[The results of valgus osteotomy in severe osteoarthritis of the hip (author's transl)]. The authors analysed 150 consecutive cases of valgus osteotomy (Pauwels II) performed in cases of very severe osteoarthritis, and followed up for 3 to 10 years (average 6 years). The quality and the permanency of the results depend mainly on the morphology of the osteoarthritic hip. A satisfactory clinical and radiologic result is attained when the stresses in the joint have been reduced by improving the congruity of the joint surfaces using the cephalic medial osteophyte as part of these, and thus increasing the weight bearing surfaces. In osteoarthritis secondary to dysplasia (single dysplasia, subluxation, or luxation with support: 49 cases) valgus osteotomy gave 77 p. 100 good results, with 83 p. 100 painfree hips. This result persists 10 years (or more) for women operated before 50 years of age. The results are good in primary osteoarthritis occuring in active age (83 cases). When the hip was extruded by acetabular and cephalic osteophytes, 60 p. 100 good results, with 81 p. 100 painfree hips, have been obtained. In protrusive osteoarthritis and coxa profunda (18 cases) the valgus osteotomy slightly improved the range of movement but the relief of pain was usual (88 p. 100) and durable. The causes of failure (lack of mechanical improvement, osteoarthritis resulting more from biological disturbance--primary osteoarthritis--rather than from mechanical causes, influence of the age) have been sought for.


Weak A.C. magnetic field effects: changes in cell sodium pump activity following whole animal exposure. A biological system consisting of a cell membrane enzyme (Na+-K+)-ATPase responded to exposure to a weak A.C. magnetic field. Analysis of Na+ pump activity in normal mouse (A/J) tissue--(a) Kidney cortex and diaphragm after 11 days of exposure to a magnetic field of 55-60 gauss, 60Hz showed a significant reduction as did (b) liver tissue but at day 17 the levels had returned to the control values. Neuroblastoma cells (C1300) transplanted to A/J mice also showed a reduction in the (Na+-K+)-ATPase activity but this persisted at day 17.


Lumbar spinal manipulation on trial. Part I--clinical assessment. Thirty-two patients with chronic low back pain were treated three times at weekly intervals with rotational manipulation. Patients with femoral or sciatic root pain were included provided they did not exhibit root compression signs. Background therapy of codeine phosphate was administered throughout. There was a significant increase in spinal flexion measured clinically during the three-week period of manipulation followed by a significant decrease in the three-week period after manipulation. The first week of manipulative treatment was more painful than the corresponding week in the control group but in the second and third weeks there was less pain in the manipulated group. Pain scores were reduced to a significant degree within four weeks of starting treatment only in the group manipulated in the first treatment period. Patients benefitting subjectively from manipulation were more likely to be older and to have had symptoms for a shorter period than those not deriving benefit. The age of onset of symptoms was significantly later in the responders.


Lumbar spinal manipulation on trial. Part II--radiological assessment. In a trial of manipulation for chronic low back pain, radiographs of the lumbar spine and radiographic assessment of spinal motion were of no value in predicting or assessing the response of the patients to manipulation. Although radiography of the lumbar spine is a commonly requested investigation, it contributes little to the management of such patients except to exclude serious spinal pathology before any form of physical treatment is commenced.


Metabolic abnormalities of tryptophan and nicotinic acid in patients with rheumatoid arthritis. The mean plasma total tryptophan concentration of 13 long-standing rheumatoid arthritis patients was found to be lower than that of seven nonrheumatoid control subjects, but the plasma nicotinic acid concentration was unchanged. In the rheumatoid patients the urinary excretion of the tryptophan metabolites, kynurenine, xanthurenic acid and 3-hydroxyanthranilic acid, was increased several fold, but the excretion of N-methylnicotinamide was normal. These findings are discussed in relationship to the dietary intakes of tryptophan, nicotinic acid and pyridoxine, the effect of antirheumatoid drugs on plasma tryptophan and liver tryptophan pyrrolase, and requirement of rheumatoid patients for pyridoxine.


Mobile arm supports: an evaluation.

Mobile arm supports: an evaluation. The results of a follow-up survey of 124 patients fitted with mobile arm supports at Mary Marlborough Lodge between 1970 and 1976 are presented. Of the patients fitted with mobile arm supports 33% are known to have used them for over one year, and 47% of those who were contacted were still using them. The reasons for non-use and the implications of the necessity for readjustments are discussed.


[A family with progressive myoclonus epilepsy (author's transl)]. To begin, a survey of the literature concerning the group of progressive myoclonic epilepsies is presented, from the initial descriptions of Unverricht (1891) and Lundborg (1903) to the present. Recently several subforms of this nosologic entity have been delineated according to the mode of inheritance, time of manifestation, severity of course, and biochemical characteristics (i.e, eventual demonstration of mucopolysaccharide storage in Lafora bodies or diffuse in the central nervous system and other organs). The most useful classification stems from Diebold (1972): early (I) and late (II) forms of the Lafora type having autosomal recessive inheritance; an autosomal recessive early form (III) and an autosomal dominant late form (IV) with degenerative changes in the central nervous system without biochemical disturbances. The authors describe 3 young siblings from Southern Tyrol, who clinically manifested the cardinal symptoms of the disease in addition to extrapyramidal cerebellar disturbances. In spite of extensive bioptic and biochemical examinations, neither Lafora bodies nor diffuse deposits or excretion of mucopolysaccharides could be demonstrated. The distant blood relationship between the parents of these patients supports the assumption of an autosomal recessive mode of transmission. The relatively early manifestation of the disease and the demonstration of degenerative changes within the central nervous system suggest assignment of these patients to Diebold's subgroup III of the progressive myoclonic epilepsy.


[Choreic dyskinesia and GABA - pharmaco-clinical approach. Preliminary note]. The effects of Baclofen, a gabamimetic drug, have been studied in 4 patients affected by Huntington's Chorea. The biochemical bases of Chorea are discussed in relation to the HVA modifications in the cerebrospinal fluid induced by the drug. Some interesting data on the extrapyramidal physiology may be achieved with further investigations in a greater group of patients.


Work conditions and health of locomotive engineers.  II. Questionnaire study, mortality and disability. A questionnaire study on work conditions, work organization, leisure time, social problems, and health was directed toward active and retired locomotive engineers. This article mainly presents responses of the active engineers. The active locomotive engineers quoted the irregular work hours as the worst occupational problem. They judged noise and vibration in the locomotive cabs as disturbing. The majority of the desired changes in the work and work conditions concerned work time. The most common complaints given on the questionnaire were back trouble, hypertension and dermatitis. Tiredness and exhaustion were the most prevalent neuropsychological symptoms. A retrospective follow-up survey on invalidity and mortality was made. Trainmen and railroad clerks were used as reference cohorts.The engineers had relatively high invalidity and mortality rates in comparison to the reference groups, especially with respect to cardiovascular diseases and malignant tumors. Higher rates for disease of the digestive system and hearing loss were also suggested by the results.


Accumulation of a tetrahydroisoquinoline in phenylketonuria. 3',4'-Deoxynorlaudanosolinecarboxylic acid (DNLCA), a tetrahydroisoquinoline derived from dopamine and phenylpyruvic acid, has been detected by computerized mass fragmentography in urine of phenylketonuric children and in urine and brain of rats with experimentally induced hyperphenylalaninemia. Levels of DNLCA in brain of treated animals were more than tenfold higher than controls, and the excess tetrahydroisoquinoline appeared to accumulate in the cerebellum and cortex. DNLCA is a noncompetitive inhibitor of dopamine beta-hydroxylase (inhibition constant, Ki, = 0.42 mM) and is taken up by the brain.


Peritoneoscopy in the management of breast cancer. Peritoneoscopy has been recommended by the Combined Breast Clinic at the Provincial Hospital, Port Elizabeth, since 1975, mainly to confirm or exclude metastatic involvement of the liver. Experience with 27 procedures is reviewed. Peritoneoscopy is shown to be a useful aid in the staging and management of selected cases of breast cancer. Positive findings, confirmed by histological examination, were recorded for 5 patients. Negative findings in 22 patients were equally helpful, and were found to be reliable, in that none of these patients had evidence of liver involvement during the follow-up period, while in 5 patients there was evidence of metastases elsewhere.


Acne, hypervitaminosis A and hypercalcaemia. A case report. The ingestion of vitamin A, which is often prescribed for the treatment of acne, may lead to hypervitaminosis A. This syndrome has a wide spectrum of clinical features, hypercalcaemia being of special note since it has been reported in 4 previous cases only. Hypervitaminosis A has been described as resulting from excess ingestion of vitamin A for prevention of sunburn and treatment of minimal brain dysfunction. With the present glut of health foods, this condition should be borne in mind when patients present with symptoms of hypercalcaemia and liver dysfunction.


Attitudes toward the chronically ill and disabled: implications for the health care systems. Health care services for the chronically ill are provided through a fragmented patchwork of activities by health care professionals. This article traces some of the origins of attitudes toward the chronically ill and identifies the problems created by disjointed patterns of care. A route for change that is humanistically based and uses a matrix model for care and management is suggested.


Steady-state gas exchange in normothermic, anesthetized, liquid-ventilated dogs. Anesthetized, paralyzed, purebred beagle dogs were ventilated for 45 min (n = 5) and 60 min (n = 5) with oxygenated (PIO2 = 685 mmHg) FC-80 fluorocarbon liquid at 38 degrees C. The PaCO2 remained constant at approximately 43 mmHg during 60 min of liquid ventilation (mean tidal volume = 290 ml, mean respiratory frequency = 2.8 breaths/min). The end-tidal PCO2 was consistently higher than PaCO2 during liquid ventilation. Histological examination by light as well as scanning electron microscopy of the lungs of dogs killed 10, 30, or 180 days after liquid ventilation revealed no pathological changes except for a slight increase in the number of macrophages, especially around the alveolar ducts. It is concluded that a steady state of gas exchange at near normal arterial carbon dioxide partial pressures can be maintained in anesthetized, normothermic dogs ventilated with FC-80 at respiratory frequencies of approximately 3 breaths/min.


Cerebral neuroblastoma.

Cerebral neuroblastoma. A cerebral neuroblastoma removed surgically from a female child is presented. Electron microscopy showed numerous neuronal processes with growth cones which are a feature of the developing neurone. In addition there were some rosettes with distinct lumina. The luminal surfaces were covered with a smooth plasma membrane lacking any surface differentiation and the lateral surface of these cells had many cell junctions (terminal bars), reminiscent of a primitive neural tube. These features in a nerve cell tumor help to substantiate it as a neuroblastoma arising from immature rather than differentiated cells. The nature of this rare tumor is discussed.


