Inappropriate coronary vasoconstriction in patients with coronary artery disease: a role for nifedipine? Coronary arterial vasoconstriction, well recognized in Prinzmetal's variant angina, may participate in the pathogenesis of classic angina as well. Several recent studies in patients with obstructive coronary artery disease suggest that apparently spontaneous reductions in coronary blood flow can result in myocardial ischemia and even infarction. Evidence supporting the alpha adrenergic nervous system as a cause of such coronary vasoconstriction is reviewed, particularly the results of provocative testing with the cold pressor stimulus. Upon exposure of the skin to cold, patients with coronary artery disease demonstrate an inappropriate coronary vasoconstrictor response, often sufficient to produce angina. Normal patients, by contrast, show no change in coronary vascular resistance. In patients with a diseases coronary circulation, inappropriate vasoconstriction further restricts myocardial perfusion and appears to be little affected by beta adrenergic blocking agents or nitrates in the usual dosages. Nifedipine has proved effective in preventing coronary arterial spasm in patients with Prinzmetal's angina. Studies currently in progress suggest that it is also effective in blocking inappropriate coronary vasoconstriction in patients with typical angina. Nifedipine may thus be a useful addition to the treatment of ischemic heart disease.


Coronary pressor reflexes.

Coronary pressor reflexes. The heart differs from other cardiovascular reflexogenic structures because it has two prominent inputs to the central nervous system. On input is spinal and is mediated by afferent cardiac sympathetic nerve fibers. The other is medullary and is mediated by afferent vagal fibers. The number of fibers projecting centrally appears to be similar in the two systems. The reflex effects produced by excitation of the two inputs are complicated and can be either pressor or depressor. However, reflex pressor effects seem to be more prominant for the spinal input and reflex depressor effects more prominent for the medullary input.


Positive feedback sympathetic reflexes and hypertension. A pressor reflex that can be elicited from the thoracic aorta in conscious dogs is described. Distension of the aorta excites sympathetic afferent fibers and results in an increase in arterial blood pressure because of increased sympathetic outflow to the heart and blood vessels. The reflex center for this positive feedback mechanism is located in the spinal cord and, when the reflex is activated, it can modulate other negative feedback control systems.


Cardiac receptors: normal and disturbed function. Widely distributed throughout the heart is a network of fibers connected to the medullary cardiovascular centers by nonmedullated vagal afferent fibers. When the traffic in these fibers is interrupted by vagal cooling, and the input from the arterial baroreceptors is prevented, the arterial blood pressure increases. Thus, these receptors act to inhibit tonically the vasomotor center. The receptors in the atria alter their rate of discharge with changes in atrial transmural pressure and contractility and are most active during end-inspiration and early expiration when the transmural pressure is maximal. The receptors in the ventricles respond to changes in ventricular end-diastolic pressure (preload), to the pressure generated during systole (afterload) and to changes in ventricular contractility. The cardiac mechanoreceptors have an equal or greater effect on the renal bed than the arterial mechanoreceptors and this effect is enhanced by hypercapnia. In animals, the cardiac mechanoreceptors have less control of the muscle vessels than the arterial mechanoreceptors, but the reverse is true in man. Both the cardiac and arterial mechanoreceptors can modulate the output of renin from the kidney, but the cardiac mechanoreceptors are more sensitive to small changes in blood volume. During coronary occlusion, in association with the bulging of the ischemic myocardium, the rate of discharge of these cardiac receptors is greatly increased.


Cardiac reflexes in normotensive and spontaneously hypertensive rats. Characteristics of left atrial receptors were studied in normotensive control (Wistar) and spontenaously hypertensive rats. The left atrial pressure was chronically elevated in spontaneously hypertensive rats and at the end of the expiratory phase was 10.3 mm Hg as compared with 4.6 mm Hg in normotensive control rats. The thresholds of the receptor endings were twice as high in the hypertensive as in the normotensive rats (10.2 and 4.6 mm Hg, respectively). In other experiments the reflex inhibition of renal sympathetic outflow was studied during plasma infusion in baroreceptor denervated normotensive and hypertensive rats was was inhibited at a lower left atrial pressure in the former. These differences are attirubted to decreased distensibility of the left atrium in spotaneously hypertensive rats. The reflex splanchnic nerve inhibition with volume load also was recorded in awake rats. At a 10 percent increase in blood volume, splanchnic outflow was more significantly decreased in spotaneously hypertensive than in normotensive rats. The mechanism underlying such a hyperreactive volume receptor response is unknown, but a less distensible venous system, centrally or peripherally, might be a contributing factor.


Overview of cardiovascular reflexes in hypertension. The problem of cardiovascular reflexes in hypertension poses several questions. The first is whether alterations in cardiovascular reflexes can initiate a persistent increase in arterial pressure. Another is whether it is an alteration in depressor or in pressor reflexes that matters in hypertension. Other questions concern the type and nature of the reflex alterations that actually occur in hypertension and the place of resetting of baroreflexes in the sequence of physiologic events leading to increased blood pressure.


The immunologic approach to the pathology of malignant lymphomas. Presentations of malignant lymphomas in the past did not have the benefit of modern developments in immunology and do not bear any relationship to our modern understanding of immunology. The malignant lymphomas in our immunologic approach are regarded as neoplasms of the immune system and involve principally the T- and B-cell systems and alterations in lymphocyte transformation. The cytologic types of our new classification are an attempt to identify specific functional subtypes of the T- and B-cell systems as defective expressions of their normal counterparts. The results of our multiparameter studies on large case series of non-Hodgkin's lymphomas and those of others have demonstrated that the malignant lymphomas for the most part mark as T- or B-cell types, with the exception of a rare lymphoma of true histiocytic type and the unmarked portion of acute lymphocytic leukemia (ALL) of childhood. They have demonstrated the heterogeneity of the cytologic types of the past that possibly account for the diversity of their clinical manifestations and responses to therapy. The immunologic approach has permitted the identification of homogeneous cytologic types that are emerging as clinical morphologic immunologic entities.


Immunologic basis for the redefinition of malignant lymphomas. As neoplasms of the immune system, lymphomas can be characterized by a variety of immunologic technics. These technics, used in conjunction with morphology and cytochemistry, have promoted the development of lymphoma classifications which relate more closely to our current understanding of the anatomy and function of the immune system than earlier classifications. This brief review of the development and function of the immune system and discussion of technics used in distinguishing B and T lymphocytes is intended to provide background and perspective for the other papers presented in this symposium.


Results of multiparameter studies of B-cell lymphomas. As advances in our understanding of the lymphoreticular system are achieved, so becomes the need to adjust our concepts of the corresponding malignant neoplasms. This paper relates the various histologic and clinical types of malignant lymphoma to current knowledge of the morphology and behavior of the lymphocyte. Aspects of normal lymphocyte morphology and function that appear to govern the histologic appearances and behavioral patterns of lymphocyte-derived neoplasms include the radical morphologic and functional changes occurring in the course of lymphocyte transformation, the division of lymphocytes into two or more functioning subgroups, and lymphocyte circulation and homing. Surface marker and immunohistologic studies of B-cell lymphomas provide support for the relationship between various neoplastic types and these aspects of normal lymphocytic function and behavior and for the logical extension of this concept to the interrelationship between these malignant lymphomas.


Results of multiparameter studies of T-cell lymphoid neoplasms. By application of combined structural and functional analyses, most lymphoid neoplasms may be categorized as of T- or B-cell origin. T lymphocyte neoplasms include types of acute and chronic lymphocytic leukemias, certain cutaneous and node-based lymphomas, and lymphomas of thymocytes (convoluted lymphocytic lymphomas). Although much less frequent than B-cell neoplasms, these T-cell neoplasms are important because their recognition has therapeutic and prognostic significance. Relatively specific histopathologic, histochemical, and immunologic criteria have been defined for each neoplasm. These neoplasms are also significant because homogeneous populations of T neoplastic cells have been used successfully in a few cases to study the normal biology of the immune system.


Psychological factors in diabetes mellitus. A review of the literature with emphasis on adolescence. In this thorough review of the literature of the past 100 years concerning psychological factors in diabetes mellitus, interpretation is channeled toward adolescence. In addition, emphasis is given to the major role that emotional components play in the development and maintenance of the brittle teenage diabetic. The integration of adolescent developmental issues of into physician treatment plans is stressed.


Reducing Medicaid expenditures through family responsibility: critique of a recent proposal. The Massachusetts Department of Public Welfare recently proposed a "Family Responsibility Plan" which would impose a financial obligation upon adult children in the state for the nursing-home care of their parents who receive Medicaid. By examining the Massachusetts plan, this Note seeks to evaluate the viability of a concept of family responsibility, under which adult children contribute to the state Medicaid expenses of their medically indigent parents in nursing homes, as a means of combating the increase in state Medicaid expenditures. The Note examines the legal and policy issues raised by the Massachusetts welfare department's plan in particular, and by the concept of family responsibility in general. The author concludes that alternative methods of cost containment, such as positive financial incentives, would be more appropriate mechanisms for reducing state Medicaid expenditures than family--that is, adult child--responsibility plans.


Bretylium tosylate: a review.

Bretylium tosylate: a review. The chemistry, pharmacology, pharmacokinetics, clinical uses, adverse effects, drug interactions and dosage of bretylium tosylate, a recently approved antiarrhythmic agent, are reviewed. Bretylium tosylate is used to treat life-threatening ventricular arrhythmias, principally ventricular fibrillation and ventricular tachycardia, that have not responded to treatment with first-line antiarrhythmic agents. The drug has a direct positive inotropic effect on the myocardium and blocking effect on postganglionic sympathetic nerve transmission. The drug is poorly absorbed orally, requiring either i.m. or i.v. administration. Drug excretion occurs primarily through the kidney, necessitating dosage modification in renal disease. Hypotension is the most commonly observed adverse reaction to bretylium tosylate. Rapid i.v. administration may cause severe nausea and vomiting, and i.m. injection at the same site may cause atrophy and necrosis of muscle tissue. Quinidine and procainamide may potentiate the hypotensive effects of bretylium. Bretylium will aggravate digitalis-induced arrhythmias. Bretylium's use in resistant ventricular tachyarrhythmias requires close clinical monitoring.


