on suspensions, containing over 90% lymphocytes, separated from peripheral blood. 2. Estimates of mean B lymphocytes plus blood monocytes in the separated suspensions, as measured by EAC rosettes (and peroxidase and differential counts for monocytes) are exceeded by TEAG-rosetting cells in the patients tested. 3. Tests on patients with chronic autoimmune conditions (e.g. ACH and SLE) do not show a highly significant difference from normal controls with respect to mean total cells forming E-rosettes. 4. It may be speculated that some TEAG rosettes are formed by T-cells which could have immune complexes or autologous anti-lymphocyte globulin on their surface and that such a condition may account for the depressed T-cell function found in these conditions.


Involvement of cells with 'B' properties in development of T helpers. Cells bearing Ig on the membrane, fractionated from either 17 day embryonic livers or from normal adult bone marrow, when transferred to splenectomized-irradiated mice, lead to development of helper cells in the thymus of the recipients. The helper function was expressed when the recipients were stimulated with flagellin-MON and the thymus cells were cultured together with anti theta treated spleen cells and stimulated with DNP-MON. The response to DNP was not enhanced when the irradiated mice were inoculated with non Ig bearing cells. Helper activity was related to cells which were eliminated with anti theta antibodies and did not have detectable Ig. Hence, cells with 'B' properties may be involved in development of T helpers.


Myocardial imaging in the noninvasive evaluation of patients with suspected ischemic heart disease. Three noninvasive radioactive tracer techniques for evaluating patients with ischemic heart disease are described: (1) myocaridal perfusion imaging, (2) acute infarct imaging, and (3) the gated blood pool scan. Myocardial perfusion imaging with tracers that distribute in the myocardium in relation to regional blood flow allows detection of patients with transmural and nontransmural infarction by the finding of decreased tracer concentration in the affected region of the myocardium. If these tracers are injected at the time of maximal stress to patients with significant coronary arterial stenosis but without infarction, areas of transient ischemia can be identified as zones of decreased tracer concentration not found when an examination is performed at rest. Acute infarct imaging with tracers that localize in acutely damaged tissue permits separation of patients with acute myocardial necrosis from those without infarction and those with more chronic damage. The gated blood pool scan permits assessment of left ventricular function and regional wall motion. The measurement of ventricular volumes, ejection fraction and regional wall motion adds significantly to the determination of hemodynamic variables in assessing patients with acute infarction. The technique also permits detection of right ventricular dysfunction. Performance of a combination of these radioactive tracer techniques is often advantageous, particularly in patients with suspected infarction. The techniques can establish whether infarction is present, whether it is acute, where the damage is located and how extensive it is; they can also provide a measure of the effect of this damage on left ventricular function.


Effects of coronary artery bypass grafting on resting and exercise hemodynamics in patients with stable angina pectoris: a prospective, randomized study. In this prospective randomized study, resting and exercise hemodynamics were determined in the nonmedicated state before ("entry") and 1 year after coronary bypass surgery in 38 patients, and at entry and 1 year in 40 patients treated medically. The surgical group showed a significant decrease in mean pulmonary arterial wedge pressure during exercise (entry 23.5 +/- 6.1 [standard error of the mean] mm Hg, 1 year 18.9 +/- 1.0, P less than 0.02); an increase in cardiac index during exercise (entry 4.3 +/- 0.1 liter/min per m2, 1 year 4.6 +/- 0.1, P less than 0.05); an increase in resting mean arterial pressure (entry 94.5 +/- 2.2 mm Hg, 1 year 100.2 +/- 2.2, P less than 0.02); and an increase in resting heart rate (entry 68.5 +/- 1.9 beats/min, 1 year: 76.0 +/- 2.0, P less than 0.01). Maximal treadmill exercise performance also improved significantly in the surgical group of patients (entry 285 +/- 24 seconds, 1 year 382 +/- 24, P less than 0.002). There were no significant changes in these variables in the medically treated "control" group. The improvement in pulmonary arterial wedge pressure during exercise and in maximal treadmill exercise time in the surgical group as a whole was due to striking improvement in these variables in a subgroup of 16 surgical patients who had a more than 10 mm Hg increase in pulmonary arterial wedge pressure during exercise in their entry study. In this subgoup, considered to contain those patients with marked "ischemicdysfunction," pulmonary arterial wedge pressure during exercise fell from 31.4 +/- 1.5 mm Hg (entry) to 19.l +/- 1.8 (1 year) (P less than 0.0001) and treadmill time increased from 217 +/- 24 seconds (entry) to 357 +/- 37 (1 year) (P less than 0.001). Thus, hemodynamic evidence of ischemic left ventricular dysfunction during stress may identify those patients who will show objective improvement in ventricular performance after bypass graft surgery.


