The effect of laser photocoagulation on the gastric mucosa and bleeding gastric lesions: an experimental study. An argon ion laser beam was tested experimentally with regard to its histological effect on and penetration of the gastric mucosa of the rat and man and its ability to induce haemostasis in traumatically produced gastric lesions and transected small blood vessels. Localized laser photocoagulation for periods of up to 5 minutes at 1 watt produced a coagulative necrosis of the gastric mucosa and half of the muscularis propria, but transmural necrosis required prolonged exposure. Laser phototherapy markedly reduced the bleeding time in experimental ulcers and small blood vessels, provided the superficial blood could be adequately dispersed from the direct beam of the laser.


Angiography in acute gastrointestinal bleeding. Angiography in patients with acute gastrointestinal bleeding is a necessary adjunct to fiberoptic endoscopy to identify the site of the bleeding, especially if it is from the small or large intestine. Clinically, a bleeding rate of 3 milliliters per minute is associated with perceptible extravasation of the contrast medium, venous bleeding excluded. Although celiac or mesenteric arteriography is preferred, abdominal aortography can be useful as the selective examination.


Transduodenopancreatic interposition mesocaval shunt using an internal jugular vein autograft. In 26 interposition mesocaval shunts using an internal jugular vein autograft which has been performed since 1970, four patients had important abnormalities in the superior mesenteric vein, making impossible the usual subduodenal position of the jugular vein graft. In these four patients, a small pancreatectomy was performed between the transverse portion of the duodenum and the right aspect of the superior mesenteric vein, placing the interposition mesocaval shunt in a transduodenopancreatic position. No patient has had any bleeding after the operation nor have esophageal varices been found at the time of the last examination. During this period, all patients showed a remarkable tolerance to proteins, so that no patient has been on a low protein diet.


[Technical problems in coronary bypass surgery (author's transl)]. The problem of selecting the most suitable operative technique for coronary bypass surgery is demonstrated by a comparison of the most current methods. The fact, that comparable results can be obtained by various technical modifications makes it appear reasonable to choose an method as simple as possible for routine. Therefore, the following procedure is recommended: Extra-corporeal circulation with hemodilution and systemic as well as local hypothermia. Distal anastomoses under ischemic cardiac arrest without vent. Proximal anastomoses under partial extra-corporeal circulation with the heart beating. Continuous suture technique for all anastomoses. Our own clinical results with 1,3% early mortality, 1% perioperative myocardial infarctions and 94% graft patency after 1 month prove the feasibility of this operative procedure.


[Postmortem investigations after coronary artery bypass surgery (author's transl)]. On the basis of postmortem findings in 60 patients who had undergone aorto-coronary vein graft bypass and 145 patients with coronary heart disease we show the morphological risk factors associated with this operation. Arteriosclerosis of the coronary artery in the region of the anastomosis and the stenosed or scared coronary outflow pathways are attended by high risk. A large difference in calibre between the vein and the coronary artery is also a risk factor. The knowledge of the morphology of the coronary muscle bridge helps to avoid operative complications. The progression of coronary artery sclerosis in the overbridged stenosis depends from the degree and the histological qualitiy of this stenosis. Beyond critical stenoses of the coronary arteries operable myocardium is evident in 89,4%, even beyond coronary occlusions revascularisation is possible in 58,9%.


[Ectopic coronary ostia and their importance for coronary and valvular surgery (author's transl)]. The incidence of ectopic coronary ostia location was investigated in coronary angiograms of 5350 adult patients without associated congenital heart disease. Ectopic coronary origin from the right coronary sinus was observed more than twice as frequently than ectopias from the left coronary sinus. The most common variation (0.7% of all patients) was the origin of the left circumflex branch from the right coronary sinus. Praeoperative knowledge and angiographic demonstration of ectopic coronary arteries is essential in order to avoid damage of these vessels during prosthetic valvular surgery or by aortotomy, to achieve complete revascularization in bypass surgery, and to prevent complications during intraoperative coronary perfusion.


[Intraoperative measurements of prognostic value in coronary bypass surgery (author's transl)]. The effect of an aortocoronary bypass graft on coronary hemodynamics was studied experimentally in dogs and during surgery for aortocoronary bypass grafting in man. In the experimental part of this study it was shown that coronary dilatory reserve is unaffected between 0 and 50% coronary narrowing. In the presence of more severe stenosis the dilatory reserve declines rapidly. Competition of flow between an aortocoronary bypass graft and the stenotic segment is related to the degree of coronary stenosis. In 53 patients graft flow was measured during surgery. The relation between hyperemic response (hyperemic/control flow = HR) after short occlusion of the graft and the poststenotic coronary pressure (poststenotic pressure/aortic pressure times 100 = PSPR) could be described by the function HR = a. exp b PSPR (r = 0,87). When the degree of coronary stenosis exceeded 80% narrowing, poststenotic pressure decreased rapidly and hyperemic response appeared. In patients with comparable LAD stenosis a close correlation was found between basal graft flow and anterior wall motion (r = 0,91). It is concluded that graft function can be evaluated by the relation between HR, PSPR and the degree of coronary stenosis. Left ventricular wall motion is shown to be an additional determinant of graft flow.


Modification of immunological potential by ultraviolet radiation. II. Generation of suppressor cells in short-term UV-irradiated mice. When normal mice are exposed for short periods to ultraviolet light (UV), they support the progressive growth of transplanted syngeneic UV-induced tumors. Normal nonirradiated mice almost always reject these tumor implants. The UV-mediated suppression of the antitumor response can be adoptively transferred to normal syngeneic mice with lymphoid cells derived from short-term UV-irradiated donors. Transfer of the suppressive effect is dosage dependent and also appears to require the presence of viable T lymphocytes. Suppressive activity was observed in both the spleen and thymus of UV-irradiated donors. In the preceding paper we have established that UV irradiation does not cause a general depression of testable immune functions. Collectively these data suggest that short-term UV irradiation of mice leads to an increase in suppressor cell activity, thereby causing an inhibition in the host's ability to respond to an antigenic UV-induced tumor. The possible role of this phenomenon in the mechanism of UV carcinogenesis is discussed.


[Available methods to modify primary graft rejection (author's transl)]. Primary graft rejection is an immunological reaction. Many modes of preventing, or at least, delaying rejection have already been tested. The present study deals with experiences and possible mechanisms of action of nonspecific immunosuppression caused by different drugs or antilymphocytic sera; furthermore, an account is given of the latest stand of knowledge gained from experimental studies to induce immunological enhancement, as well as immunological tolerance to transplantation antigens.


[Toxic action of ergocalciferol in strontium rickets]. Tests conducted on albino rats of the Wistar line demonstrated that introduction of large doses of ergocalciferol (vitamin D2) to animals kept on a strontium-rich diet exhibiting signs of rickets brings about the development in them of specific manifestations of the D-vitamin activity, viz. rising level of calcium, strontium and inorganic phosphorus in the blood serum, lowering of the alkaline phosphatase activity and a greater degree of the soft tissues calcification.


[Postoperative complications in lung resections for carcinoma (author's transl)]. There will be analyzed the postoperative results in 1351 resected patients with bronchial carcinoma from 1957 to 1975 with special reference to the problem of postoperative complications.1. The rates of complications and lethality have been dropped remarkably during the last years. The frequency of complications is now 11.9% and the lethality 4.1%. The mean value of all patients: 19.2% complications; 6.2% lethality. 2. On the top of all complications there are the empyemas, embolisms, haemorrhages-also those of the gastrointestinal tract-and the insufficiency of the cardiorespiratory system, which has a lethality of about 50%. 3. Age, lung-function and the extent of the resection are influencing the complication rate. 4. Excluding wound healing disturbances central tumors show twice as much complications (20%) as peripheral tumors (10%). But wound healing disturbances have the highest rate in intermediate tumors (9.9%), in contrast to the central tumors (3.9%) and peripheral neoplasms (6.2%). 5. The postoperative lethality has a direct and remarkable effect on to the 5 year-healing results. 6. In view of the therapy of the empyemas the plastic surgical methods should be reduced in favour to new standards of conservative therapy, which have to be worked out.


[Dependence of blood flow in human aorto-coronary bypass grafts on the extravascular resistance (author's transl)]. As has been shown in a large number of animal experiments, there is a marked difference between the systolic-to-diastolic flow ratios of the right coronary artery and the left. We examined these ratios in 107 patients who were undergoing aorto-coronary bypass surgery as treatment for coronary artery disease. After cessation of cardio-pulmonary bypass, the blood flow was recorded electromagnetically in a total of 126 venous grafts to the right or to the branches of the left coronary arteries. From these tracings, the following magnitudes were calculated: coronary stroke flow per heart beat, systolic and diastolic stroke flows, mean flow, systolic and diastolic flows. The ratio of the systolic to the diastolic stroke flow was 0.30 +/- 0.17 for the branches of the left coronary artery (n = 79) and 0.61 +/- 0.30 for the right coronary artery (n = 47). The ratio of systolic to diastolic flow was found to be 0.46 +/- 0.25 (branches of the left coronary artery) and 1.01 +/- 0.62 (right coronary artery), respectively. All these values differ statistically on a probability level of p less than 0.001. In principle, our results agree with those of canine experiments. The considerable variation of the individual values of the systolic-to-diastolic flow ratios can be explained by the following: 1. the variability of the pattern of coronary blood supply in man; 2. the actual right and left ventricular pressures; 3. the extent of stenoses present; 4. the degree of myocardial impairment due to ischemia. These factors combined determine the actual value of the extravascular (myocardial) component of the peripheral coronary resistance, which is most effective during systole.


[Percutaneous direct current treatment (myelotron) of neurogenic bladder disorders due to injuries of the lower motor neurons]. We examined 18 patients with lesion of the lower motor neuron, conditioned partly by lesion of the spinal cord, partly by lesion of the peripheral vesical nerves, before and after the percutaneous electrostimulation (myelotron) and established the urodynamically verified effect. Apart from one case of unclarified and fully therapy-resistent atony of the urinary bladder we found in all patients a subjective improvement of their complaints (retarded beginning of miction, spontaneous miction only with straining, large quantities of residual urine). Objectively an improvement of the sensitivity of the urinary bladder or of the motoricity appeared, in most cases both. We could not establish an essential influence on the tonus of an empty bladder and the tonus of the sphincter musculature. In all patients the residual urine could be reduced drastically, after the treatment the major part of the patient could urinate without residual urine.


