[Deep hypotension induced by sodium nitroprusside in neurosurgery. II.--Cerebral hemodynamic effects and metabolic rate of oxygen (author's transl)]. The cerebral hemodynamic effects of sodium nitroprusside (S. N.) have been the object of animal studies mainly. During the only human study performed, the drop in mean arterial pressure (MAP) is limited to 67 mm Hg. The study of the evolution of cerebral blood flow (CBF) in cases of more severe hypotension (MAP less than 45 mm Hg) seems of some interest. The study was composed of the measurement of the CBF using Xenon 133 and the calculation of cerebral vascular resistances (CVR) as well as cerebral metabolic rate of oxygen (CMRO2). Eleven patients with an average age of 37 years underwent surgery for cerebral aneurism 10 to 15 days after the inaugural hemorrhagic accident, under narconeuroleptanalgesia and stable ventilatory conditions. They are divided into 2 groups: Group I, 9 patients with normal levels of consciousness; Group II, 2 patients either agitated or obnubilated. The study is composed of 3 successive measures: (1) (T0) during stable anesthesia just prior to hypotension; (2) (T1) after 5 minutes of hypotension (MAP = 40 +/- 7 MM Hg); (3) (T2) 20 minutes after having stopped S. N. infusion. For the 9 patients in Group I, CBF remains unchanged at T1, the CVR decreases (p less than 0.001) and CMRO2 decreases (p less than 0.05). At T2 all of these parameters return to T0 values. The postoperative clinical evolution is favorable and uncomplicated. For the 2 patients in Group II the CBF, initially higher, falls from 20 to 30 p. cent at T1 with a drastic reduction in CMRO2. Despite the improvement of these parameters at T2, a prolonged postoperative coma is observed. This study suggests that CBF and CMRO2 are important parameters to monitor during controlled severe hypotension. Decrease in MAP must be less than 50 p. cent of control value and time-limited.


A simple implantable system for delivery of halothane. A capsule for regulated halothane delivery after abdominal implantation in experimental animals is described. The capsule is constructed of readily available medical-grade polyethylene and Teflon tubing. At 37 C linear halothane release rates of 0.4 to 15 mg/hour may be obtained.


A systems approach to the diagnosis of venous thrombosis and insufficiency. This systems approach to the diagnosis of venous vascular obstruction and venous insufficiency relies on use of the segmental pneumoplethysmograph. The method is a useful diagnostic tool when evaluating these diseases. The drainage test indicates deep, large venous thrombosis. The dependency test indicates either thrombosis or venous insufficiency. And the tourniquet test differentiates the presence of deep from superficial vein insufficiency.


Subcutaneous ancrod therapy in peripheral arterial disease: improvement in blood viscosity and nutritional blood flow. Nine patients with extensive peripheral arterial disease were treated with subcutaneous injections of ancrod (Arvin) for 10 to 21 days. Reduction in plasma fibrinogen was associated with a sustained reduction in plasma and blood viscosity, and a sustained increase in nutritional skin blood flow, measured by a Xenon-133 clearance technique (P less than 0.001). These findings may be relevant to the therapeutic effect of ancrod in ischemic rest pain.


Experience with a noninvasive evaluation for cerebral vascular disease. This report describes a newly developed noninvasive method for extracranial cerebrovascular evaluation. Two hundred consecutive cases were studied at the Massachusetts General Hospital and matched with clinical and angiographic findings. There were three false negative and five false positive results. Two ulcerated plaques without stenosis were not detected. Management routes for different groups of patients with central nervous system symptoms are outlined. We emphasize the usefulness of monitoring postoperative ophthalmic artery pressure to aid in the early detection of carotid occlusion in patients developing neurologic symptoms following carotid endarterectomy.


Plain roentgenographic estimation of systolic pulmonary artery pressure by the pulmonary arterial angle method. Chest roentgenograms of 125 patients (115 with pure or predominant mitral stenosis) were studied by the pulmonary arterial angle method to estimate systolic pulmonary artery pressure without prior knowledge of catheterization data. First the angle between the line drawn along the right upper lobe artery and the tangent drawn along the point of junction of superior and lateral borders of the right pulmonary artery was determined. Next the angle between the right middle lobe artery and the descending pulmonary artery is determined. The difference between these angles equals systolic pulmonary artery pressure. Catheter and angle values were identical in 26 patients. There was a 1- to 5-mm difference in 70, a 6- to 10-mm difference in 18, an 11- to 15-mm difference in 8, and a difference greater than 15 mm in 3.


"Malignant" brachial arteriovenous fistula in a newborn child: a case report. From the time of birth, a patient a rapidly expanding pulsatile mass in the left upper extremity. The findings are those of multiple AV fistulae: thrill, continuous murmur, cutaneous angioma, and rapidly appearing trophic changes. Cyanosis and irreversible heart failure ensued, and the patient died after 20 hours of life. An aortogram revealed numerous AV fistulas within an angiomatous network vascularized by a huge subclavian artery and drained by a large subclavian vein.


Heparin bleeding due to qualitative platelet dysfunction. On two separate occasions, a 26-year-old white woman bled from arterial puncture wounds while receiving heparin for thromboembolic disease. Bleeding time was prolonged after heparin administration at the time that she was ill and bled, and when she was re-challenged 2 years later. Heparin may produce bleeding as a result of a qualitative platelet dysfunction.


The respiratory neuromuscular response to hypoxia, hypercapnia, and obstruction to airflow in asthma. In chronic obstructive pulmonary disease (COPD), the neuromuscular response to an acute increase in airflow produced by external flow resistive loads (FRL) is impaired. The present study compared the response to FRL of 15 subjects with airway obstruction due to asthma and that of 15 normal subjects. FRL were applied during progressive hypercapnia and isocapnic hypoxia produced by rebreathing techniques to permit the response to be assessed at the same degree of CO2 or O2 drive. The neuromuscular response to FRL was assessed from the airway occlusion pressure developed 100 msec after the onset of inspiration (P100), as well as ventilation. During control rebreathing, ventilatory responses to hypercapnia (ratio of change in minute ventilation to change in PCO2, delta VE/delta PCO2) and hypoxia (ratio of change in VE to the change in percentage of O2 saturation, delta VE/deltaSO2) were the same in asthmatic and normal subjects despite differences in the mechanics of breathing. The P100 response to hypercapnia delta P100/delta PCO2) and hypoxia (delta P100/delta SO2) as well as absolute P100 at any given degree of O2 and CO2 drive was greater during control rebreathing in asthmatics than in normal subjects (P less than 0.05). FRL values of 9 and 18 cm H2O per L per sec applied during either hypercapnia or hypoxia increased the occlusion pressure to a greater extent in asthmatics than in normal subjects. Methacholine-induced bronchoconstriction was used to test the effect of acute airway obstruction on the response to FRL. Bronchoconstriction was associated with an increase in the P100 response to hypercapnia and to FRL, despite increases in lung volume and decreases in inspiratory muscle force. We conclude that: (1) asthmatics with airway dysfunction have an increased nonchemical drive to breathe mediated at least in part by sensory receptors in the airways; (2) asthmatics with airway obstruction respond supernormally to acute changes in resistance to airflow, unlike subjects with COPD. The failure of COPD subjects with prolonged airway obstruction to respond to FRL may be due to adaptation of the sensory mechanisms that respond to changes in airway resistance.


Significance of the quantification and demonstration of hyaluronic acid in tissue specimens for the diagnosis of pleural mesothelioma. Hyaluronic acid in pleural tissues from patients with mesothelioma, carcinoma, and asbestosis of the lung was quantified by using specific glycosaminoglycan-degrading enzymes. In all cases of pleural mesothelioma, the quantity of hyaluronic acid in mg/g of dry tissue was at least 0.10 mg, whereas carcinomatous pleural tissue and pleura in asbestosis contained 0.02 to 0.03 mg/g of dry tissue.


Determination of pulmonary blood flow by the rebreathing technique in airflow obstruction. To test the hypothesis that the effect of nonuniform gas distribution on the uptake of inhaled soluble gases in the lung is minimized by rebreathing, we measured pulmonary blood flow by the thermodilution technique, and pulmonary capillary blood flow, combined pulmonary tissue and capillary blood volume, diffusing capacity of the lung for CO, and alveolar volume by a rebreathing technique in conscious sheep before and immediately after inhalation of a histamine aerosol (4% solution). We also measured pulmonary resistance, distribution of ventilation by multiple-breath N2 washout, and arterial blood gases to monitor airway responses. Histamine inhalation produced a mean pulmonary resistance increase to 621% of baseline accompanied by uneven distribution of ventilation and a decrease in arterial Po2. Despite these alterations in airway function, there were no concomitant changes in pulmonary capillary blood flow, combined pulmonary tissue and capillary blood volume, diffusing capacity of the lung for CO, alveolar volume, or the ratio of diffusing capacity for CO to alveolar volume. Mean pulmonary capillary blood flow and pulmonary blood flow did not differ from each other before and after histamine inhalation. We conclude that the rebreathing technique for noninvasive measurement of pulmonary hemodynamics is satisfactory in the presence of airflow obstruction.


The effect of hyperoxia on migration of alveolar macrophages in vitro. There is in vitro evidence to support the notion that directed migration (chemotaxis) is involved in the recruitment of alveolar macrophages in vivo. Because O2 is widely used in the treatment of pulmonary diseases, we examined the effect of hyperoxia on migration of guinea pig alveolar macrophages in vitro. Migration was measured in blind-well chambers incubated in either room air or hyperoxia. N-formyl-methionyl-phenylalanine was used to stimulate random migration and to produce directed migration. Migration was quantified by counting the number of mononuclear cells per oil immersion field that had migrated completely through a polycarbonate filter with 5-micrometer pores. The average PO2 in the cell suspensions incubated in room air was 100 mm Hg. In the hyperoxic environments, the average PO2 at 1 h was 260 mm Hg, whereas at 2 and 3 h, it was 410 and 425 mm Hg, respectively. In 6 separate experiments, there was no significant difference between the mean response to N-formyl-methionyl phenylalanine in hyperoxia and in room air after 1 h of incubation. After 2 and 3h of incubation, however, the response in hyperoxia was significantly (P less than 0.002) lower than that in room air. The decreased response in hyperoxia did not appear to result from loss of viability of responding cells, diminished adherence of cells to the filters, loss of activity of N-formyl-methionyl phenylalanine exposed to high PO2, or failure of the cells to exhibit directed migration. Instead, it appeared that hyperoxia decreased the response of alveolar macrophages primarily by impairing random migration.


