The role of computed tomography in the evaluation of neck masses. Application of computed tomography (CT) to neck masses has received little attention. The authors reviewed 10 cervical masses studied with CT as well as conventional imaging modalities. CT was extremely useful in defining both the osseous and soft-tissue extent of the lesion. In several instances, CT was able to show the relationship of the tumor to the spinal canal. When combined with angiography, CT demonstrated the relationship of the major cervical vascular channels to the lesion. Pathological conditions included neurofibroma, chordoma, branchial cleft cyst, neuroblastoma, lymphoma, neurilemmoma, and metastatic carcinoma.


Computed tomography of the injured larynx. Computed tomography (CT) permitted a much more detailed appraisal of laryngeal dysfunction in patients with blunt laryngeal trauma (8 cases) and iatrogenic injury caused by radiation therapy (7 cases), surgery (2 cases), or intubation (1 case). In thyroid cartilage fractures, the fragments may be widely displaced. The cricoid ring breaks in two places, frequently involving the signet. CT facilitates diagnosis of the mechanism of injury based on the site and extent of fractures. The patterns of distortion and fibrosis of the laryngeal cartilage following radiation therapy may be manifested as encroachment on the airway, easily mistaken for recurrent tumor or localized edema. Minor distortion probably escapes detection on clinical examination. The authors consider CT the examination of choice in laryngeal injury.


Computed tomographic staging of malignant gastric neoplasms. Eight patients with proved gastric carcinoma and 3 with gastric lymphoma were studied preoperatively with computed tomography. CT accurately identified abnormal stomach wall thickening and intra-abdominal tumor extension. Mural thickening was seen on the CT scan when a moderately distended stomach had a wall more than 10 mm thick. CT was useful for assessing surgical resectability, evaluating tumor response to chemotherapy or radiotherapy, and detecting postoperative recurrence. Fourteen patients with an abnormal barium study suggesting gastric malignancy were also studied with CT, which correctly demonstrated a normal stomach or identified the reason for the abnormal barium study, such as an unusual placed spleen or a pancreatic carcinoma invading the stomach.


The accuracy of sonography in the differential diagnosis of obstructive jaundice: a comparison with cholangiography. The value of sonography in determining the site and nature of biliary obstruction with surgical jaundice is described in 32 patients. All diagnoses were subsequently established by surgery and pathology. The site of obstruction was delineated in 94%, while the nature of the lesion was established in 81%. In comparison, contrast cholangiography correctly delineated the site in 96%, but helped determine the etiology in only 82%. Sonography is sufficient to adequately evaluate patients prior to surgery, while percutaneous transhepatic cholangiography should probably be used only when satisfactory ultrasound examinations cannot be obtained.


Ultrasonography and computed tomography of carcinoma of the gallbladder. Ultrasonography and CT have been used to diagnose carcinoma of the gallbladder, since in most patients the diagnosis cannot be made through radiography alone. Ultrasonography was performed on 14 patients and CT on 7. Ultrasonographic findings are classified into four types. Frequently, there are gallstones, dilated bile ducts, or metastatic lesions in the liver or retroperitoneal lymph nodes. The diagnosis was made or suggested by ultrasonography in 84.6% of patients. Findings on CT correlated well with the ultrasonographic features.


Air crescent sign of invasive aspergillosis. Pulmonary infection in immunocompromised patients is frequently difficult to diagnose. Therapy for the more common pathogens differs greatly from that for infection with unusual opportunistic organisms. However, neither of these infectious agents offers specific radiographic signs. The authors report on 4 patients with acute leukemia and invasive aspergillosis whose radiographs demonstrated a distinctive feature of one or more air crescents within an area of pulmonary infiltrate. Autopsy studies correlated the radiographic changes with an infection due to Aspergillus species fungi. While the sign is not pathognomonic for Aspergillus infection, seen in a suitable host, it would suggest the possibility of invasive aspergillosis.


Cellular attachment as a sensitive indicator of the effects of diagnostic ultrasound exposure on cultured human cells. Dispersed cultured human cells (T-1 kidney, FL embryonic kidney, ES amniotic, and JHA amniotic) were seeded into plastic Petri dishes, incubated for 45 minutes, exposed to a clinical ultrasound source [total power output, 1.76 +/- 0.18 (S.D.) mW] for 0.25-60 minutes, and the medium replaced. Attachment was significantly reduced after only 0.50 minute of exposure. For all exposures, sensitivity of the JHA amniotic cells was greater than that of the kidney lines. Like incremental reduction in attachment, differential sensitivity among cell lines became less pronounced with protracted exposures. Thus cellular attachment is a sensitive parameter for studying the effects of diagnostic ultrasound.


Sonographic morphology of the normal menstrual cycle. Sequential gray-scale sonograms were obtained during 20 menstrual cycles in 16 normal female volunteers. Hormonal and physical parameters of an ovulatory cycle were correlated with morphological changes in the ovaries, uterus, and cul-de-sac as seen on the sonogram. Ovarian cysts of two sizes were observed, corresponding chronologically and morphologically to Graafian follicles and corpora lutea. Small amounts of free pelvic fluid were demonstrated in many women at ovulation. A characteristic uterine appearance is seen prior to menstruation and is related to hormonal influences on the uterus. These findings emphasize the importance of recognizing normal physiological changes when interpreting gynecologic sonograms.


Interpretation of indeterminate lung scintigrams. Lung scintigrams and pulmonary angiograms of 111 patients with suspected pulmonary embolism who had matching perfusion defects and radiographic abnormalities (infiltrate, atelectasis, or effusion) were reviewed. In 14 patients perfusion defects were substantially smaller than the corresponding radiographic opacity; only 1 (7%) had pulmonary embolism. In 77 the opacities and perfusion defects were of similar size; the abnormality was due to embolism in 20 (26%). In 18 patients perfusion defects were substantially larger than the radiographic opacities and were not associated with matching ventilation abnormalities; of these, 16 (89%) had pulmonary embolism. Evaluation of the relative size of perfusion defects and radiographic abnormalities occurring in the same region improves the ability of lung scintigrams to predict pulmonary emboli.


Positron-emission computed tomography of the pancreas: a preliminary study. Twenty-seven patients with suspected pancreatic disease were examined with emission computed tomography (ECT) with 11C-labeled amino acids. Of 24 patients with known clinical outcome, there were 1 false positive and 2 false negative results. One finding of interest was the increased concentration of radiopharmaceutical that accurately delineated the presence and extent of 4 pancreatic carcinomas and 1 lymphoma. In the normal subjects ECT reliably identified the pancreas. Disadvantages of ECT include the need for a cyclotron and high-quality hot chemistry laboratory, and the relatively long scanning time. The advantage of ECT is that it offers a unique opportunity to image biologic activity of the pancreas.


Radionuclide imaging in the assessment of primary chronic pyelonephritis. The diagnostic value of radionuclide imaging as a supplement to excretory urography was assessed in 33 patients with primary chronic pyelonephritis. Both 99mTc-glucoheptonate and 131I-Hippuran were used. Radionuclide imaging did not improve the sensitivity of detection by urography alone (31 of 33 patients). Nevertheless, in one third of cases the radionuclide studies demonstrated certain abnormalities more readily, including focal parenchymal damage, renal functional impairment, and decreased renal perfusion. Radionuclide imaging is useful when minimal or no abnormalities are observed on the excretory urogram or nephrotomogram.


Bone marrow dose in chest radiography: the posteroanterior vs. anteroposterior projection. The dose to active bone marrow resulting from anteroposterior (AP) and posteroanterior (PA) chest examinations was estimated using an Alderson Rando phantom and extruded lithium fluoride dosimeters. The AP projections resulted in a mean marrow dose range of 1.9-2.6 mrad (0.019-0.026 mGy) as compared to doses for PA projections of 3.4-3.8 mrad (0.034-0.038 mGy) for optimally diagnostic exposure taken at 70, 90, and 120 kVp.


Anthropomorphic test objects for CT scanners. Numerous types of artifacts can result in clinical misinterpretations in computed tomography. The authors have evaluated phantom materials and techniques of construction which would produce objects similar enough to the human body to test the accuracy of CT in vivo. The object used for this purpose is a thoracic section with five soft-tissue materials, representing adipose tissue, muscle, heart, esophagus, and lung, and three bone materials representing cortical bone, average rib, and "inner" (trabecular) bone. The accuracy of CT numbers for studies of different organs was assessed and sources of error in five commercial scanners were identified.


Magnification mammography: evaluation of screen-film and xeroradiographic techniques. An x-ray unit designed for conventional nonmagnification and magnification mammography has been evaluated in terms of image quality and corresponding radiation exposure levels. The technical advantages of the radiographic magnification technique can result in improved image quality and reduction of the recording-system noise. The microfocal spot allows 1.5 x magnification mammograms with minimal geometric unsharpness. However, the magnification technique requires an increased radiation dose to the breast, compared to conventional nonmagnification techniques. An additional radiation dose may be required for screen-film magnification views because of reciprocity law failure due to long exposure times. The increased-dose limitation and the small dimensions of the recording-system cassettes have precluded the use of magnification in place of nonmagnified images for routine mammographic examination. The magnification technique has proved to be beneficial in selected cases.


The differential density sign of pericardial effusion. Chest radiographs of 100 patients with suspected pericardial effusion who underwent echocardiography were reviewed. Fifty were echo-positive and 50 were negative. The differential density sign was present in 34 patients (68%) who were echo-positive and 2 patients (4%) who were negative; on frontal (62%) and lateral (41%) projections; and in patients with small, moderate, and large effusions. Computed tomographic findings in 1 patient correlated closely with those obtained radiographically. Experimental models suggest this sign is related to different tissue attenuation coefficients for blood and saline, different tissue thicknesses of the spherically shaped heart, the presence of epicardial fat around the heart, and chest film exposure factors. "Trapping" of the middle lobe or anterior lingula may also contribute. When pericardial effusion is not suspected, the presence of this sign should be an indication for echocardiography.


Digital radiograph of the chest using a computed tomography instrument. Digital radiography (DR) was compared with conventional chest radiography in patients with mediastinal adenopathy, sarcoidosis, and metastatic adenocarcinoma. Contrast resolution was improved by the new technique, offering a wider latitude and edge enhancement. While small, low-contrast details were resolved best by conventional radiography, DR was superior for resolution of nodules. With further improvement of spatial and contrast resolution, DR could become the preferred technique of chest radiography.


