[Complications of nephrotic syndrome with special reference to thromboembolic accidents]. The nephrotic syndrome may be associated with several complications caused by severe proteinuria. The consequences of severe renal protein loss are disturbances of water and electrolyte metabolism, thromboses and thromboembolic complications, hyperlipidemia with accelerated atherosclerosis and, finally, some other complications due to the decreased oncotic pressure and the renal loss of transport globulins and immunoglobulins. Diagnosis and treatment of these complications are important in the management of patients with nephrotic syndrome. In the present study, the frequency and localization of thromboses and thromboembolic complications in 11 patients with nephrotic syndrome are described. In addition, factors which are known to be responsible for the hypercoagulable state in nephrotic syndrome were evaluated and correlated to the thromboembolic complications in these patients. An important finding was that in all patients with thromboses and thromboembolic complications, the serum albumin concentrations were below 2 g/100 ml, whereas, with one exception, serum albumin levels were above 2 g/100 ml in cases without thromboembolic complications. Our results indicate that serum albumin levels may be used as an indirect parameter to assess the risk of thromboembolic complications in patients with nephrotic syndrome.


Binding of cis- and trans-dichlorodiammineplatinum(II) to DNA: evidence for unwinding and shortening of the double helix. The antitumor drug cis-dichlorodiammineplatinum(II) (cis-DDP) and the inactive trans isomer bind and produce cooperative changes in closed and nicked circular duplex DNA's. Covalent binding of both platinum complexes to the closed circular DNA alters the degree of supercoiling, presumably by disrupting and unwinding the double helix. Electron micrographs show the platinated DNA's to be shortened by up to 50 percent of their original length. At similar ratios of bound platinum per nucleotide, the electrophoretic mobilities of the DNA's in gels containing the dye ethidium bromide are the same for both isomers. The only detectable difference in the binding of the two platinum isomers is an increase in the electrophoretic mobility in nondye gels of closed circular DNA having small amounts of bound cis-DDP that is not apparent for the trans complex.


Amniotic fluid antibacterial mechanisms: newer concepts. In this review the factors present in human amniotic fluid that may function to inhibit bacterial growth have been examined. It appears that several potential antibacterial systems are present. Lysozyme and B-lysin may significantly contribute to the killing of gram-positive bacteria. Whether or not the remaining antibacterial systems function to inhibit gram-positive organisms remains to be determined. The phosphate-sensitive bacterial inhibitor recently described in our laboratory may represent the primary defense mechanism against gram-negative bacteria in amniotic fluid. Studies are warranted to ascertain whether this antibacterial system also inhibits gram-positive bacteria. The phosphate-sensitive bacterial inhibitor is quite different from other bacterial inhibitors in at least three respects. The system is very sensitive to the ubiquitous phosphate anion. The reason for this sensitivity is unknown and is difficult to explain phylogenetically, since phosphates are present virtually everywhere. To our knowledge this is the first antibacterial system of human origin which has been shown to require a metal cation as an integral part of the bactericidal effect. The peptide component of the phosphate-sensitive bacterial inhibitor is also unique in that it is of the molecular size of antibiotics or hormones. Additionally, the peptide does not appear to contain any unusual amino acids to explain its antibacterial activity. The mechanism of bacterial destruction of the phosphate-sensitive bacterial inhibitor, and its relation to the other antibacterial systems in amniotic fluid, remain to be elucidated.


On the mechanism of sensory transduction in bacterial chemotaxis. Sensory transduction in bacterial chemotaxis is beginning to be understood at the molecular level. At the receptor end, we have some considerable knowledge about the molecular properties of chemoreceptors. At the effector end, we know that flagella rotate and that the direction of rotation is determined by attractants and repellents, although we do not yet know the molecular features of the motor and the gear shift. Between the receptors and the effectors is a system for integrating the sensory transduction, which somewhow involves methylation of membrane proteins and possibly a change in membrane potential, but further details of how the mechanism works remain to be elucidated. It seems to us likely that the facts and concepts learned from a study of sensory transduction in bacteria can be applied to answering questions about transduction mechanisms in eukaryotic cells. Examples include the following: How do sensory stimuli produce their effects in sensory receptor cells? How do neurotransmitters act at receptors of postsynaptic cells to produce the variety of effects possible (changes in membrane potential, in secretion, in contraction, etc.)? How do hormones interact with their receptors to bring about various responses?


Septicemia in children with cancer.

Septicemia in children with cancer. Because of the persistently high mortality from sepsis in cancer patients, a retrospective study was designed to identify the causative organisms and to determine the factors affecting the outcome of sepsis. A total of 84 episodes of septicemia in 61 children with cancer were studied. The more frequently isolated organisms were: Staphylococcus aureus (21.4%); Escherichia coli (18%); Klebsiella (7.1%); Pseudomonas (6%); and Bacteroides fragilis (6%). Other isolates included Proteus, Serratia, Acinetobacter, hemolytic Streptococcus, and Bacillus cereus. In 10.7% of septic episodes, mixed bacterial infections were documented. Twenty-four (28.6%) resulted in death; in 13 (54%) death occurred within 24 hours after admission. The fatality rate was high in cases associated with absolute polymorphonuclear leukocyte counts of less than 100/cu mm, in neoplastic relapse, and when infection with gram-negative, anaerobic and mixed bacterial flora occurred.


Tungiasis in Tennessee.

Tungiasis in Tennessee. Tungiasis, an infestation by a burrowing flea, may cause multiple, painful lesions which, if they become secondarily infected, may eventuate in death. With increasing air travel to tropical areas, American physicians should recognize the lesion of this intracutaneous parasite. The fully developed lesion resembles an abscess with a black center. An infestation diagnosed in Memphis, Tennessee, is reported in a businessman who had returned from Brazil. Treatment consists of excision of the gravid female flea and careful cleaning of the cystic cavity. Healing is usually complete without sequelae. In an early infestation, the smaller gravid female, like a splinter, can be removed with a sterile needle. Tetanus prophylaxis may be indicated, depending on the wound and its location.


Behavior modification and haloperidol in chronic facial pain. Neuralgiform pain and migrainous pain, both of which are amenable to drug therapy, comprise a relatively small percentage of the group of patients with facial pain who come to the practitioner's office. The largest group of facial pain patients are those with myofascial connective tissue disorders. A second group includes patients with neuropathic pain due to trauma such as oral surgery. A third group is made up of those without any identifiable focus of pain in the extracranial tissue. In these three nonneuralgiform and nonmigrainous groups, it is thought that personality factors affecting psychophysiologic mechanisms are of great importance. These patients are generally difficult to treat. A variety of modalities of therapy, such as behavior modification, hypnosis, and biofeedback, has been reported as helpful in some of these patients. In this report we focus on 12 subjects who failed with all these forms of therapy. We found that they responded to relaxation therapy (after Jacobson) along with haloperidol. We describe further characteristics of these patients and details of our method of treatment.


Cholesterol embolism: the great masquerader. Embolization of cholesterol crystals from ulcerated atheromatous lesions can produce distinct syndromes that mimic more common disease processes. Cholesterol emboli can present as renal failure, hypertension, spells of numbness, abdominal pain, and myocardial infarction, or as a multisystem disease that closely approximates the presentation, clinical course, and even biopsy picture of polymyositis or periarteritis nodosa. A review of this problem with particular attention to the clinical presentations should help in the early diagnosis and treatment of cholesterol emboli and avoid unnecessary and inappropriate therapies.


Grand rounds: Nashville VA Hospital--Vanderbilt University. Saturday conference: renal disease in the juvenile diabetic. Renal disease, particularly glomerulosclerosis, is a major cause of morbidity and mortality in patients with juvenile-onset diabetes mellitus. Signaled by the onset of proteinuria after 15 or more years of insulin therapy, progressive renal insufficiency due to glomerulosclerosis terminates in uremia within five years. Although some patients have benefited from chronic dialysis programs, the outcome in uremic diabetics has been considerably better if successful renal transplantation can be accomplished. Extrarenal complications of diabetes mellitus and recurrence of diabetic lesions in transplanted kidneys have hampered the recovery and rehabilitation of transplant recipients. Other renal diseases encountered in juvenile diabetics are reviewed.


Patterns of infection in untreated acute leukemia: impact of initial hospitalization. Several previous authors have examined the association between infection and acute leukemia, especially at the time of death, but none has assessed this problem at the time of diagnosis and initial hospitalization. We have undertaken a retrospective review of cases of acute leukemia diagnosed at the affiliated hospitals of the State University of New York at Buffalo. Results suggest that bacteriologic findings in this population initially resemble those in the general outpatient population. Gram-negative bacilli, especially Pseudomonas aeruginosa, appear as important pathogens after the first week of hospitalization. A statistically significant association with prolonged granulocytopenia and use of antibiotics develops during this course. As a consequence of these data, we recommend careful culture and clinical delineation of the early infection, choosing the narrowest spectrum of antibiotic coverage appropriate to the infection present as data evolve.


Transurethral passage of Aspergillus fungus balls in acute myelocytic leukemia. A patient with acute myelocytic leukemia who had a chronic febrile illness during the induction of remission of leukemia developed asymptomatic discrete pulmonary infiltrates which rapidly evolved into cavities containing homogeneous opacities. Over the next five weeks, the cavities resolved without specific treatment. The patient subsequently passed large fungus balls in the urine, and the diagnosis of disseminated aspergillosis was made. A course of intravenous amphotericin B therapy was completed without complications. This case demonstrates the importance of culturing urine specifically for fungal organisms in the immunosuppressed host.


Metastatic lymphoma in the ureter complicated by bacteremia and fungemia. A 64-year-old woman presented with retroperitoneal lymphoma metastatic to the left ureter. Lymphoma was not diagnosed and her clinical course was not fully explained until after surgery. The lack of superficial lymphoma delayed diagnosis and therefore prevented effective treatment. Her situation became unmanageable when it was complicated by bacteremia (E coli) and fungemia (Candida albicans).