Comparison of five information services as sources for bioavailability data. The usefulness of five drug information services in obtaining bioavailability data from journal literature is compared. The deHAEN Drugs in Use system, the Iowa Drug Information Service (IDIS), Index Medicus, MEDLINE and International Pharmaceutical Abstracts (IPA), each for a 10-year period, were searched for citations on bioavailability studies on the oral dosage forms of acetaminophen, lithium carbonate, phenytoin, nitrofurantoin and theophylline. Both quantity of references indexed and quality of data were considered. No significant difference was found in the mean value scores for the five services. Index Medicus provided 79 citations but required 7.7 hours of search time. MEDLINE yielded 62 citations but required only 1.1 hours to search. IPA, IDIS and deHaen had lower numbers of citations and intermediate search times. IPA, deHaen and Index Medicus all cited unique articles, with 11%, 7% and 3%, respectively. Index Medicus had the lowest percent of articles duplicated by two or more services (49%). The most comprehensive serch with the fewest duplicate citations would be obtained from searching deHaen's Drugs in Use, IPA and Index Medicus.


Using pharmacokinetics in drug therapy. V: Contributions to developing dosage regimens for antihypertensive drugs. Pharmacokinetic methods that have been used to improve antihypertensive drug therapy, including antihypertensive dosage regimens, are reviewed. Pharmacokinetic variables have been determined that allow: (1) derivation of the loading dose necessary to achieve rapid control of blood pressure with propranolol hydrochloride, guanethidine, minoxidil and clonidine hydrochloride; (2) reduced frequency of dosing with methyldopa, hydralazine hydrochloride, prazosin hydrochloride, propranolol and clonidine; and (3) alteration of propranolol and hydralazine dosage based on physiologic factors (e.g., renal and hepatic impairment, binding to plasma proteins, altered enzyme activity). More rapid control of hypertension is possible, patient compliance is enhanced and drug toxicity is reduced by applying pharmacokinetic principles to develop individualized antihypertensive dosage regimens.


The Kennedy version of the Drug Regulation Reform Act. Provisions of Senator Edward Kennedy's version  of the Drug Regulation Reform Act of 1979 (S.1075) are discussed. Included in the discussions are pre- and postmarketing approval controls on drug products, product equivalency, drug promotion and information, penalties, and the National Center for Drug Sciences. Provisions of the act are compared with the Carter Administration's 1978 (S.2775, H.R.11611 and H.R.12980) and 1979 (S.1045 and H.R. 4258) drug reform bills. The Kennedy bill does not depart radically from the existing drug approval process but would open it to the public and give FDA more flexibility to impose conditions, such as limited distribution and postmarketing surveillance, to product approval. It establishes drug compendia that would meet federal standards but that preferably would be published by the private sector. Hospitals and other health care institutions are exempted from the bill's patients package insert requirements, except as otherwise regulated by FDA.


Low-dose heparin therapy in the long-term management of venous thromboembolism. The efficacy of a six-month course of low-dose heparin therapy was compared to a conventional warfarin regimen by a prospective, controlled trial in 48 patients with pulmonary embolism or deep venous thrombosis of the legs. All subjects had complicated medical illnesses and a high risk of recurrent thromboembolism. Bleeding complications were virtually negligible during heparin therapy and occurred significantly more frequently in patients receiving warfarin. Heparin was as effective as warfarin in the prevention of recurrent thromboembolism. Patient compliance with the two treatment regimens was comparable. Self-administered, low-dose heparin therapy is a useful alternative to warfarin in the long-term management of complicated thromboembolic disorders.


Experience with 1,25-dihydroxycholecalciferol therapy in undergoing hemodialysis patients with progressive vitamin D2-treated osteodystrophy. Six long-term hemodialysis patients with progressive skeletal deterioration during long-term pharmacologic vitamin D2 therapy were treated for six to 12 months with oral 1,25-dihydroxycholecalciferol (1,25-(OH)2D3) to determine its therapeutic effectiveness in vitamin D2-unresponsive osteodystrophy. On bone biopsy, three of the patients had severe osteomalacia and three showed predominant osteitis fibrosa. Previous therapies, including phosphate binders and dialysis schedules, were maintained. The three patients with osteomalacia and the two with osteitis fibrosa showed clinical deterioration. There was no significant change in serum calcium, phosphate, alkaline phosphatase, bone densitometry, immunoreactive parathyroid hormone levels or bone histology. Roentgenograms showed multiple new fractures of ribs and femoral necks in the patients with osteomalacia and increased bone resorption in two of three patients with osteitis fibrosa. 1,25-(OH)2D3 dosage had to be decreased in all patients because of hypercalcemia with a mean tolerated dose of 0.22 microgram/day. In these patients, 1,25-(OH)2D3 was not effective therapy for progressive osteodystrophy unresponsive to pharmacologic vitamin D2.


Delayed hyperacute rejection in recipients of kidney transplants from HLA identical sibling donors. Delayed hyperacute rejection, with its characteristic clinical course and histopathologic findings, occurred within one month after transplantation in five recipients of kidney transplants from HLA-A, B and D identical sibling donors. In all cases, unidirectional mixed lymphocyte cultures and immunologic studies to detect cytotoxic antibodies in the recipients against their respective donors, before kidney transplantation and after transplant nephrectomy, were unresponsive or negative. Onset of delayed hyperacute rejection was preceded by bacteremia in two of these patients. Two of these received second kidney transplants, three to six months later, from HLA-A, B and D identical sibling donors again. Although both have had an episode of acute rejection in the early postoperative period, the grafts have maintained excellent function for 21 and 25 months, respectively. Irreversible forms of transplant rejection, such as delayed hyperacute rejection, do occur even in recipients of kidney transplants from HLA-A, B and D identical sibling pairs, indicating that genetic determinants other than HLA-A, B and D loci, and perhaps other nongenetic immune mechanisms, play an important role in the ultimate results of kidney transplantation.


Molecular assembly in the contact phase of the Hageman factor system. Data obtained in the past few years have defined the molecular mechanisms of contact activation of the Hageman factor pathways of plasma, i.e., the kinin-forming, intrinsic clotting and fibrinolytic systems. Involved are four molecules: Hageman factor, high molecular weight (MW) kininogen, prekallikrein and factor XI. High MW kininogen serves as a surface cofactor to assemble prekallikrein or factor XI in proximity to surface-bound Hageman factor. Reciprocal proteolytic activation of Hageman factor and prekallikrein represents an essential step in the rapid activation of the contact phase. Although Hageman factor does undergo cleavage and activation in the absence of prekallikrein or high MW kininogen, the rate is approximately 50 and 100 times slower than when these molecules are present. Once Hageman factor is activated on the surface, it cleaves and activates clotting factor XI. Activated Hageman factor (HFa) exhibits two molecular forms. One of these, alpha HFa, activates prekallikrein and factor XI, and the intrinsic clotting system on the surface. alpha HFa and clotting factor XI remain surface bound. The other form of activated Hageman factor, beta HFa, leaves the surface, going into solution where it readily activates additional prekallikrein but not factor XI. Of perhaps even greater importance, kallikrein rapidly dissociates from the surface. Thus the formation of bradykinin and fibrinolysis is disseminated whereas clotting via the intrinsic system remains localized. Reviewed here is the molecular mechanism of contact activation of the Hageman factor pathways and discussed in the interaction of Hageman factor with the negatively charged surface, prekallikrein, factor XI and high MW kininogen. The multiple forms of activated Hageman factor and their potential biologic significance are also discussed.


Activation of pituitary gonadotropic function by an agonist of luteinizing hormone-releasing factor in the puerperium. To test the hypothesis that long-term deprivation of endogenous luteinizing hormone-releasing factor (LRF) during the course of pregnancy may account for the lack of gonadotropin in the puerperium, six normal postpartum women were treated with the potent and long-acting LRF agonist (D-Trp6, Pro9-NEt)-LRF. A 50 microgram dose of LRF agonist was administered subcutaneously every 48 hours for four doses, with the first dose given on the first day post partum. Prior to treatment, each subject was tested with two pulses of LRF (10 micrograms at 2 hour intervals) and again at the end of LRF agonist treatment on day 10 post partum. Pulses of LRF induced no significant elevation of follicle-stimulating hormone (FSH) levels on day 1 post partum. During treatment, a significant (P less than 0.005) increase in basal FSH levels occurred after the second dose of LRF agonist administration. Following treatment, pulses of LRF elicited a remarkable gonadotropin release with a relatively greater percent rise for FSH than for human chorionic gonadotropin-luteinizing hormone. Our data indicate that the lack of gonadotropin activity during the first 3 weeks post partum is, at least in part, related to insufficiency of endogenous LRF secretion and that resumption of gonadotropin secretion can be functionally activated by treatment with the appropriate dose and intervals of an LRF agonist.


Psychosocial aspects of craniofacial disfigurement. A "State of the Art" assessment conducted by the Craniofacial Anomalies Program Branch, The National Institute of Dental Research. The psychosocial sequelae of craniofacial disfigurement may have as great an impact on the patient as the strictly physical aspects of the problem. Very little systematic work has been focused directly on these effects. The following broad recommendations would constitute initial research steps in this field: Development of satisfactory measures of physical attractiveness and their use in studies to explore the role of craniofacial features in over-all physical attractiveness. The establishment of valid metrics for assessing the severity of craniofacial anomalies through the use of both physiologic and behavioral measures, thus constructing a broader definition of what constitutes a craniofacial handicap. Studies of the relationships among physiologic and behavioral variables using recently developed statistical techniques and computer methods to determine the psychosocial consequences of craniofacial disfigurement. Studies of the process through which persons with various types of malocclusion decide to seek and complete treatment. The studies would include the patients' demographic characteristics, self-perceptions, perceptions of them by others, and the complex patient-clinician interactions during the treatment programs.


