Propranolol in serum by high pressure liquid chromatography using nitrile (CN) bonded columns in reverse phase. A method for monitoring therapeutic levels of the beta-blocking and antiarrhythmic drug propranolol in serum has been developed as a high performance liquid chromatography technique using bonded nitrile columns in a reverse phase mode with an aqueous methanol mobile phase containing acetate as a counterion. The performance characteristics of eight different types of reverse phase columns are discussed with evaluation for use in the method. The present method combines basic organic (cyclohexane) extraction with fluorescence detection of the chromatographic effluent to provide a specific, rapid, precise, and reliable technique that has been successfully used to monitor propranolol metabolites or other drugs. The method is shown to compare well with other methods and is suitable for therapeutic drug monitoring by routine clinical laboratories.


Decreased phenytoin levels in antineoplastic therapy. A case history is reported illustrating the difficulties which may be encountered in maintaining seizure control in patients being treated with antineoplastic therapy. The maintenance of therapeutic serum levels of phenytoin during combined cis-platinum and bleomycin sulfate therapy suggests an absorptive defect, possibly related to damage of the intestinal mucosa. This defect did not appear to alter the absorption of primidone or phenobarbital, since increased dosages were not necessary to maintain these drugs within therapeutic ranges.


Effect of influenza vaccination on plasma phenytoin concentrations. A mean decrease in plasma phenytoin concentrations of 11-14% (p less than 0.005) was observed in seven patients within 4 days after influenza vaccination. Possible mechanisms are discussed.


Predicting phenytoin dose - a revised nomogram. The nomogram devised by Richens and Dunlop for predicting phenytoin dose has been tested in 127 residential epileptic patients, and the data obtained were used to prepare a revised version of the nomogram. In a further 78 patients, this new version was found to be superior to the original. The mean Km value was found to be 23.8 mumoles/liter. Km was independent of age and body surface area, but Dmax correlated positively with the latter two variables.


Tricyclic antidepressants in serum by a Clin-ElutTM column extraction and high pressure liquid chromatographic analysis. We sought a method for routine therapeutic monitoring of serum tricyclic antidepressants (TCAs) which offered good reproducibility, detection limits, linearity, and specificity, and which was simple, rapid, and inexpensive to perform. The method described utilizes Clin-Elut columns (Analytichem International, Inc., Lawndale, CA 90206) to facilitate the extraction. The analysis is by high pressure liquid chromatography (HPLC) with a CN bonded phase column, a mobile phase of acetonitrile/pH 7.0 phosphate/methanol and detection at 210 nm. This chromatographic system gives short equilibration times, stable calibration curves, high sensitivity and resolution, short retention times, and long column life. The method is useful for determination of amitriptyline, doxepin, imipramine, nortriptyline, nordoxepin, desipramine, and protriptyline. Trimipramine is used as an internal standard for the tertiary amines and protriptyline for the secondary amines. Recovery is linear from 25 ato 1,000 ng/ml. Rubber stoppers of a new formulation in Vacutainer blood collection tubes (Becton-Dickinson, Rutherford, NJ 07070) do not affect serum TCA levels. Sera from 53 psychiatric patients suffering from endogenous depression were analyzed using the procedure presented. The mean serum level of four patients on amitriptyline therapy having complete remission was 201 ng/ml (range, 123-259). The mean serum level of four patients on imipramine therapy rated as having complete remission was 200 ng/ml (range, 145-258). These values compare well with recently published therapeutic ranges.


Determination of 5-(3,4-Dihydroxy-1,5-cyclohexadien-1-yl)-5-phenylhydantoin (Dihydrodiol) and quantitative studies of phenytoin metabolism in man. A routine gas chromatographic assay for urinary 5-(4-hydroxyphenyl)-5-phenylhydantoin (p-HPPH), the major metabolite of phenytoin (PHT) in man, was adapted to allow quantitation of 5-(3,4-dihydroxy-1,5-cyclohexadien-1-yl)-5-phenylhydantoin (Dihydrodiol, DHD) is based on the observation that acid-catalyzed dehydration of DHD quantitatively yields a mixture of p-HPPH and m-HPPH in a reproducible molar ratio of 56:44p-HPPH: m-HPPH and on the assumption that all m-HPPH found in urine after heating with acid has been derived from DHD. The urinary DHD content was verified by a "specific" method in which urine was incubated with beta-glucuronidase and the released phenolic metabolites completely removed by extraction. Subsequent acid-catalyzed dehydration of the remaining DHD yielded p-HPPH and m-HPPH, from the sum of which the original DHD concentration in urine could be calculated. In all of the urine samples from PHT patients examined to date, there was close agreement between the DHD values obtained by the "specific" method and those calculated from m-HPPH, in the simple acid-hydrolysis method. It can be inferred that much the greater part (greater than 90%) of m-HPPH found in human urine after acid treatment has been derived from DHD. All samples of urine after acid treatment has been derived from DHD. All samples of urine from PHT patients examined have shown detectable quantities of DHD. The methods described here may be useful in a survey of PHT patients to reveal unusual patterns of PHT metabolism and to permit recognition of possible associations between such unusual patterns and the occurrence of adverse reactions.


High performance liquid chromatographic analysis of cimetidine in serum. A rapid and reliable micro procedure for the high pressure liquid chromatographic analysis of cimetidine. N"-cyano-N-methyl-N'-[2-[[(5-methyl-1H-imidazol-4-yl)methyl]thio]ethyl]guanidine, in serum or plasma is described. The percentage analytical recovery of cimetidine and internal standard (beta-hydroxypropyl-theophylline) was 65 and 99%, respectively. The between-day precision of the method at cimetidine serum concentrations of 2,000, 1,000, and 500 microgram/liter yielded coefficients of variation of 10.6, 11.5, and 10.6%, respectively. The method has been used in preliminary studies to determine the serum concentrations in patients receiving the drug by both the oral and intravenous route.


