Patient data acquisition.

Patient data acquisition. Patient data are acquired in three ways: by direct interrogation; physiological measurements; and analysis of specimens, signals, and images. When computers are used to acquire information from the patient directly, difficulties arise from the lack of standardized patient medical history, the complexities of natural language processing, and the problems of man/machine communication (patient with computer terminal, and physician with computer-generated history). A great variety of data input devices have been used for the acquisition of the patient medical history. Most have been extensively used in multiphasic health testing programs, and this experience is freely drawn upon in this paper.


Systems to support clinical decisions: automated medical signal analysis. The benefits and capabilities of an automated medical signal analysis system that can lead to more effective patient care are identified, the capabilities of different types of systems are briefly mentioned, and automated systems that support nominative and managerial decisions are described. The need for the practicing physician to anticipate computer hardware limitations and potential errors in programming are briefly discussed.


Introduction to computer systems in diagnostic radiology. Diagnostic radiology is immensely complex. It involves a consultation process, patient handling to produce images, and advanced technology. Computers have been applied extensively to these processes, and examples are given of some of these applications. Fully integrated computerized radiology systems have been an elusive goal. Integrity of patient data is probably the key to integration. Progress in the field continues.


Computers in the clinical laboratory: what we have learned. The clinical laboratory responds to a request for results by processing a specimen. The output is a report on a priority response. The role of the laboratory computer is that of a work allocation control system, which monitors and directs this intricate piecework activity. The operation is analogous to light industry. Effectiveness depends upon hardware reliability and internal laboratory control of the computer system.


[The treatment of acute dehydration (author's transl)]. In infants and children acute dehydration is mainly caused by gastroenteritis with vomiting and diarrhoea, and by feeding failures. Since in the German speaking literature very different therapeutic regimens for rehydration are discussed the principles of oral and parenteral treatment are described. The rational therapy is based on the knowledge of physiology and pathophysiology of water and electrolyte metabolism. Therefore a few basic aspects are described, i.e. compartments of body fluids, turnover rates, the balance, types of dehydration, concentration of electrolytes in body fluids and their relevance to dehydration. Special problems exist in the treatment of hypertonic dehydration. In order to avoid cerebral edema the rehydration should not be attempted quickly with very hypotonic salt solutions, but should be performed with a 1/2--1/3 isotonic Ringer-lactate solution and early begin of potassium substitution over a period of 48 h.


[Group B streptococcus infections during the neonatal period (author's transl)]. Nowadays, in severe infections during the neonatal period new bacteria--group B streptococci--have to be taken into account, since in some clinics they already predominate over gramnegative rods. Septicemia and meningitis may be caused by group B streptococci. The septicemia which especially threatents prematures starts with apnoeic spells in the very first hours after birth and may be easily misdiagnosed as an idiopathic respiratory distress syndrome. The mortality is very high (about 60%). Meningitis starts later, normally during the 3rd to 4th week. Seizures are typical at the onset.  Group B streptococci may be identified in the CSF by counterimmunoelectrophoresis within one hour. The prognosis is more favourable in meningitis than in septicemia (mortality about 20%). Survivors have little neurological sequelae. Penicillin G or ampicillin combination with an aminoglycoside is recommended as chemotherapy. Exchange transfusion should be considered early. Group B streptococci causing the septic form may be transfered during labour since up to 25% of pregnant women are colonized. Nosocomial transmission of group B streptococci may be the reason for meningitis. Prophylactic penicillin does not seem to help in preventing the disease, but it is possible, that meningitis of the newborn may be prevented by immunizing the mother during pregnancy.


Determination of radiation equivalence of ethyl methanesulphonate (EMS) for induction of gene conversion in diploid yeast. A unit Rad-Equivalent Chemical (REC) has been suggested for purposes of quantitating the mutagenic hazards of chemicals. The usefulness of this approach is demonstrated by the establishment of a constant relationship between the forward mutation frequency and haploid genome size in various organisms for both radiation and chemical EMS. However, it is necessary to determine the radiation equivalence of chemicals in as many organisms and for as many end-points as possible. For end-points we are limited to forward mutations. Another relevant genetic end-point of interest in this regard is gene conversion which can also monitor any kind of DNA damage in a suitable diploid system. Hence, we have determined the REC value for EMS in diploid yeast with gene conversion as the end-point. This agrees well with the REC values estimated in a number of organisms with forward mutation as the end-point. This finding further underlines the generality of the REC concept.


On the mechanisms of induced somatic recombination by certain fungicides in Aspergillus nidulans. Four fungicides interfered with the segregation of chromosomes at mitosis of Aspergillus nidulans by increasing the somatic recombination, shown as colour sectors in green colonies, in a strain heterozygous for spore colour mutations. In an attempt to discover the mechanisms by which these fungicides increased the somatic recombination, a prototrophic diploid strain, heterozygous for colour and several other appropriate markers in all chromosomes, was used which enabled the detection and classification of all colour recombinants to be made by genetic analysis. The fungicides investigated were: benomyl (methyl-1-(butylcarbamoyl)-2-benzimidazole carbamate) a benzimidazole derivative, botran (2,6-dichloro-4-nitroaniline) and chloroneb (1,4-dichloro-2,5-dimethoxybenzene) of the aromatic hydrocarbon group of fungicides, and the antibiotic actinomycin D. At least three different mechanisms, non-disjunction, mitotic crossing-over and breakage-deletion, were found to be responsible for the recombinogenic activity of the compounds studied.


The role of Aspergillus fumigatus fresenius in dermatitis of chickens. Aspergillus fumigatus proved to be the causative organism of dermatitis in chickens. This has been assessed mycologically as well as histopathologically. The histopathological lesions caused by the fungi are fully described. The different factors which might help the establishment of the mycotic infection are discussed.


Cobalamin analogues are present in human plasma and can mask cobalamin deficiency because current radioisotope dilution assays are not specific for true cobalamin. Since R protein binds cobalamin (vitamin B12) and cobalamin analogues, whereas intrinsic factor is highly specific for true cobalamin, we compared the serum cobalamin values obtained with these proteins in radioisotope dilution assays. With R protein, eight of 21 patients with cobalamin deficiency had serum cobalamin levels (mean, 204, range, 85 to 355 pg per milliliter) that overlapped with values for 74 normal subjects (mean, 576, range, 220 to 1230). With intrinsic factor, no patient values (mean, 36, range, less than 10 to 78 pg per milliliter) overlapped with the normal values (mean, 322, range, 130 to 785). Paper chromatography showed that these differences were due to the presence of cobalamin analogues. R protein constituted 51 to 85 per cent of the cobalamin-binding protein in 10 commercial serum cobalamin assay kits, which were said to contain "intrinsic factor". Human plasma contains cobalamin analogues that can mask cobalamin deficiency with current radioisotope dilution assays.


Improvement of kidney-graft survival with increased numbers of blood transfusions. In a study of 1360 cadaver-donor kidney transplants we found a striking correlation of increased numbers of pretransplant blood transfusions with improved transplant survival (P less than 0.0001). Graft survival rate in recipients with greater than 20 transfusions was 71 p5 per cent at one year as compared with 42p2 per cent for recipients with no transfusions; at four years the survival rates were 65p5 per cent and 30p3 per cent (P less than 10(-6). Frozen blood was less effective than nonfrozen blood in producing this effect. In contrast to previous reports based on fewer numbers of transplants, a single pretransplant transfusion of transfusions given during transplantation had no statistically significant influence on graft outcome. The beneficial effect of pretransplant transfusions was apparent at transplant centers with high or low overall success rates. Deliberate transfusion trials in prospective transplant recipients should consider this strong dose dependence of graft prolongation by transfusions.


Immunoglobulin classes of human serum antibodies in vaginal candidiasis. The titre and immunoglobulin class of antibodies against Candida albicans in serum from 60 non-pregnant women was determined. IgG titres up to 1 : 32, IgA titres up to 1 : 8, and IgM titres up to 1 : 4 were detected in 30 women with vaginal candidiasis. Similar titres were found in 20 women harbouring yeasts in the mouth or rectum, and in 10 women who were not harbouring yeasts in the vagina, mouth or rectum. Serum fractionation confirmed that antibodies to C. albicans are found in the three immunoglobulin classes and that those antibodies reside in highest titre in the IgG class. No secretory IgA antibodies against C. albicans were detected in the serum of these women.


[Amino acid composition of non-absorbed peptide fractions in rat small intestines. III. Feeding of wheat gluten and molasses yeast. Essential amino acid content of feces]. The authors investigated the nitrogen content of different fractions and in particular the aminoacid composition of the trichloroacetic acid (TCA)-precipitable and TCA-soluble peptides in the distal small intestine of rats which had been fed experimental diets (nitrogen-free or containing casein, wheat gluten or molasses yeast as a protein carrier). Parallel with this, they determined in growing rats the nitrogen and amino-acid digestibility of molasses yeast and wheat gluten according to the technique of faecal analysis, and studied the amino-acid composition of the faecal protein. Independently of the dietary protein fed, the peptide fractions of the content of the intestine showed an amino-acid composition that was largely similar to that found in case of nitrogen-free diet. The amino-acid composition of the faecal protein is, independently of the dietary protein given, relatively constant and corresponds approximately to the intestinal loss protein. There is agreement between the amino-acid composition of the TCA-precipitable peptide fractions and those of the corresponding faecal proteins. These components seem to be of endogenous origin.


Transformation of yeast by a replicating hybrid plasmid. Chimaeric plasmids have been constructed containing a yeast plasmid and fragments of yeast nuclear DNA linked to pMB9, a derivative of the ColEl plasmid from E. coli. Two plasmids were isolated which complement leuB mutations in E. coli. These plasmids have been used to develop a method for transforming a leu2 strain of S. cerevisiae to Leu+ with high frequency. The yeast transformants contained multiple plasmid copies which were recovered by transformation in E. coli. The yeast plasmid sequence recombined intramolecularly during propagation in yeast.


