Acute reversible myocardial infarction after blood transfusion in the aged. Seven elderly cases with reversible electrocardiographic changes simulating acute myocardial infarction in the absence of gross myocardial infarction on postmortem examination were observed following the blood transfusion. The underlying diseases were cancer of gastrointestinal tract or gall bladder in 4, gastric ulcer in 2, and 1 of pseudomembranous enterocolitis. The electrocardiogram revealed the abnormal Q waves with monophasic ST elevation and following coronary T inversion. These findings lasted only for 2 to 7 days and returned to the previous normal tracings. The hematocrit was elevated from 28.9 to 47.7 after the blood transfusion of 800 to 1,800 ml. The disseminated intravascular coagulation was shown in 5 cases. GOT levels were within normal ranges except 1 case. Pathological findings in cases with recent electrocardiographic changes were characterized by the mural thromboses, extending into the myocardium through the Thebesian vein. The focal small necroses of the adjacent myocardium or around the thrombosis of small vessels were also observed. In the later phase the fine interstitial fibrosis took place after the resorption of the thrombi and necrotic foci. From these clinical and pathological findings we proposed a new concept of reversible myocardial infarction induced from the hypercoagulability, disseminated intravascular coagulation, and elevated hematocrit.


Anomalous origin of left coronary artery from pulmonary artery. Case report and review of literature concerning teen-agers and adults. An adult with angina was found to have anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Review of the literature regarding this anomaly in teen-agers and adults disclosed only 25 cases diagnosed during life. Eighteen additional cases of ALCAPA in this age group have been diagnosed post mortem. In this report, we will review the management of teen-agers and adults in whom ALCAPA was correctly diagnosed during life. We shall also describe the eighth case of successful aorta-left coronary artery grafting with the saphenous vein in this age group. This case brings the total in the literature to 44. Of those patients offered surgical therapy, 13 underwent successful ligation of the anomalous artery. Saphenous vein grafts were employed in 8. Five did not undergo ligation or saphenous vein grafting. There was one death. It would appear that saphenous vein grafting is the definitive means of surgically correcting ALCAPA, because it restores the dual coronary circulation.


Postoperative chest wound infections in patients requiring coronary bypass. A controlled study evaluating prophylactic antibiotics. A controlled study investigating clean chest wound infections in 904 patients undergoing myocardial revascularization was performed. Four hundred fifty-one patients received systemic antibiotics before and after the operation, and 453 patients received no prophylactic systemic antibiotics. The infection rate was 1.10 per cent and 1.76 per cent, respectively, indicating no statistical difference between the two groups. Preoperative skin preparation and subsequent local antibiotic wound irrigation may be the most important factors in preventing clean wound infection.


The histocompatibility complex and rheumatic diseases. Histocompatibility typing has assumed an increasingly important role as a clinical and research tool in rheumatic diseases. The HLA antigens which are serologically defined (A and B series) are being used most extensively for clinical work, but the role of other immunologic determinants in the HLA complex is being evaluated. These include D-locus (MLC) determinants, several complement components, and immune response genes which have been well characterized in the mouse, but not in man. The products of the major histocompatibility complex are inherited in a simple Mendelian fashion as a series of co-dominant alleles. Large population studies have characterized the frequencies of various alleles, and family studies have allowed tentative mapping of the various loci within the complex on the sixth chromosome in man. A number of diseases which are considered to be autoimmune in nature are now known to be associated with specific HLA antigens. Of these disease associations, the strongest and best studied are the seronegative spondyloarthropathies which are highly associated with the B27 antigen. Included in this group are ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy, colitic arthropathy, Yersinia arthritis and a small group of juvenile rheumatoid arthritis patients with features of ankylosing spondylitis. The clinical application of tissue typing or B27 testing is most helpful in regard to difficult diagnostic problems in patients with early or atypical seronegative spondyloarthropathy. Its value as an indicator of prognosis, and its value in counselling family members is not well established. There are many interesting hypotheses regarding pathogenetic mechanisms of these rheumatic diseases based on susceptibility factors related to the major histocompatibility complex. An abnormal immune response gene within the complex is probably a key feature of the mechanism, but the exact details are little more than speculative at this point.


[Ulcerative colitis - indications for surgery and methods of treatment (author's transl)]. Morphology, clinical signs and symptoms as well as surgical therapy of ulcerative colitis are discussed comparing own findings with results reported in the literature. Case reports are given of 48 patients with special emphasis on indications for surgical treatment, methods of surgery and complications. Timing of surgery and medical pretreatment do play a decisive role. The treatment of choice today is proctocolectomy with terminal ileostomy in one session; more serious complications as well as transition into a carcinoma can thus be avoided. In some acute cases a fistula-operation may be indicated for short-term relief.


[Clinics and management of radiation injuries of small bowel and colon(author's transl)]. In the Surgical and Gynecological Departments of the University of Mainz, Medical School, 50 patients were operated between 1964-1976 for mechanical and paralytical  ileus and intestinal bleeding caused by radiation injury of the bowel. Diagnosis depends on the history of radiation therapy. At operation we have seen a recurrence of gynecological and other malignant growths only two times. Intestinal resection with anastomosis is the preferred method for the management of such radiation injuries. The postoperative dehiscence of the intestine was noticed only five times. In order to prevent higher mortality rates, operation should be carried out as soon as possible.


Growth of measles virus in various human lymphoid cell lines. Neurovirulent TYCSA strain and attenuated Schwarz strain of measles virus and Halle strain of subacute sclerosing panencephalitis (SSPE) virus replicated in cultures of human lymphoid cell lines of the T-cell type, MOLT-3, MOLT-4 and CCRF-CEM. TYCSA and Halle strains grew rapidly, but Schwarz strain grew slowly in these cell lines. Furthermore, these three strains established persistent infection in CCRF-CEM cells but not in the other cell lines. In these persistently infected cultures an almost entire population of cells were shown to be infected and infectious virus was produced constantly for over 100 days. Cells persistently infected with Schwarz strain contained nucleocapsid structures in both the nucleus and cytoplasm and produced low titered infectious virus, whereas nucleocapsid structures were observed only in the cytoplasm of cells persistently infected with either TYCSA or Halle strain and the titers of infectious virus produced from these cells were high.


The experience of a haematemesis and melaena unit: a review of the first 513 consecutive admissions. This report is of the results of management in a haematemesis and melaena unit at Prince Henry's Hospital, Melbourne. The unit was established in October, 1972, in response to unpublished data for the decades 1950 to 1959 and 1960 to 1969, which showed a mortality of about 15%. In the 39 months to December, 1975, 513 patients were received into a semi-intensive care setting. The unit staff consisted of a group of four surgeons and four physicians working a weekly roster. Primary care and liaison were the responsibility of the gastroenterology registrar. The basic diagnostic measure taken was the routine early use of fibreoptic duodenoscopy. The unit was set up with an agreed policy of management of the common causes of haematemesis and melaena, and data were prospectively recorded in a form suitable for computer analysis in every case. Of the 513 admissions, 378 were of males and 135 were of females. Forty-five patients died, giving an overall admission mortality of 8-8. There were 143 admissions for bleeding duodenal ulceration, 102 for acute peptic ulceration, 47 for chronic gastriculceration, 43 for oesophageal varices, 33 for Mallory-Weiss syndrome and 45 for less common causes of upper gastrintestinal bleeding. In 100 cases the source of bleeding was not discovered. Of the 143 patients admitted for chronic duodenal ulcer, either patients died, giving a mortality of 5-6%; 72 patients underwent operation, with an operative mortality of 9-7%. Of the 47 admitted with bleeding gastric ulcer, nine died (19-1%), while 26 came to operation; the operative mortality was 26-9%. There were 102 admissions for acute peptic ulceration, with an overall mortality of 11-7% (12 patients); 16 patients came to operation, with an operative mortality of 43-7%. Eleven deaths occurred in the 43 patients admitted for bleeding oesophageal varices (25-6%), with 10 patients coming to operation; the operative mortality was 30-0%. An age of greater than 50 years and shock on admission were the most significant factors for poor prognosis in this group of patients.


Coronary artery surgery in Australia, 1975-1976. A report by the National Heart Fundation of Australia. This is a report of a register of Australian experience in coronary artery bypass graft surgery over a 12-month period from October 1, 1974, to September 30, 1975. It provides data on results up to discharge from hospital. There were 967 patients and 58 (6%) hospital death.


The future of cardiac surgery in Australia. A prediction from a 15 year experience. Statistics are presented which demonstrate that the load of congenital heart surgery in Australia is between 900 and 1,000 cases per year. For valvular heart surgery the load is also approximatley 1,000 cases per year. About 800 to 900 operations are undertaken annually to institute cardiac pacing. The number of operations for coronary artery disease has increased in an explosive manner from less than 100 cases in 1970 to more than 1,000 cases in 1975. The implications of this marked increase in operation for coronary artery disease is of paramount importance for future planning in cardiac surgery.


Relation of protease inhibitor phenotypes to obstructive lung diseases in a community. To examine the relative risk for the development of obstructive lung disease in persons heterozygous for alpha1-antitrypsin deficiency, we determined protease inhibitor phenotypes in 2944 subjects in a general community population. Phenotype M was found in 89.5 per cent, MS in 7.1 per cent, and MZ in 3.0 per cent of the population. There were two persons of phenotype Z and six of phenotype SZ. The study also included respiratory questionnaires and spirometry. There were no statistically significant differences in the prevalence of respiratory symptoms and diagnoses or of ventilatory impairment among the three major phenotype groups (M, MS and MZ), nor were there differences in the rates of deterioration of function with age or smoking. Consequently, we do not consider population screening for heterozygous alpha1-antitrypsin deficiency to be worthwhile.


T and B lymphocytes in uremic patients with type B hepatitis infection. Peripheral T and B lymphocytes were measured in (1) hepatitis B surface antigen (HBsAg)-positive, (2) HBsAg-negative uremic patients on chronic hemodialysis (CHD) therapy, and (3) patients with type B chronic active viral hepatitis (CAVH). When compared to normals, a decrease in the absolute number of T and B lymphocytes was detected in both CHD groups. CAVH patients had a decrease in the total number of T lymphocytes. When expressed as percentage of T lymphocytes, normals and HBsAg-negative CHD patients had similar values, while a decrease was detected in both HBsAg-positive CHD and CAVH patients. Also, in the latter two groups, hepatitis B virus infection resulted in an increase in the total number and percentage of null cells.


