Metabolism of immunoglobulin A, lymphocyte function, and histocompatibility antigens in patients on anticonvulsants. Low serum IgA levels were found in patients taking phenytoin, together with evidence of depressed T cell function. There was no correlation between the dose or the serum level. A correlation was found, however, with HL-A status, patients with a low IgA showing increased frequency of HL-A2. It is suggested that epileptic patients with HL-A2 status are likely to develop IgA deficiency when given phenytoin.


Experimental allergic encephalomyelitis--migration of early T cells from the circulation into the central nervous system. Study of lymphocytes from the blood of guinea pigs with acute EAE induced by isologous spinal cord in adjuvant reconfirmed that in comparison to normals, the percentage of early (active or high affinity rosetting) T cells decreases dramatically and that these changes can be correlated with clinical signs. In addition, we have investigated matching samples of CNS infiltrating cells recovered by ultrasonication and have found that coinciding with the decrease in early T cells in the circulation, significantly higher levels (P less than 0.001) of these cells appear within the CNS compartment; It is concluded that the decrease of early T cells in the circulation is caused by their migration to the target organ, the CNS.


Vestibulothalamic projections in man--a sixth primary sensory pathway. 1. Responses suggesting activation of the vestibular system, elicited by electrical stimulation of the human thalamus during 22 routine stereotaxic neurosurgical procedures, were examined in a retrospective study to determine the possible existence of vestibulothalamo-cortical projections in man. 2. Such responses were most frequently described as sensations of movement through space and were associated with two distinct vestibulothalamic projections: a) an anterior relay was situated ventral to the medial lemniscus, passing lateral to the red nucleus and dorsal to the subthalamic nucleus prior to terminating in the nucleus ventrointermedius (Vim) (comparable to VPLo in primates); b) a posterior relay associated with the auditory pathway (lateral lemniscus and brachium of the inferior colliculus) projected to the medial geniculate body. 3. The production of sensations of motion in conscious patients by stimulating areas that are similar to those reported constituting vestibulothalamic pathways in cats and primates implies a distinct primary sensory cortical projection for processing information from the vestibular receptors pertaining to the recognition of spatial movements.


A respiratory survey of cedar mill workers. II. Influence of work-related and host factors on the prevalence of symptoms and pulmonary function abnormalities. The influence of certain work-related and host factors on the prevalence of respiratory symptoms and pulmonary function abnormalities in 405 red cedar workers and 187 control workers was examined. In cedar workers, but not in controls, the prevalence of chest symptoms increased with duration of exposure. The decline in pulmonary function with increasing duration of exposure was also more marked in cedar workers, but in both groups smoking was a more important determinant. Substantial proportions of cedar workers and, to a lesser extent, controls noted improvement of cough and wheeze, and particularly of conjunctivitis and rhinitis, when away from work. No deterioration, however, was found in pulmonary function during the work week in either exposure group. Atopic status was unrelated to the prevalence of chest symptoms or pulmonary function abnormalities; it was more common in workers with conjunctivitis and rhinitis, particularly in the cedar group. Similarly, Pi phenotype did not appear to influence the occurrence of either symptoms or lung function abnormalities.


Rapid diagnosis of Hemophilus influenzae type b infections by latex particle agglutination and counterimmunoelectrophoresis. Latex particle agglutination and counterimmunoelectrophoresis techniques were compared in a clinical trial to demonstrate their sensitivity, specificity, and usefulness in the rapid diagnosis of invasive Hemophilus influenzae type b disease. LPA, a simplified LPA performed by house officers, and CIE used in this study detected 0.2, 0.5, and 1 to 10 ng/ml of Hib capsular antigen, respectively. One hundred-six illnesses suspected of being caused by Hib were evaluated prospectively by these assays. A total of 39 of these were confirmed by culture or detection of antigen or both. LPA and simplified LPA were more sensitive and specific than CIE in the diagnosis of Hib disease (P less than 0.01), especially in invasive disease other than meningitis. LPA is inexpensive, can be performed quickly, and detects all invasive Hib infections. The results emphasize the usefulness of antigen detection in the rapid diagnosis of Hib infections, demonstrate that LPA is more sensitive and specific than CIE, and can be conveniently performed by physicians.


Surface charges and the effects of calcium on the frequency of miniature end-plate potentials at the frog neuromuscular junction. 1. When motor nerve terminals are slightly depolarized with increased [K+]o, progressive increases in [Ca2+]o raise min.e.p.p. frequencies until a maximum is reached; further increases then produce a depression (Cook & Quastel, 1973; Matthews & Wickelgren, 1977). 2. Increases in [Mg2+]o also produce the depression. 3. It has been suggested that the depression results from this sequence of events: (a) the divalent cations screen the fixed negative surface charges on the outer face of the nerve terminal, which (b) decreases the negativity of the surface potential, which (c) increases the voltage gradient within the membrane itself, which (d) tends to shut depolarization-gated channels for Ca2+ entry, which (e) decreases min.e.p.p. frequency. 4. In agreement with the interpretation, in frog neuromuscular junctions slightly depolarized with 11 mM-[K+]o, min.e.p.p. frequency is a monotonically increasing function of [Ca2+]o, as long as the sum of [Ca2+]o plus [Mg2+]o is kept constant. 5. The decrease in min.e.p.p. frequency caused by raising [Mg2+]o by 5 mM can be counterbalanced by raising [K+]o by about 9 mM. Using the Grahame equation (1947), assuming that the elevated divalent cations act solely by screening and have no effect on conductance, the negative surface charge is estimated to be roughly 1 electronic charge/75 A2.


Cross-bridge detachment and sarcomere 'give' during stretch of active frog's muscle. 1. A study has been made of the tension responses and sarcomere length changes produced by servo-controlled stretches applied to isometrically contracting frog muscle. Sarcomere lengths were monitored by cine-photography of diffiraction spectra obtained by illuminating a small area of muscle with a laser. 2. The tension increment produced by a ramp-and-hold stretch of approximately 1 mm (ca. 4% of the muscle length) comprises three phases whose limits are defined by two points, S1 and S2, where the slope of the response decreases abruptly. S1 and S2 correspond to extensions of 0.13 and 1.2% of the muscle length. 3. Movements of the first order spectra relative to the zero order recorded during stretch reveal that S2 coincides with an abrupt elongation of the sarcomeres. This is termed sarcomere 'give' and it occurs when the filaments are displaced by 11-12 nm from their steady-state (isometric) position. 4. The stiffness of the sarcomeres, Es, up to S2 decreases with increasing sarcomere length. The maximum force sustained by the muscle at S2, PS2, also shows an inverse dependence on sarcomere length. Both Es and PS2 fall to zero at an extrapolated sarcomere spacing of 3.6-3.7 micrometer, coinciding with the length at which the actin and myosin filaments no longer overlap. 5. The ratio PS2/P0 (where P0 = maximum isometric tension) varies with temperature and speed of stretch. It increases with increasing speeds of stretch until a certain critical velocity, Vc, is reached, beyond which it is almost independent of any further increase. Vc has a positive temperature coefficient, increasing 5-6 in the range 0-30 degrees C (Q10 = 1.8). There is a positive correlation between the maximum speed of isotonic shortening (Vmax.) and Vc in different muscles. 6. Sarcomere 'give' during stretch is considered to be due to forcible detachment of cross-bridges between the actin and myosin filaments. This results in recoil of the extended series elastic elements in the muscle at the expense of the sarcomers. The amount of filament displacement required to induce sarcomere 'give' (11-12 nm) is thought to represent the range of movement over which a cross-bridge can remain attached to actin during a stretch.


Filament sliding and energy absorbed by the cross-bridge in active muscle subjected to cycical length changes. 1. The effects of single and double cycles of stretch and release on the tension response and relative sliding movement of the actin and myosin filaments in active frog's muscle were investigated. 2. The cross-bridges linking the filaments together are able to accommodate a greater range of filament displacement before becoming detached during a second cycle stretch, providing it commences without delay following the preceding release: sarcomere 'give' then occurs for displacements of around 18 nm, as compared with 12 nm for a first cycle stretch. It is postulated that the difference arises because the myosin heads adopt different 'preferred' positions in the isometric steady-state and at the end of a previous release. 3. Muscle length-tension loops were recorded and used to measure the energy absorbed when a muscle is subjected to cycles of stretch and release. The work absorbed per unit length change increases with increasing displacement of the cross-bridges from their initial (isometric) steady-state position, up to the point at which sarcomere 'give' occurs (S2); thereafter it remains constant. 4. More work is absorbed during the first cycle of a double stretch-release combination than during the second. The greater amount absorbed during the first cycle is associated with a correspondingly greater amount of filament sliding in the period following sarcomere 'give'. Sarcomere length-tension loops were constructed and these showed that not less than 80-85% of the work done on a muscle is absorbed by the sarcomeres themselves. 5. A greater amount of work is done on stretching up to (but not beyond) S2 during second cycle stretch as compared to a first. The difference amounts about 1 mJ.m-2 per half-sarcomere. 6. The results are compatible with the mechanism for force production proposed by Huxley & Simmons (1973), in which each myosin head generates force in a number of stepping movements, from one attached state to another. It is concluded that (a) during an unloaded isotonic contraction the working 'stroke' of the head would result in a 10-13 nm relative sliding movement of the filaments, and (b) the potential energy difference separating the two 'preferred' states is 6-9.6 kT per cross-bridge, or 3-4.8 kT per S-1 sub-units, assuming that each one interacts simultaneously with the actin filament.


Local anaesthetics transiently block currents through single acetylcholine-receptor channels. 1. Single channel currents through acetylcholine receptor channels (ACh channels) were recorded at chronically denervated frog muscle extrajunctional membranes in the absence and presence of the lidocaine derivatives QX-222 and QX-314. 2. The current wave forms due to the opening and closing of single ACh channels (activated by suberyldicholine) normally are square pulses. These single pulses appear to be chopped into bursts of much shorter pulses, when the drug QX-222 is present in addition to the agonist. 3. The mean duration of the bursts is comparable to or longer than the normal channel open time, and increases with increasing drug concentration. 4. The duration of the short pulses within a burst decreases with increasing drug concentration. 5. It is concluded that drug molecules reversibly block open end-plate channels and that the flickering within a burst represents this fast, repeatedly occurring reaction. 6. The voltage dependence of the reaction rates involved, suggested that the site of the blocking reaction is in the centre of the membrane, probably inside the ionic channel.