Effect of terbutaline on movement of Cl- and Na+ across the trachea of the dog in vitro. The epithelium of canine trachea maintains a transepithelial potential difference (lumen negative relative to submucosa) by active transport of Cl- toward the lumen and of Na+ away from the lumen. This study examined the effects of terbutaline (a beta-adrenergic agonist) on short-circuit current, potential difference, electrical conductance, and fluxes of 36Cl and 24Na measured across pieces of canine trachea mounted in Ussing-type chambers. In short-circuited tissues, 10(-5) M terbutaline increased unidirectional Cl- flux toward the lumen from 4.78 +/- 1.12 (mean +/- SEM) to 6.28 +/- 1.06 muEq/cm2.h. The other measured fluxes did not change significantly. Increases in unidirectional Cl- flux toward the lumen were related to terbutaline concentration (range, 10(-7) to 10(-5) M); 10(-6) M propranolol prevented or decreased these effects. These studies suggest that terbutaline acts via beta-adrenergic receptors to increase active transport of Cl- toward the lumen.


Effect of local radioactivity on trachael mucous velocity of sheep. The effects of local isotope radiation and x-ray radiation on mucociliary transport of sheep were investigated. X-ray radiation from fluoroscopy equivalent to that used to determine tracheal mucous velocity in intact animals (approximately 3 min) did not alter transport of teflon discs in an isolated sheep trachael preparation. In conscious sheep, 2 ml of a solution containing 8 mCi of macroaggregates of albumin labeled with technetium-99m (99mTc) and 99mTc-pyrophosphate were instilled under direct vision into the trachea via a fiberoptic bronchoscope, providing an actual deposition on the tracheal epithelium of 1.8 to 2 mCi. Physiologic saline and unlabeled macroaggregates of albumin were instilled as control solutions. Tracheal mucous velocity measured by movement of teflon discs increased by 93.2 per cent with 99mTc-labeled macroaggregated albumin and 86.7 per cent with 99mTc-pyrophosphate (P less than 0.01), but no significant increase occurred after saline or unlabeled macroaggregates of albumin. Discrepancies in the values of trachael mucous velocity determined using inert particles and radioactive tracer solution or aerosols might be related in part to the local effects of the tracer radiation.


Anchoring fibrils in the normal canine respiratory system. Electron microscopic study of the normal canine respiratory tree disclosed the presence of anchoring fibrils, a distinct class of fibrils of extracellular connective tissue, in association with the following types of cells: (1) basal cells and special type cells of trachea and bronchi; (2) ciliated cells and basal cells of bronchioles; (3) ductal cells, secretory cells, and myoepithelial cells of tracheobronchial glands. Anchoring fibrils in the normal respiratory system measured up to 6,000 A in length and from 170 to 400 A in thickness, and had a banding pattern that differed from that of collagen fibrils and connective tissue microfibrils. They formed arcs, the ends of which inserted into the basal lamina underlying the basal portions of the cells, often in the vicinity of hemidesmosomes. Anchoring fibrils decreased in number and size in the more distal portions of the respiratory tree, and were not found in alveolar septums. Anchoring fibrils in lung appeared similar to those described in other organs, but were often small and inconspicuous. The function of these structures is to reinforce the attachment of the epithelial basal lamina to the underlying connective tissues.


Defective oxidative metabolic responses in vitro of alveolar macrophages in chronic granulomatous disease. After stimulation with bacteria, alveolar macrophages (AM) from uninfected normal subjects or persons with pneumonia approximately doubled their rates of O2 consumption, superoxide anion generation, and glucose (1(-14)C) oxidation. In contrast, bacteria-stimulated AM from a patient with chronic granulomatous disease (CGD) failed to consume more O2, make superoxide anion, or oxidize glucose. In addition, AM from the patient with CGD did not respond to stimulation by a chemical agent, phorbol myristate acetate, which increased the metabolic activities of AM from control subjects. The appearance, esterase and Gomori acid phosphatase staining, phagocytic ability, unstimulated O2 consumption, and response to methylene blue of AM from the CGD patient were normal. The results extend the biochemical defect in patients with CGD beyond abnormalities in their circulating neutrophils and monocytes, to their tissue-associated lung macrophages. The results also indicate that AM from patients with CGD may have an additional abnormality in metabolism, which is a lack of enhanced mitochondrial respiration during phagocytosis. The studies also document the selective action of phorbol myristate acetate, which stimulated the metabolic activities of normal AM, but not of those from the patient with CGD.


Various antigenic reactivities in delayed hypersensitivity among crystalline proteins from Mycobacterium phlei. Comparisons were made of the delayed-type skin reactivity of 6 crystalline proteins purified from the cell extract of Mycobacterium phlei in guinea pigs sensitized with whole cells of the heat-killed bacillus. These highly purified proteins elicited varying degrees of cutaneous reaction. The most active protein had almost the same reactivity as purified protein derivative prepared from the culture filtrate of Mycobacterium phlei. On the other hand, the weakest protein did not elicit a marked cutaneous reaction even after injection of 3,000 times the amount of protein of the most potent one. The other 4 proteins showed moderate reactivities. The difference in antigenic potency between proteins is probably due not to the amounts of the proteins contained in the cells used for sensitization, but to their structure.


The effect of helium on nasal resistance and nasal flows. Nasal inspiratory resistance and maximal inspiratory nasal flow were measured in 10 normal subjects while they breathed air and while they breathed a mixture of 80% helium and 20% O2. After the less dense helium-O2 mixture, there was a nonsignificant increase in K1 (15 +/- 93%), a 56 +/- 20% decrease in K2 (P less than 0.001), and a 48 +/- 20% increase in maximal inspiratory nasal flow (P less than 0.001). This is consistent with the accepted concept that K1 represents resistance to laminar flow and K2, resistance to nonlaminar flow (turbulent flow and/or flow due to convective acceleration), and that nonlaminar air flow predominates in the nose.


[Establishment of circadian rhythm of cortisol in newborn and older children (author's transl)]. In 30 children, 19 males and 11 females, aged 5 days to 36 months admitted for reasons other than neurological, endocrine, hepatic or renal diseases, the plasma cortisol levels at 9.00 and 20.00 hr. was studied to ascertain the time of appearance of a pattern of circadian rhythm comparable to adults. Children were arbitrarily divided into three groups according to their age: group I (n = 9) 5 days to 6 months; group II (n = 13) 7 to 17 months and group III (n = 8) 24 to 36 months old. The plasma corticol levels at 9.00 and 20.00 hr. were respectively for each group (X +/- SD): 12.7 +/- 8.0; 10.9 +/- 8.62; 17.7 +/- 6.65; 11.9 +/- 7.5 and 21.6 +/- 4.67; 9.7 +/- 3.8 microgram/100 ml. Evidence for circadian rhythm was statistically demonstrated only in group III and from these individual results the criteria to be satisfied as evidence of rhythm are: the cortisol value at 20.00 hr. must be less than or equal to 15.0 microgram/100 ml. with a decrease greater than or equal to 30% compared to basal (9.00 hr.) value. Only 7 out of 13 children in group II and 4 out of the 9 children in group I conform such criteria. These results show that the circadian rhythm of cortisol might be used as a valuable test to study adrenal function in children from the age of two.


[Newborn of diabetic mother. Glucose in amniotic fluid and clinical conditions (author's transl)]. Clinical and analytical data of sixteen newborns of insulin dependant mothers are studied. Relation between these data and newborn conditions as Apgar score and hypoglicemia are considered.


[Cystic adenomatoid malformation of the lung (author's transl)]. Four cases of congenital cystic adenomatoid malformation are presented. The age of the patients ranged from 1 day to 7 years. All cases were treated surgically and 3 of them survived. The only death in the group corresponded to the neonatal case. The clinical, radiological and patological features of congenital cystic adenomatoid malformation are also reviewed. Occasionally the clinical manifestations will be hardly noticeable or non existent and the malformation may be diagnosed beyond the neonatal period in the course of a radiological examination performed as routine or because of repeated respiratory infections. Surgery is the treatment of choice. In the group of neonates where the cystic adenomatoid malformation doesn't cause respiratory difficulty the authors feel that it might be advisable to postpone surgery until a later date.


[Familial vesicoureteral reflux (author's transl)]. Sixteen members of three families, eight of which had vesicoureteral reflux, are studied. Authors report a high incidence in females (7 cases) and atrophic chronic pyelonephritis (75% of the serie). Only one girl presented disminution of renal function. The types of inheritance was dominant autosomal in the A family and autosomal recessive in the B and C families. Finally the norms of investigation of the familial vesicoureteral reflux are appointed.


[Diagnostic and etiologic problems of hydranencephaly (author's transl)]. A report of hydranencephaly is made, featuring normal cephalic perimeter and where diagnosis was a pathological finding. There were no clinical suspiscions and fetal distress along with post-partum anoxia were thought to be the chief causes of the disease. A revision of clinical, diagnostic and etiological factors of this particular entity is made. It is of concern to aim this report in the direction of considering phosphorous-organic products to have a teratogenic action and therefore to be an interesting etiological aspect in the production of hydranencephaly.


[Two cases of secondary amyloidosis (author's transl)]. Two cases of secondary amyloidosis are presented. Both cases presented as nephrotic syndrome and were confirmed by biopsy dying two years later of the appearance of proteinuria. Incidence and characteristics of amyloidosis in infancy is commented.


[Myocardial fibrosis in Shwachman's syndrome (author's transl)]. A case of a child affected by Shwachman's syndrome with a chronic diarrhea, cyclic neutropenia and bone defects is described. The child died at the age of eight months from an acute cardiac failure which showed analytical alterations compatible to an acute myocardial infarction. Pathologic study showed a pancreatic lipomatous hypoplasia, myocardial fibrosis and chondrometaphyseal dysplasia. Main hypothesis that relate pancreatic pathology and development of myocardial fibrosis are discussed, although there is a lack of definitive evidence for confirming such relation.


[Stewart and Bergstrom Syndrome. Contribution of a new observation (author's transl)]. Authors report a new observation to the Stewart and Bergstrom syndrome, which to their knowledge, can be the second case in the medical literature.