Fibronectins--adhesive glycoproteins of cell surface and blood. A recently characterised class of adhesive, high molecular weight glycoproteins is present on the surfaces of cells, in connective tissue matrices, and in extracellular fluids. These proteins may have important roles in cellular adhesion, malignant transformation, reticuloendothelial system function, and embryonic differentiation.


Bacteriophages inhibit degradation of abnormal proteins in E. coli. On infection of Escherichia coli cells by bacteriophages T4, T5 or T7, the degradation of E. coli protein fragments and abnormal proteins is inhibited. Normal E. coli proteins, however, continue to be degraded at their usual rates. T4 early proteins (s) is needed to inhibit the turnover of abnormal proteins in T4-infected E. coli cells.


Lungs as a generator of prostacyclin--hypothesis on physiological significance. In vivo anti-platelet de-aggregatory activity of exogenous prostacyclin is enhanced after its passage through the pulmonary circulation of anaesthetized cats, probably because of a concomitant generation of endogenous prostacyclin by the lungs. Evidence is also presented that perfused lungs of guinea pigs and rats spontaneously release considerable amounts of prostacyclin. It is therefore postulated that a continuous biosynthesis of prostacyclin by pulmonary endothelium is a general physiological phenomenon, while the generation of thromboxane A2 by lungs occurs in response to pathological stimuli. Coronary and cerebral arteries are supposed to benefit from this hormonal function of the lungs.


Osmotic stimulation of pepsin secretion in the rat. The effect of the osmolarity of intragastric instillates on pepsin secretion was studied in rats anaesthetised with urethane. Irrigation of the stomach with solutions of sucrose and NaCl, resp. caused a concentration-dependent increase in pepsin output. A stimulation was observed already by hypotonic solutions and the maximal effect was obtained by 300 m-osmole/l of sucrose and by 600 m-osmole/l of NaCl (13- and 10-fold stimulation resp.). A similar time course in the increase of pepsin output was produced by hyperosmotic solutions (600 m-osmole/l) of sucrose, urea, NaCl and choline chloride. Pepsin output was stimulated maximally within 30 min and decreased thereafter, but remained at about 4--6-fold higher levels than during the previous irrigation with distilled water. Replacement of hyperosmotic instillates by distilled water reduced pepsin secretion to the initial level. Hypertonic ethanol (600 m-osmole/l) increased pepsin output only slightly. Vagotomy, pretreatment with atropine (1 mg/kg i.v.) or cimetidine (5 mg/kg i.v.), local anesthesia of the gastric mucosa with 4% lidocaine or intravenous infusion of PGE2 (2 microgram/kg X min) did not antagonise the stimulation of pepsin output induced by hyperosmotic NaCl (600 m-osmole/l). The results indicate that the increase of the osmolarity of intragastric instillates stimulates pepsin secretion in the rat without involvement of neural (vagal or local cholinergic reflexes) or hormonal mechanisms (release of gastrin) which are known to stimulate gastric secretion in the gastric phase.


25 years of neuroepidemiology in the Americas. In the Western Hemisphere, prior to 1950, there were few reliable data on the incidence, geographic distribution or population patterns of diseases of the nervous system. Impressions of prevalence were generally derived from the European literature and from a variety of case reports and relative frequencies based on clinic or hospital admissions or selected autopsy series. Since such data from different sources generally defy comparison, it has been necessary to develop data sources for defined populations to provide incidence and prevalence rates. Such an effort, initially concerned with multiple sclerosis, was launched in 1950 by NIH. International mortality statistics were also collected and analyzed and intensive population surveys in the United States and Canada were planned and carried out. In time, such efforts were extended to cover a wide variety of other chronic and subacute diseases of the nervous system, and support was provided by NIH and voluntary agencies for studies in many other countries. Independently, population studies were developed at various Universities and health care facilities in Latin America. ISSSTE in Mexico City provided a broad experience on multiple sclerosis, ALS, epilepsy, stroke and brain tumor; studies developed in the West Indies on Jamaican Neuropathy; and there were studies in several countries on cysticercosis, Chagas' disease and epilepsy. Also notable are recent studies in Guatemala and plans for geographic comparisons over the broad range of latitude in Chile. The advantages and limitations of mortality statistics will be discussed. The priorities in the selection of the disorders which were to be studied, the procedures which were developed, and the highlights of the results of such investigations will be presented. In addition to descriptive population surveys, case control comparisons and prospective studies are also being developed which seek to identify the risk factors or etiologic determinants that may account for the population pattern which have been observed.


[Possible role of acetylcholine-acetylcolinesterase in the etiopathogenesis of epilepsy]. Of the results obtained by numerous investigators in the study of the acetylcholine-acetylcholinesterase system, it is quite clear that it is altered significantly in the convulsive state. In the present work, a study of the acetylcholinesterase activity (AChE) in serum was made in 53 patients with different type of epilepsy during the intercritical period. A significantly high increase in the enzymatic activity (p less than 0.001) was found, compared with that of the controls, unrelated with the probable etiology of the process nor with some symptoms. We observed, nevertheless, a tendency towards diminished enzymatic activity with an increase of the severity of the electroencephalographic picture, and we interpreted this as a compensating effect. The AChE activity in serum and cerebrospinal fluid of a group of epileptic patients subjected to stereotaxic operations was studied before and after surgery, observing a significantly diminished activity of AChE in serum (p less than 0.001) after surgery. This asserts the hypothesis of the compensating increase of the AChE activity in serum, which tends to normalize once some of the factors producing the decompensation are eliminated.


Relationships between portions of the third and fourth ventricles. An aid to stereotactic accuracy for posterior fossa stereotaxy. The relationships between the third and fourth ventricles have been studied by examination of the angles formed by third and fourth ventricular projections. These have been subjected to statistical analysis and have proved useful for posterior fossa stereotactic surgery.


Valproic acid: interaction with other anticonvulsant drugs. The interaction of valproic acid and other antiepileptic drugs was studied in 25 patients for 5 to 9 months. Clinical evaluations, seizure records, and antiepileptic drug levels were followed regularly. Eleven of the 13 patients required a reduced phenobarbital dose when concurrently treated with valproic acid. This reduction was prompted by sedation. An average dose reduction of 46 percent resulted in an average serum phenobarbital decrease of 15 percent. Ten of 15 patients had decreased phenytoin concentrations during concurrent administration with valproic acid. No definitive conclusion was reached about other antiepileptic drugs. Decreased phenobarbital excretion because of urine acidification and displacement of phenytoin from protein binding sites may account for the observations. Careful monitoring of anticonvulsant levels is required in anticipation of the documented interactions.


Rectal administration of sodium valproate in status epilepticus. Six patients suffering from status epilepticus were refractory to parenteral treatment with either diazepam, amobarbital or both, and were given sodium valproate 200 to 800 mg every 6 hours. The drug was administered rectally as 200 mg lipid-based suppositories, thereby avoiding impaired absorption, which occurs in the presence of paralytic ileus. Plasma levels of sodium valproate in all patients reached the therapeutic range within 36 hours of starting therapy. Seizures were totally controlled in five patients and a 75 percent reduction was noted in the sixth. In two patients, the route of administration was changed from rectal to an equivalent oral dose with continuing control of seizures and minimal change in plasma levels, suggesting that bioavailability is similar for the two forms of the drug. The rectal route of administration was effective in achieving systemic absorption of sodium valproate in the treatment of status epilepticus.


Effect of valproic acid on hepatic function. Altered hepatic function tests occurred in four of 25 patients treated with valproic acid. An average dose reduction in three patients of 10 mg per kilogram per day resulted in reversion of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) to normal. The drug was discontinued in one patient. Careful monitoring of hepatic function is required of patients being treated with valproic acid, but our experience suggests that dose reduction alone may be effective in preventing untoward hepatic side effects.


[Functional studies after pulmonary autografts or hilar stripping. Experimental research]. pO2, pCO2, pH and ERO2 were controlled in the autotransplanted lung and after hilar stripping. The contralateral lung was excluded by ligation of the right pulmonary artery. It appeared that such ligation is not sufficient for this purpose, whereas hilar stripping offers an adequate experimental model for the simulation of autotransplantation.


[Tumoral pathology of the jejunum. Apropos of 5 cases]. 1654 cases of tumour of the digestive tube operated on in the Department of General Clinical Surgery and Surgical Therapy of the University of Pavia, during the period 2nd half 1964--1st half 1977, have been considered. Four primary tumours (1 leiomyoma, 2 adenocarcinomas, 1 reticulosarcoma) and one secondary tumour (metastases of retroperitoneal sarcoma) occurred in the jejunum and their pathology is examined from the etiopathogenetic and anatomoclinical viewpoints.


[Stomitis caused by non-absorbable sutures: a complication to be avoided]. Stomitis due to non absorbable sutures is an increasingly common endoscopic finding. Personal experience has shown that this complication is not encountered when catgut sutures are employed in stomach operations. It is therefore recommmended that this or other absorbable material be used in gastric surgery. Stress is placed on the need to make use of absorbable threads for both inside and external sutures, since inflammation may be observed in the anastomosis even in cases where catgut is used fro mucosa-mucosa stitches and nonabsorbable material for serosaserosa sutures.


[Controlled clinical study of the effects of Anasclerol in hospitalized patients with cerebrovascular disorders]. A double-blind clinical trial of vincamine hydrochloride and a known dihydrogenated ergotoxine derivative, administered i.m. for 10 days, was conducted on 2 groups of 10 hospitalised cerebrovascular patients. Hemiplegia was evaluated prior to treatment and on its 5th and 10th day, by a scoring system. Statistical assessment of the results and the clinical observations showed that vincamine hydrochloride can be usefully employed in the treatment of acute cerebrovascular accidents on account of its marked effectiveness and rapid action--these being attributable to its cerebral vasoregulatory and metabolic mechanism, and to increased availability due to salification of the basic molecule--, coupled with its excellent local and general tolerability.