[Modulating mechanism of the dorsal column stimulation for pain relief (author's transl)]. The neural mechanism of the modulating effects of spinal cord stimulation upon intractable pain was studied in cats under local anaesthesia. The electrical activity at the centre median nucleus of the thalamus (CEM), which responded to noxious stimuli and was inhibited by nitrous oxide inhalation, was recorded as an indicator of the degree of pain sensation. The suppressed effect upon the evoked potential responding to sciatic stimulation (1 Hz) was recorded during and after train stimulation of various parts of the spinal cord by means of silver ball bipolar electrode. Whenever inhibitory modulating effect upon CEM response was observed by spinal cord stimulation, the bilateral dorsal tractotomy cranial, caudal or both to the stimulating point in order to examine the influence upon the CEM potential. The results are as follows: 1) The CEM evoked potential responding to sciatic stimulation is inhibited by about 30-45% of its amplitude by dorsal column stimulation. This effect corresponds to the inhibitory effect by 75% N2O gas inhalation. Upon dorsal column stimulation, the intraspinal electrical activity is found in the central gray matter the antero-lateral quandrants of the spinal cord as well as the dorsal column. 2) Following lateral or anterior column stimulation as well as dorsal column stimulation, the CEM evoked potential responding to sciatic stimulation is inhibited by about 50% of its amplitude. 3) Following bilateral dorsal tractotomy cranial, caudal or both to the stimulating point, the CEM evoked potentials responding to sciatic stimulation are inhibited by dorsal column stimulation. According to the experimental results, it may be concluded that the inhibitory modulating mechanism by dorsal column stimulation for pain relief is not only mediated through the dorsal column, but also through other ascending spinal pathways.


[Surgical treatment of complications in cases with cancer of the colon and rectum]. Personal experience and the literature are referred to in an examination of complications arising in the course of cancer of the large intestine. A personal series assembled in about 20 years is presented. It consists of 135 cases of heteroplasia, including 57 emergency admissions for complications. The surgical technique employed is described. The results show that surgical risk and post-operative mortality are lower in patients subjected to major radical surgery, as opposed to those for whom symptomatic management or simple, derivative operations are prescribed.


[Hepatic artery aneurysm as a cause of hemobilia]. 1) Haemobilia must be kept in mind as a cause of gastrointestinal haemorrage. 2) The presence of an hepatic artery aneurysm gives a peculiar triad of symptoms: abdominal pain, gastrointestinal haemorrage and jaundice. 3) Selective angiography is the elective diagnostic aid. 4) The diagnosis may be difficult also at operation, because the aneurysms can be very small. 5) The most used surgical treatment are ligation of the hepatic artery, the excision of aneurism, the endoaneurysmorrhaphy or the end-to-end anastomosis.


[Neuroradiological studies in syringomyelia]. In the years 1973--1975 20 patients with syringomyelia were treated surgically. The surgical interventions were preceded by careful radiological examinations which was often indispensable for confirmation of diagnosis, establishing of indications to operation and choice of surgical method. On plain radiograms in 16 cases cervicothoracic scoliosis was found, in 11 cases the vertebral canal was dilated in its cervical part, in 6 cases atlanto-occipital malformations were disclosed. The basic diagnostic examination was ascending myelography which was performed in 17 cases. In 3 cases the contrast medium failed to pass to the atlanto-occipital junction because of marked dilatation of the spinal cord in the cervical part. In 9 out of the remaining 14 cases radiological findings were compatible with the diagnosis of Arnold-Chiari syndrome which was confirmed during the operation. In 1 case positive contrast central pneumoencephalography was performed demonstrating a communication between the 4 th ventricle and the cavity in the spinal cord. Early detailed neuroradiological diagnosis is indispensable in syringomyelia for early surgical treatment.


[Acute enzymatic pancreatitis. Clinical contribution]. Personal experience with acute enzymatic pancreatitis in 113 cases observed, over 11 years, at the Santa Croce Hospital Surgical Division is described. Only 58 cases (51,3%) were submitted to surgery and the remaining 55 cases (48,7%) were treated with medical therapy. A mortality of 16,8% was observed.


[Scanning electron microscopy of cultures of macular dystrophy of the cornea]. The scanning electron microscope shows that the keratocytes of the macular dystrophy of the cornea have an irregular and anfractuous surface and that some cytoplasmic particles are broken off. This explains the isolated elements found in the stroma.


[Therapy of solid tumors using high-dose methotrexate and citrovorum factor]. Methotrexat (250-1100 mg/m2) was administered to 38 patients with malignant tumors by infusion of either 6 hours or of 75 minutes duration. MTX-infusion and continued at 3-6 hours interval for Citrovorum factor rescue was started 2 hours after 24 to 72 hours. 7 different MTX doses and rescue schedules were tested. It could be shown that MTX in the dose range used is effective in various tumors when CF-rescue is not higher than 7% of the administered MTX-dose, only occasionally therapeutic success was observed with higher doses. In the group of patients where CF-rescue was lower than 7% of the MTX dose on 9/14 patients objective tumor-regressions could be achieved. Conclusions drawn are discussed and the necessity of further investigations is emphasized.


[Therapy and prognosis of obstetrical lesions of the brachial plexus (author's transl)]. Out of 26 children with 31 brachial paralyses 19 patients with 23 paralyses were examined in an average age of 7,9 years. In these cases a distinct correlation with abnormal birth positions and with more difficult deliveries respectively was given. There were 8 total, 14 upper and 1 lower paralysis. At the follow-up examination 10 cases were without any signs of paresis, on 13 extremities we found defects of different degrees, but only 1 severe and 4 slight contractures. The total paralyses and here particularly the bilateral cases showed the worst results. All cases completely or with minimal defects healed had developed already in the first 6 weeks after birth a good recovery from the paresis. In such cases a good prognosis may be given at that early time. As the earliest treatment the fixation of the shoulder joint in abduction and external rotation with flexed elbow on a splint as prevention of further stretch on the plexus and contractures seems to be the most important masure; later on a physio-therapy and mobilisation of the joints is of essential importance.


Atypical phenylketonuria with normal phenylalanine hydroxylase and dihydropteridine reductase activity in vitro. A child with phenylketonuria had normal phenylalanine hydroxylase activity in vitro. In addition, all known components of the phenylalanine hydroxylating system were within the normal range. Despite early treatment with a phenylalanine-restricted diet, the patient developed severe neurological symptoms. Although the primary molecular defect in this child is not known, there are indications that the defect lead to disturbances in phenylalanine metabolism and the biosynthesis of L-dopa and L-5-hydroxytryptophan. The administration of these two precursors of neurotransmitters brought a notable improvement in the patient's neurological symptoms.


The participation of the nigro-thalamic pathway in the nigral control of the caudate nucleus. Unilateral injections of carbachol (CCh, 2 mul) to lateral parts of substantia nigra (SNlat) of the rabbit increased the alert index (participation of alert pattern in EEG), produced epileptoidal EEG discharges, sniffing, ipsi- and contralateral rotations, and abnormal movements of fore limbs, which may be regarded as an equivalent of localized seizures. Ipsilateral rotations appeared together with epileptoidal discharges confined to SNlat, while contralateral -- with discharges in ventrolateral thalamic nucleus (VLTh). The EEG discharges appeared firstly and had the longest duration in VLTh. Injection of CCh to medial substantia nigra (SNmed) did not produce contralateral turnings and rotations, and epileptoidal EEG discharges appeared primarily in SNmed. In rabbits with previously lesioned nigro-neostriatal pathway (NSP) at the level of Forel's fields, the EEG discharges produced by CCh injected into SNlat appeared firstly and were most prolonged in SNlat, while they appeared much later in caudate nucleus (NC), cerebral cortex, and VLTh. The contralateral rotations were inhibited, and ipsilateral ones -- potentiated in the lesioned rabbits.


Local starvation for epidermal growth factor cannot explain density-dependent inhibition of normal human glial cells. Mouse epidermal growth factor (mEGF) is a potent growth promoter of human glial cells in sparse cultures, whereas very little stimulation of growth in dense cultures is induced by the factor. In the present communication, the possibility that the density-dependent inhibition is caused by a reduced binding/uptake of the factor was scrutinized. It was found that the number of mEGF binding sites was 20,000 and 35,000 per cell in sparse and dense cultures, respectively. The dissociation constant of the binding reaction was not influenced by the cell density. It was concluded that crowded cells are not starved for the factor and that a decrease in number or affinity of the EGF receptors can be excluded as a cause of the inhibition.


Systemic alteration induced in mice by ultraviolet light irradiation and its relationship to ultraviolet carcinogenesis. Chronic irradiation of mice with ultraviolet (UV) light produces a systemic alteration of an immunologic nature. This alteration is detectable in mice long before primary skin cancers induced by UV light begin to appear. The alteration results in the failure of UV-irradiated mice to reject highly antigenic, transplanted UV-induced tumors that are rejected by unirradiated syngeneic recipients. The immunologic aspect of this systemic alteration was demonstrated by transferring lymphoid cells from UV-irradiated mice to lethally x-irradiated recipients. These recipeints were unable to resist a later challenge with a syngeneic UV-induced tumor, whereas those given lymphoid cells from normal donors were resistant to tumor growth. Parabiosis of normal mice with UV-irradiated mice, followed by tumor challenge of both parabionts with a UV-induced tumor, resulted in the growth of the challenge tumors in both UV-irradiated and unirradiated mice. Splenic lymphocytes from tumor-implanted UV-treated mice were not cytotoxic in vitro against UV-induced tumors, whereas under identical conditions cells from tumor-implanted, unirradiated mice were highly cytotoxic. Our findings suggest that repeated UV irradiation can circumvent an immunologic mechanism that might otherwise destroy nascent UV-induced primary tumors that are strongly antigenic.


