Comparisons of serological tests for Babesia in British cattle. A comparison was made between the microplate enzyme linked immunosorbent assay (ELISA) and the indirect fluorescent antibody (IFA) and complement fixation (CF) tests for the detection of antibodies in the serum of cattle experimentally infected with Babesia divergens and B major. Antibodies were detected using all three tests but they were detected earlier using the CF test. However CF titres were consistently lower than those obtained using the other tests. Although there was little to choose between the IFA and ELISA tests, it was suggested that the ELISA may be preferable since it is less subject to operator error and operator stress, and can be adapted readily to field use.


Pathological features of multiple bone infection in the foal. The gross and histological features of multiple bone infection in two foals are described. In both cases the lesions were confined to the region of the growth plate. Bone and, in some cases, growth plate cartilage destruction has occurred associated with an extensive inflammatory cell infiltration. The significance of the pathological observation is discussed in relation to the pathogenesis of bone infection in the foal.


Transmissible drug resistance in Escherichia coli isolated from healthy dogs, cattle, sheep and horses. The antibiotic resistance patterns and the distribution of R-factors among Escherichia coli isolated from apparently healthy dogs, cattle, sheep and horses were studied. It was found that 102 strains (16.48 per cent) of a total of 619 isolates were resistant to one or more drugs. Twenty-six per cent (27 strains) of the resistant strains were capable of transferring either a part or the entire resistance patterns to the sensitive recipient strain. These results indicates that antibiotic resistance and R-factors are not particularly widespread among animals whose diet does not cotain antimicrobial drugs.


[Comparative studies of methods for the detection of immune carriers of the Newcastle disease virus in poultry]. Mass prophylactic vaccinations have radically chaugned the clinical syndrome, pathogenesis, and morphological picture of the Newcastle disease: clinically it is manifested with respiratory troubles, and morphologically--with tracheitis. The method for isolating the virus on chick embryos from immune birds have proved undependable: the higher the immunity of birds, the lower the probability of virus isolation. Following the vaccination of birds after the adopted prophylactic programme and at the three-fold vaccination with a lentogenic La Sota strain and four-fold vaccination with a mesogenic Komarov strain precipitating antibodies have been detected in single serum samples only. In the presence of respiratory troubles in immune birds the rise of antiheamagglutination titers and the mass manifestation of precipitating antibodies in the blood serum is said to be an indication of the presence of a field of velogenic virus, while HI and AGPT are suitable methods for the detection of immune carriers of Newcastle disease. These can be used also for the differential diagnosis of the latent forms of infectious bronchitis, infectious laryngotracheitis, the diphtheroid form of pox, and CRD. In order to restrict and do away with the velogenic field strains of the Newcastle disease virus a suggestion is made to kill all birds that have shown respiratory troubles and positive results in virologic and serologic examinations through HI and AGPT.


[Express methods of determining the biochemical properties of pathogenic microorganisms]. Comparative studies were carried out to evaluate some express methods for determining the biochemical properties of microorganisms. Described are disc methods establishing the production of indol and H2S, the breakdown of urea, and the reduction of nitrates and nitrites, with which the time of investigation is shortened severalfold. The results obtained are clear and well defined, and fully agree with the results obtained by methods described in the Bulgarian State Standards. It is suggested to apply these methods in the wide laboratory practice.


[Enterotoxic form of colibacteriosis in calves]. The enterotoxemic from of calf colibacteriosis was observed on a total of 18 occasions in newborn animals. Clinically, the disease was manifested with diarrhea, depression of the eyes, fast dehydration, the calves tending to go down and lie for a prolonged periods, with high death rates. Some of the diseased calves showed nervous symptoms. Escherichia coli 0126 was isolated from the intestinal content and the mesenterial lymph of the affected calves. It proved virulent for albino mice. Morphologically, there were strongly expressed circulatory disturbances--hyperemia, perivascular edemas, hemorrhages (Fig. 1 and 2) thrombi (Fig. 3 and 5), with a vacuolar and parenchymal dystrophia of the liver, kidneys, and heart.


[Antitumor action of preparation No. 31 in malignant tumors of the ovaries (a clinical cytological study)]. The authors have analysed clinico-cytological findings to estimate the efficacy of the preparation No 31 therapy in 18 primary patients with ascites forms of malignant epithelial tumors of the ovary. This preparation was found to be a highly effective chemotherapeutic agent possessing a marked cytolytic effect on tumor cells. The method of cytological assay of the serous cavities exudates may be utilized to determine the tumor sensitivity to the agent under test at early terms of the treatment, while being correlated with clinical data the former may be used to estimate the effectiveness of the chemotherapy.


[Immediate tasks and the potentials of conducting immunotherapy of malignant neoplasms]. This work sums up the immunological studies performed clinically and delineates the trends of further investigations in active non-specific, specific and passive immunotherapy associated with other methods of the treatment--irradiation, surgery, chemotherapy. There are offered 4 phases of the clinical study on the immunological effect on normalization of the cellular and humoral immunity responses in oncological patients: phase I--selecting of the dosage, phase II--studying of the effectiveness of immunostimulation, phase III--a detailed comparative study of new chemical drugs, phase IV--estimating the effectiveness of different schemes of immunotherapy including the combination treatment of oncological patients.


[Action of a polypeptide epiphyseal extract on cervical cancer]. The authors report the results of experimental and clinical estimation of the effect of polypeptide extract of the epiphysis (epithalamin) on cervical cancer. Injection of epithalamin is shown to improve the cell immunity indices and renders an antitumor action. The experiments on mice with the transplantable squamous cell cancer of the cervix (strain SCC) have indicated a marked antitumor effect of epithalamin and its potentiating effect on cyclophosphan action.


[So-called lymphoepithelioma of the lymphoid pharyngeal ring]. A retrospective analysis of 43 observations of "lymphoepitheliomas" has shown that in 34 cases this diagnosis was referred to low-differentiated cancer with lymphocytic infiltration, and in 9 cases--to reticulosarcomas (an epitheliod variant). The authors suggest some signs as an adjunct for the differential diagnosis between an epithelioid variant of reticulosarcoma and low-differentiated cancer. It is necessary to exclude lymphocytic epithelioma as an onconosollogical unit, since it does not exist as a double-tissue tumor.


[Quantitative determination of the mineral content of bone]. The interest shown in bone mineralometry is explained by the great medical and social importance of osteoporosis and the growing potentialities of the methods for its guantitative determination. The possibilities for visual assessment of the conventional X-ray image of the bone are discussed in the reports as well as X-ray morphometry o. the tubular bones and vertebrae, roentgen and photonabsorption densitometry and computer-tomography. The lack of an available, simple and cheap method for the present is stressed to force the objectivization of the changes in the mineral content of the bones, to be performed by the combined application of X-ray morphometry, fine analysis of bone structure, making use of the mammographic technique and roentgen (photon-absorption resp) densijometry.


[Preparation and characteristics of diploid cell strains from the tissues of a bovine embryo]. Two strains of diploid cells were prepared from the lung (BEL-2) and skin-muscle (SMBE-3) tissues of a bovine embryo. According to the results of morphological and karyological studies, these cultures consisted of fibroblast-like cells retaining diploid chromosome number (60) in the process of long-term cultivation. These cell populations have a limited life span (75-80 passages) and 3 growth phases. The species appurtenance of BEL-2 and SMBE-3 cells was confirmed. The cells were not contaminated with mycoplasma or extraneous viruses, had no tumorigenic activity. The BEL-2 cell culture is most susceptible to measles virus, SMBE-3 culture to vaccinia virus.


[Possibility of using a protein enteral feeding preparation in the overall therapy of peptic ulcer in children]. A protein-rich diet for children with peptic ulcer has been developed. The diet includes a new dietetic product--the proteinic enpit, prepared by the Institute of Nutrition of the AMS of the USSR. The effect of the diet in children with peptic ulcer at the time of exacerbation of the process was subjected to a complex study. This ration is shown to have a beneficial influence on basic symptoms of the affection, on the condition of the protein metabolism and reduces the period of the ulcerous defect cicatrization.


[Treatment of duodenal ulcer with Tagamet (cimetidine)]. The results from the treatment of 25 patients with duodenal ulcer with 1 g tagamet daily (3x200 mg after meal and 400 mg in the evening before going to bed) in the course of 20 days, are reported. The subjective complaints of the patients disappeared in 87--100 per cent (in 2/3 of the patients even in the first three days after the initiation of the treatment) and the ulcer in 44 per cent. The immediate results obtained are statistically more significant as compared with the control group (only on diet), but the differences are not significant as regards the groups treated only with oxyferoscorbon and only with Caved-S. Tagamet treatment leads to a decrease of the basic indices of gastric secretion and does not change the content of N-acetylneuroamine acid in the gastric juice. The venous administration of tagamet inhibits the gastric acid production stimulated by pentagastrin. Tagamet treatment does not change the biochemical laboratory indices, the inflammatory and structural changes in the gastric-duodenal mucosa and induces no adverse effects and complications.


[Morphological and immunofluorescent studies of the leukocytes in blood smears in hepatitis A and B and chronic liver diseases]. Morphological examination of leukocytes in blood smears from patients with viral hepatitis A and B revealed up to 34% of atypical lymphocytes (AL) in the form of cells of irregular shape with the wide basophilic cytoplasm. Their number reached maximum by the 9th--14th day of the disease and decreased to 8% by 40--50 days. The number of AL was significantly higher during the high activity of the process both in acute and chronic forms of viral hepatitis A and B. In normal subjects as well as in patients with chronic hepatitis of alcoholic etiology the amount of AL did not exceed 6%. Immunofluorescent studies with gammaglobulin from convalescents after viral hepatitis A demonstrated fluorescence of the leukocyte cytoplasm in 86.3% of blood smears from patients with viral hepatitis both early in the disease and at 14--20 days in infectious hepatitis A (in controls no more than 6%). Fluorescence was demonstrated in 70.1% of cases in examinations of blood smears from patients with chronic liver diseases of viral etiology.


[Immunofluorescence method of study of biosynthesis of human interferon]. The method of fluorescent antibody (MFA) has first been used for the study of regularities of human interferon biosynthesis in superinduced cells. The dynamics of the appearance and accumulation of interferon in individual cells and the dependence of these processes upon the time elapsing since the termination of superinduction were determined. Clear-cut inverse relationship between the interferon content in cells (MFA) and the interferon content in the culture fluid (titrations of biological activity) was established.


