A placebo controlled double-blind trial of beclomethasone dipropionate in the treatment of allergic rhinitis. Beclomethasone dipropionate aerosol, administered intransally, 50 mcg into each nostril four times a day, was compared to placebo aerosol therapy in a three-week, double-blind trial of 30 patients with allergic rhinitis. Evaluation of efficacy, derived from patient scoring on daily diary cards and a weekly evaluation of signs and symptoms by a physician, showed a statistically significant difference in favor of the beclomethasone dipropionate aerosol. The 400 mcg/day dosage did not provide for systemic absorption as determined by measurements of plasma cortisol levels and circulating eosinophils. The only side effects consisted of mild to moderate burning and stinging or drying of the nasal mucosa.


Variation in the measurement of serum IgE levels. Three assays for immunoglobulin E (IgE) are compared using seven serum samples covering a wide range of values. The assays examined are the double antibody radioimmunoassay, single antibody/ammonium sulfate precipitation method and the paper radioimmunosorbent test (PRIST). In addition, values from the double antibody and single antibody/ammonium sulfate assays are compared using two different antisera to IgE. PRIST results in consistently lower values but the three assays produce results that would not have been clinically significantly different. The range of values obtained over a six-month period with aliquots of the same two samples run in duplicate twenty-three times in the double antibody assay was 1080 to 1440 I.U./ml for the Hi sample and 5.4 to 9.0 I.U./ml for the LO. Results are compared to those of a national study in which serum samples were supplied blind to research laboratories for analysis by two methods. Coefficients of variation from 35% to 73% are unacceptably large and indicate the need to establish international standards for serum IgE quantitation.


Immunologic and genetic factors predisposing to allergy. Allergy often begins with a subtle and/or transient T cell defect. This defect is first responsible for an IgA deficiency. The normal function of IgA is immune exclusion. In its absence, allergens can pass through the mucosa and stimulate the immunocompetent cells. The T cell defect may also be implied by the synthesis of IgE directed against the allergens which passed through. Clinical, biological and immunological findings (T cell defect in allergic disease, low range of IgA in the early life of atopics) are in agreement. The genetic factor for pollinosis and house dust allergy are segregated. In ragweed allergy there is an Ir gene coding for antigen-specific Ig of different classes and a group of non-linked major histocompatibility complex alleles coding for non antigen-specific IgE. There are some links with HLA. In house dust allergy the Ir gene is very common and almost everyone can produce an allergy under some conditions (T cell defect). Whatever the immunologic and genetic factors are, they need allergens and environmental factors to induce allergy. Allergy is a complex state in which several mechanisms, often associated and sometimes unclear, are involved. Some of them may be an abnormality of the autonomic nervous system, and/or an increase in the mucous membrane permeability, and/or a subtle immunodeficiency. All these mechanisms are regulated by genetic factors and modulated by environmental ones.


Bacteriocin typing of Serratia marcescens. A simplified system. The authors describe a simplified system for the detection of bacteriocin production by Serratia marcescens with the use of six indicator strains, which include Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, Enterobacter aerogenes (two strains), and Serratia rubidaea grown on arabinose minimal medium plates. Of the 64 possible bacteriocin types, 11 were observed; 66% of the isolates tested were found to be one of three types. Occasionally more than one bacteriocin type was observed in an individual specimen; however, serotyping or antibiograms, or both, also indicated this was a different strain. The marcescin types were stable markers. With the use of this technic, different endemic strains of Serratia were shown to predominate in various areas of the hospital. In addition, when urinary tract isolates were compared with respiratory tract isolates, significant differences were found in the predominate types. The typing of these isolates by bacteriocin production was supported by serotype and antibiotype findings. The results suggest that this simple system may be a useful tool in a general hospital.


Comparative costs of microbial identification employing conventional and prepackaged commercial systems. The accuracy of commercially prepackaged kits for microbial identification has become well established. Laboratory workers may encounter increasing demands for production of objective data to justify replacement of systems using individual biochemical tests in tubes. The authors present a system of cost analysis in which materials and labor costs are separately computed, and to which are added the effects of (1) fringe benefits, (2) decreased productivity resulting from administration, quality control, education and development, and (3) the additional expense of indirect costs that are allocated to laboratory procedures by accepted and standardized hospital accounting methods. Labor costs should be based on time-engineered studies conducted in individual laboratories. Alternatively, various published "unit values" may be used. The result may present several alternative differences in cost, depending on which unit values are accepted as applicable to the individual laboratory. Despite these uncertainties, the method of analysis provides a more objective means of justifying the cost of introduction of prepackaged kits where accuracy and speed of identification have already been proven to have advantages over biochemical tests in tubes.


Valproate sodium in refractory seizures: a study of efficacy. Sodium valproate (N-dipropylacetic acid) is a newly released anticonvulsant drug with a broad spectrum of activity. Twenty-seven children with uncontrolled seizures, predominantly akinetic and myoclonic, were treated with this drug. Encouraging results were noted in those with head-nodding spells, body drops, and myoclonic jerks ("minor motor" seizures). Side effects included occasional gastrointestinal disturbance. No important hepatotoxic complications were noted. Two persons displayed transient neurologic side effects. Of particular interest was the noticeable improvements in mental status noted in 17 of the 27 patients. Some variations in blood level of other anticonvulsant drugs were noted, emphasizing the importance of monitoring these drugs. Valproate sodium provides important improvement in our ability to manage minor motor seizures.


Zoster-like eruption due to echovirus 6. A unilateral vesiculobullous eruption associated with fever was seen on the neck, shoulder, and upper part of the chest of a 7-year-old boy. Although three dermatomes in all were involved, the lesions resembled herpes zoster. The patient had had varicella in infancy. Culture of fluid from several bullae yielded echovirus 6; however, and serum neutralizing antibody to this virus rose in titer from 1:32 to 1:640. It is suggested that echovirus 6 and other enteroviruses may cause a number of vesicular eruptions that resemble herpes zoster and similar infections. Viral culture, while often difficult to obtain, is the only way to identify the cause of eruptions like this one.


Heroin addiction as a family phenomenon: a new conceptual model. The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment.


The risk of streptococcal infections in rheumatic and non-rheumatic families: an application of Greenwood's chain-binomial model. Infectious transmission of streptococci in families has been demonstrated to follow Greenwood's chain-binomial model in its simplest form which did not need beta transformation to correct for differences in susceptibility between families. Following the application of this model, an estimate of the risk of acquisition of M-typable group A beta-hemolytic streptococci is given (p = 0.05--0.06). The risk is the same among siblings of rheumatic fever patients and children from non-rheumatic families. This emphasizes that the familial aggregation associated with rheumatic fever is not due to increased susceptibility of such families to streptococcal infections.


Adult severe combined immunodeficiency and sarcoid-like granulomas with hypersplenism. A patient presented with lymphopenia, anergy, hypogammaglobulinemia and hypersplenism. Histologic examination of the spleen and lymph node revealed noncaseating sarcoid-like granulomas. Despite a significant rise in circulating lymphocytes after splenectomy there was in vivo and in vitro evidence of B- and T-lymphocyte dysfunction. A histologic picture mimicking sarcoidosis may occur in patients with immune deficiency. The granulomatous proliferation may represent an altered host response to antigen.


The influence of PEEP on survival of patients in respiratory failure: a retrospective analysis. Positive end expiratory pressure breathing (PEEP) is used to decrease morbidity and mortality in patients who are hypoxemic despite breathing oxygen in concentrations potentially toxic to their lungs. We reviewed the hospital course of 78 patients whose arterial oxygen tension (PaO2) was less than 70 torr despite a fraction of inspired oxygen (FiO2) of 1.0. Only 60 per cent of these patients were treated with PEEP and their clinical illnesses and severity of cardiopulmonary dysfunction were similar to those in patients not treated with PEEP. PEEP increased the length of survival from 4.2 to 9.2 days (P less than 0.05) whereas over-all survival, defined as hospital discharge, was similar at 31 per cent with and 26 per cent without PEEP. An improvement in PaO2 and decrease in shunt fraction following a trial of PEEP portends a favorable outcome, but its continued use appears to prolong life for a few days without affecting hospital mortality. Survival appears related more to the maintenance of adequate tissue oxygenation as manifested by a high mixed venous oxygen than to improved gas exchange as reflected by an increase in PaO2.


Renal transplantation for patients with type I and type II membranoproliferative glomerulonephritis: serial complement and nephritic factor measurements and the problem of recurrence of disease. Fourteen patients with membranoproliferative glomerulonephritis as their original kidney disease received 16 renal allografts. All 14 patients are alive, 11 currently have functioning allografts, and one graft was lost to recurrence of membranoproliferative glomerulonephritis. Originally depressed serum complement (C3) concentrations returned to normal soon after transplantation in those patients with no clinical evidence of recurrence. Two patients with type II membranoproliferative glomerulonephritis had recurrence of disease. Nephritic factor (C3NeF) was high in both these patients before they received their transplants and was absent soon thereafter. However, abnormally high levels were again detected in their course. The one recurrence of type I membranoproliferative glomerulonephritis was associated with depressed C3, Clq, C4 and factor B but without C3NeF activity. Despite warnings of "high risks/ and "high mortality" associated with renal transplants in patients with membranoproliferative glomerulonephritis, we, because of these results and a review of the literature, continue to recommend renal transplants from both living related (LRD) and cadaver (CAD) donors in otherwise suitable patients who have renal failure due to membranoproliferative glomerulonephritis.


A prospective controlled investigation of prophylactic trimethoprim/sulfamethoxazole in hospitalized granulocytopenic patients. Oral trimethoprim/sulfamethoxazole (TMP/SMZ) therapy was investigated in the prophylaxis of infections in granulocytopenia. Hospitalized granulocytopenic patients were allocated at random to receive TMP/SMZ (group 1) or to a control group (group 2). The percentage of febrile granulocytopenic days was significantly reduced in group 1, 19 per cent compared to 39 per cent in group 2 (P less than 0.01). In group 1, there were no bacteremias in 59 episodes of granulocytopenia (909 days). In group 2, there were nine bacteremias in 52 episodes of granulocytopenia (796 days)(P = 0.001). Disseminated candidiasis developed in two patients in each group. Candida occurred in similar numbers in surveillance cultures in both groups; Staphylococcus aureus and Pseudomonas aeruginosa were slightly decreased, and Enterobacteriaceae resistant to TMP slightly increased in group 1. This study suggest that oral prophylactic TMP/SMZ therapy is an effective, well tolerated, easily administered alternative to "gut sterilization" with nonabsorbable antibiotics.