Unprimed spleen cell populations recognize macrophage-bound antigen with opposite net electric charge. Previous studies have demonstrated an inverse charge relationship between the net electrical charge of antigen and the responding cells. In the present study we attempted to establish whether this phenomenon holds also for the primary recognition phase of cell-mediated immunity, when the involvement of the macrophage in presenting antigen is obligatory. Normal spleen cells were fractionated over negatively and positively charged columns. The fractionated cell populations, as well as the original cells, were sensitized in vitro on macrophage monolayers that were pulsed either with the basic encephalitogenic protein of myelin or with the acidic copolymer poly(Glu50,Tyr50). Cells eluted from glass bead columns(i.e., the more negative cells) could be sensitized only with the basic antigen, while cells eluted from poly(L-lysine)-glass bead columns (i.e., more positive cells) could be sensitized only to the acidic antigen. Thus, in delayed type hypersensitivity the inverse charge relationship prevails also for the primary immunological recognition of antigen bound to macrophages.


A correlational analysis of the effects of surgical transections of three components of the MFB on ingestive behavior and hypothalamic, striatal, and telencephalic amine concentrations. A retractable wire knife was used to transect medial or lateral components of the MFB or its lateral projections to the striatum and amygdaloid complex. All cuts produced significant depletions of NE, DA, and 5-HT from telencephalon and striatum but little or no effect on hypothalamic NE or 5-HT. Two of our cuts resulted in aphagia and adipsia, the third in hyperphagia and obesity. A detailed correlational analysis of the magnitude and direction of the behavioral and biochemical consequences of our cuts indicated that the ingestive behavior of all of our experimental animals (including animals which had been aphagic and adipsic after surgery as well as animals which were hyperphagic and obese) was positively correlated with the concentration of DA in striatum and telencephalon and negatively correlated with telencephalic 5-HT. Less consistent evidence for facilitatory noradrenergic influences on food intake was also obtained. Our results suggest that the regulation of food intake may be the result of an interaction between telencephalic serotonergic mechanisms and dopaminergic pathways which exert opposite effects on ingestive behavior.


Self-stimulation of the MFB or VTA after microinjection of haloperidol into the prefrontal cortex of the rat. Haloperidol, a dopamine receptor antagonist, was microinjected in doses of 12 or 24 microng into the prefrontal cortex of the rat. Its effects on self-stimulation of the ventral tegmental area (VTA) or the medial forebrain bundle (MFB) were examined. It was found that these injections failed to attenuate self-stimulation at either structure. However, when haloperidol was injected into the caudate-putamen complex, a decrease in self-stimulation occurred within these structures. These results suggest that dopamine in the medial prefrontal cortex is not necessarily a part of the neurochemical substrate underlying self-stimulation of the ventral tegmental area or medial forebrain bundle.


[Computer tomography in intracranial tumors. A cooperative study of 1658 neoplasms (author's transl)]. This paper decribes the results of the CT teams of the University Clinics Berlin, Mainz and Munich. 1658 patients with cerebral tumors have been examined so far (EMI Scanner Mark I, Matrix 160/160) revealing a diagnostic accuracy of 98.4%. The findings of various kinds of tumors (306 glioblastomas, 255 astrocytomas and oligodendrogliomas, 248 meningiomas, 212 metastases, 200 pituitary adenomas and craniopharyngeomas) are discussed and illustrated by typical images. Differential diagnostic problems and the importance of additional neuroradiological procedures are discussed.


[Some examples of false negative diagnoses in computer tomography (author's transl)]. Four examples of false negative diagnoses in computer tomography are discussed. The patients were suffering from tumours in the sella turcica, beside the sella turcica and in the cerebellopontine angle. With reference to the two patients with a process beside the sella turcica, the differential diagnosis of these processes (of which the clinical syndrome is characterized by ophthalmoplegia) is discussed. The diagnostic reliability of computer tomography seems to be inferior for these perisellar processes than for other localizations. Angiography and pneumoencephalography are the methods of choice in the diagnosis of these processes.


[An information retrieval system for CT-scan data (author's transl)]. A computer program for the current statistical documentation and evaluation of CT diagnostic results is presented. A diagnostic key for the purposes of CT results has been developed. Special emphasis has been given to fast and simple applicability.


Response of spleen lymphocytes shortly after thymectomy in adult mouse. The blastogenesis response to the phytomitogens, PHA-P, Con A and PWM was used to assess the effect of adult thymectomy on the spleen lymphocytes of C57B1 mice. The mitogenic response to the phytomitogens was determined by 3H-thymidine uptake. The changes produced in theta-antigen bearing spleen lymphocytes were also evaluated making use of theta antibodies from AKR/S mice previously injected with splenic and thymic lymphocytes from CBA/J mice. The present results show that the response to mitogens PHA-P and Con A is reduced early after thymectomy while the response to PWM was only slightly reduced. There was not any correlation between the disminished response to mitogens and the changes observed in theta bearing spleen lymphocytes.


Protease-induced constriction in rats' bronchi. A method is described which allows quantitative measurements of bronchomotor function in vitro in all parts of the tracheobronchial tree. With this method it was observed that chymotrypsin, trypsin and ficin elicted contraction in the intrapulmonary airways of rats. The response could be abolished or diminished by phentolamin and atropine. Physostigmine did not potentiate the response. It is concluded that chymotrypsin operates mainly through alpha-adrenoreceptors, whereas trypsin and ficin operate through both a alpha-adrenoreceptors and cholinoceptive receptors.


[HLA-B27 antigen and alkaptonuria].

[HLA-B27 antigen and alkaptonuria]. Study of urinary homogentisic acid and a determinantion of group HLA were carried out for 36 members of a family spread over three generations with three cases of ochronotic rheumatism in the second generation. Alkaptonuria was discovered in seven other subjects, six of them members of the third generation: urinary elimination was poor, less than 0.60 g/24 hours. There is a certain degree of consanguinity in the family studied here and these findings do not therefore rule out a recessive autosomal transmission of the alkaptonuria. They do however lead to the consideration that alkaptonuria may sometimes be found in heterozygotic subjects. A genetic relationship between HLA complex and alkaptonuria can only be claimed with difficulty from this familial study, but the high frequency of B 27 antigen (29 out of 36 members carring it) leaves room for the hypothesis that the B 27 gene, or more precisely a gene associated with the B 27 gene, plays a part in the development of ochronotic rheumatism.


[Surgical therapy in diverticular disease of the large bowel]. Operative proceeding, postoperative complications and postoperative mortality in 97 selective and 44 emergency operations for different states in diverticular disease are reported. In states of uncomplicated, chronically recurrent inflammation, one-stage resection is indicated. General condition of the patient and severe complicated diverticulitis may require two- or three-stage therapy. Our experience of 141 operations prompts us to propose early resection in states of chronically recurrent inflammation.


[Value of Warren's distal spleno-renal shunt in the treatment of esophageal varicosities]. Analysis of 22 patients who underwent distal spleno-renal shunt shows that postoperative mortality is low, thrombosis of the shunt rare, and the risk of encephalopathy minimal. Decompression of esophageal varicositis is effective, but probably less marked and slower than after porta-caval shunt. Accordingly, distal spleno-renal shunt is not recommended as an emergency procedure.


Vestibular stimulation influence on motor development in infants. Preambulatory, normal human infants were exposed to sessions of mild semicircular canal stimulation on 2 days per week for 4 weeks. The gross motor ability of each child was assessed before and after the 4-week period. The vestibular stimulation effected a significant improvement in gross motor skills.


Colonoscopy in clinical practice.

Colonoscopy in clinical practice. Colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. Colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. Colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.


The effect of para-aminobenzoic acid and taurocholic acid feeding on human bile composition. Seven patients were investigated after cholecystectomy and exploration of the common bile duct to determine bile composition and excretion rates. An initial depression of the major components of bile stabilized by the sixth postoperative day. Feeding of para-aminobenzoic acid and taurocholic acid to these patients demonstrated an increase in excretion of total bile acids, taurine and glycine conjugates, cholates and deoxycholates. Para-aminobenzoic acid in the doses used failed to block glycine conjugation. Preferential conjugation of bile acid with glycine is due to a deficient taurine pool and not a preferential metabolic pathway.


Cardioplegia without fibrillation or defibrillation in cardiac surgery. A group of 176 patients undergoing cardiac surgery utilizing a technique of rapid core hypothermic cardioplegia with a hyperosmotic solution is presented. A cold, 2 to 4 degrees C hyperosmotic (396 mOsm) perfusate, injected under pressure, induced cardiac arrest without fibrillation within 2 to 4 seconds in every instance. At the end of each procedure, flushing of the cold solution out of the coronary system re-establishes spontaneous normal sinus cardiac rhythm in 96% (119 of 124) of coronary surgical procedures, 69% (11 of 16) of aortic valve replacements, 62% (10 of 16) of mitral valve replacements, 55% (five of nine) of aortic valve replacements combined with multiple coronary grafting, 57% (four of seven) of mitral valve replacement combined with multiple coronary grafting, and in 50% (two of four) of double valve replacements. Combined core and topical hypothermia with ice slush used in valve replacements and combined valve with coronary operations allowed periods of total ischemia up to 134 minutes without signs of detectable myocardial damage.


[Cor triatriatum with anomalous drainage of all pulmonary veins into the superior vena cava. Diagnosis and surgical treatment in a 4 1/2 months old infant (author's transl)]. Cor triatriatum and supracardiac anomalous pulmonary venous drainage as a combined heart lesion occurred in a 4 1/2 months old infant. The history of development is outlined and successful correction using cardio-pulmonary bypass described.


[Hemolysis after aortic valve replacement (author's transl)]. Hemolysis after isolated aortic valve replacement using Björk-Shiley and Starr-Edwards (series 1260) prostheses as well as unstented Fascia-lata valves has been determined in 50 patients. A battery of hemathologic and blood-chemical tests were performed in all patients but LDH has proved to be the most reliable parameter. Survival of erythrocytes was measured in a small group of patients. Patients with Björk-Shiley prosthesis have shown lower average rate of hemolysis (LDH 201 IU, Haptoglobin 45 mg %) than patients with Starr-Edwards prosthesis (LDH 273 IU, Haptoglobin 35 mg %). When functioning regularly neither prosthesis results, however, in clinically significant hemolysis. In patients with unstented Fascia-lata valve the degree of hemolysis reflects directly the functional status of the valve.


