[Factors that control the differentiation of stem cells. I. The change in direction of hematopoietic stem cell differentiation under the effect of differentiating T-lymphocytes]. A mixed transplantation of bone marrow cells, and lymph nodes or thymic cells of mice CBA strain into lethally irradiated hybrid recipients (CBAXC57B1)F1 is accompanied with changes in the differentiation pattern from a mainly erythroid to a mainly granuloid way. Thymectomy of either donor of bone marrow cells or recipients, or both, destroys the stem cell differentiation in the direction of granulopoieseis. Intact syngeneic lymphocytes normalize differentiation of the stem cells, but in the presence of tissue antigens these provide for the stem cell differentiation mainly in the direction of granulopoiesis. The differentiation of stem haemopoietic cells is accomplished under the thymic and lymphocyte control. T-differentiating lymphocytes (Td) are the lymphocytes controlling the stem cell differentiation.


[Cell aging in vitro].

[Cell aging in vitro]. The phenomenon of in vitro cell ageing has been considered in terms of limited multiplication and defined life span of cultured diploid cell strains and lines in vitro and in situ. Theories on cell ageing are discussed. Original recent evidence is provided concerning mouse embryo fibroblast ageing in vitro. Phenotypes of early, middle and late passage cells, observed with transmission and scanning electron microscopes, are described. Using light microscope autoradiography, proliferative capacity of these cells has been examined that involves replicative index, cell cycle durations, and 3H-actinomycin binding index. Transcription peculiarities of cultured cells of different age are described using such parameters as activities of RNA polymerases and of RNA synthesis estimated biochemically in isolated nuclei, and with the help of light autoradiography in living cells.


Nipple discharge as a sign of preneoplastic lesions and occult carcinoma of the breast: clinical and galactographic study in 103 consecutive patients. A clinical and galactographic investigation was carried out on 103 patients with hematic, serous-hematic, and serous nipple discharge. The age of the patients ranged from 18 to 72 years. A single papilloma was found in 20 cases, diffuse papillomatosis in 2 cases, atypical ductal hyperplasia in 8 cases, and ductal carcinoma in 4 cases (3 of these were infiltrating and 1 was noninfiltrating associated with a diffuse papillomatosis). Mammography gave no indications of carcinoma in any of the 4 cases. In the remaining 49 patients, pictures of ductal hyperplasia, periductal mastitis or sclerosis, sclerosing adenosis, or ductal ectasia were observed. The various types of lesions were often associated. Lacunae, stenosis, or occlusion of the ducts, evidenced by galactography, correlated well with the histologic findings of proliferative lesions of the ductal epithelium. Nevertheless, in practice, it should be the type of discharge that indicates surgery rather than galactographic or cytologic data, which appeared to have little diagnostic value. The frequency with which preneoplastic (or limit) lesions, and also nonsuspect carcinomas were found in patients with a significant nipple discharge confirm the importance of this symptom for a secondary prevention of early diagnosis of mammary neoplastic lesions originating from galactophorous ducts. Finally, complete resection of the galactophorous ducts must be considered as the best treatment in all patients with a suspicious nipple discharge that requires surgery.


Thalassemia major terminating in a non-Hodgkin B-cell lymphoma: report of a case. A large noncleaved diffuse follicular center cell lymphoma occurring in an 11-year-old child with homozygous beta thalassemia is described. The possible relationship between numerous blood transfusions during a 10-year period and the occurrence of a B-cell lymphoma is discussed.


Radiotherapy for intracranial metastasis. The results obtained in a series of 64 patients with intracranial metastasis treated by radiotherapy between 1970 and 1974 are reported. The primary site was the breast in 32 cases, the lung in 24 cases, the skin (melanoma) in 5 cases, and the bones in 1 case; 2 patients had an unknown primary. All patients received a treatment with high energy (telecobalt therapy). The entire brain was irradiated by 2 lateral fields; 1.5 to 2 Gy were administered daily for a total dose of 30 to 40 Gy. The criterion for success was improvement of the functional capacity of the patient, i.e., regained intellectual awareness and physical abilities. To this aim, the patients were classified before and after therapy according to Order's neurological classification. An improvement was observed in 32 patients, whereas 21 patients remained essentially unchanged, and 11 patients worsened. Cerebral metastases from melanoma were radioresistant to the management. No influence on survival rate was observed.


[Effect of metabolism products of Shigella sonnei, Sh. flexneri and Sh. shigae on proteolytic activity of the organism connective tissue]. The activity of proteolytic enzymes, neutral proteinases and cathepsins E+D, was determined in homogenates from the tissues of capsules formed around diffusion chambers with shigella (Shigella sonnei, Sh. flexneri, Sh. shigae) 1, 2, 3, 5 and 10 days after their implantation to the abdominal cavity of rabbits. The specific proteolytic activity in the capsule tissues in the experimental variants is higher in all the studied periods than in the control and its singularities depend on the microbe species. The rise in the proteolytic activity is the highest under the effect of the Sh. shigae metabolism products, the influence of Sh. flexneri and Sh. sonnei in this respect is somewhat less pronounced.


Nuclear imaging in urology.

Nuclear imaging in urology. Over the past 10 years nuclear renal imaging has proved to be a valuable diagnostic tool. The information derived from such studies must be correlated with all other imaging procedures now available, i.e., ultrasound and computed tomography. Prior to performing a study, the physician should focus carefully on what information is desired and whether or not it can be acquired. Once that is done, the use of these procedures in urology is extremely helpful and their aid in a given instance is limited only by the creative mind of the physicianuser.


An extended view of renal autotransplantation in humans. Early cases of renal autotransplantation have resulted in 2 postoperative deaths in high risk patients, 1 nephrectomy with cure of high blood pressure, 1 cure of hypertension, 3 greatly reduced hypertensions and 2 highly successful bridgings for ureteral avulsions. Anticipated improvements in selection, especially for patients with hypertension, may widen applications in institutions in which homotransplantation is familiar.


Sexual impotence: the overlooked complication of a second renal transplant. THE INCIDENCE OF SEXUAL IMPOTENCE IN 20 MEN WHO HAVE RECEIVED AT LEAST 2 KIDNEY TRANSPLANTS WAS 65 PER CENT COMPARED TO 10 PER CENT AFTER THE FIRST TRANSPLANT. The impotence was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotance to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.


Adjunctive chemotherapy of infection-induced staghorn calculi. Bacteria induce urinary crystallization of struvite and carbonate-apatite as a by-product of ureolysis by urease. Eradication of infection and/or inhibition of urease with acetohydroxamic acid for 5 to 30 months retarded stone growth and brought about partial or complete dissolution of stones in 9 patients. Long-term chemotherapy with antimicrobial agents that achieve sterile urine or acetohydroxamic acid in those patients with recalcitrant infection lessens the risk of recurrent calculogenesis.


The pathogenesis of Trypanosoma congolense infection in calves. III. Neutropenia and myeloid response. Calves infected with Trypanosoma congolense TREU 112 had, at the onset of anemia, a very low total white cell count and neutropenia but with chronicity there was lymphocytosis. Infected calves had a marked reduction in granulocyte mobilization for the first 14 weeks of infection and there was reduced ability to mount an inflammatory response during the onset of anemia. Bone marrow aspiration biopsies showed marked erythroid hyperplasia in response to the anemia with a relative and likely absolute reduction in myeloid precursors and marrow granulocyte reserves.


We want to train toxicologists for a need. This country needs toxicologists in a variety of institutions, and needs toxicologists with different backgrounds. All programs in toxicology can't satisfy every specific need. Certification and accreditation will continue as solvable issues among the various organizations in toxicology.


[Clinical and paraclinical changes in cattle with traumatic pericarditis before and after pericardial puncture]. A puncture of the pericardium has been performed on cows with a traumatic pericarditis. The clinical status has been taken and paraclinical investigations prior to and after the puncture have been carried out. Following a puncture of the pericardium, up to the 12th hour, the movements of the rumen decrease or entirely disappear, and are restored again later, while respiratory movements and the heart activity become ever more frequent. A leucocytosis occurs without a trend towards a return to the initial level as well as neutrophilia with a nuclear left-shifting to metamyelocytes. The clinical and paraclinical changes in cattle with a traumatic pericarditis, after a puncture of the pericardium, point to a deterioration in the condition and a possible exitus.


[Effect of protein in the feed on the resistance of poultry artificially infected with Salmonella galinarum pullorum and Salmonella typhimurium]. Studied is the effect of the low protein level in rations of birds, experimentally infected with Salmonella gallinarum-pullorum and Salmonella typhimurium. Birds of different ages of the Leghorn and Cornish breeds are included in the experiments. Results obtained from the experiments indicate that the lowered level of protein in rations to young birds at the age of five months makes them more resistant to salmonella infection. This dependence is markedly demonstrated in particular in the case of the Leghorn breed.


[Indications for deep suture of the bladder wound after its resection for cancer]. The indications to putting in interrupted sutures on the urinary bladder after its resection for cancer are discussed. Based on the clinical observations, it is concluded that there cannot be any one-way approach to this problem. The bladder may be sutured, if the resection wound is located in the upper segment and anterior wall of the median segment of the vesicle in case of the unchanged detrusor vesicae and urethra, with low bacterial count of the vesical urine and providing for transurethral drainage of the vesicle by its drip irrigation. Interrupted sutures on the vesicle were used in 21 patients with favourable issues.


[T- and B-lymphocyte changes in lymphogranulomatosis]. Under study were T- and B-systems of immunity in patients with lymphogranulomatosis, and these were correlated with clinical findings (the stage, intoxication, the effect of chemotherapy). Blastransformation reaction (RBT) with phytohemagglutinin (PHA), direct blasttransformation with sheep erythrocytes, immunofluorescence were estimated. The absolute amount of lymphocytes in 1 ml and also T- and B-cells were counted. Already in the stage I--II there was noted a reduction in the amount of T-lymphocytes and RBT to PHA. These changes in cell immunity were aggravated in the stage III B and stage IV B in particular. After the chemotherapy conducted according to the MOPP programme in most patients the immunological background would be more unfavourable. There was noted a relationship between the immune indice stability during chemotherapy for lymphogranulomatosis and the duration of remission.