[A case of oral localization of Crohn's disease. Review of the literature]. A case of Crohn's disease with specific tonsillar, pharyngeal and laryngeal lesions is presented. The unusualness of this site was clear from the literature. Stress is laid on the ubiquity of lesions indicative of the systemic nature of the disease. The intestinal lesions contain a viral agent that can be transmitted to animals.


[Notes on respiratory and cardiac pathology in an unpublished letter of Maurizio Bufalini]. An unpublished letter written by Maurizio Bufalini on 8th January 1820 describes a clinical case of considerable gravity characterized by asthma with pleural effusion and "dilatation of the vena cava". On this basis, the state of knowledge of asthma in that period, particularly in relation to heart diseases, is reviewed. Following a careful examination of the letter, the possibility that M. Bufalini may have been a forerunner of the modern concept of cor pulmonale is suggested.


[Ultrastructural and immunohistochemical analysis of cells during the changeover period in isoenzyme synthesis during drosophila ontogenesis]. The ultrastructural and immunohistochemical studies of the differentiating epithelial cells of the ejaculatory bulb in D. littoralis Maigen (=D. imeretensis Sokolov) have shown that the change of synthesis of non-specific isozyme of carboxyl esterase to synthesis of organospecific carboxyl esterase is realized at the same time in all epithelial cells. The epithelium of ejaculatroy bulb is homogeneous by its celluaar composition at all stages of differetiation under study. No mitosing cells or distinct foci of degeneration were found in the epithelial layer after the flight of imago.


Speech considerations in oral surgery. Part I. Speech physiology. A brief overview of the physiologic process associated with speech is presented. The areas of respiration, phonation, and articulation are defined, along with the role each plays in the production of speech sounds. Finally, a discussion is presented as to why an understanding of the dynamics of speech production is needed when ablative surgery is the preferred course of management for oral malignancies.


Speech considerations in oral surgery. Part II. Speech characteristics of patients following surgery for oral malignancies. The characteristics of speech following ablative surgery for oral malignancies are presented. The speech following cheilotomy, maxillectomy, mandibulectomy, nasopharyngeal excavation, and glossectomy is described. Emphasis is placed on glossectomy because of the prevalence of this surgery and the nature of the research being done in this area. Finally, a discussion of research needs involving the oral surgeon, dentist, and speech pathologist is presented.


Human pulp response to a new composite system. Vytol composite restorative and bonding agent. A new two-paste composite system (Vytol and Vytol Bonding Agent) was evaluated to establish its level of pulpal response in human teeth and to determine whether a calcium hydroxide base is required. Class V cavity preparations were cut in seventy-two teeth of ten male patients whose ages averaged 52.5 years. The teeth were restored and extracted at 1 to 7 days, 12 to 14 days, and 47 to 56 days. Histologic evaluation indicated that the unlined Vytol System reacted very similarly to other commercially available composite restorative materials and that a calcium hydroxide base is effective in reducing or eliminating adverse pulp responses.


A pilot study of the treatment of outpatients with chronic pain: symptom control, stimulus control and social system intervention. Of 6 outpatients with chronic pain, 5 completed therapy based on a 3-part treatment package designed to provide symptom control, stimulus control and social system modification. Each of the components of the treatment package resulted in therapeutic change. A mean of 35.8 weekly hour long therapy sessions resulted in statistically significant decreases in pain, hopelessness, depression and analgesic medication intake. Generally, these improvements were maintained at 6 months and 1 year follow-up. This study is consistent with the notion that chronic pain is maintained by a combination of inter- and intrapersonal factors. A controlled comparison of this treatment program with other treatments for chronic pain is indicated.


[Unusual giant inclusions in blast cells during acute transformation of chronic myeloid leukemia. Cytochemical and ultrastructural study (author's transl)]. Unusual giant inclusions are reported in the blast cells during the blastic crisis of a chronic granulocytic leukemia. These inclusions coudl have their origin in degenerated mitochondria, and acid phosphatase positivity suggests fusion with lysosomes. A possible viral etiology is discussed.


[Electrical activity of the intestine in the conscious dog. Simultaneous pharmacologic investigation by chronic electrodes and electroperitoneography (author's transl)]. Two technics (chronic electrodes-electrointraperitoneography : EIG) have been used simultaneously in the conscious dog for the pharmacological study of drug effects on the electrical activity of intestine. The results show a good correlation between records obtained with the technic which needs a surgical operation (chronic electrodes) and the other which doesn't (EIG). The expected effects of the parasympathomimetic (acetylcholine-neostigmine) parasympatholytic (scopolamine) and adrenergic (epinephrine-neosynephrine) drugs used on the spiking activity are obtained with the two technics.


[Aging and atherosclerosis of human aorta. Comparative evolution of seven glycosyl-transferases and of lactate-dehydrogenase (author's transl)]. Seven glycosyl-transferases and the lactico-dehydrogenase from human aortas were assayed. These aortas were divided in five classes according to the age and in five steps according to the atherogenesis. These enzymic activities do not show any parallelism in their evolution; their variation with age and with atherogenesis is quite different. For example, the N-acetylgalactosaminyl-transferase activity increases with atherogenesis whereas it diminishes with age; on the other hand the lactate-dehydrogenase activity increases with age and decreases with atherogenesis; the sialyl-transferase activity is nearly constant during adulthood while it hardly declines with atherogenesis. These assays suggest: 1) an effect of energy metabolism on the glycosyl-transferase activities; 2) a qualitative and quantitative variation of the glycosaminoglycans biosynthesis; 3) a structural modification of the glucidic part of the glycoproteins which can induce the formation of antigenic sites.


Investigation and determination of the antifibrinolytic properties of dipeptides and synthetic compounds. 1) Investigation and evaluation of antifibrinolytic activity of some new compounds has been carried out using two technics based, one on the "standard clots" method and the other one on labelled clots methods. 2) Among the first four members of the linear amino diacids 2-aminopimelic acid possesses a slight antifibrinolytic activity, the others are non active. 3) The two dipeptides having the same chain length as EACA behave differently ; beta alanyl-glycine is practically inactive whilst glycyl-beta alanine possesses a significant inhibiting power. The question is raised as to whether this active dipeptide might play an antifibrinolytic role in the organism. 4) Among the cyclic epsilon-amino acids tested, alpha aminocampholic acid and dl cis (2,2 dimethyl-3-alpha-aminoethyl) cyclobutaneacetic acid possess and activity slightly superior to that of EACA.


[Long term course of insulin secretion in treated non-insulin dependent diabetics (author's transl)]. The long-term effects of sulfonamides were studied by means of hyperinsulinemia tests in 82 diabetics over a period of 12 months (24 months for 30 of them). Whereas for those (obese) diabetes whose only treatment was dieting--alone or combined with biguanides--hyperinsulinemia attenuates itself as do also variations in glycemia, although some asynchronism remains, in those diabetics treated with sulfonamides--alone or in combination with other treatments--the insulinemia curve is hardly modified.


Hereditary considerations in common disorders. We have reviewed the approach of the modern clinical geneticist to the genetics of common diseases. The importance of considering genetic heterogeneity within these groups of disorders has been emphasized. The physician should recognize our present inability to deliver exact recurrence risks for most families with these common disorders. As our knowledge improves, we must constantly update our counseling. Until then, in most cases, we can only utilize the empirical risk data presently available and provide an idea of the magnitude of risk, which in many of these disorders appears low. However, continued utilization of imprecise risk data must not impede recognition of potential and demonstrated heterogeneity within these disorders, or retard the development of new and improved risk data based on knowledge of the heterogeneity within common diseases.


[Demonstration of Reed-Sternberg cells immunoglobulin production by ultrastructural immunocytochemistry (author's transl)]. Presence of immunoglobulins in the Reed-Sternberg and Hodgkin cells cytoplasm is confirmed by ultrastructural immunoperoxydase methods using serum Fab human antigammaglobulins. Hypothesis proposed by Garvin of an immunoglobulin synthesis by unbound ribosomes seems probable.


[Physical state of lipids accumulated in atherosclerotic lesions (author's transl)]. The work of Small and al. concerning the physical state of lipids accumulated in atherosclerotic plaques, is analysed. This team of biophysicists studies the composition in cholesterol, cholesterol esters and phospholipids, of each type of lesion and reports it on a phase diagram, while identifying the physical state of these lipids by polarizing microscope and by X-ray diffraction. In such a way, they show that the ordinary fatty streak has a composition which situates it in the 2 phases-zone, and actually demonstrate liquid crystals of phospholipids (+ cholesterol + cholesterol esters) and oily droplets of cholesterol esters, but never cholesterol crystals. In the other types of lesions (intermediary lesions, fibrous plaques and atheromatous plaques) they find, in addition to liquid crystals and oily droplets previously mentioned, crystals of cholesterol monohydrate, which leads to 3 phases. These findings are in accord with experimental models studied by the authors, for whom the physical state of lipids plays a very important role in the formation as well as the regression of atherosclerotic plaques.


Heritable disorders of connective tissue: Ehlers-Danlos syndrome. The Ehlers-Danlos syndrome is a relatively common heritable disorder of connective tissue. The cardinal features are cutaneous hyperextensibility, joint hypermobility, bleeding diathesis, and tissue fragility, and these features lead to a large variety of additional manifestations. Of the eight presently described types, four varieties have been found to be caused by defects in the biogenesis of collagen, the major structural protein of the body. Consideration of the clinical features and probable mode of inheritance will permit subclassification of many patients into specific types, and biochemical confirmation is possible for several varieties.


[Antibody-coated bacteria in the urine of children. Technique and results (author's transl)]. The authors describe the technique used to detect the antibody-coated bacteria at the Hospital Trousseau (Paris). The presence of antibody-coated bacteria in 132 children with urinary tract infection is evaluated and compared to the serum antibody titres in 109 children of the same group.