Effects of a superactive luteinizing hormone-releasing factor agonist on gonadotropin and ovarian function during the menstrual cycle. The effect of a potent luteinizing hormone-releasing factor (LRF) agonist (D-Trp6, Pro9 NEt)-LRF on pituitary gonadotropin release and its concomitant ovarian response was examined in normal women during the early follicular (EFP), late follicular (LFP), and midluteal (MLP) phases. A single subcutaneous injection of 50 micrograms of LRF agonist in subjects during the EFP caused prompt release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to levels comparable to those found during spontaneous midcycle gonadotropin surges, while in LFP subjects gonadotropin levels rose 1 1/2 to 2 times above the levels of midcycle surges. The LH/FSH release in the MLP was almost identical to that found in the EFP. The ovarian response as measured by increasing estradiol levels followed a similar pattern during the 48 hours after injection in all three phases of the cycle. The inappropriate gonadotropin surge induced by LRF agonist in EFP subjects resulted in prolonged follicular phases and anovulation. Three of four subjects in the LFP showed evidence of ovulation in response to the same dose of LRF agonist. The pharmacodynamics of gonadotropin-ovarian responses to this potent LRF agonist reported here should provide an important reference for systemic investigation and rational clinical application.


Questions and replies: role of the collecting tubule in fluid, sodium, and potassium balance. In terms of day-to-day regulation of fluid and electrolyte balance, the collecting tubule system appears to occupy a paramount position among segments of the renal tubule. Controversy has arisen concerning the quantitative contribution by the collecting tubule system to the regulation of individual solute excretion, which in part may be due to differences among the investigative techniques employed. In this Editorial Review, R. L. Jamison summarizes current views on the function of the collecting tubule system, particularly with regard to regulation of sodium and potassium excretion, and then poses seven questions pertaining to this topic. H. Sonnenberg, who has revived the microcatheterization technique, and J. H. Stein, whose group has employed the micropuncture method, respond to these questions. The key issues addressed are: 1) the principal factors that influence transtubular movement of sodium and potassium across the collecting tubule; 2) the limitations and potential artifacts of the microcatheterization and micropuncture techniques when used to examine the function of the collecting tubule; 3) apparent discrepancies among results obtained by micropuncture in vivo, microcatheterization in vivo, and microperfusion in vitro of the collecting tubule; and 4) major unresolved questions concerning the function of the collecting tubule.


Anatomy of the juxtaglomerular apparatus. The juxtaglomerular apparatus, located in the glomerular hilum, consists of a vascular component (afferent and efferent arterioles and extraglomerular mesangium) and a tubular component (macula densa). Two types of contact between vascular and tubular components are observed: a) a complex type, involving distal tubule, extraglomerular mesangium, and proximal efferent arteriole, and b) a simple type, consisting of apposition of the basement membranes of the vascular and tubular components. Juxtaglomerular granular cells, the source of renin, are present throughout the vascular component but are more numerous in the afferent arteriole. They can be considered as "myoendocrine" cells, since they contain myofibrils and attachment bodies, together with secretory granules and crystalline protogranules. Macula densa cells differ from those elsewhere in the distal tubule in that their nuclei are closer to each other, the Golgi apparatus is basally located, and their basal membrane infoldings are less prominent. Adrenergic nerves are demonstrable by fluorescence histochemistry in the juxtaglomerular region. Electron microscopy reveals unmyelinated nerve fibers containing small dense-cored vesicles and capable, as shown by ultrastructural autoradiography, of incorporating exogenous tritiated norepinephrine. Neuroeffector junctions occur between nerves and cells of the vascular and, less frequently, the tubular component. In addition, adrenergic axons are observed in a juxtaglomerular cell tumor. Nerve terminals are seen in direct contact with the tumor cells.


Changes in the incidence of necrotizing enterocolitis associated with variation of the gastrointestinal microflora in neonates. The incidence of necrotizing enterocolitis was noted to vary in association with significant variation in the gastrointestinal microflora cultured from infants in the neonatal intensive care unit. Increased colonization with E. coli and K. pneumoniae was associated with an increased incidence of necrotizing enterocolitis, which suggests that these organisms are related to the pathogenesis of necrotizing enterocolitis.


Miconazole therapy for systemic candidiasis in a conjoined (Siamese) twin and a premature newborn. A 2.5 kg thoracopagus (Siamese) twin and a 0.73 kg premature newborn developed systemic candidiasis and were treated with intravenous miconazole. The conjoined twin was in a state of severe metabolic acidosis, respiratory distress, jaundice, anuria, abdominal distension, and shock. The 0.73 kg premature infant was also in a state of severe metabolic acidosis, respiratory distress, and oliguria. Miconazole was used in this desperate situation for the treatment of life-threatening candidiasis. Both infants responded well to treatment and recovered. All parameters of their diseases improved during therapy despite pre-existing multiple organ dysfunction. Miconazole can be a safe alternative to amphotericin B for the treatment of systemic candidiasis in neonatal infants, including those with impaired renal function.


Burn wound biopsy bacterial quantitation: a statistical analysis. Sequential paired punch biopsy samples were taken from three separate locations on each of four burn patients and were quantitated for the number of viable bacteria per gram of tissue. The range (log10 0.02 to log10 1.51) and the standard deviation (log10 0.67) were determined for each pair. The 95 per cent confidence interval based on any single observation, x, was determined to be x +/- 1.31. It is concluded that the burn wound biopsy is a reliable procedure for quantitating organisms in a burn wound and that changes in sequential samples give an indication of the dynamics of infection in the burn patients.


Duodenostomy.

Duodenostomy. The methods of managing a difficult duodenal stump after gastric resection are reviewed. One of two methods of catheter drainage of the duodenum can be used: end-stump catheterization or lateral tube drainage. A series of cases managed by end-stump duodenostomy is reviewed. The rationale for this technique and its advantages are presented.


New technique for repairing incisional hernias with Marlex mesh. A technique using Marlex mesh for the repair of incisional hernias in which the mesh is placed deep to the muscles and the musculofascial layers are closed completely over the mesh is described. Great mechanical advantage is obtained and healing of the wound by primary repair is made possible. This technique has been used in 31 patients since February 1978 with good results. Most of the 31 patients had large defects, and primary closure over the mesh was possible in all of them.


[Healing of lamellar corneal grafts in rabbit eyes after gluing with highly concentrated fibrinogen]. 24 rabbit eyes were submitted to lamellar corneal keratoplasty, the grafts being fixed by highly concentrated fibrinogen. Adhesion of the graft seemed satisfactory after 5 min, and the postoperative oedema cleared within 2 weeks. However, biomicroscopy and histology revealed a limited axial cicatrization while in the majority of cases marginal wound adaptation was insufficient. In 5 of 8 eyes followed up more than one week clear grafts were obtained, surrounded by a low marginal step.


Change of T-lymphocyte ratio after keratoplasty. Changes in the ratio of active and total E rosettes of 12 untreated and 26 corneal transplant patients with immunosuppressive therapy were examined weekly for a month and in the third month. On the basis of our results it can be stated that keratoplasty increases immune reactivity. This manifests itself in the increasing number of both the active and total E-rosette-forming lymphocytes. This increase in T cell number can be observed also after cataract operations in the first week, but in the latter case if no rejection occurs after keratoplasty the ratio of E-rosette-forming cells returns to the preoperative value in the third week. If the T-lymphocyte number is increased as late as the third week, that can be regarded as a rejection sign. Our data confirm the significance of active E-rosette-forming cells in immunological processes. Examination of the active and total E-rosette-forming T-lymphocytes has proved a suitable method for following up the cellular immunological processes directed against the corneal transplant.


Subepithelial fibrous tissue in failed corneal grafts. A histopathologic study. Clinical observation of corneal grafts often reveals subepithelial whitish opacities or membranes. To further understand the phenomenon, we undertook a histopathologic study of the changes in this region in failed human corneal grafts. Thinning and thickening of the epithelium, breaks in Bowman's membrane, and growth of subepithelial fibrous tissue were observed. Close association was found between the subepithelial fibrous growth, the breaks in Bowman's membrane, and stromal inflammation.


Oxidized and reduced glutathione levels of the cornea in vivo. A new method for preparing the rabbit cornea is described for the assay of metabolite levels in the in vivo state. The preparation includes in vivo rapid freezing of the tissue by liquid nitrogen, freeze sawing, lyophilization, and extraction with 0.5 N perchloric acid. Reduced (GSH) and oxidized (GSSG) glutathione levels and the GSH/GSSG ratios were compared with adenosine phosphate levels and ATP/ADP ratios. The most important results of this investigation seemed to be a significant difference in the redox state of the glutathione between the epithelium and the endothelium of the corea and the different reducing capacity of these tissues as indicated by the steady-state levels of the GSH and the GSSG. These metabolic processes may be used to eliminate toxic peroxides from the transparent ocular tissues produced by light or other chemical compounds.


An ether anaesthesia at Stroud in 1847--a report in search of a date. About the middle of 1847, Doctor Buchanan of the Australian Agricultural Company ligated a popliteal aneurysm under ether anaesthesia at Stroud, N.S.W. This paper summarises the results of a search for matters related to what must have been one of the first anaesthetics given in Australia.


A novel technique for high resolution analysis of the cytoskeleton. A new technique is described for producing and examining carbon-platinum replicas of the cytoskeleton of cultured cells. This technique allows the individual components of the cytoskeleton to be visualized and positively identified in the transmission electron microscope, and also permits an analysis of the 3-dimensional disposition of these components.


Mutagenicity studies with volatile metabolites of halothane. The mutagenicities of two volatile metabolites of halothane, 2-chloro-1,1,1-trifluoroethane (CF3CH2Cl) and 2-chloro-1,1-difluoro-ethylene (CF2CHCl), and a presumed halothane metabolite, 2-bromo-2-chloro-1,1-difluoroethylene (CF2CBrCl), were investigated in the bacterial assay system developed by Ames and co-workers. Both gas-phase and liquid culture tests were made. In addition, mutagenicity of CF2CBrCl was studied in a modified Ames test system using rapidly growing cells in enriched liquid medium. The purity of tested compounds was verified by combined gas chromatography and mass spectrometry. In the standard Ames test, CF3CH2Cl and CF2CBrCl were not mutagenic, and CF2CHCl was only weakly mutagenic. CF2CBrCl was detectable as weakly mutagenic, however, in the modified Ames test using rapidly growing cells. Although these results are reassuring, the effects of long-term exposure to halogenated anesthetics are still not fully known.