[Use of natulan in the different histological variants of lymphogranulomatosis]. The results of natulan therapy in III patients with spread lymphogranulomatosis are reported. An analysis of the dependence of the remission frequency and duration on different morphological variants of lymphogranulomatosis has shown that the incidence of remissions was high and practically identical in patients with nodular sclerosis, the lymphocytic and mixed cell type. The effect of natulan was found to be limited in the variant "Lymphocytic depletion".


[Radiation protection using a gaseous hypoxic mixture in oncological practice]. Studies on volunteers have shown that the gas hypoxic mixture containing 10% of oxygen and 90% of nitrogen (GHM-10) renders a protective action on the genetic apparatus of human skin cells but provides no protection of the peripheral blood leucocytes, which show the identical character of metabolic processes as neoplastic cells. Under clinically performed distant x-ray therapy for breast cancer the inhaling of GHM-10 was found to render the antiradiation protective action on different normal tissues (skin, subcellular connective tissue, muscle tissue, mammary gland tissue), but it fails to protect the tumor tissue and regional lymph nodes involved. The clinical observations were supported by pathomorphological examination of the operation material.


[Assessment of the adaptational potentials of the body of children with phenylketonuria to diets including berlofen in long-term diet therapy]. The state of the nitrogen balance and physical development of 14 children ill with phenylketonuria (PKU), aged from 5 1/2 to 8 years, kept on a long dietotherapy for 21/2--61/2 years and subsequent application of a broadened ration of alimentation, was studied. A lengthy dietotherapy is shown to bring about an adaptation of child's organism to restricted phenylalanine in the food, but a diet with berlophen is not optimal for the normal physical development of children suffering from PKU. In children aged over 5 a broadened diet is suggested.


[Evaluation of the inhibiting action of virazole on the reproduction of the vaccinia virus in tissue culture]. Experimental data of the evaluation of the antiviral activity of virazole in tissue culture using the fluorescent antibody technique are presented. Administration of virazole in the maintenance medium in a concentration range of 800--6.25 microgram/ml immediately after vaccinia virus adsorption exerts a marked inhibiting effect reducing virus reproduction by 3.1--1.6 1g, respectively. The chemotherapeutic index of the drug is 128. In a one-cycle experiment, virazole in the minimal effective concentration had the same inhibiting effect as metizason in the maximal tolerable concentration.


[Antigenic relations of the rabies group viruses studied in the blast transformation and immunofluorescence tests]. The blast transformation test with lymphocytes of mice sensitized with commercial rabies vaccine, and the direct and indirect immunofluorescence tests with hyperimmune serum to human acute encephalomyelitis virus and rabies immunoglobulins demonstrated antigenic relationships of rabies, Lagos Bat, Mokola, human acute encephalomyelitis and rabieslike virus isolated from rodents in Central Europe. At the same time, the time of appearance and the degree of intensity of specific blast transformation reaction as well as its duration indicate some differences in the antigenic structure of the Lissaviruses under study.


[Results of the short-term (28 days) cimetidine treatment of duodenal ulcer]. The results from a short-term (28 days) treatment of patients with duodenal ulcer are reported. The average surface of the ulcers from 40.4 mm2 (initial average value) diminished to 7.3 mm2 by the 14 th day of the treatment. The graphic study of the kinetics of healing of the ulcer process revealed that in a treatment with 0.8--1.0 g Simetidin, a diminution of the ulcer by half (t/2) could be expected by the seventh day. In 16, out of the 21 treated, the ulcer epithelized by the 14th day of the treatment. In one patient a prolonged treatment of 42 days proved to be necessary to guarantee the epithelization of the ulcer. In 2/3 of treated patients, the pain complaints, the sensation of warmth and acidity disappeared by the end of the first week of the treatment. The average values of the basic and peak acid output (BAO and PAO), the N-acetyl neuramine acid output, the gastrin basic level, GOT, GPT and creatinine in serum do not change after the treatment. A significant reduction of hemoglobin concentration in the gastric juice is established after the treatment with Simetidin.


[Protein metabolic change in the tissues of Aporia crataegi L. under the action of the nuclear polyhedrosis virus]. Changes in protein metabolism in the hemolymph, fat body, intestine, and gonads of Aporia crataegi L. caterpilars under the influence of nuclear polyhedrosis virus were studied. Electrophoresis in polyacrylamide gel was used to study acid and basic proteins of insect tissues normally and after virus infection. The virus infection was shown to result in sharp changes of the protein spectrum of various tissues and organs, particularly 3 days after infection. The main changes consisted in the loss of coordination of age cellular protein synthesis and formation of new virus-specific proteins.


[Weight reduction in obese diabetics: a double-blind study of diethylpropionate (author's transl)]. In a double-blind study 40 overweight maturity-onset diabetics on a weight-reducing diet were randomly assigned to treatment with either the appetite-suppressant diethylpropion hydrochloride (Tenuate), or placebo. After treatment for 8 weeks the mean weight loss achieved by each group was 4.9 and 3.3%, respectively. This approximately equal weight loss was too slight to exert any significant effect on glucose tolerance. Thus, an additional effect of this anorexiant in comparison with diet restriction alone, as described in obese non-diabetic subjects, is not evident in the case of obese diabetic patients.


[Malaria tropica with coma in early infancy (author's transl)]. After arriving in Austria a 10 month old Nigerian infant fell sick with malaria tropica and survived after specific antiparasitic therapy. Early diagnosis and immediate begin of treatment are stressed.


Clinical comparison of two contrast agents for oral cholecystography: radiologic efficacy and drug safety of iopanoic acid and iopronic acid. Oral doses of either iopronic acid (4.5 g Oravue, Squibb) or iopanoic acid (3 g Telepaque, Winthrop) were given to 98 patients requiring cholecystography. Radiographs were taken 13 to 16 hours after treatment showed good to excellent gallbladder opacification in 44 percent of patients after the first dose of iopronic acid and in an additional 29 percent after a second dose. Similar opacification occurred in 42 percent of patients after the first dose of iopanoic acid and in 34 percent after a second dose. Drug-related abnormalities in blood and urine tests occurred about equally in both groups and one patient in each group exhibited a clinically adverse reaction (diarrhea). Thus, the performance (radiographic efficacy and drug safety) of the new contrast agent, iopronic acid, was similar to a widely used drug, iopanoic acid.


[Detection of antibodies against Aspergillus fumigatus. 1st report: making of antigens (author's transl)]. A method of antigen preparation from Aspergillus fumigatus has been described. We received the antigens from medium and mycel used for the detection of precipitins and IgE-antibodies. The antigenic components are demonstrated in the immunoelectrophoresis. By the use of absorption we did not find essential differences between medium antigen and mycel antigen for the detection of precipitins. The medium antigen recommended for diagnostic is easier to produce and, moreover, has advantages for the detection of specific IgE antibodies.


Structural and functional adaptation after reduction of nephron population. This review of adaptive changes in renal structure and function in subjects with reduced renal mass has two primary goals. One is to provide a description of the remarkable compensatory increases in glomerular filtration rate (GFR), and renal blood flow, at the level of individual nephrons, and the alterations in water and electrolyte transport by tubular epithelium. These processes preserve fluid and electrolyte balance in subjects with progressive renal failure, until whole kidney GFR is reduced to about 20 percent of normal, and provide the basis for conservative clinical medical management. The other aim is an attempt to provide an understanding of the mechanisms involved in compensatory adaptation, since this information, in addition to amplifying our understanding of renal transport processes, helps to elucidate the functional limitations placed on subjects with renal insufficiency. An attempt has been made to analyze both clinical observations and relevant experimental models and an effort has been made to correlate renal function with different patterns of renal injury.


Animal models of human systemic lupus erythematosus. Systemic lupus erythematosus (SLE) is a human autoimmune disease of unknown etiology. Clinical, serologic, immunologic, and pathologic findings are highly variable in different patients and at different times in the same patient. Murine and canine animal models of SLE have been found with clinicopathologic abnormalities resembling those observed in humans. Each animal model has unique characteristics; taken together they reflect the spectrum of disease in human SLE.Investigations in the animals have suggested that genetic, hormonal, immunologic, viral, and other environmental factors contribute to and modify the expression of disease. Where analogous studies are available for humans, the same factors have been found to modify disease expression in a similar fashion. Together, these studies have helped to clarify the multifactorial basis for SLE.The best characterized abnormalities are immunologic. These include excessive B cell function with the formation of large amounts of autoantibodies, and T cell abnormalities which include defects in T cell regulatory function as well as certain T cell effector functions.The animal models of SLE also serve as convenient test subjects for newer therapeutic modalities. It is hoped that further study of the animal models will provide a more rational approach to therapeutic modulation of disease in humans with SLE.


Microsurgical techniques in organ physiology and transplantation studies. Experimental models for studies of physiology and pathology of different organs should be technically simple and reproducible, especially when large numbers of animals are required. Also uniform, often genetically identical, populations of animals are necessary to obtain reliable data. To meet these requirements studies should be performed on small animals. Modern microsurgical techniques help in solving these problems. The basic principles of microsurgical techniques and the microsurgical physiological and transplantation models have been described. Standardizing of techniques and models will allow better comparison of data from different centers.


The pig as a model for the study of obesity and of control of food intake: a review. The use of the pig for studies of food intake and obesity is reviewed. Effects of ambient temperature and taste on food intake as well as satiety factors impicating both neural and hormonal mechanisms originating in the gastrointestinal tract are considered; the integration of information in the central nervous system for both internal and external sources is hypothesized. Special concerns of food intake controls in the neonate are discussed, including effects of neonate sweet preference on food intake, gastrointestinal satiety factors, and hypoglycemia as a stimulus for food ingestion.For obesity studies, pigs offer several advantages, including their general physiological similarity to humans, similar fat cell size, and body fat distribution. Lipogenesis, lipolysis, and lipid mobilization are under intensive study in swine and the information obtained may have important application in studies of human obesity. The voluminous literature on metabolic differences between genetically lean versus obese populations of pigs suggests possibilities for application in humans. Greater characterization of differences and similarities between pigs and humans in important metabolic parameters related to regulation of food intake and obesity should facilitate better understanding and control of human obesity.