[Biochemical modifications of connective tissue induced by the non-saponifiables of avocado and soya-bean oils administered percutaneously in the "Hairless" rat (author's transl)]. A mixture of non-saponifiable fractions of avocado and soya-bean oils was administered percutaneously, for fifteen days, in a 5% dilution in decanol. They resulted in modifications of constituents of connective tissue of the treated skin and in subjacent carrageenan induced granulome. The effect on the granuloma was reduced to an increased total protein content. As for the skin, the effect of the non-saponifiables was different from that induced by the vehicle by an increase of water and lipids and an increased level of soluble proteins, including collagen, as compared to insoluble proteins. The results are in agreement with those obtained using the non-saponifiables taken orally but the effects appear sooner and are localized essentially at skin level.


Effects of continuous positive airway pressure on pulmonary function and blood gases of infants with respiratory distress syndrome. Nitrogen washout measurements and blood-gas analyses were made on 32 newborn infants with severe RDS at continuous positive airway pressures (CPAP) of 5, 10, and 15 cm H2O. Increases in airway pressure resulted in significant increases in PaO2 and functional residual capacity (FRC). It also produced significant decreases in alveolar turnover rates of the "fast" and "slow" alveolar spaces of a two-space lung model. Changes in CPAP did not significantly affect the distribution of ventilation. The changes in PaO2, due to changes in CPAP, did not correlate well with changes in FRC/wt nor with changes in alveolar turnover rates. Thus, the effects of increasing CPAP on PaO2 were not simply due to increases in FRC. The changes in PaO2 are due to a complex relationship between changes in FRC, alveolar turnover rates, and to other alterations in cardiopulmonary function that are yet to be fully understood.


Postneonatal infant mortality in infants to a neonatal intensive care unit. The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death. One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related. Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.


Treatment of chronic childhood asthma with beclomethasone dipropionate aerosols: II. Effect on pituitary-adrenal function after substitution for oral corticosteroids. The effects of beclomethasone, dipropionate aerosol (DBA) (400 microgram/day) on clinical course, pulmonary function, and pituitary-adrenal function was studied in 34 steroid-dependent asthmatic children. Asthma severity was assessed by daily symptom and medication scores, peak flow measured three times a day, and weekly spirometry. Pituitary-adrenal function was evaluated by diurnal cortisol levels, cortisol responses to intravenous (IV) corticotropin (ACTH), and steroid responses to IV metyrapone. After 12 weeks of BDA therapy, 30 of 34 patients no longer required prednisone. Mean weekly symptom and medication scores and the number of attacks decreased significantly (P less than .01)). A significant improvement was demonstrated in the patients' peak flow (P less than .01), forced expiratory volume in one second, and maximum midexpiratory flow rates (P less than .01). Thirty of the 34 patients initially had abnormal metyrapone responses, 28 had abnormal diurnal cortisol levels, whereas only 14 had abnormal IV ACTH response tests. Although significant improvement was noted in the mean metyrapone and diurnal cortisol tests, only partial recovery of pituitary-adrenal function was observed in 20 patients, complete recovery in 5, and no change in 9. BDA was found to be therapeutically superior to oral steroids in the group of steroid-dependent asthmatic children and produced no serious adverse effects.


Otitis media in the neonatal intensive care unit. Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tympanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gram-negative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.


Postvaricella acute transverse myelitis: A case presentation and review of the literature. Although the complications and sequelae of varicella are rare, they can cause significant mortality and morbidity in both the normal and compromised patient. Eight cases of "pure" acute transverse myelitis (ATM) following varicella have previously been reported in the literature. We report the ninth case of postvaricella ATM in a 9-year-old girl. Her course was characterized by paraplegia, sensory loss, hyperesthesia, and incontinence of urine and feces. All patients, except ours, recovered fully from ATM.


Experimental design deck for clinical research: A new learning resource in aid of scientific thinking. The Experimental Design Deck for Clinical Research is a simulation of a problem in experimental design in a card deck format. It is intended to stimulate the development of skills in scientific thinking by allowing the student, in a self-directed fashion, to design a clinical trial to test either a given hypothesis (specific deck) or a hypothesis that the player provides (general deck). In addition to its use as an educational tool, the Experimental Design Deck can be used as a guide to the application of scientific thinking in a variety of biomedical activities. It can easily be modified for application to problems in nonmedical research and evaluation.


The percepton of motion: Michotte revisited. This paper extends the range of artificial-intelligence vision programs to the domain of moving objects, using the work of Michotte as a source of data for a computer program which purports to 'see' the action types he examined. Given the thesis that internal descriptions of a nonlinguistic type provide the basis for a constructive, knowledge-based theory of perception, the properties of a symbol-manipulating system capable of supporting this are explored as a challenge to the Michotte notion of "direct perception without interpretation".


Sir Charles Bell on visual direction.

Sir Charles Bell on visual direction. Helmholtz is usually credited with demonstrating the relationship between the perception of visual direction and eye muscle activity: he said that directional judgements resulted from the effort of will involved in altering the position of the eyes. However, Bell reached the same conclusion many years earlier, primarily on the basis of experiments with afterimages: an afterimage appeared to move with voluntary movement of the eye, but it appeared stationary when the eye was moved passively.


The stimulus-secretion coupling of glucose-induced insulin release. XXVIII. Effect of glucose on Na+ fluxes in isolated islets. The effect of glucose upon the handling of 22Na+ by pancreatic islets was investigated. Using a triple-isotope technique, the apparent concentration of Na+ in islet cells was estimated at 50--75 mM. The pattern of 22Na+ efflux from perifused islets indicates that this intracellular Na+ load is compartmentalized among a small, possibly organelle-bound pool characterized by a low fractional turnover rate (5%/min) and a large, presumably cystosolic pool displaying a much higher fractional turnover rate (20--34%/min). Glucose provokes a rapid, pronounced and sustained increase in the fractional outflow rate of Na+ across the plasma membrane and, under steady-state conditions, moderately reduces the concentration of Na+ inside the islet cells. The glucose-induced increase in Na+ outflow rate, which is also observed in response to glyceraldehyde and dose not require the presence of extracellular Ca2+, might be mediated, in part at least, by an ouabain-resistant ionophoretic system. The experimental data suggest that glucose also increases the inward transport of Na+ in islet cells by a veratridine-sensitive channel.


A non-invasive determination of lung perfusion compared with the direct Fick method. In 5 young pigs (7--9 kg each) data on effective lung perfusion were obtained using a sinusoidal forcing function in the inspired halothane concentration. These data were compared with the cardiac output measured by the direct Fick method for oxygen, corrected for venous admixture. To produce different levels of cardiac output during each experiment the respiratory and circulatory conditions were changed. For the 5 experiments taken together, the mean of the ratios between the non-invasively obtained effective lung perfusion and the venous admixture corrected Fick data was 1.01 (SD = 0.14, n = 55) with r = 0.92.


[Cutaneous and osseous autotransplant with vascular microanastomosis for the repair of a suppurating pseudoarthrosis with major loss of substance (author's transl)]. A 37 year-old-man with suppurative pseudoarthrosis of the leg with major loss of skin and bone substance, cure was cured by the autotransplant of a cutaneous-osseous block taken from the iliac crest, its vascularisation being ensured by microanastomosis of its vascular pedicle.


[The action of dihydroergotoxine in acute sickling crisis. Results of a double-blind study carried out in French speaking Africa (author's transl)]. A double-blind multicentre study was undertaken in French-speaking African countries, using parallel series in 34 SC homozygous or double-heterozygous subjects suffering from vasculo-occlusive sickling crisis. In the patients treated with dihydroergotoxine, there was a reduction in the duration of the episodes by 43 hours, i.e. more than one quarter of the total duration. This decrease was statistically significant (p is less than 0.05).


[Primary fibrosing cholangitis (author's transl)]. Primary fibrosing cholangitis is a rare and grave disorder. It consists of an inflammatory stenosis, localised or extensive, of the extra or intra-hepatic system, with intramural fibrous thickening, leaving the mucosa and the serosa undamaged. It has many similar features to primary biliary cirrhosis, and would seem to be the same response of the biliary system to an agression which remains of unknown aetiology. The resection of localised stenoses, bilio-digestive by-pass procedures or external drainage of the common duct can only delay progression towards fatal cholangitis.


[Surgical treatment of severe club foot: cutaneous plasty (author's transl)]. As they are seen late, some club feet get an important contracture of the skin. It can be an impediment to obtain a whole straightening of the foot by the cutaneous tension when the soft-tissues are closed. In order to avoid this risk, a rotational plasty is proposed, to which a "Z" plasty is added. It allows to realize a suture without any tension; it produces a very good and esthetic scar. So as, the physical therapy can be soon begun without any risk.


Evidence for RNA-RNA cross-link formation in Escherichia coli ribosomes. Evidence is presented in three separate cases for the formation of RNA-RNA cross-links in intact E. coli ribosomes and ribosomal subunits. The first case is a cross-link between the 18S and 13S regions of the 23S RNA, induced by ultraviolet irradiation. The second is a cross-link at the subunit interface, generated by the bifunctional reagent bis-(2-chloroethyl)-amine. The third example is a cross-link between sections O'-D and P-A of the 16S RNA, induced as in the first case by ultraviolet irradiation. The RNA-RNA cross-links can be identified as such, despite the complications introduced by concomitant RNA-protein cross-linking reactions. The experiments represent a first attempt to introduce RNA-RNA cross-linking into studies of the topographical organization of the RNA within the ribosome.


pBR322 restriction map derived from the DNA sequence: accurate DNA size markers up to 4361 nucleotide pairs long. I have derived a complete restriction map of pBR322 from the total nucleotide sequence of the plasmid. Most of the restriction sites also have been demonstrated empirically. The exact sizes of all restriction fragments and the relative positions of the cuts are presented. These fragments can serve as accurate DNA size markers from small pieces up to the 4362 base pair length of pBR322. Inserts cloned in this vector may be characterized easily using this data.