Treatment of P388 leukemia in vivo with perfluoroctylbromide and radiation: a preliminary study. Perfluorinated hydrocarbon compounds (PFHC) possess unique physical properties suggesting possible usefulness in man. Their low surface tension allows free flow into tiny folds and crevices, facilitating dispersion along peritoneal surfaces affected by a tumor. These substances are also oxygen solvents. BDF1 female mice injected intraperitoneally (IP) with 10(6) P388 mouse leukemia cells were studied following treatment with preoxygenated compound 1913 and increasing doses of radiation. Preliminary results suggest increased life span compared to radiation treatment alone. Radioenhancement at high sublethal doses of whole-body radiation cannot be excluded.


Renal radiography with cephalad angulation and inspiration. Radiographs of the kidneys were obtained during inspiration with a 10 degrees cephalad angulation of the central ray. With this technique, costocartilaginous calcifications were not projected over the renal areas in 94% of cases.


A new device for barium-enema examination following colostomy. The authors developed a colostomy appliance for use during barium-enema examinations. It is 8 cm in diameter and 4 cm in height, and is made of acrylic resins. With the use of this device, 21 patients were fluoroscopically examined through the stoma; good contrast views of the lower intestinal tract were obtained in all cases without leakage of barium or air.


Percutaneous transhepatic gallstone removal by needle tract. A percutaneous transhepatic cholangiogram tract was used to visualize a large stone in the common duct; following the tract's dilation, the stone was crushed and partially removed. Fragments were flushed and also passed spontaneously into the duodenum. The approach described offers a feasible alternative to surgery.


Bacteriologic flora on diagnostic ultrasonic transducers. In a study to determine the presence of bacteria on ultrasonic transducers, the authors found micro-organisms in 82% of cultures. The results show that 70% isopropyl alcohol is not a consistently effective germicide for the sterilization of transducers. The presence of bacteria, however, appears to be of little clinical consequence.


Separation of a femoral artery catheter during withdrawal. A complication of separation of a femoral artery catheter during withdrawal is described. Probable contributing factors and ways of avoiding this mishap are discussed.


Laser backpointer for use with a radiotherapy simulator. A radiotherapy simulator with image intensification has been equipped with a laser backpointer which does not need to be removed during fluoroscopic examinations, provides negligible interference with the fluoroscopic image, and results in significant reductions in the time required for mark-up of patients. Accuracy of set-ups may be improved since rechecking of patient positioning has been simplified.


The effect of bone on dose distributions produced by the Fermi National Laboratory fast-neutron beam. The dose distortion produced by bone during fast-neutron therapy was studied using a target-to-skin distance of 153 cm, with beams 10 x 10 field size at the surface of a phantom. Doses were measured using several muscle-equivalent ionization chambers in the phantom. Results showed that the dose was reduced by interposing bone-equivalent material between the point in question and the surface of the phantom.


Adaptation of multiformat film holder to real-time ultrasound. A method is described for adaptation of a multiformat film holder to a free-standing real-time imaging unit. No additional electronics are necessary for modification.


Screening is not diagnosis.

Screening is not diagnosis. Mammography and physical examination, usually employed as diagnostic tools, may be used to screen for early detection of breast cancer. A study of these modalities used to aggressively screen patients in Cincinnati and Milwaukee is presented and compared to more traditional methods of breast cancer detection and diagnosis as done in Louisville. For a similar-sized group over the same period, the rate of cancers detected in Louisville did not exceed that in Cincinnati-Milwaukee. Aggressive screening will not increase the overall number of detected cancers but will decrease the number of advanced cancers. Mammography as a screening device is not in itself a diagnostic tool, since its potential benefit is maximized only through the use of nondiagnostic, indirect radiographic criteria.


Cinefluoroscopy in evaluating left ventricular contractility and aneurysms. Cardiac cinefluoroscopy was performed immediately prior to biplane left ventriculography in 113 patients and the findings of two independent observers compared to the angiographically documented state of the left ventricle. The observers' interpretations were correct in 44% and 46% of studies, respectively; there were 41% and 24% false negatives and 24% and 29% false positives. The observers agreed in only 59% of cases. The results show that cinefluoroscopy for evaluation of left ventricular contractility is grossly inaccurate and should not be performed.


Transhepatic cholangiography: the radiological method of choice in suspected obstructive jaundice. Twenty-five patients with severe jaundice were studied prospectively with computed tomography (CT), gray-scale ultrasonography (USG), and percutaneous transhepatic cholangiography (THC). Nineteen had obstruction of the biliary tree. The differentiation of obstructive from hepatic parenchymal causes of jaundice was 72% accurate with USG, 92% with CT, and 96% with THC. Biochemical studies when used alone were 72% accurate. Although the precise location of an obstructing lesion was determined in 12/19 cases by CT and 9/19 by USG, the cause was established in only 5 by CT and 7 by USG. THC was 100% successful in establishing both cause and site of obstructive jaundice without significant complications.


Percutaneous nephrostomy in the management of ureteral and renal calculi. A percutaneous nephrostomy tract can serve both to decompress the renal pelvis and as a route for dissolving renal stones and assisting in basket retrieval of ureteral stones. These techniques are especially valuable in patients who are poor operative risks.


Axial skeletal changes in paraplegics.

Axial skeletal changes in paraplegics. Two-hundred paraplegic men were studied to determine the nature of their axial skeletal changes. Forty-two per cent had sacro-iliac (SI) joint changes which varied from marginal blurring, erosion, sclerosis, and narrowing of the joint space (9%) to complete obliteration of the joints (33%). Radiographs of the thoracolumbar spine revealed syndesmophytes (9%), interspinous ossification (2%), intervertebral disk calcification (1.5%), and large osteophytes (2%). These changes had no relation to race, age (except spine changes), or paralysis level, but were related to the duration of the paralysis. The observed skeletal changes mimic HLA-B27 arthropathy. However, the presence of para-osteoarthropathies and negative HLA-B27 in paraplegics would help in differential diagnosis.


Hypoplasia of the lumbar vertebral body simulating spondylolisthesis. Fifty cases of spondylosis and spondylolisthesis were reviewed. In 9 of the 20 cases interpreted as Grade I spondylolisthesis at L5-S1, the sagittal diameter of L5 was shortened, creating a false impression of vertebral slippage. Such cases are felt to represent spondylolysis with hypoplasia of the vertebral body rather than true spondylolisthesis.


Volar plate fractures.

Volar plate fractures. Rupture of the volar plate of the proximal interphalangeal joint, usually secondary to hyper-extension injury, may be accompanied by a radiographically evident avulsion fracture at the base of the middle phalanx. Findings were reviewed in 55 patients with 58 cases of volar plate fracture. This fracture should be specifically looked for in a patient with the typical history, since it may be the only radiographic evidence of a potentially disabling injury.


Mammographic parenchymal patterns and risk of breast cancer. A 15-year prospective study of mammographic parenchymal patterns in 7,123 women over 30 with 658 prevalent and 131 incident primary breast neoplasms demonstrated that no pattern is a reliable indicator of initial or developing cancer. Cancer in glandular breasts is less frequent, more difficult to detect by mammography, and tends to remain prevalent compared with the more frequent tumors in fatty breasts. As women get older, their breasts assume similar patterns and the incidence of both prevalent and incident tumors increases. Parenchymal patterns cannot signify which breasts may remain glandular, nor which women may be at risk of cancer.


Venography of peripheral venous injuries. Venography is a simple and rapid technique which can be used in the diagnosis of acute penetrating venous injury. Four cases of venous lesions are presented and indications for venography discussed. Findings consisted of bleeding from lacerations and partial or total occlusion from traumatic thrombosis.


Phlegmasia cerulea dolens.

Phlegmasia cerulea dolens. Phlegmasia cerulea dolens is a severe form of venous thrombosis presenting as an edematous, painful, purplish-blue lower extremity. Its rapid recognition as venous thrombosis rather than arterial insufficiency is important in avoiding gangrene and other life threatening complications. Three cases illustrating the presentation of this disorder are reported.


Digital radiography using a computed tomographic instrument. A prototype computed radiography (CR) system was evaluated for its efficacy as an independent diagnostic modality. Preliminary measurements of high contrast resolution, low contrast perceptibility, and dose were obtained. Clinical examinations including skull, abdomen, liver, gallbladder, biliary system, spine, and extremities were performed as an adjunct to either computed tomography or CR. The data suggest that CR can be an effective diagnostic imaging modality by itself. Advantages over conventional radiography include high scatter rejection, low patient dose, wide dynamic range, and good low contrast sensitivity for large objects; disadvantages, its long exposure time and relatively poor high contrast spatial resolution.


Symmetry of bronchial angles in children. The bronchial angles in children from birth to age 18 years were measured. Symmetry of angles was found to age 15 years. After that age, an aortic indentation was generally noted on the trachea with an increased left bronchial angle. Hence, the relatively equal incidence of right- and left-sided aspiration of foreign bodies in smaller children as opposed to adults.


Mucoid impaction (inspissated secretions) in segmental bronchial obstruction. Localized persistent mucoid impaction as seen on the chest radiograph is a fairly common roentgen finding that always implies segmental bronchial obstruction. Collateral ventilation apparently permits air to enter the lung distal to the obstruction, outlining bronchi distended with trapped mucus or other secretions. This mucoid impaction sign has been seen in a variety of obstructing conditions, including primary and metastatic carcinoma of the lung, bronchial adenoma, tuberculous bronchostenosis, bronchial adenoma, tuberculous bronchostenosis, broncholithiasis, bronchial atresia, sequestration, pulmonary bronchogenic cyst, and foreign body. The roentgen appearance of the impacted mucus is variable, depending to a considerable degree on its orientation in relation to the direction of the x-ray beam. The presence of unexplained localized mucoid impaction is an indication for immediate study to demonstrate or exclude an obstructing bronchial lesion.


Hypochondroplasia: clinical and radiological aspects in 39 cases. A retrospective review of 39 cases of hypochondroplasia revealed consistent but variable degrees of clinical and radiological features sufficient to allow differentiation from other well-established metaphyseal chondrodysplasias. Macrocephaly was noted in approximately half the cases. This contradicts a finding of normocephaly in previous studies.