Stimulation of humoral immunity by peptidoglycan monomer from Brevibacterium divaricatum. Peptidoglycan monomer (PGM), a water soluble and nontoxic disaccharide pentapeptide unit obtained from Brevibacterium divaricatum, was administered intravenously into mice, and the humoral immune response to sheep erythrocytes was assayed by means of Jerne's technique for plaque-forming cells (PFC) in the spleen. The PFC response was evidently stimulated. The counts were increased to practically the same extent over a great range of doses of PGM (from 25 to 1600 microgram per animal), and the effect was present in the mice immunised with optimal, as well as in those immunised with suboptimal, doses of antigen. The magnitude of the immunostimulation depend only on the timing of PGM administration: it was maximal if PGM was injected 1 or 2 days after the antigen. In vitro, in a 4-day culture of spleen cells, PGM did not stimulate PFC formation. We conclude that stimulation of the humoral immune response to sheep red blood cell antigens by PGM probably occurs without cell multiplication and probably involves more than simply a contact of immunocompetent cells with PGM.


[Operation of hammer toes and claw toes, and treatment of unfavourable results (author's transl)]. Hohmann's operation of hammer toes and claw toes will produce a poor result if there is a contracture due to hyperextension in the metatarsophalangeal joint. In such cases, preference should be given to the operation according to Taylor (resection arthrodesis of the first or, in rarer cases, of the second interphalangeal joint, dorsal incision of the capsule of the metatarsophalangeal joint, if necessary elongation of the extensor tendon, intramedually fixation by Kirschner wire). In case the operated toe points rigidly to dorsal or hangs limply as a result of Hohmann's operation, a cosmetically and functionally entirely satisfactory result can be achieved by means of operative mobilisation of this preoperated toe and by producing a cutaneously syndactylia with the next, smaller toe. - If a hammer toe is dislocated in the metatarsophalangeal joint, removing the base according to Gocht should be combined with an operative syndactylia to guide and hold the toe accurately in line with the other toes.


[Experimental application of calcium phosphate granulate for the substitution of conventional bone transplants (author's transl)]. Autologous spongiosa, a calcium phosphate ceramic and Kiel bone chips were implanted in the tibiae of dogs and compared with respect to tissue compatibility and osteogenetic effect. After the ceramic implants and the autologous spongiosa had been left in the tibial fat marrow for six weeks, bone tissue and bone marrow had formed to the same extent around both materials. Their stimulating effect on osteogenesis was comparable. In contrast to the ceramic material, together with which they had been implanted in active bone marrow, the Kiel bone chips were surrounded by fibrous tissue in addition to bone tissue. All of the three types of implant proved to be tissue compatible. On the whole, the calcium phosphate ceramic was found to be equal to autologous and superior to heterologous spongiosa from a biological point of view. In technical terms the ceramic implant was superior also to the autologous graft.


Remediable causes of dementia.

Remediable causes of dementia. Studies show that many clinicans "write off" elderly patients as demented, when in fact many of these patients are not suffering from chronic organic brain syndrome but have medical disorders that may respond positively to appropriate treatment. The key to differentiation is comprehensive diagnostic evaluation.


Nutritional studies of the south eastern state peasant diet: studies of the effect of malarial infection (Plasmodium berghei) on electrolyte changes in rats fed the peasants' diet. 1. Plasmodium Berghei (malaria infection) is not specifically related to the nutritional status of the host though nutritional status may aid the advance or elimination of the parasite. 2. The effect of the infection is more severe in low protein diets than in diets whose protein content was adequate. 3. There was no evidence of excessive urinary excretion of electrolytes in the infected rats. 4. It is suggested that low plasma levels of electrolytes in the infected rats were due to skin losses and these losses were independent of the protein content of the diet thus severity of malarial infection is unaffected by protein nutrition.


[Theater nurse and midwife in Cameroon. Impressions and experiences in the grasslands (Northwest Cameroon) during a six-and-a-half month stay in a hospital situated at a height of 1800 m]. The author describes the circumstances of the hospital and out-of-hospital situation in the region she worked in, in focussing on the relevant practical features of the daily life of patients and staff. She deals among other things with the maternity ward (including the separate "camp" devoted to prenatal stays) and the operating theatre. As regards health activities outside the hospital, she mentions those of the existing health centres and of auxiliary personnel called first-aiders (whose job description is close to the one of the village health workers advocated by WHO and others). A health team, usually led by a physician, makes periodic visits to bush villages. The importance of the contacts thus created, for health work itself (including collaboration with traditional health practitioners) as well as for community development, is underlined.


[Initial experience with ethinyl estradiol sulfonate (J 96) in the therapy of prostate carcinoma]. Ethinylestradiol sulphate (J 96) is a depot estrogen which in a dosage of 2 mg per week has clearly antigonadotropic effects and evokes a suppression of the free testosterone in bilaterally orchiectomized patients with carcinoma of the prostate. The good compatibility in oral application and the possibility for the controlled intake recommend its use for the long-term therapy of the carcinoma of the prostate.


[Isolation of bacterial L forms from the joint fluid in rheumatoid arthritis in children]. In the bacteriological study of intra-articular fluid in 22 children with rheumatoid arthritis the L-forms were isolated in 11. Of these, 7 had not been treated with preparations of the penicillin series. The complete isolation of the focus of inflammation from the environment and the presence of the L-forms of bacteria in the children who had not been treated with preparations of the penicillin series gave us grounds for conclusions on the etiological and pathological significance of the L-forms of streptococci in rheumatoid arthritis.


[Results of a study of the reactogenicity and epidemiological effectiveness of a 2d revaccination against whooping cough]. The reactogenicity and epidemiological effectiveness of the second revaccination against pertussis were studied in conformity with all the conditions of a controlled epidemiological trial. The character of the distribution of local and fever reactions in children aged 6 years after the second revaccination with adsorbed DTP vaccine suggests the presence of high sensitivity to the pertussis component of absorbed DTP vaccine in children of this age group. The results obtained from the study of epidemiological effectiveness (in 15,621 children) indicated that the second revaccination of children aged 6 years (at an interval of 3 or more years after the first revaccination) was not advisable as it did not influence noticeably the pertussis incidence.


[Sh. flexneri population heterogeneity according to the cellular fatty acid makeup]. The composition of fatty acids in the cells of 100 clones of Sh. flexneri, strain 9054, isolated from a dysentery patient was studied by the method of gas chromatography. Fatty acid composition in 75 clones was similar to the fatty acid composition of the initial culture: 25 clones differed to a variable degree from the prevailing group of clones in the content of unsaturated and cyclopropane fatty acids and, to a considerably lesser extent, in the content of palmitic acid and a number of other saturated fatty acids. After the change of the culture medium (agar and broth) the differences in the fatty acid composition of the clones could still be observed. The data obtained in this study indicate the heterogeneity of Shigella population in the composition of cellular fatty acids.


[Antigenic activity and the reactogenicity of UV ray-inactivated antirabies vaccine from the brain of sheep]. Tests in volunteers showed that the reactogenicity of rabies vaccine prepared from sheep brain and inactivated with ultraviolet rays was not greater than the reactogenicity of Fermi vaccine. At the same time it was found to have a higher activity when injected both in the form of 5% suspension (in full and decreased doses) and with brain tissue content as low as 2.5%.


[Data to substantiate the early immunological diagnosis of dysentery]. The interaction of the whole blood from patients with dysentery and gastrointestinal diseases of non-dysenteric etiology, with the causative agents of dysentery, Sh. sonnei and Sh. flexneri, and saprophytic, staphylococci labeled with  radioactive isotopes was studied in vitro. In dysentery an increase in the capacity of the blood for Shigella fixation was observed from the beginning of the disease. During the 1st week of the disease this reaction was strictly specific and accompanied by a decrease in the fixation of staphylococci, but later the reaction became relatively specific. An increase in Shigella fixation occurred considerably earlier than immune antibody formation, as revealed by the indirect hemagglutination test. This research substantiates the possibility of an earlier immunological diagnosis of dysentery as compared with the serological methods.


[Leptospira distribution in the soil of a natural focus of the infection (an attempt at the radioisotopic labelling of infected voles)]. The mass radioisotope (32P) labelling of all tundra voles excreting Zeptospira, infected urine was carried out over the area of 1 ha, and the results of the experiment analyzed by the method of planar coherent graphs, showed the irregular (spotted) distribution of "infected spots", i. e. soil patches contaminated by Zeptospira. The borders of individual small foci of infection did not coincide with the outlines of soil and vegetational divisions of the area. The spatial structure of the "extraorganismic" part of the Zeptospira population was originally formed by the carriers and thus determined by their mobility, their manner of using the territory. Later this structure was changed by selective elimination under the influence of living conditions for Zeptospira in the soil. The "infected spots", subjected to such selection, seem to be capable of constantly sustaining Zeptospira; the presence of these organisms is also due to the fact that they are regularly added into the soil with urine excreted by the carriers visiting the same spots of their territory.


[Nocardia asteroides (Eppinger) Blanchard in the soils of the Ukrainian SSR]. The distribution of Nocardia asteroides (Eppinger) Blanchard, the main causative agent of nocardiosis in humans and animals, in the soils of the Ukrainian SSR was studied. This species was found to inhabit cultivated soils in various soil-climatic zones of the Ukrainian SSR. The isolated strains proved to be heterogeneous in their properties. N. asteroides fell into 2 groups: acetamidase-negative (A) and acetamidase-positive (B). Newly isolated N. asteroides belonging to the acetamidase-positive group were shown to be always pathogenic, whereas the organisms of the acetamidase-negative group could be pathogenic and non-pathogenic in white mice.


[Bioelectical activity of the brain in parkinsonism before and after stereotaxic operations]. The bioelectrical activity of the brain was studied in 85 patients. The bioelectrical potentials were recorded directly from the cortex of the cerebral himispheres and the subcortical structures of the brain. Clinical and electroencephalographic comparisons were made. Functional reorganization of bioelectrical potentials after stereotaxic operations is shown.


Pathophysiology of dysmenorrhea.