Status and prospects of genetic disease. The current status of our knowledge of genetic diseases is reviewed. The incidence of monogenic, multifactorial and chromosomal disorders, according to the literature to date, is given, and the possibilities of mass screening programmes are discussed. The prospects for antenatal diagnosis of genetic diseases are reviewed, with emphasis on the indications for amniocentesis and the safety of the procedure. Finally, speculations are made regarding the possible effects of medical and social practices on the frequency of genetic disorders in future generations.


Oxprenolol slow-release with cyclopenthiazide-KCl compared with methyldopa in the treatment of essential hypertension. A multicentre general practice trial. Two hundred and thirty-eight patients with essential hypertension from 39 general practice centres were treated in a double-blind trial with either oxprenolol 160 mg in a slow-release (SR) formulation with cyclopenthiazide 0,25 mg and potassium chloride 600 mg given once daily, or methyldopa 250 mg 3 times daily. After a 2-week placebo washout period, each patient was treated for 10 weeks. Both treatments significantly reduced blood pressure. Oxprenolol SR plus cyclopenthiazide-KCl was shown to possess significantly superior antihypertensive activity to methyldopa. Pulse rate, as expected, was significantly decreased by the beta-blocker and virtually unaffected by methyldopa. The overall incidence of side-effects was low. The incidence of sleepiness and dry mouth was significantly higher in the methyldopa group, and erythema in the oxprenolol group. The principle of general practitioners conducting multi-centre double-blind trials for research purposes, on drugs which are predominantly given to ambulatory patients, has been established for the first time in South Africa. Virtually no difficulty was encountered in getting patients' consent in the general practice milieu.


The effects of canthaxanthin on the photocutaneous manifestations of porphyria. An open trial with canthaxanthin, a photoprotective agent, was carried out on 7 patients with erythrohepatic protoporphyria (EHP), 5 patients with variegate porphyria (VP), and 2 patients with symptomatic porphyria (SP). In 4 of the 7 patients with EHP, sun tolerance was significantly but only moderately increased. In 2 children sun tolerance was greatly increased. Only 2 of the 5 patients with VP and 1 of the 2 patients with SP showed any improvement.


The anti-arrhythmic efficacy of perhexiline maleate, disopyramide and mexiletine in ventricular ectopic activity. The anti-arrhythmic efficacy of perhexiline maleate, disopyramide and mexiletine has been evaluated in 27 patients with chronic ischaemic heart disease who exhibited frequent ventricular ectopic beats (i.e. greater than or equal to 8/h). Holter tape recordings were made during normal working hours before, during and after the sequential administration of the three drugs. Each drug was administered to each patient for a 2-month period. The drug had to be discontinued in 4 cases because of side-effects. A significant reduction (P less than 0,001) in ectopic beat frequency occurred with all three drugs. No significant difference in anti-arrhythmic potency could be demonstrated between the drugs.


Long-term treatment with cimetidine.

Long-term treatment with cimetidine. Forty-seven patients were treated in a double-blind trial to evaluate the efficacy of 400 mg cimetidine, an H2- receptor antagonist (Tagamet; SKF), twice a day in the prevention of recurrent duodenal ulcers. A total of 7 patients was not considered in the final evaluation; 6 patients withdrew, while 1 patient did not maintain the prescribed treatment. Of the remaining 40 patients, 26 took cimetidine and 14 placebo. Ulcers recurred in all placebo patients within a year. Of the cimetidine patients, 2 had recurrent ulcers within a year, while 3 more had other endoscopic abnormalities at the termination of treatment. The remaining 21 patients (80,8%) had no abnormalities which could be endoscopically observed at the end of a year. It may be concluded that a maintenance dose of cimetidine significantly reduces the risk of recurrence of a duodenal ulcer.


The effects of hepatitis A and B in pregnancy on mother and fetus. A woman who developed hepatitis B during the 3rd trimester of pregnancy gave birth to a preterm, small-for-gestational-age infant whose blood also contained hepatitis B antigen. The effects of viral hepatitis on the fetus are reviewed and an approach to the management of such pregnancies is formulated.


Effects of prenatal fenoterol, phenobarbitone and dexamethasone administration on the total phospholipid content of amniotic fluid. The effect of prenatally administered phenobarbitone, fenoterol (a beta-sympathomimetic drug) and dexamethasone on fetal pulmonary maturity, as measured by the total phospholipid (TPL) content of amniotic fluid, was assessed. Compared with control values, there was a significantly greater rise after fenoterol (P less than 0,01) and dexamethasone (P less than 0,01), but not after phenobarbitone administration. The ability of dexamethasone to convert the TPL value to mature levels (greater than or equal 2,0 microgram/ml) was significantly greater than that of fenoterol (P less than 0,05).


Fatal veno-occlusive disease of the liver after chemotherapy, whole-body irradiation and bone marrow transplantation for refractory acute leukaemia. Rapid onset of liver failure with fatal outcome occurred in a young woman after successful bone marrow transplantation undertaken for refractory acute leukaemia. Centrilobular necrosis was demonstrated at autopsy and was attributed to prior cytotoxic chemotherapy, possibly potentiated by the total-body irradiation that was used in preparation for the transplant. This association between liver damage and prolonged drug therapy, coupled with the short median survival currently achieved within these chemotherapy regimens, has initiated an evaluation of bone marrow transplantation in patients with leukaemia during the first complete remission, rather than at a later stage when cumulative drug toxicity to the liver may have taken place.


Bicitropeptide, antacid and placebo in gastric and duodenal ulceration. A two-centre, double-blind, comparative endoscopic study. A bismuth-peptide complex (BCP Compound), an antacid (Maalox) and corresponding placebos were studied in a 6-week comparative double-blind trial of treatment in 106 randomized ambulant patients with endoscopically proven duodenal and gastric ulcers. Patients were examined after 1, 3 and 6 weeks' treatment and results assessed separately for duodenal and gastric ulcers on endoscopic evidence at weeks 3 and 6 respectively. Bicitropeptide was significantly better than antacid and placebo at 3 and 6 weeks for treatment of both duodenal and gastric ulcers. In the bicitropeptide group 100% of the patients in the duodenal ulcer group and 95,2% in the gastric ulcer group responded to treatment (improved or healed). No haematological or biochemical changes were noted and no adverse effects were recorded.


Pituitary tumours in pregnancy. A case report. A case report is presented of acromegaly occurring during pregnancy. The problems arising in association with pituitary tumours in pregnancy are discussed and current views on management are outlined.


Evaluation of the efficacy and safety of guanabenz versus clonidine. The antihypertensive efficacy and safety of guanabenz were evaluated against clonidine in two groups of 18 patients with uncomplicated essential hypertension. Both compounds reduced systolic and diastolic blood pressure at the doses used, whether pressures were measured in the supine or standing positions. Side-effects, such as dry mouth and drowsiness, were similar in both groups of patients. No postural hypotension occurred.


Measles and the state of nutrition.

Measles and the state of nutrition. The severity of an attack of measles is largely determined by the underlying state of nutrition at the time of the attack. Evidence is presented which suggests that, conversely, measles may be responsible for the precipitation of malnutrition in undernourished children, by a combination of several different mechanisms.


Group B streptococci in blacks.

Group B streptococci in blacks. Vaginal swabs were taken from 60 Black women attending a family planning clinic and from 60 attending a special clinic for sexually transmitted diseases. Using selective media, the isolation rate for group B streptococci was 26,7% in the former group and 40,0% in the latter. The isolation rates of other streptococcal serogroups are also given. All group B streptococci isolated were uniformly sensitive to penicillin but resistant to gentamicin. Clinical details of 7 patients with group B streptococcal septicaemia are also given.


Stereotaxic pontine spinothalamic tractotomy. Radiofrequency lesions of the spinothalamic tract in the pons have been made in five patients with pain from malignant disease. In all cases relief from pain in the upper limbs and neck was obtained. No important dysesthesias were reported postoperatively. Findings on stimulation in the target and elsewhere in the pons are described. In one case the lesion was verified on postmortem examination.


Reduction of postoperative infection in elective colon surgery with preoperative administration of kanamycin and erythromycin. The results of a randomized prospective preoperative antibiotic study in colon surgery is presented. Antibiotics were given by mouth for 2 days prior to operation: kanamycin (1 gm four times a day) and erythromycin (750 mg three times a day). Kanamycin combined with erythromycin significantly reduced wound infection as compared to kanamycin with a placebo (three of 38 vs. 16 of 39, P less than 0.001). Thus oral aminoglycoside given alone appears to be inadequate to offer protection against postoperative infection in elective colon surgery.


Aerosol salbutamol administration by IPPB: lowest effective dose. This study was conducted to determine whether small doses of salbutamol solution, aerosolised and delivered by intermittent positive-pressure breathing (IPPB), would be as effective as the 5 to 10 mg dose usually recommended for inhalational use. In nine asthmatic subjects we found that there was no significant difference between the peak bronchodilator effect of 1.0, 2.5, and 5.0 mg of salbutamol solution as assessed by FEV1 (P greater than 0.05). The 5 mg dose of salbutamol solution caused a significantly longer duration of effect than the 1.0 mg and smaller doses of salbutamol, but it also caused four of the nine subjects to complain of unwanted effects. In addition, a radiotracer technique in four normal subjects showed that an inverse relationship exists between the amount of aerosol deposited in the lungs and the tidal folume of IPPB. The maximum dose deposited in the lungs was about 10% of that initially present in the nebuliser.


Stenoses and functional disorders of the lacrimal drainage apparatus. Radiological examination. The diagnosis of epiphora can be greatly aided by a special radiologic technique, performed during bilateral injection of contrast medium into the lacrimal passages and utilizing seriography, magnification and image subtraction. The authors describe the technique, discuss the interpretation of the various radiologic patterns, and stress the importance of this method for evaluating inflammation, stenoses and functional alterations of the lacrimal passages.


Inhaled antihistamines--bronchodilatation and effects on histamine- and methacholine-induced bronchoconstriction. To assess further the bronchodilator activity of inhaled antihistamines ten stable asthmatic subjects inhaled aerosols of clemastine, 1 mg/ml, and saline placebo administered double blind. Subjects underwent bronchial challenge with increasing concentrations of histamine and methacholine, and specific airways conductance was measured by whole body plethysmography at each concentration. There was a significant 21.9% increase in specific airways conductance after inhalation of clemastine. Subjects could tolerate significantly higher mean concentrations of histamine when treated with clemastine than with saline. The shift of the cumulative log histamine dose-reponse curve suggests that such protection is due to competitive antagonism to the inhaled clemastine. Clemastine did not protect subjects against methacholine-induced bronchoconstriction, which suggests that its bronchodilator properties are not related to any anticholinergic action.