[Use of peroxidase and FITC labeled antibodies for express-diagnosis of influenza]. The evaluation of influenza antigen detection was done in comparative experiments on the same material during an epidemic of influenza due to A2/Victoria (H3N2) influenza virus. Cells of the nasal mucosa from 65 patients were tested at the same intervals by two methods showing no difference in the principle of the reaction: peroxidase-labeled (IP) and FITC-labeled (IF) antibody. By the latter method influenza could be diagnosed in 36% of cases, by IP in 38%, by the combination of the two in 56%. There is sufficient evidence of the specificity of IP method. This method of influenza antigen detection is as sensitive as IF (47 and 44%, respectively), however, with IP the evaluation of the results is much easier.


[Course and intensive treatment of acute falciparum malaria (author's transl)]. The case of a nineteen-year-old women with the cerebral form of malaria tropica is reported. She showed hyperpyrexia, abdominal manifestations, haemolysis and disseminated intravascular coagulation. Cerebral symptoms amounting to grade IV encephalopathy occurred. The patient responded rapidly to the administration of chloroquine, anticonvulsants, dextran, corticosteroids, antipyretics, blood and antithrombin III and her symptoms had almost completely vanished one week after the onset of therapy.


[Therapy of duodenal and prepyloric ulcers with cimetidine (author's transl)]. In a double-blind randomized trial 91 patients with endoscopically confirmed duodenal and/or prepyloric ulcers received either 1000 mg cimetidine daily (44 patients) or placebo (47 patients) for 4 weeks. At 2 weeks complete ulcer healing was significantly increased in patients receiving cimetidine (45%) in comparison with those treated with placebo (15%) (p less than 0.01). At 4 weeks 73% of the patients on cimetidine and 32% of those on placebo showed complete healing (p less than 0.001). Ulcer size decreased more rapidly with cimetidine than placebo (p less than 0.05). With respect to the number of pain-free days and nights cimetidine was significantly superior to placebo during the days of the second week only (p less than 0.05). Cimetidine patients consumed significantly less antacids than those receiving placebo (p less than 0.01). There was no significant correlations between ulcer healing and freedom from pain at the end of either cimetidine or placebo treatment in this study. No specific side effects referable to cimetidine were observed.


[The effect of antibiotic prophylaxis in vaginal obstetric procedures (author's transl)]. 202 cases of vaginal obstetric procedures (forceps and vacuum extraction, breech delivery and manual removal) were reviewed with regard to assessing the value of prophylactic administration of antibiotics. Criteria for the evaluation were fever post partum, duration of stay in hospital and involution of the uterus. The results showed that the prophylactic administration of antibiotics had no significant effect on these parameters, with or without the simultaneous administration of oxytocics. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in vaginal obstetric procedures. Scrupulous aseptic precautions during all vaginal or intrauterine procedures are considered essential for the prevention of infection.


[System of host specificity and the DNA methylases of shigellae and their phages]. In Shigella sonnei cells there is a host DNA specificity system responsible for modification and restriction of DDII phage. DNA methylase from Shigella stutzeri cells is specific for adenine and catalyses the appearance of 6-'-methylaminopurine in the acceptory DNA. Methylases from Shigella sonnei cells are specific for adenine and cytosine and provide for the presence of 6'-methylaminopurine and 5'-methylcytosine in DNA. The modifying activity of these cells may be equally likely associated with both the enzymes. A simplified version of the additional methylation test has been developed for the study of enzyme specificity. The results of additional and cross methylation suggest that several adenine methylases are present in the cells of these Shigella, one of these enzymes being shared by Shigella stutzeri and Shigella sonnei. The DNA's isolated from Shigella sonnei and Shigella stutzeri cells are undermethylated and in vitro undergo additional methylation upon incubation with the appropriate enzyme.


[Therapy of traumatic brain edema with spironolactone (author's transl)]. In 30 patients with severe brain injury a double-blind study was performed. The effectiveness of the aldosterone-antagonist Aldactone pro injectione was examined in therapy of traumatic brain edema. The results indicate elimination of sodium and water from brain cells and white matter. Concomitantly faster improvement of state of consciousness was observed.


Infectious complications associated with renal transplantation: an analysis of risk factors. To assess the multiple risk factors reported to be associated with onset of serious bacterial, fungal, viral, and protozoal infections in renal allograft recipients, a retrospective study of all renal transplantations performed at Yale-New Haven Medical Center from the inception of the transplantation program in December, 1967, to December, 1975, was undertaken. Ninety-six renal allograft transplants in 85 patients were available for evaluation during this study period. Renal allograft recipients were evaluated for incidence of infection from time of transplantation until transplant nephrectomy, death, or January 1, 1976. All infections were characterized by type of infection, organism, site, and time of onset post-transplantation. Recipients with infections were also evaluated for their donor type, living-related or cadaveric, age at time of transplantation, granulocytopenia, corticosteroid therapy, and rejection episodes. There were 215 infections, 92 of which were defined as serious, in 78 of the 96 renal allograft recipients. Eighteen renal allograft recipients had no infections. Granulocytopenia, but not rejection, correlated with serious infections at some time in the patient's course. However, no significant temporal relationship between serious infections and episodes of granulocytopenia or rejection could be established. Mortality rate and incidence of serious infection was higher in the group receiving high dose corticosteroid therapy compared with the group receiving lower doses of corticosteroids. The mortality rate in these 85 transplant recipients was 33%. Seventy-four percent of these deaths were directly related to infection (24% of 85 patients).


Induced abortion as a risk factor for perinatal complications: a review. Past and continuing studies of the influence of a prior induced abortion on subsequent perinatal complications are reviewed. Many definitive conclusions are precluded because of design problems in the extant studies and these methodological issues, therefore, form the focus for the current review. The available studies do suggest that abortion by vacuum aspiration is not a risk factor for complications of subsequent pregnancies, labor, delivery, or of newborns. Abortion by dilatation and curettage, however, may increase the risk of subsequent spontaneous abortion, low birth weight, and prematurity but these findings need to be confirmed. The impact of other abortion techniques or perinatal complications has not been studied. The more common design problems in the extant literature include: (1) failure to control for confounding maternal factors; (2) problems in reliability of reporting previous abortion; and (3) nonspecific measurement of abortion techniques. Since approximately three-quarters of all abortions performed annually in the United States are on young never-married women who may eventually wish to bear children, further rigorous research to define the risks of induced abortion is urgently required.


[Pharmacology of fibrinolytics].

[Pharmacology of fibrinolytics]. The pharmacological basis for clinical uses of the fibrinolytic agents streptokinase and urokinase is summarizing described. Since streptokinase is still the drug of choice in fibrinolytic therapy of thromboembolic disorders, its chemistry, mode of action, pharmacokinetics, toxicity, and side-effects are reported in detail.


A thematic approach to the history of physiology. This paper is a brief report of an undergraduate course in the history of physiology. A specific area, the development of the concepts of the cardiovascular system, was examined chronologically through primary readings and laboratory exercises. As an unusual approach to a frequently ignored but important subject, it may be of interest to those concerned with teaching the history of science.


Fever theory in the seventeenth century: building toward a comprehensive physiology. Physicians in the seventeenth century developed several theories to explain the causes and cures of fever. These theories relied heavily upon the most important physiological discovery of the period, the circulation of blood throughout the human body. In addition, physicians, increasingly emphasized careful observation of their patients' symptoms, in order to develop empirically effective methods of treatment.


[Pharmacology of heparin].

[Pharmacology of heparin]. After introductory notes on the history of heparin research the chemistry of this mucopolysaccharide is described. It is shown that the chemistry of heparin cannot be exactly described by one chemical formula because heparin represents a family of compounds with different chain-length. Molecular features responsible for the high structural specificity of anticoagulant activity are described. The present status of knowledge on the mechanism of the anticoagulant action of heparin is described in detail. It is shown that basic mechanism is the acceleration of the interaction of antithrombin III with the clotting factors IXa, Xa, XIa, XIIa, and thrombin which are known to be serine proteases. The effects of heparin of platelet function, lipid composition of blood, and on fibrinolysis reflect its complex influence on hemostasis. After a description of side effects and toxicity clinically relevant data on its pharmacocinetics are given.


The case of the casual chirurgeon: John Browne. In 1687 a woman whose leg had been badly injured brought action in the Mayor's Court of London against her surgeon, contesting his bill because her treatment had been neglected.


[Acute hypoxia and internal intensive medicine. III. Differentiated respiration]. In the third information concerning the topic "acute hypoxia and internal intensive medicine" the fundamentals of differentiated respiration are described. Current generators with constant and variable flow are best suited to remove the combined disturbances of the inhomogeneous lung or their results. In the Medivent-series a choice of types of respiratory apparatuses is at disposal by means of which a large part of respiratory disturbances may be commanded. A comprehensive possibility of the modification of the characteristics of respiration by an adjustibility of the sizes of respiration which are independent upon another is to be demanded. The PEEP is a valuable enlargement of the characteristics of respiration. Its effects are to be controlled in reaction to the circulation. In the centre of the information is the immediate practical approach in indication, choice of the parameters, adaptation of the patient to respiration and withdrawal.


[Role of life style and nutrition in the etiology, prevention and therapy of coronary disease with special reference to lipid metabolism]. Issuing from the epidemiological situation of the angiocardiopathies the importance of the factors of risk for the coronary heart disease are emphasized with special consideration of the disturbances of lipometabolism. Essential constituent in the reduction of the factors of risk, particularly obesity, hyperlipoproteinaemia and hypertension, is the change of the habits of nutrition. An increased supply of manifold unsaturated fatty acids, an adequate to the disturbances of lipometabolism type-specific restriction of the cholesterol and carbohydrate intake and a reduction of the saline supply are to be recommended. The importance of measures in the field of health education which should begin already at school age is emphasized.