[Casuistic contribution to alpha1-antitrypsin deficiency with liver cirrhosis in adulthood (author's transl)]. A case of alpha1-antitrypsin deficiency with liver cirrhosis bioptically diagnosed is described. The 49 year old woman had a decreased serum-level of alpha1-antitrypsin and characteristic, PAS-positive, diastase-resistant conclusions in the cytoplasma of the liver cells. An emphysema of the lungs was not seen.


Aetiology of acute upper gastro-intestinal bleeding at the University Teaching Hospital, Lusaka, Zambia. A prospective clinical study into acute upper gastro-intestinal bleeding has been done and the first 60 consecutive cases analysed. It was found that contrary to the prevailing clinical impression but in agreement with published work, the commonest associated aetiological factor was chronic duodenal ulcer (33 of 60 cases). Next came acute drug or alcohol induced gastric erosions, with oesophageal varices a poor third. The unreliability of clinical impressions is confirmed.


[Electrostimulation and stimulation electromyography in the complex treatment of facial neuritis with rheographic control]. The author treated 60 patients with facial nerve neuritis with the aid of a "Bion" apparatus. For control over the changes seen due to the use of electrostimulation, stimulational EMG was used with the registration of a rheogram of the mimical muscles. During the study the following data were obtained: a shortening of the latent period of the facial nerve in an electrostimulation was an objective criterion, permitting to control the restitution of the damaged neuro-muscular face structures. Under the effect of treatment there was also an improvement in the biolectrical activity of the superciliary muscle and an increase in the amplitude of the rheographical wave. In most cases (53 patients) there was a recovery, in 6--a significant improvement. In 1 case the state was not altered.


Maternal mortality at University Teaching Hospital, Lusaka. Eighty maternal deaths occurring at the University Teaching Hospital (UTH) Lusaka, from 1974-1976 have been reviewed. The maternal mortality rate was 1.5 per 1000 births. The commonest causes of death were pre-eclampsia and eclampsia (23), septicaemia (14), haemorrhage (13) and ruptured uterus (11). Avoidable hospital factors were present in 52 percent of cases, while avoidable outside factors were noted in 27 percent. Thirty two per cent had no antenatal care. The mortality rate may be reduced by increased awareness of high risk patients by medical staff in the central hospital. Improvements in community maternal health services and better transport and communications are essential.


[Two-phase course of IgM and rheumatoid factors during D-penicillamine therapy]. 16 patients with definite and classical rheumatoid arthritis (A.R.A. criteria) were under regular control for 210 days. 11 of them were treated with D-penicillamine and 5 with gold. They were compared to a group of 34 healthy people. In addition to clinical observations the following investigations were carried out at intervals of 20 to 30 days: Latex-fixation test and Waaler-Rose, IgM, IgA, IgG, C3, C4, C3-proactivation, ESR, coeruloplasmin, iron, complete blood picture, gamma-GT, SGOT, SGPT, alk. phosphatase, creatinine, urea and full urinalysis. Furthermore antinuclear factors (ANF) and C-3 activating ANF were determined by indirect immunofluorescence. The following observations were made: 1. The serum level of immuno-globulins changed in a two-phase fashion during D-penicillamine treatment. Initially IgM decreased significantly until the 60th to 80th day. During the 80th to 210th day it tended to increase. Rheumatoid factors changed in a similar way. 2. There was a significant correlation between the IgM serum level and the average titer of the Latex-fixation and Waaler-Rose tests. 3. The other parameters did not change significantly. 4. In one case the ANF became positive and showed a tendency to increase in titre. With higher titres complement activation was demonstrated. The treatment was discontinued. Thereafter the ANF titres and complement binding decreased gradually.


[Clinical physiological effects of electrostimulation and destruction of the ventrolateral portions of the cerebellar dentate nuclei in different forms of motor pathology]. The effect of electrostimulation and destruction of the ventrolateral parts of the cerebellar dentate nuclei is described on the basis of 27 dentotomies performed on patients with different forms of motor pathology. The dento-cortical connections were studied by advancing electrodes to the cerebral and cerebellar cortex through trephination openings made in the postero-frontal-parasagittal area for ventriculography and in the occipital area for the insertion of a stereotaxic cannula. It was found that the principal test for operative identification of the ventro-oral parts of the dentate nucleus in electrostimulation are motor reactions and changes in the muscular tonus in the homolateral limbs and reactions of the cortex of the central and precentral areas of the cerebral hemispheres revealed by electrocorticography. The main clinical effect produced by the destruction of these parts of the dentate nuclei is diminution of the spastic component of muscular hypertonus; hardly any effect is caused on the rigidity component. Redistribution of muscular tonus is among the factors inducing postoperative changes in hyperkinesia.


Bullous keratopathy (Fuchs' endothelial dystrophy) treated systemically with 4-trans-amino-cyclohexano-carboxylic acid. Twenty patients with bullous keratopathy (Fuchs' endothelial dystrophy) were treated systemically with the antifibrinolytic drug tranexamic acid. The effect was evaluated by slit-lamp biomicroscopy, measurement of central corneal thickness and determination of visual acuity. The patients subjective complaints were also registered. The duration of the treatment varied from 3 to 16 months. In most cases the treatment was given over several periods with intervening free intervals. In all cases the central corneal thickness decreased and slit-lamp biomicroscopy revealed an improvement. The visual acuity improved and all patients became free of pain. A possible mechanism involving the complement system is discussed and preliminary studies on the composition of the aqueous humour in cases of bullous keratopathy are mentioned.


[Dynamics of the otoneurologic symptoms after complete and partial removal of a tumor of the acoustic nerve at different stages of its development]. The peculiarities of the dynamics of the entire complex of otoneurologic symptoms were studied in 60 patients with a tumor of the acoustic nerve in stages II and III of the disease after total (in 38) and partial (in 22) resection of the neoplasm. The data obtained bore evidence that the dynamics of the otoneurologic symptoms depended on the developmental stage of the tumor, its relation to the brain stem, and the character of the operation (total or partial removal of the tumor). Total resection of the tumor in stage II proved most effective: in the residual period both stem vestibular disorders and statokinetic and coordination disturbances were minimum or absent. In total removal of the tumor in stage III of the disease the regression of the symptoms was delayed and much less apparent. In subtotal removal of the tumor during stage II the symptoms regressed slightly or not at all. Symptomatology remained gross, irreversible or even frequently became more severe after subtotal removal of the tumor in stage III of the disease.


Lesions after sphincterotomy.

Lesions after sphincterotomy. Within the last years 70 transduodenal sphincterotomies at stringent indication have been carried out at the Department of Surgery of the RWTH Aachen. This means 9.2% of all operations caused by cholelithiasis. The lethality was 4.2%. The following postoperative complications where stated: a) the bleeding from the divided duct of sphincter with or without haemobile (1.4%), b) the post-sphincterotomy pancreatitis (9.5%) owing to lesion of the pancreatic duct, c) the retroperitoneal abscess with biliary peritonitis (1.8%), d) insufficiency of the duodenal wall or duodenal fistula (1.9%), e) postoperative disturbances of passage of the transsected sphincter Oddi. The haemorrhagic necrosing pancreatitis, the insufficiency of the duodenal wall, the retroperitoneal abscess and the bleeding postsphincterotomy force us to immediate re-operation, while functional disturbances like a spasm or an oedema are controllable pharmacologically and functionally for a short time.


Persistence of in vitro lymphocyte response to tuberculin skin test negative children immunized with BCG in infancy. PPD stimulated lymphocyte reactivity was tested in 119 children aged 11 to 12 years. The lymphocyte responses was evaluated by measuring the extent of tritiated thymidine incorporation by cultured cells. In a group of sixty-four tuberculin negative children who had been BCG vaccinated in the neonatal period, lymphocyte response was significantly greater than in a group of non-vaccinated tuberculin negative children matched for sex. The highest reactivity appeared in another group of children vaccinated in infancy and tuberculin positive. Lymphocytes from BCG vaccinated children retain some sensitivity to tuberculin even years after the BCG vaccination and even at the time when the skin reactivity disappeared.


Antibody-dependent cell-mediated cytotoxicity by activated thymocyte populations. Nature of the effector cell(s). The results of the present experiments have shown that activated thymocyte populations are endowed with a cytotoxic potential against antibody-coated target cells. The effector cells could be divided into at least two subpopulations. 1) host-derived macrophage-like cells and 2) thymocyte-derived donor cell T lymphocytes. These two subpopulations could be separated and identified by means of commonly used immunofractionation techniques. Such data show that effector cells which kill antibody-coated target cells may be of T cell nature.


In vitro activating properties of polyene antibiotics for murine lymphocytes. The effect of four polyene antibiotics, Candicidin, Etruscomycin, Filipin and Pimaricin upon mouse lymphocytes was studied. Polyene antibiotics are known to form aqueous pores in the cell membranes inducing known anion or cation selective fluxes. Candicidin was capable of inducing marked DNA-synthesis and polyclonal antibody production when added to normal spleen cells. Etruscomycin and Pimaricin showed a weak inconsistent DNA synthetic stimulatory effect, whereas Filipin was found to be totally uneffective. The stimulating property of Candicidin was also demonstrated on spleen cells from nude mice whereas there was no effect on cortisone resistant thymocytes or spleen cells passed through a nylon fibre column. Thus we conclude that Candicidin is a PBA for mouse lymphocytes. We have previously reported that the two anionselective polyenes, Nystatin and Amphotericin B, are polyclonal B-cell activators for mouse lymphocytes and in this paper the possible mechanism of triggering is further discussed.


Effect of time on the response to cyanide anoxia of frog heart damaged by isoproterenol. Isoproterenol (IPR) induces damage to the heart of frogs living at 25 degrees. The resistance of an isometric ventricular strip to histotoxic anoxia induced by cyanide is significantly reduced 4 hours after one injection of IPR and still more after repeated injections. Macroscopically visible heart lesions are observed only on the first two days after the second injection of IPR. The response of the heart muscle preparation to cyanide is then continuously improved during 3-4 weeks after IPR and the disturbance of the myocardial function is thus only temporary and may at least partly be induced by metabolites of the catecholamine.


Volume-pressure properties of round and oval windows. A quantitative study on human temporal bone. A model study was carried out on human temporal bones to assess quantitatively the displacement of the round and oval windows when different pressure levels were applied to the external ear canal and inside the middle ear. It was found that the major displacements of the window membranes occurred in the pressure range of +/- 20 cm H2O in the intact middle ear. An additional increase in the middle ear pressure up to +/- 70 cm H2O caused a minor displacement of the window membranes.