Splenic function: normal, too much and too little. This review is concerned with normal splenic function, mechanisms and consequences of splenomegaly, hypersplenism, the medical indications for splenectomy and the various aspects of hyposplenism. The potential probelm of lethal septicemia in hyposplenic or asplenic patients is also considered.


Cardiobacterium hominis endocarditis.

Cardiobacterium hominis endocarditis. This report describes the isolation of Cardiobacterium hominis from a patient with a history of rheumatic heart disease. Seven blood cultures yielded the organism. This investigation includes the case history, significant details of the hospital course, and the bacteriological, biochemical, and antimicrobial characteristics of Cardiobacterium hominis, integrated with a brief review of the literature.


Characterization of staphylococci using the API 20E system. Fifty-four strains of coagulase-negative staphylococci, five isolates of coagulase-positive staphylococci, and seven species of Micrococcus were tested in the API 20E system. After 48 hours' incubation, results indicated that the various species and subgroups could be separated by their reactions. Staphylococcus saphrophyticus subgroup 3 was ONPG and mannitol positive. S. epidermidis subgroup 1 was positive for arginine dihydrolase (ADH), whereas S. epidermidis subgroup 4 was positive for ADH, mannitol, and arabinose. S. aureus coagulase negative was characterized by positive ONPG, ADH, and mannitol. In contrast, S. aureus coagulase positive was not positive for ONPG but was positive for ADH and mannitol. Most of these staphylococci were able to utilize nitrates, urea, glucose, and sucrose. The micrococci, on the other hand, gave varied reactions, with most species being only weakly reactive.


New motility medium for nonfermenting bacilli. Researchers compared use of a semisolid agar plate to wet mount examinations of broth cultures (16 to 18 hours) for the detection of motility of 96 reference and clinical strains of gram-negative rods. In this double blind study, 83 nonfermentative and 13 oxidase-producing, fermentative bacilli were tested by the two methods. Overall accuracy of the semisolid agar motility test was 96.8 percent compared to 89.6 percent for the broth method. Reproducibility of agar plate tests using selected reference strains was 100 percent in contrast to 90 percent for broth examinations. These findings indicate that the semisolid agar plate offers a convenient and more accurate method than wet mount examination for determining motility of unusual gram-negative bacilli.


A review of laboratory methods for identification of group B streptococci (Streptococcus agalactiae). A selected review is presented of the history of Group B streptococcal infections and the laboratory tests used to identify Group B streptococcus (Streptococcus agalactiae), an opportunistic pathogen which causes serious infections in newborn infants and compromised patients in other age groups. Its isolation may be increased by growth in a selective medium. The methods for Group B streptococci identification include the hydrolysis of sodium hippurate, the CAMP reaction, pigment production, and antibiotic disk susceptibility. Also, immunological tests, such as Lancefield's classical precipitin test, immunofluorescence staining, counterimmunoelectrophoresis, and coagglutination are available.


Microcomputers in the teaching laboratory: a hematology case study. The new mass market microcomputers offer an economical means of providing individualized instruction to medical technology students. A program that uses case studies to familiarize students with the erythrokinetic model for classifying anemias is being used to supplement classroom instruction at Minot State College, Minot, North Dakota. The program encourages students to apply the information they receive in class to solving practical problems in hematology.


Potentiation of schistosome granuloma formation. By lentinan--a T-cell adjuvant. Lentinan is a fungal polysaccharide which acts as a T-cell adjuvant. When this glucan was administered to thymus-intact mice by intraperitoneal injection, conspicuously enlarged lung granulomas formed in response to either Schistosoma mansoni or S japonicum eggs or to antigen-coated polyacrylamide beads. Liver granulomas in cercaria-induced S mansoni infection were augmented up to eight-fold in volume. By contrast, nude mice showed a complete absence of hypersensitivity granulomas, regardless of whether they received lentinan. Lentinan-potentiated granulomas show a distinctive histopathologic picture characterized by abundant, large, pale-staining macrophages; reduced and redistributed eosinophil populations; and frequent, extensive central necrosis, uncommon in unpotentiated schistosome foci. They also differ in their distributions of egg antigen and of host immunoglobulins. Optimal lentinan effects followed a single 1-mg dose when given to sensitized mice on the day of intravenous challenge with S mansoni eggs rather than at the time of intraperitoneal sensitization or following challenge. This adjuvant appears to act on effector T cells or on macrophages interacting with T cells; its effect on macrophages in a latex bead foreign body granuloma was minimal. A number of other lentinan-associated systemic effects on parasite and host were noted and described, including reduced female schistosome egg output.


The macrophage in the development of experimental crescentic glomerulonephritis. Studies using tissue culture and electron microscopy. The role played by the macrophage in the development of injury in rabbit nephrotoxic nephritis (NTN) has been assessed by electron microscopy and glomerular culture of renal tissue obtained by several biopsies during the course of the disease. These observations have been correlated with the other immune, cellular, and biochemical events occurring in the glomerulus, ie, deposition of immunoglobulin and complement, proteinuria, polymorphonuclear leukocyte (PMN) exudation, fibrin deposition, crescent formation, and renal failure. A biphasic macrophage accumulation was detected, corresponding to the heterologous and autologous phases of the disease. In the autologous or crescentic phase, macrophages accumulated within the glomerular tuft from Day 5; their appearance coincided with the accumulation of PMN and development of proteinuria. Fibrin deposition in Bowman's space, which commenced on Days 6 and 7, was rapidly followed by the migration of macrophages from the glomeruli into Bowman's space. Within Bowman's space, macrophages were observed to phagocytose fibrin, transform into epithelioid and giant cells, and accumulate to form a substantial proportion of the cells forming the crescent. The inflammatory process of PMN exudation, macrophage accumulation, fibrin deposition, and crescent formation and the degree of renal failure reached a maximum by Days 12 to 14. Thereafter, resolution of the inflammatory process occurred so that by Day 40 macrophages had disappeared from the glomeruli. However, varying degrees of glomerular damage and renal failure persisted, occurring largely as a result of glomerulosclerosis and sclerosis of crescents. The tissue culture studies also demonstrated mesangial cell proliferation during the inflammatory process but did not show any abnormality of epithelial cell activity. This study demonstrates that the macrophages participate in NTN by accumulating in damaged glomeruli then migrating into Bowman's space (probably in response to fibrin deposition) where they undergo granulomatous transformation and accumulate, contributing to crescent formation.


Group B streptococcal infections in adult males. A 19-month study of group B streptococcal infection was performed to investigate the spectrum of such infections in adult males, the relation of serotypes to clinical illnesses, the effects of previous antibiotic therapy on infection and colonization, and the antibiotic susceptibility pattern of these organisms. Twenty-four patients had definite or possible infections while 41 patients were colonized with group B streptococci. The most frequent infections encountered were pneumonia (ten cases) and soft tissue infections (nine cases). Five infections (21%) were nosocomial in origin. The most frequent serotypes were Ia and II. No correlation of serotype and type of infection was observed. Patients receiving previous antibiotic therapy were significantly more likely to be colonized than infected with group B streptococci. Penicillin was the antibiotic to which these organisms were most susceptible; tetracycline and gentamicin showed the least activity.


Case report. Staphylococcal scalded skin syndrome in adults: case report and review of the literature. An adult drug abuser with endocarditis due to a group II Staphylococcus aureus developed the staphylococcal scalded skin syndrome (SSSS). Studies of the patient's immune function found cell-mediated immunity (CMI) to be essentially normal; thus, previous suggestions that deficient CMI is required in adults who develop SSSS seem unfounded. Pathogenesis, diagnosis, and therapy of SSSS and its differentiation from drug-induced hypersensitivity reaction are discussed in detail.


The presence and possible role of monocyte infiltration in human chronic proliferative glomerulonephritides. Light microscopic, immunofluorescence, and histochemical correlations. Twenty-seven cases of chronic glomerulonephritis with proliferative pattern (11 cases of primary mixed IgG-IgM cryoglobulinemia, 8 cases of SLE, and 8 cases of primary membranoproliferative glomerulonephritis) were studied with particular attention to the glomerular monocyte infiltration. The latter, detected by means of nonspecific esterase technique, was compared with the presence of hyaline thrombi and intraluminal immunoglobulin lumps. Monocyte infiltration was heavy and almost constant in cryoglobulinemia, less important in SLE, and practically absent in membranoproliferative glomerulonephritis. By means of immunofluorescence technique on paraffin embedded material, monocytes are shown to contain IgG and IgM, suggesting a phagocytic activity on some types of immune complexes. Since monocytes are migrant cells, and therefore easily removable from the glomeruli by the bloodstream, it seems that they could be responsible for regression of glomerular hypercellularity as reported in some patients with cryoglobulinemia showing clinical improvement.


Isolation and tissue localization of type AB2 collagen from normal lung parenchyma. Type AB2 collagen was isolated from normal lung parenchyma by pepsin extraction followed by differential salt extraction. This collagen comigrates with AB2 collagen isolated from placental membranes when run on 5% polyacrylamide gel electrophoresis; it has an alpha A and alpha B polypeptide chain ratio of 1 : 2 and a cyanogen bromide peptide profile similar to known AB2 collagen on 7.5% polyacrylamide gel electrophoresis. This AB2 collagen isolated from lung tissue specifically inhibits passive hemagglutination of affinity-purified rabbit antibodies to AB2 collagen isolated from amnionic and chorionic membranes. By indirect immunofluorescence microscopy, AB2 collagen was found to be widely distributed throughout the lung and was found preferentially associated with cell surfaces (basement lamina) and basement membranes.