Granulomatous glomerulonephritis, without systemic disorder. The case of a 12-year-old girl dying of renal insufficiency is described. At autopsy granulomatous glomerulonephritis was found without any systemic disease. The glomerular light-, immunofluorescent- and electron microscopic changes were studied. Four hundred glomeruli were analyzed by light microscopic investigation and graded (I-IV). By immunofluorescent investigation, intraglomerular and in the more severely affected glomeruli, periglomerular immunoglobulin deposition was detected. Electron microscopic investigation revealed mononuclear cells and fibroblasts in the glomerular and periglomerular cellular infiltrate, resulting in fragmentation and rupture of Bowman's capsule and loss of the glomerular structure.


Lipofuscin and transsynaptic degeneration. The periodic acid Schiff reaction was applied to neurones in the Lateral Geniculate Body (L.G.B.) of a series of normal and blind patients over a wide age range. The quantity of the reaction product was determined as a measure of lipofuscin which was found to increase linearly with age in the L.G.B. neurones. The amount in the neurones of the blind patients was found to be less than that in the controls, and a further group of four patients with apparently normal vision and central nervous system disease had an intermediate amount of lipofuscin. It is suggested that the component of lipofuscin measured by this technique represents an index of both metabolic activity and functional activity of the neurone. The reduced amounts in the patients with C.N.S. disease may reflect reduced visual function in association with non-visual pathway disease.


Capillarosclerosis of the lower urinary tract in analgesic (phenacetin) abuse. An electron-microscopic study. The ultrastructural appearances in capillarosclerosis of the lower urinary tract in analgesic abuse are reported. The capillaries show thickened basement membranes consisting of numerous thin basement membrane lamellae. Between the newly formed basement membrane lamellae, masses of empty vacuoles (fat vacuoles) and a variety of membranous and vesicular structures are present. The pathogenesis of this alteration in the basement membrane is unknown. A common pathogenetic mechanism may be operative in the discoloration of renal papillae and mucous membranes of lower urinary tract on the one hand and capillarosclerosis on the other.


Ultrastructural cytology of human osteosarcoma cells. The cytology of 6 osteosarcomas was examined by electron microscopy. In keeping with the varied pattern of osteosarcomas seen by light microscopy several types of tumor cells could be differentiated: osteoblast-like, fibroblast-like, chondroblast-like, osteoclast-like and histiocyte-like cells. Moreover, atypical malignant mesenchymal cells and vascular spaces were present. The individual cytoplasmic organelles are not considered to be specific to particular types of cell as seen from the discussion of the significance of rough endoplasmic reticulum, microfilaments and lysosomes. Only examination of the composite pattern of subcellular organelles allows the differentiation of certain cell types. All tumor cells visible in osteosarcomas are considered as modifications of a transformed common progenitor cell. Because of the variegated cytological picture a multipotent mesenchymal cell rather than an osteoblastic cell is assumed to be the ancestor cell.


Experimental renal papillary necrosis in the rat: the selective vulnerability of medullary structures to injury. Acute renal papillary necrosis was produced in rats by the administration of ethyleneimine. Low doses resulted in necrosis of interstitial cells, thin limbs of the loops of Henle and vasa recta, while collecting ducts were spared (subtotal renal papillary necrosis). High doses resulted in necrosis of all elements of the papilla (total renal papillary necrosis). Athough the ranges of the doses that produced these two patterns of necrosis overlapped, it is clear that there is a dose dependent selective vulnerability or renal medullary structures to injury by the toxic agent studied.


Involvement of the larynx in a congenital "myopathy", unilateral aplasia of the arytenoid, micrognathia, and malformation of the brain--a new syndrome? Neuromyopathic changes were found in various limb muscles and in intrinsic laryngeal muscles of a two month old girl. She had been noted to have micrognathia, arthrogryposis and congenital stridor and died as a result of respiratory insufficiency and aspiration. Autopsy revealed an absent left arytenoid cartilage and severe histogenic abnormalities of the brain. Although the muscles involved showed a mainly myopathic pattern, marked signs of peripheral neurogenic involvement were present. These differed from motor neuron disease or aplasia of anterior horn cells. These findings cast a new light on the discussion of unclassified congenital myopathy resembling the picture of congenital muscular "dystrophy". This is the first case of congenital neuromyopathy in which involvement of intrinsic laryngeal muscles has been demonstrated morphologically.


[Results of immunization of seronegative children with live poliomyelitis vaccine]. The humoral immunity status to poliomyelitis viruses was studied in a group of children under 3 years previously immunized at least 3 times with SLV incorporated into dragee-candy. A regular increase with age of the number of subjects possessing virus-neutralizaing antibody to poliomyelitis viruses was demonstrated, the incidence of antibody to the three virus types being distributed by age groups as follows: under 1 year -- 24%, 1 year -- 53%, 2 years -- 71.2%, 3 years -- 84.8%. The immune response in children was observed to begin developing after the first vaccination mainly to one virus type. Among the children of 1--3 years of age examined, 1.1% to 6.0% had no antibody to polioviruses. An attempt was made to induce antibody production in these children by an additional vaccination with liquid SLV monitoring the implantation of the vaccine virus in the intestinal tract and seroconversion in the blood. Consecutive administration of the oral liquid vaccine of national make was found to result in immune response in 100% of vaccinees.


[Sociological studies in acne vulgaris. 2. Effect of the disease on the evaluation of clinical picture and motivation for therapy]. A questionnaire was presented to 2009 18--19 year old recruitment candidates. The questionnaire enabled appraisal of antipathy towards patients with severe acne vulgaris and the occupational inpediment of severe acne. It was shown in comparison of patients with clinically relevant acne and healthy subjects or patients with a minor variant of acne that acne patients are more prepared to tolerate other acne patients than are healthy subjects. A questionnaire which enabled appraisal of attitudes to therapy was presented in addition to 351 patients with clinically relevant acne in this collective. The schools attended were also recorded in these patients. It was shown that the motivation to undergo treatment can be assumed in only half of the acne patients; this motivation is less the more radical the therapy. However, the motivation is greater the higher the educational level of the person questioned.


[Natural foci of viruses borne by Phlebotomus papatasi in the USSR according to a serologic study of the population]. Seven hundred sixteen blood serum specimens from residents of presumable foci of phlebotomus fevers in Turkmenia, Tajikistan, Uzbekistan, Azerbaijan, and Moldavia were examined by the neutralization, complement fixation, hemagglutionation-inhibition and indirect immunofluorescence tests for the presence of antibody to viruses of the group of phlebotomus fevers (Sicilyan, Neapolitan, and Karimabad) and to rhabdovirus isfahan transmitted by phlebotomus papatasi. For the first time, antibody to Karimabad and Isfahan viruses were found in residents of the Central Asian republics. Antibody to Sicilyan and Neapolitan fevers were found in residents of all the republics examined. Data have been obtained indicating probable pathogenicity of Isfahan virus for man.


Amino acid uptake by amino acid analog resistant tobacco cell lines. Two tobacco cell lines resistant to p-fluorophenylalanine (PFP) and one resistant to 5-methyltryptophan (5-MT) are compared with wild type cells in their ability to absorb amino acids from the medium. One p-fluorophenylalanine-resistant cell line shows greatly reduced uptake of all amino acids so is resistant to growth inhibition by other amino acid analogs. The impaired absorption is noted with amino acids, amino acid analogs and shikimate, but not with cinnamate, salicylate, nicotine, glucose, 3-O-methylglucose and palmitate. The phenylalanine transport system of the PFP-resistant cell line and the wild type both have Km values of 90 micrograms, but have different Vmax values. Several analogs of phenylalanine and several neutral L-amino acids inihibt the phenylalanine transport system, while L-aspartic acid, L-arginine, D-phenylalanine or chlorogenic acid do not interfere with the L-phenylalanine uptake. The results indicate the presence of more than one transport system for amino acid uptake. The lessened uptake of all amino acids, the specificity of the uptake systems and the unchanged binding let us conclude that a pleiotropic mutation or that some inhibitor causes the reduced uptake of all amino acids by the PFP-resistant cell line.


Evidence for distinct amino acid transport systems in cultured tobacco cells. It is shown by competition experiments that tobacco cell lines have distinct transport systems for L-amino acids. For all tested amino acids the Lineweaver-Burk plots were diphasic indicating the presence of more than one carrier for any one amino acid. Moreover distinct transport systems for neutral, acidic and basic amino acids were kinetically characterized. Based on competition experiments neutral amino acids were absorbed by all transport systems. Aspartic acid entered the cells via its own carrier and via the basic carrier while arginine was taken up only by the basic carrier. Neutral amino acids such as L-leucine or L-phenylalanine were taken up faster than acidic or basic amino acids.


[The carcinogenic effect of polycyclic aromatic hydrocarbons (author's transl)]. The two most important theories on the mode of action of carcinogenic hydrocarbons are juxtaposed by a new theory. This theory refers to ideas which have been discussed for a rather long time in silicose research and describes a mechanism whose principle will possibly be important for the specific effect of some pharmaceutica.


Ribonuclease A digestion by proteinase K. The digestion of ribonuclease A by proteinase K yielded one major degradation product only, which could not be distinguished from ribonuclease S by electrophoretical and immunological methods. This component (ribonuclease K) possessing full catalytic activity was characterized to be (1--20/21--124) ribonuclease A. Combined action of proteinase K and trypsin on ribonuclease A leads to a significant increase of the inactivation rate which may be useful in the isolation of mRNA from polysomes.


[Phosphoenolpyruvate carboxykinase in Phycomyces blakesleeanus Bgff. (author's transl)]. Phosphoenolpyruvate carboxykinase (PEPCK) from Phycomyces blakesleeanus was partially purified by protamine sulfate precipitation, ammoniumsulfate precipitation, and diethylamino ethyl cellulose (DEAE) treatment. This preparation was employed for the characterization of the enzyme. The Km values for phosphoenolpyruvate (PEP) and ADP were determined as 1.6 and 0.42 mM. The nucleotid specificity was demonstrated for ADP exclusively. The use of sulfuryl reagents showed the presence of thiol groups sensitive against p-hydroxymercuribenzoate but not effected by N-ethylmaleimide.


The mutagenicity of dichloroacetaldehyde. Dichloroacetaldehyde, a presumed metabolite of the insecticides dichlorvos and trichlorphon, is mutagenic in the Salmonella/microsome test. Its mutagenic potency is higher than that of the established mutagen dichlorvos. It is possible that the bacterial mutagenicity test only or mainly detects the effect of methylation by dichlorvos.