Vestibular and optokinetic responses of the white cat. The vestibular and optokinetic responses of a group of white cats were evaluated and compared with the responses from a control group of pigmented animals. The results indicate that in all cases the white cats exhibited varying degrees of vestibular and/or optokinetic dysfunction, which in some animals varied from test session to test session.


Chlorpromazine plus thiorazidine poisoning and treatment with extracorporeal dialysis. One case of self-poisoning by 3075 mg of Chlorpromazine and 250 mg Thiorazidine is referred. In this case coma and uremia rose 3 days after the intoxication. Treated with extracorporeal circulation through Travenol Coil kidney, this patient recovered from coma and uremia and survived. Chlorpromazine and Thiorazidine intoxications are reviewed with particular attention to the possible kidney damage.


Acute structural hepatic alteration due to poisons. Drug hepatitis emphasized the importance of a careful history including the question to the use of laxatives in all patients with both acute and chronic hepatitis. From predictable and unpredictable hepatotoxicity we should learn to be alert to the possibility of new and unrecorded hepatic lesions resulting from drugs and other chemical or environmental toxins.


Protection from hyperbaric oxygen intoxication by some derivatives of alfa-ketoglutaric acid. A study was made of the protective effects afforded by some derivatives of alpha-ketoglutaric acid in hyperbaric oxygen intoxication. The research performed shows that these substances are able either to prevent convulsions (Paul Bert phenomenon) or to prolong the survival of treated animals. Brain ATP rates and liver succinyl dehydrogenase activity, which normally decrease in hyperbaric oxygen intoxication, are also very high after protective treatment with these substances.


Effect of urea on some electrophysiological properties of the frog muscle cell membrane. The effect of urea on the electrophysiological properties of the frog muscle cell membrane was studied with intracellular microelectrodes, together with an analysis of the electrolyte composition of the muscle. The different parameters were measured and evaluated after soaking the muscle for 60 min at urea concentrations up to 2.25 M. The resting membrane potential was markedly decreased above 1.50 M and fell to about -50mV at 2.25 M. The specific membrane resistance (Rm) was almost unaffected at concentrations of 0.75 M and 1.50 M but was reduced after 60 min in 2.25 M to very low values indicating a leaky membrane. The maximum rate of rise of the action potential (VA) was unaffected up to 0.50 M but was reduced to about 50% of control value at 0.75 M. Between 0.75 M and 1.25 M it was constant and at higher concentrations reduced to almost zero. The reduction of VA at the lower concentrations was not accompanied by changes in neither the resting membrane potential nor Rm. It is proposed that urea perturbs protein systems concerned with the generation of the muscle action potential without affecting the passive electrical properties of the muscle membrane. The electrolyte analysis revealed an increase in intracellular Na+ and K+ concentrations, mainly due to loss of intracellular water.


Prognostic value of colony-stimulating and colony-forming cells in peripheral blood in acute non-lymphoblastic leukemia. Colony-forming cells (CFC) and colony-stimulating activity (CSA) in peripheral blood cells have been studied before and repeatedly during treatment of 30 patients with acute non-lymphoblastic leukemia. WBC obtained after Isopaque-dextran separation were cultured in vitro by a double-layer agar technique. Before treatment 16 patients out of 30 had CSA and 22 out of 29 had CFC; both CSA and CFC were found in 15 patients. In follow-up studies during treatment, CSA was mainly unaffected during the leukopenic phase, while CFC were suppressed. No CFC were found at WBC counts below 900/mm3. This seems to imply that CFC are more sensitive to cytotoxic agents than colony-stimulating cells. Twelve patients entered remission; all of them had CSA and all the 11 who were investigated for CFC had CFC before treatment. Fourteen out of 18 non-responders lacked one or both types of cells. The presence of CSA and CFC in peripheral blood therefore appears to be a sign of favorable prognosis, while the absence of CSA and/or CFC implies lack of response to treatment.


Pronounced deficiency in T-cells and lymphocyte chromosomal aberrations in a patient with sarcoidosis, myelofibrosis and acute leukaemia following thorotrast angiography. A patient exposed to thorotrast angiography developed sarcoidosis 21 years after the injection and myelofibrosis 13 years later. On the latter occasion an extreme deficiency in circulating lymphocytes forming rosettes with sheep erythrocytes (T-cells) was observed and a large fraction of the cells had chromosomal aberrations. Acute leukaemia developed 1 year later. The multiple clinical symptoms may be related to radiation-induced destruction of bone marrow tissue, mutations in haemopoietic cells and depression of cell-mediated immunity.


Contrast media in diagnostic radiology: recommendations for labels, package inserts, and dosage determination. Recommendations are made for updating labels, package inserts, and dosage designation. These are based on the experience of the members of the Committee on Safety of Contrast Media of the International Society of Radiology and their collaborators in a prospective survey on adverse reactions to intravascularly administered contrast media. They are considered to be timely and an answer to a long unfilled need. It is felt that these recommendations reflect not only the opinion and concern of the committee but also that of the radiology community at large. These recommendations are of both medical and medicolegal import. Their application is in the best interests of progressive radiology and good patient care.


Fluid-filled cystic adenomatoid malformation. Two infants with congenital cystic adenomatoid malformation of the lung are described. The condition progressed from an unusual solid radiographic appearance to the more classical air-filled cystic appearance. The initial appearance is due to delayed emptying of the alveolar fluid either via the bronchi or the lymphatic and circulatory systems. After the fluid is removed, the typical air-filled cysts become apparent.


Phasic aortocoronary bypass graft blood velocity during ventricular arrhythmias in man. With use of the Doppler ultrasonic flowmeter catheter, phasic aortocoronary bypass graft blood velocity was measured in 16 conscious subjects during ventricular arrhythmias. Ventricular extrasystoles reduced peak systolic and diastolic graft blood velocities by 20 to 80 percent, generally in relation to their respective coupling intervals. When extrasystoles appeared in closely coupled salvos diastolic bypass blood velocity virtually ceased. Nineteen episodes of ventricular tachycardia produced an average 50 percent decrease in peak graft blood velocity (control mean +/- 1 standard deviation blood velocity 28 +/- 11 cm/sec; value during ventricular tachycardia 14 +/- 8 cm/sec, P less than 0.001). An "overshoot" of peak blood velocity was observed after ventricular extrasystoles and tachycardia. All such changes in aortocoronary bypass blood velocity related to tachyarrhythmia were more prominent during the systolic fraction of flow. It is concluded that (1) ventricular arrhythmias adversely influence aortocoronary bypass graft function, and (2) this finding supports an aggressive approach to the treatment of these arrhythmias in subjects with bypass grafts.


Evaluation of the capillary beta-lactamase test and antimicrobial susceptibility of Haemophilus influenzae. The capillary beta-lactamase test for the detection of Haemophilus influenzae resistance to ampicillin was evaluated against 132 strains of H. influenzae recently isolated from clinical materials and four reference strains. Nineteen strains, including two of serotype b, were beta-lactamase-positive. The minimal inhibitory concentrations (MIC) of ampicillin for the 117 beta-lactamase-negative strains ranged from less than or equal to 0.125 to 2 microgram/ml (only one strain had a MIC of 2 microgram/ml). The range of MIC's of ampicillin was 4 to 64 microgram/ml for the 19 beta-lactamase-positive strains; all but two strains required 8 microgram/ml or more for inhibition. The capillary beta-lactamase test is an easy, rapid and reliable test for the detection of H. influenzae resistance to ampicillin. It is suitable for routine use in the clinical microbiology laboratory. The MIC of carbenicillin was higher for ampicillin-resistant than for ampicillin-susceptible strains, but the highest MIC (32 microgram/ml) was within achievable serum concentrations. Both cefamandole and chloramphenicol were active against all strains.


Bacteremic hemophilus influenzae type B cellulitis in the adult. Described herein are three patients over the age of 50 years who had cellulitis of the neck and the upper portion of the chest, associated with Hemophilus influenzae type B bacteremia and respiratory tract infection--particularly that of the upper airway. Only one of the patients with cellulitis had the classic bluish-purple hue commonly seen in children affected with this syndrome. In the other two, the H. influenzae type B cellulitis could not be distinguished clinically from the more common group A streptococcal or staphylococcal cellulitis. Since the antibiotics employed in treating patients with infection due to the latter two organisms differ significantly from those used to treat patients with H. influenzae type B infection, the possibility of disease due to H. influenzae type B must be considered in any adult or child in whom cellulitis of the neck, chest and possibly face is associated with a respiratory tract infection, especially of the upper airway.


Aqueous cytology and enzymes in nematode endophthalmitis. A 7-year-old girl had a white fundus mass and vitreous cells, compatible with an endophytic retinoblastoma. Aqueous aspiration revealed normal lactate dehydrogenase levels and large numbers of eosinophils, suggesting the diagnosis of nematode endophthalmitis. Treatment with corticosteroids brought about resolution of the inflammation and an excellent visual result.


Herpes zoster ophthalmicus associated with delayed retinal thrombophlebitis. A 58-year-old woman developed typical herpes zoster ophthalmicus associated with delayed retinal thrombophlebitis and subsequent vitreous hemorrhage. Fluorescein angiography confirmed a diagnosis of thrombophlebitis and demonstrated sparing of the arteriolar circulation. The retinopathy cleared spontaneously and visual acuity returned to 6/6 (20/20).


Secondary open-angle glaucoma in histiocytosis X. A 9 month-old boy developed secondary open-angle glaucoma associated with fever and multiple lytic bone lesions 2 1/2 months after cataract aspiration. An open bone biopsy provided a diagnosis of histiocytosis X. Hisiocytes similar to those in the bone were identified in a specimen of aqueous humor from the affected eye. No other cells were found. The abnormal histiocytes may have caused the glaucoma by infiltrating the trabecular angle structures and mechanically obstructing aqueous outflow from the eye.


Listeria monocytogenes endophthalmitis.

Listeria monocytogenes endophthalmitis. A 62-year-old white man developed an acute anterior chamber inflammation in his left eye. Listeria monocytogenes was cultured from the vitreous aspirate. There was no evidence for ocular trauma or distant site of infection from which hematogenous spread of the organism occurred. No underlying state of immunocompromise was demonstrated. The endophthalmitis responded well to therapy.