The role of renal metabolism of PGE2 in determining its activity as a renal vasodilator in the dog. Since the mammalian renal cortex avidly metabolizes prostaglandin E2 (PGE2), we examined the importance of renal metabolism of PGE2 in determining its renal vascular activity in the dog. We used 13, 14 dihydro PGE2 (DHPGE2) as a model compound to study this because DHPGE2 retains similar activity to the parent prostaglandin, PGE2, but is a poorer substrate than PGE2 for both the metabolism and the cellular uptake of the prostaglandins. Using dog renal cortical slices, we found that under similar experimental conditions, PGE2 was metabolized several-fold faster than DHPGE2. Both prostaglandins were metabolized to the 15 keto 13, 14 dihydro PGE2, which was positively identified using GC-MS. In vivo, we infused increasing concentrations of DHPGE2 into the renal artery of dogs and measured renal hemodynamic changes using radioactive microspheres. DHPGE2 was a potent renal vasodilator beginning at an infusion rate of 10(-9)g/kg/min. When compared to PGE2, DHPGE2 was about 10 times more potent in affecting renal vasodilation. The intrarenal redistribution of blood flow towards the inner cortex seen with DHPGE2 was identical to that seen with PGE2. We conclude that renal catabolism of PGE2 is very important in limiting the in vivo biological activity of PGE2, but regional differences in metabolism of PGE2 within the cortex are an unlikely determinant of the pattern of redistribution of renal blood flow.


The effect of glucose on the synthesis of prostaglandins by the renal papilla of the rat in vitro. Renal pappillae from rats were incubated in vitro. The release of prostaglandin by this tissue was found to be inversely related to the glucose concentration of the buffer. Estimates of prostaglandin release were determined by a rat stomach strip bioassay, and in some instances, gas-chromatography and mass spectrometry. When incubated in the presence of C14-arachidonic acid, the specific activity of prostaglandins E2 and F2 alpha released by the tissue was lower at the lower glucose concentration. Provision of 625 micrograms/ml of exogenous arachidonic acid in the buffer obliterated the effect of glucose on prostalglandin release. These data indicate that increasing amounts of glucose suppresses prostaglandin synthesis in the renal papilla of the rat, and that the mechanism of this phenomenon is related to the release of arachidonic acid from its storage pools in tissue lipids.


Structure and quantitative determination of the major urinary metabolite of thromboxane B2 in the guinea pig. 2,3-Dinor-thromboxane B2 was the major urinary metabolite of thromboxane B2 in the guinea pig. The structure was assessed mainly by mass spectrometric analysis of a number of derivatives of the metabolite and by chemical degradation by oxidative ozonolysis. A method for quantitative determination of 2,3-dinor-thromboxane B2 in guinea pig urine based on multiple ion analysis and octadeuterated 2,3-dinor-thromboxane B2 as internal standard was developed. The basal excretion of the metabolite was 65 +/- 36 (S.D.) ng/kg x 24 h (n = 19; range 19--140 ng). This level corresponded to an endogenous synthesis of 543 +/- 300 ng of TXB2. No increase in the excretion was seen after anaphylaxis, in contrast to what has earlier been reported for PGF2 alpha.


Interaction between phenylephrine and prostaglandins E1 and F1 alpha on the contractile responses of vascular muscle. Prostaglandins (PGs) E1 or F1 alpha (1.4--8.4 x 10(-8) M) contracted strips of rabbit aorta and increased the contractions produced by 1--6 x 10(-7) M phenylephrine (PE). The addition of the PGs simultaneously with PE or after a low concentration of PE (2 x 10(-7) M) significantly increased the PE-induced contractions. However, when the PGs were added after a higher concentration of PE (6 x 10(-7) M) an additional increase in the PE-induced contraction was produced with PGF1 alpha but not with PGE1. Isobolic plots of the data obtained from the simultaneous addition of PE and the PGs indicate that both PGs interact with PE in a synergistic or potentiative manner, suggesting that their effects are mediated through different receptor mechanisms. Addition of the PGs after a high dose of PE indicates that there may also be either qualitative or quantitative differences between PGE1 and PGF1 alpha.


Central cardiovascular and thermal effects of prostaglandin F2 alpha in rats. Administration of PGF2 ALPHA (0.2--6.4 micrograms) into the lateral cerebral ventricle (i.c.v.) induced dose-dependent increases in blood pressure, heart rate and body temperature in urethane-anaesthetised rats, but had no effect on these parameters when the same dose range was administered intravenously. Peripheral pretreatment with sodium meclofenamate (50 mg/kg s.c.) shifted all the dose-response curves for PGF2 alpha (i.c.v.) to the left, but indomethacin (50 mg/kg s.c.) did not significantly affect those changes. Central pretreatment with sodium meclofenamate or indomethacin (1.25 mg per rat i.c.v.) failed to modify significantly the effects of centrally administered PGF2 alpha. The results support previous suggestions that PGF2 alpha may participate in the central control of the cardiovascular and thermoregulatory systems, and also suggest that there may be differences in the sites and/or modes of action between sodium meclofenamate and indomethacin.


Determination of prostaglandin F2 alpha, E2, D2 and 6-keto-F1 alpha in human cerebrospinal fluid. Prostaglandin (PG)F2 alpha, E2, D2 and 6-keto-F1 ALha were determined in human cerebrospinal fluid by a mass spectrometric technique. The samples were obtained from 12 patients with suspected intracranial disease. A 64 fold variation in PG levels was observed. The major PG was 6-keto-F1 alpha (0.12--15 ng/ml). PGF2 alpha and PGE2 were present in lower concentrations PGD2 was below the level of detection (0.05 ng/ml) except in one patient with extremely high total levels of PGs.


Regional and species differences in endogenous prostaglandin biosynthesis by brain homogenates. Endogenously formed prostaglandins (PGs) D2, E2 and F2 alpha were determined in homogenates of brain regions from rat, guinea-pig, rabbit and cat, using gas-chromatography-mass spectrometry. The main PGs formed in the brain regions of the rat were PGD2, in the guinea-pig PGD2 and PGF2 alpha, in the rabbit PGF2 alpha and in the cat PGE2. Brain regions from the same animal species showed the same pattern of PG formation. They varied, however, in the amount of total PGs formed, the limbic system and the cerebral cortex being highest and cerebellum lowest.


Indomethacin increases abortifacient effect of PGE2 in man. Results of this study indicate that pretreatment with indomethacin significantly increases the abortifacient effect of an intravenous infusion of PGE2 in patients admitted for abortion as a result of fetal death in utero. Indomethacin pretreatment shortened the duration of PGE2-induced abortion in primigravid and multigravid groups of patients by about 4 and 2 hours respectively. When primigravid and multigravid groups were combined, the dose of PGE2 needed for complete delivery decreases in the indomethacin-treated group by 39.9%.


Intramuscular 16-phenoxy PGE2 ester for pregnancy termination. A new PGE2 derivative (16-phenoxy PGE2 methyl sulfonylamide sulprostone) was administered by the i.m. route to 48 women pregnancy in any of the three trimesters. The indications for pregnancy interruption were either serious medical problems in intact pregnancies (21 cases) or due to fetal death in utero (27 cases). Single doses of 500 micrograms were repeated every 4 hours in the former group or every 6 hours in the latter category for a maximum period of 24 hours. The treatment was successful in 81% of intact pregnancies and in 92.6% of fetal death cases with an overall mean induction interval of 12.9 hours. More than half the subjects did not experience any side effects apart from mild or moderate uterine colics. An overall mean of 1.4 episodes of vomiting or diarrhoea per induction trial was quite acceptable from the clinical point of view. The absence of serious complications in the group of critically sick women speaks in favor of the relative safety of the drug.


Treatment with a single vaginal suppository containing 15-methyl PGF2 alpha methyl ester at expected time of menstruation. Termination of early pregnancy, by vaginal administration of prostaglandin analogues, one to three weeks after the first missed menstrual period, has advantages and disadvantages in comparison with vacuum aspiration. Some of these may be reduced if the patient is treated earlier. In the present study the effect and safety of one vaginal administration of 2.5 to 3 mg 15-methyl-PGF2 alpha methyl ester around the expected time of menstruation was evaluated in 16 women exposed to the risk of pregnancy. The overall number of treatment cycles was 35 and pregnancy was confirmed by plasma beta-HCG in eight. The treatment resulted in bleeding in all the pregnant cycles while in the nonpregnant ones it only provoked spotting and bleeding did not begin until the expected time of menstruation. Treatment with 2.5 mg 15-methyl-PGF2 alpha methyl ester resulted in complete abortion in one of three women. If the dose was increased to 3 mg all five treated women aborted. In nonpregnant patients no changes in the levels of estradiol-17 beta or progesterone at any time during the 24-hour observation period were found. Serum cortisol and prolactin but not TSH levels started to increase two hours after the start of treatment and reached a maximum after five hours. The increase coincided with the onset of uterine pain. Ovulatory cycles as judged from basal body temperature occurred in the first menstrual cycle following treatment in all nonpregnant patients. Although possible to use as a "once a month treatment" it seems preferable since the dose is the same, to postpone treatment until menstruation is delayed for a week or more.


Manic-depressive illness in three generations of one family: a case study. Two brothers presented for simultaneous admission for acute episodes of manic-depressive illness. Both had hospitalizations documented in the past for acute episodes. A family tree was constructed based on interviews with them as well as other family members and it was determined retrospectively that their father had a history of manic-depressive illness. Furthermore, the son of one of the brothers was also found to the affected. The findings for this family are inconsistent with the theory of X-linked inheritance of manic-depressive illness and adds to the growing criticism of that theory.


The relationship of 'nuclear' and 'atypical' psychoses: some proposals for a classification of disorders in the borderlands of schizophrenia. The paper sets out the arguments in favour of utilising both a 'strict' definition corresponding to the 'nuclear' concept of schizophrenia and a 'broader' definition that also subsumes 'atypical' schizophreniform and related syndromes. Evidence is adduced rejecting the view that attempts to effect a complete separation between 'nuclear' and other forms of schizophrenic disorders based on phenomenological, hereditary, prognostic, etiological and other lines. Both the unity and the diversity of the schizophrenic family of disorders must be given explicit recognition in clinical and scientific work. The value of the 'nuclear' concept has been demonstrated by the IPSS study among other enquiries. The advantages of the broad definition are twofold. It makes for a flexibility and openness of approach in diagnosis and treatment of schizophrenia that are indespensable at the present time. The value of the 'broad' definition is that it encompasses a range of phenomena that have been shown to be related to one another. They may therefore be compared and contrasted. It is argued that new knowledge about the etiology of schizophrenia may be acquired in this manner. Tentative definitions for the 'nuclear' and 'broad' groups of disorder are given.


[Phenomenology and psychodynamics of suicide patients in the awakening phase]. In the following paper is given a first survey of the phenomenology and psychosomatics of the period of awakening of patients having attempted suicide. The findings of the first period were compared to those elicited one or two days later with the same methods but under different somato-psychic circumsatnces. We found that soon after awakening patients gain some distance from events connected with their suicide. From this observation it is concluded that therapeutic intervention with these patients should begin right during the awakening period.