Fibrinogen or its derivatives in the Kurloff cells. We have investigated the occurrence of fibrinogen or its derivatives in the Kurloff bodies of female guinea pigs by means of immunofluorescence, histochemistry and ultrastructural analysis. The Kurloff bodies are fluorescent after incubation with anti-guinea pig fibrinogen immuno-globulins coupled with fluorescein isothiocyanate. PTAH, Martius scarlet blue, Masson 44--41, Picro-Mallory V stain the Kurloff bodies just as they stain fibrin and fibrinoid. However, the ultrastructure of the central mass of the Kurloff body is finely granular without fibrils. Thus the Kurloff body contains no fibrin but incompletely polymerized fibrinogen derivatives or breakdown products of fibrin.


Some aspects of fermentation of Rhizobium leguminosarum with reference to economy of ingredients in the substrate. Incremental feeding of nutrients was found to be beneficial in mass cultivation of R. leguminosarum. Similarly, semi-continuous fermentation of R. leguminosarum up to 4 days was also found to be useful in maintaining the viable number of cells.


Fermentative production of fodder yeasts. Fermentative production of fodder yeasts are achieved by different microorganisms of yeast. Influence of some biochemical factors on the formation of fodder yeast are examined. The raw ingredients and by-products which are used in the fermentative formation of fodder yeast are also reviewed.


[Plate osteosynthesis using the support principle]. In the operative treatment of fractures there are special principles for plating by support. Osteosynthesis is indicated for comminnuted fractures and bone defects in the metaphysis. Plating for distance also is established for fractures and pseudarthroses with defects in the diaphysis. This method is especially recommended for fractures of the head of the tibia and for reconstructing the pilon tibial.


[Soft tissue injuries in compound fractures (author's transl)]. Problems in the management of soft tissue injuries in compound fractures are presented. They usually originate from the initial traumatic force, but may be the result of pitfalls of the primary treatment as well. The management of open fractures--as it is performed in this clinic--is presented in detail. After primary stabilization of the fracture attention is directed to the associated soft tissue injuries, which require utmost care in the further course of treatment. Primary wound closure should never be forcefully obtained, since closure under tension will result in severe secondary tissue damage. In our experience temporary open wound treatment and delayed closure is the method of choice in the initial management of open fractures. For temporary cover we successfully use the synthetic skin substitute Epigard. Since we adopted this policy, the rate of infection declined drastically, and anaerobic infections as well as generalized sepsis could be totally avoided.


[Allogeneic osteoplasty following tumour resection (author's transl)]. Replacement by allogeneic cold-preserved bone following resection of bone-tumours is a successful method. The substitution of the allogeneic bone is delayed. Extensive allogeneic osteoplasties should be performed in consideration of the donor-recipient-selection principle.


[Sperma- and HLA-antibody demonstration in sterility]. Sperma antibodies were detected by means of passive haemagglutination, the immobilisation test and immunofluorescence in the serum of 16 females from among 150 infertile married couples. These serums (experimental group) and 16 serum samples containing no sperma antibodies (control group) were investigated for the presence of cytotoxic HLA-antibodies against lymphocytes from their married partners and from 20 selected donors by means of the micro-lymphocyte toxicity test. HLA-antibodies against the lymphocytes of the husbands involved were found in four women from the experimental group. Two of these four serums also reacted with 20% of the test lymphocytes. In the control group, lymphocyte-toxic antibodies against test subjects were also found in all three serums which cross-reacted with the lymphocytes of the husbands. No new diagnostic or therapeutic criteria for the treatment of sterility can be derived from the combined humoral sperma and cytotoxic HLA-antibodies in the serum.


[Theoretical and clinical aspects of the penetration test]. An overlook is given about the theory of penetrating tests. The assay of tests depends from some biological factors concerning sperms, spermplasma and the cervix mucus itself. The penetrating tests are important in functional disorders in the area of cervixsperm. In negative results hormonal defects and immunological factors have to be considered.


Encapsulation by transformation of strains of Staphylococcus aureus determined by the serum-soft agar technique. Transformation for capsular-types (A and B) between four Staphylococcus aureus strains was attempted using a serum-soft agar technique to distinguish the capsular-type. DNA preparations from the Smith diffuse strain (capsular-type A) transformed strain NS58C (unencapsulated variant of capsular-type B) to type A. The strain NS58C required Ala- and His-, however, the two transformants tested were Ala+ and His+. These properties coincided with those of the donor strain just as the following characters of the transformants, which are quite different from the untransformed recipient cells: i) negative clumping factor reaction, ii) diffuse-type growth in serum-soft agar, and iii) high mouse virulence. The change to capsular-type A was antigenically comfirmed by electronmicroscopy using ferritin conjugated anti-capsular antibody.


[Phage typing of rough E. coli strains isolated from urine (author's transl)]. A differentiation of E. coli rough strains is generally not well established in bacteriological urine diagnosis although these strains are relatively often isolated from urine samples of patients with urinary tract infections (see table 2). An exact characterization of rough strains seems to be necessary especially for the distinction between recurrent and reinfection during therapy and follow-up studies. The application of phage typing for characterization of E. coli rough strains isolated from urine is reported in the following paper, using a set of 13 phages (A-M) introduced by Marsik and Parisi (8). Out of 284 E. coli rough strains 166 (58.4 per cent) were found to be typable. Altogether 56 different phage patterns were observed. The most common phage patterns are presented in table 1. It is evident that GHK is the most frequent pattern occurring in 7 per cent of the strains investigated. The next most common patterns are M and BCDEIJLM (4.9 and 3.5 per cent, respectively). These, together with AM (3.2 per cent) and F (3.2 per cent) account for 21.8 per cent of all the rough strains tested. From the results it is concluded that phage typing may be a valuable tool for differentiation of E. coli rough strains.


[Experimental studies to culture bacteria from blood specimen with an addition of ampicillin in various nutrient media (author's transl)]. Ampicillin-sensitive or -resistant Staphylococcus aureus and Klebsiella strains were cultured in various nutrient media as prototypes of the agents of sepsis isolated in bacteriological routine analysis. In each case, 2 ml of defibrinated human blood containing 100 and 1000 cells, 8 gamma and 80 gamma ampicillin/1 ml blood respectively were added to 50 ml of nutrient medium. The following media were used. 1. casein soya-bean meal peptone broth (Oxoid), 2. tryptose-phosphate medium (Oxoid), 3. dextrose broth (Oxoid), 4. brain-heart-dextrose medium (Oxoid), 5. brain-heart infusion, autoclaved (Difco), 6. brain-heart infusion, after sterile filtration (Difco), 7. vacutainer culture bottles (BD) prepared medium, 8. micrognost blood culture bottles (Biotest) prepared medium. While the sensitive staphylococcus strain exhibited a slower growth than the sensitive Klebsiella strain in all nutrient media, the growth rate of the two resistant variants was approximately the same for an initial count of 100 cells per ml of blood. Among the resistant staphylococci the higher initial count of the inoculum resulted in an improved growth. After addition of 8 gamma or 80 gamma ampicillin/1 ml blood the sensitive staphylococcus strain did not show any grwoth irrespective of the inoculated number of cells while the sensitive Klebsiella strain multiplied irrespective of the initial number of cells. After 24 hours the resistant staphylococci and Klebsiella strains of which 1000 cells each had been used for inoculation exhibited growth in almost all media used.


[The biochemical activity of the aflatoxins (author's transl)]. Results of experiments with the Salmonella typhimurium-liver microsome technique make it evident that the mutagenic and carcinogenic metabolite of aflatoxin B1 is aflatoxin B1-2,3-oxide. This compound forms adducts with guanine in DNA. There is a close relationship between the mutagenic activity and the hepatocarcinogenic property of the different aflatoxin derivatives.


[Investigations on the antimicrobial activity of amine-aldehyde-condensates. 6. Communication: azomethines of substituted benzaldehydes (author's transl)]. In the scope of our research about the antimicrobial activity of amin-aldehydecondensates a number of substituted benzaldehyde azomethines was synthesized by condensation of suitable benzaldehydes with primary amines (aminoethanol and n-butylamine). Structures and physical constants are shown in the table 1. The antimicrobial activity is demonstrated by the results of the disk-test (table 2 and 3), of the minimal inhibition concentration test (MIC, table 4) and of the suspension-disinfecting test following the method of the DGHM (table 5). It may be shown that both the germistatic and the germicidal activity depends on the substituents of the aromatic ring. Bactericidal activity show the test compounds mainly versus the gram-negative bacteria.


[Cellular immunity factors in dysentery]. Cellular immune response was studied in 89 adult patients suffering from various clinical forms of acute dysentery, with the use of the lymphocyte blast-cell transformation reaction under the action of a specific antigen (dysenterin) and a nonspecific mitogen (phitohemagglutinin). Functional value of T-lymphocytes proved to be retained in patients with acute dysentery; there was also lymphocyte stimulation by a specific antigen in patients with moderately severe and severe forms of dysentery during the first week of the disease. Specificity of blast-cell transformation of sensitized lymphocytes under the action of dysenterin was shown. Patients with a high percentage of the lymphocyte blast forms displayed a more rapid positive progress of the main clinical indices at the height of the disease than analogous patients with a low blast percentage in the blood. The expediency of using the blast-cell transformation reaction for differential diagnosis and prognosis of moderately severe and severe forms of acute dysentery is discussed.


[Immunological reactions in the secretions of volunteers vaccinated against influenza by aerosol and intranasally]. Aerosol and intranasal methods of influenza vaccination were studied on volunteers. Aerosol vaccination induced intensive S-IgA-producing reaction and increase of the specific antibody titres in the saliva and nasal secretions. Intranasal vaccination led to increase of influenza antibodies in the washings from the nasopharynx. The presence of a wide spectrum of antiviral and antibacterial normal secretory antibodies was revealed in the fluids under study. Along with stimulation of specific secretory antibodies, the methods of influenza vaccination under study led to increase of the titre of antibodies nonspecific of the vaccine used.


[Electron microscopic study of experimental infection. II. A study of the dynamics of Shigella infection]. The dynamics of experimental Shigella infection of chick embryo fibroblasts was studied with the use of electron microscopy. The antibiotic-resistant forms of Sh. sonnei 1,188 was found to be incapable of invasion into the fibroblast cytoplasm and intracellular proliferation. The destruction of fibroblasts observed during the infection was seemingly caused by the action of bacterial endotoxins.