Innervation of melanocytes in human iris. An electron microscopic study. Contacts between melanocytes and nerve terminals in human iris stroma were investigated by means of electron microscopy. Four distinct types of nerve terminal making synaptic contacts with melanocytes can be distinguished: (1) nerve terminals containing only empty synaptic vesicles (400-800 A in diameter) and with intervening basement membrane material (separation 1000 A); (2) nerve terminals with both empty vesicles and granulated vesicles (600-1100 A in diameter) also with intervening basement membrane material (separation 750 A); (3) nerve terminals containing empty vesicles and forming close contacts with melanocytes (distance about 400 A) without interposed basement membrane material, and (4) nerve terminals containg both empty and granulated vesicles (750 A in diameter) which make closer contacts with melanocytes (distance 270 A) without interposed basement membrane material. Type (1) and type (3) nerve terminals are thought to be cholinergic; type (2) and type (4) nerve terminals appear to be adrenergic. Taking into consideration these morphologic findings and previously reported data, it seems justified to postulate the presence of trophic innervation of melanocytes in the human iris.


[Free carbohydrate content of the cortex and nucleus of bovine lenses as a function of ageing (author's transl)]. The determination of the products of the sorbitol pathway and of inositol in the equator and nucleus of bovine lenses of different ages, performed by gas-chromatographic analyses, is described. Independent of age, the proportion of glucose, sorbitol, and fructose is higher in the equatorial part than in the nucleus. The proportion of inositol is about 3 mg/1 g lens fresh weight in the equator, and about 2 mg/1 g lens fresh weight in the nucleus, and seems to decrease slightly with ageing.


[Electrophysiologic evidence of three different types of the 'slow fibers' of extraocular muscles (author's transl)]. The author reports on electrophysiologic investigations of extraocular muscles in rabbits in vivo by means of standardized glass microelectrodes. The results of investigation on muscle-fiber membrane resting potentials of 'slow fibers' as well as on postsynaptical potentials of 'slow fibers' are analyzed after having elucidated the problems as well as the methods employed and the experimental setup. By figures and synopses in tabular form the author illustrates the electrophysiologic parameters of three different types of muscle fibers of 'slow fibers' of extraocular muscles that can with certainty be differentiated electrophysiologically. In the discussion references are made to the importance of the submitted results of investigation for basic research and for clinical ophthalmo-electromyography. Finally, the trends of investigation of the electrophysiologic analysis of extraocular muscles are discussed.


[Animal experimental investigations of the electrophysiologic parameters of 'fast fibers' of extraocular muscles by means of glass microelectrodes (author's transl)]. The author reports on animal experimental investigations of the electrophysiologic parameters of 'fast fibers' of extraocular muscles in rabbits in vivo by means of standardized glass microelectrode. The submitted results of investigation enlarge our knowledge of the electrophysiologic parameters of 'fast fibers'. The statistically analyzed results on musclefiber action potential parameters, on musclefiber membrane resting potentials, strengthduration curves and the data on the electro-mechanical latency period of 'fast fibers' are illustrated by figures. The most important conclusions for basic research on 'fast fibers', for clinical ophthalmo-electromyography and for the duality concept of eyemovement control are given.


Biochemical study on some acid hydrolases in the normal rabbit cornea. The activities of acid phosphatase, beta-glucuronidase, beta-galactosidase, and N-acetyl-beta-D-glucosaminidase were investigated in the normal rabbit cornea. For all spectrophotometric assays, appropriate p-nitrophenyl derivates were used. Only beta-glucuronidase were determined employing phenolphthalein glucuronid as a substrante. Acid phosphatase revealed the highest activity, followed by N-acetyl-beta-D-glucosaminidase and beta-galactosidase. In the case of beta-glucuronidase the lowest activity was found. The results on the rabbit cornea are compared with those on some other tissues described in the literature. Correlation of biochemical data and histochemical findings in the same species is briefly discussed.


Cell turnover in the beak of Rana pipiens. Rana pipiens tadpoles were injected with 3H-thymidine at different stages to label basal cells of the horny beaks, the keratinized oral specializations of many anuran tadpoles. Cells in the column and sheath of the beak are derived from the basal layer. Movement of the labeled cells in beak columns can be traced, permitting calculation of the rate of cell addition into the columns. With the counts of the total number of column cells and cell addition rate, the rate of apical cell loss from a column throughout the larval stages can also be calculated. The rate of cell addition decreases steadily from stage III through stage XX, in all portions of both beaks. The rate of change of these column cell addition rates is similar among middle and lateral portions of both upper and lower beaks. There is a relatively constant rate of cell loss until stage XII or XIII. It then increases sharply, and the beaks are completely lost at stages XIX or XX. The longer, lower beak columns have a much faster cell loss rate than do the upper beak columns at late larval stages. Life spans for cells that move to the sheath may be about one-half those for cells that enter the beak columns, It is suggested that thyroid hormone accelerates the rate of column cell loss.


[Enzymatic determination of blood antitrypsic activity with centrifugal analyser]. The antitrypsic capacity of serum is in good respect with the level of active alpha1-antitrypsin in serum. Its determination can be improved by a wholly automated procedure with a centrifugal analyser Gemsaec, which allows the measure of the reaction rate of the hydrolysis of a synthetic substrate (BAPNA) for trypsin. After mixing the plasma with bovine trypsin, the residual trypsic activity is measured. By this procedure it is easy to disclose rapidly the physiopathologic changes of proteinase inhibitors of the plasma, and these of the alpha1-antitrysin especially. Besides this technique can be used to study the proteinase inhibitors in other biological fluids like pleural fluid, ascites, and joint fluid.


[Immunological abnormalities in epileptic children treated with anticonvulsivant drugs (author's transl)]. Seric IgA, IgE and IgD; antinuclear antibodies and lymphocyte and eosinophil counts were studied in 61 epileptic children; 22 patients were treated with phenobarbital and 39 with hydantoine. The mean length of treatment was 12 months to phenobarbital and 23 to hydantoins. Seric IgA was deficient in 4/36 children taking hydantoins and only 1/20 receiving phenobarbital. IgE mean was increase in hydantoins treated patients and also IgD was found higher than normal in 6 patients. Only one case showed seric antinuclear antibodies but they disappeared with drug withdrawal. The lymphocyte count was normal but an important eosinophilia rise with treatment (phenobarbital or hydantoins). These immunological abnormalities were meanly found in idiopatic epilepsy. These suggest they are produced by anticonvulsivant drugs but also by an important constitutional factor. In this way immunology and epilepsy may be related.


Penetration of gentamicin into the aphakic eye. The penetration of gentamicin is compared in the aphakic and phakic rabbit eye. Phakic and aphakic rabbits were treated with gentamicin by topical, subconjunctival, and intramuscular routes separately and in combination. These routes of therapy also were evaluated in aphakic eyes with experimentally induced endophthalmitis. The levels of gentamicin were, for the most part, higher in the aphakic, as opposed to the phakic eyes. Combination therapy produced higher levels in the noninfected than in the infected eyes. Aqueous levels were generally bactericidal by topical and subconjunctival routes. Levels in the vitreous by the routes of therapy employed in this study were at best inhibitory for the more virulent organisms.


Variable expression in flecked (speckled) dystrophy of the cornea. Five members of a three-generation pedigree had flecked corneal dystrophy. The number of flecks varied from patient to patient, and one individual was affected in only one eye. Visual acuity was normal in all family members. Homocystinuria also occurred in this family, but appeared to be coincidental. Central cloudy dystrophy of the cornea appears to be genotypically identical to flecked dystrophy of the cornea but is phenotypically distinct.


Treatment of bleeding varices by oesophageal transection with the SPTU gun. This paper presents the preliminary results with the SPTU stapling gun for oesophageal transection in the treatment of bleeding oesophageal varices. Porta-systemic shunt was contraindicated in all 12 patients treated, 10 of whom had cirrhosis. Anastomotic leakage and recurrent bleeding were not problems, but stricture formation was, 4 of the 11 survivors requiring dilatation. The average period of follow-up is only 7 months, but early results encourage further trial of the method for the increasing numbers of 'shunt rejects'.


[Possible localization of the glutathione reductase (EC 1.6.4.2) on the 8p21 band]. Glutathione reductase (EC 1.6.4.2.) (GSR) activity was measured in the red cells of patients with different rearrangements of chromosome 8. Of three patients with mosaic trisomy 8, two had a high GSR activity. The lack of correlation between GSR levels and the degree of mosaicism in lymphocytes is discussed. In six patients with trisomy 8qter the mean value of GSR activities was normal. In one patient with trisomy pter leads to q22.1 and in two with trisomy p11 leads to p22, a significant increase (+60%) of GSR activity was observed. In two patients with monosomy p22 leads to pter and p21 leads to pter, respectively, the GSR levels were normal. It is concluded that the gene locus of GSR can be assigned to the 8p11 leads to p22 segment. A comparison of these results with one other case from the literature suggests a more precise assignment of the GSR locus to band p21.


[Genetics of child spinal amyotrophy : existence of 2 autosomal recessive forms]. An analysis of within sibship resemblances in age of onset of symptoms and age of death (or at last examination) was made in families affected with infantile spinal muscular atrophy. The observed correlation coefficients, 0.52 and 0.75, favor the existence of a least two different mutant genes for the disease. In 63 families, the disease was of the acute infantile form and in 71 families it was of the chronic form. Both forms show autosomal recessive transmission.


[Study of acid soluble proteins of metaphase chromosomes isolated from KB cells before and after 5-BrdU incorporation]. Metaphase chromosomes and interphase nuclei have been isolated by two different procedures, using either acidic or alkaline media. The morphological integrity of the isolated material has been monitored by electron microscopy. In the acidic procedure the thickness of the chromosome fibers is reduced but the chromosome gross structure is preserved. However, electrophoretic analysis indicates complete disappearance of histones H1 and partial loss of H2A and H2B. No significant modification of acid-soluble proteins isolated from chromosomes or nuclei was observed after 5-BrdU incorporation for 72 hours.


Partial 4q duplication due to inherited der(20), t(4;20)(q25;q13)mat. A boy with mental and growth retardation associated with congenital anomalies has a partial duplication of the distal 4q chromosome region as a result of inheritance of a t(4:20) from his mother. Comparison with twelve other patients from the literature indicates that similar clinical features may be associated with this chromosome change suggesting a partial 4q duplication syndrome.


[Familial dermo-chondro-corneal dystrophy (François' syndrome) (author's transl)]. The François' syndrome associates disseminated firm nodular subcutaneous lesions, a deforming arthropathy and a corneal dystrophy. Inheritance seems to be recessive. Six cases of this rare syndrome have been previously published. The syndrome is reported here in two Mexican brothers. In the authors' opinion the François' syndrome is not related to the xanthomatoses. It should be considered as a genetically recessive arthropathic nodular fibromatosis.


Free trisomy 9P in elderly woman.