[Hemostatic effects of the argon laser on the gastric wall in the dog. I. Preliminary study: effects of the laser on the normal gastric wall]. The authors describe the pathological lesions caused by argon laser emitted rays on the healthy gastric mucosa in 22 dogs. They compare 126 photocoagulated areas while varying the intensity and the exposure time of the laser ray in order to determine the ideal constants of an efficient photocoagulation, devoid of risk and with rapid healing of the lesions.


[Positive blood cultures in the "Centre des Brûles du c. h. u. de Lille". Evolution of epidemiology during the last thirteen years (author's transl)]. An epidemiological study was made on 3,249 patients admitted in the "Centre des Brûlés du C.H.U. de Lille" from January 1965 to December 1977. This study showed that 7.1 per cent of these patients has one or more positive blood cultures. The main bacteria are staphylococcus aureus, streptococcus, pseudomonias aeruginosa in spite of antibiotic therapy. Infection is the dangerous development in these patients of which generally a burned surface is more than 25 p.cent surface body.


Acute leukemia: biology and treatment.

Acute leukemia: biology and treatment. A fundamental abnormality in acute myeloid leukemia is a block in cell differentiation with resultant accumulation of immature leukocytes. This abnormality can be studied in continuously growing leukemic cell lines that differentiate with simple chemical signals. Surface antigenic modulation occurring with cell differentiation can be monitored by specific antisera. These antisera have great potential as diagnostic and therapeutic reagents. More than 90% of patients with acute lymphoblastic leukemia and more than 70% of patients with acute myeloid leukemia can achieve remission of disease with aggressive multiagent chemotherapy. Long-term, disease-free survival is obtainable in about one half of patients with acute lymphoblastic leukemia but in less than 15% of patients with acute myeloid leukemia. The future directions of research for achieving cure of acute leukemia seem to be well defined.


Health risks associated with animal waste from intensive livestock units. Potential health risks associated with animal waste arise as a consequence of direct microbial problems particularly salmonellosis, indirect microbial problems arising from drug resistance etc., toxic residues from therapeutic or prophylactic agents, or from poisonous gases generated in liquid waste. The biggest of these hazards arises from direct microbial problems but fortunately experience in the UK suggests that these problems can be controlled reasonably well if sensible action is taken both at the planning and operative stages.


Brucellosis: an increasing public health hazard in Uganda. The paper highlights the importance of brucellosis as a public health hazard and that the disease appears to be on the increase in Uganda. In 5 districts cattle on newly established ranches and farms were blood-tested using ther serum agglutination test. The survey covered 5 ranches and 10 farms. The total number of cattle tested were 1606 and of these 18.1% were positive to the serum agglutination test. Attempts are now being made by the W.H.O. and Uganda Government to study and find out the impact of the disease in both animals and man.


[Study of muscle hemodynamics during exercise: Physiological and pathological variations in Xe 133 elimination: A new method of interpretation (author's transl)]. Muscle blood flow measurements are of physiological (and pathological) significance only during effort. For this reason, the authors used Xe 133, which has been known since 1964, to measure regional muscle blood flow after its injection into the muscle, to quantify results during effort (pedalling). Effort is controlled by two measurable parameters: the weight lifted by the pedal and the frequency of movements. Curves showing the reduction in intramuscular Xe 133 levels cannot be mathematically formulated. It is easy, however, to measure their areas and thus define a mean elimination time (Tm) between times T1 and T2, beginning and end of effort, corresponding to activities A1 and A2 such that: formula: (see text). Normal Tm value, measured in 58 normal subjects with variable frequencies and weights lifted is: Tm = 1.70 +/- 0.38 min. The values in 70 patients with arteritis were significantly longer and can be greater than 3.5 min. This objective test could be of value in quintifying the effects of so-called vasodilators, both in patients with arteritis and venous insufficiency.


[Low ano-rectal malformations (author's transl)]. This work includes 61 cases of low anal atresias, 42 were female and 19 male. All of them were treated with "cutback" technique with a follow up longer than two years. Results are classified in good, regular and poor, depending on the continence, stenosis, mega-rectum and enchopresis, and were 90 per cent of good results, 8 per cent regular and 2 per cent poor. Authors recommend this technique as a choice proceding in this kind of low atresias.


[Glomerulopathy during Behçet's syndrome. Immunofluorescent and electron microscopy studies (author's transl)]. Full renal investigation were conducted in 11 patients with Behçet's syndrome. Biological tests revealed the presence of mild proteinuria in 5 of them. Needle biopsy showed extra-membranous or mesangial fibrinoid deposits in 6 cases, associated in 1 case with segmental and focal glomerulitis lesions. Immunofluorescence studies demonstrated glomerular deposits of mesangial and extra-membranous C3, sometimes with immunoglobulins (IgA-AgG). Ultrastructural examination was carried out in 7 cases and showed "hump" deposits attached to the external face of the basal membrane and rounded nodules of 7 to 15 mu included in the mesangium. The presence of immune complexes in the renal glomeruli, therefore, is not all unusual in this disease, which is probably auto-immune in nature, and in fact appears to be a quite frequent occurrence. These deposits, which were probably well-tolerated by most of the patients in this series, might be involved in the production of progressive glomerulopathies in chronic cases, as observed in one of the cases studied.


[Early onset group B streptococcal neonatal sepsis (author's transl)]. Seventy one per cent of neonates had a gestational age longer than 37 weeks. Sixteen showed respiratory distress, and shock occured in twelve cases. The onset of illness happened within the first 12 hours of life, in 15 cases. No differences were observed among preterm and term infants. Differential leukocyte count were altered in all infants, being particularly relevant the fact that the relation between immature neutrophil/total neutrophil, was elevated in 50 per cent of cases. Mortality rate was 52 per cent. Clinical alert and early treatment with penicillin, together with the use of fresh blood exchange transfusion, can be considered useful methods in the treatment of these cases.


[Yersinia pseudotuberculosis septicemia in adults (author's transl)]. The authors discuss the clinical and bacterial characteristics and progressive changes occurring in Yersinia pseudotuberculosis septicemia, basing their observations on one personal case and 30 adult cases reported in the published literature. The roles played by a generally poor condition of the patient and martial overloading are emphasized, and the changes brought about by the introduction of antibiotic therapy evaluated.


[Investigation of the sella turcica and results of the LH-RH test in 19 cases of hirsutism (author's transl)]. The sella turcica was investigated systematically by radiotomography in 19 patients with either idiopathic hirsutism (6 cases) or hirsutism associated with hypomenorrhea (13 cases), without hyperandrogenism. Morphological abnormalities of the sella were noted in 9 cases, but these radiological abnormalities were also observed in 5 out of 19 women without hirsutism studied at the same time, and these images should therefore be interpreted very prudently. Only two patients had associated sella anomalies and raised LH levels, which could suggest, but not confirm the presence of an LH micro-adenoma.


[Self-implied languages and psychopathological expression]. Nevroses and dellusions are self-induced language in which the uttered statement is implemented in an immanent and intransive way, through the psycho-pathological language itself. The narrative pattern and the pathological process are closely linked together in the same two-sided utterance, clinical and at the same time narratological; as is demonstrated by the analysis of two cases.


[Depression in the child: Clinical and psychopathological aspects]. The present work is exclusively about depressions in childhood till the end of latency (11--12 years old children). It serves a double purpose: to try and show that children from their earliest childhood can be subject to feelings of sadness, moodiness, dismay, self-depreciation; to facilitate, through a better clinical and psychological knowledge, diagnoses in (cases of) depressions. In the first part, we shall study the different clinical forms of depressive states, their factors and their evolution. Three cases of personnal observations will illustrate those theoretic data. The relations between suicide and depression are introduced in the second part of this work. Finally, the authors will tell about the main psychanalytic works which permit to progress towards the recognition of the central function of the depressive phenomena in the structure of a personnality.


[Negation obsession after 30 years].

[Negation obsession after 30 years]. Report of thirty years evolution of observation princeps of " obsession de négation " which was presented to Société Médico-Psychologique by Raymond Mallet 11 may 1933. Opportunity to show different nosological qualification. Diseases are models chosen by physicians. Choice directed by means for action.


Organization of extracellular proteins on the connective tissue cell surface: relevance to cell-matrix interactions in vitro and in vivo. A model has been developed that proposes a cell surface-associated protein meshwork, composed in part of fibronectin and collagen, for a connective tissue cell attached to a substratum. In support of this model are the observations that collagen and fibronectin interact and that these proteins are similarly distributed on the fibroblast cell surface. We suggest that this external meshwork interacts directly or indirectly with the internal cytoskeleton and with the extracellular matrix and thereby mediates several cellular properties, including adhesion, shape, and motility. Loss of cell surface fibronectin as a result of viral transformation, or due to treatment of normal cells with tunicamycin, an inhibitor of protein glycosylation, may contribute to the reduced adhesion and altered morphology observed in these circumstances. We therefore predict that the changes in these properties observed with virally transformed cells, mitotic cells, and cells treated with proteolytic enzymes are related to alterations in the external protein meshwork.


Significance of donor age in penetrating keratoplasty. Because the significance of donor age in penetrating keratoplasty remains controversial, a study was undertaken to analyze the results of keratoplastics performed with older (greater than 70) and younger (less than 55) donor corneas. Thirty-seven eyes which received older donor corneas were divided into 4 diagnostic categories and were compared with 37 eyes having the same diagnosis which received younger donor corneas. The average follow-up for both groups was 24 months. There was no significant difference between the number of clear grafts in each group. It would appear that older donor corneas can withstand the surgical trauma of transplantation and remain clear for a relatively significant period.


McIndoe lecture, 1978. Burns: McIndoe's contribution and subsequent advances. My first aim is to present the state of burn care during the few years before the Battle of Britain in August-October 1940. This gives the climate of thought in which McIndoe and his collegues faced the challenge of burns. We are inclined to forget the helplessness of surgeons faced with extensive burns at that time. Some of the great changes in burn management in the past 40 years are then described and a claim is made that the results show a real improvement in treatment.