Coronary artery bypass surgery for left main coronary artery disease. The course of 146 consecutive patients with significant occlusive disease of the left main coronary artery who underwent coronary artery bypass surgery during a 4 year period is reviewed. Preoperatively, 11 patients were in New York Heart Association functional class II, 57 in class III and 78 in class IV. Seventy patients had progressive angina and 12 unstable angina. There were two operative deaths (surgical mortality rate 1.4 percent). Seven patients (4.8 percent) had a perioperative acute myocardial infarction. Complete follow-up has been achieved in the surgical survivors over an average period of 18.1 months; 77 percent of the surviving patients are completely asymptomatic and 19 percent are in functional class II. Four patients (2.8 percent) had a nonfatal late postoperative myocardial infarction and five (3.5 percent) died during the late postoperative period (3.3 percent annual mortality rate during a 2 to 47 month follow-up period). Postoperative cardiac catheterization studies performed in 35 patients an average of 12.1 months postoperatively revealed 78 percent of 80 grafts and patency of at least 1 graft in 93 percent of patients. Results of 42 (89 percent) of 47 near maximal treadmill stress tests were abnormal preoperatively compared with results of 14 (26 percent) of 54 postoperatively; in 74 percent of patients having both a preoperative and postoperative stress test, abnormal preoperative test results converted to normal after surgery. This study suggests that direct myocardial revascularization may offer an effective means of improving both the quality and duration of life in a patient with significant occlusive disease of the left main coronary artery.


Architecture of the marrow vasculature in three amphibian species and its significance in hematopoietic development. Architecture of the bone marrow vasculature, particularly that of the femur, was analyzed in three amphibian species in relation to the early phylogeny of marrow hematopoiesis. A dye-injection method and histological techniques, including both serial sectioning and reconstruction methods, were used for this purpose. From these observations the following conclusions may be drawn. (1) Marrow hematopoiesis is absent from the femur of the urodelan (Triturus pyrrhogaster) and appears first in the femur of the primitive anuran (Xenopus laevis) (2) The site of primitive hematopoiesis (granulopoiesis) is the subendosteal region where the venous vascular net develops. (3) The primitive vascular architecture observed in the femur of Xenopus is characterized by the absence of a central vein. Subendosteal veins drain the blood from the bone marrow. A vein collateral to the primary artery appears in the femur of Rana catesbeiana, an advanced anuran, in which further development of both the subendosteal venous plexus and hematopoietic activity are noted. In both anura examined, the primitive blood sinuses form near the mid-shaft of the femur. The proliferation of mesenchymal elements containing dark pigment, presumably melanin, was also noted in this area. (4) The architecture of marrow vessels in Rana approaches the structure noted in mammalian bone marrow. (5) Fat tissue is observed in the urodelan bone marrow prior to the appearance of hematopoietic activity. This indicates that the formation of marrow fat is phylogenetically unrelated to the development of hematopoiesis. The present investigation on primitive hematopoiesis suggests that the development of hematopoietic activity is intimately related to the development of the marrow vasculature, particularly that of the subendosteal venous plexus. A favorable vascular arrangement may be necessary to allow active hematopoiesis.


A comparative study of intra-amniotic saline and two prostaglandin F2alpha dose schedules for midtrimester abortion. The efficacy, side effects, and complications of two intra-amniotic PGF2alpha dose schedules and the unaugmented intra-amniotic instillation of saline are compared. All three methods resulted in satisfactory rates of abortion within a relatively short period of time and within clinically acceptable rates of complications. Each method has its advantages and disadvantages. Further large comparative studies were needed.


Retinitis pigmentosa without pigment.