Passive expiration as a test of lung function. Twenty-five normal subjects, 14 non-smokers and 11 smokers, passively expired into a spirometer after a maximal active inspiration, and after a passive inflation of the chest by a pressure cycled intermittent positive-pressure breathing (IPPB) machine. Acceptable passive expirations could be performed by all subjects after a passive inspiration but by only 12 after an active inspiration. Expired volume was found to change exponentially with time (r greater than 0.98), and the time constant of passive expiration (Tp) was obtained. There was no significant difference between the smokers and non-smokers in age, sex, forced vital capacity, FEV1 FEV1/FVC%, maximum mid-expiratory flow rate, maximum expiratory flow at 50% and 25% of the vital capacity, or the magnitude of the fall in the dynamic compliance with increasing frequency of breathing (Cdyn/f). Tp in smokers (1.06 +/- 0.47 SD) was significantly longer than in the non-smokers (0.65  +/- 0.25 SD P less than 0.02). Tp had a significant correlation with Cdyn/f(Tp = 0.6 + 161.81 Cdyn/f +/- 0.38 SE, r = 0.49, P less than 0.02). We conclude that satisfactory passive expiratory spirograms can be easily obtained after a mechanically assisted passive inspiration. Tp thus obtained is determined by the intrinsic properties of the respiratory system (lung plus thorax), and is significantly prolonged in smokers compared with non-smokers when other studies of pulmonary function including frequency dependence of compliance are unchanged.


Estimation of haplotype frequency and linkage disequilibrium parameter in the HLA system. Conventional formulae currently employed were extended to calculate the haplotype frequency and the corresponding variance for an arbitrary number (n) of loci when unrelated individuals were investigated. A formula is presented for the variance for the degree of three locus linkage disequilibrium.


Intracellular Ig identification on paraffin-embedded solitary plasmacytoid proliferation: a routine method to define the biological nature of plasma cells. The difficulty to recognize morphologically the biological nature of the exuberant plasma cell proliferations is known by every pathologist. Therefore, an immunohistochemical method has been applied to routine paraffin-embedded sections of biopsies from 26 patients suspected to bear a solitary plasmacytoma. The method has allowed to distinguish between monoclonal (likely to be neoplastic) and polyclonal cases (likely to be reactive).


Immunofluorescence in the study of sclerosing retroperitonitis. Two cases of retroperitoneal fibrosis are presented. Etiopathogenetic problems connected with various drugs are discussed, among which the methysergide is of paramount importance as well as the less known drugs such as reserpine. Histologic structures were studied by immunofluorescence which gives evidence of the antigen coloring the compound with specific gamma-globulins combined with a strongly fluorescent drug (fluorescein): its positivity is clear and precise with total anti-Ig serum, as well as with anti-IgG, less weak with anti-IgA, and negative with anti-IgM. Such results advocate a tissular immunity movement and stress the theory which aims to focus retroperitoneal fibrosis within the chapter of autoimmunization diseases.


Reiter's disease.

Reiter's disease. Reiter's disease can no longer be considered a rare and relatively benign syndrome consisting of the clinical triad of urethritis, conjunctivitis and arthritis. It is, in fact, a post-infectious reactive arthritis that belongs to a new group of diseases now called seronegative spondyloarthropathies. These diseases are characterized by an extremely high association with the genetic marker, human leukocyte antigen B27. In its full course, the disease often is incomplete with its initial clinical manifestations and characterized by chronicity and progressive crippling recurrences.


[Procedural problems in the surgical treatment of gastroduodenal ulcers]. Data concerning 175 cases operated upon for gastroduodenal ulcer are set forth in the article. Much importance is attached to a thorough mobilization of the duodenum, treatment of its stump, gastroenterostomy on the shortest afferent loop and to a broad use of suturing apparatuses and of caprone as a suture material, as well. Mortality constituted 1.1%.


[Dermatoplasty in treating trophic ulcers of the lower extremities]. The main principle of the surgical treatment of trophic ulcers of the lower extremities consists in a radical excision of all the pathologically changed tissues around the ulcer and under it and, in case of disorders of the venous reflux, in various surgical restorative and corrective interventions followed with plastic closure of the wound defect. 422 patients were operated upon (462 operations). The choice of the radical method of treatment resulted in a stable healing of ulcers in 84% of cases.


[Experience with the experimental autograft of a skin-fascia flap with simultaneous restoration of the blood circulation in the graft]. The use of the microsurgery allows to carry out the autotransplantation of the skin-fascial graft. Optic magnification, special instruments and suture material are necessary for the formation of anastomoses of the small diameter arteries and veins. The autotransplantation of skin-fascial grafts permits to correct extensive defects of the skin and underlying tissues. A thorough formation of vascular anastomoses and an adequate pharmacotherapy are of great importance.


[Resistance of E. coli and bacteria of the genus Proteus to the thermal processing of perishable meat products]. Experiments were carried out in six meat combines to establish the devitalization of Escherichia coli and bacteria of the Proteus genus at the thermal treatment of perishable meat products. Seventy series of experiments were conducted with 16 types of meat products of a different structure (homogenic and heterogenic), varying composition unequal diameter of the casings (3-4 am, 5-6 am, and 7-8 am), and different type of the latter--natural, paper, and cutis-lika. Twenty-four-hour agar cultures at a density of 10(5)-10(7) bacteria per gram of meat mass were used. In a series of experiments the temperature was dermined of the finished product when it reached 68 degrees C; in another group--after smoking and at various intervals during cooking; and in a third group of experiments the temperature was fillowed up during the entire thermal process, using thermo pairs. Studied was the heat resistance of the organisms tested under laboratory conditions, using the thermal curve in the production of meat products. The samples were investigated at the 24th, and 48th hour, and on the 5th day of room temperature storage. Results showed that devitalization of these organisms set in at 63 degrees C (E. coli) and 60 degrees (Proteus). The composition and homogeneity of the meat mass and the diameter of casings were found to have no effect on the heat resistance of these organisms.


[Immunogenic properties of a polyvalent vaccine against colisepticemia in calves]. A polyvalent vaccine was produced against coli septicaemia in calves, using the most commonly encountered serotypes of Escherichia coli as etiologic agents. The effect of the various unspecific factors on the immunogenic properties of the vaccine was followed up through vaccination of guinea pigs, rabbits, and pregnant cows. It was found that best immunogenic effects produced a vaccine that was inactivated by 0.4 per cent formalin and fixed in an oil adjuvant. Guinea pigs that were challenged with 1, 2 and 3 DIM remained 100 per cent alive. Somewhat weaker were the immunogenic properties of vaccinal batches that had such adjuvant as 1 per cent alum or 20 per cent aluminium hydroxide, and weakest proved the immunogenic quality of a vaccine having a 0.01 per cent saponin adjuvant. It was established that the colostrum of cows that were thrice hyperim munized with 5, 10, and 20 cm3 of the vaccine at ten-day intervals contained more specific antibodies than the blood serum. The level of K-agglutinins was shown to exceed considerably that of 0-agglutinins.


A family with allo-immune neonatal neutropenia: group-specific pathogenicity of maternal antibodies. A family is presented, in which the mother developed strong neutrophil granulocyte-specific antibodies with the specificity anti-NA. The first and third children, both NA1-positive, suffered from severe transient neonatal neutropenia, but the second child, NA1-negative, did not. Anti-NA1 antibodies were detectable in the serum of one affected child and the antibody level was directly related to the extent of neutropenia. The incidence of granulocyte-specific antibodies in 198 pregnant women was determined and found to be low.


On the problems of efficacy of separation of IgM and IgG by different methods. Using ultracentrifugation, gel filtration, and ion exchange, an attempt was made to completely separate immunoglobulin IgM and IgG present in pooled human serum of blood group O. The quality of separation was studied by testing IgG fractions for the presence of IgM by a sensitive detection method. It is demonstrated by rheophoresis that small amounts of IgM always remain detectable in the IgG fraction. This is of clinical importance because conclusions on the presence of specific antibody of different Ig classes are usually drawn under the assumption of complete separation. The control of the efficacy of the separation process using a sensitive detection method for Ig of different classes is recommended.


Chronic autoimmune neutropenia due to anti-NA1 antibody. A 12-month-old child neutropenic since the age of 8 months, was referred to our institute for a sepsis from Candida albicans. On exploring the cause of neutropenia, an anti-NA1 antibody could be detected in the patient's serum. This antibody seemed to be responsible for the neutropenia because the child's PMN type was NA1+. The reactivity of the autoantibody with the patient's own granulocytes was confirmed by direct and indirect immunofluorescence studies performed on blood and marrow cells. A reduced number of T lymphocytes with poor PHA responsivity has been interpreted as the possible cause of the autoimmune disease. Steroid therapy did not cure the neutropenia but the child's general condition improved.


Strokes, transient ischemic attacks and asymptomatic bruits. Research into noninvasive techniques for evaluating cerebrovascular insufficiency has shown that hemodynamically significant lesions can be identified with considerable accuracy. Concurrently, recent descriptions of carefully applied medical and surgical therapy indicate that thromboembolic stroke can be effectively prevented when patients are allocated to the proper therapeutic protocols. The approach of these two lines of basic investigation to the clinical focal point of stroke control make it imperative that clinicians review the tools at hand for identifying persons at high risk, as well as the available therapeutic alternatives for effective stroke prevention.


[The contribution made by the 2nd Department of Surgery, Vienna University, to the treatment of colorectal cancer (author's transl)]. The treatment of colorectal cancer was chosen as a significant example for the history of the second department of surgery of Vienna University. Not only was a considerable part of relevant surgical techniques developed here, but also the problem of cancer has always been one of the traditional fields of activity of this institution. After the foundation of modern abdominal surgery by Billroth, his pupil Czerny performed the first combined abdomino-perineal resection of the rectum, whilst Gussenbauer, his successor, carried out the first curative resection of a carcinoma of the colon. Hochenegg performed the first sphincter-saving resection of the rectum and devised his pull-through procedure. Moreover, he started to organize the general fight against cancer by a campaign to enlighten the public. Denk continued these activities. He founded the cancer research centre and initiated the present activities in the prevention and therapy of cancer in this country.