Calcium transients in isolated amphibian skeletal muscle fibres: detection with aequorin. 1. Single twitch muscle fibres isolated from frogs and toads were microinjected with the Ca2+-sensitive bioluminescent protein aequorin. The fibres contracted normally and emitted flashes of light (aequorin responses) in response to stimulation for many hours thereafter. 2. No luminescence was detected from healthy fibres at rest. 3. The aequorin diffused from the site of injection at a rate consistent with a diffusion coefficient of 5 x 10(-8) cm2/sec. 4. During trains of isometric contractions there was a progressive reduction in both the amplitude and the rate of decline of the aequorin response, an observation consistent with the theory that Ca is redistributed from sites of release to sites of sequestration under such circumstances. 5. In isometric tetani light emission continued to rise long after the plateau of force had been achieved. This and the fact that the amplitude of the tetanic aequorin response increased steeply with increasing stimulus frequency suggest that in tetani the sarcoplasmic [Ca2+] may normally be above the level required to saturate the contractile apparatus. 6. Both in twitches and in tetani the amplitude of the aequorin response increased slightly and then decreased substantially as the fibre was stretched progressively beyond slack length. 7. In potassium contractures the luminescent and mechanical responses first became detectable at about the same [K+], but for equivalent force luminescence was less intense than in twitches. The aequorin response was biphasic in solutions of high [K+]. 8. Exposure of the fibre to Ca2+-free solutions had no influence on either the mechanical or the luminescent responses in twitches. In Ca2+-free solutions tetanic aequorin responses tended not to be maintained as well as normally, suggesting that intracellular Ca stores do become somewhat depleted. 9. In twitches the amplitude of the aequorin response probably reflects the amount of Ca2+ liberated into the cytoplasm rather than a [Ca2+] in equilibrium with the myofilaments. Changes in the rate of decay of the aequorin response may reflect changes in the rate of Ca sequestration by the sarcoplasmic reticulum. 10. In K+-contractures and during the plateaus of tetani the aequorin signal changes slowly enough so that it seems unlikely that substantial gradients of [Ca2+] exist at the sarcomere level. Under such circumstances the amplitude of the aequorin response probably does reflect the [Ca2+] in equilibrium with the myofilaments.


Unitary recordings of near threshold responses of receptor cells in the olfactory mucosa of the frog. 1. Receptor cell activity in the frog's eminentia olfactoria was recorded using metal-filled micro-electrodes. 2. Several units discharged spontaneously with a mean frequency lower than 0.2 spikes per sec, or were silent in periods of up to 5 min. The other units displayed spontaneous activities between 0.2 and 1.05 spikes per sec; their activity could be modelled with a Poisson process. 3. Near-threshold responses to odour stimulation were investigated, considering several stimulations within a small concentration range. Low concentration stimulations were sometimes followed by a response, sometimes not. The concept of response probability is introduced to describe this incertitude. 4. The distribution of the number of spikes in several odour trials at low concentrations showed a reasonable agreement with two types of Poisson distribution. 5. The findings are discussed in connexion with receptor cell sensitivity and the excitation of second order neurones in the bulb.


Contractile activation by voltage clamp depolarization of cut skeletal muscle fibres. 1. Single frog skeletal muscle fibres bathed in a relaxing solution were cut close to the tendon and mounted across a single Vaseline gap so that a short segment of intact terminated fibre extended beyond one side of the gap. 2. A compensating circuit, set with a micro-electrode in the terminated fibre segment, was used both to correct total current for external current crossing the gap and to correct pool voltage for the voltage drop across the fibre segment in the gap. 3. The micro-electrode was then removed and the fibre voltage-clamped using the compensating circuit. This allowed movement without damage under controlled voltage. 4. Strength-duration curves for contraction thresholds of cut fibres exposed externally to TTX Ringer solution and internally to a predominantly K glutamate solution were similar to strength-duration curves reported for intact fibres. 5. The change from TTX Ringer to a predominantly (TEA)2SO4 external solution shifted the strength-duration curve for cut fibre contraction thresholds in the negative direction as reported for intact fibres. 6. When studied at 3-4 degrees C, fibres from warm-adapted frogs appeared to have higher contraction thresholds than fibres from cold-adapted frogs. 7. Delayed rectifier currents recorded from cut fibres were similar to those reported for intact fibres.


The diagnosis and management of cerebellopontine angle tumors. The diagnosis and surgical management of cerebellopontine angle tumors remains a challenge. Early detection and microsurgical technique have lowered mortality rates and have allowed surgeons to preserve facial nerve function in a high percentage of cases. The purpose of this paper is to report a series of 171 lesions removed through the middle fossa, translabyrinthine, and combined translabyrinthine-suboccipital approaches. Results and complications are covered in detail.


Kartagener syndrome with abnormalities of cilia. Kartagener syndrome of sinusitis, bronchiectasis and situs inversus has been so called since his classical description in 1933. This report presents two further cases, a brother and sister. They were extensively studied and the findings are reported. A unique finding was that in both patients, both in the maxillary sinuses and in the bronchi, abnormal cilia were discovered on electron microscopy. After a search of the literature the authors conclude that this finding is probably congenital rather than acquired and may explain the development of the sinusitis and bronchiectasis.


T- and B-cell distribution in pregnancy. We established the percentage of thymus-derived lymphocytes associated with cellular immune responses and bone marrow-derived, antibody-producing cells in maternal blood throughout normal gestation. The data are in conflict with a recent proposal that reversal ot the T:B cell ratio associated with the serum human chorionic gonadotrophin peak of early pregnancy assists in fetoplacental allograft acceptance. Moreover, variability on lymphocyte dynamics in four women followed up serially throughout pregnancy, as well as T- and B-cell determinations in 15 patients whose pregnancy complications are potentially related to maternal-fetal immunologic aberrations, suggests that more sensitive immunologic methods of monitoring the host immune response are necessary to be clinically useful in obstetrics.


Noninvasive assessment of aorta-coronary saphenous vein bypass graft patency using thermocouple. Noninvasive monitoring of patency of aorta-coronary bypass grafts can be achieved with reasonable accuracy using the thermocouple. This method is consisted of attaching the thermocouple to the surface of grafted vein during surgery and judging the patency by rapid injection of iced solution into peripheral vein. Patient grafted vein will show the thermal change after injecting iced solution. On the contrary, occluded  graft will show no thermal change. As this thermal curve is a thermodilution curve by a single injection and is measured from the outside of the vessel, thermal change depends on the temperature and the quantity of the injected solution, cardiac output, body temperature, and loss of indicator temperature along the way to the thermocouple. When the grafted vein is patent, the same thermal curves are recorded regardless of the amount of the flow, and zero flow resulted in disappearance of curve. Initially, the method was evaluated in dogs and the appropriateness was verified. Subsequently, this method was applied to 16 vein grafts of 12 patients undergoing aorta-coronary bypass surgery. Ten or 15 ml of iced solution was injected through inferior vena cava or antecubital vein and the thermal change of the grafted vein was recorded for 1-4 weeks after the operation. Fourteen grafted veins were judged to be patent and 2 were occluded. The comparison of the results by this method with coronary angiography undergone at 4 weeks after the operation showed no false positive case but 1 false negative case. This extravascular observation of the thermodilution curve is a convenient method for judging whether vein graft is patent or not.


An analysis of 5-HT hyperpolarization of sympathetic ganglion cells. Bullfrog sympathetic ganglion cells treated with nicotine are hyperpolarized with application of 5-HT. This 5-HT hyperpolarization, however, was not observed if preparations were pretreated with d-TC before being treated with nicotine. When preparations were treated with ACh or carbamylcholine, which transiently depolarizes ganglion cells, hyperpolarization did take place. Such was also observed in the presence of Ringer's solution if preparations were pretreated with the K+-free Ringer's solution. These results suggested that ganglion cells were hyperpolarized by the action of 5-HT when the Na+-pump of these cells was accelerated by accumulation of intracellular Na+, as the result of a transient depolarization or extracellular K+ deficiency.


[The intraindividual variation of fibrinolytic activity in volunteers (author's transl)]. In five volunteers fibrinolytic activity has been measured five times over a period of six weeks during increasing values of circadian rhythm. Euglobulinlysis-time, paper fibrinolysis, fibrinogen, plasminogen, alpha1-antitrypsin, alpha2-makroglobulin, thrombino-coagulase-time and fibrin-split-products were used in one study. An increase of fibrinolytic activity in the mooning was observed in all volunteers. Intraindividual variation of values is considerable but less than variation of values compared interindividually. Moreover variation was smaller at noon than in the time before noon. In clinical trial of the short-time effect of drugs the period of the plateau of the fibrinolytic activity should be used because of its smaller variation of values. Furthermore, in this period the intraindividual variation of the fibrinolytic activity is smaller than during increasing slope of the circadian rhythm of fibrinolysis. Intraindividual control should be granted.


Influence of age on the immunological activity and capacity of the CBA mouse. The immunological activity and capacity were studied in the CBA mouse as a function of its age. The activity was determined by the number of immunoglobulin containing (C-Ig) cells in different lymphoid organs and the immunoglobulin levels of the serum in non-artificially stimulated animals. It was confirmed that in older age the bone marrow takes over from the spleen the role of the major site of immunoglobulin production. A clear decrease in the number of C-Ig cells was observed in the mesenteric lymph nodes and the Peyer's patches. The Ig serum remained constant after the sixth month of age, with the exception of an increase of IgG1 and IgG,2B. There was a striking increase in variation between the individual animals with advancing age. From these data it can be concluded that the B-cell system of old animals is as active as that of young adult animals. The immunological capacity of CBA mice of various ages was assessed by measuring the levels of specific antibodies after the administration of human serum albumin in complete Freund's adjuvant. A severe decline of the primary and the secondary response was observed on ageing. The reaction of three year old animals was negligible. The discrepancy between the declining immunological capacity and the constant or increasing immunological activity is explained by an age-related deficiency of the T-cell compartment in the spleen.