Immunogenetic aspects of intracerebral skin transplantation in inbred rats. This study was undertaken to evaluate the ability of intracerebral skin grafts transplanted across different genetic disparities in the major histocompatibility complex (RT1) to elicit an immune response in inbred rats, as determined by histologic examination and by the ability of the grafts to sensitize the recipients to subsequent orthotopic skin grafts. The ability of intracerebral skin allografts to sensitize rats to transplantation antigens is related to the specific genetic disparity between the graft and the host: sensitization appears to occur more consistently across an A region barrier than across a B region barrier. Histologic changes of intracerebral graft rejection are more severe in rats with two intracerebral grafts than in those with one. The degree of histologic change attributable to intracerebral allograft rejection correlates with the ability of these grafts to sensitize the recipient. In certain strains intracerebral sensitization is accomplished with two grafts but not with one, indicating an antigenic dose requirement for intracerebral sensitization.


Immunocytochemical localization of parathyroid hormone in bovine parathyroid glands and human parathyroid adenomas. Light and electron microscopic localization of parathyroid hormone (PTH) in human and bovine parathyroid tissue has been achieved using an indirect peroxidase labeled antibody method. Granular deposition of the reaction product was found throughout the chief cell cytoplasm. There was no nuclear staining. At the ultrastructural level, parathyroid hormone localized by this method appeared to be largely confined to the secretory granules in the cytoplasm of cells. Mitochondria and nuclei were free of reaction product. Aggregated sacs of granular endoplasmic reticulum were minimally reactive, and Golgi apparatuses did not show reaction product.


The generation of electric currents in cardiac fibers by Na/Ca exchange. The presence of a detectable Ca current during the excitation of a cardiac fiber implies that the Ca lost during the resting interval of the duty cycle must also be detectable. Ca outward movement appears to be effected by Na/Ca exchange when more Na enters than Ca leaves per cycle, thus making the mechanism electrogenic. Since Na/Ca exchange can move Ca either inward or outward depending on the direction of the electrochemical gradient for Na, a potential exists where there is no electric current generated by the Na/Ca exchange mechanism, i.e., a reversal potential ER. Cardiac fibers appear to have a reversal potential that is about midway between their resting membrane potential and their plateau. Carrier currents both inward and outward are therefore generated during cardiac action potentials. The implications of the conditions stated above are explored.


The use of linear nonequilibrium thermodynamics in the study of renal physiology. Classical formulations for the analysis of membrane transport processes, which ignored possible interactions between flows of diverse permeant species, often led to inconsistencies in the evaluation of permeability coefficients. For water flow induced by an osmotic pressure difference this difficulty was resolved by Staverman's introduction of the reflection coefficient sigma, a parameter which incorporates the interaction between solute and solvent in the course of their passage through a membrane. A comprehensive nonequilibrium thermodynamic (NET) formalism suitable for many biological systems was provided by Kedem and Katchalsky. For an n-flow system each flow is in general dependent on n forces; the assumption of Onsager reciprocity, however, reduces the number of independent phenomenological coefficients. Although NET is widely applied in the study of renal physiology, fundamental theoretical and practical problems remain. Basic considerations are the need to control or evaluate the influence of all coupled flows and to establish conditions fostering linear dependencies of flows on forces. When this is done a transport system may be characterized in terms of intrinsic membrane parameters, facilitating the systematic study of the effects of drugs, hormones, and various experimental perturbations.


Relation of ventricular repolarization to electrocardiographic T wave-form and arrhythmia vulnerability. The normal sequence of ventricular recovery proceeds from epicardium to endocardium, but on the epicardium the pattern of ventricular recovery is similar to the pattern of activation. Data concerning ventricular repolarization have been obtained from analyses of electrocardiographic recordings, suction potential recordings, a limited number of recordings of transmembrane action potentials, and from measurements of refractory periods. Normal ventricular repolarization has now been characterized in sufficient detail that it can be used with theoretic models to derive T waves with forms that correspond closely to recorded T waves. These models provide insights concerning the body surface manifestations of the electrophysiologic events of ventricular repolarization and should contribute to a more physiologic approach to interpreting T wave abnormalities in clinical electrocardiograms. A relationship between inhomogeneity of ventricular refractory period duration and arrhythmia vulnerability has also been documented. Because inhomogeneity of ventricular repolarization is a factor in both T wave-form and arrhythmia vulnerability, methods of analysis of the T wave for determining patients at risk of developing arrhythmias should be possible. One such analysis is presented. The method has been tested on experimental animals before and after interventions designed to increase arrhythmia vulnerability and in a limited number of patient studies. The results to date are encouraging and suggest that in the future electrocardiographic examination will be used as a prognostic tool in addition to its already established diagnostic function.


An explanation of impaired solute mixing in extracellular fluid after hemorrhagic hypotension. A theory is presented suggesting that the slowed rate of solute dispersion in the extracellular fluid (ECF) space during or after hemorrhagic shock is largely due to a depressed cardiac output, and that mixing may be improved by any fluid therapy that decreases the mean recirculation time for the solute. This theory was tested by comparing solute mixing rates after treatment of shocked anesthetized dogs with either protein-free Ringer solution with Ringer solution containing 5% albumin. The rate of mixing was determined by computer analysis of the disappearance of an ECF tracer from plasma. Compared with Ringer-treated dogs, the albumin-treated group had a faster rate of tracer equilibration, larger cardiac plasma output, and smaller, approximately normal ECF volume. It was concluded that the abnormal dispersion of solute within the ECF space seen during or after hypotension can be corrected simply by restoring the cardiac output, and that albumin-containing fluid may be more effective in this regard than crystalloid solution alone.


Platelet monoamine oxidase activity in schizophrenia: a review of the data. The authors review studies of platelet and white cell monoamine oxidase (MAO) activity in schizophrenic patients. The data on acute schizophrenic patients remain inconclusive. Review of 26 reports of chronic schizophrenic patients leaves little doubt, however, that there is a subgroup in which the enzyme activity is decreased. Despite the strong association of decreased MAO activity and chronic schizophrenia, the etiological relationship of low platelet MAO activity to schizophrenia has not been demonstrated. More complete diagnostic descriptions will shed light on precisely which patients have lowered MAO activity. Further metabolic investigations with such patients are needed to determine the physiological significance of this phenomenon.


Medicaid audit: crisis in confidentiality and the patient-psychiatrist relationship. The authors describe their experience with a routine Medicaid audit and discuss the damage such a procedure can do to the trust between psychiatrists and patients, confidentiality, doctors' reputations, transference reactions, and patients' own emotional states. The authors point out that these crucial issues have broad implications because of the possibility of passage of national health insurance legislation.


The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. The efficacy of tricyclic antidepressants and various psychotherapies, in comparison with one another or in combination, has not been fully established in randomized clinical trials. The authors present a randomized controlled trial comparing the combination of amitriptyline and short-term interpersonal psychotherapy, either treatment alone, and nonscheduled supportive psychotherapy in ambulatory patients with acute depression. They found that pharmacotherapy and psychotherapy alone were equally efficacious and better than nonscheduled treatment. The combination treatment of psychotherapy and pharmacotherapy was more effective than either treatment alone and delayed the onset of symptomatic failure.


Intravascular migratory bullets.

Intravascular migratory bullets. The estimated course of a penetrating missile provides some clues to planning intraoperative priorities and management. However, missiles which become intravascular emboli present diagnostic and therapeutic dilemmas. Twenty-eight patients have been seen with bullet emboli. Five patients had emboli to the lungs, two of which were removed. Two large bullets embolized from a right heart injury down the inferior vena cava, one to a hepatic vein and one to the right renal vein. Fourteen patients had arterial bullet emboli, four originating in the heart, four in the thoracic aorta, and six in the abdominal aorta. Two patients died, one of cerebral infarction secondary to bullet embolus to the right carotid artery and one of an unrecognized traumatic intracardiac defect. Complications were secondary to associated injuries rather than a result of removal of bullet emboli.


Bowen's disease of the anal and perianal area. A report and analysis of twelve cases. Retrospective evaluation of twelve patients treated at the Cleveland Clinic for perianal Bowen's disease showed that these patients can be cured by wide local excision with skin grafting when necessary. No recurrence or metastasis was found during the follow-up period when the systematic technic was used. Only involved anal mucosa was removed, and normal mucosa was preserved; this aids in controlling anal continence. The margins of the resected skin must be subjected to frozen section study to be sure that total excision has been achieved. In this study a diagnosis of perianal Bowen's disease was made incidentally in six of the twelve patients during histologic examination of anorectal tissue removed for other reasons. Seven of the twelve either had had a systemic or cutaneous cancer previously or another systemic or cutaneous cancer subsequently developed, indicating the high association between Bowen's disease and other cancers. Therefore, it is important that all excised skin from anal or perianal operations be submitted for histologic examination, and if the diagnosis is Bowen's disease, the lesion must be completely removed using wide local excision. These patients should be evaluated and followed up because other malignancies may be present or evolve at a later time.


A secure method of repair of large ventral hernias with Marlex mesh to eliminate tension. The use of Marlex mesh to bridge abdominal fascial defects is well known. However, its use in reinforcing securely the repair of a minority of ventral hernias which can be approximated, only under considerable tension, is described.


Urolithiasis from stapler anastomosis.

Urolithiasis from stapler anastomosis. The simplicity of operation and versatility and speed of automatic stapling devices in the creation of ileal loops have been amply documented. Three cases of stone formation in the ileal loop, secondary to encrustation about the staples, are reported herein, and the modification to the surgical technic which would obviate this problem is presented.


The fate of exposed bone.

The fate of exposed bone. Exposed bone, even in conjunction with a fracture, will cover spontaneously with granulation tissue followed by epithelium, or will sequestrate and then cover, providing there is adequate circulation at the wound site. The healing process is lengthy but need not interfere with the reestablishment of function of the wounded part. The method requires surgical restraint but has a high success rate and avoids the risks and failures of complicated skin transfer methods.


The role of acetaldehyde in mediating reactivity to an acute dose of ethanol among different racial groups. Physiologic changes after ingestion of alcohol were monitored in Chinese and white volunteers, and absorption rate, acetaldehyde concentration, facial flushing, and heart rate increases were correlated.