[Reconstruction of the breast after surgery for cancer (author's transl)]. The tendency towards less radical, stage-dependent procedures in the surgical management of breast cancer has opened the way to improvement in the reconstructive measures available. Reconstruction of the female breast can be undertaken with greater or lesser success and facility according to whether the initial procedure was subcutaneous mastectomy, modified radical mastectomy or the Rotter--Halstedt radical operation. The different plastic reconstructive methods developed over the past years are discussed and illustrated by cases treated under our care.


[Management of the critically burned geriatric patient (author's transl)]. This paper deals with the specialised therapeutic needs regarding immediate care, parenteral nutrition and surgery in burned geriatric patients according to the experience gained in the treatment of these patients at the Burns Treatment Division of the Department of Dermatology (I) of the University of Vienna.


[An evaluation of candida serology following renal transplantation and its connexion with other postoperative complications (author's transl)]. 53 renal transplant recipients aged 13 to 58 years were followed up regularly clinically, microbiologically and serologically over observation periods ranging from 6 to 82 months following transplantation with a view to diagnosing mycetic complications. The only (facultative) pathogenic species found was Candida albicans. This species was isolated in every single patient, but far-reaching differences were observed with regard to the degree of form of infection in the individual person. Mainly, cases showed only a transient growth of Candida to a greater or lesser extent on the mucous membranes of the orointestinal tract, but in few cases serious systemic forms like fungaemia and urinary tract infections were manifest. Comparing the mycological and clinical findings it was apparent that the degree of mycetic infection and attendant complications was closely correlated to the incidence and severity of several--at least primarily--non-mycetic complications postoperatively, such as disorders of transplant function, rejection reactions, diabetes and bacterial infections. A causal connexion, thus, probably exists between postoperative mycetic and non-mycetic complications and the presumable underlying pathological mechanism is discussed.


[Kidney filtration -- mechanisms and methods of investigation (author's transl)]. Quantitative data are presented on the glomeruli in the human, dog and rat kidney. Micropuncture techniques for the determination of filtration pressure and filtration rate are described. The final part of this paper deals with the dynamics of glomerular ultrafiltration. The roles are discussed of filtration equilibrium/disequilibrium and of the renin-angiotensin systems in the filtration process.


[Morbidity during regular dialysis treatment and after renal transplantation (author's transl)]. Renal transplantation was associated with a lesser degree of morbidity than chronic dialysis treatment in a group of 48 patients with end-stage renal failure. Morbidity was defined as total days of in-patient hospitalization divided by total days of risk. The morbidity during chronic intermittent dialysis, with a mean observation time of 296.1 (20 to 2255) days, was 11.8%, whereas after renal transplantation, with a mean observation time of 1004.0 (131 to 2400) days, only 7.6% of all days at risk were spent in hospital. Morbidity rises to 38.1% during chronic dialysis if all dialysis days on an out-patient basis are considered as hospitalization days. Morbidity was lowest (3.8%) in patients sent home for the first time with a functioning graft. Cardiac complications and fluid lung were the most common causes for morbidity during haemodialysis treatment; morbidity after renal transplantation was mainly due to renal rejection and infections under non-specific immunosuppression. Social and occupational rehabilitation was better after renal transplantation than during haemodialysis treatment. It can be concluded from these data that with regard to the quality of life renal transplantation is the preferable alternative in the management of end-stage renal failure.


[Value and perspectives of endoscopic brush cytology in gastric lesions  (author's transl)]. The techniques for cell collection are well established. Cells in good quality and sufficient quantities are obtained. The preparation of the sediment depends on the microscopic techniques to be used. The cytological tumor criteria are well established. The diagnostic efficiency is more than 90% of cases with proved malignancies. In comparison with the endoscopic biopsy the brush cytology has the following advantages: A stenosis can be reached by the brush much easier than by the forceps. The tumor detection is improved by cytology under optimal conditions for 10% of the cases. Quantitative microscopic techniques can be adapted. The most important perspective for a further improvement of gastric cytology lies in the development of methods for automation in tumor cell recognition. The present status of such techniques is presented.


[Juan Huarte of San Juan and his significance for differential psychology]. The Spanish physician Juan Huarte de San Juan (about 1529 to 1588) produced in 1575 a book "Examen de Ingenios para las ciencias", which was published in Baeza and which, through the differential psychology developped by him, initiated in the impressing age of the rennaissance a new era of the history of psychology, which is called Huartism (psychologic physiology). Unfortunately his book, written in Spanish with 77 editions in all the important languages of the civilized world, became relatively little known. The following assertions are the object of his partially modern system which is based on the antique philosophers: 1) Man can have only a single talent - differentiated in a high degree and again there is a differentiation between individuals and nations. 2) It is necessary to choose a profession in accordance with the talent well in time. 3) In case of "lacking genius" the individual toils in vain with science. 4) Each talent is marked by a temperament which is corresponding to the physique of a person.


Human fetal cells. I. Mitogenic responses. Human fetal cells from 10 prematures and newborn infants (28--38 weeks of gestational age) and isolated or non-isolated fetal cells circulating in the blood of 9 primigravidae were studied in their ability to respond to phytohemagglutinin, pokeweed, dextran sulfate and lipopolysaccharide. An age-dependent responsiveness of fetal cells obtained from the prematures to all mitogens tested was detected as well as a clear graduation of mitogenic capacity with phytohemagglutinin to produce the highest stimulation. Though a moderate mitogenic response to lipopolysaccharide and dextran sulfate was noted in the blood cultures of the infants, LPS and in part DS transformation of fetal cells obtained from maternal blood appeared to be reduced or absent. A selective stimulation of fetal cells occurring in the circulation of primiparae sufficient for prenatal diagnosis could not be achieved with the mitogens tested. The findings suggest that fetal cells crossing to the mother are different from normal fetal lymphocytes. The present study was performed to elucidate in as quantitative a manner as possible the responses of human fetal cells to different T- and B-cell mitogens. Cells were obtained from various sources for comparing the mitogenic responses of isolated and non-isolated fetal cells. Our results demonstrate that mitogenic responses depend on the gestational age of the fetal cells, the source of the cells and on experimental conditions.


The interaction of opsonins with human polymorphonuclear leucocytes (PMN). I. The influence of human complement (C) and IgG on ingestion and digestion of C-resistant E. coli. The influence of opsonization on ingestion and digestion of C-resistant E. coli was tested in a phagocytic system consisting of a monolayer of human PMN to which was added E. coli opsonized in different ways. At the end of the phagocytosis, noningested bacteria were separated and the monolayer was removed. The cells were then fractionated. The number of bacteria at different time intervals and the amount and distribution of lysosomal enzymes in the cell fractions were determined. It became apparent that the ingestion of cell-attached bacteria was independent of opsonins. However, the intracellular destruction was enhanced following opsonization with C only, although this was not the result of a greater discharge of lysosomal enzymes into the phagosome. We postulate that sublethal damage of E. coli by C renders the bacteria more sensitive to the bactericidal activity of the phagocytes.


AET-treated sheep red blood cell and immunobead for combined detection of human peripheral lymphocyte subpopulations. This paper describes a method for the simultaneous determination of human thymus-dependent lymphocyte (T cell) and thymus-independent lymphocyte (B cell) populations by mixing lymphocytes, sheep red blood cells, and immunobeads. This method also detects lymphocytes possessing both T and B cell markers. T cells are detected by rosette formation with AET-treated sheep red blood cells and B cells are identified by rosette formation with polyacrylamide gel coated with antibody specific to immunoglobulin classes. The major advantages of this technique is that it is simple, convenient, and reproducible. Three different types of rosettes are distinguishable under light microscopic observation. The detection of double marker lymphocytes, using this combined technique, may have further application in clinical investigation.


[Contrast density and side effect rate in lumbar myelography--a clinical comparison of Meglumin-Iocarmate and Metrizamide]. The author reports that side effects were somewhat more frequent after metrizamide than after meglumin-iocarmate, in the course of a comparative study carried out at the reporting hospital from the beginning of 1977, using the water-soluble x-ray contrast media Amipaque (metrizamide) and Dimer X (meglumin-iocarmate).


[Contrast medium visualization of the cavum epidurale via Dimer X (peridurography) (author's transl)]. The term "peridurography" stands for visualization of the cavum epidurale via a water-soluble contrast medium. The article reports on the technique and indication. The experience collected on the basis of 93 peridurographies effected by the authors justify the assumption that this method can be considered as reliable in the diagnosis of prolapsed vertebral disk.


[Suicide risk in view of psychological test results]. The medical case histories of 32 young suicides have been studied the majority of whom has been in contact over the last two years with the East Swiss Infantile and Juvenile Psychiatric Clinic. In evaluating the case, we have relied first and foremost on the interpretation of psychological tests. The question as to whether juvenile suicides differ in any way from juveniles who have merely attempted to kill themselves can be summed up as follows: juveniles who have succeeded in suiciding point clearly and directly to suicide in their tests unlike juveniles who have not succeeded. With these the potential danger must be sought elsewhere, namely in their psychic make-up. We are at present examining the typical features of the tests carried out with suicides and potential suicides.


[Suicide prevention - current practice and theory]. The present situation of suicide prevention is portrayed by an historical outline, and the description of the practice and the theoretical foundations. It is established that suicide prevention was intensified after 1948 through the fundamental practical and theoretical works of Erwin Ringel. The present situation is characterized by the fact that after the initial recovery of desperate persons as patients for medicine, the defamation of the suicidal act by society could be avoided in another manner than by merely classifying it as a sickness. Increasing interest is being granted to political and other suicides who depict suicide as a possibility of mankind. The practical application of suicide prevention consists in the organization of rest-centres, the interdisciplinary participation of various professional groups and the application of various medical, psychological and social therapies. The theoretical foundation includes the theories of early and present psychoanalysis, social science and theoretical learn-oriented psychology. This formation and this global view of suicide prevention-practice and theory today, allow us to draw the conclusion that every physician, psychologist, social worker or other human being who comes into contact with desperate persons applies the most effective suicide prevention when he behaves in a straight forward manner, and is interested unreservedly in a candid, unforced way in the psychic and social conflict situation of the other, allthewhile respecting that person's freedom.