Arteriohepatic dysplasia: a benign syndrome of intrahepatic cholestasis with multiple organ involvement. Arteriohepatic dysplasia (Alagille's syndrome) is presumed to be one of the familial intrahepatic cholestatic syndromes, all of which present with neonatal jaundice or failure to thrive, or both. We report the findings in five patients with this syndrome, four of whom have been followed into adulthood. In addition to hepatic dysfunction, patients had abnormalities of the cardiovascular system, eyes, bones, central nervous system, kidney, endocrine system, and habitus. Analysis of these cases allows a more complete characterization of this syndrome and shows that the cholestasis improves, although the abnormalities of the hands and face become more pronounced, with age. Patients with arteriohepatic dysplasia display the variability in expression seen in many autosomal-dominant conditions. New findings in the eye and spine provide markers specific for this syndrome and serve to differentiate it from other forms of cholestatic liver disease.


Sjögren's syndrome: a defect in reticuloendothelial system Fc-receptor-specific clearance. To determine the functional status of reticuloendothelial system Fc receptors in patients with Sjögren's syndrome, we studied the rate of clearance from the circulation of 51Cr-labeled IgG-sensitized autologous erythrocytes in 19 patients. Fc-receptor-mediated clearance was abnormal in 12 of the 19 patients, with half-lives ranging from 80 to 356 min. There was a significant correlation between clearance rates and clinical manifestations of disease. Clearance rates tended to be normal in patients with disease limited to exocrine glands and abnormal in patients with widespread disease. In contrast, there were no correlations between the rate of clearance of IgG-sensitized erythrocytes and serum immune complex levels, serum complement component levels, or rheumatoid factor titers. The striking correlation between clearance rates and disease manifestations suggests that decreased clearance of immune complexes by defective reticuloendothelial system Fc receptors may contribute to disease pathogenesis.


Resin hemoperfusion for treatment of ethchlorvynol overdose. Hemoperfusion has been increasingly used to treat drug intoxication. Although efficient extraction rates have been reported with hemoperfusion devices, simultaneous measurements of drug adsorption on the columns and endogenous clearance rates have not been made. We studied three patients who ingested 12 to 22 g of ethchlorvynol (Placidyl). In each  patient saline diuresis was induced, and Amberlite XAD-4 resin hemoperfusion was done. Resin extraction of ethchlorvynol was calculated hourly, and the recovery of drugs from each column was measured. Renal clearance of ethchlorvynol was simultaneously measured. The resin removed 100% of perfused ethchlorvynol measured by gas chromatography. Ethchlorvynol recovery from the columns agreed well with calculated extraction. Renal clearance was 1 to 6 mL/min, and estimated metabolic clearance was 16% to 31% of resin extraction rate. Complications included anemia, thrombocytopenia, hypocalcemia, and pancreatitis. Resin hemoperfusion substantially supplements endogenous clearance of ethchlorvynol and is a valuable therapy in ethchlorvynol intoxication.


Streptococcus bovis septicemia and carcinoma of the colon. We prospectively studied patients with Streptococcus bovis septicemia for the presence of gastrointestinal lesions. This study was prompted by our reported findings of the association of fecal carriage of S. bovis with carcinoma of the colon. We studied 29 patients with 30 episodes of S. bovis septicemia. Fifteen completed gastrointestinal evaluations that included colonscopy, surgery, or autopsy. Eight of these had carcinoma of the colon, three had adenomatous polyps of the colon without carcinoma, and two had carcinoma of the esophagus. The 14 patients who did not have complete evaluations included one each with carcinoma of the stomach, gastric lymphoma, and adenomatous polyp of the colon and three with colonic masses not further delineated. Nineteen patients had no gastrointestinal signs or symptoms or stools positive for occult blood at admission. The results of our study suggest that all patients with S. bovis septicemia need aggressive evaluation of the gastrointestinal tract, especially the colon.


Inadvertent administration of intravenous fluids contaminated with fungus. We present here the case of a patient inadvertently infused with intravenous fluid containing a "fungus ball." Because little is known about such cases, we surveyed 113 infectious diseases specialists for their experiences and ideas on management. Seventy-six responded, of whom 18 had seen a total of 24 cases. Intravenous-fluid containers were often defective, and the fungi involved were usually "contaminants." One patient developed significant fungal infection, and six others had transient symptoms temporally related to the infusion. Most specialists would administer antifungal therapy if symptoms developed, the patient was immunocompromised, or the fungus was pathogenic for humans.


Renal amyloidosis and subcutaneous drug abuse. Two drug addicts who practiced subcutaneous injection of crushed tripelennamine and pentazocine tablets, a practice known as "skin-popping," developed nephrotic syndrome and demonstrated amyloidosis on renal biopsy. These patients had chronic inflammation of the skin in the form of abscesses and ulcerations. Although both patients were long-standing drug abusers, they had practiced intradermal drug administration for only 3 years. The occurrence of amyloidosis in these patients appears to relate to their particular drug habir and must be considered in the differential diagnosis of proteinuria in this patient population.


Extrahepatic biliary obstruction caused by metastatic breast carcinoma. We describe our experience with seven patients who had extrahepatic biliary obstruction caused by metastatic breast cancer. The interval from the original diagnosis of breast cancer to the development of jaundice averaged 40 months, with a range of 9 months to 8 years. All patients were treated with surgical decompression, radiation, transhepatic catheter drainage, chemotherapy, or a combination of these modalities. Resolution of jaundice was achieved in six patients. Prolonged survival was realized in three; one patient lived for more than 6 years after surgical bypass, and two are alive and well at present (greater than 11 months after relief of biliary obstruction). Extrahepatic biliary obstruction by metastatic breast carcinoma should be distinguished from jaundice due to hepatic parenchymal destruction by this tumor; while the latter implies end-stage cancer, the former has the potential for significant palliation and prolonged survival.


Lack of cardiovascular effects of delta-9-tetrahydrocannabinol in chemically denervated men. We have previously reported that 25 micrograms/kg of intravenous (i.v.) delta-9-tetrahydrocannabinol (delta-9-THC) produces marked increases in heart rate, prolongation of left ventricular ejection time corrected for heart rate (LVETc), and a shortening of the pre-ejection period in normal volunteers. Beta-adrenergic blockade partially attenuates these responses. To elucidate further the mechanism of action of delta-9-THC, we gave 10 normal volunteers 0.1 mg/kg of i.v. propranolol and 2 mg of i.v. atropine before they received 25 micrograms/kg of i.v. delta-9-THC. Systolic time intervals were compared in the denervated subjects before and after delta-9-THC. Post delta-9-THC responses were measured at a time approximating peak psychologic high. Mean +/- SEM heart rate before and after delta-9-THC was 89 +/- 4 and 87 +/- 3 beats/min (NS); mean +/- SEM pre-ejection period before and after delta-9-TCH was 107 +/- 5 and 109 +/- 4 ms (NS); and mean +/- SEM LVETc before and after delta-9-THC was 433 +/- 6 and 429 +/- 6 ms (NS). Since previous denervation of our subjects with atropine and propranolol totally abolished changes in heart rate and systolic time intervals, the cardiac effects of delta-9-THC appear to be mediated totally via the autonomic nervous system, probably reflecting direct central nervous system stimulation.


Mebendazole.

Mebendazole. The broad-spectrum of activity and safety of mebendazole remain, after 5 years of clinical experience, unique features of this anthelmintic. Through microtubular destruction, mebendazole kills helminths by inhibiting glucose uptake into susceptible parasites. The drug's poor absorption does not appear to affect clinical efficacy except, perhaps, in the treatment of systemic helminth infections. Mebendazole is generally considered the drug of choice for trichuriasis and has therapeutic advantages over other anthelmintics in the treatment of enterobiasis and hookworm infections. Although mebendazole is an effective agent against ascariasis, there are preferable alternatives. Among its nonapproved uses, mebendazole shows great promise in the treatment of capillariasis and hydatid disease. Further investigation is needed to establish its role in the treatment of taeniasis, Hymenolepsis nana, strongyloidiasis, trichinosis, and Dipetalonema perstans. Undoubtedly, mebendazole will find its greatest value in the treatment of patients with multiple helminth infections.


Sensitivity and specificity of screening tests for renal vascular hypertension. To facilitate the identification of patients with renal vascular hypertension, we evaluated four potential screening tests: rapid-sequence urography, systolic-diastolic abdominal bruit, upright plasma renin activity (PRA), and response to saralasin infusion. Our study included 379 normal subjects, 199 essential hypertensive patients with normal renal angiograms, and 64 patients with surgically responsive renal vascular hypertension. Thirty-nine percent of patients with renal vascular hypertension had systolic-diastolic bruits, 76% abnormal urograms, and 27% a PRA greater than 30 ng of angiotensin 1/mL.3 h. Only one half of the 23 patients with renal vascular hypertension tested had a depressor response to saralasin, as did two of 13 essential hypertensive patients. In essential hypertensive subjects, 1% had systolic-diastolic bruits, 2% abnormal urograms, and 5% upright renin values greater than 30 ng of angiotensin 1/mL.3 h. The screening combination of urogram, bruit, or upright renin value offered a test sensitivity of 93%, with a specificity of 92%. The results of saralasin infusion failed to increase the diagnostic yield.


The medical record as a basis for assessing physician competence. The medical record can be used for evaluating physician performance. Within the limitations described, it is an essential source of information on the delivery of care as well as a measure of proficiency. The process of care should be particularly emphasized, without neglecting appropriate outcome measures. The confounding of outcome measures by compliance factors, natural history of the disease process, severity of illness, status of defense mechanisms, performance of ancillary services, and personnel does not make this an attractive single measure of physician performance. Knowledge assessment and performance assessment play a complementary role; both are necessary to identify competency. The potential for improving medical care and the recording of essential findings by such an emphasis on individual assessment based on medical records is enormous. Technologic progress in recording and retrieving medical information is facilitating use of the record to measure proficiency. A carefully structured blend of cognitive examination to establish a knowledge base and review of the medical record to measure performance will provide better measures of competency.


The recent decline in ischemic heart disease mortality. Age-adjusted overall ischemic heart disease mortality declined by 20.7% in the United States between 1968 and 1976. Declines were recorded in both sexes, in all age groups, and in three major race/ethnic groups. The decline cannot be explained by shifts in assignment of cause of death on death certificates. Available evidence suggests that improvements in diet with concomitant declines in serum cholesterol concentration, decreased cigarette smoking, improved hypertension control, and possibly increased leisure-time physical exercise explain a portion of the decline. Coronary care units have probably also contributed. Emergency medical services and coronary bypass surgery were not widely enough applied during this period to have contributed to the decline. Several strategies are suggested for further elucidating the relative contributions of various preventive and curative programs. Such information is urgently needed to foster optimum allocation of scarce resources between competing (and expensive) programs.