Free trisomy 9P in elderly woman. The karyotype 47,XX,+9p was observed in a 50-year-old mentally retarded woman with dysmorphic facies, severe cerebral malformations, limb deformities, retarded sexual maturation and deviating dermatoglyphs. Banding analysis showed the extra chromosome to be composed of 9p and the proximal part of 9q comprising a large secondary constriction. The breakage point is estimated as 9q13. Hemozygous large C bands were observed in both chromosomes No. 9 as well as in the extra chromosome. Clinically this case can be regarded as a pure 9p trisomy. The mechanism causing the syndrome is thought to be malsegregation of a deleted chromosome No. 9.


Partial trisomy 14q and familial translocation (2;14) (q12;q13). A female patient with moderate psychomotor retardation, minor anomalies and proximal trisomy 14q due to segregation of a maternal translocation is reported.


[Trisomy 9p by mat. t(2;9)(q36;q31)].

[Trisomy 9p by mat. t(2;9)(q36;q31)]. Two sibs are reported with partial trisomy 9, the consequence of a maternal reciprocal translocation.


[Chromosome 8 : complete trisomy and segmental trisomies]. The phenotypic effects of trisomy of various segments of chromosome 8 have been recognized through the analysis of twelve different patients: five mosaic cases of trisomy 8, one case of trisomy for the short arm and the proximal segment of the long arm, two cases of trisomy for a portion of the short arm, and four cases of trisomy for the terminal segment of the long arm. Analysis of the data from the literature and of these personal observations allows the definition of three syndromes: trisomy 8, trisomy 8p and 8q proximal, and trisomy 8q terminal. Three clinical signs are common to the three syndromes: vertebral anomalies, depression of the mesosternum, and bulging of the forehead. This suggests that different segments of chromosome 8 carry genes affecting osseous growth. Trisomy 8p causes, in addition to severe mental deficiency, a thick nose, a large mouth, and microcephaly. Other clinical signs can be assigned to three groups corresponding to the short arm, the proximal part, and the distal part of the long arm.


[Partial trisomy for the long arm of chromosome 2 due to malsegregation of a maternal insertion : ins(6;2)(p22;q24q34)]. A 6p+ chromosome was observed in a dysmorphic and mentally retarded child. The mother was found to be carrier of an insertion: ins(6;2) (p22;q24;q34). The patient was therefore trisomic for 2q24 leads to 2q34. The same insertion was found in his brother in the balanced state. A comparison of this observation and four other cases from the literature allows a description of the symptoms characteristic of trisomy 2q24 leads to 2q34 : mid-face hypoplasia, carp-shaped mouth, neurological disorders, severe mental retardation.


[Chromosome breakage in incontinentia pigmenti]. Two cases of incontinentia pigmenti in a mother and her daughter are reported. An increase in structural chromosome aberrations of the chromatid type was observed, as already described by other authors. The aberrations rate in the same individual varied from culture to culture. Chromosomal breakage was also increased in apparently healthy family members.


[Ring chromosome 14 in monozygotic twins]. An r(14) is observed in monozygotic twins, with psychomotor retardation and no obvious somatic malformation.


[Partial monosomy 11q. A new case].

[Partial monosomy 11q. A new case]. Partial monosomy 11q due to a de novo 11q231 leads to 11qter deletion was detected in a patient who died at seven days of age with most malformations characteristic of monosomy 11q, including trigonocephaly, facial dysmorphia, and congenital heart disease. In this as in most previously reported cases, the break point was at 11q231.


Trigonocephaly and the 11q- syndrome.

Trigonocephaly and the 11q- syndrome. A seventh case of deletion of the distal long arm of a chromosome 11 is described. As in other cases with this karyotypic abnormality, trigonocephaly is the most noticeable phenotypic peculiarity. A review of common developmental and dysmorphic features among the seven recognized cases is presented.


[Partial deletion of the short arm of chromosome 8]. Partial monosomy 8p is reported in a patient with mild mental deficiency and a facial dysmorphia (a triangular mandible and a peculiarly shaped nose with straight parallel margins).


[Ring of the chromosome 4. I - With 4p- phenotype]. A ring chromosome derived from a No. 4 chromosome was found in the complement of an 8-year-old boy with mental retardation and growth retardation and developmental defects characteristic of 4p deletion. Break points were at 4p15 and 4q35.


[Ring of the chromosome 4. II. Without facial dysmorphism]. A r(4) was observed in a 5-year-old female patient, with growth retardation, a near normal psychomotor development and with no major dysmorphism. The break points were in p16 and q33. After comparison with other known observations of r(4) it is suggested that the phenotype of monosomy 4p is due to monosomy for the distal band 4p16.


Partial  tetrasomy 9(9pter to 9q2101) due to an extra iso-dicentric chromosome. A 3-year-old boy with partial No. 9 tetrasomy is described. The patient showed markedly retarded physical and mental development as well as multiple congenital anomalies. Routine chromosome analysis revealed an extra C-group chromosome. It had a pronounced secondary constriction at the proximal part of its long arm. Based on studies by a variety of banding techniques, the extra chromosome was identified to be an iso-dicentric No. 9 chromosome with inactivation of one of the two centromeres, the karyotype being 47,XY, + DIC (9)(Q2101). The value of BrdUrd treatment was emphasized in the detection of a very small piece of euchromatin within a long stretch of constitutive heterochromatin.


Mosaic 45,xy,-21/46,xy in a child with G deletion syndrome I. A mosaic 45,XY,-21/46,XY was found in a boy with G deletion syndrome I who showed microcephaly, downward, antimongoloid slanted eyes, micrognathism, large, low set ears, small penis and bilateral inguinoscrotal hernia.


[Partial trisomy 12 and 8 with mosaicism, associated with translocation t(8;12) (p21;q13)]. A translocation affecting chromosomes 8 and 12 was detected in 11 persons of 3 generations of a family. The propositus, a child with multiple malformations, had a mosaicism consisting of (a) cells with 46 chromosomes which included the balanced translocation and (b) cells with 47 chromosomes and partially trisomic for chromosomes 8 and 12.


[Two new cases of trisomy 10q21 to 10qter in two sisters due to paternal translocation t(9;10) (q34;q24)]. Two sisters with multiple congenital malformations were shown to be trisomic for 10q24 to 10qter as a consequence of malsegregation of the balanced paternal translocation t(9;10) (q34;q24). Comparison of their phenotype with that of other patients reported in the literature confirms the individuality of the partial 10q trisomy syndrome.


[Annulment of paternity recognition based on the absence of identity of chromosomes Y. A judgment of the Paris court of law]. The medico-legal expertise having having concluded to non-paternity because of a marked dissimilarity between the Y chromosomes, the Paris Court of law accepted these conclusions and gave a sentence nullifying a previous paternity recognition.


Familial trisomy 20p five cases and two carriers in three generations a review. A clinically normal mother of three retarded children has been determined by G-banding to have a balanced translocation 46,XX,t(13;20) (q34;p11.2). The children each have an unbalanced form of the translocation with partial trisomy for 20p. Extensive gene marker studies have been unable to affix any specific gene locus onto the short arm of chromosome 20. The balanced translocation was inherited from the maternal grandfather. Two phenotypically abnormal deceased members of the family are believed to have had the unbalanced trisomy 20p condition. An increases number of spontaneous abortions were possibly due to lethal unbalanced 20p deletions. The moderate to mild mental retardation and somewhate unusual features (round face, prominent cheeks and nose, short mandible) in the three siblings and two other affected relatives suggest that trisomy of the short arm of chromosome 20 may cause a distinguishable clinical syndrome. Vertebral abnormalities and abnormal dermatoglyphics are part of the picture. Clinical and cytogenetic findings of all reported cases are compared.


[Partial deletion of the short arm of chromosome 4. Apropos of 3 cases]. Three observations of Wolf's syndrome (monosomy 4p) are reported and compared to the observations reported in the literature.


Treatment of severe coronary artery disease with 5, 6, and 7 saphenous vein bypasses: review of 131 consecutive patients. One hundred thirty-one consecutive patients who received 5, 6, and 7 bypass grafts are analyzed. Ages ranged from 31 to 74 years. The male-to-female ratio was 7:1. As an indication of severity of disease, 25% were classified as having impending myocardial infarction and 46.6% were classified in New York Heart Association Functional Class IV. Left ventricular function was impaired in 37.4%, and 30% of the patients had left main coronary obstruction. Nonfatal perioperative myocardial infarction occurred in 4.6%. The hospital mortality was 3%. One hundred percent follow-up (5 to 55 months) revealed 4 late deaths, 3 presumably of cardiac origin. Only 7 patients in the postoperative follow-up group have complained of angina; 1 has since undergone successful reoperation.


Analysis of familial factors in bipolar affective illness. Familial transmission of affective illness was studied using a family interview and family history method in a group of 35 bipolar manic-depressive patients. Morbidity risk for bipolar and unipolar affective illness in first-degree relatives is approximately 30% in this population. Probands with a positive family history for bipolar illness have a significantly greater risk for alcoholism in first-degree relatives. Four cases of father-to-son transmission are reported. Linkage of color vision deficiency or Xga blood group and affective illness within families could not be substantiated in our sample. We discuss evidence regarding the mode of transmission of affective illness.


[Morphologic and cytochemical research aboard the biosatellite "Cosmos-782"]. Organs of rats flown for 19.5 days on board the Cosmos-782 biosatellite were investigated morphologically and cytochemically. After flight, as a result of drastic decrease or loss of static load on the musculeskeletal system in zero-g, the rats developed mineral metabolism changes that morphologically appeared as osteoporosis of spongy bones, their periosteocytic osteolysis, as well as inhibition of red blood cell precursors in bone marrow, atrophy and dystrophy of skeletal muscles. The development of stress-reaction which seemed to increase at certain flight stages (launch and re-entry) and weightlessness--1 g transition brought about changes in the structure and cell composition of lymph organs, changes in the hypothalamic-pituitary-neurosecretory system, adrenals, gastro-intestinal tract and other organs and systems. Changes in the receptor system of the inner ear resulted, evidently, from weightlessness and acceleration effects, whereas retinal lesions were due to heavy charged particles of cosmic radiation. The changes noted were reversible and 25 days after flight returned, completely or partly, to the normal.


[Free stromal cells in dysplasias and cancer of the cervix uteri]. The content and distribution of lymphocytes and plasma cells in stroma was studied in 452 cases of different diseases of the cervix. As dysplastic changes of the epithelium advanced up to the microinvasive form of cancer, the number of lymphocytes was found to increase progressively and blast forms appeared. In intraepithelial cancer, infiltration of the stroma with lymphocytes and plasma cells was poor, whereas in deep invasive cancer no lymphocytic and plasma cell infiltration was observed. The changes in the content and distribution of the immunocompetent cells of the stroma in different structural and functional alterations of the epithelium indicates the active part of the mechanisms of local immunological defence in combined changes of the epithelium and connective tissue.