The effect of problem-oriented medical records on clinical management controlled for patient risks. This study examines the change in clinical management by 28 medical and surgical firms in three London teaching hospitals following the introduction of Problem-Oriented Medical Records (POMR) in one of the hospitals. Comparison is made between firms using and not using POMR. The data are analyzed using a regression model. Analysis is based on the coefficient of change in each firm between the two study years when modified by the physiological and demographic patient variables significantly associated with the management of each disease. Although not conclusive, the results in four of the seven diseases studied encourage the speculation that POMR may have improved the thoroughness of patient management. The significant patient variables in each diagnosis suggest that patient risk on admission can affect management scores. Were this to be found elsewhere, the influences of patient mix might be considered in using explicit criteria to make comparisons between hospitals that serve different kinds of populations.


Chinese herbal arthritis cure and agranulocytosis. Rheumatoid arthritis remains an incurable disease, and the patient who is unable to obtain relief from standard therapies will often turn to one of the many alternative treatments available. We report an episode of agranulocytosis which occurred in a patient with rheumatoid arthritis while he was taking a Chinese herbal preparation. We understand this preparation is readily obtainable by Australians.


[The physiological principles of spa treatment (author's transl)]. The physiological principles of Spa Treatment are explained on an adaptation model with three stages of adaptive modification: 1. autonomic recovery, 2. functional adaptation, 3. trophic and plastic adaptation. The stressors are the stimuli of the physical therapy which form adaptates during the spa treatment. These adaptates are directly dependent on the quantity and specificity of the stressors. Clinical symptomatology is elucidated practically with reference to two therapeutic principles and substantiated by results from spa research. The effects and long-term success of the treatment are scientifically demonstrated from the point of view of physiological adaptation.


[Studies on the metabolism of inorganic sulfate (author's transl)]. The blood serum fasting levels of inorganic sulfate increase with age, other differences are largely due to diet. The serum sulfate shows a circadian rhythm with a minimum before noon and a maximum in the afternoon and evening. Urinary excretion of sulfate disappears during a low-protein diet. The serum sulfate levels rise temporarily if oral intake of protein, water or inorganic sulfate in non-laxative doses is increased. From the decomposition of protein, sulfate is first excreted with alkali cations and sooner than other catabolites. Drinking water mobilizes sulfate from its tissue pool, which can be blocked by the addition of sodium chloride. The subsequent excretion of an oral sulfate dose is prolonged over one day.


[Sport today: ski acrobatics (author's transl)]. Stunt skiing is popular. It includes three disciplines: ski ballet, "hot dog" or "rough track" skiing and jumping. An extensive series of investigations showed that for well-trained professionals with suitable equipment and good outdoor conditions, the danger of injury is only slightly higher compared with normal skiing. Practising ballet figures considerably improves the stability of the good all-round skier.


[Prognosis for patients of an intensive care unit. Myocardial infarct, pulmonary edema, reanimation and severe infections]. The prognosis of patients should influence diagnostic and therapeutic measurements. For this reason the survival time is shown of 516 patients with acute myocardial infarction, 200 patients with pulmonary edema, 553 patients in which resuscitation had become necessary and 201 with life-threatening infections. The survival time is correlated to clinical signs easily obtainable on admission. Small groups can be selected which with a high degree of probability will die during their stay in hospital. Intensive therapy should be withheld from those patients. But prognostic indices without the probability of error cannot yet be constructed.


[Seroepidemiology of acute infectious hepatitis (author's transl)]. Hbs-Ag, anti-Hbs, anti-Hbc and anti-HA were determined and the concentration of IgM measured in the sera of cases of acute infectious hepatitis which occurred in the Hannover area in 1975. Although there was a high degree of contamination with hepatitis A virus among the population, acute infectious hepatitis A was rare (n = 56). The hepatitis A virus is principally transmitted by contact with infection or while traveling in southern Europe. The greatest part of infectious hepatitis is due to hepatitis virus B (n = 211). Non-A, non-B hepatitis was less frequently observed (n = 62). A high percentage of patients with serum hepatitis and non-A, non-B hepatitis gave a history of parenteral exposure to possibly infectious material.


[Control of animal rabies by veterinary official and hunting measures (author's transl)]. The system of state control of rabies consists of clearing and eliminating the sources of infection, the simultaneous interruption of the chains of infection and preventing such chains developing. For this purpose different measures are instituted for rabies in domestic and wild animals. The weight of the attack lies in the control of rabies in the fox as the epidemiologically responsible carrier. Its reduction also corresponds to other gamekeeping requirements, the gassing of fox-earths being called upon when hunting measures fail. Vaccination of domestic animals, particularly the carnivores, presents an opportunity to break down epidemiological bridges for game and to reduce the danger to humans. Along with the improvement of vaccination of humans against rabies, this can contribute to a "dedramatisation" of rabies.


[Lymphogranulomatosis in infancy. histology, therapy and prognosis (author's transl)]. Between 10 and 14% of Lymphogranulomatosis are infants. In recent years distinct advances have been made through accurate histological classification, subdivision into clinical stages and aggressive radiotherapy and polychemotherapy. Therapeutic success depends particularly on the primary extent of the disease. But some therapeutic decisions require conclusive confirmation by still lacking longterm observations. In particular the number of  possible late relapses cannot be estimated at present.


[Screening newborn infants for phenylketonuria, histadinemia, homocystinuria and maple syrup disease. Results from north rhein-westphalia (1974-1976) (author's transl]. In North Rhein-Westphalia, 181 patients with phenylketonuria and 81 children with persistent phenylalaninemia were found from 1966-1973 during the phenylketonuria screening by the National Hygienic and Bacteriological Investigation Officials and the work of the Agency for tracing psychic disorders of metabolic origin. Continuation of the screenings and the work of the agency revealed 44 subjects with classical phenylketonuria and 27 with persistent phenylalaninemia between 1974 and 1976.


[Trigeminal neuralgia and its differential diagnosis (author's transl)]. Trigeminal neuralgia (Tr. N.) occurring as tic douloureux usually proves to be senile neuralgia without any etiological background. On the other hand, isolated Tr. N. of the first ramus suggests the process. Bilateral Tr. N. are rare yet most frequently an expression of a multiple sclerosis with attacks first on one side and then on the other. Symptomatic Tr. N. occurs seldom as perhaps in M.S., only as tic douloureux, usually as a continuous pain with more or less acute exacerbations. Tr. N. are therapeutically problematic after operative treatment of the maxillary sinuses, still more so after herpes zoster. Other neuralgias and facial neuralgias (e.g. a glossopharyngeal neuralgia, nasociliary neuralgia, Sluder's neuralgia, Costen's syndrome, Horton's syndrome etc.) must be diagnostically differentiated from Tr. N.


[Pathophysiology of facial neuralgia (authors' transl)]. Facial neuralgia appears in a variety of forms which have different fundamental pathophysiological mechanisms. Of decisive importance are neuralgias with sensitive trigeminal, intermediate (sensory root), glossopharyngeal and vagus nerves which are caused by functional disturbances or damage to the nerve. In addition, projected or referred pain occurs in intracranial and cervical affections. A vascular origin may be assumed for Horton's neuralgia. This periodic paroxysmal and unilateral facial neuralgia is related to migraine. Serotonin, histamine and plasma kinin may be important eliciting factors; the concomitant symptoms of lachyrmation and rhinorrhea, reddening of the eyes and the face and a transitory Horner's syndrome suggest participation of the sympathetic and parasympathetic systems. Consideration of the previously known pathophysiological mechanisms permits a differentiated therapy for the various facial neuralgias.


[Facial neuralgia and the cervical vertebral column (author's transl)]. About one quarter of the pains in cervico-cranial syndromes in 50 adults are localized in the facial region. In 19 children more than half of the pains are projected into the face. In the discussion of the possibility of radiation mechanisms it is established that the radicular lesion is of minor importance here, as is the possible compression of a peripheral nerve. The fact is stresssed that "pseudoradicular" symptoms as an expression of a painful muscular tension causes painful radiation but that it is no explanation of radiation of pain into face. The most likely explanation for this is probably "projected" pain or referred pain which must be interpreted as an abnormal cortical reaction of a pain afferent at the trigeminal nucleus into the areas of the face formed like an onion skin.


[Dental and gnathological aspects of facial neuralgia (author's transl)]. Disturbances of dental occlusion may lead to hyperactivity of the regional musculature, accompanied by a displacement of the lower jaw. The muscle and joint pains which then occur are the principal causes of the complex picture of facial neuralgia from the gnathological point of view, but the emotional factor must not be overlooked. The dental treatment of the pain syndrome demands extremely high expenditure in time and technical equipment. It usually consists of repositioning the displaced mandible with subsequent stabilization by dental technical measures. It is, moreover, important to keep parafunctional activity of the masseter muscles as low as possible or to suppress it altogether by purposeful arrangement of the occlusal surface complex.


[Diagnostic and therapuetic local anesthesia in facial neuralgia (author's transl)]. Diagnostic and therapeutic local anesthesias (DLA and TLA) in experienced hands are also an important method first of establishing the cause of certain facial neuralgias and then of treating them successfully. Diagnostic and therapeutic local anesthesias presuppose a thorough examination of all factors which may arise in a particular facial neuralgia. If local anesthesia reveals a peripheral cause for the facial neuralgia concerned, a lasting relief of pain can then be obtained through extinction of the source of pain so that the body can restore, at first temporarily and under certain circumstances after consistent repetition of therapeutic local anesthesia at the same spot continuously, the disordered functions in this area (dysesthesia, dyskinesia, dyscrasia, dysthymia). DLA and TLA are only one method of peripheral neurotherapy.


[Neurosurgical treatment of symptomatic and atypical facial neuralgias (author's transl)]. Symptomatic trigeminal neuralgia, especially in multiple sclerosis, can be successfully eliminated by percutaneously controlled thermocoagulation of the Gasserian ganglion. Atypical facial neuralgias are only improved by this intervention if secondary pains accompany the persistent pains. All neurosurgical procedures must be avoided with persistent unclassifiable pains in the area of distritubion of one or more branches of the trigeminus, especially in young people. The problem of neurosurgical treatment of analgesia dolorosa has not yet been finally solved.