[Possibilities of using hemoperfusion in the treatment of chronic kidney insufficiency]. A survey of the administration possibilities of the activated charcoal haemoperfusion in the treatment of the chronic renal insufficiency is given. Various coating methods for activated charcoal as well as important adsorption abilities of the activated charcoal for uraemia-specific metabolites are described in detail. Then comes a classification of the haemoperfusion in the treatment of ureamia. The result is that at present the use of haemoperfusion with activated charcoal in the therapy of uraemia may be regarded only as a supplementary therapy of the haemodialysis and the haemofiltration, respectively.


[A new method for evaluation of beta-lactamase production of resistant enterobacteriaceae strains (author's transl)]. Resistant strains of Enterobacteriaceae were investigated with a chemical and microbiological test on beta-lactamase activity. The chemical method was needed as screening-test basing on the enzymatic hydrolysis of the chromogenic cephalosporin compound 87/312. The microbiological test is a modified cup plate method using Staph. aureus SG 511 as sensitive test strain for penicillins and cephalosporins. In one of the two cups of the blood agar plate 20 microliter of the beta-lactam antibiotic, in the other cup 20 microliter of the supernatant of the 24 h broth of the bacterial strain was pipettet. If the lactamase in the supernatant neutralises the antibiotic, a halfemoonlike blank is forming on the left site of the inhibition zone. An unchangeable inhibition zone demonstrates stability of the antibiotic to the enzyme. Each of 10 ampicillin- and/or cephalothin-resistant strains of E. coli, Klebsiella, Enterobacter and Serratia were investigated against 6 penicillins (penicillin G, ampicillin, ticarcillin, mezlocillin, azlocillin, bay k 4999) and 6 cephalosporins (cefoxitin, cefuroxime, cefamandol, cephalothin, cefazolin, cefradine). The microbiological method allows the statement, against which beta-lactam antibiotic the enzyme is effective. A correlation between the beta-lactamase activity and the MIC values in Enterobacteriaceae was not found.


[In-vitro-effect of constant and varying concentrations of beta-lactam-antibiotics on bacteria. I. Quantitative studies on the kinetics of bactericidal effects (author's transl)]. On the basis of a continuous culture method using the Biostat apparatus (Braun Melsungen) during a six hours interval the kinetics of growth inhibition and killing of E. coli were studied under the influence of varying concentrations of carbenicillin and cephalotin. The bacteria were incubated with the antibiotic at 37 degrees C, either in the broth of the culture vessel or incorporated into the depth of the agar of a dip slide which was brought into the uninoculated broth. Constant inhibitory concentrations (1 X MIC-4 X MIC) caused a bactericidal effect with both antibiotics. The recovery of the bacteria from the toxic effects of carbenicillin and cephalotin was slow if the concentrations were decreased to subinhibitory concentrations after initial contact with inhibitory peak levels. Scanning electron microscope studies demonstrated with both antibiotics a rapid filament formation with partial lysis.


[Distribution of pathogenic enterobacteria in the water of open reservoirs]. Investigations carried out indicated that the main source of microbial contamination of open reservoirs were effluents often drained without any purification and disinfection. Salmonellae were isolated in 10.6 +/- 0.88% of the water samples examined in the Southern regions of the country. Isolation of pathogenic enterobacteria from the water of open reservoirs was seasonal, with the maximal percentage in winter and in spring, this being connected with delay of self-purification processes in the cold seasons of the year. Serovars isolated from water and patients proved to be identical. There was no direct correlation between the coli index and the isolation of pathogenic enterobacteria.


[Detection and study of the labile toxic factor of Proteus mirabilis]. The author studied the dynamics of toxin formation of the high- and low-virulent Pr. mirabilis strains. The high-virulent strain produced toxic substances of the exotoxin type detectable in 1-2-day broth cultures. Later the activity of the culture medium of both cultures under study was due to substances of the endotoxin type. By physico-chemical and immunobiological properties, and also by chemical composition of Pr. mirabilis "early toxin" was similar to the exoenterotoxins of enterobacteria. A principal possibility of concentration and purification of Pr. mirabilis "early toxin" with the use of ultrafiltration and gel-chromatography was demonstrated.


[Natural focal infections in the north of the Far East. I. The detection of natural foci of infections in Chukot]. Results of a 3-year complex (zoo-parasitological, viral, bacteriological, and serological) studies of mammals and birds in Chukotka demonstrated the presence of natural foci of pseudo-tuberculosis, intestinal yersinosis, salmonellosis (heidelberg), and of tick-borne encephalitis. The existence of natural foci of tularemia and endemic rickettsioses is supposed on the basis of serological data.


[Efficacy of the per os immunization and reimmunization of man with staphylococcal anatoxin]. By double immunization of 72 persons and single reimmunization of 38 persons per os with tablets containing 100 BU of purified concentrated staphylococcus toxoid (PCST) it was revealed that this immunization was harmless and the immunological response was adequate. The tablets were intended for application through the oral mucosa (oral) or the intestinal tract (enteral); the immunological response depended on the dose of the preparation and the scheme of administration. A high sensitization of healthy persons examined to staphylococcus was found. There was a tendency to reduction of hypersensitivity after the immunization with staphylococcus toxoid (examination in 6 months) and activation of reactions after the antigen administration (examination in 14 days).


[Selection of phage-resistent clones of streptococcus group A and their properties]. In studying the effects induced by virulent phage CAI in the sensitive cultures of streptococcus, group A, a possibility was shown of selection of phage-resistant clones with the altered enzymatic activity. These clones lost their capacity to produce proteinase and retained residual lipoproteinase activity. This evidence correlates with literature data indicating that phage-resistant streptococci served as good producers of M-protein--the main virulence factor. Infection of the culture producing streptokinase with phage CAI with a definite infection multiplicity led to an increase of the enzyme activity in the culture fluid. This process was accompanied by selection of the resistant strains characterized by greater streptokinase production and greater enzyme stability. As suggested, the latter could result from the absence of proteolytic activity in the phage-resistant clone.


[Antigenic makeup of the protective fractions of S. typhimurium]. The authors present the results of chemical and immunochemical study of 4 protective fractions (Grasset's antigens, hydroxylamine vaccines, surface antigens, and Boivin's antigens) isolated from the virulent S. typhimurium strain, and of suppressor revertant obtained from streptomycin-dependent mutant of the initial strain. Despite some differences in their chemical and antigenic composition, Grasset's antigens, surface antigens fraction, and hydroxylamine vaccine contained the main cell protective substances and could be used (after further study) as vaccines for enteral immunization. On the basis of the results of chemical analysis and the study of Boivin's antigens antigenic structure it is supposed that O-antigen was changed in the revertant strain.


[Production of auxotrophic mutants of Shigella sonnei]. Use of selection method with R. Ffm phage offered a possibility of obtaining R-forms of Sh. sonnei from the population of bacteria of phase II with a low frequency of natural dissociation. Mono- and polyauxotrophic mutant of I, II and R-phases by hir, ilv, pro, and mtl markers were obtained by treatment of Sh. sonnei strains with nitrosoguanidine and ethyl-methanesulfonate. The frequency of mutation in two Sh. sonnei strains studied in this work (UBC and No. 941) by the same genetic regions proved to differ. The change of Sh. sonnei phase I into phase II was observed only in selection by proline marker which could be connected with the existence in this region of a gene controlling the dissociation process.


[Evaluation of the nonspecific reactivity of the body in pulmonary tuberculosis by means of a "skin window"]. Cell reaction of the interstitial tissue in the aseptic inflammation areas was studied to determine the nonspecific reactivity of the organism in patients with infiltrative tuberculosis of the lungs. Rebuck's "skin window" method modified by Shurenkova was used. Results of investigations conducted in 15 patients and 10 healthy individuals indicated the absence in them of any significant difference in the character of the inflammatory exudate. Consequently, infiltrative tuberculosis of the lungs coursed against the background of unchanged nonspecific reactivity of the organism.


[Mechanism of action of serum globulin preparations]. Experiments on mice demonstrated that serum homologous globulin preparations containing normal autoantibodies caused induction of autoantibodies in subcutaneous injection to intact animals; this was recorded on the basis of increase of the blood autoantibody level and of the plaque-forming cells content in the spleen tissue. This activation was seen as soon as the first hours--24 hours after the administration of the preparation and failed to disappear in 7 days, persisting in repeated administration of the preparation.


[Morphological characteristics of Nocardia asteroides]. Morphology--by growth phases-- was studied in the N. asteroides strain isolated from cows suffering from mastitis in Cuba. During the growth N. asteroides culture underwent a number of morphological cyclic changes; definite morphology was typical for each growth phase. There was a similarity between the structure of the surface N. asteroides and mycobacteria; cyclic changes in the structure of the membranes in nocardia were also shown.


[Characteristics of the action of the biologically active factor from virulent Shigella flexneri strains in a study on mice and a cell culture]. The authors subjected to further study the biologically active factor revealed by them earlier in the virulent Sh. flexneri cultures by using the genetically bound triad of Sh. flexneri 5a-222 cultures and the corresponding couple of Sh. flexneri 2a-516. There was shown correlation of the strains virulence determined by the keratoconjunctival test, with the presence of genetically-determined production of the biologically active factor detectable in the culture filtrate, which produced toxic action of the continuous cell cultures in the virulen Sh. flexneri strains of different serovars (2a and 5a), and lethal action in intravenous injection to mice. Comparative study of toxicity of the preparations of the endotoxin, free endotoxin, and neurotoxin types showed the biologically active factor to resemble the neurotoxin, differing from it in the toxic action and thermolability. Filtrates of the virulent and genetically characterised avirulent strains differed in the protein and lipids content, this permitting to suggest participation of the protein and lipid complex in the toxic action of the biologically active factor.