[Determination of radioactive and stable cobalt in marine biological materials (author's transl)]. Studies were made to develop the method for rapid determination of radioactive and stable cobalt in a single specimen of marine biological materials. The sample was dried, ashed, and dissolved in acid. The cobalt was extracted with 1-nitroso-2-naphthol benzene and determined by absorptiometry on the benzene phase. Then, the organic solution was evaporated to dryness, and the residue was treated with nitric-perchloric acid mixture to decompose any organic matter, and taken up with hydrochloric acid. The cobolt was extracted from the solution with TIO A-toluene, and the radioactive cobalt was determined by liquid scintillation counting on the toluene phase. Examinations were made on the chemical yield and on the decontamination factor of the fission product nuclides. Analysis were made on the marine biological samples of Urazoko Bay, Fukui prefecture. Agreement of the radioactive cobalt data between that by the present method and that by Ge(Li) gamma ray spectometry was good. Also, the stable cobalt value by the present method agreed well with that by neutron activation analysis method.


[On renal excretion of sodium 4-iodo-5-methylpyrazole-3-carboxylate-131I (author's transl)]. Sodium 4-iodo-5-methylpyrazole-3-carboxylate-131I(IMPC-131I) was synthesized by isotope exchange with Na 131I in the molten state to evaluate its potential usefulness as a renal function and/or imaging agent. Tissue distribution and clearance characteristics of IMPC-131I are described. Tissue distribution experiments in rats indicated a very high renal concentration of radioactivity following intravenous administration. At 5 min the kidney took up 27.8% of the injected dose (16.1% dose per gram) and the total activity in the kidney still accounted for 9.8% of the injected dose at 30 min, with only 1.2% localizing in the liver. The ratios for kidney-to-liver in the concentration of IMPC-131I were always higher than those of hippuran -131I throughout the period of the experiment. Within 24 hr, 78.6% of the injected dose were excreted in the urine. The autoradiographic and the scannographic studies were also performed. The present results suggest that IMPC-131I has potential as a new agent for both funciton and imaging studies of the kidney.


[Radiologic patterns of the metastatic tumours of the large intestine (author's transl)]. The metastatic tumours of the large intestine are not unfrequent. In the majority of cases they are due to the direct invasion from endo or retro peritoneal tumours, especially of the stomach and the pancreas. The radiologic findings of such lesions are described, and a correlation is made with the pathologic, pathogenetic and clinical aspects.


[Lipomatosis of the ileocecal valve (author's transl)]. A case is described with histologic demonstration. The ethiopathogenetic and clinical aspects of the disease are discussed. The differential diagnosis between lipoma and lipomatosis is stressed. Laparotomy may sometimes be necessary for a correct diagnosis. The basic elements for the treatment are presented.


[Echotomography in the diagnosis of pancreatic carcinoma. Its reliability in a controlled normal and pathological series of cases]. Considering the different points of view about the echotomographic findings in pancreatic carcinoma, the authors refer their results about 89 controlled cases (38 normal pancreas and 51 pancreatic carcinomas). The pancreatic space was correctly identified as normal in 37/38 cases. Echotomography also revealed the presence of 48 pancreatic carcinomas; it gave 3 false negative and 3 false positive results; in 21 cases the size of the tumour was 5 cm or less. In a large number of cases echotomography has correctly defined the extent of the lesion by evaluating its size, the secondary liver localization (95% of accuracy) and the vascular involvement (compressions on the inferior vena cava and obstruction of the splenic vein). Basing on the echotomographic findings the authors classify the pancreatic carcinoma in 2 main types.


[Multifocal cancer of the breast. Considerations on the mammographic diagnosis]. A review is carried out of a series of mammographic investigations in 687 tumours observed at the Pascale Institute, Naples, between 1972 and 1977. Mammography shows in a high percentage of cases a multifocality of the disease which was unsuspected. This allows a better evaluation of the stage of the tumour and a correct therapeutic programme.


[Aortometric correlations in normal and pathological subjects]. The chest roentgenograms of 691 normal, arteriosclerotic and hypertensive patients have been reviewed for measurements of the aortic knob. There is a significant correlation between the width of the aorta and age, but no such correlation was found with the degree of hypertension. The comparison between average widths of the aorta in the 3 categories of subjects has shown its increase in arteriosclerotic and hypertensive patients.


[Organic micropollution of drinking water]. This work is about organic micropollution of waters sampled at the flowing in and out of three treatment stations. Micropollutants are obtained by chloroformic extraction. It is shown that the extracts have biological effects which can be measured by in vitro and in vivo assays. The treatments reduce the total amount of extractible substances but they induce modifications in their chemical composition and their biological activity. These observations allow to precise how the problem of an eventual health effect of organic micropollution could be approached.


[Epidemic of listeriosis in Western France (1975--1976)]. Cases of human listeriosis have recently increased in Western France (Maine-et-Loire and Mayenne); until 1974, there were only 15 documented cases yearly where as in 1975, there were 113 cases, and in 1976, 54 documented cases at the hospitals of Angers and Laval. Included amongst the clinical manifestations observed, were 126 cases of materno-fetal infections and 41 cases of either septicemia or meningo-encephalitis. The bacteriological study revealed a certain variability of biological characteristics examined, the overwhelming frequence of bacteria of the strain 4 b and the predictable sensitivity of this strain to antibiotics commonly employed in cases of listeriosis. The human cases were notably more frequent between January and June but their geographical distribution was not related to cases of either animal disease nor listeria that was isolated from corn silage. In this report, we propose an etio-pathological explanation for this epidemic.


[Histological and histoautoradiographical examination of the interposed jejunum after total gastrectomy in dogs (author's transl)]. Total gastrectomy was performed on purebred beagle dogs and a 30--40 cm jejunal segment was grafted isoperistaltically between oesophagus and duodenum. Histological and histoautoradiographical examinations were carried out and the wall-thickness and the cell-transformation rate in the interponate determined. Despite the isoperistaltic substitute-stomach a muscular wall-hypertrophy of 140% of the interponated jejunum was found. The reason for this hypertrophy is thought to be the result of adhesions and the functional mechanical demands. Histoautoradiographical examinations confirmed that the regeneration time in the substitute-stomach decreased by 70% compared with the normal jejunum. The distinct reduction of cell regeneration in the regeneration in the interponated jejunum could be attributed to the considerable regression of the absorbent performance and to the increase in its mechanical exercises.


The effects of intra-arterially administered histamine on vascular permeability. The influence of intra-arterially administered histamine on the permeability of the articular barrier (synovial membrane plus vascular endothelium) was studied in cats. The dye penetration from the blood through the barrier was tested by perfusing the two knee joints with saline; the histamine solution was infused through one of the circumflex branches of the femoral artery. The dye content of the two perfusates was measured colorimetrically, the local blood supply of the two knee joints thermo-electrically. In the great majority of experiments it was found that the dye excretion was considerably reduced on the histamine-infused side, in spite of marked improvement of blood supply.


The influence of linoleic acid intake on the excretion of urinary prostaglandin metabolites. The influence of linoleic acid intake on human prostaglandin formation was investigated by gas chromatographic determination of dimethyl tetranorprostanedioate, a derivative of the major urinary end products of prostaglandin metabolism. Six healthy female volunteers were put on liquid formula diets. Each person had a linoleic acid supply of 0, 10, and 50 g per day for periods of two weeks. At the end of these periods the corresponding average amounts of tetranorprostanedioic acid in urine were 92, 175, and 326 microgram per day.


Investigation of a glycoprotein-protein mixture from urine of anemic patients by analytical isotachophoresis. Nine glycoprotein-protein fractions prepared of erythropoietin-active crude urinary protein and separated by gel filtration on Sephadex G-50, ion exchange chromatography on Sephadex DEAE A-50, gel filtration on Sephacryl S-200 and Sepharose 6B were investigated by analytical isotachophoresis. 7 to 38 components could be separated of every chromatographic fraction investigated using chloride as leading and glycinate as terminating electrolyte. Improvement of resolution is possible by variation of buffer system conditions.


Hypocalcemia during restraint stress in rats. Indication that gastric ulcer prophylaxis by exogenous calcium interferes with calcitonin release. The influence of restraint stress on serum calcium (Ca) and phosphate was studied in normal and thyroidectomized rats. In addition the response of gastric stress ulcer index, blood gastrin and glucagon to exogenous Ca was investigated. In intact as well as in thyroidectomized animals serum total, ionised and previously injected radioactive Ca decrease during an 8h stress period, whereas inorganic phosphate increases. Together with a constant specific activity these findings are consistent with hypoparathyroidism and calcitonin independent hypocalcemia during stress. Intragastric infusion of 45 mg/kg Ca-gluconate per 8h proves to be a potent anti-stress ulcer regimen in intact and neck-sham operated, but not in thyroidectomized rats without and with additional adrenal demedullation. Gastrin and glucagon were not correlated with calcemia during either stress alone or stress combined with intragastric Ca infusion. It is suggested that the development of gastric stress ulcerations can be prevented by a Ca-mediated release of endogenous calcitonin.


Regional gastric mucosal blood flow in hypovolemic shock. The effect of hypovolemia on the mucosal blood flow of the gastric corpus and antrum were tested with the microsphere method 30 and 60 min after induction of hemorrhagic shock in the rat. The results demonstrate a marked reduction after 30 and 60 min without any significant differences between the corpus and the antrum. This reduction is largely dependent on cardiac and circulatory function. It is concluded that the differences in energy metabolism, which have been implicated as explanation for the different susceptibility to develop stress lesions by Menguy and Masters, cannot be attributed tod different degrees of ischemia.


The effect of the duration and type of stress on some serum enzyme levels in pigs. The effects of blood sampling from the ear vein, jugular vein and collection on exsanguination, on serum CK, LDH, GOT and PK activities were investigated. The activities of LDH and PK were higher in ear vein vena cava samples. The effect of pre-slaughter handling was also investigated. In general there was a significant progressive increase in serum enzyme activities from farm to slaughter, although the magnitude of the change varied for different enzymes.


Inhibited development of trichostrongylids of sheep in northern Nigeria. Worm counts from Yankassa ewes, lambs and tracer lambs grazing unimproved pasture at Zaria were obtained each month during the rainy season of 1976. In June and July up to 14 per cent of the Haemonchus contortus populations consisted of early fourth stage larvae (L4). In August this increased to more than 55 per cent and in October to more than 95 per cent. From June to August most of the abundant late L4 contained rodlike crystals. More than 95 per cent of the Haemonchus contortus populations of two lambs killed two weeks after infection with infective larvae, cultured for seven days at 25 degrees to 30 degrees C in the dark, were early L4. Inhibited 3rd stage Trichostrongylus spp did not exceed 26 per cent of the worm populations.