[Endomyocardial biopsy results and left ventricular function in primary myocardiopathies (author's transl)]. Endomyocardial biopsies (EMB) of the left ventricle (LV) were performed during cardiac catheterization in 27 patients with apparently primary myocardiopathies (PMC). The results of optical and electron microscopy were compared with ventricular performance indices calculated from hemodynamic and cinematographic data from the left ventricle. The telediastolic pressure of the LV increases with the spread of fibrosis (r = 0.68) suggesting that it disturbs the filling of this cavity. Systolic effort is reduced as this fibrosis increases (r = 0.56), and it contributes to the changes in the pumping function of the LV, but the contractile power of the LV is altered in a less evident and less constant manner. The association of cell and fibro-elastic tissue degeneration is always accompanied by a drop in ventricular performance (p less than 0.0001). Apart from its diagnostic role, which is limited but may be of great value, the EMB can help to clarify the physiopathology of PMC and to formulate a prognosis based on more solid grounds.


[Severe aortic incompetence from dysplasia of the valve. A report on 19 cases of this real but often unrecognized disorder (author's transl)]. A total of 19 patients were found to have severe aortic incompetence from dysplasia of the valve (thin, spread-out valves having a tendency towards eversion). This type of valve abnormality is often unrecognized but is found in 13,6% of cases of severe aortic incompetence. The relationship between this condition and Marfan's syndrome or its aberrant forms are discussed, as well as its frequency when unrelated to this disease. The dysplasias can be isolated phenomena or associated with pathological conditions of the ascending aorta. The results of this review suggest that some of these dysplasias might be rheumatic in origin.


[Clinical and biological aspects of macroamylasemia (author's transl)]. The authors report a case of macroamylasemia in which the diagnosis was made with some difficulty. A hyperamylasemia was discovered after the patient, an alcoholic, had been hospitalized for atypical abdominal pain and weight loss, and this was thought to be due to an acute episode of chronic pancreatitis. The absence of an incrase in amylasuria suggested the presence of a macroamylasemia, and both diagnoses were confirmed by suitable exploratory investigations. Alcoholic cirrhosis was also present. The two main known types of macroamylase and their iatrogenic variant are described as well as the incidence of this biological anomaly in the general population. Confirming the presence of this anomaly in the plasma is a delicate and complex procedure. Simultaneous study of amylase-creatinine clearance ratio was thought to be a decisive test, but this does not appear to be true.


A code for reporting and comparing results in phage typing. This code, like the others proposed, involves the definition of a characteristic reaction for each system. Each reaction must be positive or negative. As regards the interpretation of results, it is worth noting that if the bacteriophage typing system uses not less than 5 phages, there is no problem for interpreting the results of small series of 10 to 20 strains, whatever the code used. But should the system use more than 5 phages, the advantage offered by the octal code becomes obvious because, without computer, the manual coding for comparing the results of various series is always possible. Beyond 6 phages, the binary pattern reporting, unintelligible without correction, is possible with an octal number not exceeding 7 digits for a pattern corresponding to a 21-phage set. When very large series of strains are considered, the coding can be completely done and printed out by any computer through a very simple program. This proposed code is not only rational but also a useful method even if the number of phages used is larger than 20 or 30, but after a computer becomes necessary however the coding system used.


[The influence of thymus on mouse resistance against rabies before and after vaccination (author's transl)]. Thymus participation was investigated in a comparative study of natural resistance to rabies in Nude mice and normal litter mates. Such participation does not seem to happen during Challenge Virus Strain infection but might change the host cell-virus metabolism during street rabies infection by inhibition of Negri bodies genesis. However, this participation seems indispensable (except in few cases) to allow resistance after vaccination. For instance twice more antigen is necessary to immunize thymectomized than normal mice, and most of Nude mice can not stand intramuscular challenge nor produce antibodies, neither they are able to be protected by injection of antirabies antibodies.


IgM and IgG antibody responses in rabies encephalitis. Immunological survey of 3 patients with proved rabies encephalitis shows three interesting facts. 1) An IgM local synthesis, sometimes proportionally higher than IgG local synthesis, is observed in 8 CSF (among 13 investigated) and detected early, during the first week of the disease for 2 patients. 2) A relative poor IgG response is noted; this response is absent in one and decreasing in the 2 others patients despite their progressive aggravation. 3) A very little elevation of blood nucleic antibodies is detected in 5 CSF only. This very poor synthesis of antinucleic IgG contrast with their common increase in viral encephalitis. Thus, a viral immunosuppression may be discussed in rabies encephalitis, which may contribute to the lethal prognosis.


[Rahnella aquatilis, a new member of the Enterobacteriaceae (author's transl)]. A DNA-DNA hybridization study was carried out to determine the taxonomic position of a new group of enterobacteria (group H2) previously studied by numerical taxonomy. All the strains of this group revealed relatively high reassociation binding ratios with the centrotype; 82% of the strains of the group showed more than 69% of reassociation with the centrotype. In spite of numerical taxonomy conclusions, there was no genetic relationship with the species Enterobacter cloacae (higher reassociation binding ratio: 37%). No significant genetic relationship with the other groups of enterobacteria was found. Rahnella aquatilis was defined from phenotypic and genetic data. The strain 133 (CIP 78-65) is proposed as type strain of the species.


[Detection and significance of histidine decarboxylase (HDC) in "Klebsiella", "Enterobacter" and "Serratia" (author's transl)]. A quick colorimetric procedure for detection of histidine decarboxylase (HDC) in cultures of Klebsiella, Enterobacter and Serratia is described. Only E. aerogenes could decarboxylate histidine (production of histamine). The interest of HDC test for differentiation of E. aerogenes from K. pneumoniae (especially urease negative strains) is discussed.


Local steroid therapy in adnexal hemangioma. Hemangiomas of the eyelid and adnexa in infants may require treatment if they threaten to induce amblyopia or motility disturbances. Four cases are presented that were treated with local injection of corticosteroids. Three responded favorably. Advantages over other modes of treatment are discussed.


[A study of the action of sodium chlorate on strains of nitrate reducing soil bacteria (author's transl)]. Fours strains of nitrate reducing bacteria isolated from soil were studied for their behavior towards chlorate. They are facultative anaerobes, except for Bacillus megatherium (which is a strict aerobe) and they possess a nitrate reductase A. The growth of three strains of bacteria (Klebsiella pneumoniae, B. licheniformis and Micromonospora globosa) was slowed by sodium chlorate at a concentration of 0.06 to 0.1% while the other strain (B. megatherium) tolerated the CIO3- well. The delay of bacterial growth due to chlorate lasts for a certain period, after which the bacteria multiply again. The lag phase is due to small quantities of chlorite produced from the chlorate; the growth phase which follows is provoked by the multiplication of chlorate resistant mutants, most often nitrate reductase-negative and sometimes positive. Some reverse mutants nitrate reductase positive of K. pneumoniae no longer had the same characteristics as the wild strain: some resisted to chlorate or were different as to gas formation. The reduction of nitrate to ammonia by these bacteria is diminished in the presence of chlorate: the reduction of nitrate to nitrite was inhibited or not inhibited according to the type of strain. The bacteria broke down the chlorate partially or completely, according to the strains and the sustrates.


Intravitreal and intracameral cysticercosis. A 49-year-old Mexican male presented with a free-floating cyst in the vitreous. The cyst was removed at the time of cataract surgery and on the first postoperative day a second cyst was found in the anterior chamber. The second cyst was excised by cryoextraction 6 weeks after the initial surgery, but the eye developed an inoperable retinal detachment and phthisis bulbi. Although the diagnosis of cysticercosis was made clinically, initially, the only laboratory evidence for parasitic infection was a peripheral blood eosinophilia. The patient later developed an enlarged liver which was consistent with parasitic infection based on a liver scan. The morphology and life cycle of the parasite is described as well as suggestions for surgical removal.


Pattern of retinal diseases in Lagos.

Pattern of retinal diseases in Lagos. Although primary retinal detachments occur infrequently in Africans, retinal diseases are not so uncommon. Ninety-two out of 1,723 patients seen in the Lagos University Teaching Hospital Eye Clinic had retinal diseases, a prevalence of 5.3%. We have seen most of the diseases described in other countries but while sicklemia retinopathy and various types of tapetoretinal dystrophy constitute a problem, hypertensive and diabetic retinopathies are infrequently seen. Retinoblastoma is the only tumor encountered so far and would appear to be sporadic. Positive family histories are difficult to obtain in our patients. It is anticipated that more retinal diseases will be diagnosed as more people become literate and notice slight to moderate visual loss.


Ocular manifestations after upper dorsal sympathectomy. Fifty patients underwent ophthalmologic examination before and after bilateral upper dorsal sympathectomy performed for palmar hyperhidrosis. Postoperative examination was done during the first week, at 3 to 4 weeks and at 6 to 12 months after the operation. Immediately after surgery there were 18 patients with ptosis (6 severe) and 23 with miosis (12 severe). There were 19 patients with excessive lacrimation and some degree of congestion of conjunctival blood vessels was present in almost all patients. Uniocular decrease in tears was present in 2 patients. Most of these manifestations decreased with passage of time. At one year there remained only 3 patients with severe ptosis and 4 with severe miosis. The results suggest that the classical anatomic explanation of Horner's syndrome may require some modification.


Blood levels of thiamine and ascorbic acid in chronic open-angle glaucoma. Blood levels of thiamine and ascorbic acid in chronic open-angle glaucoma are determined in this study. Dietary vitamin intake was compared with thiamine and ascorbic acid blood levels in a sample of 38 patients with glaucoma and 12 controls. These patients had a statistically significant lower thiamine blood level than controls (P less than 0.001), but no significant difference was found for ascorbic acid blood levels. Poor absorption of thiamine occurred in the glaucomatous patients in this study.


"Congenital" hematic cyst of the orbit.

"Congenital" hematic cyst of the orbit. A case of true hematic cyst of the orbit in a 10-year-old girl, apparently resulting from birth trauma, is presented. Ultrasonic and clinical features believed to aid the examiner in correctly diagnosing such a lesion are presented. While apparently unique among reported cases, "congenital" hematic cysts of the orbit undoubtedly occur occasionally and the possibility of this entity should be considered in appropriate circumstances.


Choroidal detachment with flat anterior chamber after cyclocryotherapy. A 50-year-old black man with uncontrolled open-angle glaucoma developed a flat anterior chamber after cyclocryotherapy. Because of poor visualization secondary to a cataract, ultrasonography was used to confirm the diagnosis of a large choroidal detachment. After suprachoroidal drainage and reformation of the anterior chamber, the patient has done well.