Physical parameters and possible regulation of zeta-aminolevulinic acid synthetase. Physical measurements were made on the zeta-aminolevulinic acid synthetase from Rhodopseudomonas spheroides. These include a Stokes radius of 3.8 nm, determined by gel filtration, and sedimentation coefficient of 5.46 S by sucrose density gradient centrifugation. From these measurements and the value of partial specific volume of 0.732 ml/g determined from the amino acid composition, the following physical constants were calculated: molecular weight, 88000; diffusion coefficient, 5.65 X 10(-7) cm2s-1; frictional ratio, 1.30; axial ratio, 5.0. The enzyme is inhibited by more than 50% by glyceraldehyde 3-phosphate (1mM), pyruvate (0.02 M), alpha-ketoglutarate (0.02 M), urea (0.8 M), CoCl2 (0.2 mM) and hemin (5 micrograms). The effect of these inhibitors on the possible regulation of this enzymic activity is discussed.


Lysine as the substrate binding site of porphobilinogen synthase of Rhodopseudomonas spheroides. The 14C labelled inactive protein obtained by sodium borohydride reduction of the enzyme, porphobilinogen synthase of Rhodopseudomonas spheroides, in the presence of [4-14C]5-aminolevulinic acid, gave on acid hydrolysis and subsequent electrophoresis or two-dimensional chromatography a major radioactive spot which was confirmed to be N-epsilon-[4-(-5aminovaleric acid)]lysine (ALA-lysine) by comparing its co-chromatographic and electrophoretic behaviour with the chemically synthesized ALA-lysine. An epsilon-NH2 group of lysine residue of porphobilinogen synthase, is thus the binding site of the substrate, 5-aminolevulinic acid.


Quantification and localisation of SH-groups in human blood serum proteins. The thiol groups of human blood serum proteins were determined after 24 hours interaction with dithionitrobenzoic-acid (DTNB) to an average of 538 +/- 60 mumol/l serum. After treatment of the serum with [35S]DTNB, autoradiograms of the protein elpherograms revealed two main peaks: The first with 63% of total activity, in the albumin region, corresponding to 0.60 SH/mol, the second with 23% of total activity, in the gamma-globulin range, corresponding to 2.2 SH/mol. After 30 minutes incubation with DTNB, or with p-chloromercuribenzoate (CMB), in freshly prepared pools of IgG only 0.2 SH/mol were found which is the expected value already known from the literature. Autoradiograms taken from serum protein elpherograms after interaction with [14C]CMB only show the main SH-peak in the albumin range. Thus it is concluded that the SH-peak in the gamma-globulin region after 24 hours incubation with [35S]DTNB is due to one highly labile S-S-bond which easily undergoes a disulfide exchange with DTNB.


Host factors involved in the growth of microvirid phage alpha 3. Host factors involed in the growth of microvirid phage alpha3 were determined using various replication mutants of Escherichia coli. The viral multiplication was dependent on functional products of dnaE, dnaF(NRDA), DNAG, and dnaZ genes. Host functions directed by dnaA, so-alled dnaH, dnaI, and dnaP genes were dispensable for the viral growth. In contrast with phiZ174 and G4, alpha3 would grow sufficiently In dnaB and dnaC(D) mutants. The viral growth was not significantly affected by host polAts, seg, and groPC mutations.


[Management of the work place. Erogonomics and occupational medicine for the benefit of prevention]. Between the state of well-being and that of illness, an intermediary state often occurs, characterized by feelings of uneasiness, fatigue and pains. The study of these intermediary states in function of the work load (posture, noises, heat, etc.) constitutes an important feature of ergonomics. In this study we present the results of two polls showing pains due to inappropriate postures. Many observations of occupational medicine lead us to believe that pathological troubles of rheumatic order (arthritis, periathritis, tendinitis, myalgias, arthroses) can appear as a result of inappropriate postures and repetitive movements over a number of years. Thus, the ergonomic analysis of the work place can help to determine the risk of illness.


[Insurance and preventive medicine].

[Insurance and preventive medicine]. Not only do insurance companies have to pay in case of death, injuries or disease, they are also concerned with their prevention. This is particularly true for the "Swiss National Accident Insurance Fund" (Caisse nationale suisse d'assurance en cas d'accidents--(CNA): for them the prevention of work related accidents and occupational diseases is required by law. Preventive activities in this area are very promising. The progress in the sickness insurance programmes for preventive medicine in the general population has, however, not been as successful. To date, the legislation denies payment for preventive medical care. Why is there this difference? In the case of accidents and occupational diseases, the cause of the pathologies are for the most part exogenous and develop in well known and controlled environments. In the case of disease or invalidity in the general population, the factors are in a large part endogenous and therefore very difficult to supervise, as they develop in much more complex and uncontrolled environments. Nevertheless progress has been done in this field as well. At present, some selected scientifically proven preventive examinations could be included in insurance programmes as part of a general plan and with strict quality control of laboratory findings.


[Immunologic donor-recipient matching in living kidney transplantation]. The better results of transplantation in kidneys of relatives in contrast to cadaveric kidneys are above all traced back to a compatibility in the HLA-D-Locus which is more frequently present in relatives and which can be established by a lacking stimulation in the mixed culture of lymphocytes. Therefore, the selection of donor and recipient in transplantations of living kidneys where there is no pressure of time should apart from the serological standardization of lymphocytes should also comprise the mixed culture of lymphocytes lasting 5 to 7 days.


[Animal experiment studies on the effect of intra-articular injections of antiphlogistic-antirheumatic agents on articular cartilage in vivo]. Animal experiments have shown that weekly intraarticular injections of various antiphlogistic/antirheumatic drugs into the knee joint induce progressive degenerative alterations in joint cartilage. The observed degenerations and destructions are most similar to the pathophysiology of osteoarthrosis in humans. By X-ray and macroscopic techniques the degenerative processes can be studied qualitatively and quantitatively. A decrease of joint space is a sensitive and early indicator of osteoarthrosis and showed that 10 weeks after intraarticular application of Ibuprofen, Phenylbutazone, Oxyphenbutazone, Flufenamic acid, Niflumic acid, Na-salicylate, Clofezone, Bumadizone and Dexamethasone the degenerative alterations in the injected knee joints were more severe than by applications of Chloroquine,D-penicillamine, Salicylamide and Indometacin. The degenerative effect on articular cartilage by the investigated drugs can be explained by their inhibitory potency on anabolic metabolism of connective tissue. The results of our animal experiments lead to the conclusion, that antiinflammatory drugs may also in man induce or accelerate degenerative joint diseases especially after long term treatment with high doses of these drugs.


Comparison of clofezone and diclofenac in the treatment of out-patients suffering from activated (painful) osteoarthrosis. The effectiveness and acceptability of clofezone (Perclusone) were compared with those of diclofenac in a placebo-controlled, double-blind, cross-over trial on a group of 29 out-patients suffering from osteoarthrosis of the knee or hip. Clofezone was given at a daily dosage of 1200 mg during the first week and 600 mg during the second week; the corresponding dosages of diclofenac were 150 mg and 75 mg. The duration of the trial was 6 weeks. In order to wash out previous medication, a placebo was given for one week before and after each medication period. Eight of the patients stopped taking their drug after 1--3 weeks, namely 5 in the clofezone group and 3 in the diclofenac group, while one patient stopped taking the placebo. The principal reason for these stoppages was gastrointestinal intolerance. These 9 patients were disregarded in the evaluation of the trial results. This evaluation on the remaining 20 patients showed that clofezone brought about a significant improvement in respect of pain (both at rest and during movement), inflammation and mobility after two weeks' application. In the diclofenac group the only significant improvement after the same period was in respect of pain during movement. Statistical comparison of the two groups showed that the reduction in pain during movement and in inflammation was significantly greater under clofezone than under diclofenac and that clofezone had the longer-lasting action. These findings are discussed in the light of the kinetic characteristics of the two drugs and of the mild antidepressant properties of clofezone. There was no significant difference between the two drugs as regards tolerance.


[Surgical management of abdominal-wall insufficiency in the female (report on 94 cases)]. A clinical report is given on 94 cases of operative reconstruction of the anterior abdominal wall. There are medical and cosmetic indications. The morphological and functional results of these operations are good. Attending to the contraindications the number of dangerous complications in the postoperative course is low. No case of death was seen.


Comparative toxicity of trivalent and hexavalent chromium to rabbits. III. Biochemical and histological changes in testicular tissue. The administration of trivalent and hexavalent chromium compounds produced inhibition of the activity of succinic dehydrogenase, adenosine triphosphatase and acid phosphattase accompanied by cellular degeneration with complete absence of spermatocytes in the testis of rabbits. The biochemical and histological changes were more marked in the animals treated with the trivalent chromium than those exposed to hexavalent chromium and were progressive with the duration of exposure.


[Small-angle scattering of the quaternary structure of phosphofructokinase from baker's yeast]. The phosphofructokinase (E.C. 2.7.1.11) from baker's yeast was examined by means of small angle X-ray scattering in 0.1 M K-phosphate buffer, pH 7. A quaternary structure model was obtained from the comparison of the model scattering curve with the experimental one. The eight subunits of the yeast phosphofructokinase are arranged in a D2-symmetry. The proposed scattering equivalent model corresponds to a structural description with a resolution of 2.5 nm. Models with a C8-symmetry and D4-symmetry can be ruled out.


Relationships between association state and enzymic activity of human erythrocyte phosphofructokinase. Human erythrocyte phosphofructokinase has been subjected to active band centrifugation and stability measurements over a broad range of conditions. The enzyme behaves differently in-Tris buffer containing ATP and phosphate buffer containing fructose 6-phosphate. In the first buffer, dissociation is favoured and after prolonged storage of the enzyme tetramers represent the highest state of association. At 4 degrees C the enzyme exhibits the phenomenon of reversible cold-inactivation. This property is attributed to slow dissociation of the active associated states of the enzyme to dimers. The cold-inactivated enzyme can be reactivated by fructose 1,6-bisphosphate. Inorganic phosphate and fructose 6-phosphate have been found to protect the enzyme from cold-inactivation. Under these conditions, the sedimentation coefficient and the specific activity depend on the enzyme concentration only. The specific activity does not change on storage of the diluted enzyme at 4 degrees C. At 20 degrees C, however, a slow activation proceeds during incubation of the diluted enzyme. The correlations between the association state and the enzymic activity are discussed.