[Differential therapy of bromcarbamide poisoning with reference to primary detoxication by means of gastro- or duodenotomy]. Different Therapy of Bromisoval Poisoning and Primary Detoxication by Gastrotomy or Duodenotomy: Bromisoval poisoning is encumbered with a high complication rate and mortality. Primary and secondary detoxication methods differ in efficacy and risk of the method. Primary detoxication deserves prefrence because it terminates the invasion of the poison, the duration of coma is shortened and complications due to poisoning are eliminated. An extremely effective, and at the same time involving little risk, primary detoxication can be undertaken by gastrotomy or duodenotomy, because the tablet substances remain visible for a long time as radiopaque conglomerates in the stomach and suprapapillary duodenum. In 5 cases with 30 to 70 g carbamide, the duration of the coma was cut by more than half compared with 25 equally severe poisoning treated in the usual manner.


[Quality control between utopia and reality. Situation in surgery (author's transl)]. The aim of every German surgeon is to ensure an optimal quality of performance in every sphere of surgical activity in the German Federal Republic. Cooperation of the Deutsche Gesellschaft für Chirurgie (German Surgical Society) and the Berufsverband der Deutschen Chirurgen (professional association of German surgeons) is intended to achieve this aim by a system which offers all surgeons working independently in clinics, hospitals and private practice the possibility, on an absolutely voluntary basis, for data on their methods of treatment and results to be recorded centrally and stored in such a way that a comparison of certain criteria of quality assessment of their work is available for them. In the event of a marked difference in quality, an advisory committee of experienced surgeons specially appointed with the confidence of all involved should try to clarify the reason for this on the spot and seek ways to help.


[Malpractice--unnatural death. Medico-legal problems in the diagnostic activity of pathologists (author's transl)]. According to definitions of medical malpractice and of unnatural death it is established that medical measures under criminal principles of causality come into consideration as causes of death even without proof of guilt. That clinical and scientific sections are turned into means of judicial redress by the provisions of the Cemetery and Burial Act is challenged. It is recommended--as has been the case in other European countries for a long time--that all doctors have a duty of compulsory notification of signs of unnatural death.


[Quality reliability in the German Federal Republic. A model plan for ensuring quality and efficiency of hospital care (author's transl)]. In order to place the efforts to ensure quality in medical care in hospitals which have been begun in the surgical sphere on a broader and more permanent basis, these efforts by the hospital doctors should be supported by suitable measures. For this purpose a Model Organization for Ensuring Quality and Efficiency in Hospital Care in West Germany has been developed by an interdisciplinary project group under the leadership of professor Eichhorn at the German Hospital Institute. At the beginning of the project, considerations of the aims, the demands of method and the conditions for converting them to practice were put forward.


[Reflections on quality control in perinatalogy exemplified by the Munich Perinatal Study (author's transl)]. Quality control has four component parts: standardized observation, a procedure to measure the quality of individual production, a technique for aggregating and comparing measurements, and a means by which the behaviour of the subjects can be influenced by these comparisons. The greatest problems, which often remain unsolved, can be traced to the definition and measurement of the quality of medical care. Some problems and the feasibility of quality control are demonstrated using perinatalogy and the Munich Perinatal Study as models. This trial of self control shows that voluntary participation of the hospitals, assured anonymity, self-responsibility, and a statistical evaluation that can be used for educational purposes play an important part.


Effect of acetylator phenotype on the rate at which procainamide induces antinuclear antibodies and the lupus syndrome. To investigate the relation between acetvlator phenotype and the development of procainamide-induced lupus, we determined the rate of development of antinuclear antibodies in 20 patients of known acetylator phenotype receiving chronic procainamide therapy. The duration of therapy required to induce antibodies in 50 per cent of slow (11) and rapid (nine) acetylators was 2.9 and 7.3 months respectively. The median total dose that produced ant;bodies was 1.5 g per kilogram and 6.1 g per kilogram respectively. After one year antibodies had developed in 18 patients. Retrospective studies of patients in whom procainamide lupus had developed revealed that the duration of therapy required for induction in 14 slow and seven rapid acetylators was 12 +/- 5 and 48 +/- 22 months respectively (P less than 0.002). We conclude that acetylator phenotype influences the rate at which procainamide induces antinuclear antibodies and probably the lupus syndrome. Antibody production is probably related to the parent compound or a non-acetylated metabolite.


Long-term anatomic fate of coronary-artery bypass grafts and functional status of patients five years after operation. To assess long-term results, coronary and graft angiography was performed 53 to 84 months after operation in 22 of 30 consecutive patients who had undergone coronary-artery bypass grafting before 1973, and who had at least one graft patent at an early (three to nine months) postoperative study. Of the 33 grafts, 31 were patent at late study. All patients had severe symptoms before operation. Of 16 who became asymptomatic early after operation, angina pectoris later redeveloped in 11. Progression of disease in ungrafted vessels accounted for symptomatic deterioration in nine of these 11 patients. We conclude that most grafts patent several months after operation remain so for at least 4 1/2 years, and that although most patients improve symptomatically after operation, symptomatic deterioration is common in the succeeding years and is most often due to progression of disease in ungrafted vessels.


Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole. To assess the cause of nonspecific vaginitis, we performed a prospective case-control study of vaginal flora and a randomized unblinded trial of different therapies. Haemophilus vaginalis was isolated from 17 to 18 women with signs of vaginitis but only one of 18 normal matched controls (P less than 0.002). The concentration of anaerobic bacteria in vaginal washings also was increased in patients. Clinical improvement and eradication of H. vaginalis occurred in one of seven patients given sulfonamide vaginal cream, two of 15 given oral doxycycline, nine of 27 given oral ampicillin, and 80 of 81 given oral metronidazole. On the seventh day of therapy signs of nonspecific vaginitis persisted in 31 of 31 with, and in two of 92 without, persistent H. vaginalis infection (P less than 0.001). These data suggest the causal role of H. vaginalis in nonspecific vaginitis, possibly in concert with vaginal anaerobes. The widespread use of sulfonamide creams is inappropriate. Metronidazole is effective, but its efficacy must be weighed against its possible toxicity.


Effects of coronary-artery bypass on global and regional left ventricular function during exercise. To determine the effect of coronary revascularization on exercise-induced abnormalities of left ventricular-ejection fraction and regional contraction, we obtained electrocardiograph-gated 99mTc radionuclide cineangiograms before and after operation in 23 consecutive patients. At rest, their average ejection fraction remained unchanged: 51 +/- 3 versus 54 +/- 4 per cent (+/- S.E.M.). However, 17 of the patients showed improvement of ejection fraction during postoperative exercise (increase of 51 per cent). The remaining six patients had no change or a decreased ejection fraction during exercise. All patients with improved ejection fractions during exercise were symptomatically improved. No improvement of regional function occurred at rest, but improvement did occur in regions of exercise-induced dysfunction. Although coronary revascularization has little effect on left ventricular function at rest, the ejection fraction during exercise and exercise-induced wall-motion abnormalities improve in most patients who experience symptomatic improvement.


[Angioventriculography in the study of deep arteriovenous aneurysms]. The authors discuss the value of angioventriculotomography before surgery in deep arteriovenous malformations. This new procedure was performed in 2 infants and 3 children. In all cases, it was possible to know the precise relations of the lesions to deep structures of the central nervous system. Surgery was then contra indicated in two patients. In the remaining three patients, it not only proved to be of great value before deciding surgery, but it also determined the entire surgical procedure. The only incident encountered in this series was a rapidly regressive convulsive seizure in an infant of 3 months.


Late endocrine effects of L-dopa, 5-HTP, and 6-OH-dopa administered to neonatal rats. Neonatal rats were injected with L-dopa, 5-hydroxytryptophan (5-HTP) or 6-hydroxy-dopa (6-OH-dopa) and allowed to mature. Eye opening, vaginal opening, endocrine organ weights and pituitary hormone concentration in the serum were measured. Treatment with either the dopamine (DA) precursor or the serotonin (5-HT) precursor caused an acceleration in eye opening, a significant decrease in serum TSH (males) an elevation of serum prolactin (Prl; males), and a lowering of serum growth hormone (females). After chemical sympathectomy (6-OH-dopa) vaginal opening was delayed, thyroid weights were increased and serum TSH decreased (males). It is concluded that during the critical neonatal period overloading either of 2 of the principal monaminergic systems results in similar and persistent alterations in pituitary function. Chemical sympathectomy produced a different pattern of abnormalities.


The quest for an image of brain: a brief historical and technical review of brain imaging techniques. Each of the brain imaging techniques in common clinical use (skull radiography, midline ultrasonography, isotope scan, pneumoencephalography, angiography and computerized tomography) depicts some structural or functional characteristic of the brain. Each produces a correspondingly restricted concept of the status of the brain. Computerized tomography, which defines the radiodensity of head tissues, has a fundamental advantage over the other techniques in that it defines with quite good resolution a characteristic of brain tissue itself (radiodensity), rather than visualizing some anatomic compartment other than brain parenchyma. It provides an explicit image of the brain quite analogous to gross sections of the brain seen at autopsy. Computerized tomography has already substantially reshaped the practice of neurology wherever it has become available and probably will come to play a role as pivotal in clinical neurology as does bone radiography in orthopedics.


Immunologic thrombocytopenic purpura and pregnancy: six new cases. Six new cases of idiopathic thrombocytopenic purpura (ITP) associated with pregnancy are reported; one of these patients delivered triplets. In addition, 78 patients with 122 pregnancies and 124 fetuses have been reported previously. The maternal mortality rate was 4% and the fetal mortality rate was 18%. Prior recommendations for elective cesarean section in all mothers with a platelet count less than 100,000/cu mm at delivery is not supported by the data available. Treatment of pregnant women with ITP with adrenal corticosteroids has virtually eliminated maternal mortality, has replaced splenectomy as the therapy of choice during pregnancy, but has had little effect on fetal mortality.


Gaucher's disease and pregnancy.

Gaucher's disease and pregnancy. Two patients with Gaucher's disease during pregnancy are reported. In one there were severe puerperal hemorrhagic complications attributable to thrombocytopenia secondary to infiltration of the reticuloendothelial system by Gaucher cells. The conclusion as reported in previous literature, which is reviewed, regarding the absence of hemorrhagic complications is disputed since on of the cases reported here showed that these may be severe and occur late in the puerperium.