On the role of protein S4 N-terminal residues 1 through 30 in 30S ribosome function. 30S ribosomal protein S4 contains a single cysteine residue at position 31. We have selectively cleaved the peptide bond adjacent to this residue using the reagent 2-nitro-5-thiocyanobenzoic acid. The two resultant fragments were purified. The smaller S4-fragment (1-30) was found to be incapable of interacting with 16S RNA directly. This fragment also is not incorporated into a particle reconstituted from 16S RNA and 20 purified proteins with S4 missing. In contrast, the large S4-fragment (31-203) appears to be fully functional in ribosome assembly. Replacement of S4 with this fragment in the reconstitution reaction leads to a complete 30S ribosome containing all 30S proteins. This particle has a full capacity to bind poly U but has lost all activity for poly U directed phe-tRNA binding. We therefore propose that the N-terminus of protein S4 is not critical for ribosome assembly but is essential for tRNA binding.


[Pulmonary nocardiosis].

[Pulmonary nocardiosis]. Nocardioses are unusual broncho-pneumopathies with a dangerous evolution which should be better known. They occur usually, except in case no. 1, in patients with decreased immunity. For this reason they belong to superinfection with opportunist germs. It should be kept in mind when identfying the nocardia so as to start an early specific treatment.


[Bronchial fibroscopy. Indications and results]. The authors report a personal experience of 1.159 bronchial fibroscopies performed in 3 years. They review the literature for the indications and results of bronchial fibroscopy (except results on trans-bronchial biopsies). The diagnostic value of this technique is highly superior, where bronchopulmonary cancers are concerned, to the traditional bronchoscopy. Besides these classical indications, the place of bronchial fibroscopy in intensive care, and its help for bacteriological and parasitological diagnoses, must be underlined.


[Some observations regarding long-term intubation and tracheotomy (author's transl)]. The development of new non-irritating thermoplastic endotracheal tubes together with improved nursing techniques have resulted in a considerable reduction in the number of tracheotomies. The choice of method to keep the airways patient depends on various factors and must be made individually. The advantages and disadvantages of naso-tracheal and oro-tracheal intubation and of tracheotomy are reviewed. Some of the risks and complications attendant on long-term naso-tracheal intubation are discussed. Maxillary sinusitis due to obstructed drainage should have X-ray examination without delay and, if necessary, treatment. Suspicious of an open fracture of the base of the skull constitutes a contraindication to nasal intubation. Provided there are no contra-indications and the organs touched by the endotracheal tube (nose, pharynx, larynx) are regularly inspected, nasotracheal intubation can, with careful nursing, be continued for prolonged periods. Tracheotomy is still indicated in some cases.


[Haemodynamic changes during artificial ventilation with and without positive end-expiratory pressure in respiratory insufficiency (author's transl)]. Artificial ventilation with positive end-expiratory pressure (PEEP) affects the haemodynamic function of the various organs differently. Depending on intravascular volume, myocardial contractility and the pulmonary vasculature PEEP ventilation may result in a reduced cardiac output. By increasing the circulating blood volume the cardiovascular changes induced by PEEP can be minimized. When PEEP ventilation is stopped symptoms of hypervolaemia may appear. The effects of PEEP ventilation on the brain, liver, mesenterial circulation and kidney manifest themselves in a rise of intracranial pressure, reduced portal bloodflow, increased mesenteric vascular resistance and redistribution of the intrarenal blood flow respectively.


[Desquamative interstitial pneumonia. Peripheral eosinophilia in DIP: a new clinical aspect (author's transl)]. It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.


A case of Creutzfeldt-Jakob disease.

A case of Creutzfeldt-Jakob disease. The case is reported of a 64-year-old woman with ataxia and dementia progressing to a state of extrapyramidal rigidity and death in 10 months. The neuropathological changes characterised by severe nerve cell degeneration and loss, a hypertrophic astrocytic gliosis and a status spongiosus were widespread in the cerebral cortex, corpus striatum and cerebellum and confirmed the clinical diagnosis of Creutzfeldt-Jakob disease.


Plasma sodium valproate levels and clinical response in epilepsy. Serial plasma levels of sodium valproate were estimated in 12 epileptic patients and 10 normal subjects after a single dose of the drug, whilst random estimations were performed in another group of 32 patients already stabilised on sodium valproate. The tentative conclusions arrived at by this study were: 1) In the majority of patients and normal subjects peak plasma levels were reached by the end of the first or second hour. 2) The majority of clinically controlled subjects showed a plasma level above 40microgram/ml. 3) Similar doses of sodium valproate (mg/kg) produced higher plasma levels in normal subjects than in the epileptic patients. Whether this is an effect of other anticonvulsants the patients were taking at the same time is a matter for conjecture. 4) Dosage and plasma levels did not appear to show a close correlation. 5) Random estimation of plasma levels are of little value for monitoring therapeutic efficacy, unless timed in relation to the dose, for reasons already mentioned above.


Inactivation of phage repressor in a permeable cell system: role of recBC DNase in induction. UV light causes inactivation of phage (phi80) repressor molecules in a plasmolyzed, permeable cell preparation of Escherichia coli. Induction without UV irradiation occurs when the permeable cells are incubated in the presence of four deoxyribonucleoside triphosphates and ATP. The induction triggered by dNTP's requires a functional recBC gene product and is associated with degradation of the DNA replication fork. The role of recBC DNase in the induction of prophage and SOS functions in general is discussed.


Complementary sequences 1700 nucleotides apart form a ribonuclease III cleavage site in Escherichia coli ribosomal precursor RNA. The nucleotide sequence of Escherichia coli DNA at both ends of the gene for 16S rRNA has been determined for two rRNA operons, rrnD and rrnX. The 400 nucleotides we have examined exhibit only one base change between rrnD and rrnX. Within the 160 nucleotides that precede mature 16S rRNA sequences are cleavage sites for several E. coli endonucleases, including RNase III. A 240-nucleotide segment encompassing the 16S 3' end contains another RNase III site and the point of presumed RNase P scission at the 5' end of tRNA1Ile, the first tRNA appearing in the 16-23S spacer region of rrnD and rrnX. Most importantly, the DNA sequences predict that regions flanking the 16S gene in the rRNA primary transcript extensively base pair to form a double-helical structure whose hairpin loop includes the entire mature 16S molecule; within this structure is a 26-base-pair stem containing the two sequences at which RNase III action generates the 5' and 3' ends of a previously characterized precursor to 16S rRNA. Although our proposed secondary structure for this RNase III site is superficially dissimilar to previously described cleavage sites in the T7 early mRNA precursor, certain common features may constitute signals for RNase III recognition. The suggestion that distant portions of an RNA molecule can form a secondary structure within which specific endonucleolytic cleavages occur may have mechanistic implications for the joining of noncontiguous portions of gene sequences evident in several eukaryotic mRNAs.


Processing of the 5' end of Escherichia coli 16S ribosomal RNA. We have isolated and partially characterized an endonuclease involved in processing the 5' end of 16S rRNA of Escherichia coli. A mutant strain that is deficient in this enzyme accumulates a new precursor of 16S rRNA, named 16.3S rRNA. This rRNA has the 3' end of mature 16S rRNA but is about 60 nucleotides longer at the 5' end. In vitro, the enzyme preparation cleaves an RNA fragment of about 60 nucleotides from the 5' end of 16.3S rRNA in 30S ribosomal subunits, yielding the mature 5' end of 16S rRNA. In the mutant strain the 16.3S rRNA is associated with a full complement of 21 ribosomal proteins in 30S subunits. These particles, which comprise 50% of the total 30S subunits, are present on polyribosomes.


A protein methylesterase involved in bacterial sensing. A protein methylesterase has been identified in soluble extracts of Salmonella typhimurium and Escherichia coli. This enzyme catalyzes the hydrolysis of gamma-glutamyl methyl ester residues from membrane-bound 60,000-molecular weight proteins that are essential for chemotaxis. Analyses of methylesterase activity in a variety of chemotactically defective strains suggest that the methylesterase is a product of the cheX gene in Salmonella and the cheB gene in E. coli. In addition, the cheT gene product in S. typhimurium seems to play a role in expression of methylesterase activity. Mutant strains lacking the protein methylesterase tumble incessantly in the absence of attractant gradients. This behavior is the converse of that shown by mutant strains defective in methyltransferase activity, which swim smoothly in the absence of repellent gradients. This finding indicates that reversible methylation acts as a control mechanism and that both a methyltransferase and a protein methylesterase are instrumental in bacterial sensing.


Low molecular weight RNA species encoded by a multiple drug resistance plasmid. Multiple drug resistance plasmid NR1 is shown to code for at least 10 low molecular weight RNAs. These species, ranging in size from 60 to 120 nucleotides, have been purified from minicells by two-dimensional gel electrophoresis and characterized by RNase T1 fingerprinting. Hybridization of purified RNAs to restriction endonuclease digests of NR1 DNA indicates that most are derived from the resistance transfer factor region of the plasmid genome. One RNA was found to be coded by the transposable tetracycline resistance element Tn10, and several are associated with DNA fragments that contain origins of replication.


Fluorescent localization of membrane sites in glycerinated chicken skeletal muscle fibers and the relationship of these sites to the protein composition of the Z disc. Didansyl derivatives of amino acids and N-phenyl-1-naphthylamine were used to localize membrane hydrophobic sites in glycerol-extracted chicken skeletal muscle fibers. Epifluorescence microscopy revealed that such sites coincide with the distribution of mitochondria, the transverse tubular (T) system and the sarcoplasmic reticulum (SR). They are specifically associated with myofibril Z lines and occasionally extend from one Z plane to the next longitudinally along the muscle fiber. The hydrophobic probes interact noncovalently with the Z lines, and their induced fluorescence can be eliminated by exposure of the myofibrils to ionic detergents, nonionic detergents, or phospholipase C, before or after addition of the hydrophobic label. Extraction of glycerinated fibers with 0.6 M KI removes the majority of sarcomeric actin and myosin and leaves a scaffold of longitudinally interconnected Z planes. Membrane fluorescence remains tightly associated with these Z planes and with the remnant mitochondria. Shearing of such scaffolds results in the cleavage of the longitudinal connections and the production of large sheets of interconnected, close-packed Z discs in a honeycomb-like array. Comparison of the localization of two Z disc proteins, desmin and alpha-actinin, with that of the membrane material reveals that alpha-actinin is localized in the interior of each myofibril Z disc whereas both desmin and the membrane material surround each disc. Thus, glycerination and KI extraction of muscle fibers leaves remnants of T system and SR membranes tightly associated with the Z disc honeycomb lattice. Because the Z discs are connected at their peripheries through the T system appear to the plasma membrane, desmin and this membrane structure appear to be connected throughout the whole Z plane up to and including the plasma membrane. The congruent localization of desmin and the T system strongly suggests that this molecule mediates the adhesion of this membrane system around each Z disc.