Pathophysiology of dysmenorrhea. Mechanisms of possible pathophysiological importance in primary dysmenorrhea are discussed. Hyperactivity of the myometrium with accompanying uterine ischemia is considered to be of central importance in the causation of pain. Prostaglandins seem to be involved to a large extent in the development of the myometrial hyperactivity. Other mechanisms of possible importance such as ovarian hormones, cervical factors, vasopressin, nerves, and psychological factors can well act ultimately through prostaglandin release but an action directly on the myometrium and blood flow may also occur.


The effect of inhibitors of prostaglandin synthesis in primary dysmenorrhea studied with hysterometry. The technique called hysterometry has been used for the quantitative evaluation of effect of naproxen sodium and naproxen on myometrial tension in vivo during dysmenorrhea. It was observed that "uterine tonicity" - the datum arrived at after hysterometric recording - decreased significantly during naproxen medication in comparison with placebo treatment. Decrease in uterine tonicity was well correlated with relief of pain.


Prostaglandins and dysmenorrhea. Historical survey. This survey traces the development of the main ideas and experimental findings on the function of endometrial prostaglandins in stimulating the expulsive contractions of the myometrium during normal menstruation, and the effect of excessive action of this nature in producing dysmenorrhea. Some observations are also given on the 'menotoxin', an unidentified substance which is toxic to certain plants and which may or may not prove relevant to gynecology. Areas where further fundamental work is needed are suggested. The survey is not a complete review of the topic, which would need a much longer paper.


Effect of acetylsalicylic acid, paracetamol and placebo on pain and blood loss in dysmenorrheic women. The analgesic effect of paracetamol, acetyl-salicylic acid, and placebo on dysmenorrhea were compared in a double-blind cross-over study of 30 women. There was a moderate placebo effect, but no significant difference was found between the three treatments. Blood loss was also measured and it did not vary, with the type of drug ingested. It is concluded that paracetamol and acetylsalicylic acid in the doses used (0.5 g x 4 for 3 days) were not effective against heavy dysmenorrhea, and that none of the drugs influenced the amount of blood lost.


Naproxen and indomethacin in the treatment of primary dysmenorrhea. The efficacy of naproxen and indomethacin in the treatment of dysmenorrhea was compared in a double-blind, cross-over study. Both drugs were given to 24 female undergraduates with severe primary dysmenorrhea in four consecutive cycles in a randomized schedule. Both drugs were equally effective. Good or moderate overall relief was achieved in 73% of 48 cycles treated with indomethacin and in 61% of the 48 cycles treated with naproxen. The difference was not statistically significant. Gastrointestinal side-effects occurred in 5 and 7 patients during naproxen and indomethacin treatment respectively. Central nervous system side-effects, dizziness, headache, tiredness, were more common with indomethacin than with naproxen (p less than 0.02). The most important and frequent of these side-effects, dizziness, was complained of by six patients in association with indomethacin but by none with naproxen (p less than 0.05). Only one patient discontinued the treatment because of side-effects.


Clinical experience of naproxen in the treatment of primary dysmenorrhea. The effect of naproxen, Naprosyn, Syntex, in treatment of primary dysmenorrhea was studied in a double-blind, randomized, placebo controlled multicenter study. Nintyseven women, aged between 18--40 years, with severe dysmenorrhea, were treated with either naproxen, 48 women, or placebo, 49 women, for two consecutive menstrual cycles. No oral contraceptive was used. The patients were allowed to take supplementary analgesics 4--6 hours after the study drug was taken if adequate relief was not achieved. The recommended dose of naproxen was 1--2 tablets, 250 mg, as needed, with a maximum of 5 tablets daily. Medication was started at first sign of menstrual distress. Improvement was achieved in 70 per cent of the women in the naproxen group (good to excellent relief) but only in 30 per cent in the placebo group. This difference is statistically significant (p less than 0.001). There was much more supplementary medication used in the placebo group compared to the naproxen treated patients (p less than 0.001). Fewer patients had to stay in bed, or stay at home from work or school, in the naproxen group compared to the placebo group. Few side-effects were reported and most of them belonged to the dysmenorrhea symptomatology. No side-effects could be rement according to the patients' own judgement.


Attempt at enzyme replacement in Gaucher disease by renal transplantation. In Gaucher disease there is a deficiency of the lysosomal enzyme, cerebroside-beta-glucosidase, as a result of which cerebroside (glucosylcereamide) accumulates in various organs. In northern Sweden 22 patients with a juvenile form of this disease have been identified. In one such patient, a girl of 10 years, we have attempted enzyme replacement by renal transplantation. After this operation the hepatic glucocerebroside content fell significantly. In another child afflicted with Gaucher disease in whom splenectomy was performed for severe splenomegaly and hypersplenism there was a progressive increase in the level of this lipid. These findings suggest that enzyme replacement was achieved by transplantation of a normal organ.


The distribution and localization of immunoglobulin in the gastric mucosa and gastric cancer. The distribution and localization of immunoglobulin in the gastric mucosa and gastric cancer were studied by means of immunofluorescence. In the lamina propria of the stomach, like the other parts of the gastrointestinal tract, IgA producing cells predominated, but their population density varied from case to case. The main portion of secretion of IgA in the stomach was deep foveolar epithelium. IgA containing epithelial cells in the stomach were much less than those in the intestine, but they increased with advancement of intestinal metaplasia. Some gastric cancer cells retained the ability of secretory component production and took up IgA in their cytoplasm.


Chronic myelogenous leukemia with reticulum-cell-sarcoma-like cell proliferation--significance of eosinophilic granules in sarcomatous cells. A case of chronic myelogenous leukemia (CML) associated with proliferation of atypical cells resembling those of reticulum cell sarcoma (RCS-like cells) is presented. A number of immature eosinophils were present mingled with ordinary leukemic cells, which infiltrated in the bone marrow, lymph nodes, spleen, liver, lungs and testes. RCS-like cells either formed solitary nodular foci or randomly mingled with infiltrating leukemic cells. Charcot-Leyden crystals were seen in some areas where RCS-like cells proliferated. As a peculiar feature the presence of eosinophilic granules in some of the RCS-like cells was noted. They were proved to be immature form of specific granules of eosinophils by their staining properties and ultrastructural aspects. Based on these findings the myelogenous origin of RCS-like cells is suggested. The patient died of cerebral complication of aspergillosis.


Extramedullary plasmacytoma of the gastrointestinal tract in a renal transplant recipient. A case of gastrointestional plasmacytoma found in a renal transplant recipient is described. Immunohistochemical study using immunoglobulin-enzyme bridge technique demonstrated IgA and k-type light chains in the majority of plasma cells infiltrated in the stomach. Pathological investigation revealed multiple similar tumors in the ileum, cecum and ascending colon suggesting a plasmacytoma of multicentric gastrointestinal origin. The pathogenesis of plasma cell tumors is briefly discussed with regard to organ transplantation.


Polypoid cystitis: a catheter associated lesion of the human bladder. Histopathological examination of the urinary bladders of 63 patients dying in a geriatric clinic was performed. In 40 of 51 patients who had been treated with a urinary catheter, histological changes of polypoid cystitis were found. In 34 of the bladders the lesion engaged the posterior wall which corresponds to the localization of the tip of the catheter. The frequency of polypoid cystitis increased with increasing time of catheter treatment and reached its peak by three months. After that time the frequency was relatively constant. The frequency of polypoid cystitis seemed not to be influenced by bacterial urinary tract infection. Urothelial atypia was not seen after the catheter treatment.


Prostacyclin-dependent coronary vasodilation in rabbit and guinea pig hearts. Isolated hearts from rabbits or guinea pigs were perfused according to Langendorff and the coronary flow was recorded continuously. In addition, the rabbit heart transmyocardial effluent's content of platelet anti-aggregatory (prostacyclin-like, PCLA) activity was assayed biologically at regular intervals. Perfusion was performed with a solution gassed with 95% O2 in CO2, switching at intervals to a solution gassed with 12% O2 and 5% CO2 in N2. Perfusion with a hypoxic solution elicited reproducible increased in coronary flow. After pretreatment with indomethacin (5 x 10-5M), this increase was completely abolished and in several cases it was reversed to a marked reduction in cornonary flow. The transmyocardial effluent contained, during perfusion with normoxic solution, no detectable or only negligible amounts of PCLA. During hypoxia the efflux of PCAL into the transmyocardial effluent increased markedly. This increase was completely abolished when indomethacin (5 x 10-5M) was added to the solution perfusing the heart. The results strongly suggest that increased coronary vascular formation of prostacyclin plays a key role in the coronary vasodilation induced by hypoxia in rabbit and guinea pig hearts.


Therapeutic effects of clozapine. A 4-year follow-up of a controlled clinical trial. The double-blind method was used to compare the therapeutic effects of clozapine and chlorpromazine in a sequential cohort of 50 schizophrenic patients with similar demographic characteristics, randomly allocated to two groups ("experimental" and "control") of 25 patients each. At the end of the 6-week trial period, statistically significant differences were found between the two groups in both the symptom check-list score and the overall clinical evaluation. Follow-up evaluations conducted at 3- and 4-year intervals show that the differences between the two groups are presistent, which points in the direction of a better and more sustained therapeutic effect of clozapine over chlorpormazine. No discernible ill effects which could be attributed to either drug were detected throughout the 4-year period.


The value of automatic analysis for quantitative electromyography. The value of automatic analysis for quantitative electromyography. Acta Physiol. Pol., 1979, 30 (2): 231--239. The authors describe the automatic analysis of EMG records by means of minicomputer ANOPS-101. Computer works on-line during EMG examination, being directly connected to the output of electromyograph. During slight voluntary muscle contraction 3 histograms could be obtained--namely: distribution of MUAP duration, number of their phases and their amplitudes. During maximum voluntary contraction two more histograms could be obtained--namely: distribution of amplitudes of spikes and distribution of intervals between spikes. These five histograms are displayed on the screen and the mean values are automatically calculated. As a result all quantitative EMG data are obtained which are sufficiently accurate for differentiation between pathological and normal recordings and which help to distinguish the myogenic atrophy from neurogenic one.