A methods comparison: clonazepam by gas chromatography-electron capture and gas chromatography-mass spectroscopy. Clonazepam is an antiepileptic drug for which a number of analytical procedures have been presented, none of which have been subjected to comparison studies. We present two gas chromatographic (GC) methods involving distinct forms of detection for determining plasma or serum drug levels. Both methods involve simple extractions, common GC conditions, and routine data reduction. Both employ nitrazepam as an internal standard, require 1 ml of sample, and have a detection limit of 1 ng/ml. The two methods, GC-electron capture and GC-mass spectroscopy, are precise and accurate. Correlation of the two methods paired sample analysis gave a regression equation of y = 0.988x - 0.14 (n = 30, r = 0.971, p less than 0.001). We suggest that either method is a reasonable alternative for the clinical laboratory with the proper instrumentation.


High performance liquid chromatographic analysis of hydrochlorothiazide in serum and urine. We report a high performance liquid chromatographic method for the analysis of hydrochlorothiazide in 500microliter of serum of 25 microliter of urine. The between-day precision of the analysis (CV 5.0-7.0%) is acceptable, as is the recovery of hydrochlorothiazide (90-96%) and trichloromethiazide (96%) added to serum. No drug or drug metabolite interferences have been noted. The method represents a considerable improvement over existing techniques described in the literature.


Pharmacokinetics of Carbamazepine in man: a review. Gas-liquid chromatographic methods for determining plasma concentrations of the anticonvulsant drug carbamazepine are described. The pharmacokinetics of carbamazepine (absorption, protein binding, distribution, metabolism, and elimination) are reviewed, as well as the relationship between dose and plasma level and between plasma level and drug effects. Interactions with other drugs are noted.


Pyruvate carboxylase activities in red blood cells and liver of chicks and their dependency on biotin status. First results with activation assays.. Pyruvate carboxylase activities of erythrocytes and liver preparations and their in vitro stimulation by biotin were used for the determination of the biotin status of chicks. Reasonable stability of the enzyme in erythrocytes was achieved when storing the erythrocytes deep-frozen in a glycerol-containing medium. Results of the activation assays in erythrocytes and liver are compared with biotin levels in feed, plasma and liver. The pyruvate carboxylase activation assay appears to be a useful tool for assessing the biotin status of chicks.


Epidemiologic comparisons of the sudden infant death syndrome with other major components of infant mortality. All 1998 resident infant deaths in the 1969--1977 King County, Washington birth cohort of 139,132 resident live births comprise the data base for epidemiologic comparisons of the sudden infant death syndrome (SIDS) with eight other major infant mortality components: hyaline membrane disease; respiratory distress syndrome; asphyxia of the newborn; immaturity; birth injury; congenital malformation; infection; and "all other." These components were compared with respect to age at death; sex; race; prior fetal loss; prior live-born, now dead; birth plurality; birth weight; maternal age; birth order; marital status; prenatal care; and season of death in an attempt to determine the uniqueness of these purported SIDS risk factors. Only the age at death distribution unequivocally distinguished SIDS from the other components. The combination of low maternal age and multiparity was demonstrated to be putatively synergistic for risk of SIDS, hyaline membrane disease, and respiratory disease syndrome. Only deaths from infection exhibited seasonal variation similar to SIDS. These observations probably reflect secondary associations with as yet unidentified primary risk factors relatable to maternal experience.


The cardiovascular study in Finnmark county: coronary risk factors and the occurrence of myocardial infarction in first degree relatives and in subjects of different ethnic origin. As a part of a survey for coronary risk factors, family history of myocardial infarction (MI) was obtained in 4806 men and women aged 20--49 years. The two groups of subjects with (510) and without (3533) first degree relatives with MI showed only minor differences with respect to serum cholesterol, blood pressure, blood glucose, serum triglycerides, relative body weight and cigarette consumption. As long as no other mechanism for transmission of familial risk is revealed, the occurrence of MI among first degree relatives therefore must be considered as independent and important coronary risk factor. The material was also analyzed with regard to the three ethnic groups--Lapps, Finns and Norsemen--which comprise the study population. A discrepancy between risk factor level and MI incidence between these three groups was observed.


Selection on atherosclerosis as an explanation of the attenuated cholesterol-mortality relation in coronary heart disease populations. Recent studies of patients with coronary heart disease (CHD) at baseline have shown that their cholesterol levels are much less predictive of subsequent mortality than in populations free of CHD (FCHD). One previously suggested explanation of this attenuation is that the impact of hyperlipidemia on atherosclerosis or of atherosclerosis on mortality is reduced for post-myocardial infarction patients. In this paper it is shown that an alternative explanation is selection of CHD populations from FCHD populations for higher atherosclerosis levels. Data from all known follow-up studies on patients with baseline coronary angiograms are assembled to yield relations between cholesterol, atherosclerosis and mortality in CHD and FCHD populations. These data show that the selection hypothesis is not only logically possible but is also consistent with presently available epidemiologic information on relations between these three variables. An ethically impracticable large prospective study of a FCHD population with baseline angiograms might, however, be needed to choose definitively between the selection and reduced impact hypotheses.


Walking, cycling, or gardening, with or without seasonal interruption, in relation to acute coronary events. The case-referent study reported here investigates the relationship between acute coronary events (ACE) and sustained light physical exercise, mainly leisure-time walking, cycling, or gardening (WCG). These activities are classified as habitual WCG (greater than 8 months/year), seasonal WCG (4--8 months), or occasional WCG (less than 4 months), each category being further subdivided according to the number of hours a week: less than 4 hours, 4--7 hours, or greater than 7 hours. A significant negative association is found between ACE and habitual WCG. No such relationship is evident between ACE and seasonal WCG, however, seasonal WCG being equally frequent (27%) in both cases and referents. These observations may indicate that any effect on the incidence of acute coronary events that is caused by walking, cycling, or gardening is neutralized if these activities are interrupted for several months of the year. The negative association between habitual WCG and ACE does not depend on the number of hours a week devoted to SCG and is not enhanced by more vigorous additional exercise. The fatality of ACE (death rate within 4 weeks) is significantly higher in the least active group (WCG less than 4 months/year).


The influence of age, year of birth, and date on mortality from malignant melanoma in the populations of England and Wales, Canada, and the white population of the United States. The age-adjusted death rates from malignant melanoma of the skin have increased from 1951 to 1975 by about 3% per year in the populations of England and Wales, Canada, and the white population of the US. This is due to large increases in risk of successively later born cohorts. Any effects of earlier diagnosis of improved treatment within the period 1951--1975 have been sufficiently steady to fail to alter these trends. The slope of the log rates with log age is about 3.5. Projections of rates for at least the next decade can be made with some confidence, and provide a basis for evaluating control measures.