The ovalbumin gene: cloning of the natural gene. The structural ovalbumin DNA sequences are not contiguous and are separated by multiple "intervening regions" in native chicken DNA. EcoRI, a restriction endonuclease that does not cleave the structural ovalbumin DNA sequences, digests the natural ovalbumin gene into three distinct fragments of 2.4, 1.8, and 9.5 kilobase pairs in length by cleaving within these "intervening regions." The 2.4-kilobase pair fragment contains only about 450 nucleotide pairs of coding sequence, with the rest being intervening sequences. This DNA fragment was cloned in bacteria by using the certified EK2 vector lambdagtWES.lambdaB after enrichment from total EcoRI-digested chicken DNA by a combination of RPC-5 column chromatography and preparative agarose gel electrophoresis. Five out of approximately 20,000 recombinant phage plaques were capable of hybridizing with a (32)P-labeled Hha I fragment of a recombinant plasmid pOV230 containing the entire structural ovalbumin gene. DNA amplified in these recombinant phages, lambdagtWES.OV2.4, was shown to contain the same restriction endonuclease cleavage sites as in the 2.4-kilobase pair EcoRI fragment previously determined by restriction mapping of total genomic chicken DNA. The intervening sequences were allowed to hybridize with excess total chicken DNA and oviduct nuclear RNA after nick-translation. They were found to be unique chicken DNA sequences, and appeared to be transcribed in their entireties during gene expression. Like the structural gene sequences, the expression of the intervening sequences is also inducible by steroid hormones.


In vitro system from Escherichia coli that catalyzes generalized genetic recombination. This paper reports an in vitro system for studying generalized genetic recombination. The system uses extracts from Escherichia coli as a source of enzymes and plasmid DNA molecules as substrates. Unit-size plasmid DNA rings are converted into genomes fused at a region of DNA homology at a frequency of about 5-10% over a period of hours. That the fused structures are the result of recombination is supported by two lines of evidence. When two partially homologous plasmids of different sizes are used as substrates for the in vitro system, intermediates containing one plasmid of each size are obtained. Furthermore, fused structures are not formed with high efficiency in extracts from recombination-deficient (Rec A(-)) cells.DNA synthesis does not appear to be required for the formation of the recombination intermediates; it is possible to omit DNA precursors from the reaction mixture and, furthermore, to develop the fused structures even in the presence of chaintermininating dideoxynucleoside triphosphates. The structures formed in vitro have the basic properties of recombination intermediates previously recovered from intact cells. That is, two genomes are demonstrably fused at a region of homology. However, in one way the molecules formed in vitro have a property less frequently observed in vivo-the fused genomes often appear to be connected over an extended region of homology ranging up to several hundred base pairs in length. This extended region of pairing may indicate the presence of two crossover connections very close together and, as will be discussed, may provide an insight into the mechanism by which the recombination intermediate is formed.


Lysyl-derived aldehydes in outer membrane proteins of Escherichia coli. The major outer membrane proteins from Escherichia coli K-12 are modified to contain alpha-aminoadipic acid delta-semialdehyde (allysine). The allysine was found to be derived from lysine and it was identified by derivatizing it to chloronorleucine by reduction, alpha-aminoadipic acid by oxidation, and to alpha,epsilon-diaminopimelic acid by reacting it with CN- and NH3. The alpha-aminoadipic acid was identified by mass spectrometry. Two major outer membrane proteins were found to possess allysine, a modified lysine characteristically found to connective tissue.


Ribonuclease P: an enzyme with an essential RNA component. The activity of ribonuclease P on precursor tRNA substrates from Escherichia coli can be abolished by pretreatment of this enzyme with micrococcal nuclease or pancreatic ribonuclease A, as well as by proteases and by thermal denaturation. Highly purified RNase P exhibits one prominent RNA and one prominent polypeptide component when examined in polyacrylamide gels containing sodium dodecyl sulfate. The buoyant density in CsCl of RNase P, 1.71 g/ml, is characteristic of a protein-RNA complex. The activity of RNase P is inhibited by various RNA molecules. The presence of a discrete RNA component in RNase P appears to be essential for enzymatic function. A model is described for enzyme-substrate recognition in which this RNA component plays an important role.


A bacterial clone synthesizing proinsulin. We have cloned double-stranded cDNA copies of a rat preproinsulin messenger RNA in Escherichia coli chi1776, using the unique Pst endonuclease site of plasmid pBR322 that lies in the region encoding amino acids 181-182 of penicillinase. This site was reconstructed by inserting the cDNA with an oligo(dG)-oligo(dC) joining procedure. One of the clones expresses a fused protein bearing both insulin and penicillinase antigenic determinants. The DNA sequence of this plasmid shows that the insulin region is read in phase; a stretch of six glycine residues connects the alanine at position 182 of penicillinase to the fourth amino acid, glutamine, of rat proinsulin.


Partial amino acid sequence of penicillinase coded by Escherichia coli plasmid R6K. Direct studies of the amino acid sequence of an Escherichia coli plasmid-coded penicillinase (penicillin amido-beta-lactamhydrolase, EC 3.5.2.6) are in complete agreement with results derived from the translation of the DNA sequence of a related plasmid, apart from a single amino acid substitution. This penicillinase from a Gram-negative bacterium shows 30-35% identity with functionally similar enzymes from Gram-positive bacteria. This paper should be read in conjunction with the report of the DNA sequence of the gene.


Nucleotide sequence of the ampicillin resistance gene of Escherichia coli plasmid pBR322. I have determined the nucleotide sequence of the ampicillin resistance gene of pBR322, an Escherichia coli plasmid that encodes a penicillin beta-lactamase. This gene codes for a protein of 286 amino acid residues. The first 23 amino acids presumably form a signal for secretion, because they do not appear in the mature enzyme, whose partial amino acid sequence has been determined independently.


High-resolution 13C nuclear magnetic resonance studies of glucose metabolism in Escherichia coli. High-resolution 13C nuclear magnetic resonance spectra of suspensions of Escherichia coli cells have been obtained at 90.5 MHz by using the Fourier transform mode. Anaerobic cells incubated with [I-13C]glucose show a time course of glycolysis in which the alpha and beta glucose anomers disappear at different rates, lactate, succinate, acetate, alanine, and valine accumulate as end products of glycolysis, and fructose bisphosphate appears as an intermediate. It is shown that fructose bisphosphate is labeled at C-1 and C-6 during [I-13C]-glucose catabolism. Upon oxygenation, glutamate appears with the 13C ENRICHMENT AT THE C-4, C-3, and C-2 positions, with the C-4 most intense. From the position of the 13C label we conclude that valine is formed by condensation of pyruvate and that carbon enters the tricarboxylic acid cycle mainly through acetyl CoA.


Matrix protein from Escherichia coli outer membranes forms voltage-controlled channels in lipid bilayers. Matrix protein from Escherichia coli was integrated into planar lipid bilayers. The incorporated protein generates aqueous channels across these membranes. Channels are induced irreversibly by voltage, and their number is proportional to the protein content of the membrane and stays constant over hours. They are uniform in size, with a diameter of about 1 nm and a single-channel conductance of 0.14 nS in 0.1 M NaCl. In addition to ionic conductance, the channels allow free diffusion of small, uncharged molecules. Channels assume either an open or a closed state. Membrane potentials shift this two-state equilibrium distribution in favor of closed channels, an observation that explains both negative resistance and inactivation at high potentials. Channels are not randomly distributed in the membrane but interact cooperatively within aggregates. The smallest entity inducible consists of three channels.


Contranscription of genes for RNA polymerase subunits beta and beta' with genes for ribosomal proteins in Escherichia coli. The lambdarifd18 transducing phage carries genes for RNA polymerase (nucleosidetriphosphate:RNA nucleotidyltransferase; EC 2.7.7.6) subunits beta and beta' (rpoB,C) and genes for four ribosomal proteins (rplK for L11, rplA for LI, rplJ for L10, and rplL for L7/L12). DNA segments of various sizes, which cover the rifd allele of the rpoB gene, were cloned into lambda vector phages. The hybrid phages were then analyzed for their ability to express the rpoB gene and neighboring ribosomal protein genes in ultraviolet-irradiated lambda-lysogenic and nonlysogenic bacterial hosts. The results show that the rpoB gene is cotranscribed with two neighboring ribosomal protein genes and that in the rpoB,C transcription unit is: promoter, rp1J, rp1L, rpoB, and rpoC.


Restoration of sensation to the hand by a free neurovascular flap from the first web space of the foot. A neurovascular free flap from the first web space of the foot was used successfully in two patients for replacement of glabrous skin of the hand and fingers. The potential advantages of this flap are that (1) it may be used to replace large defects of glabrous skin, (2) it provides a rich vascular supply to the periphery of the hand, and (3) the sensation achieved approaches the normal for the intact glabrous skin of the hand.


Application of glove designs in resurfacing the dorsum of the hand. Careful surgery, a precise dressing technique with prolonged immobilization, and the utilization of designs borrowed from the glove industry are integral aspects in our attempts to resufrace the dorsal surface of the hand. One case is presented to demonstrate our method.


THe hazards of injecting local anesthetic solutions with epinephrine into flaps: experimental study. In a study using paired longitudinal flaps on the back of the rat, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps. Epinephrine concentrations of 1:200,000 and 1:400,000 were demonstrated to significantly increase losses in these flaps. Epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 were not demonstrated to be harmful to undelayed flaps, in the dosages used.