The possible fate of crystal harbouring larvae of Haemonchus contortus. An examination of the occurrence of crystalline inclusions in the intestinal cells of fourth and fifth stage Haemonchus contortus revealed that a high percentage of inhibited early fourth stage larvae (L4) and developing L4 and a lower percentage of early fifth stage larvae (L5) harboured these crystals. Before the fourth moult crystals were falling into pieces, indicating that worms harbouring crystals can develop further. The presence of crystals may be associated with a retardation of development.


The role of maternal triglycerides in the supply of lipids to the ovine fetus. Maternal and fetal blood samples were obtained for up to 20 min after the injection of an emulsion of 14C-labelled glycerol tripalmitate into the circulation of pregnant ewes. No evidence was obtained for the direct transfer of intact triglycerides across the placenta. Results obtained suggest that there was a very rapid uptake of the triglyceride from the maternal circulation followed by hydrolysis and release of free fatty acids back into the maternal circulation.


The effect of triamcinolone acetonide on plasma glucose and ketone concentration and on the total entry rate of glucose in twin pregnant hypoglycaemic ketotic sheep. Hypoglycaemic ketosis clinically resembling pregnancy toxaemia was induced by starvation in Clun Forest sheep pregnant with twins. Total glucose entry was measured by the continuous infusion of trace amounts of (2-3H) glucose before and after the induction of ketosis and 24 h after the intramuscular injection of the ketotic sheep with triamcinolone acetonide (0.5 mg/kg). The concentration of glucose in plasma fell significantly after the induction of ketosis and rose significantly after the injection of steroid. The total entry rate of glucose fell significantly after the induction of ketosis and rose, but no significantly, after steroid injection. It is suggested that the dose of steroid which was used may inhibit glucose utilisation by peripheral tissues. The induction of ketosis significantly reduced the duration of pregnancy but the steroid injection did not produce a significant additional effect.


The rate of recovery of intestinal morphology following anthelmintic treatment of parasitised sheep. Sixteen sheep which had previously been infected with Ostertagia circumcincta were dosed with 4000 Trichostrongylus colubriformis larvae/day for four weeks, then given anthelmintic and killed at intervals thereafter. Histological examination of the small intestine showed that two to three weeks were required for restoration of a normal mucosal architecture.


Clinical and anatomical studies on the scrotal and pelvic genitalia of Sokoto Gudali bulls in Northern Nigeria. The scrotal and pelvic genitalia from 2400 Sokoto Gudali bulls aged three to five years were studied clinically (by ante mortem palpation and measurement) and anatomically (by direct examination and measurement of the post mortem material). In general the difference between the mean clinical and anatomical measurements was not significant (at the 5 per cent level). Gross abnormalities observed included: testicular degeneration, 60 bulls (2.5 per cent); orchitis, 48 bulls (2.0 per cent); testicular hypoplasia, 35 bulls (1.45 per cent); epididymitis, 37 bulls (1.54 per cent); spermatic granuloma, two bulls (0.08 per cent); seminovesiculitis, 43 bulls (1.79 per cent); scrotal stryptortrichosis, 126 bulls (5.25 per cent). Lesions had no seasonal pattern and occurred randomly throughout the year.


Concentrations of immunoglobulin classes in subcompartments of the sheep lung. The concentrations of IgA, IgG and IgM were measured in plasma, lung lymph and lung lavage fluid from adult sheep. Immunoglobulin concentrations in lymph and lavage fluid should fall sequentially during diffusive flux from the vascular compartment as a result of molecular sieving at the capillary endothelium and the alveolar epithelium. This was seen only for the IgG class. High concentrations of IgA and IgM in the interstitial (lymph) and luminal (lavage) compartments of the lung (relative to plasma levels) suggest either local synthesis of these classes or the existence of class specific active transport.


Characterisation of influenza viruses isolated from turkeys in Great Britain during 1963--1977. Seven influenza viruses isolated from turkeys in Great Britain since 1963 were typed by haemagglutination inhibition and neuraminidase inhibition tests as: A/turkey/England/63 (Hav 1 Nav 3), A/turkey/England/66 (Hav 6 N2), A/turkey/England/69 (Hav 7 N2), A/turkey/Scotland/70 (Hav ? Neq 1), A/turkey/England/N28/73 (Hav 5 N2), A/turkey/England/110/77 (Hav 6 N2), A/turkey/England/647/77 /Hav 1 Neq 1). A/turkey/Scotland/70 failed to show a haemagglutinin relationship with any of the representative strains and may possess a hitherto unreported haemagglutinin subtype. Intravenous pathogenicity tests in six-week-old birds showed only A/turkey/England/63 to have high virulence for turkeys and chickens. A/turkey/England/69 produced some signs of disease in chickens and, to a lesser extent, turkeys but all other isolates were avirulent.


Pasteurella multocida antigen-induced in vitro lymphocyte immunostimulation, using whole blood from cattle and turkeys. A whole blood lymphocyte stimulation assay to study cell-mediated immune responses in bovine pasteurellosis was developed. Peripheral blood lymphocytes from cattle artificially immunised with three Asiatic haemorrhagic septicaemia strains of Pasteurella multocida exhibited higher stimulation indices when incubated with antigen preparations from homologous strains than with the heterologous shipping fever strain. Lymphocytes from cattle immunised with the shipping fever strain of P multocida exhibited a higher stimulation index when incubated with an antigen preparation from the homolgous strain than with antigen preparations from heterologous haemorrhagic septicaemia strains. These results suggest that immunogenic differences exist between the haemorrhagic septicaemia strains and the shipping fever strain of P multocida. An assay using turkey whole blood lymphocytes was also developed. The use of small amounts of whole blood, microtitre plates, either 125I iododeoxyuridine or 3H-thymidine as the labelling agent, and a multiple cell-culture harvester makes the method simple, rapid and suitable for the study of immune competence and cell-mediated immune responses in turkeys on a flock basis.


Investigations of 'transfer factor' activity in the transfer of immunity to Trichostrongylus axei infections in sheep. Three investigations are described in which non-dialysed and dialysed leucocyte lysates, 'transfer factor' prepared from the blood of sheep infected with Trichostrongylus axei successfully transferred immunity to challenge infection with that parasite in susceptible lambs. Similar leucocyte lysates from parasite-free lambs failed to transfer a similar resistance to challenge infection. 'Transfer factor' treatment produced a 30--72 per cent reduction in a total worm burden compared to susceptible control lambs. In the first two investigations the donor and recipient lambs were genetically dissimilar and in the third investigation were of different breeds. The resistance transfer was considered to operate independently of immune incompetence.


Effects of dietary protein and stage of lactation on the haematology and erythrocyte enzymes activities of high-producing dairy cattle. Blood samples were collected monthly over a nine-month period from 19 high-producing Holstein-Friesian dairy cows. Dry cows on the lowest (13 per cent) protein ration had the highest mean values for packed cell volume (PCV), haemoglobin (Hb) and red blood cells (RBC). Among the lactating cows, the group on the 13 per cent protein diet had the highest mean PCV, Hb and RBC values. Other constituents were not affected significantly by dietary protein levels. Packed cell volume, RBC, Hb, serum iron (SI), iron binding capacity (IBC) and serum albumin concentrations decreased early in lactation and rose to pre-lactation levels by mid-lactation. PCV and Hb concentrations remained low for periods up to four months. RBC count was lowest in the second month while albumin concentration was lowest in the first month and remained low up to the second month. IBC was lowest in the first month of lactation while SI concentrations were lowest in the third month. There were no significant variations in the activities of erythrocyte glucose-6-phosphate dehydrogenase (G6PD), 6-phosphogluconate dehydrogenase (6PGD) and reduced glutathione (GSH). The 13 per cent protein ration had no anaemia-inducing effect on the cows.


The experimental infection of calves with a British strain of Haemophilus somnus. Intravenous inoculation of a British strain of Haemophilus somnus resulted either in fatal peracute or chronic forms of H somnus disease. Pleuritis, pericarditis and arthritis were prominent post mortem findings. Intratracheal inoculation led to severe cellulitis and abscess formation in the neck with acute suppurative bronchopneumonia in one calf, while in another, encapsulated abscesses and pleural adhesions were seen. Intraperitoneal inoculation resulted in fatal fibrinous peritonitis in one calf. The organism was readily recovered from the lesions except when overgrown by post mortem contaminants. Rising antibody titres were detected in two calves 12 days after inoculation by a micro-complement fixation test, and the organism was demonstrated in synovial fluid by an indirect fluorescent antibody test. No organisms were recovered from and no lesions were seen in the nervous tissues of the calves in contrast to studies of this disease in the USA.


The density of equine tissue at 37 degrees C. The density of the following equine tissues was measured: white and grey brain matter, myocardium, lung parenchyma, liver, spleen, gastrointestinal tract and contents, renal medulla and cortex, muscle, fat, tendon and bone. Statistical analysis indicated that there were highly significant differences in the values for density between horses and between tissues within horses. Values for density of eight different muscles were obtained for 18 horses and these were shown to differ highly significantly between horses and between muscles within horses. The values for splenic density differed highly significantly between those for knackery killed horses and for the barbiturate killed post morten room horses.


Changes in serum immunoglobulin levels in Jerseys and Friesians near calving. IgG1 and IgM levels were significantly lower in bovine serum from four weeks before, until at least two months after calving, whereas IgG2 levels were elevated at this time. The shapes of the changes in Ig levels were different for first and second calving and it appeared that IgG1 levels were secreted earlier, from serum to colostrum, in heifers. Changes in management caused marked changes in Ig levels particularly after third calving when the cows were transferred from a balanced complete diet to grass or hay. IgG1 levels increased by 130 per cent and stayed high whereas the increase in IgM was transitory, and IgG2 levels largely unaffected. In Friesians the IgG2 levels increased with age as anticipated from previous studies but in Jerseys the levels appeared to decline with age. Mean IgG2 levels in Jerseys were also significantly lower than in Friesians.