[Haptoglobin in the course of surgery with the heart lung machine (author's transl)]. In 20 patients, who underwent open heart surgery, the results of quantitavely and semi-quantitavely determined haptoglobin (hp) were evaluated. A rapid method (Rapi tex-Hp-Test, Behring-Werke) was used. Five minutes after the heart lung machine was cut off hp decreased slightly, and increased about 200% at the 4th day after operation, compared to the preoperative value. These changes were less pronounced in patients with prosthetic heart values. Blood transfusions did not influence the results. There is a significant correlation between the results of hp determined quantitatively and semi-quantitatively.


[Broncho-cutaneous fistula by myocardial pacemaker-elektrode infection (author's transl)]. A rare complication of pacemaker therapy is reported. Shortening and retaining of myocardial electrodes after pocket infection of the pacemaker resulted in the incidence of broncho-cutaneous fistula. One similar case has been presented in the literature. Both the conservative and the operative therapy are discussed. In this report our procedure with pacemaker infections is presented.


[Prolaps of trachea as special form of asthma and its surgical correction from transcollar access (author's transl)]. A new operative method of treatment of prolaps of pars membranacea in the region from trachea is reported. One cause of this prolaps is a false breathing mechanism, mainly without respiration through the nose. The reflection of pathogenesis of this special form of asthma, the operative treatment and therapy are described.


[Isolated stenoses and occlusion of the coeliac artery--a comparative angiographic and clinical study (author's transl)]. 14 patients with occlusion (7 patients) or extreme stenosis (7 patients) of the arteria coeliaca underwent operation because of heavy abdominal complaints. The constriction of the arteria coeliaca was caused by arteriosclerosis (2 patients), ligamentum arcuatum medianum (8 patients), ligamentum arcuatum medianum and ganglion tissue (2 patients). For the restitution of a normal blood circulation in the epigastric organs the following was necessary: in 10 patients a decompression, in 3 patients an aortocoeliacal bypass and in 1 patients an enlargement plastic with vein patch. The angiographic findings indicate a connection between the arteria coeliaca occlusion or extreme stenosis and the extent of the collateral blood supply. High pressure gradients between aorta and arteria coeliaca, significantly decreased medium pressures in the arteria hepatica communis and noticably frequent morphologic changes in the epigastric organs could be seen intraoperatively.


[Vascular reconstruction in arterial occlusion of the lower leg (author's transl)]. In 84% of 115 femoro-crural arterial occlusions stage III and IV was present. All operations to revascularisation, including second operations could be performed without lethality. On leaving hospital in 93% the bypass was patent. Two to nine years after the operation in 64% of the venous grafts were good. Only eleven patients have had to subject amputations because of bypass occlusion since reconstruction. Our results prove that the femoro-crural reconstruction in arterial occlusion of the lower leg is superior to lumbar sympathectomy and the conservative treatment.


[X-ray-examination-time during implantation of pervenous leads for permanent cardiac pacing (author's transl)]. From February 1974 to December 1975 we performed 295 pacemaker operations. 165 of those were primary implantations of pervenous leads for permanent cardiac pacing. The X-ray examination time was between 0.1 and 17.0 minutes, their mean value was 2.6, their median 1.7 minutes. In those 165 cases there was a dislocation of the lead in 10.9 percent. Although our X-ray examination time was extremely short however in comparison with the literature we found no arise of our dislocation rate. Some hinces to keep radiation small are discussed.


Successfully treated cardiac luxation through right pericardium. A 54-year old laborer suffering from multiple thoracic injuries on his 16th hospital day during the gypsum bandage for his left shoulder suddenly developed circulatory collapse. Emergency angiocardiogram revieled this is caused by cardiac luxation through the right side pleuropericardium. Reposition of the heart and repair of pericardium resulted in normalization of circulatory physiology. Later, he returned to good and active physical condition.


[Extraction of tricuspid valve tissue and myocardium as a complication of transvenous cardiac pacing (author's transl)]. In a patient with transvenous cardiac pacemaker a piece of tissue, 5,5 cm in length, was removed from the wall of the right heart during the extraction of a "shouldered" electrode (Biotronik IE 85-K-O). Histologically it consisted of fibrous tissue as usually found around transvenous electrodes, tricuspid valve tissue, chordae tendineae, and myocardium. Detrimental consequences to the patient following this complication were not observed. Some problems caused by trapped endocardial electrodes and adequate therapeutic possibilities are discussed.


Effect of stimulation with impulse trains of various patterns, including adaptational type, on frog's nerve-muscle and spinal reflex preparations. The train of discharge in the nerve in the integrated nervous function is known to have a variable pattern. The question still remains open as to whether the pattern of discharge sequence plays some role like a word in communciation. The present study aimed to investigate the relationship between stimuli with various sequences and responses. The intermittent, intercalated and adaptational types of stimulation were given to the efferent or afferent nerves, and the tension of muscles of a nerve-muscle or a spinal reflex preparations of frogs was recorded. Enhancement of tension was observed when the appropriate intermittent or intercalated stimulation was applied. In the nerve-muscle preparation, this effect was made clearly detectable when the nerve-muscle preparation was equilibrated with calcium-deficient Ringer solution. An appropriate type of adaptational stimulation evoked a rapid and long-lasting tension development which may be of physiological meaning in emergency. This fact may give a guide when man stimulates the nerve to examine the response.


B-lymphocyte haplotypes in asthma families. Thirty families in whom at least one member had asthma were typed for five new B-lymphocyte specificities, as well as the antigens of the A and B loci of HLA. The B-cell reactions were consistent with the concept that they were determined by genes linked to the HLA-A and HLA-B loci. Between 22 HLA-identical siblings and 16 two-haplotype different siblings, a significant difference in concordance of reactions for the B-cell groups was noted. The data obtained were most compatible with B-groups 1 and 2 being determined by one locus and B-groups 3, 4, and 5 by another locus. The superhaplotypes of HLA-A, HL-B, and B-cell loci 1 and 2 were then determined. The most striking linkages noted were for the second B-cell locus and the HLA-B locus: B-cell group 3 with HLA-B12, B-cell group 4 with HLA-B7, and B-cell group 5 with HLA-B8, B17, and Bw35.


Characterization of cell populations used for studies of antibodies to I-region products. Mononuclear cells from peripheral blood contained at least four different cell types: monocytes, T lymphocytes, B lymphocytes, and lymphocytes with Fc receptors. Monocytes represented 41% of B-cell-enriched preparations and gave rise to extra reactions due to monocyte antibodies in allo immune sera. Polyvalent anti-Ig stained 88% of B-enriched-cells. However, 58% of these cells had IgG bound to Fc receptors, and only 42% had surface Ig stable after brief incubation at 37 degrees C. Further studies are required to determine to what extent the antibodies reacting with such B-cell preparations are also heterogeneous.


Reactivity of alloantibodies of the Merrit B-cell system with leukemic cells and lymphoblastoid cell lines. Twenty lymphoblastoid cell lines were typed with 38 antisera defining the 13 groups of the Merrit B-cell alloantigenic system, and results were compared with those of a 20-member CLL cell panel. While overall pattern of Merrit groups for the two types of cell population was similar, some sera in a number of groups showed unexpected negative cytotoxic reactions with lymphoid cells compared to other sera of the same group. However, in a number of instances, these negatively reacting cells could still specificity absorb out tb Merrit antibodies, suggesting that lymphoblastoid lines may show a higher incidence of the CYNAP (cytotoxicity-negative-absorption-positive) phenomenon than CLL cells. Twelve of the lymphoblastoid lines were HLA-D homozygous and in addition, each cell line displayed positive reactions for no more than 2 of the 13 Merrit groups, while 4 of the 8 heterozygous lines were positive for 3 of the 13 groups. These findings indicate that HLA-D-homozygous cell lines are antigenically simpler than the heterozygous lines for the Merrit system and suggest that HLA-D-homozygosity may correlate with homozygosity for at least one of the Merrit loci.


HLA antigens and mitogen responsiveness in multiple sclerosis. Thirty-one MS patients were studied for their in vitro response to lymphocyte mitogens. Patients with HLA antigens A3 and/or B7 had lower mean peak responses to all three mitogens compared to A3, B7-negative patients. The difference in the mean peak responses to Con A were significantly different at a level of p less than 0.05. This supports the concept of a histocompatibility-linked T-cell deficiency in many patients with MS.


[Evaluation of the blood coagulating system in acute gastroduodenal hemorrhages by thromboelastographic data]. Coagulation properties were studied thromboelastographically in 76 patients with acute gastroduodenal hemorrhages due to ulcerous disease of the stomach and duodenum, hemorrhagic gastritis and Mallory-Weiss syndrome. A certain regularity was revealed, i. e. the more profuse the hemorrhage the more frequent hypocoagulation associated with high fibrinolysis rate. With this in view transfusion therapy should be aimed not only at the replacement of circulary blood bolume but also at the suppression of high fibrinolytic activity of blood.


[Diathermic coagulation via endoscope for stopping gastric hemorrhages]. The authors studied experimentally the effect of different methods of diathermocoagulation on gastric wall and the possibility to arrest gastric hemorrhages of various intensity by means of the methods under consideration. Monoactive diathermocoagulation, as compared with biactive one, was found to produce more extensive lesions of gastric wall both on the surface and in depth. Biactive method of diathermocoagulation is somewhat better than monoactive one in its hemostatic effect, by means of which it is feasible to arrest even profuse hemorrhage, that arise after incinsing gastric wall along its whole depth. The results obtained are described.


[Treatment of patients with hemorrhages due to cancer of gastric stump]. In the paper, the results of studies of gastric hemorrhages due to gastric stump cancer are reported. A total of 36 patients were treated. Eighteen patients were operated previously for gastric cancer, 12 - for ulcerous disease, 5 - for polyposis of the stomach and 1 - for pylorospasm. Roentgenological and endoscopic studies are of primary importance for establishing the diagnosis of hemorrhagic cancer of the operated stomach. The treatment of such patients was initiated with conservative measures directed at arresting the hemorrhage and normalization of homeostasis. Eighteen patients were operated upon after the arrest of hemorrhage (in 6 - radical operation was performed, in 3 - palliative, in 9 - tentative laparotomy1. The total mortality in patients with hemorrhagic cancer of gastric stump was 30.5%.