Sympathetic ophthalmitis simulating Vogt-Koyanagi-Harada's disease after retinal detachment surgery. A rare case is reported of a 49-year-old myopic patient who developed sympathetic ophthalmitis simulating Vogt-Koyanagi-Harada's disease following successful retinal detachment surgery, who showed satisfactory response to systemic and subconjunctival steroids and was saved from permanent blindness.


[Nasosinusal polyposis and aspirin intolerance. Fernand Widal-Lermoyez syndrome]. The authors describe the clinical picture of the aspirin idiosyncrasy and propose to call this peculiar entity: syndrom of Widal and Lermoyez. They compare 25 cases of aspirin nasal polyposis with 26 other cases of various etiologies. Other substances than aspirin seem to be charged. The complications are regular with severe asthma and infection. The pathogenesis is discussed, excluding an allergic mechanism; it remain not quite clear. Essentially prophylactic, the treatment is poor and difficult.


[Anal symptoms of gastro-intestinal diseases]. In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy.


[Pharyngolplasty by transposition of the posterior tonsillar pillar (author's transl)]. 13 children suffering from velo-pharyngeal insufficiency were operated. A transposition of the posterior pillar was carried out. After exposing the principle of the method, the anatomical bases of the operation and the operation technique used are described. The pharyngeal sphincter thus reconstituted has nearly always resulted in an improvement in the phonation in these subjects.


[Household cleansers and nickel allergies]. Attention of authors has been drawn by the observation of patients presenting a nickel-dermatosis, instigating by the touch of jewelry (ear-rings, bracelets, necklaces...) and also a sensitization for housework cleansing agents. The chemical analysis of numerous housework cleansing agents exhibited the constant presence of nickel in these housework cleansings. These investigations enable the authors to affirm a close relationship between sensitization for nickel and sensitization for housework cleansings. Some patients present also sensitization for chromium or cobalt. The authors think this polysensitization is induced by metal's contamination.


[Dermatitis herpetiformis (author's transl)]. Detailed investigations of 9 patients with dermatitis herpetiformis are presented. In all cases cutaneous lesions were controlled by dapsone alone or by dapsone and gluten free diet. Granular IgA deposits were found in 7 patients, linear IgA deposits in one, and C3 component of complement in one. 3 patients out of 8 tested, carried the specific HLA-B8 antigen. Despite an extensive investigation, no malabsorption was detected. Jejunal biopsies were performed in 8 cases. Jejunal villous flattening was observed in one patient. It improved after a 2 months gluten free diet on subsequent jejunal biopsies. D. H. seems peculiar in France as compared with case reports from other countries: low prevalence of gluten sensitive enteropathy; rare occurrence of the specific HLA-B8 antigen; incidence of D. H. seems to be low in France. It is noticeable that french incidence of coeliac disease is low as well. This suggests a genetic difference in the investigated population (low prevalence of HLA-B8 antigen) and/or different alimentary habits, particularly a low dietary gluten amount.


[Typanosclerosis and labyrinthine trephination. Results]. 38 recent cases of tympanosclerosis have been treated by labyrinthotomy with a few number of complications of this surgery is realised on a dry ear. A platinectomy covered by a vein graft must be prefered at a simple exfoliation of tympanosclerosis covering the fooplaste if the annular ligament is not perfect. The best results are get by direct prothesis between ear drum and vein graft covering platinectomy.


[Richner-Hanhart's syndrome or oculo-cutaneous tyrosinosis (about one case) (author's transl)]. Richner-Hanhart's syndrome correspond to an hypertyrosinemia due to a deficiency of a soluble tyrosine amino-transferase. This recently described tyrosinosis has been called oculo-cutaneous tyrosinosis. This disease transmitted on a recessive way in amenable to a treatment by a low tyrosine diet. In an infant, 18 months old, presenting a bilateral dendritic keratitis, a punctiform keratosis of the extremities, a patchy leucokeratosis of the tongue and a mental ketardation, the hypertyrosinemia reached 52 mg per 100 ml and the urine demonstrated the presence of phenyl-atonic acids. There was no hepato-renal involvement. The deferency of soluble amino-transferase was studied on the hepatocytes and confirmed. The low tyrosine diet made the clinical and biological signs disappear. The improvement was noticeable from the first week on and continued during the 16 months of the follow-up. There was no ill effect of the special diet on the weight and height growth. The oculo-cutaneous tyrosinosis is similar to the experimental form obtained by Schweizer on the rat. The occurrence of intracellular tyrosine crystals probably damages lysosine membrane and the release lysomie proteases induce the cellular lesions.


[Presence of clusters of Langerhans cells and lymphoid cells in the peritumoral infiltrate of a case of basal cell naevus syndrome. Ultrastructural study (author's transl)]. A case of naevoid basal cell carcinoma syndrome with clusters of Langerhans' and lymphoid cells in the inflammatory peritumoral infiltrate, is reported. Electron microscopy shows intercellular contacts between eight to ten lymphoid cells and a single Langerhans' cell. These contacts occur over limited areas of the cell membranes by means of zones of high electron density on the outer edge of the cytoplasm. The functional significance of this finding is discussed, bearing in mind that recent observations have established certain analogies between Langerhans' and interdigitating reticulum cells. The latter might, within the thymus-dependent region of the lymph nodes, contribute to the formation of a micro-environment favourable to certain immunological activities of T-lymphocyte populations.


[Median candidiasis of the tongue (glossitis mediana candidamycetica) (author's transl)]. The median rhomboid glossitis is generally considered as a developmental anomaly of the tongue. Recent clinical, biological and experimental studies provide support for a fongous etiology: this lesion of the midline of the tongue is a chronic hyperplastic oral candidiasis, occurring sometimes in association with candidal commissural leukoplakias and palatine kissing lesions. The yeasts--mainly Candida albicans-- invade the upper parakeratotic layers of the epithelium inducing a proliferating acanthosis of the deeper epithelial ridges; superficial micro-pustules closely related to the candidal hyphae were found in most cases. Antifungal specific therapy appear effective in early lesions; later the condition becomes permanent and, in a few cases, may go further to malignant change. Fourteen cases are presented in this paper: the clinical, histopathological and therapeutic features are obviously in accord with this fongous infectious etiology (already suggested and demonstrated in 1965 by French stomatologists) and with the more recent experimental data published by Cawson, Sohnel and Kirkpatrick, Jones and Russell.


[Incontinentia pigmenti. Study of 7 cases, 2 in men (author's transl)]. We describe 7 observations of incontinentia pigmenti (0.0026 p. 100 of the patients visited in the Department of Medical-Surgical Dermatology, Faculty of Medicine, University of Granada). Two cases with congenital pigmentation and one of these with secondary inflammatory lesions. The electron microscopy shows relation between the classic stages of the process. In two patients there were defects of the Central Nervous System: brain paralysis and microcephaly. Only two patients with blood eosinophilia (13 p. 100-21 p. 100). Evolution benign, except in the case with brain paralysis. There were familiar antecedents in three women and these were not found in two women and two men with normal karyotype. It suggests a mutation. This study has shown a high rate men/women: 2/5; in comparison to other series. We think that it is possible for a mutation and that this disease is more frequent than it seems. It is necessary to think in this disease in all pigmentary abnormalities in children.


[Eosinophilic pustular folliculitis (Ofuji) (author's transl)]. A case, the first French observation of eosinophilic pustular folliculitis (Ofuji) is reported. The long lasting condition of unknown etiology is characterized by slightly indurated erythematous plaques and formation of follicular small papules and pustules. The lesions have a tendency to central healing and peripheral extension and proceed with remissions and exacerbations. Histological features are pustular folliculitis composed chiefly of eosinophiles. Blood eosinophila is often founded. Local corticotherapy and dapsone are sometimes a effective treatment.


[Xanthoma disseminatum (Montgomery's syndrome) (author's transl)]. Montgomery's syndrome is distinguished by skin and mucous membrane xanthomatosis, predominant on folds, associated with diabetes insipidus and normal lipidic balance. From one typical case history occurring in a young gravida, the authors stresse upon: --Review of literature's cases. --Peculiar therapeutic problems during pregnancy. --Nosological discussion: the position of Montgomery's syndrome compared with histocytosis X and other nonnormolipidic xanthomatosis. This problem is all the more important as in this observation xanthomatosis was first with a normal lipidic measurement, lipidic disorders appearing only secondarily.


[Plasmodium chabaudi: changes in the surface sialic acids of red blood cells during infection (author's transl)]. Surface sialic acids of mice red blood cells infected with the malarial parasite Plasmodium chabaudi are increased as compared to extracts of red cells from normal mice. This increase occurs coincidentally when reticulocytes increase in the peripheral blood. The same increase of surface sialic acids is shown by studies of reticulocytes from phenylhydrazine treated mice. Similarly, neutral hexoses, fucose, were found in greater quantities in surface glycopeptides obtained after incubation with trypsin of reticulocytes from phenylhydrazine treated mice than in surface glycopeptides of red cells from normal mice. This increase occurs also in Plasmodium chabaudi infected red cells with the development of reticulocytosis, in the same way. These facts suggest the contribution of reticulocytes to the biochemical changes observed during malaria infection.


[Leishmaniasis in Greece. Results of an entomological survey during June 1977 (author's transl)]. In relation with the recent outbreak of leishmaniasis in Greece, the authors undertook entomological investigations for delimiting the foci of transmission. A first survey, during june 1977, in continental Greece, gave 6 633 sandflies with 21% of P. major and 20% of P. perfiliewi. Captures are analysed for each species with systematic and epidemiological comments.


[Contribution to the study of Microphallidae Travassos, 1920 (Trematoda). XXXIV. Redescription of Levinseniella howensis Johnston, 1917 (author's transl)]. According to the type of L. howensis the species belongs to the subgenus Levinseniella instead of the subgenus Monarrhenos as believed before. The genital atrium has two male pockets and one female pouch.


Bradshaw lecture, 1978. Recent trends in the practice of sphincter-saving excision for rectal cancer. Current fashions in the use of sphincter-saving resections for carcinoma of the rectum are surveyed, with particular reference to the management of growths of the middle third and to the potential role of recently introduced intestinal stapling devices for construction of the anastomoses.


Surgical treatment of bronchiectasis.