[Interrelationships between the virulence and the presence of M-protein in hemolytic streptococcus group A]. Experiments on mice demonstrated that of hemolytic streptococci A M types 2, 3, 12, 22, 46, and 49 characteristic is the absence of parallelism between their virulence for mice and the presence of M+-colonies in the microbial population. There was also a greater virulence for mice of M-variants. The established changes in serological properties of the cultures passaged in vitro were brought to the acquisition of polyagglutinability by the passage cultures, and to the loss of type-specific protection by the immune sera against these cultures. A possibility of acquisition by passage cultures of a factor determining their high virulence for mice, nonidentical to M-protein, is discussed.


[Properties of the R plasmids of Sh. flexneri strains isolated in Bulgaria]. The study of 3,237 Sh. flexneri strains isolated in Bulgaria revealed that 50.72% of them were resistant to antibiotics. 95.88% of the antibiotic-resistant strains were found to have R factor of incompatibility groups F, I or N. The plasmids of incompatibility group F had the property fin+, and the plasmids of groups I and N had the property fin-. R plasmids were divided into 4 groups by their ability for phage restriction.


[Detection of receptors for the IgG Fc fragment as well as for the C3 component of complement in the spleen T-lymphocytes of CBA mice]. The presence of receptors to the Fc fragment of IgG and to the C3 component in the complement of T lymphocytes in the spleen of CBA mice was studied. The study was made by the method based on Coons's indirect immunofluorescence test with the use of antithymocytic globulin, in combination with EA and EAC rossette-formation. A significant percentage of T lymphocytes was found to have the receptor to the Fc fragment of IgG, while only a small part of T lymphocytes was found to have the receptor to the C3 component of the complement.


[Determination of the localization of the kcpA gene on the chromosome of E. coli O124. I. Use of the type F' plasmids of varying length]. The loss of virulence was observed in some of the transconjugates of E. coli O124 in the process of the transfer of the plasmids differing in length: F' 200 PS, F'x 573 and F'x 363, carrying the genes of the chromosome area lac--pur E. The genetic determinants contributing to the ability of E. coli O124 to produce keratoconjunctivitis seem to be localized near the lactose marker, and not near E as in Sh. flexneri. In E. coli O124 these genetic determinants are probably localized on both sides of the lactose operon.


[Comparative evaluation of different globulin preparations and of the means for blood sensitization in obtaining antibody erythrocytic diagnostica]. In comparing the hemosensitizing activity of various immunoglobulin preparations with different methods of erythrocyte loading the greatest activity and specificity was revealed in IgG isolated by means of DEAE-Sephadex A-50. The method of erythrocyte sensitization with the use of alizarin blue indicator was more advantageous in respect to sensitivity and specificity of Sh. sonnei and Newcastle indication over Boyden's, Jandl and Simmons', Bing's methods.


[Frozen and thawed bacteria as recipients of isolated phages and plasmid DNA]. Bacteria subjected to freezing and thawing are effective recipients of phage 1 phi 7 DNA, lambda DNA, and plasmid pMB9 DNA. The effectiveness of transfection and plasmid transformation of frozen and thawed bacteria is determined by the joint action of 3 factors: 1) the conditions of freezing and thawing of a recipient and DNA mixture with freezing carried out at a rate of 400 degrees C/min to--76 degrees C or--196 degrees C and with subsequent thawing at 42 degrees C; 2) a transitory character of recipient competence preservation in respect of phage and plasmid DNA; 3) the degree of recipient cryolability depending, in particular, on the genotype of the recipient. The maximum indices of transfection effectiveness and plasmid transformation have been obtained with bacterial concentration equal to 1--5 X 10(9) cells/ml, phage and plasmid DNA concentration equal to 0.05--0.5 mcg/ml in the reaction mixture containing 0.5--1% of Spofa bactopeptone, PH 7.4--7.6.


Biosynthesis of somatostatin in pancreatic islets of Wistar rats. Pancreatic islets of Wistar rats were isolated by collagenase digestion and incubated with [3H]-L-phenylalanine. Using a specific somatostatin antiserum radioactivity was found in the antibody-antigen-complex. The radioactivity was displaced by unlabelled somatostatin. These findings give the first evidence for the biosynthesis of somatostatin or somatostatin-like peptides in mammalian pancreatic islets.


Preparation and characterization of insulin of carp (Cyprinus carpio). Insulin of carp (Cyprinus carpio) was isolated and crystallized. The insulin was biologically active in two tests; it decreased the blood glucose level and stimulated 14CO2-formation from glucose. The chemical properties are similar to those of insulins from other species. The insulins of carp and of mammals differ greatly immunologically. Antibodies against carp insulin crossreact with carp proinsulin.


[Studies on the recognition of specific sensitization to tumor antigens by measuring passive electrical additive effects as against the electrophoretic mobility test]. Lymphocytes from cancer patients were incubated with different tumor antigens. In the medium in which the lymphocytes were suspended, passive electrical values could be measured in the Mc region. These values correlate with a specific sensibilization of tumor carriers. By comparison with the electrophoresis-mobility test (em-test) we found in 66 out of 74 supernatants, using CEA and KCl-extracts as antigens, a good conformity of the two reaction patterns.


Isolation of ribosomes from Escherichia coli by chromatography on methyl-albumin-kieselgel. The present communication shows that ribosomes isolated by differential centrifugation retain their composition and biological activity during subsequent methyl-albumin-kieselgel (MAK)-chromatography. The data obtained were used to develop a novel chromatographic procedure for the isolation of ribosomes from E. coli lysates. It could be demonstrated that purified preparations of active ribosomes can be obtained by MAK-chromatography avoiding ultracentrifugation.


[Effect of the chemical surface structure of functionalized polystyrene on the kinetic properties of immobilized yeast pyruvate decarboxylase]. The influence of the loading density of different functional groups and the length of suitable spacer structures on the kinetic properties of yeast pyruvate decarboxylase are investigated on identical polystyrene matrices. At constant concentrations of the fixed protein both the specific activity and the storage stability of the immobilized enzymes increase with increasing concentrations of the protein binding (C = O)-groups. pH-Optimum and K'M-value prove to be functions of the NH3+-content of the supports. Using four spacer resins with an equal content of spacer groups it could be shown that the optimum time of coupling as well as the maximum catalytical activity, storage stability and thermostability depend on the length of the spacer structures. On the other hand, the mobility of an ESR-marker fixed via the same spacers to the resin is not affected by the different spacer structures.


[Laboratory experiments with a polyvalent extract vaccine for oral immunization against E. coli enteritis]. Bacteria of E. coli causing enteritis can be extracted by EDTA-sodium. These extracts having lower dry weights result in better protective effects in contrast to sodium-deoxycholate extracts. The EDTA-sodium extracts can be concentrated, purified and sterile filtrated. Thus the production of polyvalent vaccines is possible. A direct relation exists between the effectiveness of the extracts and the virulence of the strains used for extraction. The more virulent the original strain the better is the protective effect of the vaccine produced by extraction of the original strain. The single components of the polyvalent vaccine show a certain improvement of their protective effects. For estimating the immunizing dose, it is necessary to consider the limiting dose. When exceeding this dose the protective effect or the vaccine does not further increase but remains constant of even decreases. The immunizing dose wanted must be greater than the ED50 but smaller than the limiting dose. Extremely high oral doses of vaccine result in symptoms of incompatibility in mice.


Prophylaxis of postoperative thromboembolic complications with low-dose heparin. An analysis of different administration intervals. The literature on low-dose heparin thrombosis prophylaxis has been reviewed to evaluate differences in effect and bleeding complications between heparin administered at twelve- and eight-hour intervals. The more frequent administration gives a slightly greater reduction of the overall frequency of thrombosis but is not more effective in reducing extensive thrombi or fatal pulmonary emboli. Moreover, it causes more haemorrage, which is why it is concluded that the twelve-hourly interval must be recommended.


[Surgical treatment of decubitus ulcer in paraplegics. Experience with 70 reconstructive procedures (author's transl)]. Based upon our own experience with 70 surgical procedures for 49 primary decubitus ulcers, 17 complications and 7 recurrences in 31 paraplegics, and upon the techniques described in the literature, the different reconstructive methods and their advantages and disadvantages are discussed and illustrated with representative cases. The surgical reconstruction of decubitus ulcers requires a thorough planning and an atraumatic surgical technique. Nevertheless complications are not seldom and recurrences are possible.


Studies on the frequency and associations of islet-cell antibodies in juvenile diabetes mellitus. Ninety-six juvenile onset type diabetics showed an increase in the frequency of HLA B8 and B15 and a decrease in frequency of HLA B7 antigens. Sixty-four maturity onset diabetics showed no disturbance in the frequency of these antigens. Fifty-four of the juvenile onset type diabetics, with an average duration of disease of 3.2 years were tested for the presence of islet cell antibodies (ICAs). Thirty-two percent were positive, the frequency decreasing from 70% in those patients tested within one year of diagnosis to 0.5% in those patients tested more than 5 years after diagnosis. No correlation was found between HLA type and the frequency of ICAs, but there was an increase in other autoantibodies in B15 positive patients. Preliminary absorption studies suggest a cross reactivity of ICAs and Coxsackie B4 virus.


In vitro conversion of proinsulin to insulin by cathepsin B and role of C-peptide. Cathepsin B, purified from isolated islets of Langerhans, when incubated with proinsulin under in vitro conditions could convert proinsulin to insulin and C-peptide, releasing free arginine and lysine. When C-peptide, prepared from rat pancreas, was added to the incubation system consisting of proinsulin and cathepsin B, it completely inhibited the conversion of proinsulin to insulin.


The effect of fenfluramine on obese, maturity-onset diabetic patients. In 38 obese maturity-onset diabetic patients the effect of fenfluramine therapy on carbohydrate tolerance was compared to placebo therapy in a double blind trial. Fenfluramine therapy did not affect weight loss, or fasting glucose levels but produced a slight but significant improvement in glucose tolerance. This improvement was not correlated with any change in body weight or insulin secretion.


