Lymphocytic leukemia in children: prognostic significance of clinical and laboratory findings at time of diagnosis. Forty-eight children with untreated acute lymphocytic leukemia were evaluated with regard to their clinical presentation and the surface membrane characteristics, mitogen responsiveness, and cytochemical staining features of their lymphoblasts. The presence at diagnosis of 20% or more bone marrow lymphoblasts possessing T-cell surface markers was associated with the development of early relapse and death. Age, sex, initial peripheral leukocyte count (WBC), lymph node enlargement or the presence of hepato- or splenomegaly bore no statistically significant relationship to the patient's lymphoblast type, and only a WBC in excess of 10(5)/microliter correlated with a poor prognosis. Leukemic T-cells were found to be periodic acid-Schiff negative from nearly all patients, helping to distinguish such patients from the larger group of children whose leukemic cells were PAS positive, but negative for T-cell membrane features. In those patients who had multiple relapses, the surface membrane characteristics, staining features, and mitogen responses of their lymphoblasts remained constant. This suggests that relapse occurs in the same clone of malignant cells present at diagnosis and that the above features may be reliably used to evaluate and classify patients beyond the time of diagnosis.


Extrahepatic portal hypertension: a review of 70 cases. Among 70 children with extrahepatic portal hypertension, more than 350 episodes of bleeding occurred. Of the 32 children who were not operated upon, six (19%) died of bleeding. Twelve children in the nonoperated group are thriving and well, although six of them have rebled 1-2 times. The operated group of 38 children had a total of 43 procedures. Central splenorenal and cavomesenteric anastomosis prevented further bleeding in 10 of 12 cases in which follow-up is available. Operative mortality was 24%, the majority of which were in emergency procedures.


Colonoscopy for rectal bleeding in childhood. Undiagnosed rectal bleeding can pose a significant problem in the pediatric patient. A systematic and logical approach to the work-up of the child with rectal bleeding is necessary for prompt and accurate diagnosis. It is our impression that the addition of colonscopy in carefully selected patients will decrease the number of children with undiagnosed significant rectal bleeding.


Differential chemotherapeutic susceptibility of human T-lymphocytes and B-lymphocytes in culture. After previous work from this laboratory revealed that asparaginase was 800-2,000 times more inhibitory against human T-lymphocytes in culture than against B-lymphocytes, a similar further study of 13 chemotherapeutic and immunosuppressive agents was done. Cytosine arabinoside and 5-fluorouracil also had differential inhibitory activities on human T- and B-cells in culture. On the basis of the dose producing 50% inhibition of viable cell growth on day 5, cytosine arabinoside had 45-80 times more inhibitory activity against T-cells than against B-cells. In contrast to asparaginase and cytosine arabinoside, 5-fluorouracil had 10-20 times more inhibitory activity against B-cells. The rest of the chemotherapeutic and immunosupressive agents tested had minor or no differential activity. These findings indicated that T-cell response to asparaginase and cytosine arabinoside and B-cell response to 5-fluorouracil may be exploitable for the differential immunosuppressive effects presumed to be active in vivo. In addition, such differential responses may predict differential tumor cell behavior against these chemotherapeutic agents by T- and B-cell neoplasms in vivo.


Chronic fatal pneumocystosis in nude mice. A chronic pulmonary disease was encountered in nude mice of a barrier sustained colony, and Pneumocystis carinii was identified as the causative agent histopathologically as well as on impression smear preparations in the affected lungs. Fatal infection was seen only in old nude mice aged more than 6 months, while focal pulmonary lesions were developed without clinical signs in young adult nudes 2 to 3 months of age. The lesions produced in aged nude mice were characterized by propagation of mononuclear cells with the presence of foamy masses of P. carinii. Heterozygous littermates were much less susceptible to the infection but pneumocystic lesions could be produced readily by multiple treatment with immunosuppressants. The infection could be transmitted without immunosuppressant to non-infected nudes but not to heterozygous littermates after intranasal inoculation of affected tissue emulsion or by cage mating with severely affected nudes.


Active rosette forming cells as a possible functional subpopulation of human peripheral T lymphocytes. Spontaneous E rosette forming cells (RFC) and active E rosette forming cells (ARFC) were separated individually by the rosette sedimentation technique. The responses of these cells to phytohemagglutinin (PHA) and concanavalin A (Con A) were studied. RFC exceeded ARFC in their responses to PHA at all concentrations of PHA and the maximum PHA response of RFC was significantly higher than that of ARFC. On the other hand, Con A appeared to stimulate RFC and ARFC equally at the level of an optimal dose. Therefore, the binding affinity for sheep red blood cells (SRBC) by T lymphocytes and their responsiveness to PHA stimulation may be inversely related. It is also suggested that the PHA-sensitive population may be different from the Con A-sensitive one, or that there may be heterogenous populations among human T lymphocytes in their mitogenic responses. Thus, it is possible that ARFC may be a functional subpopulation of human T cells. An additional finding is that spontaneous DNA synthesis of rosetting cells was significantly lower than that of non-rosetting cells.


Relaxant effect of aspirin-like drugs on isolated guinea pig tracheal chain. The interrelation of the inhibitory effect of aspirin-like drugs on the resting tonus of tracheal chain in guinea pigs, arachidonic acid-induced contraction in rat stomach fundus strips and bradykinin-induced bronchoconstriction in guinea pigs in vivo was investigated. All the drugs tested produced a dose-related inhibitory action on the resting tonus of the tracheal chain in comparatively low doses. Diclofenac was the most potent of all the drugs and was equal in activity to isoproterenol, followed in descending order by flufenamic acid, mefenamic acid, indomethacin, ibuprofen, phenylbutazone, oxyphenbutazone and aspirin. These aspirin-like drugs also inhibited arachidonic acid-induced contraction in rat stomach fundus strips. A highly significant correlation was observed between the potency of inhibition of the arachidonic acid-induced contraction and the relaxant effect on the tracheal chain. Moreover, the drugs antagonized bradykinin-induced bronchoconstriction in guinea pigs in vivo and the order of potency roughly paralleled that of the tracheal chain. These results suggest that the aspirin-like drugs produce a reduction in resting tonus of the isolated guinea pig tracheal chain by inhibition of intramural biosynthesis of prostaglandin endoperoxides.


[Interstitial pneumonias in children with malignant diseases complicating intensive cytostatic therapy. Radiological appearance and histopathological findings (author's transl)]. The article reports radiological appearance and histopathological findings of interstitial pneumonias in 58 children with systemic malignancies under cytostatic treatment. The majority of cases suffered from acute lymphocytic leukemia, and at the time of pneumonia were in partial or complete remission. Eighteen children died of this radiological type of pneumonia. The autopsies of these cases revealed the presence of pneumocystis as the causative agent in 50% of the cases, also observed by other authors. It is concluded that the radiological appearance, as reported here is mostly due to pneumocystic pneumonias. It is therefore suggested that Pentamidine treatment should be given at an early stage. The cytostatic treatment should be discontinued till the pneumonia is completely cured.


Antibiotic decontamination of the dog and its consequences. An isolation-decontamination regimen was developed which effectively reduced the numbers of resident flora of the dog. Bacterial counts in four dogs before treatment were 3.8 X 10(9) per gram of feces; no organisms were detectable in these same dogs after treatment, however, the intestinal flora had returned to slightly above normal levels 1 week after treatment. Decontamination was accomplished in a laminar air flow system designed to minimize the area that had to be under controlled conditions. By determining the antibiotic sensitivities of 67 isolated organisms representing eight species or groups of bacteria recovered from the four dogs, a standardized antibiotic regimen was developed consisting of bacitracin and neomycin administered as a dry powder in the food. The decontamination treatment apparently did not affect host metabolism because no alterations in serum levels of urea nitrogen, glucose, phosphate, total protein, chloride, sodium, potassium, serum glutamic oxalacetic transaminase, or serum glutamic pyruvic transaminase were found in the antibiotic-treated dogs. The decontamination process did, however, reduce normal granulopoietic stimulation.


Evaluation of myocardial damage during coronary artery grafting with serial determinations of serum CPK MB isoenzyme. Serial determinations of creatine phosphokinase isoenzymes (CPK) were made during the operative period and the first postoperative week in 60 patients undergoing coronary artery bypass surgery. Electrocardiograms (ECG) and serum levels of glutamic oxaloacetic transaminase (SGOT) and lactic dehydrogenase (LDH) were also evaluated. All patients had increased CPK MB activity which first became detectable during the operative period. The CPK MB curves usually showed a peak during the first postoperative hours and then a rapid decay. Some curves, however, showed a different profile with a prolonged liberation of CPK MB. This type of curve was more frequent in patients with electrical signs of necrosis or ischemic injury. In this group, the total amount of CPK MB released was greater than that in patients with unchanged ECG tracings (p less than 0.05). A mean curve of CPK MB activity was calculated for the patients without electric and/or enzymatic signs of myocardial injury. Serum CPK MB determination is a useful technique for identifying perioperative myocardial infarction (MI) and the time sequence of its occurrence. The appearance of this isoenzyme in every patient undergoing coronary surgery is an interesting finding, and it significance needs to be clarified.


Delayed semielective coronary bypass surgery for unstable angina pectoris: clinical follow-up and results of postoperative treadmill exercise. Eighty patients with continued or repeated episodes of chest pain at rest and transitory ischemic electrocardiographic (ECG) changes were classified as having unstable angina pectoris. Following 10 days of intensive medical therapy, including beta blockade, all unerwent coronary arteriography. Medical treatment completely relieved the chest pain in 43 patients (Group I, 54 percent). In 37 patients (Group II, 46 percent) angina recurred within a week of admission (12 patients) or later (25 patients). Seventeen patients were not operated upon (nine were inoperable, four refused operation, and in four operation was not recommended). Sixty-three underwent saphenous vein bypass grafting either following a month of medical therapy (Group I) or within 24 to 48 hours of recurrent angina (Group II). The over-all operative mortality rate was 1.6 percent (1 patient) and the incidence of peroperative infarction was 11 percent. Of the 62 operative survivors, 71 percent were asymptomatic (mean follow-up period 22 months). The incidence of late operative myocardial infarction was 5 percent. Of 44 operative survivors tested by treadmill ECG, 66 percent had a negative response. Thirteen patients underwent postoperative angiographic evaluation (mean, 19.5 months). The over-all patency rate was 84 percent, and in 92 percent of patients at least one graft was patent. Thus, after stabilization by medical treatment, bypass operation could be performed with a low operative mortality rate and the long-term results compare favorably with those achieved with chronic stable angina.