Osteoarthritis of the hand: longitudinal studies. Evaluation of the osteoarthritic grades of the hands of 478 participants of the ongoing Baltimore Longitudinal Study suggests that: 1) Joint degeneration due to osteoarthritis is a relatively slow process. The maximum rate of degeneration is seen in the distal interphalangeal joints where the average increase is about 1 grade per individual in an interval of 12 to 16 years between visits in each age group. The rate of degeneration in the proximal interphalangeal joints is much lower than that of the distal interphalangeal joints. 2) The progress of the degeneration in the distal interphalangeal joints of an individual (longitudinally evaluated) follows closely that which is observed at the population level (cross-sectional joint-digit study). That is, it is directly related to the age and the interval between visits. This is not always seen in the proximal interphalangeal joint data. 3) The rate of change in the osteoarthritic grade of individual hands agrees closely with that of their distal interphalangeal joints. This further supports the conclusions reached in a first report that what has been referred to as osteoarthritic grade of the hand of an individual may actually be the higher grade among the distal interphalangeal joints.


Methods for determining long-term survival in a population based study. A 98.8% response rate was achieved in a follow-up study of a community based health survey. The follow-up methodology used in contacting the residents of 1700 households in a suburban upper-middle class community is presented. Study subjects, who were predominantly white, older adults, participated in the original health survey during 1972 and 1973. When the follow-up study was conducted three years later to determine the vital status of study participants, 30% of the households had moved. Follow-up response of two sets of mailings totaled 76.1%. An additional 12.1% response was obtained by calling residents at their last known address. The final 10.5% of the contacted households were located by intensive telephone tracing. A wide variety of sources of information, both local and non-local, were used to locate these "hard to trace" households. They were different from all other contacted households with respect to mobility rate, household size, and death rate. A 15.5% underestimate of the three-year death rate would have occurred if the hard to trace group had not been contacted. These results emphasize the importance of complete follow-up in prospective studies.


Comparison of the radioallergosorbent test to intradermal skin testing in the diagnosis of stinging insect venom allergy. RAST and skin tests were compared for five venoms in a group of 60 patients with histories of stinging insect allergy. Twelve patients were skin test negative to all venoms and also RAST negative. The 48 skin test positive patients gave an 88% correlation of RAST and skin test with 92% of the skin test positive patients RAST positive and 82% of the RAST positive patients skin test positive. If patients strongly positive to honey bee showing positive RAST to vespids with negative skin test were not counted, then 91% of the RAST positive patients were skin positive. The term "false" should not be used in relating RAST to skin test results without supporting challenge evidence.


Simultaneous use of rapidly absorbed and sustained release theophylline preparations in children. Each of 12 asthmatic children received a single dose of Theolair, 5 mg/kg, a single dose of Theolair SR, 10 mg/Kg, or both Theolair, 3 mg/Kg and Theolair SR, 10 mg/Kg on three separate days. Administration of both preparations together was followed by serum theophylline concentrations significantly higher than Theolair alone at 2 or 12 hours and significantly higher than Theolair SR alone at every time except six hours. This method of theophylline administration may be useful in the asthmatic patient who requires medication only intermittently.


Comparison of Theolair SR and Theo-Dur tablets. The effects of administration of single doses of 10 mg/kg of two sustained release theophylline preparations were compared in a double-blind, crossover study in eight asthmatic children. Serum theophylline concentrations were maintained well for 8-10 hours after administration of Theolair SR and 10 and 12 hours after administration of single doses of Theo-Dur.


Incidence of fungal spores at the homes of allergic patients in an agricultural community. I. A 12-month study in and out of doors. A 12-month survey of the fungal spores in and out of homes of 145 allergic patients in an agricultural community was conducted. More than 6,100 colonies were recovered and 33 genera identified frm November, 1977, through October, 1978. Cladosporium was the most common genus identified and was recovered from 90% of the homes. Peak Cladosporium counts were observed during November through January, with another peak in March. Penicillium and Alternaria were recovered from 57% and 33% of the homes respectively. Relationships were observed between minimum daily temperature and indoor and outdoor Cladosporium and Mycelia sterilia counts. The relationship between sporulation of fungi and other environment factors is discussed.


Acute bronchial and cardiovascular effects of oral pirbuterol and metaproterenol. The acute pulmonary and cardiovascular effects of pirbuterol dihydrochloride 10 mg and 15 mg, a new orally active beta 2-selective sympathomimetic agent, were compared with those of placebo and metaproterenol 20 mg over a period of seven hours in 24 stable asthmatics. Pirbuterol 15 mg and metaproterenol 20 mg had a comparable onset of action (30 min) and magnitude of peak bronchodilator effect (29 +/- 5 mean % increase in FEV1) but the bronchodilatation following pirbuterol was longer lasting (seven hours) than that following metaproterenol (three hours). Pirbuterol 15 mg also caused a greater magnitude and duration of bronchodilatation than pirbuterol 10 mg. No effect on heart rate or PEP/LVET ratio was noted with either drug. Side effects reported following each of the active agents were comparable in frequency and were almost always mild. These findings indicate that pirbuterol is an effective bronchodilator with a relatively long duration of action, definite beta 2-adrenergic specificity and insignificant toxicity when administered in a single dose.


Analysis of the methacholine response in bronchial asthma. The airway response to methacholine was measured in 27 asthmatics. Selected indices of airway response were measured at 5-, 10- and 20-minute intervals and at three concentrations of methacholine. The mean change from control was significant at all three concentrations and there were no significant differences between time intervals. High correlations were obtained between all indices of airway response to methacholine challenge.


An evaluation of two inexpensive instruments for assessing airway flow. Studies indicate the Mini-Wright Peak Flow Meter and Pulmonary Monitor have potential utility to patients for assessing airway flow drops typical of intermittent airway disease, that instrument calibration remains stable with moderate use but that neither is able to predict absolute Peak Expiratory Flow Rate with sufficient accuracy.