Calcium and pancreatic beta-cell function. 5. Mobilisation of a glucose-stimulated pool of intracellular 45Ca by metabolic inhibitors and the ionophore A-23187. Glucose is believed to stimulate incorporation of calcium into the secretory granules of the pancreatic beta-cells. The mechanism of the glucose-stimulated accumulation of calcium in the granule pool was evaluated by measuring fluxes of 45Ca in beta-cell-rich pancreatic islets microdissected from ob/ob-mice. The incorporation of lanthanum-nondisplaceable 45Ca in response to phosphate in being suppressed by 10 micrometer antimycin A, 0.3 mM 2,4-dinitrophenol or 1 mM N-ethylmaleimide. Exposure to each of these metabolic inhibitors also resulted in a protracted efflux of the glucose-sensitive 45Ca under conditions when neither the 45Ca incorporated in the presence of 3 mM glucose nor in response to phosphate was significantly affected. The glucose-stimulated intracellular 45Ca existed in a state allowing it to be washed out with the ionophore A-23187. The results suggest that the glucose-stimulated incorporation of calcium into the secretory granules is mediated by transport against a concentration gradient into the granule sac.


Inhibition by kynurenine metabolites of proinsulin synthesis in isolated pancreatic islets. The effect of kynurenine metabolites on insulin biosynthesis was investigated in isolated pancreatic islets of the rat. Both quinaldic acid and 8-hydroxyquinaldic acid were found to produce significant inhibition of the proinsulin synthesis. However, the conversion process of proinsulin to insulin in the islet was not affected by these kynurenine metabolites. Furthermore, the inhibitory effect of these end-metabolites of dynurenine was characterized by preferential inhibition of proinsulin synthesis as distinct from non-insulin protein synthesis in the islet. In contrast to the significant inhibitory effect of quinaldic acid and 8-hydroxyquinaldic acid on proinsulin synthesis, xanthurenic acid and kynurenic acid were far less effective, and L-tryptophan, L-kynurenine, 3-hydroxyanthranilic acid and quinolinic acid showed little ability to inhibit proinsulin synthesis in islets.


Functional modifications of endocrine pancreas after internal biliary fistula (experimental research). The function of the B-insular system has been explored in dogs total internal biliary fistula (cholecysto-jejunostomy after closure of the common bile duct), an operation which causes an increase in number and total volume of pancreatic islets. Two groups of 10 animals each were either submitted to operation or used as controls. The endocrine function of the pancreas was explored 45-60 cays after surgery by assessing basal blood glucose and serum insulin. IVGTT and i.v. tolbutamide test were performed subsequently. The results indicate that in operated animals the ability to release insulin after stimulation is increased and that the control of basal hormone secretion is fully preserved.


Emphysematous pyelonephritis and perinephric gas in a diabetic. A case of emphysematous pyelonephritis with perinephric gas is presented. The patient was an elderly female diabetic and in addition had a subphrenic abscess as a complication of EPPG. Diabetes was not under control and E. coli was the sole pathogen. As the patient did not respond to conservative treatment, nephrectomy and drainage of subphrenic abscess were done and the patient improved rapidly.


Allogeneic transplantation in low-grade malignant bone tumours. A new operative technique to avoid amputation. A massive allografting of deep-frozen cadaver bone or hemi-joint was performed in 11 patients with tumours which were diagnosed as aggressive, low-grade malignancies. One patient died from a pre-existing hepatic insufficiency. The other 10 patients have been followed up from 1 to 8 years. These patients received two bone grafts and eight hemi-joint grafts around the knee joint. The operative procedure consisted of fixation of the graft by stable osteosynthesis, surrounding the graft-host junction with an autogeneic iliac chips cuff and, in cases of hemi-joint grafts, reconstruction of the ligaments. X-ray, scintigraphy and biopsy were used to judge the incorporation of the graft. The patients had to be prepared to face a considerable morbidity with long non-weight-bearing periods and possibly further operations. A full restitution of function was achieved in the bone graft cases. The patients with hemi-joint grafts were also able to retain their limb with a good or satisfactory function. No metastases or recurrences were experienced. The allograft procedure appears to be useful for younger adults, whose long life expectancy makes this operation justifiable, although the fate of cartilage still is unpredictable.


Treatment of chronic osteomyelitis by free grafts of cancellous autologous bone tissue. A preliminary report. Chronic osteomyelitis was treated by free grafts of autologous bone tissue in 13 consecutive patients aged 18 to 81 to years. In all patients the osteomyelitis was located in the leg, and Staphylococcus aureus was the causative organism. Seven had an infected non-union. The duration of the osteomyelitis varied from less than 1 year to 75 years. Surgical debridement and grafting of cancellous and cortical cancellous bone were performed at the one operation. The osteomyelitis healed after a single operation in all patients but one, who needed three operations before the infection was eradicated. In one patient a second bone grafting operation was necessary before weight-bearing could be allowed. Although the number of patients is small, the results agree well with larger series published recently. Grafting of autologous bone tissue seems to be a very valuable method of treatment for chronic osteomyelitis.


Analysis of different variants of erythrocyte survival using digital computers. In the paper a method is presented, enabling parameter estimation of erythrocyte survival patterns, what is an important element in the diagnosis of haemolytic anaemias. The method is based on a computer program, fitting the experimental data to eight variants of theoretical patterns with use of a weighted least squares criterion. A simple statistical test of approximation quality is described and several interpretational examples are given. The program may be easily handled by a physician with small programming experience.


[Granulocyte adherence in advanced Hodgkin's disease and its dependence on antiproliferative drugs used]. In 36 patients with stage III and IV of Hodgkin's disease granulocyte adherence was investigated. The determinations were carried out in minicolumns filled with nylon fibres. In 13 patients the determinations were repeated 2, 4, 6, 12 and 24 hours after administration of vinblastine and cyclophosphamide. In all patients granulocyte adherence was reduced, by 54.1 +/- 3.5% on the average. The values of adherence in the control group were of the order of 83.7 +/- +/- 4.7%. Administration of antiproliferative drugs reduced further the adherence. The lowest value of it was observed 6 hours after vinblastine and cyclophosphamide administration. After that time the adherence increased gradually reaching the initial level 24 hours after administration of antiproliferative agents. These results suggest that reduced adherence of granulocytes may be an additional cause, besides abnormal immunological reactions, of the impairment of the resistance mechanisms of the organism in advanced stages of Hodgkin's disease.


[Analysis of anamnestic data in patients with acute leukemia]. The authors report a trial of a comprehensive study of a correlations between various data obtained during history taking and the development of leukaemia in children. On the basis of epidemiological cards data were analysed concerning 200 children with acute leukaemia, including 108 boys and 92 girls. The control group comprised 217 healthy children. The method of classification of independent characteristics was used for the analysis of discernibility of children in these two groups. Continuous (or quantitative) characteristics were regarded as normally distributed, and discrete ones were defined by the frequencies found. As a result of computer processing of data 181 out of 200 patients (90.5%) and 204 controls (94.0%) were classified accurately. The mean error of classification was 7.75%.


Lymph follicular cholecystitis.

Lymph follicular cholecystitis. Ten cases of cholecystitis with severe lymphocytic reactions were selected among serially examined 131 cases of cholecystitis or/and cholelithiasis. Gram-negative bacterial infection, especially E. coli and K. pneumonia seemed to be related as the cause of these severe lymphocytic reactions, but the gallstone revealed no definite influence. We would like to separate the cases with severe lymphocytic reactions as a lymph follicular cholecystitis and consider the possibility of a gram-negative bacterial infection in bile.


Pseudomonas cepacia bacteraemia due to intrinsic contamination of an anaesthetic. Bacteriological and serological observations. In November-December 1977 an epidemic of bacteraemia due to P. cepacia was observed in Odense, Denmark (nine patients), and in Nijmegen, Holland (seven patients). All patients recovered. The epidemic was traced to intrinsic contamination of two batches of the anaesthetic fentanyl. All isolates from the patients and from the two batches belonged to the same biotype, had identical sensitivity patterns, and identical antigens. The P. cepacia strain differed from stock strains in being able to grow in two passages in methyl-p-hydroxi-benzoate, 0.5 mg/ml, which promoted the growth of the microorganism: inocula of 2-20 cfu were sufficient to initiate growth in the drug or preservative. These facts indicate the inadvisability of using p-hydroxi-benzoates as preservatives in vials. The strain was inhibited at temperatures above 38.5 degrees C, corresponding to the recovery of the patients after a period with fever above 39 degrees C. Fourteen out of 15 patients examined had agglutinin titres greater than or equal to 320, while 36 blood donors had titres less than 40. Of 12 patients with postoperative fever in the same period whose blood cultures did not yield P. cepacia, three had titres greater than 320.


Electron microscopy and immunoperoxidase staining of Streptococcus mutans during controlled growth in two different media. Streptococcus mutans subspecies sobrinus serotype d (B13) was cultivated in a fermentor under controlled conditions in two different media: a complex proteose-peptone medium and a defined minimal medium (C4). Specimens from different growth phases were examined by electron-microscopy and tested electron-immunohistochemically. Irrespective of the growth medium used, no differences were observed in the immunohistochemical staining pattern of bacteria during the lag, the exponential and the early staionary phases. Specimens obtained several hours after exponential growth contained areas where the bacteria showed staining that ranged from  a strong deposit of reaction product to no deposit. This appearance seems partly to explain the differences in the intensity of immunohistochemical staining of certain bacteria observed in dental plaques stained for identification of S. mutans subspecies sorbrinus.


Diagnosis of Salmonella bacteria: antibodies against synthetic Salmonella O-antigen 8 for immunofluorescence and co-agglutination using sensitized protein A-containing staphylococci. An antiserum against the synthetic disaccharide abequose 1 leads to 3 alpha rhamnose (AR), representative of Salmonella O-antigen 8, coupled to bovine serum albumin (BSA) was used for diagnosis of Salmonella bacteria by indirect immunofluorescence (IFL) and by co-agglutination (COA) using sensitized protein A-containing staphylococci. Among the 1150 enteric bacteria tested in IFL, the antiserum correctly identified all 99 Salmonella serogroup C2 and C3 bacteria with O-antigen 8. No fluorescence was seen with 484 Salmonella bacteria belonging to other serogroups or 567 non-Salmonella enteric bacteria. The anti-AR-BSA serum was favourable as compared to a conventional Salmonella factor O8 serum as regards both titre and specificity. In the COA test, all 22 Salmonella serogroup C2 and C3 strains agglutinated strongly and within seconds, whereas no agglutination could be seen when 93 Salmonella bacteria representing other serogroups were tested.