[Media with yeast RNA for isolating Shigella flexneri from feces]. The authors demonstrated a considerable, in comparison with the control, increase of the biomass of Sh. flexneri causative agent, when growing in meat-peptone broth with 1-4 mg of NaRNA,  and of the number of colonies in the feces of the patients and of healthy persons artificially contaminated with Sh. flexneri when inoculated in Ploskirev's agar or Endo medium with 4 mg/ml of NaRNA. Using media with NaRNA for laboratory diagnosis of dysentery is recommended.


[Reactogenicity and immunological effectiveness of an oral cholera chemical vaccine in a limited controlled experiment with human revaccination]. Oral cholera chemical vaccine in the doses tested (2 and 3 tablets) proved to be areactogenic, harmless and immunologically effective in a controlled limited trial in 150 volunteers. By the results of titration of specific antitoxins and vibriocidal antibodies in the blood serum, as well as of coproantibodies a dose of 2 tablets was chosen as the optimal one.


[Antigenic activity of a gamma-ray inactivated, concentrated, purified cultured antirabies vaccine]. Concentrated purified cultural rabies vaccine inactivated with gamma-rays caused in intramuscular injection (2 ml twice at an interval of 23 and 21 days) production of virus-neutralizing antibodies both in experiments on animals and in the vaccinated volunteers in titres not below those obtained in persons given a complete course of cultural rabies vaccine inoculations. No untoward reactions occurred.


[Use of the immunofluorescent microagglutination reaction for the purpose of studying ornithosis infection. 1. Production and approbation of a corpuscular luminescent diagnosticum]. A method of obtaining the fluorescent ornithosis corpuscular diagnostic agent providing for the extraction of the corpuscular antigen with its subsequent conjugation with fluorochrome-fluoresceine isothiocyanate. The use of this preparation permits to stage the agglutination reaction on the basis of immunofluorescent analysis, this facilitating the recording of the reaction results and considerably decreasing consumption of the diagnostic agent. As shown, the suggested immunofluorescent microagglutination reaction was characterised by a sufficiently high sensitivity, specificity, and can be used for detection of antibodies to the causative agent of ornithosis.


[Activity of the T- and B-lymphocyte systems in microbial eczema]. The author demonstrated a marked reduction in number of T-spontaneously rosette-forming lymphocyte and B-cells tested by direct immunofluorescence in the peripheral blood of patients suffering from microbial eczema. Reduction in number of B-lymphocytes was accompanied by a decrease in serum immunoglobulins (of M and G classes) content, of the titre of normal antibodies of E. coli, in parallel with increase in concentration of immunoglobulins, class A, and of agglutinating titre to staphylococcus P-209.


[Tissue and bacterial sensitization in patients with bone pathology]. The author studied sensitization to normal tissues (bone, muscle, spleen) and tissues altered by pathological process (sequestrum, scars), and also to allergens of widespread causative agents of purulent infection (staphylococcus, streptococcus, Proteus, E. coli) in 87 patients with different bone pathology and in 24 donors. Leukocytolysis reaction (modified by Karapaty) was used for ascertaining the sensitization; a total of 592 tests were conducted. With the development of infection in soft tissues and then in the bone there was an increase in frequency of positive reactions and their manifestation in interaction with the antigens of both normal tissues and those altered by pathological process. The incidence of positive reactions and their manifestation with bacterial allergens coinciding with the microbial flora of the focus of infection was also increased.


[Transforming activity of plasmid R6K DNA on Serratia marcescens strain 20-10. The behavior of the plasmid in the transformants]. The authors described transformation of S. marcescens, strain 20-10, of the isolated R6K plasmide DNA. As demonstrated by centrifugation in cesium chloride gradient and electrophoresis in agarose, the plasmide was present in the transformants in the form identical to R6K in E. coli K12. Analysis of the transforming activity of R6K plasmide from Serratia and E. coli K12 strains with a complete and defective restriction system showed S. marsescens, strain 20-10, to possess specific system of restriction and modification. In studying beta-lactamase activity and Serratia and E. coli strains ampicillin and streptomycin resistance revealed differences in the phenotypical expression of the plasmide signs in the heterologous and homologous host.


[Intracytoplasmic membrane structures in the L forms of the hemolytic streptococcus]. In studying the submicroscopic structure of the L-form of streptococcus, group A, isolated from the heart tissue of rabbit there were revealed intracytoplasmic membrane structures. Ring lamellar structures were most frequently revealed in the spheroid cells with dense and loose cytoplasm. They were also found in dense cytoplasm of elementary bodies. Myelin-like structures or those resembling a bundle of microtubules were less incident. Fibrillar structures collected into bands, 64--140 nm in with, and located on one or both sides of the cells beside the cytoplasmic membrane were revealed in the spheroid cells. Individual fibrillae, 8 to 10 nm in diameter, adhered one to another, interlaced, and were sometimes located in parallel. The fibrillar band was loose in the lysed cells.


[Aromatic amino acid metabolism in Enterobacteriaceae microorganisms]. The authors revealed phenylalanine deaminase (PAD) in the majority of the Citrobacter strains investigated; the activity of PAD varied within a rather considerable range (0.3--4.58 micrometer of phenylpiruvate in 1 hr per 1 mg of bacterial protein). The presence of this enzyme thus served as an auxiliary biochemical test characterising this group of conditionally pathogenic microbes of the Enterobacteriacea family. Tyrosine decarboxylase was absent in 26 of 50 strains of Citrobacter examined. In the rest of the strains the activity of this enzyme was low. Consequently, tyrosine decarboxylase could not be used for identification of microorganisms of the Citrobacter genus.


[Gibbs free energy in periodic enterobacterial cultures]. The authors present the results of study of the Gibbs' free energy (--delta G) output in periodic cultures of nonpathogenic and enteropathogenic escherichia, shigellae, salmonellae,  Proteus, serratia, and klebsiellae in the hydrolysate broth in a special twelve--chamber cultivator. Graphic expression--deltaG = f(N) permitted to reveal differences in the energy characteristics of individual enterobacteria genera and species. It is supposed that such studies could be useful in the choice of redox-indicators during the construction of differential-diagnostic media for the laboratory diagnosis of intestinal infections.


[Content of A-, G- and M-class immunoglobulins in adults perorally immunized with a liver Sonne dysentery vaccine]. The authors studied the immunological shifts in the blood and saliva of 357 adults immunized with live enteral dysentery Sonne vaccine from a spontaneous mutant according to different schemes (1, 2, 3, 4 injections at 2--3-day intervals. The general level of IgA, IgG, and IgM increased during the immunization; there was also an elevation of the specific antibodies level of these classes in the blood of the persons vaccinated. Accretion was the greatest of IgA both in the blood and in saliva of the immunized persons; this pointed to a marked, chiefly local, immunological activity of the vaccine. As shown, during the immunization the rise and the changes in the antibody level of various immunoglobulin classes differed from such in dysentery infection; in the latter case, along with the IgA-antibodies there was a marked elevation of the IgG- and IgM-antibodies level. It is supposed that there was a possibility of a changed of a 4-time immunization scheme  to-3-time one, with increase of intervals between the vaccine administration.


[Antibiotic and sulfanilamide resistance of the coli- and lactobacteria used for the production of bacterial preparations]. An antibiotic-resistant mutant recommended for the production of colibacterin preparation was isolated from the E. coli strain M-17 highly-sensitive to antibiotics. A possibility of complex use of bacterial preparations (coli- and lactobacterin) with antibiotics and sulphanylamides for prevention of dysbacteriosis was demonstrated.


[Nutrient medium for the isolation of hemocultures from brucellosis patients]. To isolate brucellosis causative agent from the blood of patients against the background of antibiotic therapy the authors used for the first time the medium consisting of aminopeptide, beta-globulin agar with glucose, glycerine, and twin-60. No valuable food products--meat, liver--were required to prepare the medium; by-product of gamma-globulin production being used. With the aid of the suggested medium there was isolated 2.4 times more hemocultures than on the widely used meat-peptone medium. This is attributed to the presence in the medium of human protein, essential amino acids, and blood mineral substances, which, in combination, facilitated adaptation of brucellosis causative agent to the nutrient medium similar to human blood by composition. Economical effect in using the mentioned medium constituted 53.8% annually.


[Preoperative calculation for stereotaxic clipping of cerebral aneurysms]. Preoperative calculations employing geometric methods make it possible to determine the optimum site for forming the trephination opening and the position of the plane for parting the clips in operations of stereotaxic clipping. Some new special terms are suggested which are used in geometric constructions. The suggested method was applied in 23 operations on 20 patients with arterial and arteriovenous aneurysms of the brain treated by the method of stereotaxic clipping.


Characteristics of evoked potentials and single neuron responses in the cat sensorimotor cortex to sound stimuli with different frequencies. The characteristics of the averaged evoked potentials (AEP) (experiments with awake non-paralysed animals), of the evoked potentials (EP) and of the responses of single sensorimotor cortical neurons (acute experiments) of cats to tone-bursts with frequencies within 0.1-6.0 kHz were studied. Response selectivity to the tone-burst frequencies which are energetically pronounced in some biologically significant sounds for the cat was observed. The averaged curve of the dependence of the amplitude of AEP in the somatosensory cortical region (S1) on the tone-burst frequency has reliable maximum values at the frequencies of 0.8, 1.6 and 2.0-3.0 kHz. Most pronounced changes in the heart rhythm were observed within the tone-burst frequency ranges in which the AEP of the highest amplitudes were recorded. The amplitude of the AEP was found to increase during the conditioned reflex elaboration. The curve of the dependence of the probability of the EP occurrence on the frequency at equal sound pressure levels had maximum values at the frequencies of 1.6 and 3.2 kHz. The highest amplitude values of EP were found at frequencies of 0.8, 1.6 and 3.2 kHz. More than half of the recorded neurons revealed the lowest values of the response thresholds and the maximum values of the occurrence probability under suprathreshold stimulation at frequencies close to 0.8, 1.6, and 3.2 kHz. It is supposed that the above mentioned feature of the input frequency organization in sensorimotor cortex is connected with the selectivity as to the biological significance of acoustic stimuli.