Lymphocyte mediated natural cytotoxicity in neoplasia. Peripheral blood lymphoid cells from normal donors, patients with non-malignant diseases, and patients with malignant diseases were evaluated for cytotoxicity against a cultured carcinoma cell line, using a chromium release assay. The natural spontaneous lymphocyte-mediated cytotoxicity was significantly higher in tumor-free groups. The observed decreased response in patients with malignancies correlated with depressed responsiveness to phytohemagglutinin stimulation. Removal of cell subpopulations bearing Fc receptors significantly decreased the cytotoxicity, while depletion of phagocytic mononuclear cells did not. We suggest that natural cytotoxicity is a measure of cell membrane integrity of lymphocytes and should be included as a routine test for evaluation of general immune competence.


Vestibulotixoci effect of alkylating agents. The vestibular sensory epithelia from 3 patients treated with cytotoxic drugs were studied with a surface specimen technique, 2 cases had been treated with cyclophosphamide and 1 with melphalan. In all 3 cases there was some slight degeneration affecting the cristae ampullares. The macula utriculi showed no signs of degeneration. The degeneration affecting the cristae is probably too slight to produce any serious symptoms from the vestibular apparatus.


The influence of optokinetic training upon vestibular responses induced by repetitive sinusoidal stimuli. Optokinetic and vestibular training alternatively applied during two cycles, using sinusoidal pendular rotation and a stationary projection optokinetic stimulator, resulted in a progressive vestibular response decline. This response decrement was only revealed by the parameter of the slow-phase velocity. Combined optokinetic and vestibular training shows a facilitating effect upon vestibular habituation which cannot be induced by repetitive pendular rotation alone. Both a response decline, expressed by the parameter of the slow-phase velocity and a response increment, expressed by the number of nystagmus beats, were observed during one cycle of the pendular rotation. Both phenomena could be induced by alternative optokinetic and vestibular training and were interpreted as typical visual-vestibular interaction mechanisms.


[Aortic myocytes and calciferol-induced arterial calcification: ultrastructural and biochemical study]. Thirty0seven rats were given Vitamin D2 orally at the daily dose of 4000 I.U. for two months, then 8000 I.U. for the following two months and 26 rats were used as controls. Batches of both intoxicated and control rats were sacrificed on the 15, 30, 45, 90 and 120 days after the onset of the experiment. This chronic calciferol intoxication allowed a better understanding of the calcifying process. Modified myocytes were observed early and for a long time in and around the mineralizing foci. They had the ultrastructural and histochemical characteristics of cells with an activated metabolism: excessive development of the organelles linked with synthesis processes, hyperactivity of phoshatases, of lysosomic enzymes and of enzymatic systems of cell respiration and glycolysis. Some data of the present study support the hypothesis that myocytes may be a local factor for the aortic calcification process: by increasing the conjonctive constituents calciphily, by producing phosphate and sulphate anions as well as calcifiable organic materials (glycoproteins, GAG), by modification in their own environmental physico-chemical conditions favorous to calcium precipitation (acidosis, phosphate and sulphate anions supersaturation).


Influence of dietary restriction on immunologic function and renal disease in (NZB x NZW) F1 mice. In (NZB x NZW)F(1) (B/W) mice, moderate caloric intake [10 kcal (41.8 kJ) per day] from the time of weaning was associated with maintenance of lower body weight, greater capacity of spleen cells to be stimulated with T-cell mitogens, and better preserved capacity to generate cytotoxic cells in response to in vitro and in vivo stimulation with allogeneic tumor cells. Plaque-forming cell response to sheep erythrocytes was also well maintained in animals on the restricted diets when sensitization was accomplished either in vitro or in vivo. Spontaneous suppressor cell activity against plaque-forming cells that developed in controls did not appear in the mice on the restricted diet. Significantly less circulating antibody to native DNA was present in the blood of mice 10 months of age when their dietary intake had been restricted. Histological analysis revealed that the development of renal disease and the deposition of gamma globulin in the glomerular capillaries was markedly inhibited in the mice on restricted diets. Dietary restriction from the time of weaning thus appears to prolong significantly the life of autoimmunity-prone (NZB x NZW)F(1) male and female mice and to alter lymphoid cell immune function, thereby decreasing the autoimmune processes and immunological assault associated with progressive renal disease in these animals.


Haemophilus influenzae bacteremia and meningitis resulting from survival of a single organism. Infant rats were infected intranasally with mixtures of streptomycin-sensitive and streptomycin-resistant strains of Haemophilus influenzae type b and cultures of nasopharyngeal washings, blood, and cerebrospinal fluid were obtained. If the infecting organisms cooperated with each other during the establishment of infection, nasopharyngeal, blood, and cerebrospinal fluid cultures should have contained mixtures of the variants. If each organism acted independently, then with small infecting inocula all the organisms in nasopharynx, blood, or cerebrospinal fluid should be descended from a single bacterium. Cultures should then contain only one of the variants. Single variant nasopharyngeal cultures were obtained from 8 out of 19 (42%) rats when the intranasal inoculum was <100 organisms. As the inoculum was increased, single variant cultures were less frequently observed. When the inoculum was >/=10(5) organisms, nasopharyngeal cultures were always mixtures. Single variant blood cultures were obtained in 46 of 67 (68.7%) episodes of bacteremia when rats were inoculated intranasally with 10(8) organisms. Single variants were isolated from the cerebrospinal fluid of 13 of 19 (68.4%) rats with meningitis whose blood contained both streptomycin-sensitive and streptomycin-resistant variants. When the blood contained a single variant, this same variant was cultured from the cerebrospinal fluid on 39 of 40 (97.5%) occasions. These studies demonstrated that invasive. H. influenzae b infections of infant rats resulted from independent action, as opposed to cooperative interaction of intransally inoculated organisms. The results also suggested that the meninges were invaded by the hematogenous route.


Experimental verification of an expected relation between time of incubation and magnitude of the fast and slow fractions of the sodium efflux from amphibian eggs. The Na+ efflux curves of single ovarian eggs are separable into two fractions. The magnitude of the slow fraction increases slowly with time of exposure of the eggs to labeled Na+, long after the fast fraction has reached equilibrium. The data agree with the theory that the fast fraction is rate-limited by surface permeation and that the slow fraction is rate-limited by desorption from intracellular adsorption sites.


[Gastric mucosa and anti-inflammatory agents. A comparative study by fibroscopy]. A comparison was made between the gastroduodenal lesions observed by fibroscopy in a group of 47 patients treated with anti-inflammatory drugs for rheumatic conditions and a group of 50 controls. All patients had clinical symptoms of the stomach or duodenum. A statistical study show that the two groups were similar as regards age, sex and clinical signs. Besides ulcers the gastroduodenal lesions were acute and/or chronic. Among acute gastritis forms distinction is made between superficial, muco-erosive and haemorrhagic gastritis. The study showed the very high frequency of lesions of acute gastritis in rheumatic patients, especially of the antral and muco-erosive types, whereas the incidence of gastroduodenal ulcers was no higher than in the controles. An important finding is that acute gastritis is not favoured by pre-existing chronic gastritis.


An automated method for determination of serum and urine alpha-amylase. An automated method for the determination of alpha-amylase activities of serum and urine using the Phadebas Amylase Test is described. The procedure has been adapted for the System Olli 3000 analyser using amylase tablets whose weight is half of that of normal tablets. The results are calculated by the computer with the aid of a standard curve calculated theoretically. This automated procedure is fast, as many as 120 analyses per hour can be carried out. Intra-assay precision of 2.0 and 2.2% (CV) is obtained from serum samples containing 301 and 181 u/l of alpha-amylase, respectively (n = 20), and inter-assay precision is 4.4 and 3.3% with mean values of 337 and 196 u/l, respectively (n = 20). When the automated procedure is compared with the manual procedure on 85 sera with alpha-amylase activities below 1000 u/l, a good correlation r = 0.992, and a regression equation y = 1.01x-6 are found. In the case of serum and urine samples, which contain high enzyme activities, the automated method gives slightly higher results than the manual method.


Cell-mediated immunity in juvenile periodontitis and levamisole treatment. Immunostimulation with levamisole was attempted in eight patients with juvenile periodontitis and six reference patients with gingivitis but without loss of periodontal attachment. The following parameters were studied before and after levamisole treatment: gingival status, the concentration of serum immunoglobulins and complement, T and B lymphocyte ratio, leukocyte migration inhibition and lymphocyte transformation responses by dental plaque bacteria, PPD or PHA, and lymphocyte ATP-ase activity. In juvenile periodontitis cell-mediated immunity to dental plaque antigens seemed to be impaired, but the response was not restored by treatment with levamisole. There was no evidence of a broader suppression of cell-mediated immunity in juvenile periodontitis and there was no significant clinical effect of levamisole treatment. It is suggested that the apparent suppression of in vitro cell-mediated immunity to dental plaque bacteria in juvenile periodontitis is a secondary change, caused by a long-standing chronic infection.


Role of suppressor T cells in autoimmune responses induced by polyclonal B cell activators. In order to investigate a possible role of suppressor T cells in the maintenance of self tolerance, we compared the autoimmune response induced by LPS in cultures of untreated spleen cells with the one of anti-theta treated spleen lymphocytes. It was constantly found that T cell depletion never resulted in an increase in the number of plaques directed against autologous albumin coupled SRBC. The same finding was also apparent when the autoimmune response given by spleen cells of old, normal or thymectomized and young untreated animals was compared. In order to exclude the possibility that lack of increase of the autoimmune response in animals with T cells deficiency was due to long-lived suppressor functions, cells or factors, we compared the response to autologous albumin, as induced by LPS, in spleen cells of nude mice with the one given by their normal littermates. Since even in this instance no significant increase could be detected, we conclude that suppressor cells do not play an active role in the maintenance of self tolerance.