Incidence and titres of smooth-muscle antibodies in human sera. By means of the indirect immunofluorescence method smooth-muscle antibodies (SMA) were determined in 182 patients with various diseases and the findings were compared with those of 7 patients with chronic active hepatitis (CAH) and 580 normal controls. IgG-SMA were found in 85.7% of the patients with CAH, titres above 80 occurred only in Hepatitis B-associated antigen (HBAg)-negative CAH, but IgG-SMA in low titres were also found with increased incidence in syphilis (16.7%) and in infections of the central nervous system (19%). In other diseases (Sjøgren's syndrome, ulcerative colitis, regional enteritis, myasthenia gravis, progressive muscular dystrophy, atopic dermatitis and mycoplasma pneumoniae infection) the prevalence did not differ from that of controls (3.6%). IgM-SMA were found more often in CAH (28.6%), in infections of the central nervous system (14.3%) and in the mycoplasma pneumoniae infections (13%) than in controls (2.6%), but titres above 20 occurred only in controls. IgA-SMA were detected only in a patient with syphilis. Demonstration of IgG-SMA titres above 80 seems to support the diagnosis of HBAg-negative CAH, while the demonstration of IgA- and IgM-SMA seems to be without diagnostic value in chronic hepatitis.


Effect of mycoplasmas on phagocytosis and immunocompetence in rats. The purpose of this study was to evaluate some possible mechanisms by which mycoplasmas may facilitate a subsequent bacterial infection. The effector of M. arthritidis, M. hominis and U. urealyticum on lymphocyte reactivity to mitogens, subsequent antibody response, and the ability of neutrophils to carry out phagocytosis was investigated. In vitro, large doses of M. arthritidis and M. hominis depressed the reactivity of lymphocytes and the phagocytic ability of neutrophils. In vivo, inoculation of myoplasmas had no effect on reactivity of lymphocytes from rats, and antibody response to subsequently injected E. coli was normal. However, peritoneal neutrophils from rats injected intraperitoneally with large doses of M. arthritidis and M. Hominis were invalidated in their ability to cause phagocytosis of E. Coli. U. urealyticum had no observable effect on lymphocytes and neutrophils in vitro and in vivo.


Complement receptors in human peripheral nerve tissue. Cryostat sections of human peripheral nerve tissue adsorbed sheep erythrocytes sensitized with antibody and human complement (EAC). Activated complement was essential for the reaction to occur. The receptor had specificity for the C3b fragment. In order to obrain binding to nerve tissue, the indicator cells had to be coated with more complement than that required for binding to C3b receptors in spleen and renal tissue. The receptors are located within the nerve fascicles and are probably of glycoprotein nature. The receptors for C3b in peripheral nerve tissus may be of significance in the deposition of immune complexes, which may play a role in acute polyradiculoneuritis.


Interaction of the Fc part of IgG with Lancefield extracts of hemolytic streptococci. Strain specificity and activity. Lancefield extracts of 19 types of group A streptococci as well as one group C and one group G strain were examined for agglutination of human red cells coated with various anti-Rh antibodies. Fourteen extracts agglutinated one or more of the coated cell samples, while five did not. The agglutination was inhibited by Fc but not by Fab fragments of human IgG. After mouse passages, three of the non-agglutinating strains acquired agglutinating capacity. At least three different reactivities were distinguished by the action of the extracts on IgG1 and IgG3 coated cells, respectively. Two of the streptococcal extracts, agglutinating the same anti-Rh coated cells, could be further differentiated in hemagglutination inhibition (HAI) experiments using purified IgG3 myeloma proteins. Five selected agglutinating systems were inhibited by purified myeloma proteins of the IgG1, IgG2, and IgG4 subclasses. IgG3 proteins inhibited only two of the five HAI systems.


Barbital and diazepam plasma levels during treatment of delirium tremens. Plasma concentrations of barbital and diazepam were measured daily during a double-blind study of the efficacy of the two drugs in the treatment of delirium tremens and less severe clinical states. Treatment was estimated as satisfactory in the majority of cases; the present study deals with the satisfactory groups only. Both in the barbital group and in the diazepam group the same plasma level was seen in different clinical states. This result is discussed in relation to the theories about the aetiology of delirium tremens, and it is concluded that the data fits best with the assumption that delirium tremens is released from a withdrawal state, but once established, the delirious state is not interrupted by the drugs. The barbital concentrations were rather high, many at a level where non-alcoholics would show pronounced intoxication symptoms not seen in the present material. The diazepam concentrations on the other hand were low, often below a level where a cerebral effect is measurable in normal subjects. On this basis it is concluded, that the two drugs have different modes of action. Barbital may act by its cross-dependence properties with alcohol and thus diminish the withdrawal reaction, whereas diazepam may act by its anti-anxiety effect, but not in the doses here applied, by cross-dependence properties with alcohol. Finally, this hypothesis is discussed in relation to clinical experience in the treatment of delirium tremens.


Single versus divided daily dosages of clomipramine. Plasma concentration and clinical effect. Sixteen depressed patients have been treated with a daily dose of 150 mg clomipramine for 20 days. Every patient received the total dose at night for 10 days and three times daily for 10 days according to a double-blind, cross-over design. No differences were noted between the two dose regimens, either regarding the clinical effect or the side effects. The plasma level ratio of parent drug to demethylated metabolite was higher on single than multiple doses.


Computer aided diagnosis of bone tumors. Four radiologists, three of whom having no special expertise in bone tumor radiology, analysed 177 bone tumors. One of the radiologists, using a computer aided bone tumor program, performed significantly better than the other two at a comparable level of training and was able to compete successfully with the fourth radiologist experienced in bone diagnosis. The results validate the assumption that computer aided diagnostic programs may improve the diagnostic accuracy of radiologists having limited experience with the problem at hand.


Maintenance of potassium balance during diuretic therapy. The relative efficacies of potassium chloride, amiloride, triamterene and spironolactone in maintaining potassium balance were studied in 40 patients with essential hypertension receiving diuretic therapy. The preparations were administered in random order in a cross-over manner. In 31 patients treated with 50 mg hydrochlorothiazide daily, addition of 1500 mg potassium chloride daily was the weakest and 50 mg spironolactone daily the most effective agent for maintaining serum potassium. Amiloride (5 mg daily) and triamterene (75 mg daily) were less effective and equally so. Similar results were obtained with 9 patients treated with double dosages of the diuretic and supplements. Despite changes in serum potassium, total body potassium remained constant throughout the trial.


Hemodynamic and hormonal changes induced by noise. Eighteen healthy male volunteers with normal hearing were exposed to industrial noise at different sound levels (75, 85 and 95 dB A) in a noise laboratory. Blood pressure, heart rate, stroke volume and cardiac output were recorded with noninvasive techniques. Adrenaline and noradrenaline concentration in venous plasma were analyzed before and during noise exposure. The mean resting blood pressure of the whole group was 120/70 mm Hg. During noise stimulation diastolic blood pressure increased (12.2%, p less than 0.001) as did mean arterial pressure (6.6%, p less than 0.001) and total peripheral resistance (12.7%, p less than 0.001). Stroke volume (7.3%, p less than 0.001) and cardiac output (5.0%, p less than 0.01) were both reduced at 95 dB A. Heart rate and systolic blood pressure did not change significantly. At 75 and 85 dB A there were similar but smaller changes in the hemodynamic parameters. There were no changes in adrenaline and noradrenaline in plasma during maximal noise exposure. The noise induced hemodynamic changes remained 5 minutes after the noise stimulation was stopped but had disappeared after 10 minutes of rest.


An exploration of adolescent feminine and occupational behavior development. Women in the United States have become more involved in the dual roles of homemaker and worker. This article traces briefly the development of the feminine role and occupational choice through a review of the literature; and stresses the need for occupational therapists who work with adolescents to be aware of such development. Three theoretical approaches to sex-role development are explored, and developmental aspects of occupational choice are examined. An assessment tool is included, and may be used to help identify areas of developmental lag and thereby aid in treatment planning.


Influence of development on the number of calcitonin-containing cells in the mouse thyroid. Calcitonin-containing cells in serial, 6-micrometer sections of the thyroid glands of Swiss Webster mice, at 1 day, 2 weeks, 4 weeks and 8 weeks of age, were demonstrated by an immunoperoxidase method, using antiserum to human calcitonin. C-cell nuclei were counted in every sixth section of both left and right lobes. The average number of C-cells counted in the thyroid glands of 8-week-old animals was 18-fold, 5.5-fold and 2.5-fold greater than the number observed in 1-day, 2-week and 4-week-old animals, respectively. C-cell concentration was found to be greatest in 4-week-old mice. Mitoses of C-cells were observed in animals which were 1 day, 2 weeks and four weeks old. No mitotic figures were seen in 8-week-old animals. A few C-cells were seen in close association with neurons. The volume of the thyroid glands of 8-week-old animals was about 14-, 4- and 3-fold greater than the volume in the 1-day-old, 2-week-old and 4-week-old mice, respectively. These changes in the C-cell population during development provide a model for the study of C-cell proliferation and storage of calcitonin.


Failure of oral L-histidine to influence appetite or affect zinc metabolism in man: a double-blind study. L-Histidine, 4 g/day in gelatin capsules, was administered orally to eight normal volunteers for 2 weeks in a double-blind, balanced, crossover study with 2 weeks of placebo treatment. Body weight, serum and urinary zinc and histidine concentrations, as well as subjective ratings of appetite, taste and smell perception, and food intake were monitored. L-Histidine therapy had no significant effect on appetite, taste and smell perception, food intake, or body weight. Similarly, no effects were observed on total serum zinc, albumin-bound zinc or alpha 2-macroglobulin-bound zinc concentrations, or on urinary histidine excretion. Serum histidine concentrations increased with therapy. Urinary zinc excretion was increased significantly after 1 week, but not after 2 weeks of L-histidine therapy. It can be concluded that oral L-histidine, at the dose used, has no value as an anorectic agent.