Pulmonary embolism associated with elective surgery, detected by ventilation-perfusion scintigraphy. The frequency of clinical and sub-clinical postoperative pulmonary embolism, demonstrated by combined pulmonary ventilation-perfusion scanning, and the prophylactic effect of low-dose heparin, were assessed in a randomised double-blind study in 43 patients aged over 40 years. Pulmonary embolism was demonstrated using combined ventilation-perfusion scanning in 4 out of 43 patients (9%). The incidence was 1 out of 19 patients in the heparin-treated group and 3 out of 24 patients in the placebo group. This difference was not significant. If post-operative perfusion scanning alone had been utilised for diagnosing pulmonary embolism, the frequency of pulmonary emboli would have been 33%, with 21% in the heparin group and 46% in the placebo group. This difference is not significant. It is concluded that perfusion scanning over-estimates the frequency of post-operative pulmonary embolism. The use of the more specific combined ventilation-perfusion scanning shows that asymptomatic postoperative pulmonary embolism does occur, but that the frequency is considerably lower than indicated by perfusion scanning alone. Combined ventilations-perfusion scanning must be performed in studies assessing the effects of various treatment regimes on the frequency of pulmonary embolism postoperatively. The small number of patients included in the study do not permit any conclusions concerning any prophylactic effect of low-dose heparin against pulmonary embolism.


Dexon versus chromic catgut-Mersilene simultaneously employed for gastro-intestinal anastomoses, evaluated endoscopically. Twenty gastro-intestinal anastomoses were sutured, in a randomized manner, with two layers of Dexon in the anterior or posterior suture line, and chromic catgut-Merselene in the other. Each of the suture lines was evaluated "blind" using endoscopy, 3 months postoperatively. No anastomosis failure was observed, in any of the patients, nor were there any definite differences between the two suture lines with regard to the degree of irritation. However, visible, non-absorbable suture material could be seen in two cases where conventional material had been employed. It is concluded that two layers of Dexon are preferable to non-absorbable materials for use in gastro-intestinal anastomoses.


Septic complications in colo-rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. I. Prospective, randomized, double-blind clinical study. A prospective, randomized, double-blind study was performed to compare 24 hours and 60 hours of preoperative antibiotic bowel preparation by means of gentamicin + vancomycin + mycostatin. 83 patients undergoing elective colo-rectal operations completed the study (Tablet I), and the two groups proved similar in terms of age, sex, diagnosis, surgical procedures and operation time (Table II). No significant difference in septic complications was found between patients receiving 24 hours and 60 hours of preoperative treatment (Table III). Wound infection occurred significantly more frequently in operations of long duration (Table IV). Cultures made from infected wounds revealed a mixture of aerobic and anaerobic bacteria in half of the cases, whereas pure aerobic or anaerobic infections were equally frequent (Table V).


Septic complications in colo-rectal surgery after 24 hours versus 60 hours of preoperative antibiotic bowel preparation. II. Significance of bacterial concentrations in the bowel for contamination of the operation field and subsequent wound infection. In a controlled study, the results of peroral preoperative antibiotic bowel preparation administered for 24 vs. 60 hours, respectively, were compared. No differences were found in concentrations of aerobic and anaerobic bacteria or in concentrations of antibiotics in colonic contents. Contamination of the operation field during operation was examined by quantitative culture of irrigation fluid from the peritoneal cavity and subcutaneous tissue. A significant correlation was found between concentrations of bacteria in colonic contents and the degree of contamination in the peritoneal cavity and subcutaneous tissue. A significant correlation was also found between contamination of the operation field and subsequent development of wound infection.


Short-term regulation of LH and FSH secretion in cyclic women. III. Effects of varying doses of two consecutive LH-RH injections on pituitary and ovarian response. The effects of two consecutive LH-RH injections at 120 min intervals with either a varying first or second LH-RH dose on pituitary gonadotrophin response were investigated in 15 eugonadal women to study pituitary secretory processes. Each volunteer underwent a total of 4 LH-RH double stimulation tests. In group I (n = 8) the first LH-RH dose of each of the 4 tests was fixed at 25 microgram, whereas the second LH-RH dose consisted of either 6, 25, 100 or 400 microgram. In group II (n = 7) the first LH-RH dose varied between 6 and 400 microgram, while the second LH-RH dose was kept constant at 25 microgram. Serum gonadotrophin and serum ovarian steroid levels were determined by radioimmunoassay before and after LH-RH administration. The volunteers in both groups served as their own controls. A linear log-dose response relationship was found between the various doses of LH-RH injected and the corresponding LH and FSH elevations elicited. However, the dose of the first LH-RH injection also significantly influenced the gonadotrophin reaction after the second LH-RH injection in a linear log-dose response relationship. Serum levels of oestradiol, 17-hydroxyprogesterone and progesterone significantly increased in response to the elevated serum gonadotrophin levels after LH-RH stimulation during the 4 h test period, but the rise did not correlate to the LH-RH dose used. The results indicate that LH-releasing hormone stimulates not only the release, but also the synthesis of LH and FSH in a dose-related manner. These findings are consistent with our previously reported concept that the magnitude of LH and FSH response to the first LH-RH injection reflects the "storage capacity", while the increase observed after the second LH-RH injection represents the "synthesis capacity" of the gonadotrophs.


Incidence of immune complex nephritis following active immunisation with a testosterone-3-BSA conjugate or BSA alone. Before immunisation with hormones can be applied in therapeutic medicine, the possible immunological side effects should be investigated. Therefore the kidneys of 20 rabbits immunised with testosterone-BSA conjugates were examined 4 to 30 weeks after immunisation for the presence of immune complex precipitation and glomerulonephritis. Eighty-five per cent showed differing degrees of precipitation and 50% had an exudative glomerulonephritis. None of the kidneys from normal control rabbits or those immunised with complete Freund's adjuvant or BSA showed any signs of immune complex precipitation, although high anti-BSA titres were present in the BSA-immunised animals (1/3000--1/25,000). BSA antibodies could not be detected in the rabbits immunised with testosterone-3-BSA. In the light of these findings active immunisation with steroid-BSA conjugates would not be advisable as a means of therapy.


[Automatic grinding of undecalcified bone sections with exact adjustment of thickness]. A new grinding machine for preparing thin undecalcified bone sections after methylmethacrylate embedding is described. About 20 rather small bone sections can be ground at the same time; bigger specimens, up to 8 cm of length, are allowed. Bone sections are mounted on a cylindrical specimen holder by an adhesive film. Then the final thickness of the sections is exactly adjusted by screwing three rubies out of the holder's bottom. Now the prepared holder is set in a guide ring on a turntable carrying a rough ended glass plate. The desired thickness of the sections is reached as soon as the three rubies touch the glass surface. The variation in the thickness of the sections is less than +/- 3 micron. The machine is simply constructed, easily to handle and rapidly to clean.


Morphometric evaluation of the number of exocrine pancreatic cells during early postnatal growth in the rat. The number of the various cell categories of the exocrine pancreas of the rat was evaluated by morphometric methods in paraffin sections of glands from rats aged 2, 5, 15, 20 and 33 days. The evolution of these cell types could be properly expressed by equations of the type y = aoek.x, where y = cell number, and x = age in days. The time necessary for each cell type to duplicate was thus obtained. The percentages (y') of acinar, intercalated duct and connective tissue cells also proved to be age-dependent and could be expressed by second-degree equations.


Correlations of electromyographic silent period duration and the Helkimo dysfunction index. Fifty-eight patients seen for consultation concerning mandibular dysfunction symptoms were examined utilizing the Helkimo index of dysfunction and electromyographic silent period recordings from masticatory muscles. The data collected were analyzed for correlations between the two parameters. Several significant correlations were noted between certain variables of the dysfunction index and the duration of the silent period. The mean duration of the silent period increased with increasing dysfunction index value. However, the clinical significance of this correlation is not established as long as we do not know the validity of neither the dysfunction index nor the the EMG silent period duration.


Repair of bone defects by bone inductive material. Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects are too large to be healed by autogenous bone grafts.


The neurovascular island pedicle flap.

The neurovascular island pedicle flap. Nine patients with irreparable damage to the nerves of the thumb, treated with a neurovascular island pedicle flap from the third or fourth finger to the defect thumb, have been re-examined 9 months to 8 years after the operation. Eight patients had a 2-point discrimination of less than 15 mm corresponding to the flap and all had a positive Ninhydrin test. Two had complete cortical reorientation and three partial reorientation. Six found the function of the thumb to be good or fair. Three described the result as poor and three had to be reoperated because of contractures of the donor finger and/or thumb. The method can be recommended for use in young, well motivated patients.


Renal transplantation in amyloidosis.

Renal transplantation in amyloidosis. During a three-year period renal transplantation was performed in 12 patients with amyloidosis. This disease was primary (or the cause unknown) in two cases and secondary in ten. In the latter cases the primary disease was rheumatoid arthritis in six, ankylosing spondylitis in one, osteomyelitis in two and tuberculosis in one. Five of the 12 patients were alive one year after transplantation. Two years after transplantation four out of seven were alive. Graft survival was the same. At the end of the three-year period five patients were alive. In two of these cases renal biopsy showed amyloid deposits in the transplant two and three years, respectively, after the transplantation.


Analgesic treatment with levomepromazine in acute myocardial infarction. A randomized clinical trial. The efficacy of a non-narcotic analgesic is evaluated in a double-blind randomized series of patients with acute myocardial infarction (AMI). Levomepromazine or pethidine were given in 328 consecutive cases to 316 patients within 24 hours after the onset of symptoms. Levomepromazine, 12.5 mg, appeared as effective as pethidine, 50 mg, in the alleviation of pain, though the initial dose had to be higher. Nausea and vomiting were half as frequent in the levomepromazine group as in the pethidine group (p less than 0.001). The incidences of arrhythmias, lung oedema, hypotension and thromboembolic complications did not differ between the groups. The mortality rate in the first 4 weeks was 22% in the levomepromazine group and 37% in the pethidine group (p less than 0.005), and after one year 39 and 50% (p less than 0.05), respectively. It is concluded that levomepromazine is better tolerated than pethidine in AMI. This suggests that the present management of pain in AMI should be reconsidered.