Irreversible immunological tolerance to thymus-independent antigens is restricted to the clone of B cells having both Ig and PBA receptors for the tolerogen. Mice were tolerized to the alpha1-6 epitope of native dextran. When their spleen cells were removed and activated by LPS, they did not synthesize antibodies against the tolerogen. However, when cells from tolerant mice were treated with dextranase or left untreated in culture for 24 h they were activated by LPS to the synthesis of antibodies against the tolerogen. When 24 h tolerized lymphocytes were treated with dextranase and transferred with immunogenic doses of dextran to irradiated mice they failed to produce antibodies against the tolerogen. In contrast, cells incubated with dextran for 2 h and thereafter dextranase treated were readily immunized by dextran in the same system. It is concluded that only the B cell clones having both Ig receptors and PBA receptors for the tolerogen become irreversibly tolerized, whereas B cells having Ig receptors for a different PBA are not tolerized, but remain in a resting state, even though their Ig receptors have bound the tolerogen.


Effect of membrane stabilizing agents on induction of the immune response. II. Inhibitory effects on lymphocyte activation by B-cell mitogens parallel toxicity. The effect of three membrane stabilizing compounds, chlorpromazine, imipramine and lidocaine, on mouse spleen cells was investigated. Cellular activation by the B-cell mitogen lipopolysaccharide (LPS) was found to be inhibited. Suppressing doses also inhibited back ground DNA-synthesis and the number of background plaque forming cells. However, the degree of suppression caused by all three of the membrane stabilizing agents tested, parallelled the decline of viable cells in the cultures. It is concluded that the drug induced inhibition of LPS activation was due solely to the toxicity of the compounds.


Rat memory T lymphocytes: in vitro proliferation induced by antigens of Actinomyces viscosus. Peripheral T lymphocytes from RIC-Sprague-Dawley rats primed in vivo several months earlier with Actinomyces viscosus Ny 1 reacted with a strong proliferative response upon antigenic challenge in vitro. Two different antigen preparations from A. viscosus Ny 1, a broken cell supernatant (BCS) and an extracellular fraction (EXC) gave maximum responses as measured by the uptake of [3H]thymidine at a concentration of 10 microgram at day 4 of culture. Phytohaemagglutinin (PHA) used as a control provoked a maximum proliferation in the same order of magnitude. T lymphocytes from unprimed, germfree and conventional animals showed a similar stimulation to PHA, but only a marginal reaction to BCS, and were not at all activated by EXC. Evidence is thus presented for efficient removal of cells responding non-specifically to B-cell mitogens.


Macrophage activation by lymphokines and after direct contact with sensitized lymphocytes: histocompatibility requirements and the effect of inhibitors. A comparison was made between two procedures which give rise to in vitro activation of normal mouse peritoneal macrophages: (1) normal macrophages were incubated for 22 h with sensitized lymphocytes and antigen (assay A), and (2) normal macrophages were incubated for 70 h with supernatants from sensitized lymphocytes and antigen (assay B). The activation of macrophages was measured as an increase in 1-14 C glucose oxidation. Combinations of lymphocytes and macrophages is probably necessary in assay A.s from different mouse strains demonstrated that activation of macrophages in assay A, but not in assay B, required cells which were derived from strains of mice sharing identical H-2 antigens. Treatment of lymphocytes with mitomycin C blocked the activation of macrophages in both assays. Addition of alpha-L-fucose (0.1 M) during the incubation period blocked the activation of macrophages in assay B, but not in assay A. It is concluded that there is a qualitative difference between the two methods for activating macrophages and that direct contact between lymphocytes and macrophages is probably necessary in assay A.


The polyclonal B cell activator dextran-sulphate induces formation of colony stimulating activity. The effect of dextran-sulphate (DS), a polyclonal activator known to stimulate immature murine B-cells, was assayed in a culture system allowing the growth of myeloid cells. It was known that DS induced the production of a myeloid colony stimulating factor (CSF) by cells from both spleen and bone marrow. Nylonwool purified mouse spleen cells, enriched for T cells, showed a dimished CSF production in response to DS, while CSF production in response to Con A was increased. Furthermore, DS induced CSF in both spleen and bone marrow cells from nude mice. Removal of macrophages did not affect CSF production. The CSF induced was non-dialysable and no small molecular weight or lipoprotein inhibitors could be demonstrated. The results suggest that DS activates cells other than T cells or macrophages (possibly B cells or null cells) to produce a myeloid stem cell stimulating substance. These results indicate that interactions between lymphoid and myeloid cells can take place during differentiation.


Tracheobronchial clearance in patients with emphysema associated with alpha1-antitrypsin deficiency. Tracheobronchial clearance was studied in five patients who had emphysema associated with deficiency of serum alpha1-antitrypsin but no history of chronic bronchitis. After the patients had inhaled an aerosol of 6 micrometer teflon particles tagged with 99mTc, the radioactivity in the lungs was followed externally during 2 h. Clearance in the emphysematous patients was normal or even rapid as compared with clearance in healthy subjects, and was significantly more rapid than clearance in patients with a history of chronic bronchitis. The results indicate that emphysema can develop in patients with alpha1-antitrypsin deficiency without their having an impairment of mucociliary transport.


Acute myelogenous leukemia: a human cell line responsive to colony-stimulating activity. A permanent human cell line that maintains the granulocytic characteristics of acute myelogenous leukemia cells has been established. The cells of this line form myeloid colonies in soft gel culture in the presence of human colony-stimulating activity. The cell line may be useful for studying human acute myelogenous leukemia and the mechanism of response to colony-stimulating activity.


Leftsided thoracotomy for coronary artery reoperation. 3 cases of coronary reoperations are described in which a leftsided thoracotomy offered considerable advantages. This approach is recommended for certain types of reoperations on the left coronary system.


Bietti's tapetoretinal degeneration with marginal corneal dystrophy crystalline retinopathy. In 1937 Bietti reported a tapetoretinal degeneration with associated corneal deposits at the limbus. The hallmark of the disease was the crystalline characteristics of the retinal spots as well as those at the corneal limbus. Bagolini and Ioli-Spade in 1968 presented a 30 year follow-up on Bietti's cases and presented six additional cases. The present report delas with this entity in Orientals, a Chinese woman and a Japanese man. Corneal and conjunctival biopsy from the female patient revelaed a lipid deposition in both fibroblasts and epithelium. The term "crystalline retinopathy" has been added to the description of this entity since it defines the most characteristic feature of the syndrome.


Pseudoinflammatory macular dystrophy.

Pseudoinflammatory macular dystrophy. A family with pseudoinflammatory macular dystrophy (PMD) is presented. This dominantly inherited macular dystrophy has its onset in the 3rd to 5th decades with the earliest manifestation being a macular subretinal neovascular network. Visual function tests (ERG, EOG, visual fields, retinal sensitivity) in the early and late stages indicates this is local or geographic disease. This dystrophy should be differentiated from other hereditary causes for subretinal neovascularization (angioid streaks, vitelliform dystrophy, dominant drusen of Bruch's membrane, optic nerve drusen and myopia). It is suggested that treatment be directed at early obliteration of the subretinal neovascularization with intense photocoagulation since the outcome in virtually all cases of untreated PMD is legal blindness.


[Endovascular method of stopping gastric hemorrhages using temporary occlusion of the major vessels]. The author's method consists in temporary occlusion of the hepatic and splenic arteries; and contrast-medium or hemostatic sponge, introduced into the celiac trunk proximally to the site of the occlusion, propagate into the stomach artery. The method proved to be satisfactory in 8 patients.


[Treatment of congenital incompetence of the anal constrictor]. According to the authors' data the subdevelopment of the anal constrictor followed by sphincter incompetence of the I degree can be treated conservatively by means of electrical stimulation of the perineal muscles together with exercise therapy. Surgical correction-sphincterolevatoroplasty and sphincterogluteoplasty- is required in case of the incompetence of the II and III degree. In congenital abscence of the anal constrictor muscles the obturative function of the rectum can be reconstructed through the replacement of the sphincter by the musculus gluteus maximus graft.


Myocardial revascularization in patients 70 years of age and older. Myocardial revascularization has been carried out by us in 67 patients 70 years of age or older. Advanced coronary artery disease was found at angiography in more than two thirds of the patients. The postoperative morbidity and mortality compare very favorably with those in younger patients. The early and late mortality in the 67 patients was 4.5 percent and 6.0 percent, respectively. Fifty-seven survivors have been followed an average of 21 months; for most patients there has been a pronounced improvement in clinical classification. Properly selected, patients of advanced age can undergo successful revascularization surgical procedures. The adequacy of function of the left ventricle, proper timing of the surgical operation and an aggressive yet realistic approach seem to be major determinants for a good result.


[X-ray diagnosis of hydrocephalus in infants and young children]. The article shows the results of X-ray examination of 49 children (including 41 neonates) in 43 of whom 54 various radiocontrast studies were conducted for exact preoperative identification of the form of hydrocephalus (whether closed or open). Modified pneumoencephalography without removal of fluid is suggested for infants, which yields an important diagnostic information necessary for choosing the methods of surgical treatment of hydrocephalus in children of early age and neonates.


[Postoperative haemorrhage in gastric ulceration and gallstone surgery (author's transl)]. 5463 operations for gallstone disease were followed eleven times (0,2%) by haemorrhage. 16 intragastric (1,2%) and 11 haemorrhages into the peritoneal cavity (0,8%) could be observed after a total of 1370 operations for gastric or duodenal ulcer. For the most part haemorrhage into the peritoneal cavity frequently occurred within the first 24 hours, whereas the intragastric bleeding appeared later. Both manifestations showed the signs of haemorrhagic shock. While haemorrhage into the peritoneal cavity had to be treated mostly by secondary laparotomy after adequate shock therapy, intragastric haemorrhage could be cured most without surgical treatment.


[Appearance on effort of an image of a sub-epicardial lesion in the absence of signs of myocardial necrosis. Clinical, electrocardiographic and coronographic studies of 10 cases]. A clinical, electrocardiographic and coronarographic study of ten cases shows that surelevation of ST-segment during exercise (without any signs of infarction) correspond to very different clinical situations of anatomical state of coronary vessels, occurrence of coronary spasm and evolution of the ischemic disease. "Inversed coronary Insufficiency" is proposed to design this syndrome. Practical recommandations are formulated.