Survival predictors in coronary artery disease. Medical and surgical comparisons. Linear discriminant function analysis was used to test the independent prognostic value of nine variables in patients with coronary artery diseaase. For 68 medically treated patients who met the criteria for inclusion in the discriminant function analysis, the most reliable predictor of 2-year survival status was the left ventricular ejection fraction. The prognostic value of the ejection fraction was not improved by the addition of the number of vessels diseased. Comparisons of the survival of 130 medical and 284 surgical patients were made using subsets based on the ejection fraction. When the ejection fraction was greater than or equal to 50%, the probability of 4-year survival was high for both medical (91%) and surgical (96%) groups. When the ejection fraction was less than 25%, the probability of 2-year survival was low in both groups. However, for patients with ejection fraction 25 through 49%, the surgical patients had a better chance (P less than 0.05) for a 3-year survival (89%) than did medical patients (68%). This study emphasizes the prognostic significance of the left ventricular ejection fraction, which should be considered in any comparison of survival in medically and surgically treated patients.


Partial characterization of amyloid proteins in inherited amyloidosis with lattice corneal dystrophy and in secondary amyloidosis. Amyloid fibrils isolated from two patients, one with inherited systemic amyloidosis and lattice corneal dystrophy, and the other with secondary amyloidosis due to chronic glomerulonephritis, were studied using immunologic, electrophoretic and chromatographic techniques. Amino acid hydrolysates of both amyloid types showed a high proportion of acidic and aliphatic amino acid residues but were non-identical in the overall amino acid composition. The preparations also contained 12--16% lipids. Guanidine hydrochloride denaturated amyloid fibrils of both types were resolved into four fractions in Sepharose 6B chromatography with molecular weights of ca. 160 000, 45 000, 20 000 and 8 000. The 160 000 mol. wt. fraction predominated in the chromatograms of inherited amyloid protein and was further resolved into two main fractions of 17 000 and 15 000 mol. wt. in sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis. None of these fractions from inherited amyloid protein showed immunologic identity with tissue-derived amyloid protein A (AA) whereas all four fractions from secondary amyloid reacted against anti-AA antiserum. The three major Sepharose 6B fractions of secondary amyloid fibrils were resolved into a 25 000 mol. wt. fraction in SDS-polyacrylamide gel electrophoresis without urea but into a 12 000 mol. wt. fraction in gels containing 8M urea after more drastic dissolving conditions of the fibrils.


[Lethal gastric hemorrhage caused by Hodgkin's disease (author's transl)]. A case report of a 29 years old female patient is given, who died from gastric hemorrhage in the course of generalized Hodgkin's disease. Gastroscopy was performed as an emergency procedure and the following was found: diffuse infiltration of the ventricular wall, diffuse widespread mucosal bleeding, and a big, penetrating ulcer above the angulus with an elevated circumference. The prevalence of gastric involvement during Hodgkin's disease is discussed.


[Cryotherapy for haemorrhoids (author's transl)]. Case reports of 1737 patients who were treated by cryotherapy have been analysed. The technique, indications, contraindications, complications and results of this therapy are described. This method gave a satisfactory result in 90% of the patients and 14% of the patients had severe pain immediately after the therapy. There are no follow-up results, because the treatment of haemorrhoids by cryosurgery is fairly new.


[The pathogenesis and treatment of migraine (author's transl)]. 191 migraine patients reported previous allergic diseases, tendency to vertigo and collapse, attacks of tachycardia, blood coagulation disorders, surgically treated cysts and fibromas and inflammatory diseases of various organs significantly more frequently than a control group similar in age, sex and social standing (N equal to 150). 140 patients reported retrospectively on the efficacy and side effects of different drugs. Ergotamine preparations showed a significantly better effect than others. The shorter the untreated attack, the more effective the preparations appeared to be. The younger the patients the better the effect of Dihydergot for interval treatment of migraine. Acupuncture was not successful. 16% of the patients abused their drugs.


[Problems of vascular surgery. From the specialist's portfolio (author's transl)]. Every doctor--and above all every surgeon--must have fundamental knowledge of diagnosis and treatment of surgical angiological diseases. It is no longer sufficient for specialists alone to have such knowledge. Confrontation with surgical angiological problems is possible at any time. Cases are described here in which serious consequences arose for the patient concerned because of a doctor's error. Claims for damages were the result.


[Mode of action of cardiovascular drugs. Echocardiographic studies (author's transl)]. Echocardiography--combined with additional non-invasive methods--has proved a sensitive tool for measuring hemodynamic and left ventricular function parameters. This study was undertaken to measure by these methods the effect of digoxin, isoproterenol, of the beta-receptorblocker sotalol, sodium nitroprusside and isosorbide dinitrate on the hemodynamics and left ventricular contractility in various patients and normal volunteers. Besides the good reproducibility of results of recent invasive investigations, partly in animal experiments, new aspects about the mode of action of the individual substances were obtained.


[Analgesic and anti-inflammatory efficacy of biarison. Clinical experimental studies (author's transl)]. The analgesic time-effect profile of 600 mg Biarison (clinical experimental number: RU 43-715) compared with 100 mg indometacin, placebo and a blank test was recorded for 12 healthy subjects as an intra-individual single-blind trial by means of electrical measurement of thresholds in the teeth. Biarison shows a powerful analgesic effect with a maximum increase of the threshold by 22.3 mA after 75 minutes. The maximum increase in mA with indometacin and placebo was 18 and 9 mA respectively. The differences are confirmed statistically. Under double blind conditions, no significant differences in antiphlogistic activity could be established between Biarison (900 mg/day) and indometacin (150 mg/day) with reference to the edema appearing after maxillary sinus operations.


[The position of antibiotic prevention in surgery]. The Importance of Antibiotic Prophylaxis for Surgery: The current state of the discussion of the benefits and dangers of antibiotic prophylaxis in surgery is critically considered with reference to the literature and our own investigations. Situations where prophylactic administration of antibiotics may be absolutely locigal and where such administration may be without benefit to the patient or even dangerous are commented on. "Shortterm prophylaxis" where antibiotics are given before, during and after the operation for a short period of 24 to 48 hours is particularly discussed. If antibiotics are given they must be effective against the pathogen in question and they must be present in sufficiently high concentrations at the possible sites of infection.


[Microaggregate filters for blood transfusions]. Many types of microaggregate filter are now obtainable for use in blood transfusion. The aim, indication and potential advantage of microaggregate filtration for the patient are discussed. The Pall and Swank microaggregate filters are considered the filters of choice today, expecially with regard to the number of blood conserves which can be filtered.


[Premunity, premunization and paraspecific effect of immunizations (author's transl)]. A considerable part of the paraspecific effect of immunization falls under the common term of a general increase in resistance. Bacterial competition, antibiosis, interference, interferon formation and lymphocyte stimulation, on the other hand, are more than an increase in resistance. It is proposed that the sum of the stimulation of all these activities including increased resistance shall be called premunization and the short-lasting nonspecific protection against a number of quite different infectious diseases produced by this in the body shall be called premunity. Experience with the paraspecific effect of immunizations, with increasing drug resistance, interferonization and lymphocyte stimulation form the basis for the development of a "premunity inducer". The efficacy of a biological inducer is described with reference to our own experiments.


[The effect of neonatal BCG vaccination on the incidence of leukemia (author's transl)]. Data from several publications were analyzed with respect to the possible non-specific influence of BCG vaccinations on leukemia. Our own investigations in the five largest provinces of Austria showed that there was an inverse correlation between leukemia mortality and BCG vaccination of the newborn. From this data a protection rate of 0.88 for prevention of leukemia deaths could be calculated for the first five years of life. The number of positive tuberculin reactions was significantly lower in leukemic infants than in normal ones. This finding was completely in accordance with the probability of positive tuberculin reactions as calculated from the protection rate.


Pre-B-cell leukemia. A new phenotype of childhood lymphoblastic leukemia. Large lymphoid cells containing small amounts of cytoplasmic IgM (clgM) but undetectable surface immunoglobulin (slg) have recently been recognized as precursors of B lymphocytes. They are a small, rapidly dividing pool of normal marrow lymphoblasts. Since lymphoblasts in most childhood acute lymphoblastic leukemias lack slg and other conventional B-lymphocyte and T-lymphocyte markers, we examined the possibility that some leukemias represent "pre-B"-cell neoplasms. In four of 22 consecutive patients, leukemic cells had the clgM+.slg- phenotype of pre-B cells. These patients' cells shared "common acute-lymphoblastic-leukemia" antigens and "B-cell" alloantigens, but differed in expression of several developmental features characteristic of the B-cell line. Pre-B-cell leukemias were readily responsive to chemotherapy. We conclude that a distinct subpopulation of previously unclassified leukemias reflects oncogenic transformation at the earliest recognizable stage in differentiation along the B-cell axis.


Prognostic significance of an enhanced number of T lymphocytes in chronic lymphatic leukemia. Analysis of lymphocytes carried out by means of rosette tests in 24 patients treated for chronic lymphatic leukemia established the origin of malignant cells to be from Blymphocyte population. On the basis of a reactive T lymphocyte proliferation in patients with chronic lymphatic leukemia, a "coefficient of active T lymphocytes" has been deduced which proved to be a rapid indicator of a short-term prognosis. This coefficient may contribute in a substantial measure towards an objectivation of the indication of a repeated oncostatic therapy in relatively light leukocytosis or in otherwise clinically unresolved cases.


Mutual relationship between total and active  T lymphocytes in patients with malignant tumors. The values of B lymphocytes and of active and total T lymphocytes have been followed in 104 patients with malignant diseases and 35 controls of corresponding age, using the rosette tests with sheep erythrocytes. A statistical analysis of the changes of total and active T lymphocytes in three selected groups of the malignant disorder revealed the decline in total T lymphocytes to be parallel to that in active T lymphocytes. Therefore, a follow-up of the immunocompetence of oncological patients with the criterion determination of thymus-dependent lymphocyte population by the classical method of rosette formation was found to be equally informative in the three groups of patients studied here, as an evolution of active T lymphocytes in the active rosette test.


Hodgkin's disease in children: investigation of T and B lymphocytes. A study has been made of twenty-five untreated patients with Hodgkin's disease (H. D.), ageing from 3 to 13. We have analyzed the correlations of T and B lymphocytes of peripheral blood and the involved lymph nodes and also the functional peculiarities of T-cells in PHA-response. It is shown that as well  as adults children with H. D. have the depression of T-system of immunity, more marked in the presence of general symptoms and biological stage "b". No significant influence of the clinical stage on the level of immunological disorders has been found.