[Problems in differential diagnosis between early presenile dementia and depression in elderly persons (author's transl)]. The difficulties in correct differential diagnosis between depression and early pre-senile dementia syndromes are pointed-out by the AA. They underline that, on the ground of literature reports and clinical experience, the instrumental methods (electroencephalography, cerebral blood flow examination, pneumoencephalography, evoked cerebral responses, etc...) appear of little use in differential diagnosis, if separately considered. A particular attention is called on psychometric tests, in order to worn the non-specialist against any too over-simplified and mechanistic acceptance of test results.


[Surgical treatment of fractures of the distal end of the femur]. After considering the anatomoclinical aspects of fractures of the distal third of the femur, the Authors analyse the classification of these fractures. Different types of fractures were reviewed and they discussed the best orthopaedic or surgical treatment needed. Surgical methods were studied regarding sopracondylar and intracondylar fractures, which present difficult problems of reduction, contention and consolidation. The 23 cases operated on in the last 2 years were discussed by the Authors.


[Anatomical and radiological aspects of retrograde pancreatography in chronic pancreatitis (author's transl)]. The authors performed from 1975 to 1978 1043 endoscopic retrograde cholangio-pancreatograms, of which 93.3% were successfully accomplished. They illustrate the anatomical and radiological aspects of the retrograde pancreatography in chronic pancreatitis, according to Cremer's classification. The authors confirm the reliability of the procedure, quickly accomplished and well tolerated by the patient.


[Liver and drugs: hematochemical and ultrastructural aspect after experimental administration of glucuronil-glucose-amino-glycan sulphate (author's transl)]. The Authors using a experimental model on various groups of treated rabbits have studied the pharmakinet of 3GS. After the discussion of data they conclude for an absence of injury rivelable by morphometabolic areas integrity. Further more is evident an improvement of a few hematochemical parameters.


[2 cases of adenolymphoma of the parotid gland]. Starting from two cases of adenolymphoma of the parotid gland they had under observation, the Authors underline their doubts regarding the histogenesis, discuss the clinical approach and show their attitude towards the therapy. It consists of an enucleation or nucleoresection of the tumour in case only the superficial part of the gland is affected; a total parotidectomy with facial nerve preservation and without any radiotherapy, in case of a radical operation; with complementary radiotherapy if the operation has not been radical for certain.


[Necessity of preparing the oral cavity for implantation]. The Author wanted to draw the attention of the person doing the setting, on the importance, in lasting prognosis, of the general conditions of the subject as well as of the situation of the oral cavity, which can present unfavourable elements to a setting. He is in fact referring to local original lesions or secondary lesions in pathologic states and he his stating the corrective intervention in order to prepare the month for the setting.


[Lithium treatment in Cluster headache (author's transl)]. the results of a Lithium Carbonate therapy for 14 Cluster headache patients are reported. For all of them a rapid and striking reduction of both the frequency and severity of the attacks was remarked on day doses that varied from patient to patient but never were over 900 mg. Plasmatic as well as RBC lithium levels have been constantly found below the levels generally believed as necessary for the treatment of manic depressive psychosis. The interruption of the treatment after one week without any attacks has never been followed by a new onset of them. Side effects have been checked as rare and scanty, so that all the patients have been allowed to bring the therapy to the conclusion.


Histoplasmosis diffusion in Somalia: study of skin-test and serological survey. Histoplasmin skin-test was applied to 1014 patients in two different parts of Somalia: in Mogadishu, an arid area, and in Jilib, a southern village on the banks of the Juba river. Among these patients only three gave areas of induration greater than 5 mm in diameter; all reactors were from Jilib. Results of a serological survey (latex-agglutination test) of histoplasmosis antibodies among 203 Somalian patients from three villages in river valleys are compared with the results of 171 inhabitants of the town of Mogadishu. Indirect agglutination antibody titers greater than or equal to 20 were found in 21.6% of the Mogadishu population as compared to 52.2% found in the river villages. In 96.2% of our cases in which the two tests were contemporarily used, the skin-test was completely negative despite high titres of positivity in the serological test. The results indicate the existence of founts of histoplasmosis infection in Somalia, particularly in humid areas bordering the rivers rather than in the surrounding arid semi-desert area characteristic of most of the country.


Susceptibility of Iraqi fresh water snails to infection with Schistosoma haematobium and Schistosoma mansoni Egyptian strains. A great number of Egyptian workers and farmers are seeking settlement in Iraq and some of them proved to have either Schistosoma Haematobium (S.h.) or Schistosoma mansoni (S.m) or even mixed infection. Besides, there is the possibility that some of the Iraqi fresh water snails may prove to be susceptible to infection by one or both of the Schistosoma Egyptian strains. The present study deals with investigations on the susceptibility of Iraqi B. truncatus, Gyranaulus ehrenbergi, Physa c.f. fontinalis, Lymnea lagetis, Melanoides tuberculata and Melanopsis nodes by these parasites. Egyptian S. haematobium but not Egyptian S. mansoni infect Iraqi B. truncatus and both proved to be unable to infect any of the other snails included in the study. Yet, the number of cercariae shedded by B. truncatus snails infected with the Egyptian S. haematobium strain, was much less that the number of cercariae shedded by these snails when infected with the Iraqi S. Haematobium strain.


Studies on the effects of O-isopropoxyphenylmethyl carbamate on the meiotic chromosomes of Saccobranchus fossilis. O-isopropoxyphenylmethyl carbamate in S. fossilis chromosomes has been found to induce fragmentation at pachytene and diakinesis. Fragmentation frequency increased with the increase in dose. The yield of total clumping at different doses and different intervals was inconsistent. Precocious despiralization and stickiness were also observed. Time interval was observed to be a factor in the appearance of anomalies with different doses. The dicentric bridges which were frequent at low dose, diminished in quantum with the increase in dose.


Contributions toward the study of changes in the microvascular-tissual system in diabetes mellitus (Observations on 50 biopsies of the finger-tip). Fifty biopsies of finger-tips, from diabetic patients were examined. We wish to emphasize, of damage in the blocking devices and in the preglomic arterioles as opposed to the limited modifications produced in the small dermic and hypodermic arteries. The glomera are almost constantly affected in their various components: in particular, the fusion of the glomic capsule with the intra- and extraglomic connective should be noted, as well as the presence of accumulated P.A.S. positive material among the mioepithelioid cells in the intermediate segment. The capillaries are frequently affected by hyperplasia of the intimal endothelium, sometimes with subocclusive phenomena, while the basal membrane is thickened and P.A.S. positive more often in extraglomic than in intraglomic capillaries.