Young alcoholics in treatment: their characteristics and recovery rates at follow-up. Reporting data on characteristics of young alcoholics, treatment and recovery, and comparisons made with older alcoholics in similar treatment, this study indicates the differences and similarities, as well as pointing up the need to investigate the types of treatment most needed in this section of the population.


Changes in the metabolism of biogenic amines in alcoholism--especially regarding CSF monoamine metabolites and serum DBH activity. Concentrations of the major metabolites of biogenic amines in cerebrospinal fluid and activity of serum dopamine-beta-hydroxylase in abstinent alcoholics were measured, suggesting that withdrawal symptoms of alcoholics were based on the abnormality of serotonin and dopamine metabolism in the body.


Alcohol and coronary arteries.

Alcohol and coronary arteries. The relationship between alcohol intake and the extent of coronary artery occlusion was studied and indicated that the patients who abstained or consumed less than 1 oz of alcohol weekly had significantly higher occlusion scores than those imbibing moderate amounts.


Drinking behavior, remission, and relapse: the Rand Report revisited. Utilizing the Armor, Polich, and Stambul 1976 criteria, the clinical course of patients from 26 treatment programs was studied, with relapse analyses differing from the data reported by Armor et al. The overall rate of remission at 6 mo follow-up was considerably lower (54%) in this study. The data suggest that those alcoholics who chose to reduce their drinking, as an option, experienced a substantial risk of relapse.


Alcohol use, myocardial infarction, sudden cardiac death, and hypertension. Studying coronary risk factors, this article concludes that: regular use of alcohol may protect against major coronary events; regular use of three or more drinks daily is a probable risk factor for hypertension; the relations of alcohol use to coronary disease, hypertension, and cardiomyopathy are disparate.


Varied cardiac abnormalities in alcoholics. The toxic effects of acute or chronic use of alcohol on cerebral and hepatic function have long been recognized, but it has been thought that the heart was not similarly affected. This study reexamines this traditional thought and indicates that ethyl alcohol may have chronic toxic effects on the cardiovascular system.


Alterations in phospholipid composition in ethanol tolerance and dependence. Mammalian cells may retain a limited capacity to alter membrane phospholipid fatty acid composition. This may play a role in adaptation to the presence of ethanol (cellular tolerance) and in the response to the removal of ethanol and the withdrawal syndrome.


Cross-tolerance to effect of ethanol and temperature in Aplysia: preliminary observations. Reporting an unexpected finding, this article suggests a bidirectional cross-tolerance between ethanol-tolerant and temperature-adapted preparations may be a widespread phenomenon. Further investigation of these findings may provide useful insight into the nature of the specific membrane changes in alcohol tolerance.


Effect of ethanol on membranes: a fluorescent probe study. Using fluorescence techniques to study changes in membrane structure as a function of ethanol concentration and alcoholism, it was found that ethanol primarily affects probes located at the membrane-water interface. Changes in the lipid composition of membranes during alcoholism were detected by fluorescent probes that partition into the hydrophobic interior of the membrane.


Developmental level and prognosis in alcoholics. An index of developmental level of functioning, derived from the Rorschach, was compared with several other prognostic measures to predict treatment outcome.


Alcoholic liver damage is provoked by 4-methylpyrazole, which prolongs the influence of ethanol but reduces acetaldehyde levels. Rats chronically fed ethanol developed liver injury only if they also received low doses of the alcohol dehydrogenase inhibitor, 4-methylpyrazole, suggesting that the consistency of the influence of ethanol and its metabolism, rather than the level of acetaldehyde or the degree of the metabolic effects, contributes to the pathogenesis of alcoholic liver damage.


Central pontine myelinolysis.

Central pontine myelinolysis. A patient is reported whose ailment meets the criteria of CPM. The illness was complicated by pneumonitis, most likely of the aspiration type. Of particular interest was the reversibility of a clinical picture of marked deterioration when attention was paid to fluid and electrolyte balance and maintenance of respiration. This patient's illness appears to meet the criteria of CPM, namely impairment of the facial muscles and tongue with dysphagia and dysarthria, flaccid quadriparesis or quadriplegia, and frequently, lack of response to painful stimuli followed by respiratory paralysis. The presence of peripheral neuropathy has been previously noted in a patient with CPM, but it is not an integral part of the disease.


Amniotic fluid embolism.

Amniotic fluid embolism. The statement that amniotic fluid embolism is the most dangerous and untreatable condition in obstetrics appears to be true. It must be suspected in any patient who collapses or bleeds excessively during labour or the immediate post-partum period. Attempts should be made to secure a definitive diagnosis in life by examination of blood obtained from the right side of the heart and the sputum for elements of amniotic fluid. Lung scanning is a useful aid to diagnosis. The principal factors that have been implicated in the clinical syndrome of amniotic fluid embolism are anaphylaxis, vascular obstruction by particulate matter, vascular spasm due to prostaglandins and possibly some other vasoactive substances, and the possibility that all the changes could be explained by disseminated intravascular coagulation as a primary event. Further work is required to elucidate the relative contributions of these various factors. Due to the suddeness of the catastrophe and the very high mortality, haemodynamic data in humans is virtually non-existent. With improved methods of resuscitation it is to be hoped that the mortality rate will be reduced and that such data will become available. In this way it might become possible to apply the results of animal research and indicate the most effective method of treatment.


Episodic hypertension caused by recurrent renal artery lesions following transplantation: a case report. A kidney transplant patient developed recurrent hypertension on two successive occasions associated with lesions of the renal artery. The first episode of hypertension was caused by renal artery stenosis and was surgically corrected; the second was caused by a sizable pseudoaneurysm at the site of arterial anastomosis which was resected, and arterial continuity was successfully re-established.


The broken wire suture.

The broken wire suture. The body is a hostile environment for wire sutures. Although the problems of electrochemical corrosion, direct chemical attack on the suture, and inflammation produced in reaction to the suture have been largley eliminated by the use of austenitic stainless steel wires, failure of the wires may still occur due to mechano-chemical cracking -- the combined effect of insignificant stresses, usually from cold working, and insignificant chemical potentials produced by body fluids. Although stainless steel wire remains a satisfactory material for sternotomy closure or for reattaching costal cartilages, the two spectacular complications of a broken wire point out the need for care in using wire sutures. Bending, twisting, kinking and knotting must be avoided as much as possible.


[Familial infantile cortical hyperostosis (author's transl)]. A new case of familial Caffey's disease is referred with focused clinic, radiologic and anatopathologic aspects. The hereditary patterns may obey a autosomic dominant one, with variable penetrance and expressivity. Thus a improved familial research is necessary in all the infantile cortical hyperostosis cases.


Laetrile: end play around the FDA. A review of legal developments. We consider here some of the legal and political background behind today's laetrile controversy. First, we provide a brief historical review of our present food and drug legislation and discuss details of these laws with respect to attempts by laetrile's backers to use the courts in the legalization of this compound. We analyze one case, Rutherford v. United States, that was won in the lower courts by the advocates of laetrile and conclude that the courts may have allowed emotionalism to interfere with the process of rational decision-making. On a larger scale, this emotionalism manifests itself as political pressure that may bring about changes in our food and drug legislation. These changes could loosen restrictions on the effectiveness requirement and result in the sacrifice of consumer protection in favor of making available more drugs, some of them ineffective, from which the patient may choose for treatment.


A model for plasmid maintenance of bacteriophage P1. Studies of the stability of P1 plasmid in a P1 cry Escherichia coli lysogen have suggested a model for equipartition of plasmid copies. Equipartition might be controlled by the detachment of P1 copies after replication, followed by their reattachment to membrane sites, in coordination with bacterial division.


[A new culture medium for growth and sporulation of Entomophthorales species, pathogens of aphids (author's transl)]. No one of the 3 specific egg yolk fractions (neutral lipids, polar lipids and proteins) was necessary for growth and sporulation of species such as Entomophthora aphidis, E. phalloides and E. thaxteriana, normally grown on egg yolk media. Egg yolk could be replaced by a sunflower oil-yeast extract mixture. E. thaxteriana was especially well studied. Various animal and vegetable fats and even chemically pure triglycerides could replace sunflower oil as a carbon source. Yeast extract was the best nitrogen source tested. In liquid culture, sporulation was directly dependent on yeast extract concentration. When yeast extract concentration was held constant, an increase in oil concentration did not produce an increase in sporulation. High dextrose concentrations inhibited resting spore formation. Liquid cultures of E. thaxteriana regularly produced 3 x 10(6) azygospores/ml in a 20 l fermentor.


[Investigation of the immunity status towards tetanus of a population of mechanics at the car-factory "Renault" (author's transl)]. Tetanus immunity has been studied in a population of mechanics working at the car-factory "Renault". For the study, 283 individuals were divided into 3 groups. The first group consisted of non-vaccined individuals, the second of vaccinated individuals and the third of individuals who had been boostered. The influence of different parameters on tetanus immunity status was considered, i. e. the age of the subjects, the time at which boostering was given, the serotherapy (when it was administered) and the contact with machine lubricating and cooling fluids. Clostridium tetani bacilli and spores were frequently found in aqueous machine fluids. Their presence is a potential hazard for non-vaccinated mechanics coming to contact with the fluids. Tetanus antibody levels in the sera of the tested population were determined in vivo by the toxin neutralization test. The influence on tetanus immunity of the different parameters considered in this paper was subjected to statistical analysis. From the whole population, 27% of the individuals were found to have no protection against tetanus. When age was taken into account, 53% of the individuals over 45 years old and 10% of those under 45 years old were shown to be devoid of tetanus immunity. It could be shown that younger individuals were better protected than older ones, because the formers had been immunized with adsorbed tetanus toxoid and most of the latters with fluid toxoid. Of the individuals in the third group who had received a booster injection within 15 years after primo-vaccination, 98% showed protective tetanus antibody levels in their sera in contrast to 25% when boostering had occurred more than 15 years after primo-vaccination. Contact with machine fluids was found to influence the degree of immunity of only those individuals whose boostering dated back to more than 25 years. Unexpectedly, 3 mechanics seemed to develop immunity after coming into contact with machine fluids. From the results reported here, it is concluded that tetanus immunity in vaccinated individuals should be renewed by a compulsory booster injection given every 5, 10 or, at the minimum, 15 years. Moreover, high-risk  populations such as that represented by the mechanics should be immunized or boostered on commencing employment.