[Peripheral blood lymphocytes in melanoma]. In 20 patients with melanoma and 8 healthy donors the number of lymphocytes binding type-specific immunoglobulin in peripheral blood was determined by the method of direct immunoluminescence. The content of B-and T-lymphocytes was calculated. The results obtained made it possible to find some regularities with respect to the cell concent of lymphocytes population in patients with melanoma. High values of T-cell amount were revealed mostly in the absence of metastases, the most high indices being observed in patients with prolonged absence of the recurrence and metastases after their surgical removal. There is a tendency to an increased number of T-lymphocytes under the influence of the combination treatment- surgical and pharmacological. In unfavourable course of the disease with metastasization and generalization the fall was noted in the number of T-cells.


[Surgical treatment of portal hypertension]. From the surgical point of view is reported on the therapy of the portal hypertension by operations of anastomoses decreasing the pressure. Here the treatment of the haemorrhage of the oesophageal varices dangerous to life is in the first place. The porto-caval shunt is justified and successful in this emergency situation, since it has the decisive advantages of a short time of operation and an optimal release of pressure. Obstructive operations are indicated only in exceptional cases. Issuing from the haemodynamic criteria and from the moment of haemorrhage, the indication to the typical shunt operations is explained. Hereby it is established that the surgery of portal vessels is still considerably burdened by the postoperative encephalopathy. The modern anastomotic operations are directed to its prevention. Finally the author adopts a definite attitude to the peculiarities of the hypertension of the portal vein in children and it is in short referred to the operative treatment of the therapy-resistent ascites as well as of the hypersplenism.


[Immunopathogenetic aspects of chronic hepatitis]. In a short survey aspects to the immunopathogenesis of chronic hepatitides are explained. Hereby, partly critically, humoral and cellular immunophenomena are discussed, furthermore, the author deals with genetic factors, viruses and drugs as a cause of autoimmune hepatitides. Finally a simple working hypothesis to the pathogenesis is formulated and it is tried to classify the chronic aggressive hepatitis into six sub-groups on the basis of immunological, clinical and biochemical criteria: 1. much HBAg-associated, 2. lupoid, 3. drug-induced, 4. autoimmune cholostatic mixed form, 5. much associated with Ak to endoplasmatic reticulum and 6. undefined.


[Peripheral cochleo-vestibular syndrome caused by vertebro-basilar insufficiency]. The author examined 55 patients with disorders of circulation in the vertebrobasillar basin where the most prevalent clinical signs were expressed in a cochleo-vestibular syndrome due to a lesion of the receptor apparatus of the inner ear. It was marked that in the clinical respect this syndrome was very similar to genuine Meniere's disease. The differential diagnosis of this disease is frequently very complicated. A detailed neurological and otoneurological examination demonstrated a combined lesion in the form of a simultaneous involvement into the process, of the inner ear, the brain stem and cerebellar hemisphere (in different varieties). Inasmuch as the blood supply is provided by the different branches of the anterior inferior cerebellar artery in a vascular brain disorder the clinical signs may be qualified as a variant of the syndrome of the anterior inferior cerebellar artery.


Pathology of cardiomyopathy. An autopsy analysis of twenty-five cases. Pathology of twenty-five autopsied causes of cardiomyopathy is presented. Twenty cases were those of congestive cardiomyopathy. The ages varied between eleven and sixty-eight years and there were nine females and eleven males. The heart weights ranged between 240 gm and 600gm. Thrombi in the heart were encountered in 60% cases. Five cases conformed to endomyocardial fibrosis. The age ranged between twelve and forty years and all were males. Three cases out of five had severe left inflow tract involvement. Only one case showed predominant right sided involvement. No cases of hypertrophic cardiomyopathy were encountered. There appears to be a higher incidence of EMF in the Southern parts of India as compared to the other regions where COCM is most commonly encountered. The variation in the type of cardiomyopathy encountered in different parts of India, may well be related to dietary, climatic conditions or infections, peculiar to that area.


Re-entry ectopic ventricular rhythm caused by artificial pacing. Two cases with coupled ectopic ventricular rhythm associated with artificial pacing are presented. The premature ventricular beats appeared at a fixed distance from the R of the previous electrical stimulus complex and when pacing was stopped ventricular arrest occurred. This provides strong evidence that the ectopic ventricular beats were dependent on the electrical stimulus and therefore that they were produced by its re-entry. It was observed that the re-entry phenomenon occurred at low rates. This arrhythmia even persisted after the permanent pacing and was successfully suppressed by procainamide in both cases.


Haemodynamic changes with blood transfusion in chronic severe anaemia. Circulatory behavior in chronic, severely anaemic patients on volume loading is not precisely known. Twenty young male subjets with hook-worm anaemia, (Hb 2 to 5 gm %), without any complications were transfused with 300 or 600 ml of whole blood at 3 6 or ml/mt. Haemodynamic study was done before and immediately after. Blood volume was low, intracardiac pressures normal or minimally abnormal, cardiac output raised and vascular resistances low. After transfusion, there was a small but significant rise in arterial and mixed venous oxygen content, oxygen transport, heart rate, pulmonary wedge and mean polmonary arterial pressures and fall in % coeffcient of oxygen utilisation. Central venous pressures rose only with bigger transfusion. Change in cardiac output was related to the output before transfusion. Three subjects with cardiac index above 7 1/min had a fall and 6 of 7 below 7 1/min. a rise. Fall is perhaps related to the rise in blood oxygen content. It is argued that it is not an index of cardiac failure, as is often believed. Changes in pulmonary pressures are more sensitive than central venous pressure. One of our subjects died suddenly a day after uneventful study. Existing knowledge of haemodynamic status in severe anaemia and the change on transfusion helps little in explaining such deaths and others due to pulmonary oedema during or shortly after small to large transfusions. Further work in this field aiming to study changes in myocardial function and dynamic pressure volume relation in the vascular system is required.


[Influence of perhexiline maleate on the electrocardiographic signs of myocardial ischemia. Ergometric study]. The improvement in the electrocardiographic signs of coronary insufficiency under the influence of perhexiline maleate is the object of an ergometric study in 28 patients. Ergometric tests repeated at regular over an average period of 8.3 months show a rapid ECG improvement, sustained over the period of the study. The heart rate, registered while at rest, which diminshes between that noted at the beginning of the study and that noted at the first registration under treatment, remains stable during the three following registrations. At the end of the effort, on the other hand, a significant reduction in tachycardia is observed during all the registrations.


[Use of an electric field for experimental thrombosis of vessels and arterial aneurysms]. Two series of experiments with canine arteries were conducted with the employment of extravascular electrodes, I volt power and I to 2500 micronA current. With a current up to 500 micron A, as well as with the optimum current (2000-2500 micronA), but with an over 3.5 mm diameter of the vessel no complete thrombosis is achieved. This, according to the author, is due to the flow rate and power of the electric field created. The critical flow rate that permits to achieve electrothrombosis of an artery, is 250-300 ml/min. Electrothrombosis of artificial aneurysms permits to achieve their obstruction rather promptly. The optimum time of thrombosing is 40-60 min with a 2000-2500 micronA current. Any further exposure to the electric field does not result in thrombosis of the vessel in question.


The effect of glucocorticosteroid administration on the survival of patients with acute myocardial infarction. Because of conflicting reports in the literature, we decided to test the effect of the administration of glucocorticosteroids on the survival of patients with A.M.I. admitted to hospital within 24 hours from the beginning of symptoms. When tested by sex, age or as a whole, there was no significant difference between the steroid treated group and controls. However, recent reports show that steroids reduce the size of the infarction and improve the chances for survival and less late complications in experimental animals. We feel that renewed efforts in this direction should be made, possibly with larger doses of steroids and for longer periods.


Myocardial contractility after injection of prolonged infusion of magnesium sulphate. The effect of magnesium sulphate administration on myocardial inotropism has been evaluated by means of the noninvasive indexes of myocardium contractility in 18 patients affected by myocardiosclerosis associated with signs of cardiac impairment of different degree. Magnesium has been administered via either a prolonged infusion (30-50 mg/min) or a single injection (2.5 g/30 sec). It is emphasized that the influence of this agent on systolic time intervals (STI) is dependent upon its route of administration. Thus, prolonged infusion does not modify significantly these parameters, whereas a single injection induces marked variations, i.e., decrease of LVET, increase of PEP, ICT and PEP/LVET ratio, which are all more marked in cases of severe cardiac impairment. In view of the strict correlation established between the STI and the invasive indexes of myocardial contractility, it is suggested that administration of magnesium sulphate via prolonged infusion does not induce a decrease of cardiac performance, while a single injection of this agent leads to this effect.


[253 patients with acute pancreatitis treated at the surgical clinic in Zagreb]. 253 patients with acute pancreatitis were treated in clinic for surgery in Zagreb through last 23 years. The most frequent cause of pancreatitis were diseases of biliary tract, obesity, vascular deseases, alcoholism etc. In the symtomatology, the pain was present in all patients and majority of them had abdominal symptoms as well. Most of the patients came to the treatment within the firsts 24 to 48 hours. Besides Trasylol various conservative therapy was applied and some patients were operated either on billiary ducts or on pancreas. 85 patients had to be operated again on billiary tract afterwards. From 253 patients treated 24 died (9,48%) because of the necrosis of pancreas and alterations on various other organs.


[Acute pancreatitis in our case reports]. On the Surgery Department of Military Hospital in Zagreb 164 cases of acute pancreatitis, among them 88 male and 76 female, were treated during the period of 1963 to 1974. Diagnosis was based on anamnesis, clinical symptoms, laboratory tests as well as X-ray pictures of the lungs and abdomen. In most cases (72,5 percent) etiology of the disease has shown changes of biliary tract; obesity and alchoholism were also present in high percentage. Operative treatment was applied in 72 cases and 92 cases have undergone conservative treatment. Indications for surgical intervention were lithiasis, cholecystitis, inefficiency of conservative therapy during the first 12 hours and such cases in which diagnosis could not have been given with sufficient certainty. Along with usual surgical treatment in 23 cases in which biliary obstruction and serose pancreatitis were present choledochoduodenostomy was applied with satisfactory results. 28 patients died out of 164; mortality percentage 17,1.