Association behaviour of human erythrocyte phosphofructokinase. Dependence of molecular weight on enzyme concentration as analyzed by frontal gel chromatography. Self-association of human erythrocyte phosphofructokinase has been studied at pH 8.0 and at 4 degrees C in the presence of 2 mM fructose 6-phosphate by means of frontal gel chromatography. Under these conditions the basic associating catalytically active species is the tetramer of the enzyme with a molecular weight of about 330000, the monomers of which having a molecular weight of 83000 as determined by sodium dodecyl sulphate electrophoresis. The experimental data have been compared with various models describing the enzyme association. The mode of association can sufficiently be described by assuming a weakly negative cooperative process in which the association constant of the nucleation step (association of two tetramers to an octamer) is larger than that of the following propagation steps. The geometry of association appears to be approximately spherical.


[Granulocyte chalone: tissue specificity of action in short-term cultures]. Granulocytic chalone containing extracts were obtained by incubating rat bone marrow cells in Hanks salt solution and further purification of the conditioned medium by ultrafiltration and gel chromatography. These extracts cause specific inhibition of 3H-thymidine incorporation in short-term cultures of rat bone marrow and murine myeloic leukemias. Ehrlich ascites tumour, spleen (mouse), lymphatic leukemia L1210 and melanoma AMel 3 (hamster) are not influenced under identical experimental conditions. Comparing the action of cell proliferation inhibitors (chalones) from Ehrlich ascites tumour and spleen lymphocytes it was shown that inhibition of 3H-thymidine incorporation occurs only with those cells corresponding to the origin of the inhibitor. Therefore, the described short-term cultures seem to be suitable for testing the tissue specificity of action, as the main criterion for authenticity of the chalone effect, at least in the case of granulocytic chalone.


Achilles tendon injury. II. Structure of tenotomized rabbit crural muscles after primary and delayed tendon suture. This investigation was designed to study the long-term effects of surgical treatment, as recommended and followed in clinical practice, on the fine structure of rabbit crural muscles after Achilles tenotomy. Two main results were made: (A) Even after 12 weeks of mobilization a number of morphological changes were found, especially in the soleus muscles. These abnormalities were similar to those found in human soleus muscles after surgically treated Achilles tendon rupture. (B) There were a large number of small heavily stained (for myofibrillar ATPase at pH 9.4) fibres in the experimental soleus muscles, such that the normal ratio of fibre types was reversed. This was apparent if tendon suture had been performed after a delay of 3 weeks. The results suggested that as a consequence of the de- and regenerative events, induced by immobilization or tenotomy plus immobilization, a number of new fibres had been formed. Some of these were so short that they were out of reach of nerve terminals and remained non-innervated. Furthermore, from the point of view of clinical practice, the extensive long-term effects of suture delay make themselves manifest not until at least a delay of one week.


The behaviour of some enzymes in the mouse liver due to chronic benzene intoxication. 1. Long trem benzene action brings about a permanent decrease in oxidoreductive enzymes and active transport as well as an inactivation of the lysosomal apparatus in liver-cells. 2. Particular liver lobule zones show different sensitivity to toxic action of benzene which might result from their different role in the processes of benzene biotransformation.


Electron microscopic localization of Mg2+ -dependent adenosine triphosphatase activity in the amphibian pancreas (Salamandra salamandra L. and Rana esculenta L.). The ultrastructural distribution of Mg2+ -dependent adenosine triphosphatase (ATPase) activity has been investigated in the salamander and frog pancreas by using glutaraldehyde fixations and a modified Wachstein-Meisel reaction medium. In both species the reaction product (lead phosphate) was found associated with the plasma membrane external side of all islet cell types (B-, A- and D-cells) and of acinar and ductular/centro-acinar cells. Except the apical pole of salamander acinar and centro-acinar cells, usually devoid of reaction, no preferential distribution of enzyme activity depending on endocrine or exocrine cell aspects could be observed. Other specific enzyme localizations included the mitochondria matrices, nucleoles, condensed nuclear chromatin, periaxolemmal spaces in nerve bundles and sometimes the cleft of neuro-glandular junctions. The occurrence of reaction deposits in connective tissue, in the cytoplasm of both islet and exocrine cells and in the nerve fiber axoplasm was considered as a possible diffusion artifact. The reaction intensity, but not its distribution, varied sensibly with the incubation period. 2-iodoacetamide and p-chlormercuribenzoic acid decreased the amount of reaction deposits at the level of all reactive sites and especially in mitochondria. The specificity of Mg2+ -ATPase demonstration in this paper is analysed taking into account several inherent shortcomings of the Wachstein-Meisel incubation medium and of the fixative. The different enzyme localizations, as well as their functional significances are discussed in relation with the findings of other authors.


Effect of intravenous calcium load on the serum calcium level in postmenopausal osteoporosis (a study of the pathogenesis, and diagnostic use of the test). Analysis of calcium tolerance in suggested to represent a valuable diagnostic aid in osteoporosis, particulary in the menopause. The serum calcium level was found to exceed 11.0 mg/dl 60 min after the intravenous injection of 3.6 mg per kg body weight of Ca++ in all patients with osteoporosis, while the level was normal at that point of time in every subject without osteoporosis, including patients with bone disease other than osteoporosis. Administration of norandrosterone decanoate or dehydroepinandrosterone to patients with menopausal osteoporosis resulted in normalization of the post-load hypercalcaemia. Calcium tolerance of menopausal patients without osteoporosis was not affected by dehydroepiandrosterone.


Morphology and enzyme activities of the retinal capillaries in mice with the obese-hyperglycaemic syndrome (gene symbol ob). The retinal capillary bed from 67 obese-hyperglycaemic mice and 64 lean litter mates was isolated by trypsin digestion and investigated with respect to structure and enzyme activities. There was no significant difference in the ratio between numbers of endothelial and mural cells. The capillary walls did not show any obvious structural differences and microaneurysms were not observed. The retinal vessels from the obese-hyperglycaemic mice, however, displayed significantly higher activities of the enzymes hydroxyacyl-CoA-dehydrogenase, asparate aminotransferase (ASAT) and adenylate kinase than their lean litter mates. The activities of glutathione reductase, glucose-6-phosphate dehydrogenase (G-6-PDH) and phosphofructokinase were similar in the two experimental groups. It is suggested that the present data reflect early metabolic disturbances related to diabetic retinopathy.


Histiocytosis X. IV--Immunologic response assessed by lymphocyte transformation tests. Eight children with histiocytosis X were investigated with reference to immunologic reactivity in vitro (PHA, PWM, Con-A and MLC testing). No significant impairment of immune function was detected, but a subnormal (statistically insignificant) response in the MLC test may suggest some abnormality of the T lymphocytes reacting against allogeneic cells. In a patient who relapsed a marked, but insignificant, increase in lymphocyte reactivity in vitro was observed.


Gray scale features of hematomas: an ultrasonic spectrum. Forty-eight B-scan ultrasound examinations were performed on 25 patients with hematomas. Hematomas are usually spherical or ovoid within the abdomen, and lentiform within the pleural space or abdominal wall. They generally decrease in size with time, and usually have irregular walls. Hematomas contain a variable amount of internal echoes during the first month, and then gradually become anechoic. The sonographic appearance is not specific; an abscess may have a similar appearance. An old, anechoic hematoma may contain a gelatinous material which cannot be aspirated.


Relationship of atrial fibrillatory wave amplitude to left atrial size and etiology of heart disease. An old generalization re-examined. It is commonly stated that coarse f waves in atrial fibrillation suggest the presence of rheumatic heart disease and large left atrial size, whereas fine f waves indicate non-rheumatic disease and small left atrial size. Using echocardiography as a more reliable indicator of left atrial size, 37 consecutive patients with chronic atrial fibrillation were evaluated. The correlation coefficients between left atrial size and maximum f wave amplitude was -0.12 and -0.07, using average f wave amplitude. Only 53 per cent (9 of 17) of patients with rheumatic heart disease had f wave greater than 1 mm. and 56 per cent (10 of 18) of patients with f wave size less than or equal to 1 mm. had non-rheumatic disease. This study refutes the contention that the f wave amplitude in atrial fibrillation is correlated with either left atrial size or etiology of heart disease. It is possible that an intra-atrial conduction defect is responsible for coarse f wave morphology.


Sampling the fetoplacental circulation. III. Combined laparoscopy-fetoscopy in the pregnant macaque for hemoglobin identification. To demonstrate increased technical experience with fetoscopy and fetal blood sampling, two groups of macaques were compared to control animals. Group 2 had a perinatal mortality rate that was not significantly different from that of the control group. A 2.7 mm. Hopkins rod lens endoscope encased in an eccentric cannula, 3.8 mm. outside diameter, was used. When compared to the earlier test group (Group 1), the later test group (Group 2) showed greater adequacy of the fetal blood sample for laboratory analysis (P less than 0.01). Anthropometric and hematologic data collected at term births compared favorably in test and control groups, with the exception of the white blood cell count, which was significantly lower with fetoscopy (P less than 0.01). This is the first report of experimental fetoscopy with the use of a control group to provide precise data to aid in clarification of the ethical issues yet unresolved in this technology.


Development of pulmonary arterial changes in rats fed Crotalaria spectabilis. The early changes in pulmonary artery structure and the timing and development of right ventricular hypertrophy were examined in rats after ingestion of Crotalaria spectabilis; the arteries were distended with a Micropaque--gelatin mixture. The earliest change, detected at Day 3, is the appearance of new muscle in normally nonmuscular arteries. Increased medial wall thickness of the normally muscular arteries is apparent from Day 7, reaching significance in the smaller arteries from Day 10 and in the larger arteries from Day 14. A reduction in number of small, filled peripheral arteries is apparent at Day 14 and is significant at Day 21 as is the increase in the ratio of alveoli to arteries per unit area of section. Right ventricular hypertrophy is detected and significant at Day 21 and, like all the arterial changes, continues to increase to Day 35. Hypoxia produces similar changes to those described above, although without the inflammation seen after Crotalaria ingestion, but the time table is different. New muscle appears in both models at the same time, but the other changes appear more slowly after ingestion of Crotalaria spectabilis.