The effect of single and divided dose administration on the efficacy of fenbendazole against adult stages of benzimidazole resistant sheep trichostrongylids. Sheep infected with benzimidazole resistant strains of Haemonchus contortus and Trichostrongylus colubriformis were used to compare the anthelmintic efficacy of fenbendazole given as a single dose or administered in a divided dose regime over five days. Statistical analysis showed no significant difference between the two methods of administration for H contortus. On the other hand, divided dose fenbendazole was significantly less effective than single doses against adult T colubriformis at dose rates of 5 and 7.5 mg/kg. In the case of H contortus a highly significant correlation coefficient between post treatment egg counts and worm counts (r = 0.789) was obtained. This suggests that reduction in faecal egg output following drug treatment would provide a useful field indication of anthelmintic performance of fenbendazole (and possibly related compounds) against benzimidazole resistant strains of this parasite.


The anthelmintic efficacy of albendazole against Fasciola hepatica and benzimidazole resistant strains of Haemonchus contortus and Trichostrongylus colubriformis in sheep. The anthelmintic efficacy of albendazole (methyl [5-(propylthio) - 1H - benzimidazole -2 -yl] carbamate) against immature and adult Fasciola hepatica and against standardised strains of benzimidazole resistant Haemonchus contortus and Trichostrongylus colubriformis was evaluated in experimentally infected sheep. A single intrarumenal treatment of dose rates of 3.8 and 7.6 mg/kg was ineffective against immature (six weeks old) F hepatica. Dose rates of 5.7 and 7.6 mg/kg reduced the number of mature (12 weeks old) F hepatica by 70 and 91 per cent respectively. Dose rates of 5.7 and 7.6 mg/kg removed 92 and 99 per cent of four-week-old, benzimidazole resistant H contortus and 89 and 99 per cent of four-week-old, benzimidazole resistant T colubriformis.


The isolation of peste des petits ruminants virus from Nigerian sheep and goats. Four isolates of peste des petits ruminants virus were obtained from sick Nigerian sheep and goats. One was identical antigenically with the prototype Senegalese strain. A cross relationship was found between peste des petits ruminants virus and rinderpest virus based on neutralisation in vitro.


Dco at various breath-holding times: comparison in patients with chronic bronchial asthma and emphysema. Measurement of Dco is known to be dependent upon functional inhomogeneities. Because different types of inhomogeneities are operative in patients with bronchial asthma and patients with emphysema, different changes of Dco with increasing breath-holding time, tA, are to be expected. We studied the change of Dco with increasing breath-holding time in healthy subjects, patients with asthma bronchiale and patients with emphysema. In the patients the severity of airway obstruction was about the same. The following results were obtained: (a) in healthy subjects and in the asthmatics Dco decreased with tA, in a similar manner, approaching a value (ml . min-1 . Terror-1) of 34.7 and 31.6 at 10 sec, respectively, and (b) in patients with emphysema Dco increased with tA, yielding negative values at small tA: 1.5 sec-23.4; 10 sec: 11.7. From these results we suggest that in healthy subjects and in patients with bronchial asthma parallel inhomogeneities influence the course of Dco. In emphysema the time couse of Dco is best explained with a faster intrapulmonary mixing of He compared to CO. This behavior indicates that in emphysema low Dco values can be mainly attributed to large diffusional resistances (stratification) within the lungs.


Effect of carboxyhemoglobin on the single breath diffusing capacity: derivation of an empirical correction factor. The effect on measured DLco of different blood concentrations of COHb produced by breathing CO was studied in 19 healthy nonsmoking subjects. The DLco calculated without adjustment for blood COHb was found to be spuriously reduced by approximately 1% of the observed baseline value for each percent increase in blood COHb saturation. When measuring DLco of subjects who are likely to have elevated COHb blood levels, it is recommended that either blood COHb concentration or equilibrated alveolar PCO be determined in order to correct the DLco for the effect of COHb.


Respiratory response to carbon dioxide after propranolol in normal subjects. The ventilatory response to carbon dioxide, using the rebreathing technique, was investigated in 5 healthy nonsmoker volunteers, without obstructive bronchopathy. The administration of propranolol (20 mg) in a single oral dose did not produce significant modifications of the slopes of the response curves, but caused a significant increase of the intercept of the curves (p less than 0.05). Since no changes of the spirographic values were noted, the results obtained were attributed to a decrease of ventilation. It is concluded that propranolol, even at the dose of 20 mg, is able to induce a depression of the respiratory center, concomitant with significant reduction of heart rate and arterial blood pressure.


Effects of inhaled lidocaine on airway function in asthmatic subjects. We measured the effect of inhaled lidocaine on pulmonary function in 8 asthmatic subjects. Plethysmographic specific airways conductance (SGaw) and the 1-sec forced expired volume (FEV1) were measured before and after the inhalation of 2cm3 of lidocaine (4%). Responses were also measured after patients were pretreated with either aerosolized isoproterenol, aerosolized atropine, or intramuscular atropine. In response to lidocaine alone, we observed a 23.4 +/- (SE) 4.8% fall in FEV1 and a 64.1 +/-(SE)3.8% fall in SGaw (p is less than 0.001). These effects were reversed with aerosolized atropine or isoproterenol. After pretreatment with aerosolized atropine or isoproterenol, the bronchoconstrictor effect of lidocaine were either prevented or markedly reduced. The protective effects of intramuscular atropine varied in different subjects, but in general, aerosolized bronchodilators afforded better protection against the bronchoconstrictor effect of lidocaine. Although lidocaine is theoretically capable of blocking neurogenic reflexes in the lung, our studies indicate that this topical anesthetic agent produces untoward reflex-mediated bronchoconstriction in patients with asthma and hyperirritable airways.


[133 Xe radiospirometry: prediction of VC and FEV1 (author's transl)]. In patients with impaired lung function who are scheduled for lung surgery, a means of estimating the ventilatory consequences of parenchymal resection is needed. We have tested the ability of lung scanning with aerosolized and intravenous 133Xe to fulfil this purpose in 100 pneumonectomized or lobectomized patients. Postsurgery VC and FEV1 values were evaluated as follows: each lung was horizontally divided into two areas and lower and upper VC values were calculated as percentages of the total radioactivity count. Using the regional percentages and the absolute values of VC measured spirometrically, the VC expected postsurgery values were calculated according to the type of resection planned (e.g. if the left lung was to be removed and if it accounted for 50% of the radioactivity on the scan, the postsurgery VC would be halved). Postsurgery FEV1 values were estimated by using the VC value and the FEV1/VC ratio measured before surgery. A significant correlation (p less than 0.001) was found between the values estimated in such way and the actual FEV1 and VC values obtained shortly after surgery (between 6 and 15 days). From these results, we conclude that the xenon scan is a valuable technique for estimating the consequences of lung removal on ventilation.


Accumulation of 99mTc-tetracycline in lung infarction area. An experimental study. In 10 dogs, lung infarction of the right middle and of the left inferior lobe was obtained experimentally. 1 h after operation, 2.0 mCi 99mtechnetium-tetracycline was given intravenously. 5 h after injection, a maximum of accumulation in the infarcted tissue was detected. Conventional perfusion scintigrams were done by injecting 0.2 mCi of 131iodine-albumin particles. Correspondingly, a perfusion reduction in the infarcted area was seen by this technique. This method described seems promising for clinical use for the detection of lung infarction. Clinical studies in this field are in progress.


Bronchiectasis: a cause of pulmonary symptoms in heroin addicts. Extensive and severe bronchiectasis was found in 7 heroin-addicted individuals with pulmonary symptoms whose chest roentgenograms were not suggestive of severe airway disease. Abnormalities consisted of varicose and cylindrical alterations. Pulmonary function tests revealed airflow obstruction, decreased lung volumes, and diffusion capacity impairment. Arterial blood gas analysis demonstrated mild hypoxemia in all patients and chronic hypocapnia in 4. Serial pulmonary function tests in 2 patients revealed only modest improvement in the degree of airflow obstruction. The occurence of bronchiectasis appeared to be related to episodes of heroin-induced pulmonary edema and infection.


Fibroleiomyomatous hamartoma of the lung. Fibroleiomyomatous hamartoma of the lung is an extremely rare, nonneoplastic overgrowth of pulmonary muscle tissue which can be found in various sites throughout the lung. Several cases have been previously described. The case presently reviewed demonstrates the multinodular form of this entity. Fibroleiomyomatous hamartoma may also appear as a solitary coin lesion or as a diffuse interstitial pattern on chest radiographs.


Radioisotopic labelling of endoalveolar surface-active phospholipidic fractions from rabbit pulmonary lavage. A simple method of detecting endoalveolar tensioactive system fractions employing intravenously injected 131I-triolein has been devised. The tracer has been administered to 7 adult rabbit groups then sacrificed at different time intervals after the injection. Endoalveolar tensioactive system lipidic fractions collected by pulmonary lavage have been separated with thin-layer chromatography and their radioactivity evaluated by scanning plates. Endoalveolar tensioactive system fractions containing considerable amounts of C 18 fatty acids have been selectively labelled.


Body plethysmographic measurements in children with an accompanying adult. If a child refuses to enter the body plethysmograph, he may be accompanied by a relative or an assistant. Measurements are possible after the companion has stopped breathing and box pressure has stabilized. The reliability of this procedure is proved by a comparative examination of 25 children performed without and with a companion.


Small airways disease: a trial of an easy functional discrimination of preclinical emphysema. In the genesis of small airways obstruction (SAO) we have to consider two alterations with different prognoses: the first, in which the obstruction depends on a reduction of the diameters of the small bronchi (i.e. with prevalent 'intrinsic mechanism)'), is reversible; the second, probably irreversible, is due to pulmonary emphysema in its pre-clinical stage. It is useful to distinguish between these two mechanisms by means of functional tests which are easily applicable in epidemiological screening. We have studied, by means of different lung mechanics tests, 5 normal, male, non-smoking subjects (N) and 10 male smokers considered to be affected by SAO. Several theoretical considerations, experimental data and prospective studies suggest that under various tests of easy execution for a screening program there are some which have, in some cases, a prognostic value and seem to be coupled to a qualitative meaning: this is the case for delta N2 which is significantly greater in subjects of the extrinsic group where the abnormality is considered irreversible. Some other tests are very sensitive to detect SAO subjects by they are lacking in specificity and in prognostic meaning (CV, VEmax, FDC). Finally, other tests [maximal mid-expiratory flow (MMEF) and residual volume (RV)] seem to have a prognostic value only because they indicate an advanced stage of the illness, not depending on the kind of the affection (SAO Ex or SAO In).