Deficiency of T and B lymphocytes in uremic subjects and partial improvement with maintenance hemodialysis. Lymphopenia of a group of uremic patients was associated with normal percentages of T cells but reduced percentages of B cells. Lymphocyte counts improved after a period of maintenance hemodialysis, although not to control levels, and B cell percentages returned towards normal. Uremia is therefore associated with depression of total T and B cell numbers, with a relatively more pronounced effect on B cells. A period of maintenance hemodialysis produces increase in numbers of both cell types and depression becomes nonselective.


Positive ventriculography using water-soluble contrast media in infants with myelomeningocele and hydrocephalus. Ventriculography with meglumine iocarmate (Dimer X) or Metrizamide (Amipaque was carried out in 15 infants with myelomeningocele and progressive hydrocephalus. In all cases, an Anold-Chiari-Malformation type II was diagnosed with compression of the structures of the posterior cranial cavity and their displacement within or below the level of the foramen magnum. The aqueduct was always patent but laterally compressed. In the region of the third ventricle there was often encountered an enlargement of the massa intermedia with indentation of the lamina terminalis and enlargement of the recessus suprapinealis. Aspects of pathogenesis of the malformation and possible causes of hydrocephalus originating from these findings are discussed. Methods and advantages of positive ventriculography using water-soluble media are presented.


Prevalence of high blood pressure treated and untreated in an urban adult New Zealand population: Napier 1973. The prevalence of hypertensive levels of blood pressure was investigated in a random sample of 2535 adults in Napier in 1973. More than 70 percent of all persons examined had been measured for blood pressure within the previous five years. A retrospective analysis of results using the WHO classification indicated that 16.4 percent of the adult population had a mean systolic pressure of not less than 160mmHg or mean diastolic pressure of not less than 95mmHg. One third of the hypertensive group was receiving treatment and one half of those on therapy were effectively controlled. The total prevalence of treated and untreated hypertensives was estimated to be 20 percent of the survey population. According to the WHO criteria for blood pressure classification 33 percent of those over 60 years were hypertensive.


Phacoemulsification.

Phacoemulsification. Ten years have passed since the phacoemulsification procedure was introduced to ophthalmology. Enough experience has now been gained to evaluate its effectiveness. This report sets forth a list of case-selection criteria designed to avoid the most common complications associated with the operation. Average visual acuity results have been tabulated for the purpose of assisting those who are deciding whether or not ot adopt the procedure.


Series elastic properties of skinned muscle fibres in contraction and rigor. Isometric tension of skinned fibres from the frog semitendinosus muscle is sigmoidally related to Ca2+ concentration between pCa 7 and 6. Stiffness measurements showed that the Ca2+-activated tension may be due to recruitment of attached cross-bridges. In the absence of ATP (rigor solution) the skinned fibre develops a rigor tension which reaches about 80-110% of the maximum Ca2+-activated tension. However, stiffness measurements showed that in rigor many more cross-bridges are attached to actin at any one moment than in contraction. It was concluded that the force per cross-bridge is 37% smaller in rigor than in contraction.


Real time ophthalmic ultrasonography.

Real time ophthalmic ultrasonography. Material from three years of experience with a real time contact ophthalmic scanner is presented. Routine screening of patients with cataracts revealed unsuspected retinal detachments and advanced vitreous hemorrhage in a significant percentage. Foreign bodies near the posterior ocular wall were optimally evaluated by both radiographic and ultrasonic localization methods to avoid the inherent error of the x-ray triangulation system. The traumatized eye may be effectively studied for internal damage by using a thick layer of methyl cellulose without putting pressure on the globe. Many types of vitreous and retinal pathology may be confirmed or better evaluated by this simple, noninvasive technique.


Selective transcatheter embolization of the upper gastrointestinal tract: an experimental study. Transcatheter gastric embolization using Ivalon shavings was performed on three groups of dogs. The left gastric artery and splenic branches (the short gastric and left gastroepiploic arteries) were embolized in Group I, the left gastric artery in Group II, and the splenic branches in Group III. Infarctions of the gastric mucosa occurred only in Group I. Ischemic ulcers developed in three of the five dogs in Group I and in one of the three dogs in Group II. The study suggest that embolization can only be performed safety if particles of 0.3 mm or larger are used.


Observations on electric brain-stem responses in retrocochlear hearing loss: a preliminary report. Far-field recorded electric brain-stem responses on acoustic stimulation (BSER) were recorded in 29 patients with 31 verified cerebellopontine angle tumors. The responses were compared with the normal response and with responses in cochlear hearing loss by visual observation, considering reproducibility and (supra-liminal) configuration in the first place. There were established (a) obvious differences in response pattern between cochlear and retrocochlear lesions. (b) In the retrocochlear cases, BSER appeared to be more consistent that conventional audiometry, as demonstrated in ears ipsilateral to the lesion, with residual hearing and cochlear or inconsistent auditory findings. (c) BSER also proved able to offer additional diagnostic information by way of the ear contralateral to a retrocochlear lesion, not only in cases where the tumor caused a radiologically visible dislocation of the brain stem.


Ultrastructural studies of leucocytes which form rosettes with homologous erythrocytes in human auto immune haemolytic anaemia. Leucocytes which form rosettes with himologous erythrocytes in auto-immune haemolytic anaemia, infectious mononucleosis and following the stimulation of lymphocyte cultures with PHA have been studied by electron microscopy. The studies showed that the predominant homologous rosette forming cell was lymphocytic and the evidence favoured the conclusion that they were non-immune in nature. This identification does not classify the lymphocyte as thymus or bone marrow derived. Just under half (44%) of the total lymphocytic RFC had perinuclear microfilaments and limited clearing of the plasma of ribosomes close to the cell membrane. These features are consistent with activated T lymphocytes. The remainder of the lymphocytic RFC had no features which allowed their identification as T or B cells. The form of contact between lymphocytic RFC and erythrocyte was mainly of a pointlike nature, with little deformation or invasion of the attached erythrocytes. Monocytes were the only other type of cell encountered with any frequency. Their prime distinguishing feature was the deformation of attached red cells which they caused.


Factor VIII inhibitor postpartum.

Factor VIII inhibitor postpartum. Acquired factor VIII deficiency in women postpartum due to a factor VIII inhibitor is rare and the etiology is unknown. In this study a case report and a review of the literature are given. The haemorrhagic diathesis resembles classic haemophilia, with the exception that ecchymoses and tissue bleeding occur more frequently. The potency of the inhibitor may vary from weak to strong and the inactivation of factor VIII coagulant activity (factor VIII-C) by the inhibitor is of a non-linear type. Severe bleeding has been fatal in a few cases, but factor VIII concentrate substitution has usually been successful without anamnestic response of inhibitor activity. There is no convincing evidence that immunosuppression is effective, also because the natural history of the disease is characterised by a spontaneous disappearance of the factor VIII-C inhibitor. Treatment of bleeding symptoms with factor VIII concentrate should therefore not be reserved for life threatening haemorrhages only.


Lymphoid cell surface markers in acute lymphocytic leukaemia. Peripheral blood lymphoid cells of 29 patients with acute lymphocytic leukaemia (ALL) at onset were studied for characterization of B and T membrane markers and phytohaemagglutinin responsiveness. 24 cases (83%) were classified as "null" cell ALL and 5 (17%) as T-cell ALL. No relationship could be found between cytological presentation and immunological classification. Moreover, no correlation has been demonstrated between clinical-immunological parameters and prognosis, indicating that in our series of patients, assessment of cell size and surface markers were not a reliable predictor of prognosis.


Aspects concerning the lymphocytic nonimmune and immune rosettes in Graves' disease and thyroiditis. Evaluation of the role of cell-mediated immunity (CMI) in thyroid-gland pathology has been carried out by calculating the percentage of nonimmune (ER) and immune rosettes (EAC)--(erythrocyte-antibody-complement), i.e. of T--(thymus-dependent) and B lymphocytes (bursa equivalent) in the peripheral blood. The mean percentages found in the 10 normal subjects under study were of 65.8% ER (ranging between 56.6% and 74.9%) and 15.1% EAC (ranging between 12.2% and 17.9%. In the 8 nontreated patients with Graves' disease the means were of 77.5% and 12.9%, respectively. For the same parameter the following values were also found: in 6 patients in remission, 62.2% and 22.7%, respectively; in 8 patients with acute and subacute thyroiditis, 87.5% and 13.4%, respectively; in 7 patients with thyroiditis under remission, 64.1% and 24.2%, respectively.


T lymphocyte recognition of alloantigen in vitro. II. Significance of Fc receptor positive and negative responder T cells in the generation of cytotoxic T lymphocytes from normal or immune mice. The present experiments were carried out in order to answer the question whether the precursor T cells of cytotoxic T lymphocytes (PCTL) are Fc receptor positive (FcR+), Fc receptor negative (FcR-), or both. The data show that cytotoxic T lymphocytes (CTL) can be generated in vitro from both FcR+ and FcR- PCTL. Furthermore, we investigated if the function of FcR+ and FcR- CTL differed in the allograft response in vitro. Qualitatively, FcR- PCTL differentiate into FcR- CTL only, whereas FcR+ PCTL differentiate into both FcR+ and FcR- CTL. However, quantitatively, CTL generated from FcR- PCTL display a higher T cell mediated cytotoxicity than CTL generated from FcR+ PCTL. Mixing experiments indicate that FcR+ T cells regulate the differentiation of FcR- PCTL into CTL. These conclusions hold true for PCTL in both normal and memory responder cell populations.


Cytotoxic T cells in the lungs of mice infected with an influenza A virus. Cytotoxic T cells are present in the lungs and the bronchoalveolar washings of mice infected intravenously (i.v.) or intranasally (i.n.) with live influenza A/WSN virus. After i.v. injection, cytotoxic T cell activity in both spleens and lungs reaches a peak at 6 days when the level of infectious virus recovered from the lungs falls sharply and the mice do not die. If a lethal dose of virus is given intranasally, very high levels of virus appear rapidly in the lungs, and the development of lung consolidation follows slightly behind the appearance of cytotoxic T cells there. When a non-lethal dose of virus is given intranasally, lower levels of virus are found in the lung and the appearance of cytotoxic T cells is delayed. These results suggest that the cytotoxic T cells play a protective role if the level of virus in the lungs does not reach very high levels. After injection of antithymocyte serum, the subsequent level of cytotoxic T cell activity in the lungs was greatly reduced, suggesting that the T cells recovered in lungs had at an earlier stage been circulating cells. However, splenectomized mice develop high levels of cytotoxic T cell activity, after intranasal infection of mice, indicating that the spleen did not contribute substantially to the T cells recovered in the lungs.