[Immunofluorescence and immunoperoxidase: a comparison for sensitivity in cutaneous immunopathology (author's transl)]. A comparative study of the sensitivities of the immunofluorescence (IF) and immunoperoxydase (IPo) techniques was undertaken. The material used was biopsies of various skin lesions and especially pemphigus, bullous pemphigoid, lupus erythematosus and dermatitis herpetiformis. Direct and indirect methods were performed for the detection of fixed immunoglobulins and complement deposits. With large deposits, immunoperoxydase and immunofluorescence show an equal sensibility and the labeling obtained with IPo is never more intensive than the labeling obtained with IF. In contrast, with small deposits, IPo was less sensitive than IF and appears negative in the majority of the cases and especially in dermatitis herpetiformis. These results are confirmed in using increasing dilutions of conjugates and can be explained by the difficulty in doing the observation of small positive deposits with IPo.


Versatility of lumbar transposition flaps in the closure of meningomyelocele skin defects. A simple method for repair of skin defects after neurosurgical ablation of meningomyelocele is described. One or two skin flaps adjoining the defect are elevated, the right based superiorly and the left inferiorly. They are then transposed to cover the dural repair, and the donor site is repaired by a split-thickness skin graft. The ability of these flaps to close defects of all sizes is stressed.


Bovie: the man and the machine.

Bovie: the man and the machine. The origins of electrosurgery are presented and recognition given to one of its forgotten pioneers, William T. Bovie. Though not a physician, Bovie contributed greatly to patient care.


Nutritional importance of colostrum in the piglet. Suckling of colostrum by piglets is very important in order to improve the survival rate. Colostrum provides maternal antibodies, energy and protein. Rearing piglets suckling an artificial milk of a similar chemical composition to that of sow's milk failed when the animals were housed in conventional conditions although numerous research workers succeeded in rearing 90% of animals delivered and fed in sterile conditions. Studies on the chemical analysis of colostrum showed a high dry matter content (30-40% higher than that of milk) in particular a high protein level (twice that of milk). The high proportion of globulins, i.e. 38% during farrowing, drops to 12% of the protein 4 days later; conversely the casein content rather low at birth doubles over the same period. Colostrum proteins are not used to proved energetic nutrients; some of them are absorbed without hydrolysis and have a special physiological rôle. The transmission of maternal immunity by gamma globulins is well known; lactotransferrin plays an important rôle as a transporter and a bacteriostatic factor. Enzymatic proteins such as lyzozyme govern the metabolism of glycoproteins. Hydrolyzed albumins, casein and proteose-peptone fraction provide the essential amino acids for de novo protein synthesis. The fat content is relatively low during the first 24 hours and increases threefold in the 4 days after farrowing. It provides the majority of the energy required by the young animal. A high proportion of some fatty acids, mostly oleic and linoleic acids, are used preferentially as sources of energy. Other components, including enzymes of the mammary cells, were found, but their particular rôle has not been explained. Colostrum contains in addition numerous vitamins (vitamins A and E) and some particular trace elements (iodine and selenium), and their transfer from the maternal diet to the young is particularity efficient by colostrum suckling. The nutritional rôle of those nutrients is important and their levels could affect the survival rate of the piglets. Hypotheses concerning the digestion and absorption of nutrients and antibodies are summarized, and finally, recommendations are made for further research and for the minimum amount of colostrum required by each piglet for survival and efficient postnatal growth to be assessed.


Physiology of colostrum production.

Physiology of colostrum production. The mammary gland growth--appearance of a lobulo-alveolar structure--, the secretion of colostrum and lactogenesis occur when precise endocrine equilibrium take place during gestation and lactation in the cow and the sow. The formation of alveoli requires hormonal sequences including first, ovarian and foetoplacental hormones--estrogens and progesterone--and, then, antepituitary--prolactin--and adrenal--corticoids--hormones. These sequences appear during pregnancy and lead to a near complete development of the mammary gland at parturition in the cow and the sow. Administrations of ovarian steroids which produce the same variations of levels of these hormones in plasma as during the pregnancy allow the lobulo-alveolar structure to develop in the non pregnant dried cow. The synthesis of specific products of milk--casseins and lactose--remains low throughout pregnancy and then increase sharply after calving or farrowing. Around parturition, the secretion of colostrum takes place when plasma levels of progesterone drop very fast and those of estrogens increase and are at the highest level observed during gestation. A few hours later, the plasma levels of prolactin and corticoids increase significantly. The colostrum secretion, the appearance of high affinity IgG1 receptors and the specific uptake of IgG1 in maternal serum coincide with a complicated hormonal environment in which a lower progesteronemia and a higher prolactinemia seem to play a major role. Estrogens--especially 17 beta-estradiol--are required for the apperance of new epithelial mammary cells which acquire specific binding sites for IgG1 later. After injections of 17 beta-estradiol and progesterone to non pregnant, dried cows, the IgG1 secretion takes place when the plasma levels of these steroids decrease. On the other hand, the secretion of colostrum is the same as in a normal parturition when calving is induced by dexamethasone or dexamethasone + estradiol benzoate injections. After parturition, there is a lower uptake of proteins from the serum when prolactin and corticoids induce the onset of copious mileticulum, of the Golgi apparatus, of mitochondria and of the appearance of a polarized structure which depress the possibilities of migration of proteins from the serum through the cell.


Use of polyvalent cow colostrum in the prevention of enteric infections in calves and piglets. Colostrum of cows immunized with a polyvalent vaccine against enteropathogenic strains of Escherichia coli gave good protection to piglets and calves against enteric coli infections. Bovine immunoglobulin (IgG1) and its precipitable fragments persisted in the small intestine of piglets for 6 hours after oral administration. The proteolytic breakdown of porcine colostral IgG2, which occurs predominantly in the small intestine proceeded at a higher rate than that of heterologous bovine colostral IgG1. Colostrum of cows immunized with transmissible gastroenteritis (TGE) virus by intramammary administration protected newborn piglets from virulent TGE virus on oral administration. The prevention of enteric coli infections in suckling piglets and calves in Czechoslovakia is based on vaccination of pregnant cows and sows and on additional passive protection of weanlings by oral administration of dried or liquid immune colostrum or serum of cows vaccinated with polyvalent vaccines prepared from enteropathogenic strains of E. Coli.


The distribution of immunoglobulins in the intestine of the neonatal calf. The distribution of immunoglobulins G, M and A in the small intestine of colostrum fed calves was monitored using immunofluorescent techniques. Colostral immunoglobulins were located in villous region of the small intestine where they were found either in the lamina propria, in the epithelial cells or on the mucosal surface of the epithelial cells. The distribution varied according to the age of calf examined. In very young calves, the villous epithelial cells were seen to be absorbing immunoglobulin of all 3 classes, whereas in 4 day old calves, the epithelial cells were generally devoid of immunoglobulin. In unsuckled calves, the intestinal immunoglobulins were synthesised in the Peyers patches and crypt region of the mucosa of the small intestine and immunoglobulin was found in the crypt epithelial cells and in plasma cells in the surrounding lamina propria.


Specific protection by colostrum from cows vaccinated with the K 99 antigen in newborn calves experimentally infected with E. coli Ent+ K99+. We have measured the protective effect of colostrum of vaccinated cows with the K99 antigen comparatively with the colostrum of non vaccinated cows, in calves receiving at birth 2 liters of colostrum and just after 5 times 10(10) to 1 times 10(11) E. coli Ent+, K99+. The K99 antigen was prepared from E coli B41 (0101:K99:H-) cultured in a fermentor. Cows were vaccinated subcutaneously with 100 mg or 300 mg (wet weight) in emulsion in Freund uncomplete adjuvant 45 and 15 days before parturition. Of 4 calves receiving a colostrum of non vaccinated cows 4 had a diarrhoea, 3 became dehydrated and 2 died. Of 6 calves receiving colostrum of vaccinated cows, 5 were healthy and the 6th calf had a mild diarrhoea for few hours and became again healthy. Control and protected calves excreted E. coli K99+, 24 HOURS AFTER INFECTION. The protection is probably due to K99 antibodies which inhibit adhesion of E. coli K99+ to the intestinal epithelium.


Multiple sclerosis in the Faroe Islands: I. Clinical and epidemiological features. Intensive search over the past five years for all cases of multiple sclerosis (MS) on the Faroe Island since about 1920 has revealed 25 cases among native-born resident Faroese up to 1977. All but 1 patient had clinical onset of MS between 1943 and 1960; 1 case began in 1970. Four cases of MS in Faroese with prolonged foreign residence and 5 among Danish-born Faroese were excluded. The 24 included cases with onset between 1943 and 1960 meet all criteria for a point-source epidemic. The median year of onset was 1949. The cumulative risk of MS for Faroese in 1940 was 8.7 per 10,000. All 14 early-onset cases (1943 to 1949) were in patients 11 to 45 years old in 1940; all but 2 late-onset cases (1952 to 1960) were in persons aged up to 10 years old in 1940. British troops occupied the Faroese in large numbers for five years beginning in April, 1940. During the war, all but 3 patients resided in locations where the troops were stationed, and these 3 also had direct contact with the British. We conclude that there was an epidemic of MS on the Faroes and that the disease was probably introduced by the British troops (or their baggage). If so, then MS on the Faroes is a transmissible disease, most likely infectious; but only about 1 in 500 of the exposed individuals were clinically affected.