Enzyme histochemical, biochemical and metabolic effects of Solcoseryl in connection with its radioprotective capability. The lethal irradiation with gamma-rays (LD 100/30) of adult mice at ambient temperature of 32.5 degrees C heavily alterates the pattern of LDH in liver. In close correspondence with the radioprotective effect of Solcoseryl on the survival rate of irradiated mice -- which amounts to 100% as compared with 40% survival of solely heat adapted animals -- Solcoseryl normalizes the LDH distribution both histochemically and biochemically. Since Solcoseryl alone generally enhances enzyme activity the normalization observed is obviously attributable to an intrinsically regulatory property of this natural compound.


Effect of gamma irradiation and cystamine on kidney lipids of rats. Effect of whole body gamma irradiation (1200 r) and the effect of administration cystamine prior to irradiation has been studied on kidney total lipids, cholesterol, phospholipids (phosphatidylcholine and phosphatidylethanolamine). Irradiation significantly decreases kidney cholesterol and this decrease was not prevented by administration of cystamine prior to irradiation. Irradiation did not affect the incorporation of NaH232PO4 into kidney phosphatidylcholine and phosphatidylethanolamine but the incorporation of glucose-U-14C was significantly reduced in kidney total lipids and phosphatidylcholine. Administration of cystamine before irradiation was ineffective in modifying the incorporation of glucose-U-14C into kidney lipids and phosphatidylcholine.


Correlations between capillary microscopy and electrocardiographic results in the diabetic. Ninety-nine diabetics were simultaneously given a capillaroscopic examination of periungual walls and an electrocardiogram evaluated according to the Minnesota Code. From these tests the following data were recorded: a. the number of knobs revealed by capillaroscopy is inferior, in a statistically significant manner, in groups having "major abnormalities"; b. capillaroscopic abnormalities did not seem to be definitely correlated to age, but rather to the length of time diabetes mellitus was present; in particular, these abnormalities were quite evident in subjects diagnosed as diabetics for the first time. This procedure is therefore extremely useful for the early diagnosis of diabetic microangiopathy; c. electrocardiographic abnormalities are correlated to patient's age, whereas are not related to the period of the illness. Although the small sampling obliges us to maintain certain reservations, such abnormalities were more frequent in subjects taking antidiabetic drugs orally.


Cell population kinetics and biochemical changes in the rat stomach during magnesium deficiency. Cell populations of rat stomach have been counted following varying (4-60 days) periods of magnesium-deficient diet and compared to a control group. The activity of beta-glucuronidase and the serotonin concentration were assayed in magnesium-deficient and control rats within four weeks. In the rat stomach the magnesium deficiency produces a numerical decrease in mucous cells, especially marked after 3 and 4 weeks. At this time, the activity of beta-glucuronidase decreases significantly. The concentration of serotonin increases at an earlier time and this increase coincides with the onset of the typical erythema occurring in magnesium-deficient rats.


The present prophylactic trends of rubella and measles. Starting from the epidemiological investigation on a sample of 22.560 subjects of different chronological age classes in the Latium region with the research of hemoagglutinoinhibiting antibodies of the Rubella virus, and of 9.800 subjects with the research of hemoagglutinoinhibiting antibodies of the Measles virus, the authors observe that the diffusion of the seroprotection presents on an average 82.5% for Rubella and 79.8% for Measles. On the strength of the results, referred also according to the established chronological age classes, any obligatory treatment against Rubella is excluded in prepuberal age. In order to prevent the risk of congenital malformation in cases of pregnant and not seroprotected subjects who, during the first three months of gestation might come into contact with sick affected by Rosolia or with healthy carriers, the authors suggest the vaccination three months before the conception. Evidently, this involves a screening of the adult female population before their marriage. On the contrary as concerns Measles, the vaccination within the second year of life is being hypothesized exactly on the basis of the consideration that this is a matter of a serious illness and not always free from grave complications. In these cases, after shortly referring on the results of the experiments of different authors, the mixed anti-Measles and anti-Rubella vaccination might be taken into consideration, though with all the precautions that are suggested.


Further studies on lactate dehydrogenase from serum of leukemic individuals. The kinetic properties of SLDH were investigated in untreated patients with acute leukemia at 37 degrees. SLDH was found to be inhibited by high pyruvate concentrations to a degree which depended on the pH of the reaction mixture; the degree of inhibition of normal SLDH at pH 7.5 was much higher than leukemic SLDH. 0.4M citrate was found to activate SLDH reaction rate at low pyruvate concentrations, while it was inhibitory at high pyruvate concentrations; the degree of inhibition being greater for leukemic SLDH than for normal SLDH. Citrate was also found to be a non-competitive inhibitor with respect to NADH and the value of Ki was determined. Methanol (3-4M), acted as a strong inhibitor to SLDH. The inhibition was found to be purely non-competitive with respect to pyruvate. Ki was calculated to be four times higher for leukemic SLDH than for normal SLDH.


Muscular microcirculation in diabetic microangiopathy (histangiopathy): new morphohistochemical aspects. The A.A. describe the pathological alterations of the blood flow regulatory mechanisms (blocking devices, "Sperrarterien"), systematically found in muscle biopsies of diabetic patients. The functional significance of these structure in normal and pathological conditions, as microangiopathic diabetics, is emphasized.


Monoamine oxidase and aspartate aminotransferase in cellular fractions of thyroid gland in rats after hypophysectomy and TSH stimulation. Monoamine oxidase (MAO) and aspartate aminotransferase activities in cellular fractions of thyroid gland in rats after hypophysectomy and TSH treatment were investigated. MAO and aspartate aminotransferase activities in thyroid mitochondria were decreased after hypophysectomy and significantly increased after daily injection of TSH during five days to hypophysectomized rats. In microsomes after hypophysectomy a similar decrease of MAO activity was found but TSH was without effect on this activity. it is evident that MAO and aspartate aminotransferase in thyroid mitochondria the enzymes which could be a source for hydrogen peroxide to catalyze thyroid hormone synthesis are under the regulatory influence of TSH.