The significance of the evolution of the cerebrospinal fluid system. A study of the comparative morphology of the cerebrospinal fluid (CSF) system has been made in amphioxus, lamprey, dogfish, goldfish, lungfish, frog, salamander, turtle, pigeon, and mouse. Using mainly intracardiac fixation and a careful histological technique, serial sections have been obtained of the brain in situ surrounded by its various membranes and the skull. The ventricular system, the roof of the hindbrain, the meninges and subarachnoid space, the ependyma with its various derivatives, including the choroid plexuses and paraphysis, and the relationship between the various CSF compartments and the cerebrovascular system have all been compared in these animals. The hypothesis has been derived that the CSF system is primarily developed to maintain the chemical environment necessary to the function of the cells of the central nervous system, including the neuroendocrine pathways.


Anaesthesia and the potter.

Anaesthesia and the potter. The causes and historical background of the high incidence of severe silicosis among pottery workers in the Stoke-on-Trent area are described. The pathogenesis, pathology, and clinical manifestations of the disease are discussed. Although the incidence of silicosis in the Potteries has declined spectacularly in the past 20 years with the introduction of preventive measures, there still remains a generation of middle-aged and elderly potters with the disease who pose special problems for the anaesthetist and the thoracic surgeon.


Vestibular neuroanatomy: recent observations. The modern neuroanatomical technique of using a retrograde axoplasmic tracer (horseradish peroxidase) to label neurons has aided the revelation of several important connections in the vestibular system. The organization of the oculomotor nucleus and the existence of an interneuron in the abducens nucleus have importance in understanding some ocular disorders. A detailed description of the location of vestibulo-ocular neurons to individual extraocular muscles is now available which may provide a basis for understanding how these reflexes function normally and abnormally. Interconnections between the vestibular nuclei are provided by commissural neurons located in the superior, medial and group Y nuclei. These projections are probably of importance in vestibular compensation. A possible hypothesis of vestibular hair cell projection suggests that type I cells project over vestibulo-ocular neurons while type II cells project over commissural pathways.


Laryngeal paralysis--teflon injection.

Laryngeal paralysis--teflon injection. This report is a review of the literature combined with the author's experience concerning Teflon injection of the larynx. Included are the etiology and diagnosis of vocal cord paralysis, indications and contraindications for Teflon injection of the larynx, its histopathology, pre- and postoperative management, proper and improper techniques for injecting Teflon, complications, and reasons for failure.


Objective and subjective assessment of ephedrine combinations in asthmatic outpatients. 11 asthmatic outpatients were treated with placebo, ephedrine + theophylline + hydroxyzine, ephedrine + theophylline, and ephedrine + hydroxyzine, orally t.i.d. for 4 days each in random order. Both objective (PEF rates) and subjective (ranking list) assessments demonstrated the efficacy of the triple combination over placebo. The combination of two drugs proved objectively or subjectively somewhat less acceptable.


Double-blind controlled trial with colloidal bismuth subcitrate in the treatment of symptomatic duodenal ulcers with special references to blood and urine bismuth levels. To test the efficacy and toxicity of colloidal bismuth subcitrate (CBS) in a double-blind trial, forty-six consecutive outpatients with active duodenal ulceration were randomly allocated either to treatment with CBS or to a placebo for a period of four weeks. Symptomatic assessment was based on frequency and severity of pain. The ulcer size was measured endoscopically before and at the end of the trial. During the trial blood and urinary bismuth concentrations were measured. The symptomatic assessment of the patients receiving CBS or placebo showed that the reduction in pain was highly significant in both groups, but there was statistically significant difference in the degree of reduction of duodenal ulcer size in favour of the colloidal bismuth subcitrate-treated group (p less than 0.025). Although a marked increase in urinary bismuth concentration was noted, the blood bismuth levels remained within the acceptable levels.


[An introduction to synthetic progestogens pharmacology (author's transl)]. Synthetic progestins differ in their progestomimetic and other endocrine effects. Their affinities for different steroid hormone receptors have been measured and their pharmacological activities (progestomimetic, uterotrophic, anti-estrogenic, androgen and anti-gonadotrophic) have been evaluated concomitantly. Derivatives of the pregnane series are basically progestomimetic only, whereas derivatives of the norandrostane series have distinctly androgenic and anti-estrogenic properties. A knowledge of these various activities facilitates the choice of an appropriate therapy.


[Sensitivity of Gram-negative microflora to lysozyme]. Sensitivity to lysozyme of the representatives of various species of gramnegative microflora (476 strains) was studied with a new modified procedure, which is more exact and economic as compared to the method of serial dilutions in agar. High resistance of Eltor vibrio cholerae and Pseudomonas to lysozyme was found. Cultures of various sensitivity levels to lysozyme were detected among Aeromonas, enteropathogenic E. coli and NAG-vibrios.


[Results of testing a new method of using antibiotics in nutrient media for the isolation of Shigella: the 2-streak method]. A new variant of media with antibiotics for isolation of Shigella, i.e. a method of 2 streaks each containing different antibiotics was tested in analysis of excrements from patients with acute dysentery. It was found that the new method is more effective than the well known method of gradient plates (isolation of Shigella in one series of the experiments amounted to 85.2 and 64.7 per cent respectively, and in the other series of the experiments the respective figures were 95.4 and 89.3 per cent). Its efficiency was lower as compared to the procedure of inoculation onto 2 plates, i.e. onto the media with and without an antibiotic (isolation of Shigella was 67.5 and 77.4 per cent respectively). The new method provided a higher frequency of Shigella isolation as compared to inoculation onto the media without an antibiotic, as well as onto any of the media used with one antibiotic. The method of 2 streaks offers wider possibilities for choosing the antibiotics for adding to the nutrient medium, as well as estimation of the antibioticograms and species structures of Shigella distributed in a concrete area.


[Sterol affinity of Candida albicans cells resistant to polyene antibiotics]. The affinity levels of sterols in the sensitive and resistant cultures of C. albicans for polyenic antibiotics were studied comparatively. The affinity level was determined by liberation of potassium under the effect of the antibiotic participating in interaction with the sterol. The protective effect of the sterol suspended in solution and included into the composition of the liposomes from egg lecithin was studied. It was found that the sterols of the resistant cultures of C. albicans had the same (or even somewhat higher) affinity to amphotericin B as those from the sensitive cultures. The data indicate that resistance of the strains studied is not based on the loss of the sterol capacity for binding polyenic antibiotics.


[Effect of amphotericin B on the energy metabolism of tissue forms of Candida albicans]. Dehydrogenase activity of the tissue form cells of C. albicans during the infection process in albino mice with and without amphotericin B treatment was studied. The strength of the metabolic reactions resulting in accumulation of ATP was evident from the activity of 4 main enzymes, i.e. succinate dehydrogenase, lactate dehydrogenase, alcohol dehydrogenase and glucose-6-phosphate dehydrogenase. The enzymatic activity was determined by the tetrasol method based on formation of diphormazan. Investigation of the fungal cells 10 minutes after the infection showed that preliminary intravenous or intraperitoneal administration of amphotericin B did not change the activity of the tissue forms. The cytochemical characteristics of the fungal cells remained the same as that in the untreated animals. Six hours after infection of the animals treated with amphotericin B administered intravenously the fungus vegetation decreased from 52 to 38 per cent, while in the animals treated with amphotericin B administered intraperitoneally it was suppressed completely. Simultaneously the energy metabolism was also suppressed, the activity of alcohol dehydrogenase being suppressed most significantly. The activity of this enzyme in the cells of C. albicans isolated from the animals treated with the antibiotic administered intraperitoneally was 14 times lower than that in the cells of the culture isolated from the control animals.


[Conjugative properties of the R factors found in 2 different strains of Escherichia coli]. The transfer frequency of R124-17, RI, RI-19 and RP4 factors as dependent on the origin of the donor strain was studied. The transfer frequencies of these factors from E. coli W strains are much lower than those from the strains of E. coli K12. The effect is connected neither with the repression of the tra-genes, nor with the restriction enzymes activity against the alien DNA in the recipient bacteria.


[Ampicillin treatment trial in gonorrhea recurrences]. The results of using ampicillin in treatment of 54 gonorrhea patients (41 males and 13 females) previously treated with other antibiotics without success are presented. Ampicillin was used in a daily dose of 500 mg administered 5 times a day at equal intervals and an 8-hour interval during the night time. The course dose was 6--10 g. Patients with chronic and fresh gonorrhea with insignificantly pronounced symptoms were subjected to immunotherapy before the treatment with ampicillin. Pure gonococcal strains sensitive to ampicillin were isolated from 16 patients before the ampicillin use. Clinical improvement after the treatment with ampicillin in most of the patients was observed by the end of the 1st day and was evident from elimination of the urethral discharges, absence of urination colics and urea clarification. Etiological recovery was recorded in all the gonorrhea patients due to the treatment with ampicillin. All the patients were crossed off the register. The clinical and laboratory investigations showed high efficiency of ampicillin in treatment of gonorrhea relapses. The antibiotic is rapidly absorbed into the blood. Its therapeutic blood levels are maintained during 24 hours. It is well tolerated by the patients.


On Leeuwenhoek's magnifications.

On Leeuwenhoek's magnifications. The thesis of this communication is that the 'secret method' of Leeuwenhoek was the augmentation of the magnification of his single glass lens by the refraction at the quasi-hemispherical surface of a column of liquid containing the microorganisms. The linear increase in magnification thus secured could be as much as three-fold, depending on the degree of curvature of the liquid surface, the diameter of the column of liquid, and the index of refraction necessary for observation of details beyond the resolution of his best glass lenses. The hypothesis also accounts for the second part of the secret method, the high density of microorganisms in a single field of view, by successive recostitutions of the curved surface of the medium.