[Significance of omental dialysis in the treatment of acute pancreatitis]. The omental dialysis is an elimination procedure of active pancreatic enzymes from the omental burse. The cases of acute serose and haemorrhagic pancreatitis are always indications for the omental dialysis. Naturally, there will be no results, if the major part of pancreas is necrotic. The purpose of the omental dialysis as a supplement to conservative treatment is to reduce rethalty, which, in our up to date acute pancreatitis casuistics total in average 14,5%. The application of omental dialysis justified with favourable clinical results.


[Supplement on the treatment of acute pancreatitis]. The authors describe their perceptions in pathogenesis, clinic and healing of acute pancreatitis. The importance of food fat and albumen metabolism, and alcohol effect are described. Authors prefere conservative cure. Removing the pain and shock, better function of pancreas drain channel, and parenteral feed with enough calories and vitamins are very important in the treatment of acute pancreatitis. Special care is dedicated to take infection away and to the orderly function of cardiorespiratoral circulation. Operative treatment is strictly indicated in special cases. Holding on these lines of directions in treating medically acute pancreatitis we deduced mortality on hardly 2,14%.


[Acute necrotizing and hemorrhagic pancreatitis as a surgical problem]. The authors have analysed 235 patients suffering of acute pancreatitis. From that number 42 sick persons had severe pancreatitis with necrosis and hemorrhage. Mortality in this group was 83%. Mortality of the patients who were under the non-operative (conservative) therapy was 95%, and in the same time mortality of the patients who were treated surgically was 72%. Based upon their own experiences, the authors consider that patients with acute necrotizing pancreatitis have to be treated surgically, when there's not change for the better by shock and improvement of patient's condition, when one has respiratory or cardiovasculary distresses, or when electrolytic disbalance is present, in these cases the operation has to be done 48 hours from the beginning of illness. Good drainage to peripancreatic and retroperitonel areas by sump drainage is the most essential part of action, wery useful are cholecystostomy, gastrostomy and jejunostomy.


Retrograde axonal transport of horseradish peroxidase from cornea to trigeminal ganglion. Horseradish peroxidase (HRP) was dripped on the scarified left cornea of adult mice. Twenty-four hours later the animals were fixed by vascular perfusion and frozen sections cut from both trigeminal ganglia. After incubation for peroxidase activity labelled nerve cells were restricted to the medial ophthalmic part of the ganglion ipsilateral to HRP administration. If the scarification was omitted no neuronal labelling was observed. This labelling of the neurons is most probably the result from axonal uptake and subsequent retrograde axonal transport of the tracer. The similarity in distribution of peroxidase labelled nerve cells and the first ganglionic lesions occurring after instillation of  herpes simplex virus in the cornea is pointed out.


Effect of the polyene antibiotic filipin on the permeability of the inward- and the outward-facing membranes of the isolated from skin (Rana temporaria). The effect of the polyene antibiotic filipin on the electrical properties and the passive permeability of the cell membranes was investigated. The addition of filipin to the outside bathing solution has the following effects: 1. it results in a drastic reduction in the transepithelial resistance and potential, 2. it causes a 10-20 times increase in the passive transepithelial chloride, sodium and sucrose flux, 3. it results in the formation of an amiloride insensitive sodium pathway in the outward facing membrane, 4. it results in an active outward transport of potassium, 5. it results in a highly significant swelling of all the cells in the epithelium. The addition of filipin to the inside bathing solution has the following effects 1. it results in an activation of the active sodium transport, 2. it causes a slight increase in the passive transepithelial chloride and sodium permeabilities but has no effect on the sucrose permeability, 3. it has no effect on the amiloride inhibition of the short-circuit current, 4. it has no effect on the volume of the cells in the epithelium. It is suggested that the addition of filipin to the outside bathing solution increases the direct sodium flow from cell to cell in neighbour layers. Furthermore these experiments indicate that the outward facing membrane of the isolated frog skin has a high cholesterol content as compared with the cholesterol content of the inward facing membrane.


Determinants of left ventricular function following aorto-coronary bypass surgery. Ventricular function was evaluated by the development of ventricular function curves from the vulumes stress of angiographic contrast media in 30 patients before and an average of 5 months after coronary bypass surgery. Patients were grouped according to preoperative operative indications, perioperative events, and postoperative status to determine the most important factors affecting postoperative ventricular function. Progression of lesions in the native coronary circulation correlated most significantly with a decrease in postoperative ventricular function. In 18 of 19 patients the changes in native coronary circulation were progression to complete occlusion. Seventy-three per cent of these changes were associated with a patent graft distal to the change. Patients with very ischemic ventricles as evidenced by a markedly positive stress test (greater than 2 mm. ST depression) and/or main left coronary obstruction maintained or improved postoperatively ventricular function. Increase in postoperative ejection fraction was often associated with decrease in aortic mean pressure, making it difficult to use this parameter to evaluate postoperative ventricular function.


Clinical pathologic conference. Purulent pericarditis with asymmetric cardiac tamponade: a cause of death months after coronary artery bypass surgery. This relatively young man with a host of medical problems including polycystic kidneys. chronic renal failure, long-standing hypertension, and premature atherosclerosis, died of cardiovascular disease; not, as might be expected, from his severe coronary artery disease but rather from purulent pericarditis. The latter was an unusual and unexpected consequence of the entire complex of his illnesses and because of its confinement to the posterior pericardium by postoperative adhesions produced an asymmetric cardiac tamponade.


Effect of aortocoronary saphenous vein bypass grafting on death and sudden death. Comparison of nonrandomized medically and surgically treated cohorts with comparable coronary disease and left ventricular function. The effect of saphenous vein bypass grafting on the incidence of sudden cardiac death and total cardiovascular death was studied by comparing the survival of subsets of surgically and medically treated patients with coronary disease who were similar in two major prognostic variables: extent of coronary disease and ejection fraction. Significant differences in some baseline variables existed between medical and surgical subgroups with similar ejection fraction and extent of coronary disease. Medically treated patients tended to be in a lower functional class, to have more extensive ventricular contraction abnormalities, to have a larger end-diastolic volume, and to have fewer distal vessels feasible for grafting. Surgically treated patients with two vessel disease and normal or moderately reduced election fraction had improved survival when compared with medically treated patients with two vessel disease and similar ejection fraction. Improved survival of borderline statistical significance was also seen in surgically treated patients with three vessel disease and moderately reduced ejection fraction. When categorized according to end-diastolic volume, surgically treated patients with two vessel disease and normal or moderately increased end-diastolic volume also had improved survival over similarly defined medically treated patients. The sudden death rates for subgroups of mecically treated patients were 1.8 to 10.9 times higher than the rates in subgroups of surgically treated patients with a comparable extent of coronary disease and ejection fraction.


Ultrastructure of traumatic cataractogenesis in the frog: a comparison with mouse and human lens. Normal and needle-punctured lenses of Rana pipiens were examined with the electron microscope in order to characterize the sequence of ultrastructural changes that follow the injury over a 5-month period. Results were compared with those obtained previously in experimentally injured mouse and accidentally injured human lenses. The normal adult frog lens was found to have a morphology similar to that of mammalian lenses. As in the human, frog lens epithelial cells contained scattered microfilaments and were connected by desmosomes and gap junctions. They differed from mouse cells, which had been shown to lack desmosomes and to have microfilaments organized into dense bundles. These differences are postulated to be related to the degree of accommodative deformation of the lens displayed by these species. After injury, cellular debris and fibrin, accumulated in the wound, were phagocytized by extrinsic cells derived from the blood and ocular tissues. Leucocytes, pigmented cells and fibroblasts remained in the wound for eight weeks, along with epithelial cells which proliferated and migrated from the wound margins.Epithelial cells showed an increase in those organelles associated with protein synthesis and transport, and in microfilaments. In cataractous lenses, epithelial cells showed changes in matrix, and lens fibers became organized into smaller, denser compressed units. At five months, considerable healing had taken place, but localized opacities persisted in many frog lenses.


The effect of the synthetic prostaglandin analog 15 (R) 15 methyl-PGE2 methyl ester on gastric mucosal hemorrhage induced in rats by taurocholic acid and hydrochloric acid. The incidence of mucosal hemorrhage induced in rats by the oral administration of taurocholic acid (TCA) and hydrochloric acid (HCl) both singly and in combination was investigated. The effect of prostaglandin 15 (R) 15 methyl-PGE2 methyl ester (Me-PGE2) on the occurrence of hemorrhage induced by TCA with HCl was also studied. The incidence of hemorrhage induced by TCA (10 mM) alone and HCl (160 mM) alone was minimal and not different from that induced by the control solution. The combination of TCA (10 mM) and HCl (160 mM) produced bleeding in 67.7% of animals. The addition of 15 (R) 15 methyl-PGE2 methyl ester (9.9 micronM, corresponding to 50 microng/Kg) significantly reduced the incidence of hemorrhage induced by the combination of TCA with HCl from 67.7% to 31.3%. This suggests that this synthetic prostaglandin may be of value in conditions thought to be associated with reflux of bile into the stomach.


Treatment of cardiogenic shock in myocardial infarction by intraaortic balloon counterpulsation surgery. Thirty-seven patients in cardiogenic shock due to acute myocardial infarction were treated with intraaortic balloon counterpulsation and/or surgery. Eighteen of these patients were treated with counterpulsation alone; eight survived and five were in functional class I or II at the time of follow-up; two were in functional class III, and one was in functional class IV. Nineteen patients were treated surgically, eight survived and seven were in functional class I or II at the time of follow-up; one was in functional class III. Good functional recovery with counterpulsation alone is most common with inferior infarction. With surgery, functional recovery depends not only on the extent of the infarction and the coronary anatomy, but also on the ability to perform surgery within 12 hours of infarction or to support the patient with mechanical means for 10 to 14 days after the infarction and then perform surgery.


Fatigue and posttetanic potentiation in single muscle fibers of the frog. At 15 degrees C, direct stimulation of frog single muscle fibers at a frequency of 20 Hz produced a tetanic tension that remained constant for 20 s and then declined. The decline was reversed during 1-s interruptions of the stimulus train in the first 50 s of stimulation, but not with longer stimulation. Posttetanic potentiation (PTP), characterized by prolonged twitch relaxation and contraction times and elevation of twitch height, remained for 10-40 min after a 10-s tetanus and for at least 90 min after a 50- to 150-s tetanus. Posttetanic fatigue appeared only after at least 50s of tetanic stimulation. Fatigue was manifested invariably by a reduction in the height of a 200-ms tetanic contraction and usually by a reduction in twitch height after PTP. Fatigued fibers recovered normal contractile responses in 40-160 min. Hypertonic solutions, which blocked contraction in response to tetanic stimulation, prevented posttetanic fatigue but not PTP. The observations suggest that fatigue is caused by a failure in excitation-contraction coupling, probably in relation to consumption of metabolic substrates. Even 10-s tetani which do not produce fatigue can affect muscle contractile function for up to 40 min.