Pathology of chronic rheumatic heart disease with particular reference to tricuspid value involvement. This study is based on a retrospective analysis of 144 autopsied cases of rheumatic heart disease. Majority of cases (79%) were chronic and 21% were acute in nature. The mortality was high and was maximum below the age of 30 years. The males predominated over females. A high incidence of organic tricuspid valve involvement was observed (45.8%). Tricuspid stenosis was observed in 3 cases. Latter was associated with aortic and mitral valve involvement. Mitral stenosis was severe in all the three cases. Criteria, both gross and microscopic for the involvement of the tricuspid valve have been described. Involvement of mitral valve either singly or in combination with the other valves, emerged to be the commonest. Changes observed in the lungs in these cases have been dealth with briefly. Pulmonary vascular changes were usually severe, particularly in the juvenile age group.


[Morphologic study of the arterial vasa vasorum of the pulmonary veins in dogs]. The authors studied 54 hearts of dog, to try and find a pattern of the origin, traject and distribution of the vasa vasorum of the great vessels in the heart of the dog. They used the injection-corrosion-fluorescence method imagined by one of them, verifying the good penetrability of the substance they injected and a fine visualization under Wood light. They observed that the arterial vasa vasorum of the pulmonary veins come from the atrial branches of the circumflex artery, from an atrial antero-right branch of the artery of sinusatrial node, branches from the right-coronary artery and from the bronchial arteries. The systematize the arterial blood supply of the different sides of the pulmonary veins, though it is not a rigid classification as the atrial arterial branches, supplying the vasa vasorum, show a great variability of size and there are several anastomosis between them.


Diagnosis of myocardial infarction by the orthogonal vectorcardiogram. From the literature concerning the electrocardiological diagnosis of myocardial infarction, data are reviewed illustrating the role of the scalar orthogonal approach by the Frank system. Special attention is drawn to the Q/R ratio as a parameter. Criteria for the most frequent differential diagnoses are summarized in a practical way. The importance of the concepts sensitivity and specificity is stressed, while statistical methods for establishing the value of parameters are discussed. Results of multivariate analysis are indicated.


[Study of the connections of the thalamus in Rana temporaria frogs by the peroxidase method]. In frogs, on the base of the axonal transport of horseradish peroxidase, the connections ascending to the primordial hippocamp were shown from the ipsi- and contralateral pyriform pallium, contralateral primordial hippocamp, ispilateral amygdala and nucleus accumbens, as well as from rostral parts of the postero-central thalamic nucleus (bilaterally). The ascending connections from the dorsal column nuclei were followed with reliability till the rostral parts of the contralateral mesencephalic tegmentum, but very likely they reach also the dorsal thalamus.


Correlation between percutaneous transhepatic portography and clinical findings in 56 patients with portal hypertension. 56 consecutive patients with portal hypertension were studied with percutaneous transhepatic portography and the results were correlated to clinical findings and the number of upper gastrointestinal haemorrhages and the size of the individual bleeding. An abundance of collateral paths was noted in most patients. No regularity in development of these collaterals was found. It was not correlated to liver disease etiology, sex or liver function parameters. Portal pressure was not correlated to the size or amount of collaterals. In four patients with liver cirrhosis hepato-fugal flow in one segment of the liver was noted proving that portal flow through the liver is not uniform in this disease. The size of the haemorrhages was only correlated to presence of hepato-fugal flow in the main stem of the portal vein. It was not correlated to the estimated size of the oesophageal varices or to portal pressure. Percutaneous transhepatic portography seems to be of little help in selecting "high risk bleeders" in portal hypertension. Other factors may be of greater help in this task as indicated by the findings in this investigation that patients with alcohol cirrhosis had larger haemorrhages than those with cirrhosis of another etiology and that patients with none or few bleeding episodes had higher thrombocyte count than those with several haemorrhages.


[Catecholamines of the blood vessels of Rana temporaria frogs]. In histochemical (with the glyoxylic acid) and biochemical (spectrofluorimetric trioxyindolic method) investigations sources and content of catecholamines (dopa, noradrenalin, adrenalin) in the blood vessels, sympathetic chains, adrenals and cardiac ventricles have been studied in autumn-winter and spring-summer frogs at various temperatures. It was found that the catecholamines in the studied tissues are located in the sympathetic neurons, adrenergic terminals and chromaffin cells. The ratio of these structures in different tissues was various. It was found that the catecholamine level in frog blood vessels and various organs undergoes seasonal and temperature variations. The increase of temperature from + 5 to 20 degrees caused a decrease in the catecholamine level in the autumn-winter frogs, but increased the catecholamine concentrations over 60--100% in the spring-summer ones.


Combined Conray-Myodil ventriculography. Combined Conray-Myodil ventriculography is described. An emulsified mixture of the two drugs is prepared immediately before injection into the lateral ventricle. The method gives excellent visualization of the entire ventricular system. There were no complications in 208 neurosurgical cases.


Acute postoperative graft phlebitis: a rare cause of saphenous vein-coronary artery bypass failure. Most graft occlusions occurring early after saphenous vein coronary artery bypass procedures result from technical problems at the graft to coronary artery anastomosis site. This report describes an unusual cause of graft occlusion in a 67-year-old man who died three weeks after operation--a postoperative acute phlebitis of an implanted saphenous vein graft. Infection in the graft wall resulted in isolated graft thrombosis in the setting of a patent anastomosis. Graft phlebitis in this patient was associated with a purulent pericarditis and mediastinitis which failed to respond to surgical débridement and antibiotic therapy. Although mediastinitis is not infrequent, infection of an implanted saphenous vein coronary artery bypass graft in association with mediastinitis has never been reported. The findings in our case show that such graft infection may occur, and may result in graft thrombosis and occlusion.


Unusual complications of coronary bypass surgery. Five patients after coronary bypass surgery developed unusual complications. Three developed new apical thrombi which are thought to be due to the trauma of the left ventricular vent or deterioration of the left ventricular contraction. Significant new mitral regurgitation in one patient probably is secondary to papillary muscle dysfunction as the result of stenosis distal to anastomoses. The leakage of angoigraphic material around distal anastomatic site is due to technical error. Although these unusual complications are very rare, however, they should be considered as potential source of morbidity in asymptomatic patients who leave the hospital after bypass surgery.


Pi-Z phenotypes in a pulmonary clinic. Their prevalence and physiologic state. A  series of 1,458 consecutive patients referred to the Cleveland Veterans Administration Pulmonary Clinic for pulmonary function studies was evaluated for alpha 1-antitrypsin deficiency by determination of serum trypsin inhibitory capacity (STIC). Protease inhibitor (Pi) phenotyping was performed on all sera with STIC values less than 1.6 mg/ml. The following non-MM phenotypes were found: 1FZ, 32MZ, 2ZZ, 3SZ, 5SS, 33MS, 21M. The prevalence of Pi Z heterozygosity is 2.74%. This figure is not significantly greater than that observed in a healthy population. A group ( n = 12) with heterozygous Z phenotype (MZ + SZ) was compared with a control (MM) group (n = 13) matched for age, race and smoking history from this same population. Our findings indicate similar deviations from predicted normal values in both control (MM) and Z-heterozygotic groups for physiologic tests of airway resistance, lung volumes, diffusing capacity, and static and dynamic compliance. There was no significant difference between MM controls and MZ heterozygotes in the physiologic variables measured.


Peripheral corneal degeneration and occlusive vasculitis in Wegener's granulomatosis. A 61-year-old white woman, who had progressive arthritis over a two-year period, developed bilateral peripheral corneal degeneration. The superior cornea thinned to a thickness of approximately two thirds of normal. She died suddenly in the hospital and a primary occlusive vasculitis of the anterior ciliary arteries within the superior rectus muscles was found. There was necrotizing arteritis in the lungs, kidneys, adrenal caps, spleen, fallopian tubes, and skeletal muscle. The observation of an occlusive vasculitis of the anterior ciliary arteries in this patient supports the belief that ischemia may play a major role in peripheral marginal degeneration of the cornea.


Endothelial degeneration and posterior collagenous proliferation in aphakic bullous keratopathy. In series of 39 corneal grafts, aphakic bullous keratopathy comprised 13 (33%) of the cases. By scanning and transmission electron microscopy, endothelial degeneration and posterior collagenous proliferation were consistent features. In all 13 cases, the patchy loss of endothelial cells occurred diffusely over the entire posterior corneal surface. The remaining endothelial cells had become extremely attenuated to increase their surface area. In nine cases, acellular proliferations of collagenous tissue were interposed between the endothelial cells and Descemet's membrane. These posterior collagenous layers were composed of collagen fibrils and basement membrane material, randomly arrayed in a feltwork of uniform thickness; they appeared ultrastructurally identical to those encountered in a variety of conditions involving endothelial distress.


Cefamandole levels in primary aqueous humor in man. We administered cefamandole nafate to 69 patients before cataract extraction and assayed serum and aqueous humor for antibiotic content at the time of surgery. Average aqueous humor levels of 0.33, 0.59, 0.21, and 0.14 microgram/ml were achieved at one half, one, two and four hours, respectively, after a 1-g intravenous dose. After a 2-g intravenous dose, we found average aqueous humor levels of 1.26, 1.0, 1.57, 0.73, and 0.34 microgram/ml at one half, one, two, four and six hours, respectively. Therapeutic levels in primary aqueous humor effective against common grampositive pathogens were consistently achieved with the 2-g dose, but levels effective against Enterobactereaceae were attained only erratically.


Treatment of Reis-Bücklers' corneal dystrophy by removal of subepithelial fibrous tissue. We treated five eyes of three patients with Reis-Bücklers' corneal dystrophy by blunt dissection of the subepithelial fibrous tissue layer. The postoperative follow-up ranged from four months to three years. Four of the five eyes had improved vision, and all four symptomatic eyes had cessation of the recurrent erosions. This simple effective technique eliminated the need for corneal transplantation.


Orbital apex syndrome secondary to herpes zoster ophthalmicus. Two women, one with Hodgkin's disease and the other with no malignancy, developed herpes zoster with optic neuropathy and total ophthalmoplegia. Both patients developed an associated mild meningoencephalitis with a predominantly lymphocytic spinal fluid reaction that cleared spontaneously. The patient with Hodgkin's disease suffered a protracted course of the disease and developed a secondary bacterial endophthalmitis that necessitated an envisceration of the left eye. The patient without evidence of immunologic deficit recovered quickly with administration of corticosteroids.