Rate of drying and the survival of microorganisms. The survival rate of cells of the genera Arthrobacter, Pseudomonas, Mycobacterium, Escherichia, Micrococcus and Saccharomyces when counted immediately after fast or slow drying (20 minutes and 24 hours, respectively) was rather similar. However, after prolonged periods of dry storage, the number of viable cells after slow drying was much higher as compared with the rapidly dried cells. Investigations with Escherichia coli demonstrated this phenomenon only when more than about 8 mg of water per 10(8) cells was available on a filter paper disc. In order to obtain optimum resistance to water loss the dessication period of 0.025 ml of suspension of E. coli must be longer than 13 hours.


Growth inhibition of Candida albicans by folate pathway inhibitors. Their potential in the selection of auxotrophs. Growth studies were conducted on C. albicans in a glucose - salts - biotin (GSB) medium in the presence of folate inhibitors. Sulfanilamide inhibited growth which was restored by PABA or tetrahydrofolate (THF). Aminopterin inhibited growth to about the same level as did sulfanilamide, but this inhibition was not reversed with PABA nor THF, singly or in combination. Inhibition by combined sulfanilamide and aminopterin was synergistic, reducing growth by more than 90% for 48 h. The sulfanilamide component of the combined inhibition was reversed by PABA or THF to the level of that of aminopterin alone. Cytochrome synthesis was not affected by the inhibitors, but marked increases occurred in alpha-ketoglutarate, malate, isocitrate, and pyruvate dehydrogenases, especially in the presence of both inhibitors. The pyrimidines in combination with sulfanilamide were as inhibitory as was the combination of aminopterin and sulfanilamide, but they had no effect when added alone or in combination with aminopterin. Unlike the pyrimidines, the purines stimulated about a 50% recovery from inhibition by either of the inhibitors. Growth inhibition by combined sulfanilamide and aminopterin was overcome by about 50% by the addition of the THF-mediated end-produits: deoxythymidylate, adenine, histidine and methionine. The use of GSB medium containing adenine, histidine, methionine and the folate inhibitors but without deoxythymidylate resulted in thymineless death of prototrophic cells providing a method for the selection of auxotrophic mutants.


Competition between an Escherichia coli tyrosine auxotroph and a prototrophic revertant in glucose- and tyrosine-limited chemostats. A tyrosine-requiring strain of Escherichia coli was grown in tyrosine-limited chemostats at a range of dilution rates between 0.08 h-1 and 0.42 h-1, conditions which always resulted in the selection of a prototrophic revertant population able to synthesise tyrosine. Analysis of the two-membered mixed cultures which arose showed that the prototrophic population outgrew the auxotroph since its growth rate was not restricted by the growth-limiting concentrations of exogenous tyrosine. During the take-over of the culture, the prototroph population grew exponentially but the specific growth rate increased with decreasing dilution rate of the competition experiments. In glucose-limited chemostats (in the presence of non-growth-limiting concentrations of tyrosine) of the tyrosine-requiring strain, prototrophs were never detected. Constructed two-membered mixed cultures with both populations competing for limiting amounts of glucose, showed that the prototroph was less competitive than the auxotroph.


Effects of fungicides on Aspergillus fumigatus. Aspergillus fumigatus was the most frequently isolated thermophilous fungus from green leaf surfaces. The application of fungicides significantly reduced the frequency of its occurrence there. A. fumigatus was relatively tolerant to fungicides. On Captan-, Thiram-, and Verdasan-treated leaves, A. fumigatus constituted 66%--80% of the total number of isolates obtained at 45 degrees C from each treatment while Dicloran did not depress the percentages. At 45 degrees C, A. fumigatus was found to be strongly cellulolytic with a slow rate of radial extension on YpSs agar and rapid rate of mycelial growth in Czapek Dox liquid medium. Increasing concentrations of all four fungicides reduced or prevented growth, sporulation, starch depletion and cellulose clearing of A. fumigatus. The fungus could tolerate higher concentrations of HgCl2 than of Verdasan. 2.5 microgram/ml of the four fungicides altered the rates of mycelial growth but not the maximum amount of mycelial dry weight attained.


[Some experimental evidences for immune functions of interstitial plasma-cells of the submaxillary glands (author's transl)]. Interstitial plasma-like cells, constantly present in the submaxillary glands, are they endocrine cells or true plasma-cells? They do not show any change in case of hypertrophy of the salivary glands which is observed under isoproterenol repeated administration. In contrary their number increase greatly during the immunologic stimulation by human albumin injections in the Hamster cheek pouches. So, it does appear that they would be true plasma cells involved in immunoglobulins synthesis.


[Contribution to the morphological study of mouse odontogenesis. Causality of tooth differentiation (author's transl)]. Odontogenesis in mouse is characterized by progressive morphogenesis and cytodifferentiation. Temporal dispacing was observed between the cusps of the same tooth and between lower and upper homologous teeth. These phenomenons underlined the importance of epithelial-mesenchymal interactions and the role of the stage of differentiation reached by the different cells before overt differentiation could be initiated.


[The vascular patterns in choroid tela of the fourth ventricle in cat (Felis domestica) (author's transl)]. The tela choroidea of the fourth ventricle of the cat is vascularized principally by the caudal cerebellar artery and secondarily by the dorsal plexus of the medulla oblongata. The choroidal branches that result from these two systems give the capillary network of the choroidal plexus. This drains rostrally into the emissary veins, tributaries of the cerebellar veins, or caudally, towards the dorsal plexus of the medulla oblongata, which is itself a tributary of the rostral petrosal veins.


[The connective network of the spleen from a 18 cm long (crown-rump) human foetus. Plastic reconstruction and some reflections concerning the architecture of the human spleen (author's transl)]. In the human foetus, the splenic function is double: metabolic action and blood storage. The primitive structure of the spleen is more clearly demonstrated at that stage than in the newborn or the adult. 1. Our negative reconstruction by means of "Hominit" and "Negokoll" demonstrates the connective network of the spleen from a 18 cm long (crown-rump) human foetus with a linear magnification of 300. The complete model is 15 cm high. 2. Dimensions: :formula (see text):3. In man the connective network originates from the capsule and from the trabecular ramifications. 4. In the 18 cm long foetus, there is an intense budding of cylindrical radiating trabeculae from the internal face of the capsule. 5. At the same stage, the undercapsular network is still incomplete. It firstly appears between the radiating trabeculae and the periphery of the venous trabeculae. 6. We divide the splenic parenchyma into two zones: an outer layer (undercapsular) and an inner layer which shows itself an internal and an external zone. 7. The internal zone contains the 1st to 3rd order ramifications of the trabecular tree (vascular trabeculae with venous and arterial components). The external zone corresponds to the 4th, 5th and 6th order ramifications (venous trabeculae). 8. The splenic lobules are delimited from the connective network. Their dimensions are as follows: :formula (see text):.


[Perturbations of the implantation, the foetal growth and the foetal morphogenesis after ligatures of uterine artery terminal vessels in the rabbit (author's transl)]. Uterine terminal vessels are ligatured in the rabbit. These reduction of the utero-placental blood supply during the pregnancy is one "intra-uterine growth retardation" factor. These I.U.G.R. rabbits shown one important decrease of their total cellular population. More the intervention is executed near the term more the cerebral mass is affected. At the beginning of the pregnancy one teratogenic effect is superadded to the I.U.G.R. effect. Modification of the blood supply before pregnancy with the same proceeding product on decrease of the implantation, one I.U.G.R. effect and one teratogenic effect.


Synoviorthesis with erbium-169: a double-blind controlled comparison of erbium-169 with corticosteroid. Intra-articular injections of erbium--169 citrate and methylprednisolone acetate in hand joints were compared in a randomly selected double-blind trial. The patients included 21 with rheumatoid arthritis and 3 with psoriatic arthritis, and the design was an intrapatient comparison. No difference between joints treated with the radioisotope or steroid was observed in the year following injection.


Measurement of clinical change in progressive systemic sclerosis: a 1 year double-blind placebo-controlled trial of N-acetylcysteine. N-acetylcysteine was employed as a therapeutic agent in a 1-year, parallel, double-blind, placebo-controlled, prospective study of 22 patients with progressive systemic sclerosis (PSS). Patients were closely followed-up and were extensively evaluated at baseline, 6 and 12 months. Most parameters remained unchanged during 1 year of study in both the NAC and placebo groups, which showed the need for prolonged studies of drugs in PSS if definitive results are to be obtained. Over the year of the study the diffusing capacity decreased in both groups, while several other parameters measured both increased and decreased. Several simple measures of function and skin distensibility were tested and two (oral aperature and handspread) were reproducible and sensitive enough to measure moderate changes of disease activity. They may be useful in future trials of drug effect in PSS.


Biochemistry of intraerythrocytic parasites. I. Identification of enzymes of parasite origin by starch-gel electrophoresis. Enzymes of parasite origin were identified by starch-gel electrophoresis. The species of parasite studied were Plasmodium berghei, Plasmodium yoelii nigeriensis, Babesia rodhaini and Anthemosoma garnhami. Lactate dehydrogenase, glucose phosphate isomerase and (NADP) glutamate dehydrogenase were detected in all species; phosphogluconate dehydrogenase was detected in both Plasmodium species but malate dehydrogenase only in P. y. nigeriensis. Glucose-6-phosphate dehydrogenase, alanine aminotransferase and aspartate aminotransferase were not detected in any parasite.


Biochemistry of intraerythrocytic parasites. II. Comparative studies in carbohydrate metabolism. Comparative studies were carried out on the glucose catabolism of mouse erythrocytes infected with Plasmodium berghei, Plasmodium yoelii, Babesia rodhaini, Babesia microti and Anthemosoma garnhami, as well as on uninfected erythrocytes and reticulocytes. The results showed that there was little qualitative difference between the glucose utilization and lactate production of the parasites although quantitative differences between malaria parasites and piroplasms were observed. The rate of glucose utilization of the infected cells was at least an order of magnitude higher than the rate for uninfected erythrocytes. Reticulocytes were also shown to have higher rates of glucose utilization and lactate production than uninfected erythrocytes.