Case report: mesangial IgA-IgG deposition in mixed cryoglobulinemia. Glomerular deposits of immunoglobulin A (IgA) (and immunoglobulin G [IgG]) has been described in IgA-nephropathy (Berger's disease), in anaphylactoid purpura, and systemic lupus erythematosus. The pathogenesis of mesangial IgA deposits in these disease states is unclear. Circulating immune complexes have been speculated to be involved although their existence in blood in IgA nephropathies have never been reported. We describe a 53-year-old man who presented with a petechial rash in lower extremities accompanied by painful swelling of left ankle and wrist. Polyclonal elevation of IgA and IgG in serum was found, along with cryoglobulins containing IgA and IgG (rheumatoid factor positive). After two years, hematuria, mild proteinuria, and active urinary sediment developed and renal biopsy revealed focal proliferative changes. Immunofluorescence revealed predominantly mesangial deposits of IgA and IgG but no IgM nor complement. This experience suggests that circulating complexes consisting of IgA and IgG may lead to renal lesions presenting clinically and histologically in a way similar to that commonly seen in IgA nephropathies.


The effect of EMG biofeedback on postoperative pain following abdominal surgery. To investigate the effects of electromyography (EMG)-biofeedback on pain experienced during the immediate post-operative period following abdominal surgery, twelve patients were randomly assigned to either (1) EMG-biofeedback from abdominal muscles; (2) EMG-biofeedback from the frontalis muscles; or (3) were given no EMG treatment. EMG training consisted on one pre-operative 30 minute session, and three 30 minute postoperative sessions. All patients were able to reduce EMG activity. A within-sessions analysis of pain reports (on a 0-10 pain intensity scale) indicated that EMG biofeedback is an effective method of pain relief only when feedback is given to the muscle site involved in the operation.


Hypoxia with a third flowmeter tube on the anaesthetic machine. Hypoxic mixtures of oxygen and nitrous oxide were demonstrated with three anaesthesia machines which had cyclopropane flowmeters. In one machine the bobbin did not prevent back flow and the hypoxic mixture occurred when the cyclopropane flow control was left open. Two other machines only delivered hypoxic mixtures if the cyclopropane bobbins were removed from their seats and the flow controls opened. The vaporizer on one machine increased the hypoxia when turned on.


Combination of Spigelian and Richter's hernias: a case report. Spigelian and Richter's hernias, individually, are both moderately rare. To encounter a patient having both of these surgical diseases as a single entity is indeed unique. Such a patient with an acute partial enterocele of cecum (Richter's hernia) strangulated in a lateral ventral musculoaponeurotic defect (Spigelian hernia) was successfully treated with wedge cecectomy and simple herniorraphy.


[Dietary protein levels, and experimental inflammation in the rat]. The inflammatory response was studied using the contents (mucopolysaccharides and collagen of granuloma induced by turpentine in rats fed for 28 days after weaning), with semi-synthetic, isocaloric diets containing 0, 3.5, 9, 26 or 81% protein in the form of casein or with a laboratory chow. When the wet and dry weights and the water content of the granuloma are expressed in absolute values they show a substantial drop when the protein intake is low or excessive. If however the wet weight of the granuloma is expressed per 100 g of body weight, the differences become no longer significant, hence the importance of the nutritional state of the animal at the time of investigation. Using this test of the anti-inflammatory action of substances, it is necessary to differenciate between actual anti-inflammatory action and direct or secondary effects of the substance on the growth and behaviour of the animal. The levels of mucopolysaccharide drop in rats fed on hypo or hyper-proteinic diets, this would seem to be a sign of the decrease in the intensity of the anti-inflammatory response. What is more, the collagen itself undergoes modifications; there is a shift towards greater solubility of the fractions which would seem to indicate that a drop or a increase in the protein intake brings about a change in the processes of reticulation and maturation of the collagen; several hypothesis can be put forward to explain this phenomenon.


[Researches on the physiopathologic effects of rapeseed oil with high and low erucic acid content]. The physiopathological effects were studied of a common high erucic acid rapeseed oil as well as of Janpol, a low erucic acid oil produced of a rapeseed variety selected in Poland. Its erucic acid content equals 2.8% of total fatty acids. The studies were carried out on white male Wistar rats, 25 days old at the beginning of experiment. These animals were divided into 6 groups fed the diets in which 10 or 20% of kcal well supplied either by high erucic acid rapeseed oil, by Janpol rapeseed oil, or by the sunflower oil. The experiment lasted 6 months. Following parameters were determined: increase in body weight, the weight of selected organs, blood serum alkaline phosphatase and pseudocholinesterase activities, blood serum cholesterol and triglycerides level, the content of corticosterone in the adrenal glands and blood plasma. The liver was studied histochemically for the activity of acid and alkaline phosphatases and of ATP-ase, as well as for the presence of lipids. Morphological studies of the myocardium comprised macroscopic, histological and electron microscopic investigation. The low erucic acid rapeseed oil Janpol seems to evoke less disturbances than the high erucic acid one. Supplied in the amount corresponding to 10% of total calories intake the former exerts the effect on the biochemical and morphological parameters similar to that of sunflower oil. It can be thus assumed that the low erucic acid rapeseed oil Janpol can be used in the feeding of man when served in the amount lower than 10% of total calories.


Isolation and identification of the cytoplasmic membrane from Saccharomyces carlsbergensis by radioactive labeling. The cytoplasmic membrane of Saccharomyces carlsbergensis was isolated by enzymatic digestion of the yeast cell wall, followed by lysis of the protoplasts and fractionation by ultracentrifugation in a discontinuous sucrose density gradient. Location of the cytoplasmic membrane fraction on the sucrose gradient was made by labeling intact protoplasts with [G-3H]dansyl chloride, and was settled at the 50% (wt/vol) sucrose gradient (d = 1.186 g/cm3). Approximately 80% of the radioactivity was found in the membrane fraction prepared in the presence of Mg2+ ions. However, when protease inhibitors were used in the preparation step, the membrane fraction contained over 90% of the total radioactivity. The presence of Mg2+ ions during membrane isolation and purification enhanced the aggregation of membrane components but, at higher concentrations, as well as in the prolonged presence of Mg2+ ions in the membrane suspension, it caused the breakdown of membrane components. The membrane preparation contained Mg2+-adenosine triphosphatase, which was insensitive to oligomycin and ouabain. The distribution of Mg2+-adenosine triphosphatase in different fractions during sucrose gradient is reported.


[Alopecia areata and trisomy 21. About 2 cases (author's transl)]. Two cases of alopecia areata coexisting with trisomy 21 are reported. In the first case, the two diseases were associated with Hashimoto's thyroiditis and in the second, with vitiligo. Pathogenic implications are discussed.


[Malignant atrophying papulosis (Degos' disease) (author's transl)]. From 74 observations, 55 p. 100 of which caused death by intestinal lesions, the author searches, through the symptomatology of the disease, for possible factors of prognosis. No relation between the importance of cutaneous symptoms and the appearance of intestinal symptoms has been found. There is no constancy in the chronological evolution of the lesions. The interest of laparoscopy is emphasized. No biological constant seems specific of the disease. A few modest arguments are suggestive of an auto-immune disease. In spite of a varied range of therapeutic orientations, none of them could prove to be efficient, not even heparinotherapy.


Iodochlorhydroxyquin-hydrocortisone treatment of fungal infections. Double-blind trial. A double-blind multicenter study compared the antifungal effectiveness of an iodochlorhydroxyquin-hydrocoritsone cream with that of its individual components in 354 patients with cutaneous fungal infections. After seven days of treatment, the combination was considerably better than hydrocortisone or the cream vehicle with respect to erythema, scaling, itching, and patients' and physicians' evaluations. The proportion of patients in the iodochlorhydroxyquin-hydrocortisone and iodochlorhydroxyquin groups who changed from positive results on potassium hydroxide examination at baseline to negative results on potassium hydroxide examination after treatment was significantly greater than that in the hydrocortisone and placebo groups. The conversion rate associated with the iodochlorhydroxyquin-hydrocortisone and the iodochlorhydroxyquin treatments was significantly different from that associated with hydrocortisone alone or placebo treatment.


Zinc sulfate in acne vulgaris.

Zinc sulfate in acne vulgaris. The effects of orally administered zinc sulfate in 52 patients with mild to moderate acne vulgaris were compared to those of a placebo capsule. The numbers of comedones, papules, pustules, infiltrates, and cysts were counted at each visit over a 12-week period. Forty patients completed the study. Zinc appeared to have a somewhat beneficial effect on pustules but not on comedones, papules, infiltrates, or cysts. Fourteen patients (50%) in the zinc group had side effects of nausea, vomiting, or diarrhea. Six patients (21%) in the zinc group could not tolerate the nausea and withdrew from the study.


Florid cutaneous papillomatosis.

Florid cutaneous papillomatosis. The abrupt onset of acanthosis nigricans (AN) or of multiple seborrheic keratoses in middle-aged or older people is often associated with underlying malignant neoplasms. We describe a 64-year-old woman who developed a large number of verrucous papillomas on the trunk and extremities, followed within a few months by the sudden appearance of both the lesions of AN and those of multiple seborrheic keratoses. Laparotomy disclosed a gastric adenocarcinoma. A number of similar cases have been described in the literature. It is emphasized that patients with suddenly appearing verrucous papillomas should be examined carefully for an underlying cancer. To call attention to this eruption, which may be mistaken for generalized warts, we suggest the term "florid cutaneous papillomatosis".


Familial comedones. Evidence for autosomal dominant inheritance. Thirteen members of a family had multiple comedones. Three other relatives were also ascertained to be affected. This peculiar dermatosis affected both sexes and was present in one individual as young as 10 years of age. The lesions were more numerous in male family members, increasing in number with age. The pedigree showed a definite pattern of autosomal dominant inheritance.


Urticarial vasculitis: report of a case and review of the literature. A woman with cutaneous vasculitis had a severe bullous eruption that was suggestive of erythema multiforme. The patient also had a history of recurrent urticaria that continued intermittently for over a year of follow-up examination. Skin biopsy specimens of both urticarial and erythema and multiforme lesions showed leukocytoclastic vasculitis. An illness resembling systemic lupus erythematosus (SLE) is suggested by transient, low-titer, positive antinuclear antibody tests, persistent deposits of immunoglobulin and complement in normal skin, arthralgias, circulating immune complexes, and chronic hypocomplementemia. This case is similar to cases previously reported as "hypocomplementemic vasculitis," an "unusual SLE-related syndrome," and "urticaria with vasculitis."