Radiometric detection of Haemophilus influenzae in cerebrospinal fluid specimens. The investigation demonstrates the usefulness of a radiometric urease test in the rapid detection of Haemophilus influenzae in cerebrospinal fluid specimens. The test is simple and economical to perform and results are obtained within a one hour incubation period.


Xeroderma pigmentosum--biochemical and therapeutic aspects. Case report. Four patients with Xeroderma pigmentosum are reported: 2 diagnosed following the development of multiple cutaneous tumours, and 2 at an earlier state. The repair synthesis of DNA after ultraviolet radiation was reduced in 3 and normal in 1 patients. Para-aminobenzoic acid (PABA) was used topically as sunscreen; for those intolerant to PABA, alternatives are given. 5-fluoro-uracil had satisfactory effect against actinic keratoses. Two patients had associated neurologic and mental abnormalities compatible with deSanctis-Cacchione syndrome, a Xeroderma pigmentosum variant.


[Acute epiglottitides in the adult].

[Acute epiglottitides in the adult]. Two adults were admitted to the University Hospital of Geneva with acute Haemophilus influenzae type b epiglottitis. The disease was characterized by rapid progression of sore throat, upper dysphagia, fever and dyspnea. Acute upper airway obstruction required emergency tracheotomy in both cases. The patients recovered under ampicillin therapy. All the 100 cases from the literature for which clinical data were available have been analyzed:--Epiglottitis in adult is not exceptional.--Haemophilus influenzae type b is the most common infective organism documented, and was found in all positive blood cultures but one.--The typical presentation is severe sore throat, with upper dysphagia, fever and dyspnea.--Clinical course is rapid and serious, and acute respiratory distress develops in 57% of cases; overall mortality is 27%.--Emergency routine tracheotomy appears to be the most reliable treatment.


[Surgical treatment of associated coronary disease and heart valve disease]. 25 patients underwent combined surgery for coronary artery and valvular heart disease. Although patients suffering from associated coronary artery and valvular lesions represent a high operative risk group, the combined surgical procedure is clearly justified by the functional improvement of the patients. Selective coronaro-angiography should be carried out in the assessment of patients over 40 years of age with valvular disease, since not all patients present angina in spite of diseased coronary arteries. Three hospital deaths (13.5%) indicate the gravity of the procedure, but the absence of intra- or postoperative myocardial infarction and the comparatively rapid recovery of the patients with relatively few complications are very encouraging.


Duodenal leiomyoma as a cause of gastrointestinal hemorrhage. A case report and review of the problem of duodenal leiomyoma are presented. Although these lesions are rare and usually asymptomatic, they can present with symptoms of hemorrhage, obstruction, pain, and perforation. Barium roentgenographic examination may show filling defects of compressive lesions. Angiography shows a hypervascular, encapsulated lesion. Endoscopy may reveal a submucosal mass with central depression. At operation, it is important to distinguish the benign leiomyoma from leiomyosarcoma.


Percutaneous epidural neurostimulation for paraplegic spasticity. A case of post-paraplegic, post-traumatic spasticity, alleviated by percutaneous epidural neurostimulation from implanted electrodes at the L1 and L3 intervertebral levels, is presented. Secondary beneficial physiological effects and controls of involuntary activity that were achieved were regulation of a bowel regime, production of sweating below the level of the lesion, increased piloerections, and morning penile erections. Electrical modulation of the involuntary motor and autonomic activities below a complete spinal cord injury is discussed. The main advantages of such treatment in modulating spasticity are the avoidance of all other destructive neurosurgical procedures and the regulation of secondary physiological, autonomic responses. Long-term follow-up and additional therapeutic proofs are necessary to substantiate this preliminary report.


Maternal alloimmunisation in pregnancy. In vitro studies of T cell-dependent immunity to paternal alloantigens. A secondary in vitro allograft reaction was used to demonstrate that spleen cells derived from allogeneically mated inbred mice were immunised against paternal alloantigens. In addition to the heightened alloantigen-specific in vitro response of these spleen cells, it was also found that spleen cells froma a wide variety of syngeneically and allogeneically mated mice were nonspecifically more reactive in the in vitro allograft reaction than spleen cells from virgin mice. However, when spleen cells freshly harvested from allogeneically mated mice were tested in a direct 51Cr release assay, lysis of target cells bearing the paternal alloantigens was demonstrable in only one-third of the experiments. It is proposed that T cell immunisation to paternal alloantigens occurs in pregnancy, but that cell-mediated cytotoxicity is inhibited.


[Acute ulcers of the gastrointestinal tract complicated by hemorrhage and perforation]. The data on 130 patients with acute ulcers of the gastrointestinal tract complicated hemorrhage and perforation are reported. Acute ulcers developed in patients with cardiovascular diseases (47%), intoxication (17.7%), postoperative paresis of the stomach and intestine (10%), other pathology (15.3%), and in medication (10%). The former manifested in acute hemorrhage in 108 patients, perforation--in 8, hemorrhage and perforation--in 14. In 86% of cases ulcers were located in the stomach, and in 63%--these were multiple. Conservative therapy was employed in 97 patients and 33 patients were operated upon. The mortality after early operations was 2.5 times as low as in the expectation policy and conservative therapy.


[T- and B-lymphocytes in lymphoproliferative diseases]. T-cell and B-cell markers and the response of lymphocytes to phytohemagglutinin (PHA) have been studied in 62 patients with chronic lymphocytic leukemia (CLL), in 3 patients with well-differentiated lymphocytic lymphoma and in 1 patient with lymphosarcoma. To investigate the functional integrity of T-lymphocytes in 10 patients with CLL the response of the T-cell-rich population to PHA was determined. The leukemic lymphocytes in all the cases but one had B-cell characteristic. The T-cell-rich population would show a normal response to PHA.


[Stimulating action of the albumin fraction of soluble placental proteins on T- and B-lymphocyte transformation]. Under study was the effect of the albumin fraction of soluble placental proteins on the transformation of T- and B-lymphocytes, stimulated by Salmonellae phytohemagglutinin and lipopolysaccharides, respectively. Placental proteins were separated by their fractional sedimentation with ammonium sulphate and subsequent gelfiltration on Sephadex-G-200. The albumin fraction of placental proteins was shown to stimulated the reaction of the T- and B-lymphocytes blasttransformation. Some possible mechanisms of this effect are discussed.


[Immunological features in ankylosing spondylitis (author's transl)]. Sera from 50 patients with various stages of ankylosing spondylitis were tested for the presence of antinuclear antibodies (ANA), anti-DNA antibodies, rheumatoid factor and antistreptolysin. Antinuclear antibodies (immunofluorescent technique) were detected in the sera of 10 patients (20%), associated in one case with anti-DNA antibodies (immunofluorescent technique). The disease activity in ANA-positive cases was low to moderate.


Prodolic acid: analysis and disposition studies in rats and dogs. 1. A specific fluorimetric method for the determination of prodolic acid in serum has been elaborated and has a limit of detection of 2 microgram/ml. 2. Common anti-inflammatory drugs do not interfere with the method. 3. In rats and dogs, prodolic acid is rapidly absorbed and has a short half-life of elimination. 4. The rate of elimination was marked by secondary rises in the blood level profile which were shown to be due enterohepatic recirculation of prodolic acid. 5. Prodolic acid is highly bound to serum protein.


Lymphocyte transformation, rosette formation and behaviour of immunoglobulins in sarcoidosis. 1. Patients with sarcoidosis indicated significant decrease of the mean value of lymphocyte transformation (LT) in all stages and all periods of sarcoidosis. In chronic sarcoidosis the mean value of LT was significantly lower (27.6%) than in the initial active stage I (44.6%) and increased among patients who recovered from sarcoidosis. 2. Patients suffering from sarcoidosis have depressed percentage of T lymphocytes compared to healthy subjects and depressed ability to lymphocytes blast transformation after PHA stimulation. No significant difference exists in the percentage of B cells detected by rosette formation with normal subjects. 3. The mean values of IgG, IgA and IgM in sarcoidosis patients were higher, and became normal after recovery. Levels of immunoglobulins were successively increased according to the stage. An increased IgG level is connected with active phase of the process whereas IgA is more stable but rised.


A search for thymie (T) lymphocyte inhibitory factors in sarcoid sera. Sarcoid patients frequently show depression of skin delayed hypersensitivity reactions suggesting depression of thymic (T) lymphocyte function. In vitro demonstration of such depression, however, to date, is inconclusive. We have used the macrophage migration inhibition test with Kveim "antigen" (KMIF), and spontaneous sheep red cell rosetting (SRC) techniques as indicator systems. We found that a positive KMIF test obtained in 7 of 16 subjects (13 sarcoid and 3 non sarcoid) in the presence of foetal bovine sera (FBS) became negative in the presence of sarcoid patients sera. Using lymphocytes from a single normal healthy subject the SRC tests were performed in the presence of sarcoid, normal healthy sera and FBS. With sarcoid sera 38% of lymphocytes showed rosetting as compared with normal human sera, 54%, and with FBS, 57%. Where lymphocytes were pre-incubated for one hour in the various sera the percentage of rosetting cells were even further reduced, sarcoid sera 23%, as compared to normal human sera, (49%), and FBS, (54%). Thus, using two tests of lymphocyte function our preliminary results suggest the presence of T cell inhibitory factors in sarcoid sera.


[The oral administration of N-benzoyl-L-tyrosyl-paraaminobenzoic acid (PFT) in the assessment of exocrine pancreatic function and its value within the diagnostic approach to pancreatic disease (author's transl)]. Exocrine pancreatic function was determined by the oral administration of N-benzoyl-L-tyrosyl-PABA in 343 persons, including controls, patients with diseases of the pancreas, and patients with non-pancreatic disease. The results revealed a sensitivity of 85% in chronic pancreatitis and of 78% in carcinoma of the pancreas. The specificity of the PFT amounted to 92%. No toxic side effects were noted. The PFT is likely to be a useful screening procedure for pancreatic disease.