Amoxapine versus amitriptyline in endogenous depression. A double-blind study. A new antidepressant, amoxapine, which is a dibenzoxazepine deprivative, was compared with amitriptyline in a randomised double-blind trial. Forty-eight patients were included and 41 completed a 4-week treatment. Most of the patients were maintained on 150 mg daily. Assessments were made by the Hamilton Psychiatric Rating Scale for Depression (HAM-D), Nurses' Observation Scale for Inpatient Evaluation (NOSIE), Clinical Global Impression (CGI) scale and Patient's Self-Evaluation. The total HAM-D score was considerably reduced in the majority of the patients. Amitriptyline was the most effective with regard to symptoms included in the factor Sleep Disturbances and-secondary maybe-towards some items included in the factor Somatization. For the remaining items,including the items of the factors Anxiety/Depression and Apathy, the last score was lower in the amoxapine group than in those treated with amitriptyline. Among the unipolar cases the amoxapine treated patients were more satisfied with regard to efficacy (P = 6.3%). The frequency of side effects such as tremor and dizziness was considerably lower in the amoxapine group. In total, the side effects lasted longer in the amitriptyline group. We conclude that amoxapine seems to be an effective antidepressant with a low frequency of side effects.


Effects of atropine and toxogonine on metabolism of the isolated rat liver changed by diisopropylofluorophosphate (DEP). Effects of atropine and toxogonine on metabolism of the isolated rat liver changed by diisopropylofluorophosphate (DFP). Acta Physiol., 1979, 30 (2): 289--294. In the investigations on isolated rat liver it was found that DFP in a dose corresponding to 1/2 of the LD50 inhibited the activity of AChE, caused hypoglycaemia, decreased the level or pyruvate and increased that of lactate and hepatic glycogen, and increased the activity of transaminases. Atropine and toxogonine administered separately in a concentration of 0.5 mg/100 ml reduced the pyruvate level without changing the other parameters. Administered together with DFP they reactivated the activity of AChE, abolished hypoglycaemia and antagonized in part the effect of DFP on lactate level and transaminase activity.


Evidence that the pituitary gland is the site of inhibitory action of porcine follicular fluid upon FSH secretion in the rat. This study has examined the effects of porcine follicular fluid (PFF) on the adenohypophyseal secretion of LH and FSH following LHRH treatment. The animal model selected for study the the proestrous rat in which preovulatory LH and FSH surges were blocked with phenobarbital. To elicit the release of gonadotropins from this preparation, two different i.v. LHRH infusion protocols were used. The first elicited a proestrous-like LH and FSH surge while the second infusion schedule evoked the predominant release of FSH with only minor changes in LH. PFF suppressed LHRH-induced FSH secretion in both preparations but had only negligible effects on LH secretion. Interestingly, the suppressive effects of PFF were variable and depended upon the mode in which LHRH was presented.


Hypothalamic-pituitary-ovarian interactions during reproductive senescence in the rat. The neuroendocrine status of Long-Evans female rats was evaluated at several key stages of reproductive senescence. Young (4-8 mo), middle-aged (10-14 mo) and old (24-30 mo) animals were studied according to reproductive state. The reproductive states studied were (1) regularly cycling, (2) constant estrus and (3) pseudopregnant, as determined by vaginal smear cytology. Neuroendocrine parameters at the levels of the hypothalamus, pituitary and steroid-producing organs were compared between each group. DA3, E and NE concentrations in the median eminence of the hypothalamus were determined by a highly sensitive radioenzymatic assay. LRF content in the median eminence was measured by radioimmunoassay. Circulating levels of LH, FSH, PRL and six steroids were determined. Changes in hormone and neurotransmitter concentrations were deomonstrated in association with the various stages of reproductive senescence and with age advancement. These changes involved the hypothalamic, pitiutary and steroid systems. NE content in the median eminence, FSH in serum and circulating androstenedione were all significantly increased in middle-aged, cyclic rats prior to the onset of senescent anovulation. DA concentration in 24 mo. old constant estrous rats (30.7 +/- 7.7 pg/microgram, N = 6) and in 30 mo. old pseudopregnant rats (27.5 +/- 7.1 pg/microgram, N = 6) was significantly reduced compared to young (6 mo. old), cyclic controls on proestrous (55.0 +/- 4.7 pg/microgram, N = 12). This DA reduction was associated with a 3-fold increase in circulating prolactin. The results are discussed in terms of  a regulatory cascade model of female reproductive senescence (Finch, 1976).


Relevance of polyclonal antibody formation to the development of autoimmunity : the model of African trypanosomiasis. There is an induction of anti-DNA antibodies in mice following the administration of bacterial lipopolysaccharides, Dextran sulfate and PPD, which is closely associated with the property of these substances to trigger a polyclonal B cell activation. In the experiments model of African trypanosomiasis there is also an intense polyclonal antibody synthesis paralleled by the formation of several autoantibodies: anti-DNA, anti-bromelain treated mouse red blood cells and antithymocyte antibodies.


A combined clinical and immunological assessment of four cyclophosphamide regimes in rheumatoid arthritis. Four dosage regimes of cyclophosphamide have been compared in patients with late rheumatoid arthritis, in an attempt to separate toxicity from efficacy. Joint inflammation was assessed clinically and objectively by quantitative thermography. Delayed hypersensitivity in vitro was assessed using leucocyte migration inhibition (L.M.T.) to a standard antigen, Streptokinase. There was no significant difference in clinical response or side-effects between a continuous oral regime (1 mg/kg/day) and the same total dose given as an intermittent oral regime. Responders and non-responders were seen in both groups and there was a significant relationship between clinical response and fall in platelet count, suggesting a variable threshold. The same total dose given as an intermittent intravenous regime caused considerable side-effects but these could be avoided by the addition of methylprednisolone. Both intravenous regimes induced a much more rapid fall in the Thermographic Index (T.I.) than the oral regimes. Indeed many patients receiving oral cyclophosphamide showed an increase in joint inflammation in the first three weeks of treatment. Immunological studies demonstrated a corresponding increase in reactivity to Streptokinase over this period. There was a highly significant correlation between changes in L.M.T. and T.I. both early in treatment and, in the oral groups, over a period of six months.


Fine structure of cells and their histologic organization within internodal pathways of the heart: clinical and electrocardiographic implications. The fine structure of the normal internodal pathways was studied in 1 human and 2 canine hearts and correlated with histologic observations on more than 100 human and 10 canine hearts. From the electron microscopic studies six different kinds of myocardial cells were classified from two locations: the Eustachian ridge (posterior internodal pathway) and the Bachmann bundle (anterior internodal pathway). Five of the six kinds of cells (working myocardial cells, Purkinje-like cells, either broad or slender transitional cells and P cells, all previously described) were present in both locations. A sixth cell, pleomorphic and dark in appearance, with a special intertwined relation to P cells, is newly designated as an ameboid cell. It was found solely in the Eustachian ridge. In the same area a rare direct contact between a nerve and a myocardial cell was observed. The importance of these different kinds of cells, their respective cell connections, and their topographic locations inside the internodal pathways are discussed relative to certain functions such as rapid conduction and subsidiary pacemaking. The possible influence of these factors on clinical electrocardiographic changes is considered.


An annotation on the pulse in aortic regurgitation: Thomas Cuming, 1822. The classic bounding pulse of aortic regurgitation was described by several authors before Corrigan made his comprehensive study of the disorder in 1832. The case report of Thomas Cuming, published 10 years earlier, is worthy of review. This Dublin practitioner not only presented signs and symptoms of aortic regurgitation proved at autopsy, but also attempted with considerable success to relate the signs to circulatory dynamics.


Clinical experience with the soybean protein diet in the treatment of hypercholesterolemia. The efficacy of the total substitution of animal proteins with a textured soybean protein in hypercholesterolemic individuals was assayed in 42 in-patients and 18 out-patients. The in-patients studied followed one of three different crossover protocols: in protocol A, the soybean diet was compared with a standard low lipid diet; protocol B compared two soybean diets, one with added cholesterol, one without; and protocol C compared a soybean diet containing a high P/S fatty acid ratio to one with a low P/S ratio. In all three protocols, the soybean regimen provided valid and reproducible hypocholesterolemic effects that were not modified by the addition of cholesterol. P/S variations appeared, however, to modify the final effect: soybean definitely had a decreased effectiveness with a low P/S (0.1) regimen. The overall plasma cholesterol changes in the 42 in-patients after 3 weeks on the different soybean diet protocols was -20%. Patients with type IIA and IIB hypercholesterolemia provided almost equivalent results, whereas patients with mixed phenotypes (IIB-III) appeared somewhat more sensitive to the dietary effect. Cholesterol decreased mostly in the low density lipoprotein fraction, but some very low density lipoprotein changes were also noted upon variation of the P/S ratio. The out-patients studied provided less satisfactory results. possibly due to the difficulty of adequately complying with the diet. These studies indicate that treatment with the soybean diet is an effective regimen for inducing a significant cholesterol reduction in type II patients refractory to standard low lipid regimens.


Home screening for the detection of urinary tract infection in infancy. One hundred sixty-five infants of both sexes, 2 weeks to 2 years of age, were screened by their parents at home for bacteriuria. Parents were instructed during a single brief period during the initial office visit to collect and to culture their infants' urine at home. Urine was collected by specimen bag and cultured promptly at cribside using a newly developed culture kit and inoculating swab. The same specimen was cultured by the office laboratory staff by kit and swab and, as a reference standard, by the loop-MacConkey method. Infants were screened at home after three consecutive office visits. Then, 870 specimens were processed. Urinary tract infection (UTI) was diagnosed in 3.6% of the study population. Results show that home screening of infants for UTI by the parent compares favorably with screening by the office laboratory.


Bullous disease of childhood.

Bullous disease of childhood. Bullous disease of childhood (BDC) is a persistent or recurrent blistering skin disease characterized by large, tense bullae in a generalized distribution, but with a predilection for the scalp, trunk, pubis, and inner thighs. It usually begins in the first decade of life and spontaneously remits after several months to three years of activity. Sulfapyridine or dapsone therapy usually controls the disease. Administration of corticosteroids for systemic effects should be avoided.