Familial foveal retinoschisis associated with a rod-cone dystrophy. A brother and sister born of a consanguinous marriage had bilateral foveal retinoschisis and a generalized rod-cone dysfunction. This was associated with nyctalopia, hyperopia, minimal vitreous opacities in the sister, a paramacular tapetal sheen reflex, normal retinal vessels, an abnormal electroretinogram, and a normal electro-oculogram in the less affected brother. Foveal retinoschisis is not pathognomonic for x-chromosome-linked juvenile retinoschisis. It may be seen as a manifestation of a macular dystrophy or associated with a generalized tapetoretinal dystrophy.


Specular microscopy of the corneal endothelium and lens implant surgery. Specular microscopy helps to estimate the viability of the corneal endothelium long before clinical signs of decompensation occur. Therefore, specular microscopy is useful for the selection of eyes for lens implantation in general; for the prognosis of the eye with a lens implant; and for the evaluation of the method of cataract surgery, of lens implantation techniques, and possibly of lens design, material, and manufacturing. A long-term study of intracapsular and extracapsular pseudophakic eyes revealed that the intracapsular pseudophakic eyes had significantly less endothelial cells, which could partly be explained by toxicity of the Supramid used as loop material, but mostly by assuming continuing endothelial disintegration in the intracapsular eyes. In 41 patients our extracapsular technique caused an average cell loss of only 6.7%.


Clinical differentiation of recessive congenital hereditary endothelial dystrophy and dominant hereditary endothelial dystrophy. Our review of previously published reports and familial cases revealed that corneal clouding in autosomal recessive congenital hereditary endothelial dystrophy was present at birth or within the neonatal period. Further, corneal changes with time were minimal, nystagmus was often present, and there were no other signs or symptoms. Patients with autosomal dominant endothelial dystrophy usually had clear corneas early in life; corneal opacification was slowly progressive, nystagmus was infrequent, and photophobia, as well as epiphora, may have been the first indications of the dystrophy. As there is usually little or no congenital evidence of the dominant type, "infantile" or "autosomal dominant" hereditary endothelial dystrophy would be more appropriate names for the dominant variant.


Metastatic Peptostreptococcus intermedius endophthalmitis after a dental procedure. A 46-year-old man developed symptoms of a chronic progressive uveitis in his right eye approximately one week after a dental procedure. The patient's intraocular inflammation was not diminished by massive treatment with topical and systemic corticosteroid therapy or intravenously administered adrenocorticotropic hormone. The inflammatory process progressed to an overt endophthalmitis during a period of three weeks and the eye eventually required evisceration. A pure culture of Peptostreptococcus intermedius was isolated from the eye. The most likely source of this organism was hematologic transport following a dental procedure.


Effect of long-term subconjunctival administration of Diamox (acetazolamide) on the ocular tension in rabbit. In eight normal rabbits, sodium acetazolamide (5.5 mg per kg of body weight) in 11% solution was injected subconjunctivally daily for about four weeks in the left eye of each rabbit, with the right eye serving as a control. Ocular tension in both eyes was measured by the Perkins hand-held applanation tonometer. Five of the eight rabbits showed a significant difference (P less than 0.05) in ocular tension between treated and untreated eyes, with a decrease in the treated left eye. The ocular tension decrease in the treated left eye began about one week after the beginning of the injections and lasted for about two weeks. Thereafter, ocular tension in the treated left eye returned to base-line levels, despite continued subconjuctival injection of sodium acetazolamide.


Anterior segment fluorescein cineangiography. We have developed a technique for performing anterior segment fluorescein cineangiography. Illumination is obtained with a halogen lamp of a standard slide projector that is fitted with a blue excitation filer. Cinematography occurs with a movie camera fitted with an absorption-type barrier filter and mounted to a photo slit lamp through a cineadapter. The technique has been successfully employed with animals, and it is anticipated that the light levels used are tolerable and safe for application with humans.


[Scanniing electron-microscopic study of vascular distribution in the choriocapillaris and lamina vasculosa of the rat eye]. The choriocapillaris and lamina vasculosa of the rat eye were injected with methylmethacrylate and their vascular replicas were studied in the scanning electron microscope. There was not outstanding lobular distribution of vessels in the rat choriocapillaris. Their capillaries form a continuous anastomosed network that covers 85-95% of the surface of pigment epithelium. The terminal arteries ramify into many precapillary vessels that present a lacelike network. Advantages and disadvantages of vascular plastic replicas are discussed.


Diagnostic ultrasound in cases of acute iritis. The A-scan ultrasound technique was used to examine the vitreous bodies of both the sick and the healthy eye in 47 patients with acute iritis. The acoustic findings were then compared to observations made with the slit lamp. Of the 47 iritis eyes, only 19 were amenable to a least some degree of optical examination. The most common factors preventing optical examination were opacity of the aqueous humor and posterior synechia. Comparison of optical and acoustic findings were difficult, since optical examination was possible in only 19 eyes. It would seem, however, that there is a farily close correlation between acoustic and optical findings. Ultrasound often offers the only possibility of ascertaining the presence and degree of exudation in cases of acute iritis, and such information may be important in planning treatment and following the course of the disease.


Rapid detection of changes in the optic disc: stereochronoscopy. II. Evaluation technique, influence of some physiologic factors, and follow-up of a case of choked disc. A simple device for viewing stereochronoscopic (Sc) picture pairs under any azimuth is described. The influence of pulse, irradiation, time, and ocular pressure on disc configuration of some healthy and affected subjects is investigated. To test the sensitivity of Sc as compared to that of conventional steroscopy (St), a case of choked disc in which pictures of both kinds had been taken was followed up. This material also served to test 10 observers as to their ability to detect St and Sc effects in fundus pictures. Despite good stereo vision in all observers as tested by the Titmus charts, considerable differences were found in the analysis of fundus pictures. Detailed instruction resulted in improved results. Two cases of glaucoma simplex incipiens are presented in which a change of disc configuration could be detected by SC while ocular pressure and visual field remained normal in one case and did not change in the other.


[Influence of adaption level upon oscillatory potential in the electroretinogram (author's transl)]. Oscillatory potentials (OP's) were recorded using constant energy stimulating from 2.5 J at different levels of adaptation from 400 to 30 fl, as well as pre-dark adaptation. O1, O2, and O3 regularly appear in the ascending branch of the b-wave complex, and after pre-dark adaptation the less differentiated O4 and O5 appear as well, exhibiting variable potental heights and durations as the dark time progresses. With intensive pre-light adaptation there is a relative reduction of potential, as is also true following weak prelight adaptation or dark adaptation; the culmination time in the former case being more rapid, and in the latter case slower. Good discrimination of the OP with a concurrent diminution in the amplitudes was only observed after a pre-dark adaptation.


Off-components in response to brief light flashes in the oscillatory potential of the human electroretinogram. Amplitudes and implicit times of the several oscillatory potentials (OP's) in the human electroretinogram have been studied in relation to temporal, adaptive and spectral stimulus variables. The last of the OP-wavelets responds differently from the preceding ones; its implicit time shortens with increase in stimulus frequency or adaptive illumination, whereas that of the preceding OP's is prolonged or stays constant. Moreover, the last OP-wavelet is time locked with the stimulus offset, whereas the others are not. This can be confirmed by linear subtraction of responses to an isolated stimulus onset from responses to stimuli of variable durations. These results indicate, that the last oscillatory potential is related to the light offset and is presumably generated by the retinal off-elements described in single cell recordings.


[Spectral sensitivity of off-response in human VECP during selective chromatic adaptation (author's transl)]. The spectral sensitivity of the visual system of man during selective chromatic adaptation was determined. The criterion was an off-response of constant amplitude in the evoked cortical potential. Criterion of height of response differed among the subjects investigated. Generally, a pupillary radiant intensity between 0.4 and 1.0 lg unit above the sensory threshold was used. With stimulation of both the green- and the red-sensitive mechanism, the sensitivity of the off-response was low. It was high if either the green or the red mechanism were suppressed by selective chromatic adaptation. Demonstration of an opponent color mechanism in the visual system was easier with recording of the off-response in the VECP than with determination of the sensory threshold. The presence of the blue-sensitive mechanism as revealed by the VECP off-response was shown for light stimuli near the sensory threshold during adaptation which orange and red light for a late response of low amplitude.


[Spatial arrangement and inner wall surface of ocular vessels. Scanning electronmicroscopy of vascular casts (author's transl)]. Vascular corrosion casts of the rabbit eye vessels were studied by scanning electron microscopy. Compared with light micrescopy, this method provides great depth of field and better contrast. Thus the pictures are more informative and documentation is easier. The high resolving power of scanning electron microscopy of suitable vascular casts allows the study of structures of the inner vessel wall. Such information could not be retrieved from these replicas until now.


[Niemann-Pick disease type B: An enzymatically confirmed case with unexpected retinal involvement (author's transl)]. In a 6-year-old girl with normal to outstanding intelligence Niemann-Pick disease was diagnosed by the demonstration of an about 90% deficient sphingomyelinase activity. Abnormalities of the eye fundi are described which are comparable to but quantitatively deviate from the classic cherry-red spot as known from neurolipidoses. The brownish-red foveola was surrounded by a relatively thin opaque ring around which punctate white deposits (lipids?) could be detected. The absence of any other neurologic symptom was in contrast iwth an extreme hepatosplenomegaly, foam cells in the bone marrow, lung infiltration, underweight, and undergrowth. Therefore, the case was classed with the type B of Niemann-Pick disease, although the common definition of this type excludes cerebral as well as oculoneural involvement. In the literature only one comparable case could be found which, however, had not been enzymatically confirmed. In the future the definition of type B of Niemann-Pick disease should include the possibility of oculoneural involvement.


The registration of slow ERG potentials of the perfused extracorporeal bull's eye. Enucleated bull's eyes were perfused with blood and ERG recorded, with special attention paid to the slow components. When the blood flow was interrupted, the ERG components vanished in the following order: b wave, c wave, off-effect (d wave), and a wave. When the perfusion was continued afterward, we saw a variation in the standing potential that hinted at the biochemical activities causing slow electrical potentials of the retina.