[Clinical behaviour after aorto-coronary vein bypass grafting related to the degree of revascularization (author's transl)]. The clinical behaviour after bypass-surgery was analysed with regard to anginal symptoms at rest and during daily exercise, working habits and postoperative medication in 135 patients, 3 to 28 months (average 18 months) postoperatively. All patients underwent postoperative coronary and left ventricular angiography, allowing a close correlation between postoperative clinics and patency-rate (average 84%) as well as the degree of revascularization (average 64%). 80% of the patients were clinically improved and, furthermore, there was a close correlation between the degree of improvement and revascularization. In contrast, only 42% of the patients were back to work and there was no correlation between the working habits and patency-rate or the degree of revascularization. Finally, postoperatively clearly improved patients showed a signif. smaller consumption of antianginal drugs, esp. nitrates.--This analysis of postoperative clinics and angiography suggests that improvement of symptoms through bypass-surgery is primarily due to the improvement of local perfusion in previously underperfused myocardial areas.


[Symptoms of cellular immunity in chronic and lupus nephritis]. On the one hand, the results of our investigation reveal a hypersensitivity to renal antigen in patients with GN and LN. On the other hand, they refer to a change of the number of lymphocytes of the peripheral blood with a decrease of their functional activity. In patients with GN the sensibilisation of lymphocytes appeared in the same degree to the antigens of the renal extract as well as to the antigens of the basal membrane of the glomerulus. In contrast to this in the group of patients with LN the sensibility to antigens of the basal membrane was found only in 2 among 17 examined patients. The expression of the sensibilisation of lymphocytes to renal antigens correlated with the activity of clinical diseases and was most frequently connected with a higher pathological activity in patients with GN as well as in patients with LN. The analysis of RMHL and BMK did not show such legitimacies. In signs of the cellular immunity there could not be found any essential differences also in the examination of clinicomorphological variants of the GN.


[Gastrointestinal bleeding and emergency endoscopy in portal hypertension (author's transl)]. Portal hypertension is found in about one quarter of the cases with upper gastrointestinal bleeding. 57 patients with portal hypertension underwent endoscopy for gastrointestinal haemorrhage. Despite visible varices in all cases varice rupture underlies only 50% of the bleeding episodes. Conditions other than rupture were found to bleed in 50%. Superficial mucosal erosions, which escape radiological detection, were the most frequent other bleeding sources.


[Endoscopy of the cerebellopontile angle using the retrosinusal-suboccipital route]. In spite of the introduction of new examination methods (positive contrast demonstration, tomography, CAT) difficulties may be encountered in the instrumental diagnosis of smaller neurinomas of the auditory nerve. That is why one has already for some time tried to reach the pontine-angle with the endoscope. Until now, this has been done by the transpyramidal-retrolabyrinthal route. Since this access is too complicated for diagnostic purposes, the authors have chosen the retrosinal-suboccipital route and proved its suitability by examinations in corpses. This is the same route of access which is used by most neurosurgeons for carrying out operations to the pontine-angle tumour.


[Thymus-dependent lymphocytes in multiple sclerosis and amyotrophic lateral sclerosis]. A study of the rosetteforming possibilities of T-lymphocytes in the peripheral blood of patients with disseminated sclerosis and lateral amyotrophical sclerosis detected a significant deficit of a subpopulation of T-cells, which form the most active rosettes of the morula type. Besides, in patients with disseminated sclerosis the relative amount of rosetteforming lymphocytes in the peripheral blood is significantly lower.


[Prolonged effect of 5-hydroxytryptophan on trace processes of neuronal activity]. In experiments on rabbits a study was made of the influence of serotonin's precursor, 5-oxytriptophane (5-OTP), on trace processes in spike activity of neurones in the visual and sensorimotor cortical areas. Rhythmic light was used as a stimulus with a frequency of 2 or 5 per second. Administration of 5-OTP produced prolonged action of the trace processes, significant for 2 per second frequency and less pronounced for 5 per second frequency of the flashes. This property was possessed both by the neurones which increased their activity frequency and those which reduced it. It is assumed that the prolonging effect of 5-OTP is the consequence of its modulating influence on the brain activity, which is manifested in a selective potentiation of the functioning of a neuronal system with a relatively lower frequency of spontaneous firing.


Acute gastrointestinal haemorrhage. Experience with early panendoscopy and tranexamic acid in a rural hospital. One hundred and fifty-nine consecutive patients admitted to a small rural hospital because of acute gastrointestinal haemorrhage were studied. Patients with haematemesis and/or melaena were treated with antacids and tranexamic acid from the very beginning and were examined by means of early panendoscopy. All patients were closely observed on a general medical ward by a staff especially trained to deal with acute gastrointestinal bleeding. Eight patients required acute surgery. The overall mortality rate was 4.4%. It is concluded that acute gastrointestinal haemorrhage can be successfully handled with modern diagnosis and treatment even in a small hospital.


Uncontrollable hemorrhage and tissue adhesive. A case is reported of uncontrollable hemorrhage from suture lines in a patient having undergone coronary surgery. Ultimately the bleeding was brought under control by the use of isobutyl-cyanoacrylate. A piece of fascia was affixed to the suture line. Tissue adhesive is a valuable tool in difficult hemostatic situations, and should be available where major surgery is performed.


Hemostatic defect in endoscoped upper gut bleeding. In an effort to assess the role of salicylate ingestion in upper gastrointestinal bleeding, one observer obtained a blood specimen for salicylate determination, performed a Duke bleeding time, and obtained a detailed drug history at the time of diagnostic endoscopy. Although a salicylate ingestion history was common, other variables did not correlate with it. Prolonged bleeding time occurred in 21 of the 81 patients, versus 1 of 22 controls. It was strongly associated with liver disease, with the alcohol habit by history, and with endoscopically severe gastritis, but was not correlated with plasma salicylate levels or evidence of salicylate ingestion by history, or with thrombocytopenia. Additional relationships linked liver disease and gastritis with prolonged bleeding time. There was no direct evidence from this study that salicylate ingestion occurred more frequently among gastrointestinal bleeders than among controls, and there was no evidence that the hemostatic defect increased the magnitude of bleeding.


Root formation in ectopically transplanted teeth of the frog rana pipiens. II. Comparative aspects of the root tissues. In the second part of an experimental study of the behavior and fate of the roots of ectopically transplanted frog teeth the comparative aspects of the tooth root and its tissue composition were examined. Experimental results showed that the root or pedicel area of the frog tooth was an intrinsic part of the tooth. The tooth was capable of growth to normal size and shape with or without the presence of underlying bone. When compared with existing descriptive exidence and analysis it was determined that the best terminology for the amphibian root tissues would be dentin right up to the point of attachment where cellular basal bone is seen. This is because it is an intrinsic part of the tooth, if formed on the pulpal side of the root sheath, and is formed by odontoblasts. Because of the above observations, the original Hertwig's epithelial root sheath appeared both homologous and analogous with the mammalian sheath, but since all the root tissues were under this sheath, no tissues homologous to any of the paradental tissues of cementum, periodontal ligament, or alveolar bone could be found except when the root sheath injury resulted in induction of an acellular tissue upon the outer surface of dentin.


The occurrence of TMJ -disorders in an elderly population as evaluated by recording of "subjective" and "objective" symptoms. The occurrence of "objective" symptoms of TMJ -disorder, as measured by clinical examination, and self-reported "subjective" symptoms, were investigated in a survey of 241 persons ages 65-79. This group constituted the participants of a sample which was drawn to cover all persons in this age category living in the county of Troms in Norway. The participation rate was 86. Participants were examined and interviewed by dentists in graduate training. Eight per cent of the group reported to have had TMJ pain recently. Fourteen per cent said they had clicking or creptiation. These symptoms were twice as commonly reported by women as by men, and they were also most frequent among people complaining of rheumatism or general joint pain. By the clinical examination, clicking and/or crepitation was found in 27% of the individuals. Limitation of jaw movement was registered in only 3 persons. These "objective" symptoms were evenly common with both sexes. Dental/prosthetic status had seemingly no distinct influence of the findings.


Tumor cell phagocytosis and cytotoxicity of lymphoblastoid cells following concanavalin A treatment. Cell-to-cell interaction was investigated in various malignant tumor cells (human ovarial tumor, lung cancer, carcinoma of larynx and hamster melanoma cell) and in human lymphoblastoid cells (T-cell (MOLT-4 cell), thymoma cells and B-cells (Burkitt lymphoma cell)). Live lymphoblastoid cells did not adhere to the cell surfaces of tumor cells nor the lymphoblastoid cells were ingested by tumor cells without immunologic and specific treatment. Tumor cells as well as T-cells and B-cells had receptors to concanavalin A on their surfaces, and they showed marked cell binding of tumor cells and lymphoblastoid cells. Moreover, tumor cells that phagocytized lymphoblasts underwent marked cell destruction within 4 hours of cell binding. The cytolytic mechanism of the target tumor cell was probably related to contact with the lymphoblastoid cells and was increased by ingestive activity, and metabolic disturbance by lymphotoxin in tumor cells.


Human leucocyte response to migration inhibitory activity from lymphocytes. Modification by aprotinin, Tranexamic acid and phenylmethyl sulfonylfluoride. Human lymphokines can elicit several effects associated with inflammation, e.g. leucocyte migration inhibition and fibrinolysis. These effects can be assessed in vitro by the leucocyte migration agarose technique (LMAT) and the leucocyte migration fibrinolysis technique (LMFT). The present study shows that preincubation of normal leucocytes with aprotinin, tranexamic acid and phenyl-methyl-sulfonylfluoride (PMSF) reduces or abolishes their migration inhibition response to leucocyte migration inhibition factor. The compounds exert this effect at non-toxic concentrations, which do not otherwise interfere with migration or fibrinolysis, and are non-toxic as estimated by PHA stimulation of lymphocytes. The LMFT is more sensitive to the modifying effect than the LMAT. The effect of aprotinin and tranexamic acid is reversible, the effect of PMSF is irreversible.


Regional myocardial blood flow in regions of prior myocardial infarction before and after revascularization. In 30 patients who received 102 saphenous vein bypass grafts, 91 were patent. Preoperative intracoronary injection of 99mTc-labeled albumin particles suspended in contrast revealed 81 regions of perfusion deficit which subsequently received successful revascularization. With postoperative graft injection of isotope, 48 of these regions no longer showed a perfusion deficit (59%), while 33 showed no change (41%). In these 30 patients, 16 of 17 (94%) revealed perfusion defects in regions of prior transmural myocardial infarction. Conversely, only 55 of 96 regions distal to coronary artery stenosis of greater than 50% revealed perfusion defects (57%). Thus, 99mTc-labeled microsphere studies seem to be valuable in detecting regions of prior infarction. After angiographically documented revascularization, the method continued to reveal perfusion deficits in 41% of abnormal regions noted preoperatively, even though almost half of these same specific regions showed improved postoperative regional contractility after postextrasystolic potentiation.