Cytotoxic effects of phallolysin on a human heteroploid cell line. The effect of Phallolysin on cellular growth, macromolecular biosyntheses and cellular membrane structure was analysed using cells from the EUE line. Concentrations of the toxin that do not affect cellular growth, as determined by plating efficiency, have no effect on RNA or protein synthesis, but stimulate DNA synthesis. The doses of Phallolysin that inhibit cell survival do not affect macromolecular biosyntheses, but greatly increase the percentage of cells stainable with Trypan blue after 1 hour of incubation. At the same dose of the toxin the cells, analysed by electron microscopy, show increased vacuolization indicating an alteration of the membrane apparatus.


The free fatty acid pattern in blood serum in young spontaneously hypertensive rats. An investigation on the free fatty acid (FFA) profile in blood serum, using liquid gas chromatography, has been carried out on young (8-9 week-old) spontaneously hypertensive rats (SHR). A significative increase in the level of unsaturated FFA was found in SHR in comparison to their controls. The deviations in the composition of the FFA spectrum found were elevation of the polyunsaturated fatty acids: hexadecanoic acid (C16:2), linoleic acid (C18:2), linolenic acid (C18:3), eicosadienoic acid (C20:2), eicosatrienoic acid (C20:3), eicosapentaenoic acid (C20:5). The differences between FFA profile in SHR and control group can reflect genetically controlled variables.


Humoral control of thrombopoiesis.

Humoral control of thrombopoiesis. There is increasing evidence that an important mechanism by which platelet production is regulated depends upon a humoral substance (thrombopoietin) that affects the production of platelets by megakaryocytes. Plasma from thrombocytopenic donors increases the rate of appearance or concentrations of subsequently administered Na235SO4 or selenomethionine-75Se in platelets. Both isotopes are initially incorporated into the cytoplasm of megakaryocytes, and labeled platelets appear in the circulation after their production and release from megakaryocytes. Thrombopoiesis-stimulating activity also can be detected in the plasma of normal donors when endogenous thrombopoiesis has been suppressed in recipient assay animals by the hypertransfusion of platelets. Recent studies have indicated that certain fractions of plasma from throbocytopenic donors are also capable of stimulating thrombopoiesis in recipient animals. The nature of thrombopoietin(s) and its mechanism of action remain unknown. However, currently available data indicate that thrombopoiesis-stimulating factors may act both on diploid precursors and immature megakaryocytes and upon maturing megakaryocytes. The site of production of thrombopoietin also is unknown. Although the sensor that regulates thrombopoietin or other humoral mediators of thrombopoiesis has not been identified, it appears that platelet numbers, per se, are not the sole variable to which megakaryocytopoiesis eventually responds.


Does autoregulation of megakaryocytopoiesis occur? Although a major regulator of thrombocytopoiesis is the number of circulating platelets, several observations suggest that independent alternative regulatory mechanisms may exist. In some situations there is a curious association of megakaryocytopenia and megakarocytic macrocytosis in spite of normal platelet counts. If macrocytosis is considered as a sign of stimulation, this association suggests a cause and effect relationship between decreased numbers and increased size of megakaryocytes. This thesis was tested by examining the delayed effects of sublethal irradiation and the acute effects of hydroxyurea in mice. It was found that megakaryocytopenia and macromegakaryocytosis occurred together and that platelets counts were either normal or only slightly reduced. Therefore it was concluded that normal numbers of platelets could be produced by decreased numbers of megakaryocytes. Megakaryocytopenia appeared to be compensated, in part, by increased size of megakaryocytes, but the mechanism by which this occurred has not been elucidated. It is postulated that a reduction in the number of cells of the megakaryocytic system is sensed by a homeostatic mechanism that then acts to stimulate the cells that are present. This stimulation may then be manifested as macrocytosis of megakaryocytes.


Megakaryocyte colony culture using a liver cell conditioned medium. Megakaryocyte colonies may now be grown in semi-solid agar, agarose, and plasma clot systems using a variety of conditioned media. These include mitogen activated mouse spleen cells, L-cells (fibroblasts), and a myelomonocytic cell line. To these is now added a conditioned medium from BRL-3A, a rat liver cell line. Megakaryocytes show full maturation to cytoplasmic fragmentation in this system. It is suggested that colony stimulating factor for megakaryocytes may come from a variety of sources; the relationship of any of these to the physiological regulator or regulators remains quite unknown.


Growth of human megakaryocyte colonies in culture from fetal, neonatal, and adult peripheral blood cells: ultrastructural analysis. Megakaryocyte colonies can be grown in culture from human blood cells and fetal liver cells in plasma clot containing erythropoietin. Megakaryocyte progenitors were found in a fraction of mononuclear cells isolated by Ficoll density gradient centrifugation from adult, neonatal, and fetal blood. Megakaryocytes were identified by their morphology and particularly by their polylobulated nucleus when examined by light microscopy. The megakaryocytic nature of large cells was clearly confirmed by the presence of platelet peroxidase, demarcation membranes, and alpha-granules detected by electron microscopy; in addition mature small megakaryocytes were recognized. Megakaryocyte colonies were seen after 9 days of culture and consisted of 2 to 20 cells. The colonies were pure or mixed with the burst erythroblasts. The mixed colonies were numerous in fetal and neonatal cultures, while pure megakaryocyte colonies were seen three times more frequently in those from adult blood. The total number of colonies was also much lower in adult cultures. In colonies derived from neonatal and fetal cells, megakaryocytes often reached a more complete maturation than in those from the adults, proceeding as far as platelet shedding. This study demonstrates for the first time that a megakaryocyte committed cell present in human blood can develop megakaryocyte colonies in culture.


The cellular biology of megakaryocytes.

The cellular biology of megakaryocytes. Megakaryocytes show a pattern of cellular proliferation and maturation which is unique in mammalian biology. Cells mature to the point of cytoplasmic fragmentation in three major ploidy classes, 8n, 16n, and 32n and the three are fed from a precursor committed stem cell. Two-thirds of the cells belong in the 16n class, and approximately one-sixth in the 8n and 32n classes. The cytoplasm of cells in each ploidy class has a characteristic concentration of granules and demarcation membrane system which appears to be translated into the characteristic features of the platelet progeny from each class. These differ from normal young platelets. Megakaryocytes release fragments of cytoplasm into marrow sinusoids and these differ from platelets in that they do not have the peripheral microtubular bundle or sub-marginal dense tubular system. Transition from fragment to circulating platelet presumably takes place elsewhere in the circulation. With stimulation of platelet production, "stress" platelets are produced, from megakaryocytes which show changes with respect to content of polyribosomes, glycogen and membrane.