Reconstruction of mandibular defects with revascularized free rib grafts. Two cases of hemimandibular reconstructions with revascularized free rib grafts are presented. The viability of the transplants was confirmed by bone scans and biopsy, even though the main nutrient vessels providing the intramedullary blood flow were not included in these grafts (and only the periosteal circulation was utilized). The removal of a rib graft without the nutrient vessel eliminates the need for a complicated posterior dissection, close to the costovertebral joint. Revascularized free bone grafts have a greater chance of survival, provide more rapid healing, offer less risk of absorption, and are more resistant to infection than conventional bone grafts.


Transfer of free flaps to provide well-vascularized, thick cover for breast reconstructions after radical mastectomy. The use of a free flap to bring in well-vascularized cover for a breast reconstruction (following radical mastectomy) is presented. Eleven of 12 such transfers were successful. (One free groin glap failed, and that reconstruction was abandoned.) Patients for breast reconstruction who have a marked deficiency of healthy, well-vascularized skin and subcutaneous tissue in the area are suitable candidates for this operative procedure. When a free groin flap is transferred, the donor defect is minimal.


Choosing the correct Limberg flap.

Choosing the correct Limberg flap. A technique is presented for designing the 8 possible Limberg flaps to close any given rhomboidal defect. Then we show how to choose out of those 8 the only two that will be correctly oriented so the donor area of the Limberg flap can be closed with a minimal amount of tension.


Experience with the glans flap operation for distal penile hypospadias. A review of 62 consecutive cases. We review our results from the surgical treatment of distal penile hypospadias, using the glans flap operation of Horton and Devine, in 62 consecutive cases. We recommend this operation, as it is our treatment of choice for this crippling congenital deformity.


Use of a cross-forearm neurocutaneous flap to provide sensation and coverage in hand reconstruction. A cross-forearm, neurocutaneous flap has been used in certain clinical situations to restore coverage and sensation over hand defects. Based on the superficial branch of the radial nerve, this flap provides a combination of handlike skin and subcutaneous tissue with sensation, which can be transferred. A fascicular neurorrhaphy between the superficial branch of the radial nerve and an appropriate recipient nerve stump has resulted in new epicritic sensation in the reconstructed area.


Two new procedures for plastic surgical repair, as used in a shotgun injury of the hand. We report a shotgun injury of the hand, in which two new procedures for plastic surgical repair were carried out. These procedures may be applicable elsewhere in plastic surgery.


Secondary correction of the burned eyelid deformity. We describe our experience in late reconstructions of 35 burned eyelids. On this basis we advocate wide, aggressive release of all scar contractures, including the distal part of the levator when necessary. To cover the resultant defects we use generous full-thickness skin grafts, if available, for both the upper and lower lids. Rarely has a tarsorrhaphy been required, and properly constructed dressings provide satisfactory lid immobilization and permit conjunctival hygiene. During the postoperative period the vision need not be obstructed by a tarsorrhaphy, Frost sutures, or the dressings.


Primary one-stage repair of large lateral defects of the nose. We report our procedure for a primary one-stage repair of a large lateral defect of the nose.


Study of encapsulation of silicone rubber implants in animals. A foreign-body reaction. It has long been known that the formation of a fibrous capsule around an implant is a general phenomenon in nature, an inevitable result of the tissue defense mechanism called the foreign body reaction. We have investigated this reaction in animals and find it consists of a series of interrelated processes in which the final result may vary, depending on the susceptibility of the foreign material to phagocytosis, incorporation by giant cells, or isolation by fibrosis. This susceptibility depends, in turn, on the physical and chemical properties of the implant. The process of capsule formation, as well as the structure of the final capsule, is similar in animal models and in humans--so that investigations of human encapsulation may be done in animals. The cause of abnormal induration around human breast implants is still unknown, and the question of whether normal induration in the animal model can be used to elucidate abnormal clinical induration depends on further investigation of both phenomena.


Immediate reconstruction of full-thickness burn of an ear with an undelayed myocutaneous flap. Case report. We report a case in which an undelayed cervical myocutaneous flap was used early to cover the denuded cartilage of a burned ear. The ear was saved, and a good result was obtained.


External fixation of endotracheal tubes while skin grafting severe burns of the face. The use of an external cranial device for endotracheal tube fixation can prevent mechanical dislodgement of skin grafts and permit easy access while one is operating on extensive burns of the face.


The aetiology of the hyperventilation syndrome. A review of the literature. The aetiology of the hyperventilation syndrome is reviewed with special emphasis on psychological aspects. Early reports linking overbreathing and the emotions can be found as far back as the 16th century. During the last 50 years research has been carried out into respiration in psychiatric disorders but as far as the hyperventilation syndrome is concerned there have been few psychiatric studies. Though many people believe that hyperventilation occurs as a response to anxiety, it has recently been suggested that it is due to a bad breathing habit. Whichever view should prove to be correct, most people would agree that the distressing symptoms produced by hyperventilation may themselves cause anxiety and exacerbate the hyperventilation, thus setting up a vicious circle. By the time the patient presents, this vicious circle has usually become established.


Xenon contrast enhancement in computed body tomography. Xenon has been investigated as a contrast medium for conventional radiography, and in vitro as a contrast medium for computed tomography. The authors evaluated xenon contrast enhancement in vivo for CT body scanning. Nine healthy subjects had CT scans before and during xenon inhalation. Concentrations of xenon used varied from 10--50%. Consistent useful changes in attenuation from inhaled xenon were found in the lung but not in abdominal organs. Lung attenuation varied linearly with the xenon concentration in the inhaled gas. Inhalation of xenon concentrations greater than 30% resulted in side effects. Further studies are required to demonstrate whether xenon contrast enhancement is of diagnostic value in computed tomography.


Enhanced formation of PGI2, a potent hypotensive substance, by aortic rings and homogenates of the spontaneously hypertensive rat. Intact rings and homogenates of aorta from spontaneously hypertensive rats (SHR) contain enhanced capacity over normal rats (NR) to convert arachidonic acid into PGI2. The PGI2 synthetic system in SHR is stimulated to a greater extent than NR by norepinephrine. Indomethacin blocks this stimulation. PGE2 and PGF2alpha were detected in much smaller amounts in homogenates (undetected in rings) but their formation was not enhanced by the hypertensive tissue. The identity of PGI2 was based on 1) direct pharmacological assay on the rat blood pressure. In this system identical vasodepressor responses to PGI2 are observed after intracarotid and intrajugular administration 2) indirectly as 6-keto PGF1alpha isolated after incubation of aortic homogenates with tritiated arachidonic acid and 3) indirectly by GC-MS assay of PGE2, PGF2alpha and 6-keto PGF1alpha formed during incubation of aortic homogenates with excess unlabeled arachidonic acid. These results provide additional support to our recent hypothesis that PGI2, of aortic origin, might actively participate in the regulation of systemic blood pressure. Its enhanced formation by intact hypertensive vascular tissue reflects an increase in the number of enzyme molecules immediately available to the substrate. This could probably be an adaptive response to the elevated levels of catecholamines in the circulation.


The effect of prostacyclin on the human umbilical artery. Prostacyclin was tested on human umbilical artery obtained after spontaneous delivery or by Cesarean section. Isometric and isotonic responses were measured on spiral preparations in Krebs-bicarbonate buffer at 37 degrees C equilibrated with 95% O2 and 5% CO2. Spiral artery strips, whether superfused or mounted in organ baths isometrically or isotonically, responded in a dose-dependent manner to both prostacyclin and serotonin; the PGI2 response was biphasic in that low doses (2.5 x 10(-8) M -1.0 x 10(-6) M) elicited a dose-dependent relaxation which changed with higher concentrations (1.0 x 10(-6) M -2.53 X 10(-5) M) to a contractile response. The maximum tension exerted was 50% less than that elicited by serotonin. The data indicate that the human umbilical artery is responsive to prostacyclin and may be involved in the regulation of fetal placenta blood flow.


Pharmacological activity of PGI2 and its metabolite 6-oxo-PGF1alpha on human uterus and fallopian tubes. The actions of prostacyclin (PGI2) and its stable metabolite 6-OXO-PGF1alpha were investigated in strips of normal human uterus and in fallopian tubes. Both compounds were also compared with natural prostaglandins (PGE2, PGF2alpha and PGD2). PGI2 showed biphasic response both in uterus and fallopian tubes qualitatively and quantitatively similar to that induced by PGE2 and PGD2; prostacyclin was also able to inhibit the spasmus induced by PGF2alpha but not that induced by BaCl2 and vasopressin. 6-0XO-PGF1alpha on the other hand induced only small contractions on both tissues investigated. The authors discusse the possible implication of these findings in the physiology of the reproductive system.


The effect of ibuprofen on the intrauterine pressure and menstrual pain of dysmenorrheic patients. In 12 dysmenorrheic patients we examined the therapeutic action of the Prostaglandin-synthesis inhibitor: Ibuprofen, a non-steroidal analgesic agent. Ibuprofen highly significantly reduced the resting pressure (P less than 0.001), active pressure (P less than 0.001) and frequency (P less than 0.05) of cyclic activity of the uterus, as well as menstrual pain (P less than 0.001). Since these effects occurred after a single oral dose of 800 mg Ibuprofen, without side effects or complications, extensive field trials are recommended with this and other PG-synthesis inhibitors, to assess their therapeutic benefits.


Termination of second trimester pregnancy with intra-muscular administration of 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide. A new prostaglandin analogue, 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide was used for the termination of second trimester pregnancy in 60 patients. The drug was injected intramuscularly in doses of 0.5 mg 4 hourly, 1 mg 8 hourly or 1 mg 6 hourly for a maximum of 36 hours. Fifty five patients aborted. The incidence of gastrointestinal side effects was low and there were no complications.