Autogenous profundaplasty: The key to long-term patency in secondary repair of aortofemoral graft occlusion. The records of 281 patients undergoing aortic grafting to 522 femoral arteries over a period of 18 years were reviewed. Fifty-four patients suffering graft limb occlusion to 71 femoral arteries requiring subsequent secondary repair were identified for detailed analysis. Occlusive disease of the profunda femoris artery was identified as the primary cause of thrombosis. Repair consisted of profunda femoris angioplasty, and transfemoral retrograde graft thrombectomy was possible in all but three instances which were managed by cross-over femoral-femoral bypass. In no instance was laparotomy and abdominal graft replacement necessary. The 30 day operative survival and graft patency were 100%. Analysis of factors that have influenced late graft patency demonstrated that the key factors were the method of profundaplasty and the association of diabetes mellitus. When autogenous profundaplasty (on-lay arterial patches, saphenous vein, or limited endarterectomy) was employed, the overall patency combining diabetics and non-diabetics was two and one-half times greater than when profundaplasty was performed with an on-lay Dacron((R)) patch. If diabetics were separated from nondiabetics in the autogenous angioplasty group, the 36 month patency for non-diabetics was 85%, and 0% for diabetics. We conclude that autogenous profundaplasty provides considerable advantage from the standpoint of long-term patency and that the diabetic patients are relatively poor candidates for secondary arterial repair of an occluded aortofemoral bypass graft.


6-Chloro-2(1-piperazinyl) quinoxaline (CPQ): action on serotonin-induced behavioral responses and interactions with chloromethamphetamine and dimethyl-meta-tyramine. 6-Chloro-2(1-piperazinyl) quinoxaline (CPQ) was examined pharmacologically and biochemically as an inhibitor of the neuronal reuptake of serotonin, dopamine and norepinephrine. The compound was 25-50 times more potent than chlorimipramine in potentiating the head-twitch response to 5-hydroxytryptophan (5-HTP) and in antagonizing p-chloromethamphetamine (PCMA)-induced depletion of brain serotonin in rats. CPQ also potentiated the forepaw clonus produced by 5HTP in rats and antagonized PCMA-induced head twitches. At dose levels 30 times those necessary to significantly affect serotoninergic systems, CPQ was ineffective in antagonizing either tetrabenazine-induced sedation in mice or the depletion of rat brain and heart norepinephrine or brain dopamine produced by 4, alpha-dimethylmeta-tyramine (H77/77). The data indicate that CPQ exhibits a high degree of potency and selectivity in inhibiting the neuronal reuptake of serotonin.


Possible mechanisms of sustained tremor induction by nicotine in pilocarpine treated animals. Alterations of steady state and metabolism of putative neurotransmitters were studied in the brain of rats with a sustained tremor evoked by nicotine and pilocarpine. The norepinephrine content in several brain regions was decreased whereas striatal dopamine was unchanged. Homovanillic acid concentrations were slightly increased, while 5-hydroxyindoleacetic acid concentrations were markedly increased. Pilocarpine alone increased the 5-hydroxytryptamine (5-HT) turnover rate at high ambient temperature (30-32 degrees C), but not at normal ambient temperature (22 +/- 2 degrees C), atropine partially blocked the increase of 5-HT turnover rate by pilocarpine. Pretreatment with p-chlorophenylalanine and hemicholinium-3 decreased the tremor intensity elicited by nicotine and pilocarpine . It is proposed that the increase of cholinergic function caused by nicotine and the activation of muscarinic receptors and the increase in 5-HT function caused by pilocarpine might be involved in the mechanisms of tremor induction by nicotine and pilocarpine.


Differential deoxyribonucleic acid synthesis during microcycle conidiation in Neurospora crassa. In conidia of Neurospora crassa germinating at 25 degrees C, DNA synthesis measured by incorporation of tritiated adenosine reaches a maximum soon after the outgrowth of the germ tube (6--7 h after inoculation). In conidia heat-treated at 46 degrees C (for 15 h), a maximum of incorporation of the DNA precursor occurs already 1 h after inoculation, then the incorporation progressively declines until the end of the heat-shock. When such conidia are shifted to 25 degrees C, a maximum of DNA synthesis occurs during the development of the presumptive conidiophore as at the outgrowth of normal germ tubes. This wave of DNA synthesis is followed by a second maximum of DNA synthesis, occurring only in the microcyclized cultures, when the premature differentiation of proconidia takes place. Prevention of this second wave of DNA synthesis with hydroxyurea or 5-fluorodeoxyuridine respectively reduces or fully inhibits such induced conidial differentiation.


Stress management training for the handicapped. Stress Management Training (SMT) is described for teaching handicapped patients the use of relaxation as a coping skill. The procedure combines progressive muscle relaxation and clinical meditation into a standardized but flexible 8-session protocol. The training consists of 3 components: First, the patient is given a cognitive understanding of stress and relaxation. Second, the patient is taught to relax by controlling muscle tension and sympathetic activation. Third, the patient adapts the relaxation skill to real-life stress situations. Case reports demonstrating the process are included. Methods of assessing outcome and adaptations for particular handicaps are described.


[Histochemical data on changes of various indicators of protein metabolism in the myocardium beyond the infarct zone]. Changes in some values of protein metabolism in the heart muscle (the activity of myosin ATPase, leucilaminopeptidase, glutamate dehydrogenase, as well as the content of SH-groups, urea, RNA and DNA) were studied by histochemical methods in the parts of the myocardium remote from the zone of the ligated coronary artery. Disorders in the metabolism of nucleic acids were found to consist in nuclear polymorphism and in the development of regressive changes in some nuclei down to necrobiosis as well as in a decrease of the RNA content within the first 12 hours after ligation of the coronary artery. Subsequently, the amount of RNA increased. An increase in the amount of SH-groups, in the activity of leucilaminopeptidase and a decrease in the amount of glutamate dehydrogenase, formation of crystals of xanthhydrolurea as well as in increase in the activity of myosin ATP-ase early in the experiment attest to the occurrence of heterogeneous disorders of protein metabolism in parts of the myocardium beyond the infarction zone.


[Mechanisms of carcinogenesis associated with DNA repair]. The paper presents data from the literature and the author's own materials on the correlation between the extent of activity of reparation processes and the development of cell malignization. A review cites the results of investigations on the molecular mechanisms in some hereditary human diseases in which a defect in some stages of the reparation processes has been found (xeroderma, ataxia telangesthesia. Fanconi anemia, Down's syndrome, etc.). These diseases are also characterized by a high rate of neoplasia development. It is emphasized that inhibition of the reparation process is observed only in the first stages of normal cell transformation into a malignant one. A correlation between carcinogenic and mutagenic activity of chemical compounds which is in favour of the mutation hypothesis of the origin of tumours is discussed.


Orthopaedic pitfalls.

Orthopaedic pitfalls. When presented with an orthopaedic problem, rational management cannot occur without a reasonable diagnosis. Such a diagnosis can only be made by listening to the patient's history, and by examining him with a clear knowledge of important and relevant anatomy. Such relevant anatomy has been outlined in order to make sense of the symptom complexes in: --arm pain --knee pain --back pain without sciatica --back pain with sciatica The behaviour of collagen, which takes three weeks to heal and at least three weeks more to strengthen, is the basis of rational treatment of ligamentous injuries. Advice is given on specific situations to avoid the pitfalls of treatment which is too much, too little, too late or too soon.


Isolation and properties of brain alpha-actinin. alpha-Actinin isolated from bovine brain migrated on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis like muscle alpha-actinin with an apparent mol.wt. of 100000 and cross-reacted with antibodies to muscle alpha-actinin. Brain alpha-actinin modulated actin-myosin Mg2+-activated adenosine triphosphatase activity and, when bound by polystyrene particles, was found to bind muscle actin and tropomyosin from solution. Brain alpha-actinin, in conjunction with the other components of the contractile and relaxing complex, may play a role in the release of neurotransmitters from synaptic vesicles.


Studies of immune functions of patients with systemic lupus erythematosus. I. Dysfunction of suppressor T-cell activity related to impaired generation of, rather than response to, suppressor cells. T cell suppressor function in patients with systemic lupus erythematosus (SLE) was evaluated by studying the ability of concanavalin A- (Con A) activated T cells to suppress proliferative responses by responder cells autologous with the Con A-activated T cells. Impaired suppressor T-cell activity in patients with SLE was observed with regard to three effector functions: 1) the allogeneic response of T cells, 2) the Con A response of T cells, and 3) the B cell response to pokeweed mitogen (PWM). No defect was found with regard to suppression of the T-cell response to phytohemagglutinin (PHA). Mixing experiments between SLE and normal cells were carried out to further define the nature of the SLE suppressor defect. When responder cells from SLE patients were cultured with Con A-activated T cells from normal controls, the normal suppressor T cells caused suppression of SLE responder cells. In contrast, Con A-activated T cells from SLE patients were incapable of exerting suppressor effects on normal responder cells. These observations indicate that the impaired suppressor activity in SLE patients resides in the generation of suppressor T cells, rather than in the response to suppressor T cell signals.


Mixed lymphocyte reaction in healthy women with rheumatoid factor. Lack of association with HLA-Dw4. In independent studies, 51% and 36% of patients with rheumatoid arthritis have been shown to possess HLA-Dw4 compared to 7% and 13% of controls. In one study Dw4 positive patients more frequently had rheumatoid factor in their sera than did Dw4 negative patients. In order to determine if the Dw4 specificity is associated with the disease or with the presence of rheumatoid factor, the frequency of this HLA antigen has been determined in 24 healthy women known to have rheumatoid factor (median titer 1:160). Only 3 were found to have the Dw4 specificity, suggesting that this specificity is not associated with rheumatoid factor in the absence of rheumatoid arthritis.


Testosterone production with hydatidiform moles--in vitro and in vivo studies. Fresh molar tissues obtained from seven patients were incubated in vitro with dehydroepiandrosterone and androstenedione. The testosterone concentration in molar tissue ranged from 5.4 ng/g wet weight to 43.8 ng/g wet weight. Both precursors were readily converted to testosterone indicating that 17-hydroxysteroid dehydrogenase and 3beta-hydroxysteroid dehydrogenase are present in molar trophoblast. A 50 mg dose of dehydroepiandrosterone was infused into patients with hydatidiform mole before and after uterine evacuation. There was a testosterone peak preceding an oestrogen rise which disappeared after uterine evacuation. It is suggested that the elevated testosterone level in molar pregnancy is mainly due to the conversion of dehydroepiandrosterone in the molar trophoblast.


Ionic charge on phospholipids and their interaction with the mitochondrial adenosine triphosphatase. The activity of the lipid-depleted, oligomycin-sensitive mitochondrial ATPase has been measured in the presence of liposomes prepared from mixtures of phosphatidylglycerol and phosphatidylglycerol lysine. Enzyme activity increased linearly with an increase in the negative charge of liposomes prepared from the phosphatidylglycerol-phosphatidylglycerol lysine mixtures. The electrophoretic mobility and activating capacity of liposomes of several other phospholipids were determined. A linear relationship between electrophoretic mobility of the liposomes and oligomycin-sensitive activity was again apparent. These observations demonstrate that the activity of the ATPase is directly proportional to the ionic charge on phospholipid activators if the acyl chain composition of the phosphoglycerides is relatively constant.