Significance of new Q waves after bypass grafting: correlations between graft patency, ventriculogram, and surgical venting technique. New postoperative electrocardiographic Q waves have been described in eight of 40 per cent of patients undergoing bypass grafting for coronary artery disease. Various theories have been proposed to explain these new Q waves. Correlations of new Q waves to vein bypass occlusion, prolonged pump time or aortic cross-clamping time are controversial. Indeed, whether or not the appearance of new postoperative Q waves means real transmural myocardial infarction is not clear. We report herein our experience with postoperative Q waves in 56 patients with vein bypass grafts and the relationship of new Q waves to ventricular venting, graft patency, and the postoperative ventriculogram. Our observations indicate that: (1) Not all Q waves are due to occlusion of the saphenous bypass grafts (as noted by others). (2) A certain percentage of new Q waves may not reflect true transmural myocardial infarction, especially when all the vein grafts are patent and the postoperative ventriculograms show improvement. (3) Some new Q waves reflect true transmural infarction due to occlusion of grafts or of distal coronary arteries with deteriorated left ventriculograms. (4) The high incidence of new Q waves in patients with ventricular vents is probably due to direct myocardial trauma at the apex of the left ventricle.


Mycosis fungoides-like cells. Their presence in a case of pityriasic dermatitis with a comment on their significance as an indicator of primary T-cell dyscrasia. A case of pityriasic dermatitis in which the histologic findings mimicked mycosis fungoides was examined ultrastructurally. Large numbers of mycosis-like cells were found in the dermis and within epidermal spongiotic vesicles. Such cells occur in the epidermal and dermal infiltrates of primary T-lymphocyte disorders, notably in mycosis fungoides, the Sézary syndrome, and parapsoriasis en plague. However, they have also been found in the dermal infiltrates of benign dermatoses, in some skin tumors, and occasionally in normal controls. They share ultrastructural features with transformed T lymphocytes. It is emphasized that cells with this morphology may be found in the skin in any condition involving T-cell transformation or dysplasia. The mere presence of cells with this morphology within skin infiltrates is insufficient evidence for the diagnosis of primary T-cell dyscrasia.


Acute toxicity of aspirin in hospitalized medical patients. Among 2,391 recipients of plain aspirin tablets, 121 (5.1%) were reported to have adverse reactions. Minor gastrointestinal disturbances, particularly heartburn and nausea, were most common (2.1%). Central nervous system effects were second (1.2%). Among these, tinnitus was reported most often (0.8%); deafness occurred in eight patients (0.3%). Gastrointestinal bleeding, the third major category of adverse reactions, occurred in 1.0% of recipients; it was not considered serious in any of the patients with reactions judged "definitely" or "probably" related to aspirin. The frequency of all adverse reactions increased as the unit dose, daily dose and total dose became larger. Deafness occurred only at high doses. Reactions were more common in females.


The dose-response relationships of dipivalyl epinephrine in open-angle glaucoma. The intraocular pressure responses of topically applied dipivalyl epinephrine (DPE: 0.025, 0.1, and 0.25%) were investigated in three series of open angle glaucoma patients in a double blind study. IOP responses were compared intra-individually with the effects of 1% epinephrine hydrochloride. 0.1% DPE gave an IOP reduction similar to that of 1% epinephrine-HCl. The change in IOP was less with 0.025% DPE and statistically significantly greater with 0.25% DPE when compared with the conventional epinephrine preparation. The clinical advantages of the 'pro drug' DPE are pointed out.


[The macular fatty degeneration of the peripheral retina a variety of the snail track degeneration (author's transl)]. A previously undescribed form of snail-track degeneration with scattered flecks was found in three eyes with absolute glaucoma. Light- and electron-microscopic examination of these lesions in the retinal periphery revealed atrophy and gliosis with massive accumulation of fat within the astrocytes and Müller's cells. It was not possible to explain the patchy distribution of the lesions. The fatty change in the macroglia is believed to indicate 'in situ breakdown' of slowly atrophying retina. Morphologic and pathogenetic similarities suggest that all forms of snail-track degeneration with snowflakes represent nonspecific fatty degeneration of the retina.


Proliferations in the vitreous cavity after perforating injuries. A histopathological study. Histologic specimens from 32 human eyes that had been enucleated at different intervals after servere injuries were studied. Following the rules of general wound repair, intraocular proliferations start two to four days after the injury and may be massively developed within one week after injury. Their cell composition and extent are related to the site and extent of tissue damage and the amount of hemorrhage. The findings support the recommendation of a primary vitreous repair in severely injured eyes.


[Laser lesions of the anterior segment of the rabbit eye. Studies of cornea, iris, lens and sclera using an argon, ruby and YAG-laser]. The anterior segment of the eye of 100 rabbits was exposed to radiation from Argon, Ruby and YAG lasers. The healing process of liminal and supraliminal lesions was evaluated histologically. The iris is the most sensitive tissue for all three lasers (threshold radiant exposure, Argon: 0.004 kJ/cm2, Ruby: 0.01 kJ/cm2, YAG: 0.05 kJ/cm2). Higher energies necessary for lesions in the transparent media were available only with the Argon and YAG lasers. The Argon laser failed to produce lesions in the lens, and threshold radiant exposure for the central cornea was 8 kJ/cm2. The thresholds for YAG lasers lesions in the central cornea and lens were of the same magnitude. The marked absorption of energy by the iris may lead to an accumulation of heat, resulting in lesions of adjacent tissues or a reduction of threshold for those lesions: The threshold in the peripheral cornea was ten times lower than in the center with the Argon laser, four times lower for the YAG laser. The thresholds for Argon and YAG laser lesions in the peripheral sclera lay between the thresholds for the iris and for the peripheral cornea. A safety standard for the anterior segment of the eye should be based on the lowest threshold (Argon laser lesion of the iris). The application of a factor 100 results in a maximal permissible exposure of 40 mJ/cm2. The influence of the beam diameter could not be evaluated.


[Permeability of hydrogel plastics (PHEMA) to different substances of corneal metabolism (author's transl)]. With a new two-chamber apparatus for diffusion measurements, the permeability of Poly (2-hydroxy-ethyl-methacrylate) (PHEMA) is determined for metabolites of the corneal metabolism. Except for ATP, all substances tested, including several amino acids, penetrated the PHEMA material. Compared to the corneal stroma, the permeability of PHEMA is relatively low. Therefore, intracorneal implants of this hydrogel should be as thin as possible.


Transcutaneous electrical stimulation. Its use in the management of postoperative pain. Forty patients who were to have total hip replacement were randomly allocated to two groups. One group received intramuscular pethidine (30 mg) alone for postoperative analgesia in the first 24 h, the other received transcutaneous stimulation (TES) and pethidine as necessary. The use of pethidine was compared in the two groups under standardised conditions of time, operative and anaesthetic techniques. There was less pethidine used in the TES group. The technique is simple and non-invasive and can be used continuously. It was well accepted by both patients and staff. The electrodes must be prepared carefully and placed accurately. An ideal stimulation effect was often achieved by similar patterns of stimulating parameters.


The ultrastructure of the normal human thymus: a study of 36 cases. Electron microscopy of the normal human thymus demonstrates a supporting framework of epithelial-reticular cells with long branchticular cell processes lie lymphocytes, macrophages, and rare myoid cells. Both small and large lymphocytes are evident. No desmosomes are observed between the lymphocytes and the epithelial-reticular cells. Macrophages are most numerous in the cort(x were they often contain phagocytized nuclear debris. The possible functional significance of the above-described fine structural features is discussed.


An in-vitro model of malignant hyperthermia: differential effects of inhalation anesthetics on caffeine-induced muscle contractures. Clinical concentrations of anesthetics augment caffeine-induced contracture of frog sartorius muscle; however, anesthetics differ in this characteristic. The potentiation was quantitated using six paired sartorius muscles for each specified concentration of anesthetic and controls. At a concentration of 1 MAC, the greatest potentiation occurred with 2 mM caffeine for all anesthetics studied. Under these conditions the order of magnitude of augmentations was: chloroform (15 times); halothane (11 times); methoxyflurane (10 times); cyclopropane (5 times); enflurane (4 times); isoflurane (3 times); diethyl ether (2 times); Baxter 3224 (2 times); fluroxene (1.4 times); nitrous oxide (1.3 times). Halothane at .5 MAC augments the 2 mM caffeine-induced contracture almost seven times, and at 2 MAC almost 13 times, whereas 2 MAC isoflurane potentiates the caffeine-induced contracture only four times and 4 MAC diethyl ether only two and a half times. It is postulated that those anesthetics that most potentiate caffeine-induced contracture may be the most potent triggering agents of malignant hyperthermia.


In vitro and in vivo effects of corticosteroids on peripheral blood lymphocytes from ponies. The in vitro and in vivo effects of corticosteroids on peripheral blood lymphocytes (PBL) from ponies were studied. Prednisolone inhibited lymphocyte stimulation by phytohemagglutin (PHA) in a dose-dependent manner, without inducing lysis even at large doses. The PBL from horses heterozygous for the combined immunodeficiency trait responded to corticosteroid treatment the same as did PBL from normal ponies. Removal of the corticosteroid after incubation with PBL from normal ponies partially restored responsiveness of these cells to PHA. Chronic in vivo treatment of ponies with corticosteroids caused a marked decrease in the absolute numbers of circulating lymphocytes. Most remaining lymphocytes had detectable surface immunoglobulin and C3 receptors, suggesting a greater decrease in the T-lymphocyte population. In spite of this, there was little change in the in vitro PHA- or keyhole limpet hemocyanin-sensitized ponies. In general, the corticosteroid effects of lysis, as well as the mitogenic and antigenic responses of PBL from ponies, were similar to those previously reported for human lymphocytes.