Actions of prostacyclin (PGI2) and its product, 6-oxo-PGF1alpha on the rat gastric mucosa in vivo and in vitro. The effects of prostacyclin (PGI2) and its breakdown product 6-oxo-PGF1alpha on various aspects of gastric function were investigated in the rat. PGI2 increased mucosal blood flow when infused intravenously. PGI2 was a more potent inhibitor of gastric acid secretion in vivo than PGE2. Like PGE2, PGI2 inhibited acid secretion from the rat stomach in vitro. PGI2 had comparable activity to PGE2 in inhibiting indomethacin-induced gastric erosions. Thus prostacyclin shares several of the activities of PGE2, and may be involved in the regulation of gastric mucosal function.


Prostaglandin I2 has more potent hypotensive properties than prostaglandin E2 in the normal and spontaneously hypertensive rat. The blood pressure lowering effects on PGI2 in the normal and spontaneously hypertensive rat are described. Comparison of dose response curves for PGI2 and PGE2 indicate that PGI2 is twice as potent as PGE2 in the normal rat and 3--4 times more active in the spontaneously hypertensive rat. Furthermore PGI2 is equiactive through intracarotid and intrajugular administration indicative of the complete lack of pulmonary inactivation. These findings supported by evidence of enhanced PGI2 synthesis in aorta during hypertension support the notion that PGI2 could participate in blood pressure control mechanisms.


[Plastic surgery of the thumb, using the epiploon. The problem of integrating mechanical hand prostheses into the body]. The techinque using epiloon tissue in hand surgery was introduced by the author in 1974. The efficiency of the method was checked in several cases of radionecrosis of the hand, deep burns with complete destruction of the tissues on the back of the hand, severe trauma with tearing of the teguments and uncovering of the bones. Epiploonoplasty of the hand achieves a massive transfer of thick epiplooic tissue which is well vascularized, rapidly integrated in the circulatory system of the hand. An extensive description of the surgical technique is presented. A case of severe trauma with amputation of the thumb and of three other fingers of the right hand is further described. The thumb was repaired with a fragment of rib covered with epiplooic tissue exteriorized from the abdominal cavity through laparotomy. The epiplooic pedicle was sectioned after 35 days, and grafting was continued with free dermo-epidermal flaps. The functional result obtained was excellent. The author also presents his experience with a hand prosthesis made of metal and acrylate, which, after being joined to the bones of the forearm and connected with flexor and extensor muscular groups, was completely covered with a thick layer of epiplooic tissue and grafted with skin. A mechanical hand can be achieved with the aid of epiploonoplasty.


[Guillain-Barré syndrome].

[Guillain-Barré syndrome]. An exhaustive study of the Guillain-Barré syndrome that was based on the review of 22 clinical records from the "Manuel Ascunce Domenech" Camagüey Provincial Teaching Hospital files is presented. The clinical presentation of the syndrome is pointed out, and results are compared with those from other authors.


[Results obtained in the parasitological exam of a group of students of different level in the city of Santa Clara]. Results of the parasitic study of 1920 stool samples from school children in different school levels of the Santa Clara city are presented and compared with those obtained in a recently performed national survey.


[321 multiple myelomas (Kahler's syndrome) studied in relation to age, race and sex in Cuba]. Three hundred and twenty one patients with multiple myeloma were studied. The most frequent age at presentation was between 60--69 years both in males and females. A predominance in white patients as well as in males in comparison to females was found. These findings are compared with those reported in the reviewed world medical literature.


[1st finding of the Ancylostoma braziliense nematode (Gómez de Faria, 1910) in Canis familiaris in Cuba]. According to the results obtained by investigators who have been devoted up to date to the study of dog helminthiases in Cuba dog ancylostomiasis is produced by Ancylostoma caninum. Now, Ancylostoma braziliense (Gómez de Faria, 1910) has been found in two dogs from the Havana province. The knowledge of the invasion extension as well as of the intensity of infestation should wait for the exhaustive study of the collected material.


[Acute appendicitis caused by Balantidium coli]. A patient who was surgically treated for acute appendicitis is presented. In the sections of cecal appendix many Balantidium coli trophozoites were found. The history, characteristics, habitat, location, biological aspects and reproduction of this parasite are commented.


[Effect of synthetic LH-RH and hypothalamic extracts on RNA synthesis by rat pituitaries in vitro (author's transl)]. Incorporation of 14C-Uridine in pituitary RNA from adults or prepuberal female rats in vitro, incubated with synthetic LH-RH or hypothalamic extracts, was studied in this work. RNA synthesis was not increased by any of the assayed stimuli in adult female rat pituitaries. The 14C-Uridine incorporation in pituitary prepuberal female rats increased in presence of synthetic LH-RH or adult female hypothalamic extracts, but not in presence of prepuberal female hypothalamic extracts. The differences found in the in vitro behaviour between pituitaries from prepuberal and adult female rats, and between their respective hypothalamic extracts, are attributables to the evolution of these organs along the sexual maturing process.


The action of inhibitors (histidine and AMP) on the ATP phosphoribosyltransferase of E. coli. The inhibitors histidine and AMP cause the enzyme ATP phosphoribosyltransferase of E. coli to associate into a hexamer from its initial dimeric form. The behaviour of these inhibitors has been studied by three different methods. I) Equilibrium dialysis studies have shown that one mole of dimeric enzyme (67,000 g) binds one mole of histidine. II) By kinetic inhibition of the reaction studied at 21, 25 and 38 degrees C the enthalpy changes in the process of histidine and of AMP inhibition have been deduced. The inhibition has also been studied in function of enzyme concentration and temperature. The inhibition appears to be slightly negatively cooperative for histidine and positively cooperative for AMP. In neither case is it possible to obtain 100% maximal inhibition. III) By microcalorimetric analysis the values obtained for the enthalpies of histidine and of AMP interaction with the enzyme are similar.


Dopaminergic, GABA-ergic and cholinergic interaction in the regulation of striatal acetylcholine concentration. Muscimol (2--5 mg/kg), amino-oxyacetic acid (50 mg/kg), and sodium di-n-propylacetate (400 mg/kg) significantly increased acetylcholine concentration in the stratium. These observations suggest that dopamiergic, GABA-ergic and cholinergic interaction regulate the concentration of acetylcholine in the stratium.


[German Roentgen museum Coulomb, Joule, Watt, Becquerel and Gray (author's transl)]. The contribution "SI Units in Radiotherapy and Radioprotection" (Röntgen-B1. 30 (1977) 267-272) lists five units (electric charge, energy, efficiency, activity and energy dose) bearing a special name. The following article commemorates the research workers after whom these units were named.


[Sonography for clarify complications after renal transplantation (author's transl)]. The diagnostic value of the ultrasound method was studied via 170 individual examinations in 75 patients. The method is particularly well suited for an accurate determination of the location and size of the transplanted kidney and for demonstrating perirenal growing and displacing processes such as cystic lymphangiomas, haematomas and abscesses. In addition, ultrasound supplies information on the area covered by lacunae. However, the use of the method for diagnosing casting-off reactions is limited on account of the great variability of the dimensional parameters. It can be used without risk in followup studies of patients with transplanted kidneys, since it is a non-invasive method. It deserves preference among the possible methods of investigation, especially when growing and displacing processes have to be identified.


Acute cholecystitis treated by early and delayed surgery. A controlled clinical trial. 100 patients with acute cholecystitis (AC) diagnosed by clinical, laboratory, and roentgenological examinations were randomly divided into 2 groups; early surgery (ES), operated within 7 days after the onset of acute symptoms, and delayed (DS), operated 2--3 months after the acute episode. Patients with elevated serum bilirubin and/or amylase were included in the trial. Two patients died during conservative treatment, and in 4 cases medical treatment was interrupted because of peritonitis, and in 3 cases because of increasing jaundice. Recurrence of AC was found in 24% of the patients in the DS group. There was no mortality in the ES group, but 2 patients died postoperatively in the DS group. Wound infection developed in 3 patients in the ES, and in 8 patients in the DS group. Retained stones remained in 3 cases of the DS and in 1 case of the ES group. The operative procedures were easier to perform in the ES group than in the DS, as estimated by the duration of operation. The operation time was 76.7 +/- 4.6 min (mean p S.E.) in the ES and 98.0 +/- 7.3 min in the DS group. There was a statistically significant difference between the 2 groups (p less than 0.01). The results suggest that early surgery in the treatment of acute cholecystitis is recommended. The complications of failed medical treatment can be avoided by early operation without added risk of mortality or complications.


Effect of cimetidine on pentagastrin-stimulated gastric secretion before and after proximal gastric vagotomy for duodenal ulcer. Nine patients with duodenal ulcer were studied before and 2--3 months after proximal gastric vagotomy (PGV). Infustion or cimetidine, 1.2 mg.kg-1h-1, reduced mean gastric acid output, in response to infusion of 1.5 microgram.kg-1h-1 of pentagastrin, by, on an average, 79.4% before and 79.1% after vagotomy. The corresponding values for pepsin output were 66.5% before and 77.0% after the operation. The values were not statistically different. Thus, in terms of per cent inhibition, cimetidine was similarly effective before and after PGV. No correlation was found between per cent reduction of acic output by vagotomy and by cimetidine. The effect of the drug was added to that of the vagotomy. Patients with relapse ulcer after vagotomy are therefore interesting candidates for cimetidine treatment.


The effects of ultrafractionated X-ray therapy in malignant lymphomas. To improve the therapeutic methods in malignant lymphomas a new irradiation schedule is suggested i.e., ultrafractionated radiotherapy in small daily doses spaced out over a long period of time until the tumor dose of 3,500 R is reached. This treatment was used in 26 patients with malignant lymphomas--most of whom in stages III and IV--as well as in patients with recurrences that no longer responded to chemotherapy. Total remissions were obtained as well as an improvement of survival : 18 of the 16 patients are still in life and 8 of these have already been followed up for more than 5 years. The tumor dose per field did not exceed 2,000 R in the patients under concomitant chemotherapy. Ultrafractionated X-ray was very well tolerated by patients with altered general condition and even by those with recurrences or previous irradiation sequelae.