Chemoreceptor stimulation and hypoxic pulmonary vasoconstriction in conscious dogs. Dogs with electromagnetic flow probes implanted on their left (QL) and main (QT) pulmonary arteries, catheters in their left atria and external jugular veins, and chronic tracheostomies were trained to accept Carlens dual-lumen endotracheal tubes into their tracheostomies, thus allowing separate ventilation of the two lungs. Swan-Ganz catheters were inserted through the jugular vein catheters. Pneumotachographs measured air flow to each lung. During bilateral ventilation with room air or O2, QL was about 36% of QT. When the left lung was ventilated with N2 while the right remained on O2, PAO2 was above 90 mmHg and QL fell to about 25% of QT. When the left lung was ventilated with N2 and the right with room air, PAO2 fell below 40 mm Hg and QL increased to control levels. This increase in perfusion of the hypoxic lung during systemic hypoxemia was not seen in dogs after surgical deafferentation of the systemic arterial chemoreceptors, indicating that stimulation of the arterial chemoreceptors may interfere with the hypoxic pulmonary vasoconstriction.


A statistical description of the human tracheobronchial tree geometry. Most physiological studies which made use of lung geometry have utilized average deterministic models of the tracheobronchial tree geometry, such as Weibel's Model A (1963). However, as shown by morphometric studies, it is well known that there are significant inter-subject and intra-subject variabilities in the structural components of the human lung. Hence, inherent inaccuracies exist when deterministic dimensions for lung geometry are used. In this paper, a statistical description of the lung geometry is presented. Using Weibel's Model A as the underlying average model, probability distributions for the lengths and the diameters of airways and for the number and volume of alveoli are proposed based on morphometric data. As a check for consistency, the probability distribution of the functional residual capacity is derived from those associated with airways and alveoli and it is compared with reported data. Results of this comparison are favorable, suggesting that the statistical description presented herein represents a self-consistent model for lung geometry which can be used for studies of problems related to pulmonary physiology.


Trapped gas at maximum lung volume in intact isolated rat lungs. Excised rat lungs were ventilated with air in a liquid filled plethysmograph that was enclosed in a large pressure chamber, C(B). The lungs were inflated then deflated by removing or adding saline to the plethysmograph while the trachea was attached to a cannula extending through the plethysmograph base. In this system, tracheal pressure, Pao, was equal to gas pressure inside C(B). The gas pressure was held constant at either ambient pressure (Pamb), Pamb + 350 Torr, or Pamb - 350 Torr. When excised lungs were ventilated slowly from their atelectatic state for 10 inflation-deflation cycles with Pao equal to any one of the three pressures, an equivalent amount of gas was trapped in the lungs. If after 10 cycles, however, lungs containing trapped gas were inflated and held at maximum lung volume, the trapped gas spaces could be made to expand in response to rarefaction or compression of the tracheal gas. The amount of expansion and contraction of the trapped gas spaces demonstrates that trapped gas is likely trapped between menisci of a foam that occlude the alveoli or small airways.


Experimentally induced Cheyne-Stokes breathing. We have studied the propensity for periodic breathing to occur in cats anaesthetized with pentobarbitone breathing either spontaneously or with the aid of a 'servo-respirator' governed continuously by the efferent phrenic nerve activity. Sustained periodic breathing could be induced increasing 'controller gain', either by increasing the gain of the respirator, or by lung deflation, which reflexly increased controller responses to both hypoxia and hypercapnia. Periodic breathing was potentiated both by hypoxia and by diminishing the central (CO2, H+)-drive by focal cooling at the ventral surface of the medulla, two procedures which increase the relative influence of hypoxic drive. Less hypoxia was needed to produce periodic breathing at high rather than low controller gains. Reducing controller gain to zero by constant artificial respiration always abolished periodic breathing. Periodic breathing was also eradicated when the relative importance of CO2 drive was enhanced by breathing the cats with CO2-enriched gas mixtures or with 100% O2. The results are consistent with theoretical predictions for the occurrence of oscillations in the mechanisms for the chemical control of breathing and indicate that increasing controller gas can produce periodic breathing. The results further emphasize the importance of the (CO2, H+)-drive in preserving ventilatory stability.


O2-chemoreflex drive of ventilation in awake birds at rest. Three varieties of birds (a non-flyer, the chicken; a diver, the duck; a flyer, the pigeon) were studied in resting conditions at neutral ambient temperature, while awake, either intact or sham operated, or after bilateral chronic carotid body denervation. Tidal volume (VT), ventilatory period (T) and minute volume (V = VT/T) measured plethysmographically, were recorded breath-by-breath in steady state at two levels of oxygenation, and in the course of transient pure O2 inhalation (60-sec O2-test). O2 partial pressures in the inspired and expired gases (PIO2 and PETO2), and in the arterial blood (PaO2) were also measured. In intact and sham operated birds, the abrupt switch from a normoxic gas mixture (FIO2 = 0.21) to pure O2 resulted shortly in rapid increases of PIO2, PETO2 and paO2, and in a fall of V which was completed within 20--30 sec and accounted for about 30% of the control minute volume. In the animals previously made hypoxic (FIO2 = 0.12) and hyperventilating, the O2-test provoked a 50--60% fall of V. In chickens, a decreased VT and an increased T contributed to the transient ventilatory changes; in ducks, mainly VT changed, and in the pigeon only T changed. In the birds with denervated carotid bodies, there were no ventilatory responses to hypoxia and to the O2-test. A few of these birds developed a tachypneic response to hypoxia with no apparent change in the effective pulmonary ventilation, which was partly overcome during the O2-test. It is concluded that in the three varieties of birds, the O2-chemoreflex drive from the carotid bodies controlled about 30% of the resting minute volume near sea level, and 50--60% in hypoxic conditions duplicating an altitude exposure to 4000 m.


Particulate emboli retained by the Intersept (R) transfusion filter; a sem study. The Intersept (R) transfusion filter is the transfusion filter developed by Johnson and Johnson. Filtration is performed by both adsorption and mechanical retention. Not only microaggregates, but damaged and injured cells are likely to be trapped and/or adsorbed. Such a filter is not injurious to the blood components, but thrombotic material accumulation can occur with fresh blood.


[Fluorocarbons as blood substitutes. Toxicity in the rat]. Liquid fluorocarbons, having high solubility for gases (O2, CO2...) have been used as artificial blood substitutes in animals with variable results. The great diversity of these products and the lack of reproductiveness in their composition have not permitted, up to now, a standardization of their utilisation norms. Our work was to study the toxicity, in the rat, of a new kind of fluorocarbon emulsion (E-66, Ugine-Kuhlmann, France) used as an artificial blood substitute during exchange-perfusion. The short survival of the rats is in opposition to the good in vitro results obtained in other experiments (high solubilities of oxygen and dioxide carbon). The toxicity of this fluorinated emulsion is demonstrated by histologic lesions in lungs, liver and kidneys and the great amount of fluor stored in these organs. The mechanism of this toxicity is still to be demonstrated. Hepatic lesions (hyperhemia with dilatation of central veins and sinusoids) and pulmonary lesions (vascular congestion, alveolar oedema) prove a circulatory disturbance leading to right-sided cardiac failure. However, cellular degenerescence lesions, observed in hepatocytes and renal tubular cells, do not permit to exclude formally a cellular toxicity of the E-66 emulsion.


[Biological changes observed after infusion of modified gelatin in women who had cesarean sections]. We suggest to study some biologic parameters after perfusion by 1,000 ml modified gelatin to young women who have a caesarian operation. The level of gelatin is determined by previously proposed method. Gelatin is also revealed at electrophoresis. Concurrently, protein contents in sera and hematocrit are estimated. These investigations are also made at the same time for a reference population who has a ceasarian operation without perfusion of gelatin. The highest level of gelatin is reached at t(0) + 90 mn. Gelatin is not present in sera at t(0) + 6 hr. At electrophoresis the beta-globulins raise concurrently with the level of gelatin. The alpha-globulins decrease but that variation is small and later. Protein level decreases also in conjunction with hematocrit. Hematocrit value is about 30 p. cent. It seems to the authors that this value allows a better oxygen transmission to tissues. For reference population these biologic parameters are not modified.


[Detection of lipid abnormalities in blood donors]. The high incidence of cardio- or cerebro-vascular diseases is positively correlated with hyperlipoproteinemia. A large-scale screening of blood donor's populations could be used for the prevention of the atherogenic disease. Therefore lipoproteins electrophoresis on cellogel was compared with serum levels of triglycerides, cholesterol and lipids in 1184 blood donors (792 men, 392 women). The electrophoretic pattern was found abnormal in 32 cases (25 men, 7 women). It was a type IIb hyperlipoproteinemia, according to the classification of the World Health Organization. In these 32 subjects, serum triglycerides, cholesterol and lipids concentrations were significantly higher (p less than 0,001) than in 41 other donors with a normal electrophoretic pattern. A good positive correlation was found between high blood pressure or obesity or blood group O and abnormal electrophoretic pattern. Lipoproteins electrophoresis on cellogel appears to be a suitable test (easy, fast and economical) in large-scale screening for dyslipidemia in subjects over 40, or at least in cases of mild hypertension or obesity.


[Physiopathology of ischemic transitory attacks in the vertebro-basilar region. II. Physiopathological and clinical aspects]. Hemodynamic and metabolic factors of regional cerebral blood flow regulation are analyzed, and pathophysiology and clinical aspects of transient ischemic attacks of vertebro-basilar system are discussed.


[Physiology of transitory ischemic attacks in the vertebro-basilar region. I. Functional anatomy of the vertebro-basilar system]. Regions of supply by the posterior segment of the circle of Willis are discussed in terms of anatomo-functional organization.


[Hematic radio-immunologic monitoring of clonazepam: clinical-pharmacological evaluations in a group of epileptic patients]. In a group of 22 epileptic patients under treatment with clonazepam (CNP) it has been evaluated the serum levels of CNP in a seried way for a period of several months, by a radio-immunological technique. Except for one patient, all the others were under politherapy. On the basis of the data obtained from this study we tried to evaluate the pharmachological action of CNP. Even if we found a good clinical efficacy of CNP with therapeutic ranges (from 19,57 +/- 10,98 ng/ml up to 60,16 +/- 31,18 ng/ml) we didn't find any correlation between the oral dose and serum level, taking into account also other parameters such as sex, pound and age. The Authors discuss the possible factors which may be thought involved in this lacking correlation.


[Gerstmann's syndrome: report of a case]. In recent years, several authors have questioned the reliaty of Gerstmann syndrome and have claimed that "aphasia might be regarded as the true Grundstörung of the Gerstmann symptoms". This paper describes a case of Gerstmann syndrome ictally risen with aphasia in a patient suffering from a tumour of the left PTO region. After the remission of aphasia, the syndromic association typical of the Gerstmann syndrome lasted up the exitus.