Abnormal haemoglobins in the Sudan savanna of Nigeria. II. Immunological response to malaria in normals and subjects with sickle cell trait. Children born in areas hyperendemic for Plasmodium falciparum are protected by maternal antibodies for up to about five months of life, after which they are subject to intense infection until they acquire sufficient immunity--by about five years of age. Children with sickle cell trait (Hb.AS) are at an advantage during these critical years, probably because of preferential phagocytosis of parasitized red cells. This could lead to either (i) early processing of antigen by macrophages and an accelerated immune response, or (ii) less antigenic stimulus and hence lower antibody production. Immunoglobulin (Ig)G and IgM determinations, agar gel diffusion (Ouchterlony) against soluble P. falciparum antigen, the indirect fluorescent antibody (IFA) test using P. falciparum and P. malariae antigens, and the indirect haemagglutination (IHA) test with P. falciparum antigen were performed on sera from a population with different Hb electrophoretic types in the hyperendemic malarial area of Garki, Kano State, Nigeria. Plasma immunoglobulins and antimalarial antibodies rose with age. After the first year of life, lower mean concentrations of immunoglobulins (especially IgM), and lower mean titres of antibodies specific against P. falciparum (Ouchterlony, IHA and less significantly IFA) were present in Hb.AS compared to Hb.AA; these differences increased with age. Antimalarial intervention was followed by a decline of all values and final levels showed little difference between haemoglobin types. It was unlikely that either a relative inability to produce antibody or a more rapid catabolism of immunoglobulins was responsible for the lower levels in sickle cell trait. The observations are more easily explained by the hypothesis that Hb.AS persons have less antigenic stimulus due to the early removal of parasitized sickled cells by macrophages, which then degrade the antigens. The antibody difference between Hb.AA and Hb.AS increased throughout life, suggesting that this process remained a feature of sickle cell trait even after parasite frequencies and densities were similar in the two Hb groups. These observations have implications in the aetiology of tropical splenomegaly syndrome, which is rarely seen in sickle cell trait subjects. Mean IgG and IgM were slightly higher in Hb.AS than Hb.AA infants, the difference for IgG achieving significance. This suggested that during infancy early phagocytosis of parasitized cells had led to enhanced processing of antigen and hence an earlier immune response in Hb.AS, but this was unlikely to be a major factor in survival. IFA titres against P. malariae were slightly but not significantly lower in Hb.AS, possibly as a result of cross-reaction with P. falciparum antibody or of a slight degree of protection against P. malariae.


Studies on Plasmodium falciparum in continuous cultivation. I. The effect of chloroquine and pyrimethamine on parasite growth and viability. Recent advances in the in vitro study of human malaria have provided the knowledge to maintain Plasmodium falciparum in continuous culture. Using relatively cheap and easily obtainable materials it is now possible to study many parameters including parasite chemotherapy. The activity of two standard antimalarials, chloroquine and pyrimethamine, has been examined in vitro. The effect on the parasite is easily observed and can be measured not only as a decrease in parasite density, but also as the viability of the remaining parasites after drug pressure. Both chloroquine and pyrimethine showed activity against P. falciparum in vitro in concentrations equivalent to those obtained in plasma levels in vivo. The technique is very reproducible and offers a most valuable tool to the research worker.


Biochemistry of intraerythrocytic parasites III. Biochemical taxonomy of rodent Babesia. Biochemical methods were investigated for use in taxonomic studies on Babesia. The techniques used were variation in the mobility of parasite enzymes on starch gels after electrophoresis and the measurement of the buoyant density of the DNA of the parasites. The study was carried out on four rodent species of Babesia (B. microti, B. rodhaini, B. hylomysci and B. muratovi) as well as two human isolates of Babesia believed to be of rodent origin. In addition a related piroplasm of rodents, Anthemosoma garnhami, was also investigated. The results indicate that biochemical methods would be of value in taxonomic studies on Babesia.


Gonadotropin-releasing hormone test for hypogonadic men. Gonadotropin patterns before and after stimulation with gonadotropin-releasing hormone (GnRH) have been studied in 69 hypogonadic men of various types: patients with expansive hypothalamus--pituitary disorders before and after surgery, patients with hypogonadotropic hypogonadism, and patients with oligozoospermia or azoospermia who have primary partial or total testicular deficiency. Three characteristic gonadotropin patterns were found: (a) low basal values of LH and FSH with either absent or decreased and delayed responses; (b) normal basal values and pituitary responses above the normal range; or (c) high basal values and pituitary responses above the normal range. These gonadotropin patterns were correlated with disorders of the hypothalamus--pituitary--testis axis. The advantages and disadvantages of the GnRH test for the clinical evaluation of male hypogonadism are discussed.


[Administration of equally divided doses of propylthiouracil every two-eight hours in hyperthyroidism]. Serum propylthiouracil semi splitting occurs in 1.1 and 1.65 hours when administered in a single dose. In this work treatment for hyperthyroid patients is described; 350 mg were administered daily in divided doses, every two and eight hours. In group A fifteen patients received 50 mg every two hours from 8:00 to 20:00 hs. and in group B nine patients were administered 100, 100 and 150 mg at 8 hour intervals. The patients were hospitalized the first seven days and during this time circulating triiodothyronine and thyroxine concentrations were measured daily at 8:00 and 20:00 hrs. and then at 8:00 hrs. at days 8, 14, 21 and 28. After almost one week of treatment, in group "A", seven patients (46.6 per cent p 0.05) had normal concentration levels in both hormones. In group "B" only one patient reached normal levels in the first eight days. The administration of propylthiouracil every two hours is a useful procedure to attain the euthyroid state in less time than with other therapeutic patterns without undesirable side effects.


[Congenital galactosemia detected by severe Escherichia coli infections]. Three babies with untreated galactosaemia presented with severe coliform infections in the first month of life. The frequency of coliform infections in untreated patients is emphasised. Galactosaemia should be considered in any baby with a severe coliform infection.


[Use of computer-aided x-ray diagnosis in oncology (author's transl)]. The introduction of computer-aided diagnostic reveals new perspectives for diagnostic decisions. The results of the hitherto used mathematical diagnostic models are represented. The Bayes's theorem as the most used model exhibited very different, in parts unsatisfactory results. More convenient seems to be multivariate models, like discriminant analysis. Hitherto the computer-sided diagnostic was used in a relative small number of differential diagnostic problems. There are yet many replying questions. It is necessary to compare the efficiency of the different mathematical-statistical methods and to search for optimal solution ways for all differential diagnostic problems.


Effect of preimplantation treatment on the bone-forming potential of decalcified allogeneic and xenogeneic bone-matrix implants. Bone-forming property of 0.6 M HCl decalcified (a) allogeneic bone matrix preserved in 70% alcohol, (b) allogeneic bone matrix preserved in anaesthetic ether, (c) allogeneic 'Ossein' provided by the Leather Research Institute, Madras, and (d) xenogeneic bone-matrix preserved in alcohol was studied by fitting the implants in surgically created complete circumferential osteo-periosteal gaps in the ulna of rabbits. Bone formation was assessed radiologically, macroscopically, histologically, and by tetracycline fluorescence up to 16 postimplantation weeks. Successful bridging of the gap by new bone formation was observed in 75% of (a) and 28.6% of (d) preserved up to 2 weeks. Ether-preserved implants did not induce bone formation. The 'Ossein' implants remained as inert material neither invaded by host cells nor inducing any bone formation. The xenogeneic implants exhibited local immune response which was probably responsible for poor osteogeneic response. Bone forming quality of bone-matrix implants appears to be influenced by the chemical treatment during preparation and preservation, host cellular response and immune reaction invoked by the implant.


Helping one another: a speculative history of the self-help movement. The Independent Living Movement represents a direct challenge to current notions of rehabilitation (see the article by Gerben DeJong in this issue). It is a unique challenge, spearheaded not by new technical advances but by a new social awareness, and not from within by medical personnel but from without by lay groups. In another sense, however, it is but the latest evolution of an old theme in American life--the notion of self-help. This paper traces the history of self-help, to illuminate the problems and prospects of the Independent Living Movement.


Attendant care as a prototype independent living service. Of all the services and programs associated with the movement for independent living, attendant care has particular symbolic significance for the movement's adherents. Because it is a self-directed service, attendant care can be contrasted with home health services which are directed by professionals and agencies. This article demonstrates how attendant care mirrors key independent living values and concepts, partially by evaluating the provisions of attendant care services under titles XIX and XX of the Social Security Act. An analysis is made of how selected states have used titles XIX and XX authority to make self-directed attendant care services available. Consideration is also given to how selected eligibility criteria for titles XIX and XX create serious work disincentives that compromise the independent living goals implicit in self-directed attendant care services. Funding prospects and their effect are on the future of attendant care also are discussed.


DL-phenylalanine versus imipramine: a double-blind controlled study. In a double-blind study, DL-phenylalanine (150--200 mg/24 h) or imipramine (150--200 mg/24 h) was administered to 40 depressed patients (20 patients in each group) for 30 days. Diagnoses were established according to the International Classification of Disease (ICD). The AMP system, the Hamilton Depression Scale and the Bf-S self rating questionnaire (von Zerssen et al., 1974) were used to document psychopathological, neurologic, and somatic changes. Twenty-seven patients (14 on imipramine, 13 on phenylalanine) completed the 30-day trial. No statistical difference could be found between these two drug treatment groups (Student's t-test) using the Hamilton Depression Scale and the Bf-S self rating questionnaire. Ratings for anxiety were significantly lower in the imipramine group on days 10 and 20, but not on day 30; in addition, sleep disturbances were more influenced by imipramine on days 1, 5, and 10, but not on days 20 and 30. Separate analysis of psychopathological syndromes as somatic depressive syndrome and retarded depressive syndrome did not show a group difference (0.05 level of significance using a two-way analysis of variance). It is concluded that DL-phenylalanine might have substantial antidepresant properties. However, certain methodological considerations still warrant a careful interpretation.