Creutzfeldt-Jakob disease: patterns of worldwide occurrence and the significance of familial and sporadic clustering. The worldwide epidemiology of Creutzfeldt-Jakob disease (CJD) is presented from an analysis of 1,435 patients. In the United States, the average annual mortality rate is at least 0.26 deaths per million. Temporal-spatial clustering of cases was not found in the United States, but reports from other countries indicate that such clustering does occur. Fifteen percent of the cases were of the familial type, suggesting a genetic susceptibility to infection. Iatrogenic transmission by corneal transplantation and neurosurgical operations has occurred, and the possibility is raised that previous surgery or preexisting neurological operations has occurred, and the possibility is raised that previous surgery or preexisting neurological disease may be associated with an increased risk of developing CJD. It remains to be determined whether the virus of CJD is maintained only by patient-to-patient transmission, has a zoonotic reservoir such as scrapie, or causes widespread latent infection of man that is occasionally activated.


Creutzfeldt-Jakob disease in France: I. Retrospective study of the Paris area during the ten-year period 1968-1977. A systematic search for cases of Creutzfeldt-Jakob disease occurring in the ten-year period 1968 through 1977 was conducted in the city of Paris and surrounding departments which comprise the greater Paris area. Fifty-six cases were found among the total population of approximately 10 million inhabitants, with a maximum incidence of 1.1 cases per year per million people in the densely populated city of Paris and a progressively lower incidence in the less heavily populated suburban and rural areas of the region. There was no temporal or geographic clustering of disease. Attention is drawn to the often rapid onset and short duration of illness (nearly two-thirds of the patients died within five months of onset) and the frequent early occurrence of symptoms such as asthenia, diaphoresis, and disturbances of sleep and appetite.


[Inflammation and resistance of mice infected by "Candida albicans" (author's transl)]. An inflammatory reaction induced by the subcutaneous injection of talc embedded in a gel calcium phosphate increased resistance of mice challenged intravenously with Candida albicans. The relationship between the absolute number of polymorphonuclear phagocytes in the blood and this protective effect seems to indicate a major role of polymorphonuclear leukocytes following inflammation.


[Action of tetracycline and sodium deoxycholate combinations on protein and nucleic acid synthesis in the cells of the NAG vibrio, Staphylococcus aureus and Escherichia coli]. The effect of tetracycline combination with sodium desoxycholate, a surface-active substance, on the synthesis of proteins and nucleic acids in the cells of NAG-vibrio, Staph. aureus and E. coli was studied by incorporation of 1-14C-glycine and 8-14C-adenine into proteins and nucleic acids. It was found that sodium desoxycholate suppressed the synthesis of proteins and nucleic acids in the cells of NAG-vibrio and Staph. aureus. Its combination with tetracycline resulted in summation or increase of the suppressive effects on proteins and nucleic acids as compared to the effect of the substances used alone. Sodium desoxycholate even in very high concentration, up to 12800 gamma/ml, had no effect on the synthesis of proteins and nucleic acids in the cells of E. coli and respectively it did not change the activity of tetracycline on combined use.


[Therapeutic use of carminomycin in Ewing's sarcoma in children]. The therapeutic effect of carminomycin in various combinations with other antitumor drugs, i. e. vincristin, cyclophosphan, dactinomycin and metatrexate was studied in clinics on 18 children with wide-spread Juing sarcoma. Satisfactory direct effect was observed with the use of the above combinations in 47.0 per cent of the patients, which was evident from a decrease in the secondary tumor, disappearance of the pains and improvement of the general state of the patients.


Bacitracin production by whole cells immobilized in polyacrylamide gel. Whole cells of Bacillus sp., bacitracin-producing bacteria, were immobilized in polyacrylamide gel prepared by using 5% total acrylamide (95% acrylamide monomer and 5% N, N'-methylenebis acrylamide). Bacitracin production by the immobilized whole cells was examined by using various fermentation media. In starch-bouillon medium, the initial activity of immobilized whole cells for bacitracin production was 20 to 25% that of an equivalent amount of washed cells. With successive utilizations in 1% peptone as reaction medium, activity of the immobilized whole cells increased gradually and reached a steady-state maximum having a value of 80 to 90% of the activity obtained initially with washed cells, whereas the washed cells lost most activity when utilized successively. What appeared to be growth of the bacteria in the gel was observed by electron microscopy. Therefore, the activation of immobilized whole cells during successive utilizations apparently resulted from the growth of whole cells in the gel, especially at the gel surface.


SCE-963, a new potent cephalosporin with high affinity for penicillin-binding proteins 1 and 3 of Escherichia coli. A few biochemical activities of SCE-963, a new cephalosporin with potent antibacterial activities against gram-negative bacteria, were compared with those of several currently available cephalosporins against strains of Escherichia coli K-12. The minimum inhibitory concentrations of SCE-963, cefazolin, cephaloridine, cephalothin, and cephalexin were 0.2, 1.56, 3.13, 12.5, and 25 mug/ml, respectively. Affinities of these cephalosporins for the penicillin-binding protein (PBP) 1B of E. coli correlated well with their antibacterial activities; among tested cephalosporins, SCE-963 showed the highest affinity for PBP 1B. SCE-963 inhibited cross-linking of peptidoglycan in a cell-free system the most strongly suggesting that this inhibition results from its high affinity for PBP 1B. SCE-963 also showed the highest affinity for PBP 3; it caused filamentation of cells over a wide range of relatively lower concentrations. Thus its superior antibacterial activity is believed to be manifested through its high affinity for the PBPs.


Double-blind clinical trials of oral cyclacillin and ampicillin. A double-blind study was performed to compare the clinical response and the incidence of side effects in 2,581 patients administered ampicillin or cyclacillin for infections of the genitourinary or respiratory tract, infections of the skin and soft tissues, or for otitis media. There was no significant difference in clinical response and bacterial eradication. All side effects, including diarrhea and skin rash, were approximately twice as frequent in patients treated with ampicillin.


Investigations of the occurrence of gentamicin-resistant Staphylococcus aureus. During the 19-month period from June 1976 to December 1977, 90 patients became colonized or infected with gentamicin-resistant Staphylococcus aureus (GRS). Of 63 adults, 56 had hospital-acquired GRS, whereas only 9 of 27 children had hospital-acquired GRS (P < 0.001). The other 7 adults and 18 children had GRS present on admission. More than half of those who acquired GRS in the hospital had received prior aminoglycoside therapy. Attack rates were higher in adults than in children and significantly higher on the plastic surgery service than on any other adult service. Phage typing revealed a single-strain outbreak on the plastic surgery ward involving 11 patients, whereas other isolates were of several phage types. Community-acquired GRS occurred more frequently in rural native communities (P < 0.02) and may be related to the use of topical gentamicin. Of 17 native children, 10 were from the same area but there was no common phage type. Agar dilution minimal inhibitory concentration (MIC) testing confirmed that all isolates were gentamicin resistant (MIC >/= 8 mug/ml) and almost all were tobramycin resistant (MIC >/= 8 mug/ml). Although the MIC distribution between gentamicin disk-susceptible and -resistant strains was significantly different, MIC's for 90% of gentamicin disk-resistant strains were </=8 mug of amikacin per ml, and MIC's for 92% of the strains were </=4 mug of netilmicin per ml.


Induction of streptomycin uptake in resistant strains of Escherichia coli. Different streptomycin-resistant strains of Escherichia coli, including an R100 plasmid-carrying strain of E. coli W3110, the ribosomally resistant mutant SM10, and the spontaneous revertant from dependence to independence d1023, exhibited poor accumulation capacity for aminoglycoside antibiotics. This was due to a failure of these mutants to induce the general polyamine transport system that is utilized by streptomycin to enter the cell. It is shown that the aminoglycoside kanamycin, which is effective on these streptomycin-resistant strains, was capable of inducing the uptake of streptomycin, thus giving rise to streptomycin accumulation up to wild-type levels. Plasmid-determined resistance, which has been speculated to be the result of a blockage of the uptake system by modified antibiotic molecules, cannot be overcome by the induction of streptomycin transport. Increase in permeability of the antibiotic does not affect the susceptibility of the bacteria. It is shown that all of the antibiotic taken up was enzymatically modified. R-plasmid-conferred resistance to aminoglycosides is therefore explained by the inactivation of the antibiotic entering the bacterial cell.


Growth conditions and rifampin susceptibility. The susceptibility of Escherichia coli to rifampin was measured during unlimited growth in rich and poor media and during chemostat growth limited by the carbon source. During batch growth at low turbidities, the susceptibility of the bacteria increased as the growth rate decreased, consistent with the longer time available for drug penetration in the poorer media. During chemostat culture, the bacteria remained highly susceptible or became genetically resistant, dependent on the manner in which the bacteria were exposed to the antibiotic. If the concentration of rifampin was abruptly raised, susceptible cells were replaced by genetically resistant cells. However, if the concentration of antibiotic was raised slowly, the genetically susceptible cells continued to grow. This difference in response of chemostat cultures according to mode of drug administration was attributed to an inducible detoxification of the drug by the bacteria, because the susceptible genotype is maintained only when the concentration of rifampin is increased gradually and when a high population of cells is maintained. Direct evidence for the inactivation of the rifampin from the bioassay of culture supernatants is presented.


Chloroquine resistance in malaria: accessibility of drug receptors to mefloquine. The process of mefloquine accumulation was studied in mouse erythrocytes infected with either Plasmodium berghei CS (chloroquine susceptible) or P. berghei CR (chloroquine resistant). In both cases, mefloquine was accumulated by a saturable process with an apparent dissociation constant of 2.5 x 10(-6) M and an apparent maximal capacity of 700 mumol per kg of erythrocyte pellet; uninfected mouse erythrocytes accumulated more than half as much mefloquine as infected erythrocytes. The process of accumulation was not stimulated by providing glucose as a substrate, and it was not inhibited in infected erythrocytes by azide, iodoacetate, or incubation at 2 degrees C. Although mefloquine was accumulated more effectively than chloroquine by uninfected erythrocytes and by erythrocytes infected with P. berghei CR, competition between chloroquine and mefloquine was observed, raising the possibility that the same process of accumulation serves both drugs. Chloroquine competitively inhibits mefloquine accumulation, with an apparent inhibitor constant of 1.7 x 10(-3) M, and mefloquine competitively inhibits chloroquine accumulation, with an apparent inhibitor constant of 2 x 10(-6) M. The same process of accumulation and the same group of receptors could serve both drugs if mefloquine has greater access than chloroquine to the receptors. Regardless of whether the same process serves both drugs, undiminished accumulation by erythrocytes infected with P. berghei CR provides an explanation for the superiority of mefloquine in treating chloroquine-resistant malaria.