Dientamoeba fragilis. An intestinal pathogen in children? A retrospective study was conducted of 35 children in whom Dientamoeba fragilis was the only parasite found in the gastrointestinal (GI) tract. Gastrointestinal symptoms were present in 32 (91%) of these children; diarrhea was the most common finding in patients with acute symptoms, whereas abdominal pain was more common in children with chronic symptoms. Peripheral eosinophilia was present in half of the children examined and was statistically more significant in patients with D fragilis than in a control group of children admitted for elective surgery. Therapy with diiodohydroxyquin or metronidazole was effective; children's symptoms were diminished or were eliminated on follow-up evaluation after treatment. From this association between therapy and symptomatic relief, D fragilis should be considered pathogenic in those children with GI symptoms.


Reiter's disease in children.

Reiter's disease in children. Three Canadian Indian boys, aged 2, 14, and 15 years, with features of Reiter's disease (RD) had arthritis occur that was characterized by noticeable tenderness and large effusions. The two youngest also had conjunctivitis and urethritis and thus conformed to the classical triad of RD. The eldest had dysuria and a history suggesting keratoderma blennorrhagica. All had HLA-B27 antigen. Inclusions indicative of chlamydial infection were seen in assays from the two youngest boys. Previously documented cases of childhood RD have been reviewed. More flexible diagnostic criteria may be useful in identifying this class of seronegative arthritis in children.


Perirectal abscess in childhood. A review of 29 cases. A total of 29 cases of perirectal abscess at Milwaukee Children's Hospital between 1965 and 1975 were retrospectively reviewed. One fourth of these children had a serious underlying chronic disease. Staphylococcus aureaus was the organism that grew most frequently from pus obtained from the abscesses, accounting for 52% of the isolates. Therapy included incision and drainage alone and incision and drainage plus parenteral and/or oral antibiotic treatment. One patient, a child with leukemia, died of this infection. Complications, primarily fistulain-ano or recurrent abscess, occurred in 42% of the survivors.


Effect of gastrin on the exocrine pancreas. A review. Studies in animals demonstrate a gastric hormonal phase of pancreatic exocrine secretion. Endogenous or exogenous gastrin causes a marked elevation in the pancreatic enzymes and a lesser increase in the pancreatic volume and bicarbonate. It is possible that these "gastrin" effects may be the basis of a "cephalic" phase of pancreatic secretion. These observations have been only partially confirmed in human subjects with and without the Zollinger-Ellison syndrome. The physiologic importance of these ecbolic actions as well as a possible trophic effect remains to be elucidated.


BCG treatment of Crohn's disease.

BCG treatment of Crohn's disease. Among 53 patients with documented Crohn's disease, 30% manifested a defect in delayed hypersensitivity demonstrated by negative DNCB skin tests and significant (p less than 0.01) T-lymphocyte hyporeactivity. A double-blind controlled trial was conducted to evaluate oral Bacillus Calmette-Guerin (BCG) therapy in nine of these patients with Crohn's disease and deficient cellular immunity. All patients had a Crohn's Disease Activity Index (CDAI) greater than 150 (at least moderate activity) upon randomization to BCG (five patients) or placebo (four patients) treatment for six to 12 months. No significicant differences between BCG and placebo treatment were found in the CDAI, laboratory tests and gastrointestinal roentgenograms. We conclude that the disturbance in cell-mediated immunity in patients with Crohn's disease probably is a manifestation of the disease rather than an etiological factor and that immunostimulation with oral BCG is not effective therapy.


Sampling considerations in the gathering and analysis of pedigree data. A general expression for the likelihood of a set of phenotypic observations on a randomly sampled pedigree, suitable for a wide variety of genetic models, has been previously modified to allow for independent ascertainments via probands. In this paper, further allowance is made for the fact that a pedigree usually contains some individuals who, whatever their phentoype, could never be probands, and we derive the limiting form of the likelihood appropriate for single ascertainment. The case when the sampling frame is ill-defined is discussed, and suggestions made for how to proceed in such a case.


Donald E. Francke Medal lecture. The transition from apothecary to pharmacist in British hospitals. The transition from hospital apothecaries to contemporary hospital pharmacists in Great Britain is reviewed, beginning with the monk-apothecaries associated with the monastic infirmaries as early as the 12th century. Briefly reviewed is the use of the title Apothecary, from about the mid-1500s to about the mid-1800s, at three Royal Hospitals--St. Thomas's Hospital, St. Bartholomew's Hospital and the Bethlehem Hospital. The responsibilities, pharmaceutical and otherwise, of persons who held this title over the years are discussed. Pharmaceutical duties were eventually entrusted to the dispenser (or, at St. Thomas's, the pharmaceutist) and then to the pharmacist. The history of hospital apothecaries is also traced at the voluntary hospitals, University College Hospital, and hospitals in Scotland, Wales and the British provinces. British hospital apothecaries changed from a pharmaceutical orientation to a medical orientation, but they retained control of hospital pharmacies for about 50 years after this change was sanctioned legally.


Reference aids for developing policies and procedures for intravenous admixture services. A table of literature citations designed to help hospital pharmacists develop a policy and procedure manual for i.v. admixture services is presented. The table is categorized according to literature that will aid in developing policies and procedures for specific aspects of admixutre services (e.g., distribution procedures, quality assurance). The citations were selected from two periodicals (American Journal of Hospital Pharmacy and Drug Intelligence & Clinical Pharmacy) and three other publications.


Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens. One hundred forty nosocomial Serratia marcescens infections (including 76 cases of bacteremia) were identified by prospective surveillance from 1975 through 1977 and retrospective chart review from 1968 through 1974. Thirty-four cases (24 per cent) involved gentamicin-resistant strains. All gentamicin-resistant strains appeared after 1974. Ninety per cent of the patients had undergone surgery, and 88 per cent had received prior antimicrobial therapy. The emergence of gentamicin-resistant S. marcescens paralleled the increase in usage of gentamicin. Prior use of gentamicin for more than two days in an individual patient was a significant risk factor (P = 0.0002) for being infected with a Serratia that was gentamicin-resistant. Other factors which separated gentamicin-resistant Serratia infections from gentamicin-sensitive Serratia infections were (1) urinary site of infection (P = 0.0005), (2) urinary catheter (P = 0.002), (3) endotracheal tube or tracheotomy (P = 0.03) and (4) increasing duration of hospitalization (P less than 0.05). Thirty-three of 34 (97 per cent) patients with gentamicin-resistant strains had urinary catheters. Specific measures to control infection were effective in decreasing the incidence of infections caused by gentamicin-resistant Serratia.


Lead poisoning from a gunshot wound. Report of a case and review of the literature. A man was hospitalized on three occasions for symptoms of lead intoxication 20 to 25 years after a gunshot wound that resulted in retention of a lead bullet in his hip joint. The potential for lead toxicity as a complication of a lead missile injury appears to be related to (1) the surface area of lead exposed for dissolution, (2) the location of the lead projectile, and (3) the length of time during which body tissues are exposed to absorbable lead. Cases of lead poisoning of immediate onset resulting from lead shot have been reported in Europe, but all documented cases of ammunition-related plumbism reported in the United States have involved synovial fluid dissolution of a single lead bullet over many years. The solvent characteristics of synovial fluid and associated local arthritis are apparently important factors in the dissolution and absorption of lead from projectiles located in joints. Awareness that lead intoxication can be a complication of retained lead projectiles should allow rapid institution of appropriate diagnostic and therapeutic modalities when such a clinical situation arises.


Amyloid deposition in a renal allograft in a case of amyloidosis secondary to rheumatoid arthritis. A case of amyloidosis secondary to rheumatoid arthritis is presented in which renal transplantation was performed. Five years after transplantation the patient died following an episode of acute pancreatitis. During the intervening period the rheumatoid arthritis was considered quiescent, but his course was marked by several infectious processes caused by unusual organisms. The allograft function remained normal. Apart from renal amyloid the autopsy showed extensive generalized amyloidosis, most marked in vessel walls and endocrine organs. Amyloid deposits were located exclusively in the vessel walls of the transplanted kidney.


Identification of the high-risk asthmatic patient. Experience with 39 patients undergoing ventilation for status asthmaticus. Thirty-nine asthmatic patients required mechanical ventilation (IPPV) for status asthamticus over a seven and a half year period. We reviewed their clinical records with particular emphasis on the events leading to intermittent positive pressure ventilation (IPPV) and the long-term courses of those patients who survived IPPV. Long delays by patients before seeking medical attention, incomplete assessment of acute attacks, underuse of corticosteroids prior to admission and overuse of sedation were important factors often influencing the necessity for IPPV. Four patients died during IPPV. Of the 35 who survived, 32 were regularly followed in our Respiratory Clinic. Nine patients subsequently died, eight undoubtedly from asthma. Serial measurements of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were retrospectively analyzed to determine patterns of asthma. Of the 23 patients still alive, 14 have well controlled asthma, five have a pattern of persistent airflow obstruction, two have markedly labile asthma, and two have gradually deteriorating airflow obstruction. By contrast, seven patients who died sufficiently long after IPPV to enable categorization of their patterns showed either markedly labile asthma or gradually deteriorating airflow obstruction. None had relatively constant ventilatory function at either normal or suboptimal levels. We suggest that patterns of asthma are useful guides in detecting patients at high-risk. Patterns characterized by markedly labile asthma or gradually deteriorating airflow obstruction appear to be associated with an increased risk of sudden death from asthma.


Randomized trial of empiric antibiotic therapy with ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer. A randomized trial of ticarcillin plus gentamicin (group 1), ticarcillin plus amikacin (group 2) and ticarcillin plus netilmicin (group 3) as empiric antibiotic therapy in patients with granulocytopenia and cancer was carried out at the Baltimore Cancer Research Center. The response rate for all infections was 97 per cent in group 1, 91 per cent in group 2 and 95 per cent in group 3. Patients with bacteremias showed improvement in 93 per cent (group 1), 78 per cent (group 2) and 82 per cent (group 3) of cases. All failures were among patients with gram-negative bacteremias. Both antibiotic susceptibility of the bacteremic organism and granulocyte recovery correlated with patient improvement. Nephrotoxicity and ototoxicity were rare and were not significantly different in three groups of patients. Therefore, ticarcillin plus gentamicin, ticarcillin plus amikacin and ticarcillin plus netilmicin appear to be equally efficacious and minimally toxic in this patient population. Excellent over-all results can be expected with these combinations provided the etiologic agent is susceptible.