Socialization and the human physiologic response to crowding. Cross-sectional data were analyzed for a possible relationship between household densities and physiologic alteration, based on socialization experiences with siblings in an earlier home environment. The measure of household density was persons-per-room and the measure of physiologic alteration was urinary vanillylmandelic acid. The results show an interaction between number-of-sibs and number-of-younger-sibs, with a statistically significant positive correlation between household densities and VMA values for subjects with fewer total sibs and no younger sibs, while a negative correlation was observed for subjects with one or more younger sibs. One possible interpretation of these results is that the physiologic response to crowding in humans is dependent at least in part on the earlier socialization experiences of the individual.


Collection method dependent concentrations of some metabolites in human tear fluid, with special reference to glucose in hyperglycaemic conditions. Concentrations of the metabolites glucose, lactate, pyruvate, and urea were determined in human tear fluid. Collection of the tears in glass capillaries, without mechanical irritation, permitted the estimation of naturally occurring levels of these metabolites. Glucose concentrations were very low, also in diabetics with high blood glucose levels. Lactate was present at higher levels and pyruvate and urea in about the same concentrations as normally for blood. Collection of the tears with filter paper strips as absorbent material caused slight epithelial damage and consequently a loss of the barrier function of the epithelium. In filter paper eluates glucose concentrations were found to be much higher, especially in diabetics with high blood glucose levels. Lactate and pyruvate concentrations were not influenced, whereas the urea concentrations decreased. The value of clinical tear glucose tests is discussed.


Some characteristics of the C-wave of ERGs recorded by a pair of electrodes on the cornea and sclera. Light-evoked responses of the rabbit retina in situ were recorded between the electrode on the longitudinal line of the nasal (positive) and the electrode on the opposite longitudinal line of the temporal side (negative). The c-wave was negative and the a-, b-wave was reversed when the negative (temporal) electrode was closer to the corneal center than the positive (nasal) electrode. The c-wave decreased its amplitude as the positive electrode came to the same latitudinal position as that of the negative one. Then, the c-wave was cancelled out in appearance on the recordings. When the negative electrode moved further into the posterior pole, the polarities of the c-wave as well as of the a-, b-wave were returned to those of routine ERGs.


Studies on the "vascular labeling" phenomenon in the iris and the ciliary body of the rat after intravenous injection of colloidal carbon. The occurrence of carbon deposits after intravenous injection of colloidal carbon (vascular labeling phenomenon) in the iris and the ciliary body of the rat eye was studied by vital microscopy, unstained perfused mount preparations, and by electron microscopy. Generally in the untouched eye the vascular labeling phenomenon is either absent or appears only in the form of finest granular deposits in some capillaries and venules of the iris and the ciliary body. A decrease of intraocular pressure by paracentesis causes a certain blackening phenomenon, which prefers the capillaries and the venules of the iris and the capillaries in the ciliary processes. This effect is intensified by a further decrease of the intraocular pressure to -30 mm Hg. Predominantly the deposits are found stronger in the ciliary region than in the iris. Increase of the intraocular pressure of up to 30 mm Hg diminishes the blackening phenomenon. After administration of the vasodilator bencyclane into the anterior chamber the vascular labeling phenomenon shows a clear graduation of carbon affinity depending upon the concentration of the drug: The capillaries and venules are exclusively blackened at low concentrations, additionally the collecting venules and arterioles are influenced at medium and high doses. By electron microscopy an intraluminal as well as an intramural (subendothelial) deposition of carbon, partly accompanied with signs of hemoconcentration, can be seen. Extravascular position of carbon material is seldom observed and restricted to a state of abnormally high vascular permeability. The observations give evidence for a 'gradient of permeability' between the different types of vessels of the terminal anterior uveal vascular system and also permit the assumption that the vessels of the ciliary processes are more permeable than those of the iris.


Chemical composition of the aqueous humor of bovine eyes dependent on predetermined time upon removal. The content of several carbohydrates [glucose (alpha and beta), inositol, fructose, galactose] and aminoacids in the aqueous of bovine lenses was measured in dependence on time after globe puncture, using the method of gas liquid chromatography (carbohydrates) and ion exchange chromatography (amino acids). The contents of the investigated compounds show distinct postmortal changes. Aqueous humor which had been obtained immediately after enucleation of the bovine eyes and kept at 37 degrees C for different periods of time (1-8 h) showed for the carbohydrates investigated a decrease in fructose concentration, whereas almost all amino acid concentrations were increased, with the exception of leucine, tyrosine, and arginine, which were decreased.


[Elements of photoreceptors in retinoblastomas (author's transl)]. In 3 cases of 29 retinoblastomas (roughly 10%) structures similar to processes of photoreceptors were found. In each of them so-called fleurette cells were seen. In one case, described in detail, many lamellar structures appeared corresponding to the outer segment of the photoreceptor.


[Topographical variations in the development and distribution of the pattern of retinal phosphatides (author's transl)]. The present study deals with the topographical variations of the pattern of the retinal phosphatides. For evalution of the phosphatides in the central and peripheral retina served the eyes of rabbits, 15, 26 and 60 days after birth. The essential process of maturation was only in the central retinal area provable. In the retina of adult pigs the pattern of the fatty acids of the phosphatides showed a decrease of the polyunsaturated fatty acids towards the periphery.


[Histocompatibility antigens and open-angle glaucoma (author's transl)]. In 41 patients with open-angle glaucoma and 450 healthy, unrelated controls of identical ethnic origin the frequencies of 36 HLA antigens were determined using the microlymphocytotoxicity test. In contrast to recent publications it was not possible to confirm a significant difference in the incidence of the antigens in both groups. The possible reasons for this difference are discussed.


Relationship of leukocyte elastase concentration to severity of emphysema in homozygous alpha1-antitrypsin-deficient persons. In 9 alpha1-antitrypsin-deficient (PiZZ) persons 40 to 53 years of age, the relationships between the concentration of elastolytic protease of polymorphonuclear leukocyte granules and cigarette smoking, and the degree of abnormality in detailed pulmonary function tests were explored. Regardless of the statistical analytic approach used, elastase concentration was related more frequently and significantly than smoking history to the degree of abnormality observed in tests of pulmonary function. The data suggest that the severity of pulmonary dysfunction in PiZZ persons may be determined by variables other than age and cigarette smoking, including the concentration of elastolytic protease in leukocyte lysosomes.


[Successive connective tissue diseases (scleroderma, then lupus). Clinical and biological study of 4 cases]. The authors present 4 patients who had suffered for several years from isolated systemic scleroderma and in whom, after 3, 10, 19 and 22 years, clinical, biological and histological signs of DLE appeared. There was no current further progression of the scleroderma in two cases, at the time of onset of DLE. In the oter two cases, it had disappeared. All four patients had a serum cryoglobulin. In all cases the kidneys were involved histologically : extra membranous glomerulitis in one, segmental glomerulitis in a second, and diffuse progressive glomerulitis in the last two. The authors analyse the biological changes which accompanied the clinical transformation. One of the patients had anti-ribonucleoprotein antibodies. She died from severe renal involvement which would be against the good prognosis usually associated with the presence of this type of antibody.


Antibacterial activity of netilmicin, a new aminoglycoside antibiotic, compared with that of gentamicin. The antibacterial activity of netilmicin (Sch 20569), a new semisynthetic aminoglycoside, was compared with that of gentamicin against a variety of gram-negative bacteria, staphylococci, and streptococci. Both antibiotics had similar activity against most organisms, but netilmicin had appreciably greater activity against gram-negative organisms that were resistant to gentamicin because these species synthesized aminoglycoside 3-N-acetyltransferase I or aminoglycoside 2''-O-nucleotidyltransferase. Netilmicin was also more active than gentamicin against gentamicin-resistant strains of Staphylococcus aureus that produced two enzymes-aminoglycoside-2''-O-phosphotransferase and aminoglycoside-6'-N-acetyltransferase.


Comparison of in vitro activity of cephalexin, cephradine, and cefaclor. Inhibitory activity of cephalexin, cephradine, and cefaclor was compared by the WHO-ICS agar dilution technique. Cefaclor was substantially more active against staphylococci, streptococci, gonococci, meningococci, Haemophilus, Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, Proteus mirabilis, salmonellae, and shigellae than was cephalexin, which in turn was more active than cephradine. Cefaclor appeared to be less resistant to staphylococcal penicillinase than did the other two agents. None of these cephalosporins was active against Enterobacter, Serratia, indole-positive Proteeae, Pseudomonas, or Bacteroides fragilis.


Ampicillin-induced morphological alterations of Haemophilus influenzae type b. Inhibitory levels of ampicillin induced filamentation of growing Haemophilus influenzae ATCC 19418 within 30 min. Filaments became swollen and interrupted by regular periodic saccular outpouchings along the major axis. The degree of filamentation was dependent upon ampicillin concentration and time.


Comparative acitivity of ampicillin and cefuroxime against three types of Haemophilus influenzae. On the basis of their susceptibility to ampicillin, strains of Haemophilus influenzae can be divided into three types: type 1 are normally susceptible strains, type 2 produce stable spheroplasts from low inocula, and type 3 are beta-lactamase producers. Because of the production of spheroplasts, standard broth and agar dilution techniques have failed to differentiate between the responses of type 2 and 3 strains to ampicillin, or to identify the superiority of cefuroxime over ampicillin against the beta-lactamase-producing strains. Disk susceptibility tests with heavily seeded plates were also difficult to interpret. To overcome these problems, we developed a medium that supports the growth of H. influenzae, but not survival of spheroplasts, thereby reducing the complicating influence of spheroplast formation. Utilization of the medium made it possible to identify beta-lactamase-producing strains via both minimal inhibitory concentration and disk susceptibility techniques, as well as the superiority of cefuroxime over ampicillin against such strains. In vivo experiments showed that cefuroxime and ampicillin are equally active against infections with type 1 and 2 strains, but that cefuroxime is superior to ampicillin against infections with type 3 beta-lactamase-producing strains.