Fusion-fission reorganization of membrane: a developing membrane model for thrombocytogenesis in megakaryocytes. Freeze-fracture and thin-section electron microscopy indicate that a sequence of fusion-fission leads to reorganization of membranes and the demarcation of platelets within the cytoplasm of megakaryocyte. Invagination of the megakaryocyte plasma membrane leads to the formation of tubular structures within the cytoplasm of megakaryocytes. Fusion of these tubular membranes in the plane of their long axes is followed by fission in the perpendicular plane. This results in the formation of two flat membranes, forming plasma membranes of two adjacent platelets. A similar fusion-fission reorganization of membranes could mediate a wide variety of other biologic phenomena. These observations also indicate that megakaryocytes are located in the subendothelial compartment of the marrow with their projections penetrating the endothelium and reaching the lumen. This direct contact with the circulation may serve as a means of receiving information as to the requirements of the body for platelet production.


Nature of the hemopoietic stem cell compartment and its proliferative potential. The nature of the hemopoietic stem cell compartment has been the subject of much controversy. Data are presented to support the concept of a 'continuum' model of the stem cell compartment. The important characteristics of this model are that within the continuum there are cells with varying proliferative capacities. As cells move through the compartment, their proliferative capacity becomes more limited, their likelihood to be in cycle increases, and their commitment to a specific differentiated pathway increases. Experiments with busulfan, cyclophosphamide, 5-flurouracil, and BCNU demonstrate defects in proliferative potential of the surviving CFU-S population. These defects persist throughout the life of the animal without any evidence of recovery. The clinical implications of late stem cell failure may be important as a consideration in the use of cytotoxic agents.


Mechanisms of haemopoietic stem cell proliferation control. The control of stem cell (CFU-S) proliferation is mediated by short-range acting factors which can be detected by the proliferation modifying activities present in media conditioned by haemopoietic cells. A specific inhibitor of stem cell proliferation is obtained from haemopoietic tissue containing minimally proliferating CFU-S, whilst stimulatory material is obtained from cell suspensions containing rapidly proliferating CFU-S. Used competitively, these factors, which are detected in different molecular weight range fractions, manipulate the rate of CFU-S proliferation in a manner compatible with a physiological control mechanism. In addition, a long-term bone marrow culture system has been shown to provide an in vitro model of stem cell control. Fractionation of cell populations from haemopoietic tissues reveals marked concentration differences of the CFU-S proliferation modifying activities depending on the proliferative state of the CFU-S. However, irrespective of whether the tissue contains stem cells that are actively or minimally proliferating, both stimulatory and inhibitory activities are detected. From dose-response studies it is concluded that stem cell proliferation is controlled by an appropriate balance of stimulatory and inhibitory factors which, however, are not produced by the stem cells themselves.


Pluripotential stem cell replication in continuous human, prosimian, and murine bone marrow culture. Prolonged replication of pluripotential stem cells and committed progenitor cells is sustained for prolonged periods in a murine marrow culture system. Alterations in stem cell replication and differentiation are observed after infection of the cultures with Friend virus and Kirsten sarcoma virus consistent with transformation of pluripotential stem cells in the first case and transformation of the macrophage component of the hemopoietic microenvironment in the second. Prolonged myelopoiesis and CFU-c proliferation was also observed in continuous human and prosimian marrow cultures, suggesting the applicability of this technique for analysis of stem cell control and in vitro leukemogenesis in species other than the mouse.


The effects of humoral factors on amplification of nonrecognizable erythrocytic and granulocytic precursors. These studies were to evaluate the effects of humoral factors on amplification of nonrecognizable erythrocytic and granulocytic precursors by the in vivo plasma clot diffusion chamber and the in vitro plasma clot culture methods. Changes in the plasma erythropoietin levels in the reticulocyte concentration and hematocrits of irradiated and nonirradiated Long-Evans rats exposed to hypoxia were also determined. While erythropoietin plasma concentrations appeared to affect BFU-E and CFU-E growth, results suggest erythropoietin may not be the sole regulator of red cell production and that inhibitors of chalone-like mechanisms may be involved. Measurements made on granulocyte precursors treated with colony stimulating factor (CSF) containing L-cell-conditioned medium revealed granulocytic colonies and burst-like formations similar to those seen for erythrocytic growth. There is strong evidence suggesting that CSF is a regulator of granulopoiesis; however, it is not the sole regulator and it appears that inhibitors may play an in vivo role. Growth of colonies with cell numbers not a power of 2 implies either asymmetric mitosis due to loss of genetic information required for continuing division, or differences in concentrations of, or ability to recognize, inhibitory factors. These possibilities are examined in the light of results from in vivo and in vitro culture techniques.


Forced differentiation of CFU-S by Iron-55 erythrocytocide. Cascades of Auger electrons are emitted in the decay of 55Fe and absorbed in tissue within a 1 micrometer radius. Cytocidal amounts of 55Fe can therefore eliminate erythroid precursors with minimal damage to adjacent cells. A single intravenous injection leads to continued erythrocytocide in mice because the isotope is reutilized and has a 2.7 year half-life. The cytocide evokes an early compensatory response from morphologically unrecognizable precursors which differentiate into pronormoblasts. These early events leave the granuloid series undisturbed but they are accompanied by a precipitous fall in pluripotent stem cell (CFU-S) numbers in bone marrow, spleen, and blood. The pretreatment levels of CFU-S are not restored. Gradual decline of CFU-S is associated with intermittently increased turnover rates and reduced settings of cell production, yet the capacity for quick restoration of blood loss is unimpaired. The precipitous initial stem cell decrease is not caused by irradiation damage, as shown in a separate experimental series that used the frozen-storage cytocide technique. Only over several weeks could 55Fe radiation accumulate to lethal levels in nondividing stem cells. This irradiation is attributed to incorporation of small amounts of 55Fe into CFU-S, from where it is slowly cleared. The stem cell loss immediately following 55Fe injection is in our interpretation caused by rapid differentiation along the erythroid pathway in a response that involves all progenitor populations. Data are consistent with the hypothesis of limited cell renewal capacity which thereby gains further support.