Turner's syndrome occurring with Horner's syndrome. Seen with coarctation of the aorta and aortic aneurysm. A patient with 45, XO Turner's syndrome, subclinical coarctation of the aorta, and aortic aneurysm is described. She had left Horner's syndrome. The literature is reviewed for cases with the combination of aortic aneurysm and coarctation.


Recent developments in understanding the pathogenesis of aplastic anemia. Bone marrow failure in aplastic anemia (AA) could result from abnormalities of hematopoietic stem cells, abnormal control of hematopoiesis, or abnormalities of the hematopoietic environment. Bone marrow transplantation, in vitro marrow culture techniques, and studies in animal models of marrow failure have provided insights on the possible pathogenetic mechanisms underlying AA. Studies in man and in murine models suggest that most often AA results from injuries to hematopoietic stem cells. Despite the intriguing report of abnormal regulatory cells in congenitally anemic mice, instances of marrow failure due to defective humoral or cellular control of hematopoiesis have not been identified in man. In vitro studies employing allogeneic marrow targets have suggested that immune suppression of hematopoiesis may occasionally mediate AA in man. Marrow failure due to abnormalities of the hematopoietic microenvironment has been suggested by experience with bone marrow transplantation, but no direct study of this possibility has been reported. Based on available evidence, it seems likely that AA will prove to be many diseases that share common clinical and morphologic features.


Analysis of genetic data on Jewish populations. I. Historical background, demographic features, and genetic markers. Part I describes the data sets on which the analysis of Part II is based. This covers the nature of the populations sampled, the extent to which the samples are representative, and a brief review of historical and demographic facts on the populations involved.


Analysis of biochemical genetic data on Jewish populations: II. Results and interpretations of heterogeneity indices and distance measures with respect to standards. A nonparametric statistical methodology is used for the analysis of biochemical frequency data observed on a series of nine Jewish and six non-Jewish populations. Two categories of statistics are used: heterogeneity indices and various distance measures with respect to a standard. The latter are more discriminating in exploiting historical, geographical and culturally relevant information. A number of partial orderings and distance relationships among the populations are determined. Our concern in this study is to analyze similarities and differences among the Jewish populations, in terms of the gene frequency distributions for a number of genetic markers. Typical questions discussed are as follows: These Jewish populations differ in certain morphological and anthropometric traits. Are there corresponding differences in biochemical genetic constitution? How can we assess the extent of heterogeneity between and within groupings? Which class of markers (blood typings or protein loci) discriminates better among the separate populations? The results are quite surprising. For example, we found the Ashkenazi, Sephardi and Iraqi Jewish populations to be consistently close in genetic constitution and distant from all the other populations, namely the Yemenite and Cochin Jews, the Arabs, and the non-Jewish German and Russian populations. We found the Polish Jewish community the most heterogeneous among all Jewish populations. The blood loci discriminate better than the protein loci. A number of possible interpretations and hypotheses for these and other results are offered. The method devised for this analysis should prove useful in studying similarities and differences for other groups of populations for which substantial biochemical polymorphic data are available.


Polyvalent pneumococcal vaccines: a review. The development, pharmacology, effectiveness, adverse reactions and clinical use of polyvalent pneumococcal vaccines are reviewed. Patients with sickle cell anemia, asplenic and elderly patients, infants and closed populations are particularly susceptible to Streptococcus pneumoniae infections. Polyvalent pneumococcal vaccine induces a satisfactory antibody response wihin about two weeks which declines with time but generally remains elevated for at least 20 months after infection. The vaccine has been reported to reduce the incidence of pneumococcal disease by 76 to 100% and to reduce the carrier rate of pneumococci covered by the vaccine; however, infants younger than two years of age repond inconsistently. Local reactions to the vaccine (soreness at injection site, erythema, induration and tenderness) occur in 86% of adults and nearly all children. The incidence of adverse reactions increases on revaccination. The recommendations of the U.S. Public Health Service and Center for Disease Control on use of the vaccine are presented. Mass immunization with the vaccine is not recommended, but the vaccine may be of benefit in sickle cell, asplenic and elderly patients, and in closed populations.


Familial herpes simplex infection associated with activation of the complement system. A patient with severe recurrent herpes infection was evaluated for immunologic analysis including a profile of complement components. The peripheral blood lymphocytes from the patient responded by proliferation to herpes simplex antigen but failed to produce leukocyte migration inhibition factor. Herpes simplex antibody titers increased during active infection. Total hemolytic complement (TCH50), the third (C3), fifth (C5), sixth (C6) and seventh (C7) components of complement, and factor B were dramatically reduced; the first (C1), second (C2) and fourth (C4) components of complement were within normal limits. In family members with a history of recurrent herpes simplex, one or more of the later complement components (C5, C6 or C7) was reduced. This study demonstrates the activation of complement in these serums via the alternative pathway.


Combined modality treatment of Hodgkin's disease confined to lymph nodes. Results eight years later. Eighty-seven patients with newly diagnosed Hodgkin's disease, pathologic stages IA, IIA, IIB and IIIA, were assigned at random to receive either extended field radiotherapy alone or that therapy followed by six cycles of MOPP (nitrogen mustard, Oncovin, procarbazine, prednisone) chemotherapy. Patients were entered into the study from January 1970 to January 1974. Patients were followed for a median of 69 + months from the end of all treatments. Patients whose disease was less than stage IIIA had a 31 per cent relapse rate with radiotherapy alone compared to a 6 per cent relapse rate with combined modality treatment (P = 0.04). No deaths from Hodgkin's disease have occurred in patients who received combined modality therapy, whereas 24 per cent of the patients who received radiotherapy alone have died with active disease. However, three patients with stage IIIA disease who were treated with both modalities have died from other causes (myocardial infarction, adenocarcinoma of lung, acute leukemia). Combined modality therapy of patients with early Hodgkin's disease may be superior to radiotherapy alone, especially for certain subgroups of patients discussed in detail.


Recurrence of nephrolithiasis. A six-year prospective study. Retrospective studies of nephrolithiasis tend to overestimate the severity of the disease and mistakenly ascribe benefits to treatment regimens. The results of a three-year study of recurrent nephrolithiasis in three patient groups adhering to a calcium-restricted diet who were treated with phosphate therapy, placebo or diet alone are re-examined at the close of an additional three-year follow-up period. Nearly half the subjects in all groups remained free of stone for the six-year period. A reduction in the need for lithotomies occurred in all groups. The absence of renal calcification at entry into the study as well as increasing age were associated with a marked reduction in stone passage. Drug therapy should probably be avoided in older patients as well as in those who are free of renal calcifications.


Clinical uses of microorganisms and their products. Although antibiotics and conventional vaccines are the two most familiar examples of man's exploitation of microorganisms as clinical allies, microorganisms and their products are assuming an increasingly prominent role in the diagnosis, treatment and prevention of human diseases. This report attempts to give a brief overview of the status of the use of microorganisms in clinical medicine and to identify potentially fertile areas for future progress in their clinical application, concentrating on areas other than the already extensively reviewed ones of antibiotics and classic immunization.


Pseudo-Gaucher cells in multiple myeloma. A bone biopsy specimen from a patient with multiple myeloma showed numerous Gaucher-like cells scattered throughout a homogeneous background of plasma cells. Further studies using histochemical stains, immunofluorescence, and light and electron microscopy were carried out to further define these cells. Light microscopy of Wright-stained and hematoxylin and eosin-stained marrow preparations showed large, round cells with fibrillar appearing cytoplasm and eccentric, pyknotic nuclei. These cells were periodic acid-Schiff positive, resistant to diastase digestion. Electron microscopy demonstrated plasma cells containing crystals in membrane-bound vesicles. Also, large macrophages among these plasma cells contained similar crystals surrounded by a single limiting membrane. Immunofluorescence staining of thin sections of marrow with fluorescein-labelled specific antiserums showed fluorescence of these large cells. Strong immunofluorescence was seen with polyvalent kappa and gamma antiserums but not with anti-albumin or serums with anti-lambda, mu or alpha specificity. It appears that these large cells have the light microscopic and histochemical characteristics of true Gaucher cells but, when studied with immunofluorescence and electron microscopy, it appears that the pseudo-Gaucher cells of multiple myeloma are bone marrow macrophages engorged with immunoglobulin.


Luteinizing hormone--releasing hormone levels in human plasma: a radioimmunoassay method. A sensitive double-antibody radioimmunoassay, developed to measure luteinizing hormone--releasing hormone (LHRH) levels in fetal brain tissues, has been modified to quantitate LHRH in unextracted plasma samples. Pure, synthetic LHRH was iodinated with 125I for tracer and was also used as standard. The antibody utilized was specific for LHRH and did not cross react with other hypothalamic or pituitary hormones. The separation of free from antibody-bound tracer was performed by dextran-coated charcoal. The sensitivity of the assay was 2.5 pg/tube. The intra-assay and interassay coefficients of variation were 5.9 and 6.1% for 50 pg/ml and 11.8 and 14.9% for 25 pg/ml samples. Recovery of known amounts of LHRH added to plasma samples that had no detectable hormone was 96.4 +/- 8.8%. Whether these samples were previously prepared and kept frozen at -20 degrees C or freshly prepared, the recovery of LHRH was consistent and quantitatively stable in each assay. Serial determinations of LHRH in plasma obtained from ovulatory volunteers averaged between 20.5 +/- 2.1 pg/ml in the follicular phase and 19.4 +/- 4.5 pg/ml in the luteal phase. At midcycle, coincident with the luteinizing hormone surge, LHRH levels averaged 17.6 +/- 4.4 pg/ml.


Erythrityl tetranitrate: sustained effects on systolic time intervals. changes consistent with sustained preload reduction. The effects of sustained preload reduction have been demonstrated for several nitrates but not for erythrityl titranitrate. In seven patients with coronary heart disease, a randomized double-blind crossover clinical trial showed that chewable erthrityl tetranitrate, 10 mg, produced significant changes in systolic time intervals consistent with preload reduction and lasting for at least four hours. As compared with placebo, ejection time index (ETI) fell and remained significantly low between 6 and 90 minutes after administration, and pre-ejection period (PEP), isovolumic contraction time IVCT),  and pre-ejection period/left ventricular ejection time (PEP/LVET) rose and remained significantly increased between 22 minutes and the four-hour endpoint. We conclude that erythrityl tetranitrate is a physiologically effective long-acting agents in patients with coronary heart disease.