Lymphocyte responsiveness to mitogens and quantitation of T and B lymphocytes in canine malignant lymphoma. Two canine malignant lymphoma cases were studied, one from the time of detection of enlarged palpable lymph nodes through the terminal stage and another at the terminal stage. Hematologic and histopathologic studies were confirmative of leukemia. The lymphocyte subpopulations, T and B cells, were quantitated as identified by the presence or absence of surface immunoglobulin and erythrocyte-antibody-complement-rosette formation. The average number of B cells in the peripheral blood lymphocytes throughout the study were approximately 80%. The B cells in the lymph node lymphocytes were 82%. There was considerable fluctuation in the number of blood lymphocytes, but the percentage of T and B lymphocytes remained nearly constant. There was marked impairment in the lymphocytic response to mitogens. The results of this study indicate that the canine malignant lymphoma is predominantly a B-lymphocyte type.


Pi phenotypes and the prevalence of chest symptoms and lung function abnormalities in workers employed in dusty industris. Epidemiologic surveys were carried out on 1,138 white men employed in sawmills and grain elevator terminals in British Columbia. In addition to the administration of an occupational-health questionnaire and spirometry, Pi phenotype and the concentration of serum alpha1-antitrypsin were determined. Most of the workers (88.8 per cent) had the Pi M phenotype, whereas 8.0 per cent had the MS phenotype, and 2.7 per cent had the MZ phenotype. Very few workers (0.4 per cent) had other phenotypes. No differences were found among the 3 major phenotypes in the prevalence of chest symptoms and lung function abnormalities, even among cigarette smokers. These findings did not indicate that workers have the MZ phenotype with intermediate alpha-1-antitrypsin deficiency are particularly susceptible to the development of chronic obstructive lung disease under the conditions prevailing in these industries.


[Cutaneous manifestations of angio-immunoblastic lymphadenopathy]. The authors report four cases of angio-immunoblastic lymphadenopathy, presenting with cutaneous lesions: these have a tumoral presentation in two cases while in the other two, the polymorphic aspect of the cutaneous lesions is reminiscent of a toxidermic eruption. In contrast to the relative clinical polymorphism, the pathological findings are monomorphic, i.e., in all cases, there was a vascular proliferation together with a more or less dense cellular infiltrate consisting of cells indistinguishable from those involving the abnormal lymph nodes.


[A theoretical model of structural chromosome rearrangement induction]. A theoretical model to explain the occurrence of chromosome rearrangements at the DNA molecular level is proposed. It involves: (10) breakage of one strand of each DNA molecule; (20) enzymatic digestion by an exonuclease of a short sequence of bases adjacent to the lesion, hence the presence of a short monocatenar segment on the complementary strand; (30) association of two monocatenar sequences if they are sufficiently complementary hence the formation of an X-shaped heteroduplex; (40) repair synthesis of DNA and, during this repair, an exhange of strands identical to that occuring in sister-chromatid exchanges, hence the rearrangement. This model has the advantage of necessitating one single breakpoint per DNA molecule, and explains the efficiency of radiations with low linear transfer of energy, such as X- and gamma-rays. It also explains how rearrangements such as translocations can be totally balanced since they would occur base to base within identical sequences.


[Ring 6-chromosome: a nonspecific clinical picture]. A new example of ring-6 chromosome is reported in a 5-year-old girl with psychomotor and growth retardation, microcephally, and microphtalmia. The breakpoints are considered to be distal on both arms of chromosome 6, in view of apparently normal transmission of HLA phenotypes.


Partial monosomy and partial trisomy for different segments of chromosome 13 in several individuals of the same family. A reciprocal translocation, 46,XX,rcp(13;17)(q13;p13), was found to be segregating in a family. Two children have duplication of the distal portion of the long arm of chromosome 13, 46,XX,der(17),rcp(13;17)(q13;p13)mat. They are mentally retarded, have long philtra and postaxial hexadactyly. A maternal half-uncle has a duplication of the short arm and proximal portion of the long arm of chromosome 13, 47,XY,+der(13),rcp (13;17)(q13;p13)mat. He is mentally retarded, has scalp and skull defects and a very short philtrum. A fetus was found, on analysis of amniotic fluid cells, to have a deletion of the distal portion of the long arm of chromosome 13, 46,XX,der,(13),rcp(13;17)(q13;p13)mat. The fetus had multiple internal abnormalities and only 4 fingers on each hand.


Partial trisomy 4q.

Partial trisomy 4q. Three new cases (one patient and two sibs) of partial trisomy 4q resulting from a parental translocation are reported. From the literature 22 cases are reviewed and the segregation risk of unbalanced and balanced translocations involving 4q chromosome is discussed.


The effect of procarbazine on the chromosomes of normal and malignant mouse cells. The effects of the cancer drug methylhydrazine derivative procarbazine (PC) on the chromosomes of normal and malignant cells in the mouse strains Swiss Albino, CF1, and BDF1 have been analyzed. PC broke chromosome in the hypotetraploid Ehrlich and the diploid P388 ascites tumors. Practically all breaks seemed to be of the G2 type and, as far as could be determined, took place in the quinacrine-dark or the corresponding Giemsa-light regions. The vast majority of the broken ends had rejoined to form chromatid translocations. No increase in chromosome breaks were seen in any of the normal tissues treated in vivo: spleen, bone marrow, spermatocytes, or spermatogonia (in this tissue the cells were not counted). The chromosomes of the Ehrlich ascites tumor have been studied by means of both Q-banding and G-banding. Very few, if any, chromosomes seem to have an exact homologue or to correspond to any of the normal mouse chromosomes.


[Assignment of the genes of beta-glucuronidase, enolase-2 and phosphoglycerate kinase to chromosomes 7, 12 and X in the Chimpanzee]. By cellular hybridization with C11D cells, the following gene assignments to specific chromosomes were demonstrated for the chimpanzee: beta-glucuronidase on chromosome 7, enolase-2 on chromosome 12, and the phosphoglycerate kinase on the X.


[Ring-20 chromosome: a new syndrome].

[Ring-20 chromosome: a new syndrome]. A comparative study of five observations of a r (20) syndrome characterized by facial dysmorphism, the absence of severe malformations, and rather late onset of encephalopathy and seizures.


X-linked recessively inherited non-specific mental retardation. Report of a large family. A large kindred is described in which 22 males and 3 females show non-specific mental retardation with impaired speech. An X-linked recessive is the most likely mode of inheritance of this condition. Similar families have been described in the literature, characteristic physical abnormalities are absent and performance I.Q. tends to be higher than verbal I.Q. This possible heterogenous condition may be a major individual cause of mental deficiency in males, and may account for the excess of male retardates in the population.


45,X/46,X,dic(Yq) mosaicism and mixed gonadal dysgenesis. Case report and review of the literature. A 4 year 7 month-old boy with ambiguous genitalia, histological evidence of mixed gonadal dysgenesis, and 45,X/46,X,dic(Yq) mosaicism is reported. The identity of the dicentric Y chromosome was stablished by its typical fluorescent banding patterns and the presence of two centromeres demonstrated by C-band technique. A review of the literature yielded nine additional cases of mosaic 45,X/46,X,dic(Yq). Phenotypical and histological findings among these cases were compared, and the possible localization of the genes responsible for testicle induction and maturation is discussed.


Extended evaluation of previously reported twins with a ring 14 chromosome. Extended studies of recently described twins with ring(14) are presented. A single C band and nucleolar organizer region were observed in the r(14). Gene marker evaluations are compatible with monozygosity of the twins.


Five month extrauterine survival in a female triploid (69,XXX) child. The case of a (69,XXX) triploid infant who survived 160 days is reported. Previously, the longest survival of a non-mosaic triploid had been 9 days. Possible reasons for this extensive survival are discussed.


Partial duplication 5q syndrome: phenotypic similarity in two sisters with identical karyotype (partial duplication 5q33 leads to 5qter and partial deficiency 8p23 leads to pter). Two sisters with statomotor developmental retardation microcephaly, hydrocephalus internus and externus without signs of pressure, heart defect (ventricular septal defect), early pulmonary resistance and characteristic facial changes were found to have the same unbalanced karyotype with partial trisomy 5q3300 leads to 5qter and partial monosomy 8p2300 leads to 8pter, derived from a balanced reciprocal paternal translocation: 46,XY,t(5;8)(q3300;p2300). The older girl was tested for the erythrocyte enzyme glutathion reductase. She had normal values.


[Partial trisomy for the distal part of the long arm of chromosome 15 due to a balanced maternal X/15 tranlsocation]. Partial trisomy for the distal part of 15q due to a balanced maternal translocation t(X;15) is described in a 21-month old girl with growth and psychomotor retardation and a cranio-facial dysmorphism ressembling that of a previously reported patient. Treatment of lymphocytes with BrdU has shown inactivation of the normal X in the mother, and inactivation of either the abnormal or the normal X in the proposita. When the abnormal X was inactivated, the extent of inactivation of the autosome was variable.


Deletion of the long arm of chromosome 4 [46,XX,del(4)(q31)] in a patient with congenital anomalies. A girl with congenital malformations and del 4(q31), identified by QFQ- and RFA- techniques, is described. The clinical findings are compared with the four cases of 4q- of the literature. Evident variability of the clinical features and the small number of cases of 4q- does not allow the delineation of a clinical syndrome.


[The Prader-Willi syndrome and 15-15 translocation]. The association of the Willi-Prader syndrome and a t(15q15q) is reported. This, in conjunction with an earlier report of this association, suggests that a gene related to the Willi-Prader syndrome may be present on chromosome 15.


Survival following infusion of Pitressin into the superior mesenteric artery to control bleeding esophageal varices in cirrhotic patients. Morbidity and mortality data from patients with bleeding esophagogastric varices treated with portosystemic shunts relate to the clinical status of the patient and to control of hemorrhage both in the immediate postoperative period as well as later. To obtain comparable data following selective infusion of pitressin into the superior mesenteric artery (SMA), records of 23 consecutive patients with cirrhosis, diagnosed by endoscopy as bleeding from varices and treated with SMA pitressin infusions, were reviewed. Twenty-four infusions were performed and hemorrhage was controlled in 12. Fourteen of the 23 patients subsequently underwent portosystemic shunts. Pitressin infusion controlled hemorrhage preoperatively in seven of these, and five survived one year or longer. The remaining seven, in whom bleeding was not controlled by pitressin, died postoperatively. One of the nine patients not undergoing a portosystemic shunt survived more than eight weeks after pitressin infusion. Vascular complications occurred in seven of 17 who died. These complications and the delay between institution of pitressin and operative therapy to control variceal hemorrhage appears to be a factor in the high mortality rate. Portosystemic shunt remains the best therapy for uncontrolled hemorrhage and to prevent recurrent bleeding from esophageal varices.