Application of mathematical methods to the study of familial aggregation in endemic nephropathy. I. The hypothesis of infectious etiology. Among many etiological factors, infection and the genetic factor are the main two causes which could explain the familial aggregation of endemic nephropathy (EN). The data collected over all the EN cases during 1957--1976 in the endemic village Bistriţa have been analysed for time-space clustering and a particular type of spatial clustering (within household) by the Knox's space-time interaction test and Walter's pair statistic test. The lack of clustering could be interpreted as suggesting the lack of infection (human transmission pattern) in the occurrence of endemic nephropathy.


Study on the onset of atherosclerotic lesions in human coronary arteries. The coronary arteries of 300 fetuses, neonates, infants and children were examined by light microscope in an effort to reconstruct the natural history of the first atherosclerotic lesions. The critical period for the passage from processes of growth and remodelling to atherosclerotic involvement appeared in this series at the age of 5 years. The incidence of the earliest lesions was distributed as follows: fibrous plaques in 2% of the subjects 6--10 years old and 4% of the subjects 11--15 years old; gelatinous plaques and fatty streaks in 6% of the subjects 11--15 years old. Indirect evidence was obtained that certain branch pads or cushions acted as precursors of the first fibrous plaques. Their conversion into atherosclerotic lesions was induced by insudation, histolysis (elastolysis, collagenolysis, ground substance depletion and degenerative cell changes), followed by nodular proliferation of smooth muscle cells and abundant neoformation of ground substance and collagen fibers. The onset of the first gelatinous plaques was also preceded by insudation and histolysis followed by swelling necrosis. The appearance of the first fatty streaks seemed to be not preceded by particular structural changes. The first fibrous plaques developed only in bifurcation and emergence areas, whereas the first gelatinous plaques and fatty streaks involved the proximal segments of the main coronary vessels.


Comparative clinical study of the effects of Na isobutyrate and clofibrate on the clotting factors in patients with atherosclerosis. The effects of Na isobutyrate and clofibrate on human hemostasis were studied in 24 patients with atherosclerosis. Significant changes were recorded only with respect to platelet adhesiveness and blood fibrinogen concentrations. Thus, the index of platelet adhesiveness decreased significantly in 17 out of 19 patients with high initial values, after six weeks of Na isobutyrate therapy (1 g/day), and in 9 out of 17 patients, after clofibrate administration (1.5 g/day) in the same conditions. Blood fibrinogen concentrations were significantly lowered by clofibrate therapy and only slightly influenced by Na isobutyrate.


Morphogenesis and pathogenesis of chronic lung diseases. XVI. The influence of drugs on the stereotyped development and cellular kinetics of experimental lung granulomas. The stereotyped development and the cellular kinetics of lung granulomas experimentally-induced in rabbits by an intravenous injection of the complete Freund adjuvant with addition of human gammaglobulin, were studied under the influence of hydrocortisone acetate, rifampicin, heparin and phenobarbital. As in a previous study using actinomycin and puromycin, the analysed drugs delayed up to inhibition (hydrocortisone) the development of lung granulomas which remained small, unfused, without epithelioidosis; the primary and secondary immune responses were more or less influenced up to their suppression. The delivery of macrophages was reduced by hydrocortisone, but enhanced by heparin and phenobarbital. The latter induced a persistent intragranulomatous granulocytosis, expressing the repair of decreased activities of dehydrogenases and especially of NADP-NADPH-oxidases. The action of these drugs was phasic, their intervention being active only during the cellular phase of granulomas; fibrillogenesis was influenced only indirectly. Extrapolation to humans of these results suggests the use of these drugs during the cellular phase of chronic pneumonitic lesions and suppression of the immune component of the inflammatory processes.


Subphrenic abscess simulating metastatic carcinoma. Subphrenic abscess is reported in two patients, one previously operated on for pancreatic carcinoma and the other for clear cell carcinoma of the left kidney. The subphrenic abscess presented with cachexia and low grade fever six months and one year after surgery. Metastatic carcinoma was erroneously diagnosed in both patients. Despite massive antibiotic treatment, both patients succumbed to sepsis. Because of the inherent diagnostic challenge, delineation of a subphrenic abscess in cancer patients without clear-cut evidence of a metastatic spread is crucial.


[Disfiguring ulcer forms of the carpal tunnel syndrome]. On the basis of 3 personal cases and 13 cases in the literature, the authors carried out a study of these rare forms of the carpal tunnel syndrome. The syndrome itself generally has a unique character marked on the etiologic level by a frequent occurrence of unilateral and post-traumatic forms, and on the clinical level by the existence of severe sensitivo-motor, vasomotor and trophic problems; it rarely resembles Raynaud's syndrome. The cutaneous lesion most often appears as a torpid ulceration located on the forefinger and/or the second finger and involving the palmar surface or the sub-ungual region of the 3rd phalanx. Cutting of the ligament of the middle finger, whether or not accompanied by an additional surgical act, is almost always followed by a regression of the classical signs and the curing of the ulcerations.


Serologic diagnosis in the differentiation of autoimmune hemolytic anemias. A complex serologic study was carried out in 20 patients with autoimmune hemolytic anemias (AIHA). The methods used were: the direct Coombs' test with specific sera anti IgG, IgM, IgA and complement (C), the direct and indirect test with papain treated erythrocytes (at 37 degrees C), determination of cold agglutinin titer and of warm and cold hemolysins. By these investigations using indigenous sera, the 20 cases of autoimmune hemolytic anemia could be classified: a) according to the thermal behaviour of autoantibodies, into warm antibody AIHA -- 15 cases, cold antibody AIHA -- 2 cases and both warm and cold antibody AIHA -- 3 cases; and b) according to the sensitizing globulin, into: IgG type -- 10 cases, IgG + C type -- 7 cases, IgG + IgM + C type -- 1 case, type C + cold agglutinins -- 2 cases.


Value of the test of spontaneous reduction of nitroblue tetrazolium in diabetes decompensation. Nitroblue tetrazolium (NBT) test was performed in forty-four diabetic patients of both sexes ranging in age from 15 to 64 years. Some of the patients were tested both before and after diabetes compensation. In cases of decompensated diabetes caused by dietary errors or by inadequate dosage of the antidiabetic drugs, NBT results were within normal range. Significantly higher values were observed in decompensation of diabetes caused by bacterial infection. This observation may be used to detect the real cause of diabetes decompensation.


Erythropoiesis in sickle cell anaemia during acute infection and crisis. Erythropoiesis was evaluated in 37 patients with sickle cell anaemia, 26 of them children under 12 years of age. Mean haemoglobin, haematocrit, reticulocyte, and erythropoietin levels were similar for 11 who were asymptomatic, 11 with infections, and 12 in vaso-occlusive crisis. Mean haemoglobin, haematocrit, and reticulocyte values were significantly lower and the mean erythropoietin level significantly higher for three patients in aplastic crisis. Reticulocyte counts reflected erythropoietic activity during the asymptomatic state but were variable during infection and crisis. No erythropoietic inhibitory activity was found in any of the four clinical states. It has been suggested that erythropoietin production decreases during infection. Patients in this study responded appropriately to stress, showing no decrease in erythropoietic activity during acute infection or crisis.


The effect of sonicated serum on growth of normal and leukaemic human cells in agar cultures. The existence of circulating factors in blood of possible importance for granulopoiesis was investigated by examining the effect of sonicated serum on agar cultures of human haematopoietic cells. Ultrasound treatment of serum can activate enzymes normally bound to carrier proteins. In normal bone marrow cultures, growth was inhibited by sonicated serum when the cells were cultured in a single layer without exogenous colony-stimulating factor (CSF) included in the culture, while an enhancing effect with a 2--5 fold increase in the number of colonies was seen in feeder layer-stimulated cultures. Morphologically, in contrast to the normal change to eosinophils and monocytes-macrophages during the culture period, the cultures with sonicated serum added showed continuous growth of neutrophils and no increase of other cell types. Experiments using tritiated thymidine indicated that the enhancing effect of sonicated serum involved marrow cells which were more prone to thymidine S-phase kill. The effect of sonicated serum was further evaluated in cultures from patients with leukaemia. In AML in relapse, feeder-layer stimulated cultures of bone marrow cells were inhibited (11/14 cases) by sonicated serum, while reversion to the normal enhancing pattern was seen for patients in remission.


Blood colony-forming cells (CFU-C) and leucocyte colony-stimulating activity (CSA) in patients with neutrophilic leucocytosis. The incidence of circulating colony-forming cells (CFU-C) and the ability of peripheral leucocytes to stimulate the colony formation (CSA) have been studied through a double layer agar culture system in 26 patients with neutrophilic leucocytosis and compared to the values obtained in 26 normal subjects. Both mean CFU-C incidence and mean leucocyte CSA of the whole group of patients were found significantly higher than normal, but considerable variation was observed among singular patients. The different patterns of blood CFU-C and leucocyte CSA are discussed. The combined evaluation of blood CFU-C and leucocyte CSA is found a useful tool to investigate the pathogenetic mechanisms of neutrophilic leucocytosis.


Studies of the haemopoietic microenvironment. II. Content of glycosaminoglycans in murine bone marrow and spleen under anaemic and polycythaemic conditions. Different glycosaminoglycans are described to be involved in processes of cell proliferation and differentiation. To investigate a possible direct involvement of glycosaminoglycans within the haemopoietic organs in erythropoiesis, biochemical separation and quantification of splenic and bone marrow glycosaminoglycans in anaemic and polycythaemic mice were performed. Hyaluronic acid, chondroitin sulphate A, B and C were present in both organs under both conditions. Both in spleen and bone marrow of polycythaemic mice very low amounts of chondroitin sulphate A, B and C, and a higher amount of hyaluronic acid were found in comparison to normal mice. In anaemic mice only the amount of splenic chondroitin sulphate C was found to be lower than in normal mice. It is demonstrated that considerable changes in sulphated and unsulphated glycosaminoglycans occur during erythropoietic stimulation and suppression. The present findings do not indicate a causal relationship between sulphated glycosaminoglycan levels in the haemopoietic organs and the extend of erythropoietic maturation.


Osteogenesis imperfecta associated with multiple myeloma. In a case of osteogenesis imperfecta with multiple fractures already from childhood, myelomatosis was diagnosed at the age of 52 years because of a serum M-component (IgG, lambda), Bence Jones proteinuria, myeloma cells in the bone marrow, and osteolytic skeletal lesions. She died 10 months later. A partial postmortem examination of a larger bone lesion confirmed the diagnosis.