Modification of high molecular weight plasmic degradation products of human crosslinked fibrin. The predominant high molecular weight products of plasmic digestion of human crosslinked fibrin Fragments DD, E and (DD)E complex were purified by column gel filtration in a non-dissociating buffer or by ion-exchange chromatography on DEAE-cellulose. The structure of the degradation products was studied by proteolytic degradation, polyacrylamide gel electrophoresis immunodiffusion and sucrose density gradient centrifugation. Unaltered derivatives were very resistant to proteolytic degradation by plasmin. In the the presence of 10 mM EDTA the (DD)E complex did not dissociate, but similar to Fragment DD, became susceptible to plasmic degradation forming Fragment D derivatives. The (DD)E complex dissociated in 3 M urea at pH 5.5, had an altered conformation as evidenced by its aggregability and by its increased susceptibility to degradation by plasmin resulting in the formation of Fragment d. The gammagamma chain remnants of Fragment DD were attacked first, followed by cleavage of the beta chain remnants. It is concluded that plasmin resistance is a function of the intact structure and it is not directly dependent on the presence of the crosslink bonds or calcium ions.


Cross-linking of the (Ca2+ + Mg2+)-ATPase protein. The addition of cupric-1,10,-phenanthroline, a cross-linking catalyst, to sarcoplasmic reticulum membranes caused protein sulfhydryl groups to form disulfide bridges. Following a short exposure to the catalyst (15 s, 22 degrees C) most of the protein was in a dimeric form (Mr = 248 000). Longer exposure times resulted in the formation of trimers, tetramers and other oligomers too large to enter the gel. At low temperatures (4 degrees C) dimer formation predominates even for exposure times as long as 5 min. Cross-linking in the presence of 7.5 mM Triton X-100 (a concentration that resulted in clearing of the membrane suspension and thus solubilization of the membrane components) showed the appearance of a considerable dimer fraction, however, most of the (Ca2+ + Mg2+)-ATPase protein appeared as a monomer. Following 1 min of cross-linking at 22 degrees C, freeze-etched membranes showed no alteration in the number or appearance of 80 A intramembranous particles. Thus extensive cross-linking of the (Ca2+ + Mg2+)-ATPase protein can occur without disruption of the normal position of the intramembrane portion of the molecule.


Chemistry of heparitin sulfate and heparin from normal tissues and from patients with Hunter syndrome. Some structural features of heparitin sulfate excreted by patients with Hunter syndrome are described. It is shown, with the aid of heparitinases and heparinase from Flavobacterium heparinum, that the Hunter heparitin sulfate is a very complex structure composed of nine different disaccharide units containing regions akin to normal heparitin sulfate and regions akin the heparin. Two-thirds of the iduronic acid residues of Hunter heparitin sulfate are devoid of sulfate, contrasting with heparin in which most of the iduronic acid residues are sulfated. The isolation and characterization of the non-reducing ends of heparin and of the heparitin sulfates is also described. Based on these results the specificity of the heparinase and heparitinases as well as the biosynthesis of iduronic acid-containing heparin-like compounds is discussed.


[Esterase activity of the mitochondria oligomycin-sensitive ATPase complex]. It was found that mitochondrial oligomycin-sensitive ATPase (OS-ATPase) possesses the esterase activity with respect to some carboxylic acid esters with phenols and arylalcane alcohols. The substrate specificity of the esterase found was studied. The effects of some inhibitors and activators of ATPase on the enzyme activity were demonstrated. It was found that ADP inhibits the enzyme from submitochondrial particles containing factor F1 and does not inhibit the enzyme from the particles devoid of this factor. The data obtained suggest that esterase is localized in the hydrophobic part of the oligomycin-sensitive ATPase complex and are indicative of the functional interrelationship between the esterase and ATPase activities.


[Inhibition of mitochondrial ATPase by water-soluble carbodiimide]. Modification of the carboxyl group with pK 6,8-7,0 of isolated factor F1 by N-cyclohexyl-N'-beta-(4-xethylmorpholine) ethylcarbodiimide (CMCD) leads to the inhibition of the ATPase activity of the enzyme. The reaction rate of factor F1 with CMCD drops in the presence of ATP. It has been shown that during the first stage of the reaction reversible binding of CMCD with factor F1 occurs, forming a stable "enzyme--inhibitor" complex (Kdis=2.10(-4) M). N-cyclohexyl-N'-beta-(4-methylmorpholine) ethylcarbamide, a close analog of CMCD, is a competitive inhibitor of the ATPase reaction with Ki=9.10(-4) M. It is assumed that the carboxyl group, which reacts with CMCD, is located in the catalytic site of factor F1 and serves as the ligand of Me2+ in binding the substrate of the ATPase reaction Me-ATP. The reaction of factor F1, which was modified by CMCD, with proflavine, is accompanied by the covalent binding of the fluorescent label to the enzyme. The binding of proflavine to factor F1 leads to a sharp drop in the solubility of the enzyme in water.


[Purification and properties of plasminogen activator from human blood plasma after sudden death]. Plasminogen activator from human blood plasma after sudden death was isolated and purified 60-90-fold by precipitation with ammonium sulfate, ZnSO4 and ethanol as well as by chromatography on DEAE-Sephadex A-50 and gel--filtration through Sephadex G-200. The resulting enzyme had specific activity of 110-210 units per mg of protein. The enzyme prepartion possessed no plasmin activity; total content of carbohydrates was 2.4-2.5%; that of syalic acids--1.2-1.3%. The enzyme was found heterogeneous during disc electrophoresis in 7.0% polyacrylamide gel and corresponded in its mobility to beta-globulins of blood plasma. Molecular weight of enzyme as determined by gel-filtration through Sephadex G-200 is 70000. The isoelectric point lies at pH 6.2.


[Conformational changes in soluble mitochondrial ATPase by the spin probe method]. Modification of soluble mitochondrial ATPase (factor F1) by spin-labelled iodoacetamide and spin-labelled methyleneketone does not cause and change in the catalytic properties of the enzyme. The temperature dependence of tau corr. of labels bound to factor F1 testifies to conformational changes in the enzyme at temperatures of 18--20 degrees C and 34--37 degrees C. At these temperature intervals, breaks are observed in the temperature dependence of the ATPase reaction rate in the Arrenius plot. The results obtained indicate that the thermally induced conformational changes in factor F1 affect large areas of the protein molecule. The interaction of factor F1 with the hydrophobic spin probes, namely fatty acid derivatives, was studied. It was shown that the interaction of foctor F1 with Mg2+, Mg-ATP, Mg-ADP and ADP, results in an increase in the ability of the enzyme to adsorb spin probes.


Turnover of antiplasmin, the fast-acting plasmin inhibitor of plasma. Human antiplasmin, the fast-acting plasmin inhibitor in plasma, was purified to homogeneity and labeled with 125I. This material, which was indistinguishable from antiplasmin in plasma with respect to several physicochemical and functional properties, was injected intravenously and its turnover measured in control subjects and in patients undergoing thrombolytic therapy. In eight control subjects (four healthy persons and four patients with atherosclerosis), the following turnover characteristics were obtained: plasma radioactivity half-life 2.64 +/- 0.32 days, fractional catabolic rate 0.53 +/- 0.09 of the plasma pool per day, intravascular fraction 0.51 +/- 0.05, and synthetic (catabolic) rate 1.4 +/- 0.27 mg/kg/day. The half-life of the plasmin-antiplasmin complex in plasma, measured from the disappearance rate of labeled antiplasmin, plasmin or plasmin-antiplasmin complex during thrombolytic therapy was approximately 0.5 days.


Nature of the calcium regulatory system of bovine arterial actomyosin. A calcium-sensitive actomyosin was prepared from bovine aortic muscularis. The results of applying filament displacement tests indicate that bovine arterial actomyosin possesses predominantly a calcium regulatory system associated with the myosin filament, but also may possess a calcium regulatory system associated with the filament. Calcium binding to highly purified myosin preparations could not account for the calcium binding to calcium-sensitive actomyosin. A calcium-insensitive actomyosin preparation, prepared by omitting dithiothreitol from the isolation procedure, showed a definite loss of tropomyosin but no change in calcium binding relative to the calcium-sensitive actomyosin.


[Hormonal dynamics during pregnancy: critical discussion and clinical interpretations]. Although the clinical interpretation of its results varies greatly among perinatologists, the dehydroepiandrosterone sulfate (DHEA-S) loading test has become an integral part of fetal monitoring in many centres dealing with high-risk pregnancies. Currently four main metabolic responses to administration of DHEA-S to the mother are monitored to predict the functional state of the fetoplacental unit: the metabolic clearance of DHEA-S, the metabolic clearance of DHEA-S into estradiol, the conversion of DHEA-S into estradiol or esterol, and the increase in the plasma concentrations of DHEA and androstenedione after administration of DHEA-S. This article critically reviews each of these responses and its possible clinical interpretation, and assesses the clinical future of the DHEA-S loading test.


In vitro functional studies of mononuclear cells in patients with CLL: evidence for functionally normal T lymphocytes and monocytes and abnormal B lymphocytes. In vitro functional studies of mononuclear cells from 34 patients with B-cell type CLL were investigated and the results of these studies were as follows: 1) The T lymphocytes from patients with CLL were capable of responding normally to PHA or PWM, of inducing allogeneic normal B lymphocytes to respond to these mitogens and of stimulating normally to allogeneic lymphocytes in "one-way" mixed lymphocyte reaction; 2) The monocytes from these patients were capable of enhancing the T lymphocyte response to mitogens and of stimulating normally to allogeneic lymphocytes; and 3) The leukemic B lymphocytes were incapable of responding to mitogens even in the presence of normal T lymphocytes and their enhancer cell activity on T lymphocyte response or their stimulating capacity on allogeneic lymphocytes was depressed. These observations suggest that the T lymphocytes and monocytes from patients with CLL are functionally normal while the leukemic B lymphocytes from these patients are functionally abnormal.