Bactericidal factor produced by Haemophilus influenzae b: partial purification of the factor and transfer of its genetic determinant. When aerobically grown on complex media, Haemophilus influenzae b and unencapsulated variants, Rb strains, produced a bactericidal factor that was active against other Haemophilus species and certain genera of the Enterobacteriaceae. A total of 341 clinical isolates of Haemophilus were tested for susceptibility to the factor. Ninety-three percent of H. influenzae (nontypable), 75% of H. haemolyticus, 71% of H. parainfluenzae, and 22% of H. parahaemolyticus were susceptible. H. influenaze b strains were resistant producers of the bactericidal factor and H. influenzae f strains were susceptible nonproducers. Only one strain each of H. aegyptius and H. aphrophilus was isolated and each was susceptible and resistant, respectively. 143 clinical isolates of the Enterobacteriaceae were tested and of those 82% of Escherichia coli, 85% of Salmonella sp., and all Citrobacter sp., Shigella sp., and Yersinia sp. were sensitive to the bactericidal factor produced by H. influenzae b. Attempts to isolate the bactericidal activity from mechanically disrupted, solubilized, or osmotically shocked cells failed to release active bactericidal factor. However, we partially purified the bactericidal factor from the spent culture medium of aerobically grown H. influenzae b by a series of extractions. The ability to produce the bactericidal factor was transferable to nonproducer strains without also genetically transforming for type b encapsulation. The converse was also true in that type b capsules were produced by transformed H. influenzae Rd strains but no bactericidal factor was detected from these strains. Additionally, nitrosoguanidine-induced mutants of H. influenzae b lost the ability to produce bactericidal factor without loss of their type-specific capsule, demonstrating that production of the bactericidal factor was genetically separable from production of the type capsule of H. influenzae b.


Immunoblastic lymphadenopathy with purpura and cryoglobulinemia. Immunoblastic lymphadenopathy is a recently described lymphoproliferative disorder, presumably of B-cell origin. It is characterized by regional or generalized lymphadenopathy, usually associated with hypergammaglobulinemia or dysproteinemia. Other findings may be hepatosplenomegaly, dermatitis, fever, malaise, weight loss, and various altered immunologic reactions. Histologically, the involved lymph nodes show immunoblast, plasmacytoid, and plasma cell proliferation. This may be extranodal as well. The case reported here is one of the few followed up prospectively. The patient's purpuric eruption was an apparent manifestation of a type II mixed cryoglobulinemia. Differing from what has usually been reported, we noted hypogammaglobulinemia and findings in part of altered cell-mediated immunity. Despite leukopenia and anemia there were no infectious episodes. Although a satisfactory treatment regimen has not been established, there was beneficial response to prednisone and short courses of melphalan.


Treatment of pneumocystis carinii pneumonia in children. Eighteen children with pneumocystis carinii pneumonia diagnosed over a period of 16 years at a children's hospital are reviewed. All had an underlying disease, either congenital immunodeficiency or a malignancy. 15 patients were treated, 10 with pentamidine isethionate alone, 2 with both pentamidine and co-trimoxazole, and 3 with co-trimoxazole alone. 12 of the treated group recovered and the 3 untreated patients died. The 3 deaths after treatment occurred in children receiving pentamidine alone, and in whom secondary factors contributed. The side effects of treatment with pentamidine were high, and included local reactions, hypoglycaemia, and uraemia. However, our results confirm that pentamidine is an effective treatment for pneumocystis carinii pneumonia in childhood. Co-trimoxazole may be an effective and relatively nontoxic alternative treatment.


Protease and antiprotease levels in blood of arthritic rats. Protease, antiprotease, and acid phosphatase blood levels of adjuvant arthritic rats were determined. The protease levels appear to vary inversely with the antiprotease levels. Changes in the protease levels correspond closely to changes in the acid phosphatase levels. Thus it is likely that the lysosomes contribute to the proteases present in the blood. Administered cortisol appears to raise blood antiprotease levels in both normal and arthritic rats and this may reflect an anti-inflammatory action by this drug.


Lymphocyte subpopulations in rheumatoid synovial tissue. Synovial tissue obtained at synovectomy of the knee joint in 21 patients with rheumatoid arthritis contained a significantly lower proportion of T lymphocytes as measured by spontaneous rosette formation with nonsensitized sheep red blood cells than did synovial fluid or blood from the same patients. There was on concomitant increase in synovial tissue lymphocytes with B-cell markers such as surface immunoglobulin or Fc fragment receptors. Removal of lymphocyte receptors with trypsin followed by culture to allow new receptors to form, led to an increase in rosette forming cells, suggesting that part of the synovial cells without B- or T-cell markers may be T lymphocytes with blocked receptors.


Gastric devascularization: a useful salvage procedure for massive hemorrhagic gastritis. Due to poor results with conventional operative therapy for diffuse hemorrhagic gastritis (DHG), a prospective evaluation of gastric devascularization was performed on 21 patients. Sepsis, alcoholism, and steroid abuse were the common etiologic factors. In spite of the fact that these were all critically ill patients, all stopped bleeding with this operation and only two rebled (9%). The average operating time was 84 minutes. There were two operative complications and gastric necrosis did not occur. The mortality was high (38%) due to the primary disease. Gastric devascularization is a useful salvage procedure for the patient with DHG because it can be accomplished rapidly, with few complications, has a low rebleed rate, and causes no permanent sequelae. Since this procedure causes severe gastric mucosal ischemia, it casts doubt only on the importance of this mechanism alone as the cause of "stress ulceration."


An improved technique for coronary vascular anastomosis. A vein holder is described that is used for anastomosis of both ends of aortocoronary bypass grafts. It minimizes handling of the graft, ensures precision in placing sutures with excellent visualization, and provides maximum patency at the anastomotic sites.


An alternative method of left ventricular decompression during aortocoronary bypass. A method is described that allows decompression of the left ventricle without the necessity of inserting a cannula into the cardiac chambers. The left ventricle may be completely decompressed through the vein grafts attached to the aortic root opened to the pericardial sac.


Gastrointestinal hemorrhage in Turner syndrome. Long-term follow-up with postmortem examination. A 57-year-old woman with Turner syndrome had severe recurrent gastrointestinal bleeding. Exploratory laparotomy at the age of 26 showed an extensive telanglectasia of the entire small intestine. Following death due to myocardial infraction at age 57, postmortem examination revealed only a 0.2-cm residual telangiectasia in the mucosa of the distal part of the ileum. Spontaneous regression of the intestinal telangiectasia observed in Turner syndrome may occur and account for the improved prognosis with age.


Necrosis of the hepatocytes with hepatitis B surface antigen. Occurrence in a chronic hepatitis B surface antigen carrier. Light and electron microscope finding from a liver of a chronic carrier of hepatitis B surface antigen (HBsAg) showed small lymphocytes and macrophages in close contact with liver cells, partial lysis of variable degrees, lytic necrosis, and the complete loss of a few hepatocytes with HBsAg in the cytoplasm. On the basis of these findings, together with the results from immunofluorescence study, the pathogenesis of hepatitis B is discussed, with emphasis on the importance of host cellular immune response. The cytopathic and cytolytic activities of immunologically activated T lymphocytes against liver cells that have antigenic targets associated with HBsAg at their surface and in the cytoplasm are discussed.


Inhibition of experimental tumor growth in hamsters by small direct currents. The effect of three electric current levels (3 mamp, 500 micronamp, and 960 mmicronamp) on the growth of A-Mel-4 tumor was evaluated in hamsters as a mode of therapy. Direct current (dc) was applied for one hour a day from the third to sixth posttumor implant day by the introduction of a shielded point electrode directly into the tumor site. Tumor growth was inhibited, and metastases were reduced in the exposed animals. The higher dl levels produced necrosis in the tumors, and in several animals, the implantation site tumor was completely destroyed. These effects were most pronounced with the positive electrode.


Experience with interposition mesocaval shunt for management of variceal bleeding. We present an experience with 20 patients undergoing interposition mesocaval shunts for decompression of esophageal varices. There were 14 men and six women, ranging in age from 32 to 80 years. Two patients were classified as good risks, nine as moderate risks, and nine as poor risks. There were ten elective operations, seven urgent operations, and three emergency procedures. An operative mortality of 10% was noted in the entire group, with one late death due to shunt occlusion. All deaths occured in the emergency group. A shunt patency of 88% and minimal problems with postoperative hepatic encephalopathy were noted. The interposition mesocaval shunt is judged to be a safe, technically easy procedure that is currently a satisfactory solution to the problem of hemorrhage from esophageal varices.


Visual interference on vestibular response. A case study. Eliminating opportunity for visual fixation as well as providing for the maintenance of an optimal degree of a patient's mental alertness are necessary for a valid assessment of nystagmic response to caloric stimulation. Controlling only for alertness can result in suppressed, absent, or dysrhythmic nystagmus. Data from four normal patients dramatically illustrate the suppressing effects of fixation opportunity despite an alert state. A new clinical instrument for obtaining optimal control over visual influences is described.


Sense in the sun.

Sense in the sun. Sunlight causes more cancers in man than does any other known carcinogen. Studies in this country more than 20 years ago implicating ultra-violet light as a factor in the aetiology of malignant melanoma are being ratified by epidemiologic studies in the United States. In the US, the death rate from melanoma has doubled in the last 15 years. Australian cancer registries have shown this to be so (from recorded deaths in capital city registries) for at least two decades. Figures for prevalence and incidence are not available for the non-melanoma epidermal cancers. Routine application of effective topical sunscreens could feasibly reduce the incidence of skin cancers and other skin disorders associated with chronic insolation. Oral photoprotectants are in their infancy, but show promise.


Homozygosity for HLA-B27. Impact on rheumatic disease expression in two families. The effect of homozygosity for HLA-B27 on the clinical expression of rheumatic disease was studied in two families. The 1 homozygous patient in each of two families demonstrated extraordinarily severe peripheral and axial arthritis compared to other affected heterozygous relatives. In addition, predominant peripheral or axial disease appeared to segregate with different B27 haplotypes. The 2 homozygous patients were not homozygous at the hla-a,c, or D loci.