Effects of luteinizing hormone-releasing hormone on sexual arousal in normal men. Six normal adult male subjects were administered either luteinizing hormone-releasing hormone (LRH, 500 micrograms, intramuscularly injected) or a saline placebo 10 min before a 40-min laboratory session in which they were exposed to erotic stimuli; subjects attended four such sessions, twice receiving LRH and twice the placebo in a balanced, double-blind, crossover design. Sexual arousal was inferred from degree of tumescence, with penile circumference measured by a mercury-in-rubber strain gauge. Heart rate was monitored continuously, and blood samples were taken periodically and assayed for serum luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone (T). Rapidity of onset of erection, maximum degree of erection obtained, and overall levels of tumescence were consistently greater following LRH administration than following saline placebo; however, the differences were not statistically significant. The anticipated LH and FSH response to LRH was noted as well as a small increment in LH levels following erotic stimulation. No significant alteration in serum testosterone was observed within the time sampled. There were no significant correlations between hormonal data and any measurement of penile tumescence. In view of the results, further investigation of the behavioral effects of LRH appears justified.


[State of several rat hematopoietic organs following total and subtotal irradiation and after bone marrow autotransplantation]. Hemopoiesis was studied in rats after x-ray irradiation. Lethal doses of 800--820 R were applied totally, with screening the shin and with subsequent autotransplantation of bone marrow taken from noninjured hemopoietic tissue. Survival of the animals and status of hemopoietic organs (quantitative indices of the peripheral blood, bone marrow and the spleen, as well as morphological changes in hemopoietic organs) served as tests. All totally irradiated animals died by the 20th day, the 30th day in the group of screened animals 32% survived, in the group with autotransplantation of bone marrow--62%. According to the indices studied restoration of hemopoiesis proceeded more quickly and completely in the group with autotransplantation of bone marrow and somewhat slower in the group with screening the shin (but without autotransplantation); this was accompanied by repopulation of bone marrow comparing with the totally irradiated animals. Restoration of the hemopoietic organs was followed by a comparatively rapid increase in the number of myeloid cells, while the number of lymphoid cells increased more slowly.


[Effect of long-term thyroxine administration on the endocrine epithelium of rat pancreas]. The effect of prolonged thyroxine administration (0.001 mg/g BW) on pancreatic islets has been studied on 64 Wistar male rats by means of radioautographic, morphometric and electron microscopic methods. The phase response in the amount of the DNA-synthesising cells of the middle class islets has been revealed: the initial increase (5 days) is followed by a decrease (30 days) and then by a return to the control levels (60 days). The level of metabolism in sulphur-containing proteins has decreased in both A- and B-cells. After 30 days of the experiment, B/A cell volume ratio has been shown to increase. Electron microscopic studies have revealed ultrastructural reorganization of B-cells from "resting" B-cells into "dark" B-cells at increased excretion of secretory material.


Flunisolide intranasal spray in the treatment of perennial rhinitis. A flunisolide-containing intranasal spray and matching placebo were used in an eight-week, double-blind parallel study in 67 patients with perennial rhinitis. Seventeen patients who did not benefit from treatment with the placebo then switched to flunisolide for a six-week open trial. Flunisolide-treated patients showed greater improvement in both duration and severity of symptoms, as well as a greater preference for flunisolide; 75% of patients either had "mild" symptoms or were asymptomatic and 67% stated that they experienced "substantial" or "total" control of symptoms. No serious side effects were encountered. Chief side effects in both drug and placebo groups were brief, mild, nasal burning and stinging on spray application. The drug exhibited no adverse effects on adrenal function (morning plasma cortisol levels).


Thread augmentation.

Thread augmentation. A review of thread augmentation has added helpful points to the technique and given an opportunity to assess the long-range results. It is obvious at this stage that there is no panacea for the wrinkling process. Each technique has advantages and disadvantages. The simplicity and low complication rate of thread augmentation supports this appeal. It is reasonable to state that the full application of the concept of this type of augmentation has not as yet been realized with this ongoing principle. This technique has been found of value when used as a single procedure or in combination with blepharoplasty or rhytidectomy.


Biological methods of dental caries prevention. A review. A number of measures by which tooth resistance could be increased or by which potentially cariogenic bacteria could be eliminated or their deleterious effects minimized are discussed. Many of them have proved valuable at the individual patient level but cannot be applied as a public health measure.


The dental application of electroformed pure gold. I. Porcelain jacket crown technique. The use of gold electroforms provides (1) a porcelain jacket crown and adaptable gold margin; (2) a matrix for porcelain inlays; (3) an adaptable margin for cast ceramic bonded to metal crowns or abutments. Further, by the application of electrodeposited tin to the gold, excellent bonding of porcelain occurs. This system can be used advantageously as a substrate for bonding porcelain to metals.


An electron microprobe investigation of the extent of microsegregation occurring in base metal dental casting alloys. Standard tensile specimens were cast from a cobalt base commercial partial denture casting alloy, and from a nickel base alloy. Specimens from the castings were examined metallographically. The electron microprobe was used in order to determine the degree of microsegregation present.


The plague and its place in history.

The plague and its place in history. An outline is presented of the various pan-epidemics of a disease which has been in the past one of mankind's greatest scourges--the plague. Its pathogenesis, spread and effect on the course of history from biblical times until the seventeenth century is traced with a detailed review of the origins of the Black Death. The opinion is forwarded that plague has had a greater impact on the course of human history than any war or any other single disease.


The structure and function of the Burns Unit at the Royal Perth Hospital. This article describes the design of the Burns Unit at the Royal Perth Hospital, and emphasizes the importance of flexibility, while at the same time providing opportunities for isolation and the control of infection. The manner in which the Unit functions is described with special reference to a modified hospital bed which facilitates bathing of the patient. Control of infection and early replacement of full thickness skin loss have been regarded as essential. The facilities and the treatment regime adopted have been shown to produce excellent results.


Cephaloridine prophylaxis in resection of the large intestine. A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients). In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P less than 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the would infection rate was reduced from 40.0% to 14.9% (P less than 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis. The results support the routine prophylactic use of cephalosporins in patients undergoing intraabdominal resection of the large intestine with anastomosis.


The mental illness of Captain Hyndman.

The mental illness of Captain Hyndman. The mental illness of Captain Charles Robertson Hyndman resulted in his compulsory hospitalization in Tarban Creek Asylum in 1843 and 1864-1866. His illness, and the question of mental health law which was subsequently raised, were of great significance for the colony of New South Wales in that it led to the first specific lunacy legislation in the state. The issues raised are still the fundamental questions with which contemporary mental health law is concerned.


Evaluation of assisted positive pressure breathing on +Gz tolerance. The effect of both assisted and unassisted positive pressure (PPB) breathing on +Gz tolerance was evaluated. A GOR (gradual onset rate = 0.1 G/s) acceleration profile was used to evaluate five different experimental conditions: 1) G-suit-only, 2) G suit + unassisted PPB, 3) G suit + PPB assisted by the English jerkin, 4) G suit + PPB assisted by the Canadian waistcoat, and 5) the Swedish counterpressure garment G suit combination. Acceleration tolerances for these experimental conditions (excluding the Swedish garment) with the subjects performing M-1 maneuvers were measured using an exhaustive ACM (Aerial Combat Maneuvers) acceleration profile. GOR tolerances were similar for both assisted and unassisted PPB with the pressure breathing experimental conditions providing a significant GOR tolerance increase over the G suit only condition. Assisted PPB increased ACM tolerances over both unassisted PPB and G suit only conditions. It appears that assisted PPB may offer a practical method for reducing the fatigue associated with exposure to high G.


The role of subunits in yeast DNA-dependent ribonucleic acid polymerase A. The properties of RNA polymerase A, which lacked the subunits of 48 000, 37 000 and 16 000 mol. wt., were compared with those of RNA polymerase A by using native calf thymus DNA as the template. The results showed that: (1) the specific activity of RNA polymerase A was about one-third that of RNA polymerase A; (2) more than 80% of RNA polymerase A, but only about 25% of RNA polymerase A, made RNA; (3) initiation by RNA polymerase A, but not by RNA polymerase A, began after a lag of 2 min; (4) the temperature-dependence for productive binding to DNA was greater for RNA polymerase A; (5) the apparent Km for UTP was greater for RNA polymerase A. These results support the supposition that the subunits missing from RNA polymerase A are involved in DNA binding [Huet, Dezélée, Iborra, Buhler, Sentenac & Fromageot (1976) Biochimie 58, 71-80] and show also that the loss of these subunits affects the elongation reaction.


Purification and properties of nitrogenase in ethylene glycol at sub-zero temperatures. Both the protein components Kp1 and Kp2 of nitrogenase from Klebsiella pneumoniae were found to be stable in aq. 50% (v/v) ethylene glycol at +30 degrees C or below. At -20 degrees C in this medium their sensitivities to O2 were diminished somewhat. Though purification could be carried out at -20 degrees C, the product had the same specific activity and was obtained in the same yield as when the purification was carried out by standard procedures. This suggests that such procedures yield enzyme undamaged in the course of the purification by O2, thermal denaturation or proteolytic digestion.


Proteolysis of the products of mitochondrial protein synthesis in yeast mitochondria and submitochondrial particles. Degradation of mitochondrial translation products in Saccharomyces cerevisiae mitochondria was studied by selectively labelling these entities in vivo in the presence of cycloheximide and following their fate in isolated mitochondria. One-third to one-half of the mitochondrial translation products are shown to be degraded, depending on the culture growth phase, with an approximate half-life of 35 min. This process is shown to be ATP-dependent, enhanced in the presence of puromycin and inhibited by chloramphenicol. Further, the proteolysis is suppressed by detergents and is insensitive to antisera against yeast proteinases A and B when measured in mitochondria or 'inside-out' submitochondrial particles. It is concluded that the breakdown of mitochondrial translation products is most probably due to the action of endogenous proteinase(s) associated with the mitochondrial inner membrane. This proteinase is inhibited by phenylmethanesulphonyl fluoride, leupeptin, antipain and chymostatin.


[On the molecular mechanism of action of (+)-cyanidanol-3 (author's transl)]. The pharmacological actions of (+)-cyanidanol-3 [(+)-flavan-3,3',4',5,7-pentol, (+)-catechin, Catergen) in various experimental liver diseases are described according to the recent available literature. On this basis the hepatoprotective activity of the drug is due to its stabilizing effect on biological membranes and its specific inhibitory activity on the Fe-ADP-, CCl4- and CBrCl3- stimulated lipoperoxidation in vitro and in vivo.