Lack of effect of an interferon inducer, N,N-dihexadecyl-m-xylylenediamine, on rhinovirus challenge in humans. CP-28,888-27 and placebo nasal sprays were compared in 62 normal volunteers challenged with rhinovirus type 13 or 21 in two randomized, double-blind studies. Half of the subjects received CP-28,888-27 and half received nasal placebo administered at 24, 20, and 16 h before challenge and 4 and 8 h after challenge. In each study, the number of subjects shedding virus in nasal washes, the number developing fourfold or greater serum antibody responses, and the number developing afebrile or febrile upper respiratory tract illness were not significantly different comparing subjects given CP-28,888-27 and those given placebo. Interferon was detected in nasal washes from 5 of 15 volunteers tested in the CP-28,888-27 group compared to 2 of 15 volunteers from the placebo group.


Unusual subepidermal bullous diseases with immunologic features of bullous pemphigoid. Sixty-seven patients with histologic and immunologic features of bullous pemphigold (BP) were evaluated. Eleven patients had a localized blistering disease that was predominantly confined to one area of the body, most commonly the lower extremities. Two patients displayed a dapsone-responsive blistering disease that was characterized by a flexural distribution of ten to 20 1-cm or less, intensely pruitic, subepidermal bullae and linear IgA basement membrane zone deposition. Two patients had a chronic recalcitrant generalized scarring, hyperkeratotic, subepidermal blistering eruption that demonstrated serologic and direct immunofluorescence (IF) findings of BP. One patient displayed grouped small vesicles surmounted on an erythematous base; the clinical diagnosis was dermatitis herpetiformis, but direct IF examination of the biopsy specimen showed features of BP. One patient with epidermolysis bullosa acquisita had serologic and direct IF features suggestive of BP.


Early tangential excision and immediate mesh autografting of deep dermal hand burns. Thermal injuries to the hand constitute not only one of the most common burns, but one of the most difficult for the burn surgeon to treat. Early wound closure is mandatory if maximum functional return is to be attained and scarring minimized. Over the last three and one-half years, 60 patients with deep dermal dorsal hand and finger burns were treated by tangential excision and immediate mesh autografting. All patients were admitted to the hospital within 24 hours of injury and excision was performed between the third to the tenth post burn day. Operative technique consisted of sequential eschar excision using the Humby knife or Goulian-Weck dermatome until viable dermis was visible. Mesh autograft, ratio 1 to 1(1/2) without expansion, was applied. There was 100% graft take in all but four hands. Hand function with full range of motion returned by the tenth postoperative day. Complications were minor. Patient follow-up ranged from six months to three and one-half years. No patient has required subsequent surgery for scar revision or contracture release. Range of motion in all patients has been excellent and all patients have continued to maintain normal hand function. The cosmetic appearance has been good except for the early "mesh" appearance of the graft which has become less apparent with time. In summary, early tangential excision and immediate mesh autografting of deep dermal dorsal hand burns has fulfilled the following burn principles-preservation of tissue, prevention of wound infection, maintenance of function and early wound closure.


100 HLA-identical sibling transplants. Prognostic factors other than histocompatibility. Analysis of 100 patients receiving HLA identical sibling transplants was performed. Excellent graft survival demonstrated in the group attests to the importance of matching serological determined antigens. There seems to be a modest beneficial effect on antilymphoblast globulin in low dosage, but not in high doses. Insulin dependent diabetes mellitus results in a significant negative influence on patient survival and graft function in the male recipient but not in the female. A particularly striking point that emerges is the potential hazard in incorrectly treating for rejection. Rejection occurs very rarely in these patients; in a patient with deteriorating renal function, etiologies other than rejection should be vigorously sought (including transcutaneous biopsy) prior to initiation of rejection therapy.


Protection by plasma proteins of the isolated lamb heart perfused with stroma-free hemoglobin at 38 degrees. Isolated lamb hearts were perfused for eight hours at 38 degrees with stroma-free hemoglobin solution (SFHS). The preservation of cardiac structure and function was studied. Control hearts perfused with blood (N = 6) developed no ventricular failure or significant weight gain (13% +/- 5), showed no alteration of cellular ultrastructure, and little interstitial edema. Hearts perfused with 7% (N = 7) or 11% (N = 5) SFHS contracted less well, became edematous (22% and 44% weight gain) and showed altered mitochondria, capillary endothelial swelling and hemoglobin extravasation into the interstitial space. The addition of 5-7% albumin to SFHS (N = 9) markedly reduced interstitial edema (weight gain 11% +/- 13), preserved mitochondria, prevented endothelial swelling, and limited transcapillary escape of hemoglobin. Thus isolated hearts perfused with SFHS develop vascular endothelial damage and an increase in capillary permeability. The addition of plasma proteins to the perfusate protects against this injury.


Effect of diflunisal on the human plasma levels and on the urinary excretion of naproxen. A double-blind placebo controlled crossover study was performed in twelve healthy volunteers receiving multiple doses of naproxen (250 mg b.i.d.) and diflunisal (250 mg b.i.d.) to study the effect of diflunisal co-administration on the naproxen levels in plasma and urine. The naproxen steady-state level was reached between the second and the third day. The peak plasma level appeared about 2 hr after drug administration and varied from 68 to 75 microgram/ml. This maximum was not modified by a simultaneous administration of diflunisal neither in its position nor in its intensity. Statistical analysis using a parametric method, did not reveal a significant influence of diflunisal on the plasma kinetics or on the urinary elimination of naproxen.


Complications of chrysotherapy: a review of recent studies. Chrysotherapy has become a cornerstone in the treatment program of patients with rheumatoid arthritis. Unfortunately, approximately one third of these individuals will experience an adverse drug reaction at some time. Cutaneous manifestations are most commonly recognized and do not necessarily preclude reinstitution of gold after their resolution. Other complications involving the hematopoietic and renal systems are less frequent but may be severe. Recently, investigators have described serious toxic reactions involving the liver and lungs. The pathophysiologic mechanism of these untoward effects appears to be immunologic, although there are conflicting data. Treatment is primarily supportive, and the role of corticosteroids and chelating agents remains controversial. Emphasis should be placed primarily on early detection of adverse reactions through patient education and careful monitoring of blood and urine values.


Failure of trimethoprim/sulfamethoxazole in invasive Nocardia asteroides infection. A case of pulmonary nocardiosis occurred with progressive involvement of the pleura, pericardium, mediastinum, and sternum. Surgical resection and drainage procedures followed by administration of the drug combination, trimethoprim/sulfamethoxazole, over a six-month period led to clinical recovery. Discontinuation of drug therapy, however, was followed by relapse and further invasion by the same organism. A literature survey of Nocardia asteroides infections treated with trimethoprim/sulfamethoxazole disclosed that posttreatment follow-up is often too brief or unknown, making the ultimate success of therapy uncertain.


[Prolonged glomerulonephritis and cyanotic heart disease]. Three children with congenital heart disease presented with more or less severe renal dysfunction. Histologic studies showed signs of membranoproliferative pseudoglomerulonephritis without deposits on immunofluorescence. Surgical correction of the heart defect induced a spectacular functional and histologic improvement.


Medieval and early modern theories of mental illness. Historians of medieval and early modern psychiatry have utilized limited source materials in their research. They have focused on printed works, particularly formal treatises by celebrated authors, and neglected manuscript collections. The resulting histories depict early European psychiatric thought as dominated by demonology. Examination of the archives of an early English legal incompetency jurisdiction flatly contradicts this picture. Starting in the 13th century, the English government conducted mental status examinations of psychiatrically disabled individuals, using commonsense, naturalistic criteria of impairment; private, supervised guardians were appointed for such persons. Furthermore, etiological theories entertained by royal officials and laymen relied on physiological and psychological notions of psychiatric illness. These findings raise serious questions about conventional accounts of this period and underline the need for more research using original manuscripts.


Psychoanalytic training. Problems and perspectives. The increasing prolongation of the didactic analysis and supervisory hours that has occurred in most psychoanalytic institutes over the past several decades has not only failed to guarantee a better trained and more scientific group of psychoanalysts, but, because of the unhealthy and authoritarian hegemony of training analysts over their candidates, may be having a contrary effect of fostering rigidity and dogmatism. If psychoanalysis is to remain vital, it must be open to growth and change like any other branch of science and its practitioners must be flexible and open to new vistas of knowledge from whatever source. A suggestion is offered that would enable psychoanalytic candidates, in most instances, to complete their training within a four-year period.


[Cytology of metastases of rare tumors in the pleura (author's transl)]. In the Oncocytological Center of Zala Country were investigated in the recent years 2378 cases from effusions of pleural cavity. Ten of the tested cases had been proved to be metastases of sarcomatous lesions. Three of them were myosarcoma, two of them were malignant melanoma and one fibromyosarcoma, reticulosarcoma, osteosarcoma and sarcomatous stage of Hodgkin disease, each. The author gives a review of the cytological characteristics of metastatic sarcomatous lesions. Up to the opinion of the author there are some characteristics which can help in the typing.


[Epidemiology of lymphogranulomatosis (M. Hodgkin) (author's transl)]. Lymphogranulomatosis (Hodgkin's disease) is a rare neoplasm in the G.D.R.: incidence (standardized for "Europe-population") male 3.2--3.5, female 1.8--2.1 per 10 000 per year. Geographical differences in incidence and mortality are remarkable, but firm conclusions cannot be drawn. Epidemiological research has demonstrated: familial aggregation; association with HLA-antigen; space-temporal clusters which are considered as suspicious for infectious aetiology; association with occupational factors; higher incidence after tonsillectomy and appendectomy as an index of social factors; no influence of ionizing radiation. Multiple primary malignant neoplasms are strikingly often found in patients with Hodgkin's disease. It may be that Hodgkin's disease is no nosological entity but clinical and morphological manifestation of two diseases, namely infectious granuloma in youth and true neoplasm in the elderly.