Retinitis pigmentosa without pigment. Sixty-eight consecutive patients with retinitis pigmentosa were studied to determine the frequency of the nonpigmented form of the disease. There was an overall incidence of 22%. Fifty percent of all cases had no characteristic pigmentation, if the duration of night vision difficulty was three years or less. The nonpigmented form of retinitis pigmentosa was frequently an early stage of the disease and not an unusual or atypical variant. Patients without the pigmentary changes characteristic of the disorder also showed less functional impairment: the electroretinographic b wave was more apt to be recordable, although impaired, and the rod threshold, as determined by dark adaptation measurement, was less elevated. The clinician should suspect retinitis pigmentosa, even in the absence of pigmentary changes, if there is a family history of the disorder, night blindness, peripheral field loss, and an impaired or nonrecordable electroretinographic response.


Endophthalmitis after vitrectomy.

Endophthalmitis after vitrectomy. A 29-year-old white man with growth-onset diabetes developed fulminant endophthalmitis after vitreous lavage. The only significant symptom was severe pain 36 hours after surgery. The endophthalmitis rapidly became more severe. Despite systemic antibiotics, therapeutic vitrectomy and lensectomy, followed by the intraocular injection of antibiotics 48 hours postoperatively, the eye was lost.


Chest wall stimulation for temporary suppression of competitive rhythms due to permanent pacemaker malfunction. Chest wall stimulation by electrical stimuli was employed to suppress permanent demand (ventricular-inhibited) pacemakers in two patients with competitive ventricular rhythms. The stimuli were nor perceived by either patient, and were continued until surgical intervention was effected. In selected patients with permanent pacemaker malfunction, chest wall stimulation may be appropriate and necessary initial therapy until definitive correction is performed.


A characterization of human tonsillar lymphocytes after separation from other tonsillar cells in an isokinetic gradient of ficoll in tissue culture medium. Purified human tonsillar lymphocytes responded less to mitogentic stimulation than did unseparated tonsillar cells. Their response to mitogens was restored when they were combined with cells from all other gradient fractions. We interpret our data as evidence that the majority of tonsillar lymphocytes require the presence of more rapidly sedimenting cells for a maximum response to the tested mitogens. The purified tonsillar lymphoyctes were 47.0% lymphocytes that have detectable surface immunoglobulin and 29.9% lumphocytes that form rosettes with sheep red blood cells. The predominant cell surface immunoglobulin was IgM. Digestion of the tonsil with trypsin yielded tenfold more plasma cells, more vialbe cells, and a larger proportion of blasts, histiocytes, and binucleated cells than were obtained by mechanical dissociation of the tissue.


Interactions of diphenylhydantoin and cardiac glycosides on atrial potassium. Effects of diphenylhydantoin (DPH) on amphibian atrial myocardium K were investigated using a method which permits both total tissue K and tension response to be monitored continuously. In normal (nondigitalized) preparations, DPH caused a decrease in average K efflux, a net gain of tissue K, and negativeinotropy at low perfusate K concentrations. However, the DPH-induced gain of tissue K was abolished at high perfusate K concentrations while marked negative inotropy was still observed. It is concluded that a gain of tissue K is not the cause of DPH-induced negative inotropy. When digitalis-induced inotropy was associated with tissue K loss, DPH reversed tissue K loss and positive inotropy and caused a decrease in average K efflux. In the presence of toxic effects of digitalis, DPH reversed the K loss and the contracture, but the loss of developed tension was not reversed by DPH. Transmembrane resting potentials and action potential duration were reduced by digitalis and were returned to or above control levels in the presence of DPH. The present findings are consistent with the hypothesis that the therapeutic effect of DPH in digitalis toxicity is brought about by an inhibition of K efflux. This would tend to minimize the loss of tissue K which results from sodium pump inhibition.


Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage. Vasopressin infusion initially controlled 80 per cent of patients bleeding from portal hypertension, and 53 per cent did not rebleed after removal of the catheter. This figure is significantly greater than the 28 per cent of patients totally controlled by esophageal tamponade (p less than 0.075). Similar rates of success were achieved by vasopressin infusion for gastric, duodenal, and colonic bleeding sites. These results suggest that visceral arterial infusion of vasopressin is the method of choice for the short-term therapeutic management of massive gastrointestinal bleeding from portal hypertension. Vasopressin infusion also appears to be a valuable means of treating patients with massive gastrointestinal bleeding secondary to shallow gastric ulcers, gastritis, Mallory-Weiss tears, colonic bleeding and "poor risk" patients with deep gastric, marginal, or duodenal ulcers when conventional medical therapy has failed. The presence of a coagulation abnormality in patients with portal hypertension significantly reduced the complete control of bleeding to only 27 per cent ( p less than 0.010) and survival rate to 14 per cent (p less than 0.050). Visceral arterial perfusion proved to be an effective means of arresting hemorrhage, but the overall improvement in hospital mortality in this group of poor risk patients remains unproved.


The central vascular pattern of the eyeground in children with drusen of the optic disk. In a series of 50 children with optic disk drusen the anomaly was found to be associated with unusual properties. A cilioretinal artery was more frequent in the series with drusen than in a control series of the same age. The emergence and course of the central retinal vessels were studied in the right-sided fundi of 46 of the children and in two control series (the fundi of the "better" eyes of 46 strabismic children and the fundi of one of the eyes of 10 children or young adults with papilledema). Analysis of the measurements indicated that early branching of the central vessels and vascular tortuosity are so frequently associated with optic disk drusen that they can be considered features of the anomaly. On the other hand, the fundal vascular features in papilledema seem to be distinguishable by the method used from those associated with optic disk drusen. When the peripapillary choroidal vascular pattern was studied by fluorescein angiography, choriocapillaris filling was delayed in about the half of the angiograms. The aberrant vascular features found on and around optic disks with drusen can be explained by an embryonic affection of the developing vascular system at the optic nerve head. In this respect the anomaly seems to resemble congenital disorders of mesodermal origin.


[The disjunction zone in the slit-image-photograph of the human aging lens (author's transl)]. Standardised slit-image-photographs of 178 clear lenses were evaluated by microdensitometry. The mean distance of the disjunction zone from the anterior capsule and the density of the disjunction zone remain constant during life. Its thickness will be reduced and its extension into deeper layers increases with age. In contrast to these findings the thickness of the whole lens according to the increasing thickness of the cortex increases with age. Its density increases too in a not linear manner probably on behalf of the increasing number of reflecting zones (Alterskernstreifen). The density of the nucleus of the lens increases with age, whereas its densitometrically defined thickness remains constant during life. The disjunction zone behaves independently from age in contrast to other parts of the lens.


[The disjunction zone in the slit-image-photograph of the human lens in eye diseases (author's transl)]. Standardised slit-image-photographs of the clear human lens in 78 eyes with wide angle glaucoma, 29 eyes with uveitis and 35 eyes after an operation of a retinal detachment were evaluated by microdensitometry and compared with clear lenses of 178 eyes without eye diseases. Most significant alterations were observed in the anterior disjunction zone. Its thickness was increased in all these diseases with the exception of the glaucoma eyes treated with derivates of phenylephrine and/or cholinesteraseinhibitors. Under these conditions the disjunction zone disappeared. The alterations of the lens cortex and of the nucleus of the lens with respect to the thickness and its density were mostly accelerations of the normal aging process and only glaucoma eyes were partly in contrast to this process. Thickening of the anterior disjunction zone may be combined with a thickening of the whole lens and vice versa.


Treatment of Coats' disease with photocoagulation. 71 eyes with Coats' disease were treated with photocoagulation. By coagulation of the abnormal vessels the disease process could be halted in 64 eyes over a mean observation time of 2 years and 3 months after completion of treatment. In 51 of these eyes the lipoid deposits regressed. In only 7 eyes a progression of the disease could not be prevented. Complications of photocoagulation treatment were not observed.


[Experimental fluorescein angiographic and microscopic investigations on laser treated rat eyes (author's transl)]. On fundi of pigmented rats, with Argon laser constantly 300 mW of power. 2 seconds exposure time and 50 microns spot diameter, coagulations have been performed. The eyes have been observed up till 3 months after the intervention, then angiographies were performed, and the following enucleated eyes have been examined with the fluorescence microscope. Neovascularizations and dye diffusions were observable mainly in the marginal zones of the arised cicatrices. The neovascularizations were starting from the choroid and penetrating into the outer retinal layers.