The clinical spectrum of posterior polymorphous dystrophy. We examined 61 affected members of eight families with an inherited corneal dystrophy. The corneal abnormalities varied greatly from one member of a family to another. Some patients had only a few isolated endothelial vesicles, while others in the same family had severe secondary stromal and epithelial edema. In some patients edema was present at birth or in early childhood; in others it developed later in life. The wide variation of corneal abnormalities suggests the possibility that several conditions previously described as separate disease entities, such as grouped vesicles, Schnyder's posterior herpes, posterior polymorphous dystrophy, and congenital hereditary endothelial dystrophy, are part of the clinical spectrum of expression of a single familial corneal dystrophy. Some affected family members also had ocular hypertension or open-angle glaucoma. Broad iridocorneal adhesions were present in some of the patients with glaucoma and in others with normal intraocular pressures. Other ocular abnormalities present in a few patients include pupillary ectropion, "glass membranes" on the anterior iris surface, and bands in Descemet's membrane. The transmission in most of the families was autosomal dominant. In two families it appeared to be autosomal recessive.


Cytophotometric characterization of cortical and medullary lymphocytes in the chicken bursa and thymus. We have evaluated by means of cytophotometric techniques the nuclear content in DNA, in total nucleic acids and in histone proteins and the nuclear volume of the thymic and bursal lymphocytes in adult chickens. We have also made the same determinations in the developing bursal follicles before and after hatching. The results indicate that cortical differ from medullary lymphocytes for all the parameters considered both in thymic lobules and bursal follicles. Furthermore these differences appear analogous in both the organs, independently from the fact that they produce precursors of T and B lymphocytes respectively. As concerns the developing bursal follicle, the lymphocytes show the characteristics of the adult medullary lymphocytes. At the hatching changes occur in the nuclear content of total nucleic acids and histones. This is probably related to the exposure to antigenic stimulation through the cloaca.


Biological properties and clinical application of propolis. II. Studies on the antiprotozoan activity of ethanol extract of propolis. Solutions of the ethanol extract of propolis (EEP) have shown a lethal effect on Trichomonas vaginalis in vitro. Similar lethal action was exhibited by EEP after a 24-h contact with Toxoplasma gondii.


Human T lymphocyte subset identification according to avidity for sheep erythrocytes and rosetting capacity with allogeneic red blood cells. Peripheral blood T lymphocytes of healthy adults were separated in appropriate Ficoll-Hypaque mixtures according to their avidity for sheep red blood cells (SRBC) and re-rosetted with both SRBC and human red blood cells (HRBC). The results showed that separation procedures causing relative depletion of lymphocytes with high avidity for SRBC led to a parallel increase in the percentage of cells forming rosettes with HRBC. Separation procedures leading to almost complete depletion of cells forming rosettes with SRBC also almost completely eliminated cells forming rosettes with HRBC. The overall data suggest that circulating T cells of healthy adults can be divided into two subsets according to their avidity for SRBC. T lymphocytes with low avidity for SRBC preferentially express receptors for HRBC. These data are presented as further evidence of T lymphocyte heterogeneity.


Lymphocyte involvement in rheumatoid arthritis. Studies during thoracic duct drainage. Grip strength, ring size, duration of morning stiffness, and the number of tender joints improved significantly in 9 patients with severe rheumatoid arthritis during prolonged continuous removal of thoracic duct lymphocytes through a surgical fistula. There was no improvement in 4 subjects in whom surgery failed to establish satisfactory lymph drainage. Reinfusion of unlabeled or 51Cr-labeled autologous lymphocytes resulted in transient exacerbation of disease activity in 3 subjects. Following reinfusion, some 51Cr-labeled lymphocytes could be found in the inflamed synovium and synovial fluid by autoradiography, and radioactivity was detected over the joints by surface counting of gamma radiation. Active rheumatoid arthritis recurred in all subjects at variable intervals after cessation of lymph drainage. These findings are compatible with the hypothesis that some of the lymphocytes in the thoracic duct lymph are essential for the continued activity of the inflammation associated with rheumatoid arthritis.


[Lymphocytotoxic antibodies and systemic lupus. Clinical correlations and prognostic significance]. The present prospective study was designed to examine the diagnostic and prognostic value of lymphocytotoxins in 20 patients with Systemic Lupus Erythematosus both in active stage and in remission. Lymphocytotoxic antibodies were present in 79% of all the sera examined, in 100% of the sera of patients with active disease and in 52% of those in remission. The different frequency in the two groups is significant as well as the correlation of these antibodies with anti-DNA antibodies, hypocomplementaemia and leukopenia. In spite of their diagnostic value, lymphocytotoxins do not appear as sensible parameter as complementaemia and anti-DNA antibodies in monitoring the disease, since they are still detectable in the sera for several months after the disappearance of clinical signs of activity.


[Lymphocyte typing in chronic lymphoid leukemia]. We used the membrane fluorescence and the rosette formation test to study the lymphocyte populations in 25 patients with untreated chronic lymphocytic leukemia (CLL). The results show a significant increase, absolute and percent of S-Ig bearing cells, whereas the E and EA rosette forming cells are decreased in per cent, increased in absolute. The number of lymphocytes with the receptor for the Fc fragment of IgG, is unchanged. The lymphocytosis causes mainly a significant decrease in percentage of E rosette forming cells. A big splenomegaly and a bad clinical stage, according to Rai et al. classification, are responsible for a decrease of E, EA, EAC rosette forming cells; unchanged the percentage of S-Ig bearing cells. Such a modification of the surface receptor pattern is present not only in those CLL more advanced in clinical stage and with hyperleucocitosis and/or splenomegaly, but also in those forms with worse clinical feature and prognosis. Our work confirms that CLL is mainly a B proliferative disease; we observed only one case due to T cell proliferation. Four cases were impossible to classify immunologically: one had no cells bearing the markers, three had a subnormal surface receptor pattern.


Myocardial infarction after aortocoronary saphenous vein bypass. Vectorcardiographic study. Vectorcardiograms and scalar electrocardiograms were recorded in 30 patients before and after aortocoronary saphenous vein bypass surgery to determine whether vectorcardiograms are helpful in making the diagnosis of perioperative transmural infarction. The vectorcardiogram indicated inferior infarction in 2 cases and anterior infarction in 1 case when the diagnosis was not apparent on the electrocardiogram. In the solitary case of anterior infarction diagnosed by the electrocardiogram, anterior infarction was already present on the preoperative vectorcardiogram. The study indicates that the recording of vectorcardiograms before and after aortocoronary bypass surgery facilitates the diagnosis of perioperative anterior and inferior infarction and may reveal perioperative infarction about a previously infarcted area.


The carotenoid band shift in reaction centers from from Rhodopseudomonas sphaeroides. A specific carotenoid associated with reaction centers purified from Rhodopseudomonas sphaeroides shows an optical absorbance change in response to photochemical activity, at temperatures down to 35 K. The change corresponds to a bathochromic shift of 1 nm of each absorption band. The same change is induced by either chemical oxidation or photo-oxidation of reaction center bacteriochlorophyll (P-870). Reduction of the electron acceptor of the reaction center, either chemically or photochemically, does not cause a carotenoid absorbance change or modify a change already induced by oxidation of P-870. The change of the carotenoid spectrum can therefore be correlated with the appearance of positive charge in the reaction center. In these studies we observed that at 35 K the absorption band of reaction center bacteriochlorophyll near 600 nm exhibits a shoulder at 605 nm. The resolution into two components is more pronounced in the light-dark difference spectrum. This observation is consistent with our earlier finding, that the "special pair" of bacteriochlorophyll molecules that acts as photochemical electron donor has a dimer-like absorption spectrum in the near infrared.


Regulation of CFU-S proliferation by locally produced endogenous factors. The presence of proliferating and non-proliferating CFU-S in, respectively, the bone marrow and spleens of phenylhydrazine (PHZ) treated mice has afforded the opportunity to investigate the presence and role of local factors responsible for the control of CFU-S proliferation. When bone marrow cells from PHZ treated mice are incubated with irradiated spleen cells taken from the same mice, there is a marked fall in the proportion of femoral CFU-S in DNA synthesis. In the converse experiments rapid triggering of splenic CFU-S is achieved. Changes in CFU-S proliferation have also been demonstrated in other situations where cell populations containing proliferating and minimally proliferating CFU-S are mixed.


[Characteristics of rat training on emotionally varied reinforcement under conditions of an oriented change in the level of brain serotonin and noradrenaline]. The effect of serotonin and noadrenaline precursors on the training of the animals on emotionally different reinforcement was studied. 5-OTP (10 mg/kg) facilitated the training of rats on the food reinforcement, but aggravated it on the pain reinforcement. D, L-DOPA (20 mg/kg) facilitated the training on the food reinforcement. The influence of precursors on the peculiarity of the serotonin and noradrenaline distribution in the brain structures of trained animals was also determined by the biological significance of the reinforcement used in the training.


[Lymphocyte reaction in schizophrenia patients to the phytomitogens, concanavalin and phytohemagglutinin]. The capability of the schizophrenic patients' lymphocytes and lymphocytes of healthy persons to respond to the stimulating action of T-mutagens -- concanavalin A and PHA -- was studied. The T-cell count was determined by the method of rosette formation; the influence of adhesive cells on the lymphocyte response to mitogens was ascertained. The response to both the mitogens in the patients' lymphocyte cultures was reduced as compared to control, and the T-cell count failed to differ from the normal. The removal of adhesive lymphocytes results in the disappearance of differences between the response of the patients' lymphocytes and normal lymphocytes to both the mitogens.


[Effect of avitaminosis B6 in mice on the function of the T-lymphocytes in vitro]. The influence of different degrees of avitaminosis B6 in mice on the cytolytic activity of T-lymphocytes measured by the amount of Na2Cr51O4 released from the lysed target cells was studied on a model of primary immune response in a mixed lymphocyte culture in vitro. Keeping of the animals for 3 weeks on pyridoxine-free diet failed to influence the capacity of lymphocytes to proliferate in vitro and their cytolytic activity. In animals on pyridoxine-free diet for 45 days the amount of pyridoxal 5(1)-phosphate in the spleen decreased by 55% in comparison with control. Lymphocytes obtained from these animals and cultivated in vitro had a markedly decreased capacity to 3H-thymidine incorporation into DNA in response to alloantigen. The cytolytic activity of these lymphocytes also diminished. The capacity of various pyridoxine forms to restore T-lymphocyte functions disturbed by avitaminosis B6 was studied.