Surgical treatment of bronchiectasis. In recent years several reports have suggested that pulmonary resection is the treatment of choice in selected cases of primary bronchiectasis. In this study the clinical features and results of surgical treatment in 53 cases of primary bronchiectasis are described.


[About Serpentostephanus Sudarikov, 1961 (Strigeata : Cyathocotyloidea : Prohemistomidae : Szidatinae) (author's transl)]. The genus Serpentostephanus Sudarikov, 1961 is placed in the subfamily Szydatinae Dubois, 1938, the diagnosis of which is emended. It is near to being Gogatea Lutz, 1935, Szidatia Dubois, 1938 et Mesostephanoides Dubois, 1951. A key of the genera is proposed.


[Intestinal schistosomiasis in the freshwater mangrove of Guadalupe (French Antilles). Ecology of the vector, Biomphalaria glabrata and its parasite Schistosoma mansoni (author's transl)]. In the freshwater mangrove of Dubelloy-Devarieux (Guadalupe), the dynamics of populations of B. glabrata and the transmission of S. mansoni, mostly depends on the alternation of dry and rainy season. The flooding of the mangrove (in september), permits a yearly renewal of the malacological populations. The sizes analysis of the snails shows that the life cycle of B. glabrata include two rainy seasons separated by one dry season. The prevalence of B. glabrata (0,25%) and cercariae densities (0,8 c/l) are very slow. The acrophase of the rhythm of presence in standing waters is reached at 2 pm. Men and rats are infected. The infections of rats is of 20% at the beginning of the rainy season and of 100% at the end of the rainy season. Principal factors involved in the infection of rats are discussed.


The surgical anatomy of the superficial and perforating veins of the lower limb. The superficial venous system was dissected in 60 legs. A possible function is ascribed to the long saphenous vein and an argument against its stripping in varicose veins presented. Abnormality of the long saphenous vein and its association with varicose veins is described. Particular features of the saphenous tributaries are noted and their relevance in varicosity discussed. The perforator system is described, the distinguishing properties of the medial ankle perforators being examined and their anatomical confinement delineated.


Helminths of birds and mammals of Israel. VIII.- Skrjabinocapillaria rodentium n. sp. (Nematoda Capillariidae) from gerbillid and murid rodents. Skrjabinocapillaria rodentium n.sp., found in the stomach of Meriones crassus, Gerbillus pyramidum, G. gerbillus, G. dasyurus and Acomys cahirinus, is described. It differs from the other two species in the genus, S. bakeri and S. eubursata, mainly in being larger, having a larger number of stichocytes and having a cephalic influation in the female and not in the male.


An open technique of pleural biopsy in the diagnosis of tuberculous effusions. To assess an open technique of pleural biopsy as an aid to diagnosis in pleural disease 107 African patients with radiological evidence of pleural effusion underwent biopsy. In 87 there was radiological evidence of an effusion but not of underlying lung disease; 73 patients (84%) in this group were ultimately diagnosed as suffering from tuberculosis and of these 56 (77%) had a positive pleural biopsy. There was a heavy male predominance of tuberculous infection (male:female ratio approximately 5:1) and half of the patients were aged 21 to 30 years. In the 20 patients with radiological changes in the lung a diagnosis was established by biopsy in 13 cases. Four of these were tuberculous and a further two cases of tuberculosis were established on clinical grounds.


[Redescription of Onchocerca gibsoni C. et J., 1910 (author's transl)]. O. gibsoni is redescribed; the hypoderma and the musculature of the female body are studied on transversal sections and compared to several other species of Onchocerca. These structures and the general morphology show the autonomy of a small line of asiatic and african Onchocerca of Bovines (O. gibsoni, O. dukei, O. ochengi and, probably, the other nodular Onchocerca of Bovinae), to which the human parasite, O. volvulus, belongs. The presence of O. gibsoni in Africa is doubtful.


[Baeodasymyia modesta n. g., n. sp. from the Republic of Haïti (Diptera, Ceratopogonidae) (author's transl)]. The authors describe a new genus and a new species of Ceratopogonidae: Baeodasymyia modesta n.g., n.sp., which somewhat resemble the two genera Paradasyhelea Macfie, 1940 and Baeohelea Wirth and Blanton, 1970.


Induction of urogenital neoplasia and abnormalities from prenatal exposure to diethylstilbestrol. The occurrence of vaginal clear cell adenocarcinoma in young women following exposure in utero to diethylstilbestrol (DES) is now well documented. In addition to this carcinogenic potential. DES has been shown to be teratogenic. In females, the DES-related malformations include vaginal adenosis, transverse ridges of the vagina or cervix and uterine abnormalities. Although no neoplasms have been observed in DES-exposed males, malformations of the epididymis, testes and phallus are relatively common and may result in infertility. The carcinogenic mechanism of DES may be either a direct induction of malignant potential in vaginal cells or a teratogenic effect causing ectopic Müllerian epithelium which could be exposed later to mutagenic agents in the vagina. The absence of malignancy in DES-exposed males may favor the latter hypothesis since male Müllerian remnants are internal structures and thus would not be exposed to surface carcinogens.


Ectopic hormone production by malignant tumors. Malignant tumours of nonendocrine tissues may produce ectopic hormones. The most likely mechanism is depression of genes which code for hormones. Ectopic hormones are invariably peptides, and each is identical to some peptide product of an endocrine gland. However, the majority of ectopic hormones occur as biologically inactive precursors or subunits and therefore remain occult unless they are specifically sought. When appropriate assays are made for such inactive forms, it is found that ectopic production of hormone-like peptides occurs frequently. Clinical syndromes result only in the relatively rare patients in whom a biologically active form is synthesized in large quantities. Laboratory research in this area improves our understanding of genetic control mechanisms in neoplasia. Ectopic hormones may be of limited use in diagnosis of cancer, especially when multiple markers are measured simultaneously.


[Transferrin types in the Dama (Southwest Africa)]. The transferrin type of 238 Dama serums was determined and an estimate made of the gene frequencies. Using the SANGHVI method, the distribution of the transferrin types of the Dama was compared with 53 African populations south of the Sahara. The comparison demonstrates the great dissimilarity of the Dama to the Khoisanide tribes and confirms--at least in part--the results of polysymptomatic affinity comparisons of the Dama with other African populations.


Electron microscopy in the diagnosis of pituitary tumors. The usefulness and limitations of electron microscopy (EM) in pituitary tumor diagnosis are reviewed and illustrated with clinical examples. The traditional classification of chromophil and chromophobe adenomas is often inconsistent with the hormonal activity of the tumors. Virtually all pituitary adenomas contain some secretory granules when viewed with EM. Endocrine inactive chromophobe adenomas contain 150 nm granules with no demonstrable hormone function. Typical growth hormone (GH) secreting eosinophil adenomas contain large 375 nm granules which dominate the cell cytoplasm. GH secreting chromophobic tumors contain secretory granules of abnormal size and concentration which are invisible to the light microscopist. The variability in granule size may indicate the production of abnormal granules or reflect the stage of the cell in a secretory cycle. Because of this wide range in granule size, the identification of tumor cell type or hormone produced is not reliable by granule measurement alone. Some neoplasms in the sella turcica may be so bizzare or undifferentiated as to defy classification. In such instances, EM can reveal ultrastructural details which identify their origin from pituitary tissue. Malignant pituitary tumors may contain minute secretory granules, and rare pituitary oncocytomas are packed with abnormal mitochondria.


[Iris heterochromia: variations in form, age changes, sex dimorphism]. On a sample of n = 25,346 individuals from Vienna (10,855 males, 14,491 females) the iris pigmentation has been typed by the author. In this sample 65 cases of different types of heterochromia were found. The frequency of the occurrence of the different types of this anomaly could be calculated for the first time. Neglecting age, sex, and type of heterochromia the total frequency amounts to 0.256 (males: 0.157; females: 0.37) %. The variants of heterochromia very from cases of total heterochromia to those of various size; in addition to it a number of special types could be observed. The localization of the heterochrome parts of the iris shows certain variations; mostly, however, it is seen in the lower half of the iris. The nasal part is concerned in only one case; the temporal region never. Thus, the partial heterochromia is characteristic by a marked dependency of its localization. The colour of heterochromia varies from 2 a-14 according to the Martin-Schultz standard set of coloured eyes. However, No. 9 (ca. 50%) and No. 7 (ca. 20%) were the most frequent colours. The age variations are considerable. 5/6 of all heterochromias were found between the age from 2-19 years. Finally, a marked sexual dimorphism was observed, as in females heterochromia is much more frequent than in males.


Incidence of squatting facets on the talus of Indians (Agra region). 230 adult Indian tali (from Agra region) were studied for the incidence of squatting facets. Extension of medial articular facet was observed in all the cases. Medial extension of trochlea was observed in 37% of cases; lateral extension of trochlea in 71.6% of cases, lateral squatting facets in 43.5% of cases and medial squatting in 8.6% of cases. The present data are compared with that of other workers.


Thin needle aspiration biopsy of endocrine organs. The purpose of this paper is to summarize the advantages and disadvantages of the fine needle aspiration technique in reference to the endocrine organs. The principles of technique and interpretation are presented. The application of aspiration biopsies to the breast, the prostate, the pancreas and the thyroid are briefly discussed.


Nickel concentrations in nasal mucosa, plasma, and urine in active and retired nickel workers. The objective of the present investigation was to study the influence of the occupational nickel exposure on the concentration of nickel in nasal mucosa, plasma and urine. Plasma, urine and biopsy specimens of nasal mucosa from 318 nickel workers, 15 retired nickel workers and 57 non-exposed controls were analyzed for nickel by atomic absorption spectrometry. The results showed that nickel exposure led significantly to raised nickel concentration in nasal mucosa, plasma and urine both in active and retired nickel workers. The average nickel concentration in the nasal mucosa was highest in workers exposed to the highest atmospheric nickel concentration, inhaled as nickel subsulphide and oxide dust. Workers exposed to aerosols of nickel chloride and sulphate at a lower atmospheric nickel concentration had, on the other hand, the highest mean nickel concentration in plasma and urine. The mucosal, plasma and urine nickel concentration were significantly correlated to duration of nickel exposure. The accumulated nickel in the nasal mucosa was retained for years after termination of the nickel exposure, and slowly released with an estimated half-life of 3.5 years.