Posterior ventricular aneurysm, severe mitral regurgitation, and rupture of the left ventricle after acute myocardial infarction: six-year survival after surgical correction. Posterior ventricular aneurysm and severe mitral regurgitation due to acute myocardial infarction are rarely recognized during life. This report describes the successful surgical treatment of a patient with this combination of lesions who at operation was found to have rupture of the left ventricle as well. Aneurysmectomy, mitral valve replacement, and coronary artery bypass were performed with a gratifying late result. Aggressive investigation of patients with hemodynamic deterioration after posterior myocardial infarction may identify surgically correctable mechanical complications.


Technical considerations in saphenous vein bypass grafts to the right coronary artery. Measurement of the proper length for saphenous vein bypass grafts to the right coronary artery can be complicated by the increase in cardiac volume that takes place when extracorporeal circulation is discontinued. Inadequate or excessive allowance for this increase can cause undue tension on the grafts or troublesome kinking. This report describes an improved method of orienting vein bypass grafts to the right coronary artery which eliminates problems of incorrect measurement.


Stainless steel markers for aorta--saphenous vein anastomosis. A stainless steel marker for tagging the proximal aorta--saphenous vein anastomosis in a bypass operation has been devised and utilized in more than 600 patients over the past 3 years. This marker has been found superior to other methods used for marking vein grafts in that it encircles the anastomosis, providing accurate marking, and can be attached after both anastomoses are complete.


Left ventricular aneurysm resection: indications and long-term follow-up. Forty-four patients had resection of a chronic postinfarction left ventricular aneurysm. Operative indications were heart failure, angina, and ventricular arrhythmias. Twenty-six patients (59%) had coronary grafting in addition to aneurysmectomy. The operative mortality rate was 4.5% (2/44), and late mortality (mean follow-up, 31 months) was 17.9% (7/39). Preoperatively all patients were in New York Heart Association Functional Class III or IV; 91% were Class I or II postoperatively. Coronary bypass grafting did not increase the operative mortality rate, and long-term survival was similar between those receiving coronary grafts and those not receiving grafts. Postoperative ventriculograms were evaluated in 10 patients by means of a system of internal grids. Amount of regional myocardial contraction correlated well with the patient's postoperative functional capacity. It is concluded that ventricular aneurysmectomy in combination with coronary bypass grafting is safe and effective, resulting in marked improvement in the patients' functional capacity and longevity.


Coronary artery aneurysm.

Coronary artery aneurysm. The case is presented of a 28-year-old woman with systemic vasculitis, aortic insufficiency, and an aneurysm of the proximal right coronary artery. More than 100 patients with coronary artery aneurysm have been reported, and this represents the twenty-first case treated surgically. Coronary artery aneurysms occur more frequently than previously realized and are seen in approximately 1.5% of patients with coronary artery disease. In addition to arteriosclerotic aneurysm, other common types of coronary aneurysm include those occurring congenitally or from mycosis, dissection, trauma, vasculitis, or periarteritis nodosa. Because of the risk of thrombosis and rupture, aneurysmectomy and saphenous vein bypass grafting are recommended for all but small, diffuse, or multiple aneurysms or dissecting aneurysms.


Helium effect on isolated nerve activity. Various gases were administered to isolated frog sciatic nerves in which action potential amplitudes were recorded in sheathed and desheathed preparations. In the sheathed preparation, nitrogen and argon showed significant anesthetic effects while in the desheathed preparation, helium also depressed the action potential amplitude. In the desheathed frog sciatic nerve, helium demonstrates an anesthetic effect similar to 10(-6) M lidocaine suggesting that at long exposure periods helium may demonstrate anesthetic properties.


Intraoperative localization of intestinal arteriovenous malformation. Intestinal arteriovenous malformation (AVM) is an uncommon cause of gastrointestinal hemorrhage and is difficult to diagnose. Selective visceral angiography is essential to make the diagnosis and to localize the lesion. We treated two patients in whom AVMs of the small intestine were located by means of arteriography and intraoperative selective mesenteric venous pressure and PO2 measurements. The local venous return from an intestinal AVM is characterized by elevated venous pressure and PO2 levels compared with the venous drainage of adjacent normal intestine.


The monitoring of serum factors in patients with cancer. Numerous changes occur in the sera of patients bearing malignant neoplasms. These changes may take the form of appearance of oncofetal proteins that are normally not detectable in non-cancer-bearing patients, or an alteration in the normally present serum constituents such as the serum proteins. Monitoring of these serum factors may be of considerable value in assessing the progress of cancer patients following treatment of their primary tumour. This paper reviews progress in this area to date and documents our early results with six non-specific serum factors (total protein, total protein hexose, total protein hexosamine, ceruloplasmin, alpha-1-antitrypsin, and haptoglobin), in 64 patients bearing a variety of malignant neoplasms in various stages of the disease. Present methods of postoperative assessment of cancer patients are inadequate for detecting early recurrence. Preliminary results indicate that the nonspecific serum factors that we are studying may be of considerable value for monitoring of cancer patients, and may also possibly serve as a diagnostic screen in high-risk groups.


Tumour immunology.

Tumour immunology. Antigens which distinguish neoplastic cells from their normal counterparts can be identified in some, but by no means all, experimental tumours. Specifically immunized hosts can in appropriate circumstances reject small tumours immunologically. The mechanisms of rejection remain unknown. The extent to which most human neoplasms excite a rejection reaction is still not clear. While the behaviour of neoplasms appears to be influenced by the immune system, the concept of immunological surveillance against neoplasia is losing support. Clinical immunotherapy has not yet achieved notable success, and remains empirical.


Visual-vestibular interaction in the control of eye movement. Three experimental conditions have been used to investigate the extent to which inappropriate reflex eye movements of vestibular origin can be suppressed by visual feedback. First, the ability to read digits in a display which moved with the head was assessed during angular oscillation about the yaw and pitch axes of the body. Performance decrement was observed at frequencies above 0.2 Hz in pitch and 1.0 Hz in yaw, being greater at higher stimulus velocity levels. A second experiment revealed that the performance decrement was associated with eye movements relative to the head, which increased with the frequency of stimulation. Finally, the response of the pursuit reflex was investigated under similar experimental conditions. The results indicated that the breakdown in the pursuit reflex and in the suppression of the vestibulo-ocular reflex occurred over the same frequency band, implying the similarity of the mechanisms responsible for suppression and pursuit.


Visual target acquisition and tracking performance using a helmet-mounted sight. Experiments have been conducted on human subjects to assess the efficiency with which a helmet-mounted sighting system can be used to locate and track target sources in the horizontal plane. In the first experimental condition, in which the sight was aligned with discrete stationary target sources, the latency between target presentation and final target location was in the 2-4 s range, dependent upon the amplitude of target offset and the rate of head movement. In the second condition, subjects were instructed to track a sinusoidally oscillating visual image with the sight. Tracking performance was found to be impaired when the frequency of oscillation was increased beyond 0.8-1.0 Hz. Recording of eye movement during both experimental conditions indicated that the impairment of performance could, in part, be attributed to involuntary eye movements consequent upon stimulation of the vestibulo-ocular reflex by the head turning movements.


Effect of prehatching weightlessness on adult fish behavior in dynamic environments. At 16-17 months of age, three groups of fish from the embryonated eggs in the ASTP killifish experiment were subjected to postflight tests consisting of rapidly changing environments. It was found that the group of fish with the least amount of development at orbital insertion (A-32) had a decreased rheotropism for both the moving background and the rotating water current tests when compared to ground control fish. Exposure to parabolic aircraft flight conditions revealed that the A-32 fish were less disoriented during zero gravity periods and were hypersensitive to high-gravity periods. These results suggested a modified vestibular competency due to a 9-d prehatching weightlessness exposure.


Familial lupus. Family studies of HLA and serologic findings. HLA profiles in 103 members of 4 separate kindred with multiple occurrence of SLE were compatible with the presence of a disease susceptibility factor linked to HLA or a direct effect of antigens B8, A11, and B35 on disease expression. Serum ANA was found in 52.9% of consanguineous, 56.5% of nonconsanguineous relatives of SLE probands, and 5% of controls, a finding that suggests the presence of a transmissible agent in the families. By contrast, lymphocytotoxic antibodies were not increased in relatives compared to controls.


Effect of altered lymphocyte function on immunologic disorders in NZB/NZW mice. III. Acceleration of disease by thymosin. Administration of thymosin fraction V to NZB/NZW F1 mice, an animal model for human SLE, accelerated the appearance of proteinuria and anti-nDNA antibodies, increased deposition of immunoglobulins in kidneys, and significantly shortened survivals. Although the addition of thymosin to in vitro cultures of spleen and lymph node cells from thymosin-treated mice increased DNA synthesis in response to stimulation with Con A, in vivo treatment with thymosin did not affect the Con A response. There was no effect on in vitro responses to PHA or LPS, or on IgM antibody formation to SRBC (T cell dependent) or SSS III (T cell independent) immunizations. Antibodies to thymosin or contamination of our thymosin preparations with nucleic acids could not be demonstrated. The acceleration of autoimmune disease produced by thymosin treatment could not be explained by alteration of the T and B cell functions studied.


Automated rheumatoid factor assay in a population of patients with rheumatic disease. Rheumatoid factor has been measured in 128 patients having rheumatic disease to compare the Singer-Plotz assay with an automated particle size assay. Correlation coefficient between the two methods using regression analysis revealed r = 0.89, P less than 0.00001 when two different commercial sources of sensitized latex particles were used. Thus rheumatoid factor may be quantitated electronically and represented in arbitrary units (MPRF) without altering clinical interpretation. This methodology may be applicable to many other immunologic assays.


3-Tertiary amino-1-aryloxy- or aryl-propanes and -propan-2-ols and some related compounds. The synthesis and pharmacological activity of some 3-tertiary amino-1-aryloxy- or 1-aryl-, 1-thiophenoxy and 1-anilino-propan-2-ols and -propanes, particularly those derived from N-phenylpiperazines are described. Effect of substituents (nature/position) on the phenyl ring, the phenoxy ring as well as alteration in the hydroxylic function vis-à-vis the structure-activity relationships (SAR) are discussed. In general, the 1-aryloxy compounds have hypotensive activity--this being more pronounced in those carrying an o-substituent on the phenyl ring, while m and p-substituted derivatives have their effect primarily on the CNS. Variations in the phenoxy moiety do not significantly alter the intrinsic activity. The 1-aryl compounds, on the other hand, have significant CNS activity, which is markedly affected by the substituents on the 1-aryl residue.