The role of platelets in infections. I. Observations in human and murine malaria. The interaction between platelets and microorganisms may be underestimated. Our in vivo studies support a direct role of thrombocytes in malarial infections. We have found intrathrombocytic parasites of Plasmodium vivax (in 10% of men naturally infected) and P berghei (in 53% of mice experimentally infected); these were both merozoites and trophozoites. Neither the mechanism of parasitization (whether by active penetration or by phagocytosis) nor the outcome of this phenomenon is known. However, structures suggestive of partially digested parasitic material were seen in platelets of almost 50% of the men and 75% of the mice. These findings suggest that other microoganisms (fungi, bacteria, and viruses) may also enter thrombocytes in vivo. If so, platelets could play important roles, either favorable or deleterious, in infections.


Embedding in large plastic blocks. Diagnostic light and potential electron microscopy on the same block. Specimens destined for light and electron microscopy were fixed in a modified buffered formalin, postosmicated, dehydrated, and embedded in a mixture of epoxy resins (Epon-araldite) in large plastic molds. These blocks were sectioned at 0.5 to 1 micron on a JB-4 microtome and stained with a combined nuclear and cytoplasmic stain (Paragon). The sections were examined by light microscopy for diagnostic evaluation. If ultrastructural examination was also desired, the selected area was isolated using the "mesa" technique. The trimmed block was then sectioned on an ultramicrotome, picked up on grids, stained, and examined in the electron microscope. We think these techniques offer the diagnostic pathologist the potential of viewing 1-micron sections at a light microscopy level with the option of subsequent electron microscopy of the same area of the same block.


Pneumoperitoneum and pneumoretroperitoneum. Consequences of positive end-expiratory pressure therapy. Patients receiving positive end-expiratory pressure (PEEP) therapy should be considered at risk for pneumoperitoneum. In the four patients described, chest roentgenographic demonstration of pulmonary interstitial gas and pneumomediastinum, frequently but not always associated with pneumothorax, preceded the dissection of gas into the abdominal cavity. Neither prompt intubation of the pleural space with reexpansion of the lung in the event of pneumothorax nor decrease in the PEEP applied precluded dissection of gas from the mediastinum into the retroperitoneal and peritoneal spaces. This sequence of roentgenographic events should strongly suggest pneumoretroperitoneum and pneumoperitoneum as a sequela to PEEP therapy rather than a ruptured viscus.


Cholangitis with a silver lining.

Cholangitis with a silver lining. Acute obstructive cholangitis developed secondary to a common duct stone formed around a silver hemostatic clip, introduced at cholecystectomy two years previously, that had migrated from a long cystic duct remnant. Stone formation around a silk suture is well known, and silver clips in the area of the porta hepatis may constitute a similar hazard.


[Role of epithelial basement membrane of the small intestine in providing immunologic homeostasis]. A morphometric method was used experimentally to prove the immune barrier function of the epithelial basal membrane of the small intestine mucous membrane. The epithelial basal membrane located on the border of the epithelium and connective tissue provides biochemical and immunological protection of the layer proper against penetrotion into it of antigens from the epithelium, being a barrier of immunological homeostasis. The damage of the epithelial membrane is accompanied by coming of the intestinal lumen antigens into the layer proper causing there a disturbance of immunological homeostasis. In response to this lymphoid cells migrate from the stroma to the epithelium towards the antigens, and lymphocytic reaction in the layer proper increases.


[Functional-morphological model of organization of the epithelium of normal, hyperplastic and neoplastic human endometrium]. A model of functional-morphological organization of epithelium of human normal, hyperplastic, and tumour endometrium is described. The model is based on a hypothesis that a population of stem cells capable of indefinite unlimited self-maintenance exists in normal glandular epithelium of the endometrium. The population of normal stem cells of endometrium epithelium is the source of emergence of differentiated types of epithelial cells among which, according to the model, three cell types can be distinguished: cells sensitive to estradiol alone, cells sensitive to both estradiol and progesteron, and cells sensitive to progesteron alone. The conditions necessary for transition of one cell type to another as well as histochemical characteristics of each of the cell types are described. The model has been used for the analysis of morphological changes developing in hyperplastic processes and cancer of the endometrium as well as for the substantiation of the current schedules for hormone therapy of these diseases.


[Acute respiratory insufficiency syndrome ("shock lung") in adults]. The causes of the development of acute respiratory insufficiency ("shock lung") may include any shock, burn disease, posttransfusion syndrome, hyperoxygenation and trauma of the lungs. Morphologically, against the background of inflation of the lung parenchyma, bilateral fine-focus atelectases, focal disorders of the circulation of the type of leukostases, sludge, leading to extensive hyalin (spodogenic) thromboses, develop. Secondarily, a small-focus edema, hemorrhages, sometimes, hyalin membranes, develop. Atelectases are initially reversible, but later, when surfactant desintegrates against the background of circulatory disorders, they become stable. The main mechanism of the development of this process consists in the release, during shock, of biologically active amines in the lungs leading to circulatory disorders in them. This is attested to by the possibility of producing the "shock lung" picture in intact animals by inoculation into their blood of plasma from the animals in a shock condition.


[Pathomorphosis of acute renal insufficiency]. The pathogenetic treatment of acute renal insufficiency (ARI) of the type of "shock kidney" started early in the disease changes the clinico-anatomical picture of ARI. Therapeutically conditioned pathomorphosis of ARI may exist. According to the data of the literature and the author's data based on morphological analysis of 400 autopsy cases of ARI, the ARI pathomorphosis consists of the following : (1) emergence of reversible ARI forms (when the treatment is started early and nephron is not deeply affected); (2) disappearance of some morphological signs of ARI (reaction of the renal tissue to cyclinders, tubulorexis); (3) appearance of unusual regeneration of nephroepithelium in deep affection of the kidneys. Renal changes associated with therapy should be regarded as pathology of ARI therapy.


[Morphogenesis of complicated and uncomplicated influenza]. Changes in the lungs in the prodromal period immediately after inoculation of animals with influenza virus were studied at length by electron microscopy. An early involvement in the process of pulmonary alveolar cells was demonstrated. Particular attention is drawn to viral and viral-bacterial associations determining the severity of the course of influenza and its lethal outcomes. The paper deals with the importance of latent infection in intrauterine infection with influenza virus.


Clinical and radiologic remission in reticulum cell sarcoma of the brain. Two patients with cerebral reticulum cell sarcoma (CRCS) are reported in whom neurologic abnormalities and radiologic (computerized tomographic [CT] scan) evidence of tumor remitted. In one patient, remission followed craniectomy and corticosteroid therapy and lasted for eight months. In the other patient, at least four remissions occurred over a span of seven years, each in conjunction with the administration of corticosteroids. Corticosteroids may favorably alter the biologic activity of tumor tissue in some cases of CRCS, predisposing to clinical remission and disappearance of tumor on CT scan.


Timolol maleate: efficacy and safety.

Timolol maleate: efficacy and safety. A randomized, double-masked trial of various concentrations of timolol maleate ophthalmic solution (0.1%, 0.25%, 0.5%, and 1.0%) vs placebo demonstrated that all concentrations of timolol effectively lowered intraocular pressure (IOP). A 0.5% solution of timolol was as effective in reducing IOP as the 1.0% concentration. Blood pressure, visual acuity, and pupillary diameter were not altered significantly by any concentration of timolol tested during this study. There was a dose-dependent decrease in resting pulse rate with increasing concentrations of timolol. No objective signs of drug intolerance were found on external ocular examination, nor were any subjective symptoms elicited on questioning the subjects. Timolol applied topically twice daily in concentrations of 0.1% to 0.5% appeared to be an effective and safe ocular hypotensive agent.


Prescribing in Australia. Part 1.

Prescribing in Australia. Part 1. A brief history of the Australian Pharmaceutical Benefits Scheme is given. Available statistics in recent years have been analyzed indicating the more frequently prescribed drugs both individually and in the major pharmacological groups.


Candida infection in human.

Candida infection in human. Sputum, vaginal smear, skin and nail scraping, and oral scraping from 269 suspected cases of fungus infection were examined by microscopy and culture for fungus. One hundred similar specimens from healthy individuals were examined as controls. Statistically significant (p less than 0.001) difference was observed (67.3% versus 7%) in the rate of isolation of fungus in the two groups. Three strains of Candida species were found among the isolates. In sputum, oral scraping and vaginal discharge, C. albicans, and in skin and nail scraping Candida stellatoidia were the prevalent strains. Candida tropicalis was isolated in fair proportion from the skin and nail scraping.


Classification of leukemic cells by Ia alloantigens and complement receptors. Surface probes for cell differentiation. Of particular interest in the study of cell membrane markers of leukemic cells were cytotoxic and immunofluorescent results obtained in comparing Ia alloantigen and complement receptor (CR) expression on normal leukocytic and leukemic cell types. Using discontinuous Ficoll gradients, Ia alloantigens were found on varying numbers of leukemic myelo- and lymphoblasts, and on the early stages of normal melocytes. Ia alloantigens, however, were not detectable on mature polymorphonuclear cells. This establishes human Ia alloantigens as cell surface differentiation markers. The appearance of complement receptors was observed later than that of Ia alloantigens. CR1 (EAC1-4b) showed up later in the differentiation than CR2 (EAC1-3d). Thus, an immunological discrimination between AML blasts and CML blast crisis blasts appears to be possible: AML blasts are mostly Ia-positive but CR-negative, whilst CML blast crisis cells are only 20-30% Ia-positive and carry complement receptors in at least equal amounts. The AML blast cell would appear as the less-differentiated cell type when compared to the CML blast crisis cells. The picture, however, remains complex since in CML blast crisis at least three different types of blast cells can be identified: an Ia-positive and an Ia-negative myeloid blast as well as an  Ia-positive lymphoid blast. The quantitative composition of these three elements within the myeloid differentiation profile can vary somewhat from patient to patient. Furthermore, these studies revealed a disturbed differentiation of leukemic cell types.