[Stomatological studies of the slavic cemetery at the Spandau Burgwall, Berlin]. The dentition of a medieval population from the former Spandau Burgwall in Berlin was investigated with regard to caries and other abnormities of the teeth, the palate and the jaws. The caries frequency amounts to 7.9%, while 63.6% of the individuals had a caries dentition. The diminuation of the caries frequency from the juveniles to the 40--60 years old individuals depends on the high rate of loss of tooth during life. Probably, all teeth which have been lost during life can be evaluated as decayed teeth. X-ray pictures have shown that three sets of teeth have hypercementotic alterations at the roots, eight permanent dentitions have cysts and apical parodontitis. Supernumerary cuspids at the toothcrowns are to be seen as a tuberculum paramolare and a tuberculum intermedium. A second upper molar has a reduced crown with only two cuspids and shows the tendency of reduction to a bicuspid. Toothrotation and other deviations of teeth from their position in the row are frequent in this material. Four deciduous dentitions of children were investigated, too. Three carious teeth were found among 45 available teeth, two deciduous molars and one first upper molar show a Carabelli's tubercle, the other first molar has a fovea carabelli.


Dopamine-beta-hydroxylase effectors in neuroblastoma. Investigation of dopamine-beta-hydroxylase (DBH) serum activity as a potential diagnostic/prognostic tool for neuroblastoma did not confirm previous reports. However, age-dependent differences in normal children's DBH "activation" by water dilution +/- copper addition was revealed. These findings of age-related DBH effector differences suggest that the strong age relationship of DBH activity may be due to alterations in effectors. Additionally, these effectors may be variably affected by assay methodology, influencing DBH results obtained in neuroblastoma and other disease states.


[Plantar zygodactylous triradii in a population comparison]. The plantar prints of 125 male Japanese were examined with regard to the frequencies of zygodactylous triradii and their expression types. Comparing the results with those of 500 males Viennese the two samples proved to be significantly different. The differences amount to such an extent that even by enlarging the Japanese sample no fundamental changes in the relations between the two populations might be expected. In Japanese the medium expression occurs in very low frequencies and the strong one not at all, while Europeans show those traits in about 60%. Comparing the pattern types characteristic for zygodactylous triradii, the Japanese revealed almost no proximal loops in the second and almost no whorls in the third interdigital area whereas Viennese showed high frequencies of both types. The findings of a sample of Angolan Bantus as well as those of a German one differ from the Japanese in the same way as the Viennese. It was observed that the line connecting the distal ends of the 2nd, 3rd, 4th and 5th toes is formed rather transversally in Japanese, while it is declining towards the 5th toe in Europeans and in Bantus. It requires further studies to prove if there exists a relation between this anatomical trait and the occurrence of zygodactylous triradii.


[Formation of the antibiotic complex 4041 by a culture of Actinoplanes ianthinogenes subsp. octamycini subsp. nov]. A new variety of Actinoplanes, named Actinoplanes ianthinogenes subsp. octamycini Gause et Svechnikova is described. It produces an antibiotic complex consisting of purpuromycin and a new antibiotic belonging to the group of polyens, i. e. octamycin. Maximum accumulation of the above antibiotics in the mycelium was observed in the soybean-glycerol medium.


[Methodological approaches to developing a method of regulated antibiotic biosynthesis]. Methodologic approaches to the development of methods for controlled biosynthesis of antibiotics are discussed with reference to oxytetracycline biosynthesis. The method of acute experiments in conjunction with mathematical methods of experiment planning was used for determination of the substrate concentrations optimal for the culture growth and biosynthesis of oxytetracycline. It was found that such mathematic procedure provided simultaneous determination of optimal concentrations of all the substrates.


The significance of creatine kinase (CKBB) in metastatic cancer of the prostate. Alterations of serum creatine kinase isoenzymes were observed in five cases of prostatic carcinoma. Creatine kinase isoenzyme BB was found in the serum of two of three cases with metastases. Its presence in serum does not seem to be related to acid phosphatase activity but seems associated with extension of the tumor to other tissues. Preliminary studies on effusions from patients with malignant and non-malignant prostates showed that CK-BB was detectable only in cytology positive effusions. This finding suggests that CK-BB may be a tumor product rather than a result of a host response. The observation of CK-BB in a significant percentage of patients (two of three) with metastatic carcinoma of the prostate is of interest and suggests that CK-BB isoenzymes may have some predictive value in following patients with malignant disease.


The microscopical pathology of primary parathyroid hyperplasia. The microscopical pathology of the two types of primary parathyroid hyperplasia is reviewed. The importance of the differential diagnosis between chief cell hyperplasia and adenoma is stressed. The problems of the surgical pathologist in masking this differential diagnosis of a biopsy, especially on a frozen section sample, are discussed.


[Pharmacokinetics and biotransformation of rifamycins in the body of experimental animals]. The study on distribution of 14C-rifampicin and 14C-rifamycin S in experimental animals after intramuscular administration of the drugs showed that concentrations of rifampicin in the organs and blood were higher than those of rifamycin S. Biotransformation products of both antibiotics, such as 25-deacetylrifampicin, N-oxide of rifampicin, 3-phormylrifamycin SV, rifamycin SV and others were found in the liver, kidneys, bile and urine. No products of the antibiotic metabolism were found in the blood, lungs and spleen.


[Action of penicillin on the causative agent of paratrachoma in the dynamics of an in vitro infection]. Monolayer cultures of L-cells (mouse fibroblasts) were inoculated with the causative agent of paratrachoma (strain LB-I). Simultaneously penicillin in doses of 0.01, 0.1, 1, 10, 25, 50, 100, 150 and 200 microgram/ml was added and its effect on the causative agent in the infection dynamics (18, 24, 48 and 72 hours after the inoculation) was studied with the light and electron microscopes. Gradual changes in the ultrastructure of the vegetative forms were observed by the 24th hour with the use of penicillin in a dose of 0.01 microgram/ml: the size of the vegetative forms increased, the cell wall membranes separated and periplasmic space significantly enlarged, the protoplast fragments disjoined into it, large forms vacuolized and were fragment with membranes, sometimes multilayer ones. When the culture was exposed to large doses of penicillin, the rate of the changes in the structure was higher and they were simultaneously of several types. Various types of the changes and possible modes of their formation were analyzed. Morphologically they are similar to the processes observed in L-transformation of bacteria. However, these structures were not infectious.


[Comparative evaluation of methacycline hydrochloride capsules and tablets according to their dissolubility and rate of solution]. Desintegration and dissolution of capsules and tablets of methacycline hydrochloride were studied. The study on solubility of methacycline hydrochliride capsules filled with methacycline granulate or powder according to the same formula showed that the rate of the antibiotic liberation from the capsules filled with the powder decreased during storage while that from the capsules filled with the granulate did not change. Investigation of the effect of the mass packing value in a drop on the antibiotic liberation from the capsules showed that an increase in the packing coefficient above 1.38 resulted in a marked decrease in the rate of methacycline liberation from the capsules filled with the granulate. No correlation between desintegration and dissolution of methacycline capsules and tablets was found.


[Bioavailability of ampicillin suspensions]. The rate of ampicillin transfer into solution from suspensions of 2 types, i.e. suspensions of anhydrous ampicillin and suspensions of ampicillin trihydrate was studied. Conditions for estimation of the rate of ampicillin dissolution from the suspensions were developed. The pharmacokinetics of the pharmaceutical forms was studied on dogs. Definite advantages of the anhydrous ampicillin suspension were shown as compared to the ampicillin trihydrate suspension.


[Bioavailability of peroral drug forms of oxacillin]. Bioavailability of experimental tablets and capsules of oxacillin was studied. Significant differences in absorption of the antibiotic from the above dosage forms were found. By the amount of the antibiotic absorbed the capsules were 3 times more effective than the tablets containing the same amount of oxacillin. The therapeutic concentrations of oxacillin in the blood after the use of the capsules persisted by an hour longer than after the use of the tablets. The results of the study on oxacillin absorption in rabbits allowed a prediction of the antibiotic absorption levels in humans.


[Effect of the polyene antibiotic, roseofungin, on the liberation of the intracellular components from Candida guilliermondii cells and from rat erythrocytes]. Liberation of inorganic ions (potassium and phosphorus), nucleotides and protein from the cells of Candida guilliermondii and rat erythrocytes was studied. It was found that leakage of these components depended on the incubation time, antibiotic dose and amount of the cell material. The potassium ions proved to be most sensitive to the antibiotic: even at low concentrations of roseofungin (2-4 microgram/ml) the amount of the intracellular potassium changed. A decrease in the dry mass and volume concentration in the cells of Candida guilliermondii and lysis in the red blood cells were observed in addition to the leakage of the above intracellular components. The cells of Candida guiliermondii at the beginning of the semilogarithmic growth phase were especially sensitive to roseofungin. The coefficient of roseofungin distribution in the cells of Candida guiliermondü was evaluated. The maximum distribution coefficient was observed at roseofungin concentrations of 40 and 80 microgram/ml for the 4- and 18-hour cultures respectively. Therefore, the effect of roseofungin is characteristic of polyens.


[Use of carminomycin in combination with UHF hyperthermia in the therapy of sarcoma 180]. It was found that combined treatment of sarcoma 180 with local U. H. F.-hyperthermia and carminomycin resulted in the tumor growth inhibition by more than 90 per cent, which was much higher than the effect of every agent alone. The thermochemotherapy allowed a decrease in the dose of the antibiotic without decreasing the antitumor effect. The U. H. F.-hyperthermia has an independent tumorolytic effect and promotes selective accumulation of carminomycin by the tumor.


[Ampicillin pharmacokinetics in the lymph and blood in acute inflammatory diseases of the abdominal cavity organs]. Ampicillin levels in the lymph, blood and urine were studied in 15 patients with various inflammatory diseases of the organs of the abdominal cavity. It was found that ampicillin administered intramuscularly to such patients at early postoperative periods was well absorbed not only to the blood but also to the lymph, reaching in parallel its maximum levels in an hour. After that the drug concentration in the lymph persisted for 6 hours and markedly exceeded that in the blood. Adsorption of the lymph lowered the antibiotic concentration in it to 25 per cent indicating the necessity for increasing the drug therapeutic doses.


[Gentamycin sulfate effectiveness and tolerance in patients with myelotoxic agranulocytosis]. Patients with myelotoxic agranulocytosis were treated with gentamicin administered intravenously as drop-wise infusions in a dose of 5 mg/kg body weight a day every 8 hours. The treatment course consisted of 7--24 days. No toxic reactions were observed. The therapeutic efficacy of gentamicin depended on the neutrophilic level and amounted to 50--60 per cent when the drug was used without identification of the causative agent. The prophylactic use of gentamicin decreased the infection incidence in patients with myelotoxic agranulocytosis, while the prophylactic efficacy of gentamicin was evident only when the number of the granulocytes was higher than 100/mm3 of the blood.