The amnion in surgery, past and present. The clinical application of the fetal membarnes has been under study for many years. An attempt is made to bring the reader up to date in this fascinating subject and to indicate practical employment of the membrane in modern medicine. The amnion and chorion are detailed separately where possible, particularly in the field of surgery.


Perioperative cephalosporin prophylaxis in cesarean section: effect on endometritis in the high-risk patient. A total of 120 patients who were to be delivered by cesarean section and who were at high risk of postoperative infection received three doses of either cefamandole, cephalothin or placebo perioperatively. Maternal serum levels for both antibiotics were in the therapeutic range. Although both drugs reduced the incidence of febrile morbidity and endometritis, only cefamandole significantly reduced the fever index. Risk factors for postoperative infections were the presence of ruptured membranes, labor, and internal fetal monitoring. Cefamandole beneficially influenced all risk factors while cephalothin was able to reduce only the risk of ruptured membranes. When a new method for obtaining endometrial tissue was utilized, 50% of cultures were negative. There was no difference in the organisms isolated from patients with and without endometritis.


Lower eyelid full-thickness vertical lengthening. Two cases of lower eyelid retraction caused by loss of full-thickness eyelid components were successfully treated with a tarsal-confunctival flap and skin graft procedure. One patient also had upper eyelid retraction, which was decreased by excising Müller's muscle and recessing the levator aponeurosis simultaneously with the lower eyelid surgery.


Donor cornea contamination with McCarey-Kaufman medium preservation. A patient had corneal infection with Staphylococcus aureus after keratoplasty from tissue preserved in McCarey-Kaufman medium. The small, successfully treated corneal infection was from the same organism cultured from the tissue culture medium at the time of transplantation. Possible sources of donor-tissue contamination included the increase in ocular flora seen in postmortem eyes, blood-borne bacteria, lack of sterile technique in securing donor tissue, inadequate irrigation of the tissue, and inadequate use of topical antibiotics on the tissue. Preservation medium and specimens from medium-preserved and refrigerated corneas should be cultured before and during surgery.


Congenital perforated cornea in Peter's anomaly. A male infant was born with a perforated left cornea associated with bilateral central corneal defects caused by mesodermal dysgenesis. Smears and culture of the perforated cornea revealed no infectious agents, and there was no evidence of systemic infection in the child or mother at birth. Histopathologic material excised during keratoplasty was compatible with persistent hyperplastic vitreous, possibly causing a forward displacement of the lens/iris diaphragm with pressure on the corneal endothelium and possible dissolution of the cornea leading to perforation. The relationship of increased intraocular pressure in this case was unknown.


Mycotic endophthalmitis in drug abusers. We diagnosed mycotic endophthalmitis by positive cultures in a 47-year-old man and a 42-year-old woman, both intravenous amphetamine users. Reinfection with a different fungal species was documented in one case. Rapid identification of the isolate, in vitro susceptibilities, selection of appropriate routes and dosages of antifungals, and the role of adjunctive corticosteroids are crucial factors in the management of these difficult cases. We prescribed antifungals and adjunctive corticosteroids, and our patients' vision improved.


Scanning electron microscopy of trabeculectomy specimens in open-angle glaucoma. We examined trabeculectomy specimens obtained at the time of surgery for inadequately controlled open-angle glaucoma by scanning electron microscopy. Of the 50 specimens ten included a broad area of the trabecular meshwork. In these ten specimens the meshwork was obscured by material. We believe the degree of occlusion was significant in these specimens, which would lead to obstruction of aqueous outflow. No similar material was found in control specimens from persons of similar age.


Prevention of immune graft rejection after corneal transplantation. The effectiveness of fluorometholone was compared to dexamethasone phosphate and prednisolone acetate in preventing the immune corneal graft reaction in rabbits. Clear corneal grafts were obtained. Rejection was induced after skin from the corneal donor animal was grafted subcutaneously in the host animal and the animals were randomized into four treatment groups. Rejection occurred in eight of nine rabbits in the control group; one of eight in the dexamethasone phosphate group; one of eight in the fluorometholone group; and one of ten in the prednisolone acetate group. Histologic examination confirmed the above findings. In this animal study fluorometholone prevented immune graft rejection in a percentage similar to that of prednisolone acetate and dexamethasone phosphate.


Comparative studies of cellular reactions to injuries between the inner medulla and the cortex of rat kidneys. The inner medulla and the cortex of the rat kidney were surgically traumatized or threaded with a silk suture, and the sequence of morphologic events occurring in these two topographic locations were studied by light microscopy on Days 7, 14, and 28. On Days 7, 14, and 28 following the infliction of the surgical trauma, such cellular reactions as mononuclear cell infiltration and fibroblastic proliferation were less intense in the injured site of the inner medulla than in the cortex. Numerous foreign body type giant cells appeared about the suture material in the cortex as early as Day 7 and were persistently present on Days 14 and 28. A similar type of foreign body giant cells did not appear about the suture material within the inner medulla throughout the experiment. Our results suggest that there is a difference in cellular reaction to injury or to a foreign body between the inner medulla and the cortex of rat kidneys.


A study of torus palatinus and torus mandibularis in Pre-Columbian Peruvians. An incidence of tori lower than previously reported was found in a population from Pre-Columbian Peru. It is suggested that the prevalence of tori along with other genetic markers with racial variation may be used to help identify and define a population group.


Size and morphology of the permanent dentition in prehistoric Ohio Valley Amerindians. Metric and morphological characterizations of the permanent teeth from a total of 155 prehistoric Amerindians are presented. The individuals represent samples from three Ohio Valley burial complexes (considered together as the Late Diffuse group): Glacial Kame, Adena and Ohio Hopewell. Metric data include common measures of central tendency and dispersion. From these measures estimates and analyses of the magnitude of sexual dimorphism and relative variability are presented as well as analyses of the patterns of these estimates. Forty morphological characters are also tabulated. The results indicate a number of provisional hypotheses: the generally larger tooth size of the Late Archaic Indian Knoll when compared to the Late Diffuse groups is consistent with the hypothesis of mitigated selective pressures in more technologically advanced groups; although tooth size is smaller in the Late Diffuse groups, dental morphology is as complex, or more so when compared to the Indian Knoll group. Since morphology and size do not covary exactly the biocultural forces resulting in smaller tooth size do not seem to act as strongly on dental morphology; odontological differences within the Late Diffuse arise primarily between the Glacial Kame-Adena and the Ohio Hopewell. These differences correspond to major biocultural changes in this area; although provisional hypotheses concerning odontological variability are erected, hypotheses concerning evolutionary trends must await the discovery of evolving lineages within these groups; similarities are noted among all compared groups including the pattern and magnitude of sexual dimorphism and relative variability. These parameters may be similar for all eastern Amerindians during this period; finally, the morphology of the deciduous dentition, which generally predicts that of the permanent teeth, is found to be less complex than the permanent teeth. This may be the result of a selective disadvantage for the individuals in the deciduous dentition sample which is reflected in the dentition.


Calcium transport in the nephron.

Calcium transport in the nephron. Ionized and complexed calcium are filtered at the glomerulus and more than 95% of the filtered load is reabsorbed along the length of the nephron. In the proximal convoluted tubule calcium is absorbed in proportion to sodium and water, suggesting a passive mechanism. The high permeability of this segment is compatible with passive transport, but evidence for active transport has been advanced. A role for Ca2+-ATPase and/or for a Ca2+/Na+ antiport has also been proposed. The straight portion of the proximal tubule appears to transport calcium actively but little is known about the mechanism and regulation of calcium absorption in this segment. Both passive and active transport of calcium in the thick ascending limb have been demonstrated, and heterogeneity in the function of medullary and cortical segments has been proposed. Definite evidence has been advanced for avid active calcium absorption in the distal convoluted tubule. Both chlorothiazide and parathyroid hormone enhance the transport of calcium in this segment. The granular portion of the collecting tubule resembles in its properties and function the distal convoluted tubule. The light portion, however, is incapable of transporting calcium. The distal tubule and collecting tubule may be the final regulators of urinary excretion of calcium but much more data are required before this view can be adopted.


Vitamin B12 uptake in dog kidney: its use as an extracellular reference marker. The renal handling of [3H]cyanocobalamin has been investigated in dogs in vivo using the pulse injection multiple-indicator dilution technique. Simultaneous renal vein and urine outflow curves were obtained for [3H]cyanocobalamin relative to T-1824-albumin (plasma reference) and creatinine (extracellular reference). The renal vein recovery of [3H]cyanocobalamin relative to creatinine was significantly less than unity and increased with increasing intraarterial dose. This indicates a saturable postglomerular uptake mechanism. The urine recovery of [3H]cyanocobalamin relative to simultaneously filtered creatinine is also less than unity and increases with increasing intra-arterial doses. This indicates a saturable interaction at the luminal surface of the nephron. Saturation interaction at the luminal surface of the nephron. Saturation of postglomerular and luminal interactions can also be achieved by systemic preloading with unlabeled vitamin B12. After saturation the renal vein and urine recoveries for [3H]cyanocobalamin and creatinine become equal. However, significant differences can be observed between their renal vein mean transit times, depending on experimental conditions. During hydropenia [3H]cyanocobalamin behaves as a true extracellular marker and emerges in renal vein and urine outflows, superimposing on creatinine. During mannitol diuresis vitamin B12 still behaves as a glomerular marker, but its renal vein mean transit time is now significantly less than that of creatinine and its calculated postglomerular volume of distribution is reduced by approximately 15% of the available interstitial space.