Insulin in portal, hepatic and peripheral venous blood after glucose, tolbutamide and glipizide stimulation. Indication of insulin release from peripheral tissues. Insulin in portal, hepatic and/or peripheral venous blood was determined in 16 patients admitted to a surgical ward for various diseases. Portal venous blood was obtained via a catheter introduced into the portal vein either through the umbilical vein remnant or transhepatically. Four subjects were given a peroral load of glucose, followed after 60 min by i.v. tolbutamide. In simultaneous blood samples, two of these subjects showed higher insulin concentrations in peripheral venous blood than in portal venous blood. Twelve subjects were given i.v. glipizide. In one subject blood samples were drawn from the portal vein, a hepatic vein and a peripheral vein and in six subjects from the portal vein and a hepatic vein. Two subjects showed higher insulin concentrations in peripheral venous blood than in portal venous blood. The mean peripheral insulin response (six subjects) was of the same magnitude as the mean hepatic insulin response (six subjects). It is suggested that these findings reflect a release of previously bound insulin from peripheral tissues.


A stroke unit in a medical department. Organization and the first 100 patients. A non-intensive stroke unit of 10 beds has been started in the Medical Department, Serafimerlasarettet, Stockholm. The aim is to make diagnostic and therapeutic studies in unselected stroke patients. Patients with suspect cerebrovascular disease in the Casualty Department are admitted to the unit non-selectively and without any age limit. Relevant physical findings and laboratory data are followed and registered by code on special charts to make evaluation by computer possible. A preplanned investigative programme is adhered to. Strict criteria for diagnosis and treatment are followed. The experience and results from the first 100 patients treated in the Stroke Unit indicate that the unit is a good basis for both education and research.


Pancreatic beta cell secretion during oral and intravenous glucose administration. The contribution of decreased hepatic insulin extraction to the relative hyperinsulinemia after oral glucose load as compared to intravenous glucose load was studied in 6 normal weight male volunteers by means of an analysis of the relationship between peripheral venous concentrations of insulin and C-peptide following similar glycemic stimuli after oral and intravenous glucose administration. The incremental areas  under the insulin and C-peptide curves were higher during oral as compared to intravenous glucose administration, 436 (251--762) per cent and 267 (124-378) per cent respectively (mean and range). The ratio between corresponding incremental areas of insulin and C-peptide were 53 (17--103 per cent higher during oral glucose load. These findings suggest that the augmented peripheral insulin levels after oral glucose administration are caused by a combination of increased beta cell secretion and decreased hepatic insulin extraction.


Effect of anterior deafferentation of the hypothalamus on the release of luteinizing hormone (LH) and reproductive function in sheep. The present study was designed to determine the effects of the anterior deafferentation of the hypothalamus performed at the level of posterior border of the optic chiasm--group I and above the midline of the optic chiasm--group II, on the release of LH and reproductive function in sheep. All 13 ewes of the group I lost their estrous cycles and did not experience ovulations as well as preovulatory type of LH surge. In 8 ewes the basal LH concentration in the blood plasma remained in physiological range of the diestrous phase of the cyclic ewes. In the remaining 5 animals in which deafferentation caused some lesions of the ventromedial-infundibular area the basal plasma LH level was markedly reduced. In contrast in all 18 ewes of group II, estrous cycles occurred regularly during the whole postoperative period of the breeding season. Moreover, throughout the subsequent quiescent non-breeding season 10 of these ewes displayed regular estrous cycles, 3 ewes had irregular estrous cycles and 5 ewes became anestrous. In all the ewes of this group the basal plasma LH levels were in physiological range, but preovulatory peaks of LH were lower than in the control ones. The neuroanatomic organization of the sheep hypothalamic structure participating in the control of gonadotropin secretion and estrous cycle regulation is discussed.


Kidney function in acromegaly.

Kidney function in acromegaly. Creatinine clearance and daily urinary albumin and beta2-microglobulin excretion rates (radio-immunoassays) were measured several times in 14 patients with acromegaly. Eleven patients were treated with bromocriptine, 5 to 55 mg/day. The activity of the disease was assessed by measuring urinary growth hormone excretion (radio-immunoassay). In agreement with previous investigations we found the creatinine clearance elevated. However, no correlation was found between this variable and urinary growth hormone excretion. Urinary albumin and beta 2-microglobulin excretion rates were not significantly different from our previous results in 27 adults control subjects. There was no correlation between urinary growth hormone excretion and urinary albumin or beta 2-microglobulin excretion rates. Bromocriptine treatment reduced urinary growth hormone excretion from 220 to 91 ng/24 hours, p less than 0.01, but no significant alterations were induced in the above mentioned kidney function variables.


Variations of matrix electrondensity in brain mitochondria. The configuration of brain mitochondria was compared in situ, after aldehyde perfusion and/or osmium immersion fixation and in isolated fractions of different functional performance. After combined aldehyde perfusion osmium immersion fixation in situ, mitochondria were condensed having a dark matrix. Fractions capable of controlled respiration also consisted of condensed mitochondria. On the contrary, expanded mitochondria with light matrix were brought about by immersion fixation. Fractions consisting predominantly of light mitochondria displayed no controlled respiration. Light matrix and expanded form are therefore regarded as a functionally impaired state of brain mitochondria. The condensed form is thought to be a landmark of good fixation.


Blood supply of the rat amygdala.

Blood supply of the rat amygdala. The cerebral vessels of the rat were filled with inks of different colours. The topography of the vessels of the amygdala were reconstructed from serial sections. The circulation of the individual amygdaloid nuclei was studied in detail. The arteries of the amygdala arise from the deep and cortical branches of the internal carotid and middle cerebral arteries. Eight major arteries were found to supply blood to the amygdala. All amygdaloid nuclei receive branches from both arterial trunks. The vast majority of the veins are collected by the middle cerebral and basal veins. Only a small fraction drains into the hippocampal vein. Of particular importance are the veins ending in the basal vein and those cortical ones that run in the rhinal sulcus. All amygdaloid nuclei have a multidirectional drainage.


The effect of high dose dexamethasone in children with severe closed head injury. A preliminary report. Out of a total 157 hospitalized head-injured children, twelve years of age and under, fifteen were considered to be severe, three of whom died within 72 hours of admission. Nine children with closed head injuries who were in coma for at least 24 hours (did not open eyes, speak, or follow commands), with absent or impaired oculocephalic reflex, impaired pupil reactivity to light, and who were decerebrating for at least twelve hours, were studied. Five were given high dose dexamethasone therapy (1 mg/kg) within six hours of injury, repeated at six hours, and then maintained at 1 mg/kg/day for eight days, and four either received none or were treated with a low dose regimen (0.25 mg/kg/day). In those receiving high dose therapy, intracranial pressure waves were noticeably less, peak intracranial pressure was lower, and intensive care and hospital stay were shorter. It was also noted that in the high dose therapy group spontaneous eye opening and speech returned sooner, and all were considered to have returned to their premorbid status by six months following injury. Of the no steroid or low dose group, one died, and of the remainder at six months one was aphasic and still decerebrating, another was aphasic and severely handicapped, and the third returned to school seven months after injury.


Energy metabolism in feasting and fasting. During feasting on a balanced carbohydrate, fat, and protein meal resting metabolic rate, body temperature and respiratory quotient all increase. The dietary components are utilized to replenish and augment glycogen and fat stores in the body. Excessive carbohydrate is also converted to lipid in the liver and stored along with the excessive lipids of dietary origin as triglycerides in adipose tissue, the major fuel storage depot. Amino acids in excess of those needed for protein synthesis are preferentially catabolized over glucose and fat for energy production. This occurs because there are no significant storage sites for amino acids or proteins, and the accumulation of nitrogenous compounds is ill tolerated. During fasting, adipose tissue, muscle, liver, and kidneys work in concert to supply, to convert, and to conserve fuels for the body. During the brief postabsorptive period, blood fuel homeostasis is maintained primarily by hepatic glycogenolysis and adipose tissue lipolysis. As fasting progresses, muscle proteolysis supplies glycogenic amino acids for heightened hepatic gluconeogenesis for a short period of time. After about three days of starvation, the metabolic profile is set to conserve protein and to supply greater quantities of alternate fuels. In particular, free fatty acids and ketone bodies are utilized to maintain energy needs. The ability of the kidney to conserve ketone bodies prevents the loss of large quantities of these valuable fuels in the urine. This delicate interplay among liver, muscle, kidney, and adipose tissue maintains blood fuel homeostasis and allows humans to survive caloric deprivation for extended periods.


Iatrogenic disorders from cancer treatment. All cancer therapies have potential and often serious side effects. With judicious selection of therapies, the risks are acceptable as are the contributions to better care, including that of iatrogenic disorders from therapy. It should, again, be stressed that new drugs and new modalities in combinations of treatments increase iatrogenic disorders from cancer therapy; as this increase is more and more appreciated, adjustments in schedules are resulting in decreased incidences of such disorders. Truly long-term effects over decades or generations are, of course, not yet known for most of the modern cancer therapies.


Medical complications of drug abuse.

Medical complications of drug abuse. Because we do not fully understand the cause of drug abuse, we do not currently have specific therapy for the abuse phenomenon. It is likely that those patients who abuse drugs are not a homogeneous treatment group. The patients seen most frequently because of medical complications probably represent only a small percentage of the total number of drug abusers. The medical complications of drug abuse affect almost all organ systems, and may result acutely from overdose or may not become apparent until after prolonged or recurrent use. Special emphasis has been placed on recognizing the key points of the physical examination in the overdose setting and in the drug-abusing patient that will give clues as to the nature and degree of the drug abuse. It is not clear whether drug abuse causes behavioral problems or vice versa. Physicians need to develop the medical expertise necessary to care for patients with drug abuse problems. Special attention is called to new drug abuse problems: complications associated with phencyclidine, amyl nitrate, and layman's remedies; acute and pulmonary complications; rhabdomyolysis; the brown heroin syndrome; and methylphenidate abuse. Although each of these complications has individual importance, a high incidence of alcohol use and smoking further compromises the general health of drug-abusing patients. Treating all of the medical complications of drugs must be viewed as only the beginning of a therapeutic attempt to restore these patients to a more physically and emotionally healthy life.