[Prodigiozan aerosols in the treatment of nonspecific respiratory organ diseases in children]. High efficacy of prodigiozan, a bacterial polysaccharide used in the form of inhalation in combined therapy of 123 children at the age of 3 to 14 with nonspecific bronchopulmonary pathologic conditions was shown. The drug was administered by means of inhalators UI-I and PAI-I once every 4--5 days in the form of 0.02 per cent solution prepared in situ. The single and the course doses were 100--400 and 300--2000 micrograms respectively. The positive therapeutic effect was observed in 85.0 per cent of the patients: improvement of the patient state was registered 4--6 days earlier than that in the control group, the indices of the respiration mechanics and nonspecific immunity (titers of lysozyme and complement) also improved. The rate of viral respiratory diseases among the children treated with prodigiozan decreased 2.5 times. High efficacy and physiological character of the aerosol method for administration of prodigiozan used the the first time in pediatry provided its recommendation for wide use.


[Formation of antibiotic 2562 by a culture of the actinomycete, Streptomyces griseovariabilis]. An actinomycetous culture 2562 inhibiting the growth of gramnegative bacteria was isolated from a soil sample. The culture was classified as Streptomyces griseovariabilis. It was found that culture 2562 produced an antibiotic belonging to the group of novobiocin. It consists of 2 components. One of them is identical to chlorobiocin and the other is a minor component of this group. Some parameters of the antibiotic complex production by strain 2562 under submerged conditions were studied. Nutrient media providing the predominant biosynthesis of the first (main) or the second component of the antibiotic were developed.


[Effect of inorganic phosphate on levorin biosynthesis and on the mycelial makeup of Streptomyces levoris]. The effect of inorganic phosphate on biosynthesis of the polyenic antibiotic levorin by Streptomyces levoris and composition of the culture mycelium was studied. It was found that the synthetic medium with 0.4 mM of phosphate was optimal for growth of Str. levoris. When the concentration of phosphate was higher, the biomass increased, while the synthesis of levorin appeared to be inhibited and morphological changes in the culture were observed. Phosphate had a significant effect on the mycelium composition. When its concentration was increased 10 times as compared to the optimal one, the amounts of protein, RNA, total phosphorus and polyphosphates increased 1.3--1.4, 1.6--1.7, 2--3 and 10 times respectively, while the synthesis of levorin decreased 5 times. Changes in the lipid component of the mycelium were also observed. In the absence of inorganic phosphate in the medium the acetone precipitating fraction of the lipids contained 20--40 per cent of the phosphoruless compounds. During cultivation their portion increased up to 70--77 per cent. However, in the presence of its excess the polar lipids were represented only by phospholipids during the whole life cycle. The fatty acid spectrum of the lipids did not depend on the phosphate concentration and was represented mainly by saturated fatty acids with a branched chain of a series of iso- and anteiso-structures containing 14--18 carbon atoms.


[Mechanism of the myeloinhibitory effect of carminomycin]. The proliferative activity and level of aberrant mitoses in the cells of the bone marrow were studied experimentally on 223 noninbred mice treated with carminomycin administered intraperitoneally in single (LD50) and repeated doses. When the antibiotic was used in a single dose the values of the mitotic activity of the bone marrow elements did not correspond to the severity of depression and thir quantitative composition, which was explained by an impairement of the mitosis quality and possible interkinetic destruction of a significant part of both erythroid and immature myeloid cells capable of division at early stages after the exposure. At the same time the level of the bone marrow devastation under conditions of the treatment with repeated doses was mainly determined by inhibition of the erythronormoblast proliferative activity.


[Effect of streptomycin sulfate on the process of higher nervous activity recovery in dogs in the postanesthesia period]. The effect of streptomycin on recovery of the higher nervous activity during the postanesthesia period was studied on 3 dogs with the method of the conditioned reflexes. It was found that streptomycin sulphate administered in a dose of 25 mg per 1 kg body weight induced no changes in the conditioned reflexes of the non-anesthetized animals. After ether anesthesia disorders in the conditioned and unconditioned reflexes, as well as differentiation was observed during the postanesthesia period. On an average they normalized in 7, 6 and 2 days respectively from the moment of anesthesia. When streptomycin sulphate was used during the post anesthesia period, both the strength and the character of the disorders in the conditioned reflexes changed. In this case recovery of the conditioned and unconditioned reflexes was registered in 2 days, while that of the differential inhibition was registered in 3--7 days from the moment of anesthesia.


[Pharmacokinetic study of rifampicin in the body of pregnant animals]. The study on distribution of 14C-rifampicin administered intramuscularly to pregnent animals showed that its concentrations in the blood, liver, kidneys, lungs and other organs did not practically change from those in nonpregnant animals. The concentration of 14C-rifampicin in the fetus organs was much lower than that in the organs of the adult animals. The liver and kidneys of the pregnant animals, as well as the fetus though to a less extent had a capacity for metabolism of 14C-rifampicin. The following products of biotransformation were detected: N-oxide of rifampicin, 25-deacetylrifampicin, 3-formylrifamycin SV and rifamycin SV.


[Dependence of the nephrotoxic effect of kanamycin on its concentration in the blood (an experimental study)]. The kinetics of changes in the urea nitrogen level of the serum was studied experimentally on narcotized cats with constant blood levels of kanamycin. A relationship between the intensity of the nephrotoxic effect of kanamycin and its blood level was found. On the basis of this relationship lower nephrotoxicity of kanamycin as compared to that of gentamicin and streptomycin under conditions of their constant blood levels was shown. However, the concentrations of gentamicin and kanamycin provided in the blood by their use in therapeutic doses differeing 3--4 times allow a conclusion that the nephrotoxic effect of kanamycin and gentamicin to be practically the same.


Comparison of the activities of the new ureidopenicillins piperacillin, mezlocillin, azlocillin, and Bay k 4999 against gram-negative organisms. The in vitro activities of the new ureidopenicillins piperacillin, mezlocillin, azlocillin, and Bay k 4999 were compared with those of ampicillin and ticarcillin against 336 Enterobacteriaceae, 109 nonfermenters, 55 Neisseria, and 28 Haemophilus influenzae isolates. Bay k 4999 displayed the largest spectrum of activity and had lower minimal inhibitory concentrations than any of the other penicillins against all of the species tested. Piperacillin showed the same spectrum but was slightly less active than Bay k 4999; it was slightly more effective than mezlocillin against Enterobacteriaceae and fully as active as azlocillin against Pseudomonas. All ureidopenicillins were substantially more active than ampicillin and ticarcillin. Isolates highly resistant to ampicillin or ticarcillin were also less susceptible to the ureidopenicillins.


In vitro activity of sodium fusidate against anaerobic bacteria. The microtiter broth dilution method was employed to determine the in vitro susceptibility of 525 recent clinical isolates of anaerobic bacteria to sodium fusidate. The minimal inhibitory concentrations of sodium fusidate ranged from </=0.06 to 1.0 mug/ml for 155 strains of anaerobic gram-positive rods and 130 strains of anaerobic gram-positive cocci. Minimal inhibitory concentrations ranging from </=0.06 to 32 mug/ml were observed for 240 strains of anaerobic gram-negative rods. Among the latter group a minimal inhibitory concentration of 16 mug/ml or greater was encountered with 16% of 45 Bacteroides fragilis strains, 19% of 32 Bacteroides thetaiotaomicron, and all 7 strains of Fusobacterium necrophorum. Minimal inhibitory concentrations for Veillonella parvula, the only gram-negative coccus tested, ranged from 0.5 to 8.0 mug/ml.


Human pharmacology of cefotaxime (HR 756), a new cephalosporin. Cefotaxime (HR 756) is a new semisynthetic parenteral cephalosporin with exceptional activity against gram-negative organisms and considerable stability against their beta-lactamases. To study its pharmacokinetic properties, 0.5-, 1-, and 2-g doses were administered to each of six volunteers intravenously over 15 min, followed by a sustaining infusions of 0.5, 1, and 2 g/h, respectively, for 3 consecutive hours. The loading doses produced mean peak levels of 41, 93, and 160 mug/ml, and mean steady-state serum concentrations were 27, 64, and 138 mug/ml, respectively. The mean terminal half-life was 75 +/- 7 min. The total volume of distribution averaged 0.22 +/- 0.03 liters/kg of body weight. Total body and renal clearances were 232 +/- 30 and 145 +/- 24 ml/min per 1.73 m(2), respectively; 63 +/- 9% of the administered dose was excreted through the kidneys in 24 h. To determine the effect of cefotaxime on the renal tubules, urinary alanine aminopeptidase excretion was measured before, during, and after the infusions. It remained within the normal range in all instances; however, 48 +/- 14% of the total daily alanine aminopeptidase output was recovered during the infusion period. Side effects were dose related and included fatigue, loose stools, and night sweats. No significant changes in hematology, serum chemistry, or urinalysis were recorded.


In vitro antiherpesviral activity of 5-alkyl derivatives of 1-beta-D-arabinofuranosyluracil. Several 5-alkyl derivatives of 1-beta-d-arabinofuranosyluracil (araU) were tested for antiherpesviral activity and inhibitory action on cell growth in human embryonic lung fibroblasts. 1-beta-d-Arabinofuranosylcytosine, 9-beta-d-arabinofuranosyladenine, and 5-iododeoxyuridine (IUdR) were included as reference materials. Among the 5-alkyl derivatives of araU, arabinosylthymine was the most active, followed by 5-ethyl- and 5-propyl-araU. 5-Ethyl-araU was as active as IUdR and more active than 9-beta-d-arabinofuranosyladenine against herpes simplex virus (HSV) type 1 and did not inhibit cell growth at a concentration as high as 1,000 mug/ml. 5-Butyl- and 5-methoxymethyl-araU, as well as araU, exhibited relatively low activity. The araU derivatives tested were as active against HSV WT-34, an isolate from a patient with keratitis, as against HSV type 1. Against an IUdR-resistant isolate, HSV WT-20, arabinosylthymine was less inhibitory than IUdR. Deoxyribonucleic acid synthesis in HSV type 1-infected cells was markedly inhibited by arabinosylthymine, IUdR, and 5-ethyl-araU, whereas cellular deoxyribonucleic acid synthesis in uninfected cells was significantly inhibited by IUdR but not by arabinosylthymine or 5-ethyl-araU.