Immunodiagnosis in ovarian cancer: blocking factor activity. Tumor immunology studies have been utilized for development of a blocking factor assay for therapy monitoring in ovarian cancer. The blocking factor index was defined as the arithmetic difference between assays conducted in the presence and absence of the patient's serum compared to incubations with normal control lymphocytes. Eighteen advanced ovarian epithelial malignancies have shown blocking factor activity during treatment. Blocking factor has abated in eight patients whose clinical disease completely regressed. Chemotherapy was discontinued after 18 to 24 months. In 10 patients, blocking factor persisted and chemotherapy has been continued. Some of these patients showed decreasing blocking factor; others have shown increases, which led to death due to disseminated disease in four cases. Blocking factor activity was found to correlate with tumor growth.


Transfer of bacterial infections by donor cornea in penetrating keratoplasty. A 45-year-old man died of Hogdkin's disease complicated by peritonitis and possible septicemia. His corneas were used for transplant in a 26-year-old man with advanced keratoconus and a 42-year-old man with vascularized central leukoma of old herpetic keratitis. Both recipients developed a fulminating endophthalmitis with Pseudomonas aeruginosa. We believe that the donor corneas, although clinically normal, were heavily infected, with signs of inflammation possibly suppressed by the Hodgkin's disease.


Lack of blood group antigen A on human corneal endothelium. Using direct immunofluorescence and mixed agglutination, we did not find blood group antigen A on human corneal endothelium from patients of blood type A or AB. The antigen was easily detected on the epithelium of these patients. We believe that the ABO blood group antigens are probably absent on human corneal endothelium, therefore they cannot play a direct role in specific corneal endothelial rejection.


Clinical comparison of dipivalyl epinephrine and epinephrine in the treatment of glaucoma. Dipivalyl epinephrine, 0.1%, though slightly less effective in decreasing intraocular pressure, showed significantly fewer side effects than epinephrine hydrochloride, 2%. Seventeen patients with symmetrically increased intraocular pressures who completed a six-month double-masked crossover study showed a significant decrease in intraocular pressure averaging 23.7% for dipivalyl epinephrine over the entire study and 27.4% for epinephrine. In the first treatment period, dipivalyl epinephrine was slightly less effective than epinephrine. In the second treatment period, dipivalyl epinephrine was statistically less effective than epinephrine. Two of the original 25 patients were dropped from the study because of epinephrine allergy or intolerance, one had uncontrolled pressures with either drug, and five failed to maintain adequate follow-up. Complaints of side effects such as burning and irritation occurred much more frequently in eyes receiving epinephrine (24%) than dipivalyl epinephrine (3%). Mild mydriasis occurred with each drug, averaging +0.65 mm with dipivalyl epinephrine and +0.55 mm Hg with epinephrine. No effect on blood pressure or pulse rate was found for the two drugs.


Possible foreign body granuloma of the retina associated with intravenous cocaine addiction. A 27-year-old man who was a heroin addict had light flashes in front of the right eye and a hemicentral scotoma immediately after intravenous cocaine. The initial ophthalmoscopic appearance was of a white foreign body lying over the papillomacular bundle of the retina in the right eye. This ophthalmoscopic finding was consistent with intraocular talc, cornstarch, or lactose, common diluting agents that are present in intravenous injections of heroin, cocaine, or methylphenidate hydrochloride, and are known to cause systemic embolic phenomena in chronic drug abusers. This glistening crystal on the surface of the retina changed and evolved into a noninfectious but inflammatory organization of retinal granuloma, in which the foreign body crystal could still be visualized at the apex of the lesion. The anterior and posterior segments of the eye remained free of inflammatory signs throughout the course of the organization of the retinal granuloma.


The visual status of diabetic patients after renal transplantation. To determine the effect of renal transplantation on visual status, we studied 134 eyes of 67 diabetic patients prospectively for one to seven years, with a mean of three years, after surgery. The best-corrected visual acuity and retinopathy status were determined at the time of surgery and annually thereafter. Useful visual acuity (greater than or equal to 6/15 [20/5o]) was present in 49% (66) of the eyes at the time of the baseline examination and in 51% (69) at the final determination. Of the 134 eyes 40% (54) were legally blind (less than or equal to 6/60 [20/200]) before surgery. Sixty-eight percent (91) of the eyes showed no significant visual change during the period of follow-up, 15% (20) showed significant improvement, and 17% (23) deteriorated significantly after surgery. With regard to the retinovitreous findings, 13% (12) of the eyes had non-proliferative retinopathy, 20% (26 had active proliferative retinopathy, and 67% (90) had inactive or involutional retinopathy. The results of this study showed stable or improved visual function in 83% (111) of the eyes after renal transplantation. Transplantation before dialysis becomes necessary may ben an important consideration in an attempt to reduce the high incidence of visual impairment in diabetic patients with renal failure.


Creutzfeldt-Jakob disease and optic atrophy. A 49-year-old man developed ataxia, myoclonic jerks, cortical blindness, and dementia. In 3 1/2 months, he rapidly deteriorated and died. Clinical and autopsy diagnosis confirmed Creutzfeldt-Jakob disease. The eyes were examined and bilateral optic atrophy was noted. No other ocular changes were noted. Optic atrophy had not been noted before death.


An adjustable transposition procedure for abduction deficiences. We used an adjustable transposition procedure in two cases of horizontal abduction deficiency (one of lateral rectus palsy and one of Duane syndrome with marked co-contraction). Primary position balanced alignment and maximum balanced rotations were obtained without inducing vertical deviation as the result of the transposition. The vertical force vectors were neutralized by the self-adjusting nature of the vertical rectus union. The procedure allowed for both intraoperative and postoperative adjustment of the result.


Split-level full-thickness eyelid graft. A new method of surgical treatment for cicatricial eyelid retraction involves grafts placed in both the anterior and posterior lamellae of the upper eyelid, when there is a shortage of tissue in both layers, caused by previous surgical procedures. The anterior lamellar graft is of postauricular skin and the posterior graft is of buccal mucosa. The two grafts are placed at different levels in the eyelid so that each has a viable vascular bed. The procedure, called the split-level full-thickness eyelid graft, is not designed to correct problems involving only the eyelid retractors, such as retraction secondary to thyroid disease.


Pedicle skin flap to prevent corneal perforation. A pedicle skin flap from the lower eyelid was passed through the lower eyelid into the lower fornix and sutured over the cornea in a 36-year-old man with impending perforation caused by lye burns. Perforation was avoided but occurred in the control eye.


Regulation of the immune response to tumor antigen. Reduction of syngeneic tumor growth in primary tumor-bearing murine hosts has been accomplished using a variety of treatments designed to decrease endogenous suppressor cell activity or augment host effector responses. Selective interference with suppressor cell function can be achieved by in vivo administration of anti-thymocyte serums at critical times during the early stages of tumor development or by continuous treatment with antiserums directed to interact with I-J determinants on suppressor cells or suppressor factors. This later mode of therapy also results in a delay in tumor appearance when suboptimal doses of tumor are given. Preferential diminution of suppressor cell precursor activity has also been observed by pretreatment of tumor recipients with low doses of cyclophosphamide. Normal animals so treated are capable of adoptively transferring primarily helper-type activity to tumor-bearing recipients. Decreased tumor growth and prolonged host survival have also been achieved using BCG as a means of augmenting host effector potential. Thus, it is possible to inhibit tumor development in a murine model by modes of immunotherapy which may be relevant to the early treatment of certain human neoplasms.


Kinetics of prostaglandin production in various inflammatory lesions, measured in draining lymph. Efferent lymph was collected over long periods via catheters surgically placed in popliteal and prefemoral lymph nodes of sheep. Prostaglandin (PG) E and F equivalents were measured with a radioimmunoassay. After stimulation with heat-killed Escherichia coli, PG levels rose dramatically in the efferent lymph but were undetectable in the contralateral control lymphatics or in the systemic circulation. When E coli were infused directly into a lymph node, the PG levels in the effluent lymph were inhibited with indomethacin. Carrageenan, delayed hypersensitivity, and lymphocyte transfer reactions were also studied. In the classic acute inflammations (caused by E coli and carrageenan) the PG levels rose early in the response (first 4 to 6 hours) compared with delayed production in the immune reactions. With PPD, PG levels peaked between 10 and 20 hours after injections, while PG rose 127 hours after allogeneic lymphocytes were injected. These results are discussed in relation to the role of PG in inflammation, and the use of the sheep lymphatic model in PG research is emphasized.


Effect of synthetic C-terminal fragments of hGH on glucose oxidation by isolated islets. The effect of polypeptides containing the human growth hormone sequence 177--191 on the glucose metabolism of isolated islets of Langerhans has been investigated. It has been found that such peptides accelerate the incorporation of hydrogen at carbon atom 5 into water while accelerating the flux (1-14C oxidation) through the pentose phosphate shunt and inhibiting the oxidation of [6-14C]glucose. The latter inhibition was found not to be due to inhibition of the pyruvate dehydrogenase complex, and it was further found that the previously demonstrated potentiation of glucose-induced insulin release by the peptides was independent of energy provision because none of the glyceraldehyde, pyruvate, or leucine could substitute for glucose. In view of the fact that the insulinogogue effect of this peptide is to potentiate the glucose stimulatory effect on islets, these phenomena may well be unrelated.


Sensory functions of the liver--a review. In this paper we critically review anatomic, electrophysiological, physiological, and behavioral evidence for neural receptors in the liver. Several lines of evidence suggest that the afferent innervation of the liver may be substantial, although few anatomic studies have directly addressed the question of an hepatic sensory supply. On the other hand, there is convincing functional evidence for a variety of hepatic sensory receptors. Hepatic osmo-, ion, and baroreceptors, sensitive to changes in the osmolarity and electrolyte concentrations in blood and to variations in portal venous pressure, modulate diuresis and natriuresis. Metabolic receptors, for which the adequate stimuli have not yet been specified, influence feeding behavior and gastric acid secretion in response to alterations in hepatic metabolism associated with changes in the supply of metabolic fuels. Directions for future research are suggested and general conclusions about the role of hepatic receptors in homeostasis are discussed.