Fluvoxamine, a specific 5-hydroxytryptamine uptake inhibitor. 1. On the basis of both in vitro and in vivo experiments fluvoxamine has been characterized as a potential anti-depressant drug with almost exclusively 5-hydroxytryptamine (5-HT) uptake inhibiting properties. 2. Fluvoxamine is effective in inhibiting 5-ht uptake by blood platelets and brain synaptosomes. Due to inhibition of the membrane pump the compound prevents 5-HT depletion by the tyramine-derivatives H 75/12 and H 77/77. As a result of the interference with the neuronal re-uptake mechanism for 5-HT, fluvoxamine produces a decreased 5-HT turnover in the brain. Effects of 5-hydroxytryptophan (5-HTP) are potentiated in mice and in combination with pargyline, fluvoxamine induces 5-HT-like behavioural effects. 3. In contrast to tricyclic antidepressants, noradrenaline uptake processes are either unaffected or only slightly inhibited by fluvoxamine. The noradrenaline depleting effects of tyramine derivates are not influenced by fluvoxamine. Reserpine effects, such as ptosis are affected only at very high doses of the test compound. The antagonism by fluvoxamine of the reserpine-induced lowering of the pentamethylenetetrazole convulsive threshold can be regarded as due to an effect upon 5-HT uptake. In contrast to the effects of desmethylimipramine and imipramine, no stimulatory effects are found in rats when rapidly acting reserpine-like compounds are given following a dose of fluvoxamine.


Effects of lesions of various medial forebrain bundle components on lateral hypothalamic self-stimulation. Unilateral lesions of various medial forebrain bundle components were assessed for their effects on lateral hypothalamic self-stimulation. Damage of areas containig nigrostriatal dopaminergic or ascending noradrenergic neurons had negligible effects on bar pressing, tail moving and alley running for hypothalamic stimulation. Lesions which appeared to destroy most or all of the catecholaminergic fibers in the posterior medial forebrain bundle virtually eliminated reinforced bar pressing and tail moving, but only partially suppressed alley running. The results suggest that brain stimulation reinforcement of the bar press and tail movement tasks depends upon the integrity of neural tissue in the area of the catecholaminergic pathways of the medial forebrain bundle, but not upon specific dopaminergic or noradrenergic systems. The data further suggest that the reinforcement of alley running is at least partially mediated by different neural tissue (possibly non-catecholaminergic) at the level of the posterior medial forebrain bundle lesions.


Coronary artery surgery.

Coronary artery surgery. Coronary artery disease has been described as the largest public health problem in Western society. In spite of the many advances in recent years in its medical management, many patients remain disabled even after optimal medical therapy. The aortocoronary bypass operation, introduced in the mid-1960s, has been shown to have consistent subjective and objective effects on the course of the disease in a large proportion of patients. The procedure consists of inserting a portion of the saphenous vein into both the aorta and a coronary artery to bypass the obstruction. It is usual now to bypass obstructions in several coronary arteries at the same operation if necessary. The prognosis for patients with ischemic heart disease with medical management depends on the extent of the disease. Patients with obstruction of only one coronary artery have a prognosis very little different from normal. On the other hand, obstruction of several arteries is consistently associated with a mortality approaching or exceeding 10% per year.


Malignant lymphoma of peripheral T-lymphocyte origin: immunologic, pathologic, and clinical features in six patients. In a continuing study of patients with lymphoproliferative diseases, six adult patients were encountered with a distinctive malignant lymphoma of peripheral T-lymphocyte origin. Cell suspensions from lymph nodes of these patients contained a pleomorphic, cytologically atypical population of lymphocytes, of which an average 58% marked as T cells in the E-rosette test. The average percent of surface immunoglobulin-bearing B cells in these suspensions was 6%; they were of polyclonal distribution. Lymph node biopsies revealed a malignant lymphoma with certain characteristic features of the organization of the infiltrate, the morphology of the lymphoid cells, and the nature of non-lymphoid cellular elements. The average age of the patients was 67 years; they presented with generalized lymphadenopathy, anorexia, and significant loss of weight. Four patients hd lung and/or pleural involvement by lymphoma at presentation. The immunologic, pathologic, and clinical features of these patients serve to characterize this recently recognized malignant lymphoma further.


Specific attachment of T-lymphocytes from cancer patients to tumor cells. The present study describes a new approach for detecting the immune reaction of peripheral blood lymphocytes of cancer patients against tumor antigens. T-lymphocytes from patients with carcinoma of the urinary bladder were found to attach specifically to monolayers of cells of urinary bladder carcinoma line (T24). The attached T-cells were identified by their capacity to form E-rosettes with sheep red blood cells. The number of rosette forming--target attached lymphocytes (RF--TAL) was 6 times higher in bladder carcinoma patients than in healthy controls or in patients bearing other types of cancer.


In vitro regulation of a mouse myelomonocytic leukemia line adapted to culture. Regulation of the growth and production of granulocyte colony-stimulating activity (CSA) by WEHI-3 cells, a lysozyme-secreting mouse cell line adapted to culture, was investigated in vitro. WEHI-3 cloning efficiency is not enhanced by exogenously added CSA. However, WEHI-3 cloning efficiency in agar was suppressed by an activity in human polymorphonuclear neutrophil extract (colony-inhibiting activity) which inhibits endogenous WEHI-3 CSA production. The addition of increasing concentrations of WEHI-3- or L cell-conditioned medium containing CSA to CIA-depressed WEHI-3 agar cultures resulted in graded increases of cloning efficiency to that of the untreated sample. Testosterone, Deca-Durabolin, and bacterial lipopolysaccharide increased production of CSA by WEHI-3 cells and overcame colony-inhibiting activity-mediated suppression of CSA production, even when activating agents were added 1 day after the addition of colony-inhibiting activity. The activating agents had no direct stimulatory effect on normal mouse marrow colony-forming cells and did not enhance CSA activity. WEHI-3 cells respond to growth inhibitory and stimulatory activities and can serve as an in vitro model for studying the regulation of neoplastic cells.


Binding of colonic tissue membrane to mononuclear peripheral blood leukocytes. Colonic tissue membrane binding to peripheral blood mononuclear leukocytes was quantitated by 125I labeling of membrane fragments and by determining the acquisition of membrane-specific enzyme activity and radioactivity in mononuclear cells after contact with the tissue membrane fragments. Mononuclear cells bound equal amounts of normal and tumor tissue membrane fragments. Mononuclear cells capable of binding homologous but not autologous colonic tissue membranes were recovered from the  peripheral blood of colon cancer-bearing patients. Mononuclear cells capable of binding autologous colonic tissue membranes appeared in the peripheral blood of patients after curative but not palliative tumor resection. Tumor membrane enzymes, including alkaline phosphatase, were introduced to mononuclear cells by bound tissue fragments. The activity of alkaline phosphatase present in the bound membrane fragments was inhibited by the immunorestorative drug, levamisole. Cellular debris liberated from tumors may play an important role in overcoming the host's defenses by binding to mononuclear cells, saturating antigen-binding sites, and introducing exogenous enzymes.


Analysis of methotrexate in human plasma by high-pressure liquid chromatography with fluorescence detection. Methotrexate in human plasma at a concentration as low as 0.01 microgram/ml can be assayed with the use of high-pressure-liquid chromatography and a fluorescence detection system. Methotrexate is oxidized stoichiometrically to 2,4-diaminopteridine-6-carboxylic acid, a fluorescent product that is separable from other fluorescent materials in plasma with the use of an octadecylsilane (reversed phase) column. The detector response is linear over the range of 0.01 to 10 microgram/ml. Neither folic acid nor citrovorum factor interferes with the analysis. N-((4-([2,4-Dihydroxy-6-pteridyl)methyl]-amino)benzoyl))glutamic acid may be used as an internal standard, since it can be extracted from plasma and oxidized like methotrexate. The procedure is rapid (about 30 min) and should be a useful method for monitoring methotrexate plasma concentrations.


The action pattern of human salivary alpha-amylase in the vicinity of the branch points of amylopectin. Salivary alpha-amylase hydrolyses amylopectin in stages. At the end of the so-called second stage, there are present glucose, maltose, and a series of alpha-limit dextrins containing (1 leads to 4)- and (1 leads to 6)-alpha-D-glucosidic bonds. The structures of the limit dextrins containing a single (1 leads to 6)-bond were examined. Six such dextrins were found. Of these, two were capable of being further hydrolysed by alpha-amylase, whereas the remaining four were true, amylase-resistant alpha-limit dextrins. The structures of the limit dextrins afforded information about those (1 leads to 4)-alpha-D-glucosidic bonds of amylopectin that are capable of being cleaved by salivary alpha-amylase and those that are resistant. In order to define further the action of alpha-amylase, the alpha-amylolytic products of 6-alpha-maltotriosyl-D-glucose, 6(3)-alpha-maltotriosylmaltotriose, and 6(3)-alpha-maltotriosylmaltotetraose were examined.


Mathematical models for the action of alpha-amylase on amylose. Mathematical treatments have been developed to describe the action of alpha-amylases on amylose. The treatments are based on the unique properties of the exponential (or most-probable) distribution of molecular weights of the substrate, namely, that (a) the principal averages are invariant to chain-end attack if the product molecules are ignored, and (b) the ratio of the principal averages is invariant to random attack. The relations so developed allow published, qualitative data for the alpha-amylolysis of amylose to be interpreted in a quantitative manner. As a result, it appears that multiple attack is of little or no significance in the action patterns of alpha-amylases, with the exception of those derived from the pancreas.


Accuracy of treadmill testing in assessment of direct myocardial revascularization. Near-maximal treadmill exercise tests (TET) performed at the time of coronary arteriography and bypass graft visualization an average of 13 months after direct myocardial revascularization were analyzed in 217 consecutive patients to assess the accuracy of the TET in predicting completeness of revascularization. TET results were correlated with bypass patency and extent of revascularization. Although conversion of a TET from an abnormal to a normal test or relief of TET-induced angina following surgery is closely correlated with bypass graft patency, the high incidence of normal exercise tests in the presence of residual coronary disease limits their usefulness in the individual postoperative patient in estimating the completeness of revascularization.