Comparative trial of low-dose adriamycin plus cyclophosphamide with or without additive hormonal therapy in advanced breast cancer. We treated 56 women with advanced metastatic breast cancer who had not received prior chemotherapy in a comparative trial of cytotoxic chemotherapy with low-dose adriamycin plus cyclophosphamide alone or in combination with the androgenic steroid calusterone. The response rate to chemohormonal therapy (65%) could not be shown to be statistically better than that for chemotherapy alone (53%) for this size patient population. However, the median remission duration (21.5 months) was significantly prolonged over the 11.5-month remission duration for chemotherapy alone (p = 0.03). The median survival of the chemohormonal therapy group was 23.5 months, whereas that for chemotherapy alone was 13.5 months (p = 0.05). These results indicate that the addition of a potent hormonal agent to effective cytotoxic chemotherapy improves the results of treatment of women with metastatic breast cancer.


Immunity to cell surface antigens and immune complex glomerulonephritis in hamsters bearing human epithelial tumors. A glomerulopathy in hamsters bearing human epithelial tumors is described. The tumors resulted from the s.c. implantation of human heteroploid cells (MA160) derived originally from a benign prostatic adenoma. The renal immunomorphological and ultrastructural changes include expansion of mesangial matrix and cellularity, electron-dense mesangial deposits, and mesangial deposits of immunoglobulin G and C'3. Renal eluates obtained from the tumor-bearing animals contained substantial amounts of immunoglobulins. Our immunopathological studies demonstrated that virtually all of the eluate immunoglobulin G was tumor-specific antibody directed exclusively against surface determinants of the MA160 cells. There was no demonstrable activity against cytoplasmic or nuclear constituents of the MA160 cells or against certain hamster antigenic determinants. The antibody in the eluate could be removed by repetitive absorptions with viable MA160 cells but not with similar absorptions with either normal human diploid fibroblasts, human heteroploid HeLa cells, or BHK21 hamster cells. Our data support the concept of a specific nephritogenic immunopathological process occurring as a result of immunity to tumor-specific surface determinants.


Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size and pump function. Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size has been reported only once previously [3]. We now present a 13-month-old patient with severe and progressive congestive heart failure who demonstrated normal ventricular cavity size with biatrial enlargement. Ejection fraction and echocardiographic ventricular function studies were normal.


Certification of smallpox eradication.

Certification of smallpox eradication. The world's last known case of smallpox resulting from human-to-human transmission in an endemic focus occurred in Somalia in October 1977, and there remains the task of documenting the global eradication of the disease and establishing the safety of vaccination. Those countries as yet uncertified have been grouped into four categories according to the procedures recommended for their certification. An important criterion for deciding the type of procedure is how recently smallpox was endemic in a particular country. This paper is concerned with those countries in which the disease has been nonendemic for some years but which have not yet received certification of eradication. One such country is Burma, which was certified free of smallpox in 1977, some 8 years after its last reported case but 2 years after the last case in Bangladesh, with which it shares a long frontier. The procedures used in Burma and the lessons that were learnt therefrom are described.


Control of trachoma and prevention of blindness in rural communities in Burma. Trachoma was identified as the single most important cause of blindness in central Burma in a study carried out in 1961-1962. Control measures started in 1964 considerably reduced the degree of endemicity and severity of the disease in the areas treated. According to recent simplified criteria of evaluation, the prevalence of active trachoma has been reduced by more than 60% and that of active inflammatory disease of moderate and severe intensity from 7.4% to 1.8% of the active cases. A reduction in the risk of becoming infected is evident from changes that have occurred among the younger age groups.The experience acquired by the trachoma control project in central Burma-covering a population of more than 4 million in 8000 villages-emphasizes the importance of the active participation of the community and the role of local auxiliary personnel. Most of the activities, including surgical repair of trichiasis, are the responsibility of health assistants; their training includes, in addition to the recognition and treatment of patients requiring topical application of antibiotics or surgical repair of trichiasis, the screening and referral to the general practitioner or to the eye specialist of those needing more specialized attention.The results already obtained have made possible a gradual replacement of control activities by a surveillance programme, and their integration into the basic health services. The objectives of the trachoma control programme have been expanded to include the prevention and management of other causes of preventable or curable blindness, with special emphasis on eye injuries and glaucoma.


Instantaneous transmitral blood flow and anterior mitral leaflet motion in man. Transmitral blood flow was measured in man by numerical differentiation of left ventricular volume as a function of time in 11 patients undergoing cardiac catheterization. Using this technique, transmitral blood flow may be studied in a variety of pathologic states without the need for surgically introduced flowmeters. Just before left ventriculography, echocardiography of the mitral valve was performed. The pattern of transmitral blood flow was strikingly similar to the diastolic movement of the anterior mitral leaflet. At any equivalent diastolic filling time, the percent of the integrated area beneath the curve inscribed by the diastolic anterior mirtal leaflet echoes closely approximated the percent of stroke volume which had entered the left ventricle. This observation supports the hypothesis that mitral leaflet motion accurately reflects transmitral flow. Consequently, at a given time during diastole, the relative velocity of transmitral flow and the percent of the stroke volume which has entered the left ventricle may be approximated noninvasively from the anterior mitral leaflet echogram.


[Beckwith Wiedemann syndrom (author's transl)]. In connection with four new observations and a revue of 82 cases published the mains features of Beckwith-Wiedeman syndrom are described insisting on the neonatal troubles of the glycoregulation upon the structural development of the childrens and on the pathologics associations.


Prenatal monitoring for the Hunter syndrome: the heterozygous female fetus. An abnormal level of 35S-sulfate labeled mucopolysaccharides was found in cultured amniotic fluid cells from a pregnancy, at risk for the Hunter syndrome, with a female fetal karyotype. Subsequent prenatal analyses suggested heterozygosity for the X-linked Hunter syndrome, and this was confirmed by clonal analysis of fibroblasts of the child after birth. The possible implications of abnormal biochemical results in association with a female karyotype in the prenatal diagnosis of the Hunter syndrome are discussed.


The use of laparoscopy in gynaecology.

The use of laparoscopy in gynaecology. Diagnostic laparoscopy is of most value in the evaluation of infertility and for completing the gynaecological investigation of obscure cases of chronic pelvic pain. Its use to exclude ectopic pregnancy, salpingitis and pelvic cancer is more controversial. The management of some cases of primary amenorrhoea is aided by laparoscopic gonadal biopsy. The excessive demand for female sterilization will ensure that the laparoscope continues to be used for this purpose and is leading to a compromise. The surgical techniques which have been proved to be most effective are being replaced by methods favoured for their potential reversibility and rapid patient turn-over. If all our laparoscopes were abandoned, gynaecological surgery would perhaps not suffer a major setback, but, for the present, those who neglect laparoscopy are losing an important dimension of modern practice.


Hearing loss in Down's syndrome. A treatable handicap more common than generally recognized. Significant hearing loss was found in about two-thirds of a series of 107 individuals with Down's syndrome. Hearing loss of that degree causes retardation of speech, language and intellectual development in normal children. Down's children are presumably affected even more by this sensory deprivation and without correction are prevented from reaching their full potential.


Photocontact dermatitis to hydrocortisone. A patient was found to have a delayed positive patch test to hydrocortisone on multiple testing. This proved to be due to a photoallergy with an action spectrum in the UV-A range. The patient coincidently had a polymorphous light eruption in the UV-B range.


Coolant oil dermatitis due to ethylenediamine. Two outbreaks of hand dermatitis in light engineering works are reported. In both cases a number of workers shown to be allergic to soluble coolant oils were found to be allergic to ethylenediamine, which had either been incorporated into the oil or had been added to it later.


Asymmetric septal hypertrophy in patients on long-term hemodialysis. Echocardiographic studies were performed in 23 hypertensive patients who were receiving therapy with long-term hemodialysis. Five patients (22 percent) had normal thickness of the left ventricular wall. Eleven (48 percent) had symmetric left ventricular hypertrophy, and seven (30 percent) showed asymmetric septal hypertrophy, with a ratio of septal to posterior wall thickness of 1.3 or greater. The latter group differed from patients with hypertrophic cardiomyopathy in that patients on long-term hemodialysis had a dilated left ventricular dimension, a relatively normal diastolic slope of the mitral valve, absence of systolic motion of the mitral valve, and a septal to posterior wall ratio of less than 1.5. A high incidence of asymmetric septal hypertrophy in this and other studies indicates that this condition is not specific for hypertrophic cardiomyopathy. We suggest that in addition to asymmetric septal hypertrophy, the diagnosis of hypertrophic cardiomyopathy should be made in the light of the clinical picture, as well as other echocardiographic features.


Loculated interlobar air-fluid collection in congestive heart failure. Two patients are described who had congestive heart failure with loculated interlobar air-fluid collections. Although pseudotumor (interlobar effusion) is a well-known finding in congestive heart failure, the additional presence of air is unique. Both are somewhat related to the underlying failure.


Mirrow reactions of Down's syndrome infants and toddlers: cognitive underpinnings of self-recognition. To examine the developmental significance of mirrow self-recognition in early childhood, a cross-sectional study with 55 Down's syndrome children was conducted. When their image is altered by rouge on the nose, normal infants by 22 months indicate self-recognition by touching their noses while looking in the mirror. Only a small percentage of Down's syndrome children touched their noses by this age, confirming the expected lag in this development. However, those young Down's syndrome infants with near-normal development quotient did manifest the reaction. In general, when developmental age was equated, the Down's syndrome children showed parallel development to normal children.


A new biochemical subtype of the Sanfilippo syndrome: characterization of the storage material in cultured fibroblasts of Sanfilippo C patients. Fibroblasts cultured from the skin of three unrelated patients with the clinical symptoms of the Sanfilippo syndrome (mucopolysaccharidosis III) accumulated intracellularly excessive amounts of heparan sulfate and showed a lengthened turnover time for this mucopolysaccharide. They exhibited, however, neither a deficiency of heparan sulfate sulfamidase or alpha-N-acetylglucosaminidase nor of any other known glycosaminoglycan-degrading hydrolase. This new mucopolysaccharidosis was therefore designated as type C of the Sanfilippo syndrome. The abnormal heparan sulfate metabolism of Sanfilippo C fibroblasts could not be normalized by addition of crude urinary proteins or concentrated secretions from normal fibroblasts to the culture medium or by cocultivation with normal fibroblasts. The accumulated heparan sulfate was characterized by a reduced negative net charge. A small proportion of it could be adsorbed onto a cation exchange resin. It was sensitive to nitrous acid degradation under conditions where glucosamine residues with free amino groups are attacked. It is therefore suggested that the primary defect in this new mucopolysaccharidosis concerns the step which follows the hydrolysis of N-sulfonate groups in heparan sulfate degradation.