Effect of growth hormone on acute glucagon and insulin release. The aim was to clarify whether or not sudden spike concentrations of plasma growth hormone (GH) can affect the endocrine pancreas in vivo. The peaking of GH was reproduced by an injection (10 mg/kg iv) of bovine GH to anesthetized normal, pancreatectomized, and alloxan-diabetic dogs. In portal but not in peripheral blood, immunoreactive plasma glucagon (IRG), glucagon-like activity (GLI), and immunoreactive insulin (IRI), were significantly elevated within 10 min in normal and alloxan-diabetic dogs. In pancreatectomized dogs, GH did not affect either IRG or GLI. When a physiological dose of GH (6 microgram/kg) calculated to produce ambient peak plasma concentrations of 40 ng/ml was given to four conscious, normal dogs with indwelling portal catheters, a rise of IRG from 108 +/- 19 to 170 +/- 17 pg/ml and of IRI from 20 +/- 12 to 67 +/- 19 muU/ml (mean +/- SE) occurred within 2 min. GLI was not affected. Thus a sudden rise in GH concentration can stimulate the release of a) GLI in the presence but not in the absence of the pancreas, and b) pancreatic IRG and IRI but not extrapancreatic IRG.


Urate transport in the nephron.

Urate transport in the nephron. This paper summarizes the literature on the sties of urate transport, secretory and reabosrptive, in the nephron. In the animals studied thus far the bulk of urate transport occurs in the proximal tubules. Two patterns of transport have been uncovered. In one, urate is secreted and reabsorbed throughout the convoluted tubule (perhaps the pars recta as well). The direction of net transport depends on the kind of animal studied and in some instances on the experimental conditions. In the second pattern there is a strong secretory process in the pars recta, and net secretion of urate, when it occurs, is attributable to that segment. In some but not all animals it is clear that urate secretion in the proximal tubules occurs by a mechanism separate from that which secretes p-aminohippurate (PAH). One important unresolved question is: How general is the occurrence of separate secretory mechanisms for PAH and urate? Another unresolved question is: What are the magnitudes of the unidirectional fluxes of urate in the segments in which bidirectional transport occurs?


Acute high-dose parenteral haloperidol treatment of psychosis. After 2 days of drug-free observation, 20 newly admitted psychotic patients received 20-35 mg of haloperidol intravenously and 20 patients received 30-40 mg of diazepam intravenously. Posttreatment ratings at 4 and 24 hours with the Brief Psychiatric Rating Scale and the Clinical Global Impressions revealed significant improvement in both groups but no significant differences between the two treatments.


Plasmodium gallinaceum-parasitized chicken erythrocytes in a practical hemagglutination test for IgM antibodies in human malaria. A new hemagglutination test for human malaria, done with Plasmodium gallinaceum-parasitized, aldehyde-fixed, chicken erythrocytes as a stable lyophilized reagent, is described. The test was positive in every human case of falciparum or vivax malaria in which there was parasitemia. It detected only IgM anti-plasmodial antibodies and usually became negative within a few weeks after treatment. As a practical and sensitive test for active malaria, the P. gallinaceum hemagglutination test should be complementary tool for seroepidemiological studies.


Free microvascular flaps for defects of limbs, head, and neck. Twenty-three free microvascular flaps were transferred during the period September 1975 to December 1978. These included skin flaps, osteocutaneous flaps, and flaps of omentum and jejunum. These flaps were used for a variety of conditions ranging from life-threatening bleeding from a tumor to facial contouring in congenital deformities. In selected patients a microvascular free flap has significant advantages over multi-staged conventional flaps.


Colon perforation in renal transplant patients. Seven patients had perforated colonic diverticula 1 to 17 months after transplantation. Operation was performed immediately in four patients and from 4 days to 3 months later in three patients. Three patients are alive 9 to 36 months later. Two died of sepsis and two of myocardial infarction. Immediate operation with exclusion carries the best prognosis.


Combining segmental systolic pressures and plethysmography to diagnose arterial occlusive disease of the legs. Computer-assisted analysis of the data from SLP and PVR study of the legs with angiographically documented arterial occlusive disease, projected against a background of normal limbs, was used to assess the diagnostic value of each study, including its individual variables, as well as their varied combinations. The accuracy of both SLP and PVR interpretation was significantly improved by standarization against brachial values, but even with the aid of superimposed physician interpretation, each only reached 86 per cent when cases with multilevel occlusive disease were included. The combination of these two studies, which compensate for each other's limitations in several respects, achieved an overall accuracy of 97 per cent, with no errors observed in diagnosing either normal limbs or those with isolated occlusive disease. Objective diagnostic criteria for both SLP and PVR interpreatation are presented in algorithmic form.


Contributions of Thomas Jefferson to American medicine. Thomas Jefferson, the third president of the United States and author of the Declaration of Independence, had a consuming interest in all fields of education and science, including the practice of medicine and public health. He actively developed medical education, supported measures for public health, and encouraged scientific research supported by the government without policy intervention. Although a close friend of eminent physicians, his rationalism and scientific method placed him ahead of many practitioners of his time. He disparaged medical quackery but actively supported therapies such as vaccination that were based on research and careful observation. The School of Medicine at the University of Virginia was Jefferson's concrete contribution to the advancement of medical education in the United States and epitomized his preoccupation with medicine and science as important cornerstones of a healthy American nation.


A simplified technique for loop colostomy closure. Stapling instruments have been used for gastrointestinal anastomoses and reconstruction with increasing regularity. A technique for loop colostomy closure employing a stapling device is described. This approach provides a secure closure while avoiding major contaimination.


Study of filamentary keratitis by replica technique. Histopathological study of filamentary keratitis was done by using replica technique in five patients. The filaments are produced by sliding of the epithelial cells around small areas of focal degeneration of the superfical epithelium. In comparison to the filaments in other conditions, the filaments in KCS are smaller and thicker and do not show the torsional segment. The filaments contain degenerated epithelial cells and alcian blue-PAS positive mucoid material. Making a corneal replica may result in healing of filamentary keratitis.


[Infusions emergencies following the administration of plasma substitutes -- analysis of case reports to the committee on drugs. The problems of medical statistics, prophylaxis and immediate therapy (author's transl)]. In the period 1967 to 1976 the Adverse Drug Reaction Committee of the Medical Association of the Federal Republic of Germany (AMK) received 323 reports of transfusion emergencies following the administration of colloid plasma expanders (dextran, gelatin, starch). The reports ranged from medium to severe cases. Nine percent of the reported cases had a fatal outcome. The data contained in these case reports could only be statistically analyzed within certain limitations as the reports were incomplete and other parameters necessary for a definite statistical evaluating were missing. Furthermore the results do not cover the following points: 1. What percentage of reactions to plasma expanders in W. Germany was reported? --2. What percentage can be attributed to the individual colloids within the entirety of these undesirable side effects? --3. What percentage of the individual colloids can be allocated to the varying degrees of severity of these reactions? -- Further limitations which complicated the analysis of the case reports are discussed individually. Despite these difficulties an attempt was made to analyse the parameters necessary in the diagnosis of acute transfusion emergencies and to compile a guide for the clinical symptomatology. Grading of reactions into four degrees of severity has proved useful both in terms of diagnosis and immediate therapy. The medical statistical evaluation presented in this paper gives an indication as to the significance of the observed side-effects and confirms the statement and recommendations made elsewhere in the literature. In these emergency cases life-threatening incidents appear to be more common than is generally assumed and the user is aware of. The incidence of product-specific emergencies can only be determined to some degree of accuracy by randomized prospective studies. These would have to be conducted with numerous strict guidelines. On the basis of the results presented here, these studies should be attended to with a sense of urgency. Regardless of the difficulties encountered in the evaluation of the case reports, guidelines as to the recognition of reactions, prophylaxis and immediate remedial therapy could be established. These would appear to suffice as urgently required comprehensive information for the nursing staff as well as all doctors. Recognizing side-effects and instituting immediate remedial therapy along the principles laid down in these guidelines can in most cases of severe reactions remove the acute threat to life.


[The circulatory system in patients under electrostimulation anaesthesia during ophthalmological operations (author's transl)]. Anaesthesia by electrostimulation and its effects on the circulatory system were investigated in 65 elderly patients, in whom operations on the retina and vitreous body were performed. Stimulation of the dermatomes of the first and second trigeminal nerve as well as of C3 and C4 was performed using stimulating needles in 25 patients and adhesive electrodes in 40 patients. All patients were intubated after injection of thiopentone and a muscle relaxant. Anaesthesia was maintained by continuous electrostimulation, intermittent relaxation and normoventilation with N2O/O2 in a ratio of 1/1. During this anaesthesia technique, marked stability of the circulatory system was observed. This was noted in 32 normotensive and 33 hypertensive patients, the latter being partly under antihypertensive medication. Electrostimulation anaesthesia therefore may be recommended for elderly and high risk patients.


[Combined-electrostimulation-hypalgesia in surgery of the lumbar vertebral column. A tentative evaluation of this method (author's transl)]. A new concept of anaesthesia in patients undergoing operations of the lumbar vertebral column is presented. Electrostimulation of four auricular acupuncture points is combined with controlled ventilation of nitrous-oxide oxygen mixture. This combination is comparable to similar anaesthesia procedures of other operative fields. In 30 patients the anaesthesia was performed as a "combined electrostimulationhypalgesia". In a control study of 30 similar patients a mixture of nitrous-oxide and oxygen only was used. For 120 min systolic and diastolic blood pressure as well as heart rate of both groups are measured and compared. The postoperative state as well as individual data from the patients are included in the investigation. The analgesia established by "combined electrostimulationhypalgesia" seems to be based essentially on the effect of nitrous-oxide as well as premedication, induction of anaesthesia, relaxation and kind of ventilation. Electrostimulation of auricular acupuncture points seems to induce stabilisation of the circulatory system. On account of our findings the relevance of electrostimulation in this method of anaesthesia must be judged very critically.


[Plasma-catecholamines under electrostimulation and neurolept anaesthesia for retina and vitreous body operations (author's transl)]. We determined in two groups of patients with normal circulation and metabolism during operations on the retina and vitreous body the concentration of plasma catecholamines. The intensity of stress was compared between electrostimulation anaesthesia and neuroleptanaesthesia. Venous blood was sampled 1) before premedication, 2) 30' after premedication, 3) at the start of surgery, 4) 45' after the start of surgery, 5) 30' after extubation. Plasma catecholamines (adrenaline and noradrenaline) were determined using a modified trihydroxyindol-spectrofluoremetric method (combined "Batch-technique"). There was no relevant difference between the two techniques of anaesthesia when using the concentrations of plasmacatecholamines as an indicator of stress resulting from operation and anaesthesia.