Coronary revascularization in patients maintained on chronic hemodialysis. Thirty-two thousand patients are presently maintained in chronic dialysis programs. Cardiovascular complications have been shown to be responsible for 50 to 65% of the deaths in such patients. Despite this and the increasingly frequent use of coronary bypsss surgery in the general population, only two patients have previously been reported to have successfully undergone coronary bypass surgery while maintained on chronic hemodialysis. This reports two additional such patients who successfully underwent coronary revascularization without difficulty. Pertinent details of preoperative, intraoperative, and postoperative management are outlined for these patients and the other 13 chronic dialysis patients who have had cardiopulmonary bypass for other reasons. With careful planning, coronary revascularization can be successfully carried out in this group of patients with minimally increased operative risk.


Circulating immune complexes in systemic lupus erythematosus. Sera from twenty-one patients with systemic lupus erythematosus (SLE) were analysed for the presence of circulating soluble immune complexes by a sensitive and quantitative radioimmunoassay employing radioiodinated human Clq (Clq-deviation test). In twenty-five normal individuals the percentage of Clq inhibition was 2-64 +/- 4-45%. Eleven of the SLE patients had significantly elevated values, and the mean value for the group was 20-38 +/- 20-64%. The seven patients with renal disease had somewhat higher levels (24-14 +/- 18-70%) than those without kidney involvement (19-00 +/- 21-84%), and elevated levels of antibodies to native DNA also were associated with high levels of percentage of Clq inhibition. Both intermediate (7S-19S) and large (greater than 19S) complexes were present in the sera, and digestions with DNase and RNase indicated that antibodies to DNA and RNA accounted for only some of them. Serial studies in individual patients demonstrated the assocation of circulating complexes with, and often preceding, falling complement levels during disease activation.


Crude transfer-factor preparations stimulate trypsinized human lymphocytes to form rosettes with sheep red cells. The binding sites for sheep red cells (E) on human lymphocytes are trypsin-sensitive but regenerate in vitro on incubation at 37 degrees C. The rate of this regeneration was increased in the presence of dialysates of human leucocyte extracts (DLE). Thus incubation of trypsinized lymphocytes for 3 hr in appropriate dilutions of DLE resulted in a 2- to 6-fold increase of E-binding activity above that observed in medium-incubated control lymphocytes. Dialysates prepared from human thymus and brain similarly accelerated recovery of E-binding activity whilst dialysates of human fibroblasts and liver cells were inactive. The regeneration of trypsinized membrane immunoglobulin was slightly delayed in the presence of DLE. These findings indicate that leucocyte dialysates contain an activity which preferentially stimulates the regeneration of a T-lymphocyte membrane component. It is suggested that this activity may account for the immunological restoration observed in some patients with T-lymphocyte deficiency after injection of leucocyte dialysates.


Bovine lymphocytes: enhanced E-rosette formation after storage or gradient centrifugation. Incubation of bovine thymus lymphocytes with SRBCs for 1 hr or more at 0 degrees C during the E-rosette test gave higher rosette counts than tests receiving no such incubation. Further enhancement was seen if lymphocytes were stored in foetal calf serum (FCS) or BSA solutions at 4 degrees C for 18 hr prior to rosette tests. Best enhancement due to storage in BSA was seen when cells were subsequently tested in FCS. However, after storage in BSA many rosettes occurred when tests were done in BSA, Albeit few rosettes occurred in BSA without prior storage. Less enhancement was seen after storage in sodium metrizoate (NaM). Enhancement in FCS and 10% BSA occurred after 1 day, but not 2 or more days, of storage at 4 degrees C, but was not seen when cells were stored at 37 degrees C. Rosette formation was about doubled by centrifugation of lymphocytes through BSA gradients prior to rosette tests; centrifugation through NaM gradients had no such effect. It is suggested that rosette formation is a property of an immature bovine T cell, and that on storage some cells develop and subsequently lose the ability to form rosettes.


Evidence for the existence of self-reactive human B lymphocytes. Supernatants from human tonsil cells cultured in the presence of the PBAs, LPS and F (ab)2 monomers of rabbit anti-human beta2-microglobulin were found to have a complement-dependent cytotoxic activity to tonsil cells of the same donors. A direct toxic effect of the PBAs on the target cells was excluded by controls. Therefore the most likely explanation for this finding is that human lymphocytes contain a subpopulation of self-reactive B cells which can be triggered by PBAs to release antibodies to self-antigens. The implications of this finding for the understanding of infections accompanied by auto-immune phenomena are discussed.


In vitro effects of lidocaine on anaerobic respiratory pathogens and strains of Hemophilus influenzae. Lidocaine is commonly employed as a topical anesthetic agent during fiberoptic bronchoscopic procedures or transbronchial brushing. Previous studies have demonstrated an inhibitory effect of lidocaine on the growth in culture media of gram-positive and gram-negative organisms, as well as several species of Mycobacterium and various fungi. The current in vitro investigation demonstrates an inhibitory, as well as a bactericidal, effect of lidocaine hydrochloride (in concentrations identical to those encountered during fiberoptic bronchoscopic procedures) on the common anaerobic respiratory pathogens and on multiple strains of Hemophilus influenzae. The finding helps to explaint the difficulty in producing proof via culture of the specific etiologic agent in inflammatory lesions from specimens obtained by fiberoptic bronchoscopic procedures or transbronchial brushing.


Echocardiographic and roentgenographic determination of left ventricular size after coronary arterial bypass graft surgery. In 38 patients undergoing elective coronary arterial bypass graft surgery, the radiographic dimension of the left side of the heart was determined and echocardiographic studies were performed before and after surgery. On the plain chest x-ray film one week after surgery, all patients showed an increase in the size of the left side of the heart, which usually was not accompanied by an increase in the echocardiographic left ventricular end-diastolic dimension; however, in 25 patients, pericardial fluid was detected soon after surgery, which would explain the enlarged cardiac silhouettes. Several months after surgery, the radiographic size of the heart returned to the preoperative value in most patients, and pericardial fluid was no longer demonstrated on the echocardiogram. Thus, pericardial fluid frequently is found in the first week following coronary arterial bypass graft surgery and may give the impression of increased cardiac size on plain chest x-ray films; however, echocardiographic studies provide a more accurate estimate of left ventricular size and reveal the presence of pericardial effusion.


Antitrypsin and chronic obstructive pulmonary disease among Japanese-American men. A total of 161 patients with chronic obstructive pulmonary disease (COPD) plus 100 control subjects (identified during a study of heart disease in 6,860 Japanese-American men aged 52 to 75 years who were residing in Hawaii) were analyzed for phenotype in search of the antitrypsin gene Z, which has been shown to be associated with pulmonary emphysema in other racial groups. No carriers of the Z gene were found, and the question of whether the rarity or absence of this gene relates to a low frequency of COPD among Japanese-Americans is reviewed.


[Prevention using cephalothin in open-heart surgery]. To assay the efficiency of cephalothin prophylaxis in open-heart surgery, bacteriological examination of pressure-measurement units, intravenous catheter tips, and urine were made in 211 consecutive patients as well as blood cultures and sputum in suspected postoperative sepsis. Furthermore, cephalothin concentration in serum and tissue was determined in 12 consecutive adults with intact kidney function. Samples were taken before, during, and after the cardiopulmonary bypass, the tissue from the right atrium only before and after cardiopulmonary bypass. A high serum cephalothin level (80.04 +/- 23.35 microgram/ml) was measured 30 min after administration of 2 g cephalothin given as a 15-min-long i.v. infusion on induction of anesthesia. An antibiotic regimen - 4 X 2 g dose of cephalothin daily (first dose on induction of anesthesia) - provides a serum cephalothin level which is significantly higher than the cephalothin minimum inhibitory concentrations for most gram-positive organisms (0.475 microgram/ml) and so ensures an adequate antibiotic coverage throughout the surgical procedure and during the early postoperative phase of open-heart surgery.


[Clinical aspects and therapy of spontaneous under-anticoagulants-occurring intramural intestinal hemorrhages]. Massive spontaneous "anticoagulant" hemorrhage in the bowel wall may cause an acute abdomen with signs of intestinal obstruction within a few hours. An operative revision is indicated if a barium study is not possible to secure this rare diagnosis and therefore other much commoner causes of an acute abdominal illness are not to be excluded. While out of 42 patients, in whom the hemorrhagic segment was resected, only two died as a probable result of the operation, several cases are known where a survival without laparotomy was unimaginable. The dangers of a laparotomy should not, therefore, be overemphasized.


[Incidence of infant tuberculosis in Germany during the first year after cessation of unselected BCG vaccination (author's transl)]. At the end of May 1975, BCG vaccine was withdrawn from the market in the Federal Republic of Germany, because a newly introduced vaccine had given rise to untoward reactions. Neonatal vaccination practically ceased. The results of a survey by questionnaire, undertaken on behalf of the Vaccination Committee of the German Society for Social Paediatrics, are reported. From 1.9.1975 to 31.8.1976 the incidence of tuberculosis in the first year of life had already doubled compared with the reported annual rate in both 1973 and 1974. Almost all cases were due to infection by adults not thought to be infectious. It is recommended that indications for "selective vaccination" should be broadened and the results of longer exposure time of unvaccinated children be awaited before any stoppage of general vaccination is decided upon.


Biological activity of bullfrog growth hormone in the rat and the bullfrog (Rana catesbeiana). Highly purified bullfrog growth hormone (GH) was tested for growth promoting activity in rats and bullfrogs (Rana catesbeiana). In repeated assays, the potency of bullfrog GH in the rat tibia assay was 1 X bovine GH, which is significantly greater than all other non-mammalian GHs tested. It also stimulated significant whole body growth in immature hypophysectomized rats injected daily for 16 days. In bullfrogs, the bullfrog GH (about 2 microgram/injection) stimulated growth and appetite in intact frogs, and improved survival in hypophysectomized frogs. In contrast, even relatively high doses of bovine GH (up to 200 microgram/injection) were inactive in the bullfrog.


Effect of multiple sclerosis serum on ventral root responses in isolated frog spinal cord. Serum from patients with multiple sclerosis (MS) and other diseases was added to the medium perfusing isolated hemisected frog spinal cord, and the effect on ventral root responses (VRR) tested. As control, a standardized commercial human serum (Moni-trol I) was used. In 25 out of 40 spinal cord preparations Moni-trol gave inhibition of VRR ranging from 2.8 to 23.1%. 76% of the tests with confirmed MS sera showed inhibition of VRR, after deduction of the control serum effect, while 53% of the tests with sera from other diseases were inhibitory. Sera from cases of suspected but clinically unconfirmed MS gave strong inhibition (above 20%).