Marrow flask cultures -- a system for examining early erythropoietic differentiation events. A technique for observing in flask cultures the differentiation and proliferation of murine CFU-S into each of the three myeloid lines is described. The differentiation of cells along the erythroid pathway is arrested at a very early stage making it possible to obtain large numbers of primitive erythropoietic cells derived from adult murine bone marrow. The pattern of differentiation obtained from these BFU-E suggests that the capacity for granulopoiesis is usually lost before a committment to either megakaryopoiesis or erythropoiesis is made.


Radioimmunoassay of erythropoietin.

Radioimmunoassay of erythropoietin. A radioimmunoassay for erythropoietin has been developed using 125I labeled pure human erythropoietin and an anti-erythropoietin antiserum produced in a rabbit immunized with human erythropoietin. Two techniques are presented for labeling erythropoietin, both resulting in an immunologically reactive labeled reactant. One method involves the use of lactoperoxidase and the other a reagent known as IODO-GEN. The second International Reference Preparation of human erythropoietin is used as a standard and a double antibody scheme is used for the separation of the free and antibody bound labeled hormone. The radioimmunoassay is sensitive to an absolute amount of erythropoietin equivalent to 0.4 milliunits. Bioassays for erythropoietin require approximately 100 times this amount. The use of pure erythropoietin as the labeled reactant has removed certain discrepancies seen in previous attempts to develop radioimmunoassays for this hormone, e.g., sera from patients without kidneys do not give the high values previously seen. Sera from anemic individuals not only give rise to high radioimmunoassay values but also show a parallel relationship with the erythropoietin standard when halving dilutions are analyzed. Desialated erythropoietin is also reactive with the same parallelism. Bleeding of a normal individual increases the serum erythropoietin level and transfusion decreases it. Erythropoietin from a variety of laboratory animals is also reactive in the radioimmunoassay, with very high values being observed in hypoxic animals.


Absence of erythroblastic islands in plasma clot culture and their possible reconstitution after clot lysis. Ultrastructural studies of erythroid colonies derived from human peripheral blood and growing in plasma clot culture have confirmed the absence of a macrophage inside each colony of erythroblasts. However, when macrophages and erythroblasts were liberated from the semisolid media by clot lysis, these two types of cells rapidly acquired intimate contacts, suggesting the reconstitution of any erythroblastic island. The possible significance of this phenomenon is discussed.


Lymphocyte recirculation and the gut: the cellular basis of humoral immunity in the intestine. During the last 15 years evidence has accumulated which shows that the B immunoblasts generated in the gut associated lymphoid tissue (GALT) in response to antigenic stimuli from the intestinal tract are discharged into the intestinal lymph. The lymph stream carries them to the blood but most of them soon extravasate in the gut (and some other mucosae) and develop into plasma cells which synthesise secretory immunoglobulins. In sheep, there is some evidence that these cells may be derived initially from a sub-set of small lymphocytes which circulate preferentially through the GALT, but the situation in rodents is less clear. However, in most species it is becoming clear that although some of the antibodies produced by the sub-mucosal plasma cells are secreted directly into the lumen of the gut many find their way, via the lymph, into the blood and, if in the form of polymeric IgA, they are rapidly and actively transported by the hepatocytes into the bile and thus gain direct access to the duodenum in concert with the entry of freshly ingested food and bacteria.


Enzyme release and morphological changes in leukocytes induced by mechanical trauma. Polymorphonuclear (PMN) leukocytes exposed to mechanical trauma in vitro will release enzymes both from azurophilic and specific granules at shear stress levels of between 75 and 150 dyn/cm2 for 10 min. In addition, at these shear stresses the leukocyte count in whole blood decreased only slightly and the number of ruptured leukocytes on Wright-stained blood films increased significantly. At higher shear stresses, enzyme release and leukocyte damage increased monotonically. Transmission electron microscopy evaluation of sheared PMNs revealed that remaining intact cells had minor morphological changes at stresses of 150 dyn/cm2. They were characterized by clublike cytoplasmic potrusions, spherical shape, and a circumferential distribution of cytoplasmic granules. At higher shear stresses (600 dyn/cm2) cell destruction was marked. Intact PMNs contained fewer cytoplasmic granules, a large number of vacuoles, and condensed nuclear chromatin. These studies show that PMN morphology and function are at least as sensitive to mechanical trauma as similar platelet alterations seen in other studies.


Iron deficiency and dyserythropoiesis in bilharzial and non-bilharzial patients. The degree of dyserythropoiesis was studied in bilharzial patients with iron deficiency anaemia. It provides a reliable indication of the severity of iron deficiency as measured by the serum iron and total iron binding capacity. A positive correlation has been found between the percentage incidence of dyserythropoiesis in the bone marrow and both the serum iron and percentage of iron saturation.


Studies on certain serum enzymatic activities in hepatosplenic bilharziasis. Determination of serum enzymatic activities in hepatosplenic bilharziasis (H.S.B.) were conducted in 100 bilharzial patients, in different stages and 30 controls SGot, SGPT, ALK pH, ALD and SLDH with its both fractions heat stable and labile.). Early elevation of serum enzymatic activities of SGOT, SGPT and SALK. pH, may be considered as a sensitive parameter for functional changes in H.S.B. rather than other conventional liver function tests. The elevated enzymic activity of total LDH in this study was associated with elevation in its both fractions. In particular, the changes in the total activity was in parallel with that of its heat labile fraction. The latter may be considered as a confirmatory test for marked deterioration of liver functions in H.S.B. The changes in the heat stable fraction was inconstant and may be attributed to extrahepatic bilharzial dissimilation. Significantly high serum enzymatic activity of SALD was found in cases of H.S.B. particularly those showing striking muscle wasting.


Studies on bilharzial dysentery: the relation among the egg count, the number of bowel motion and the antibody titre and the relation between the schistosomal antibody titre as detected by indirect haemagglutination test and the size of the wheal area of the intradermal test. The authors studied the relation among the egg count, the number of motions and the antibody titer in 185 patients suffering from bilharzial dysentery. They found that no significant relation between the level of antibody titre and the number of ova and also no relation between egg count and number of motions but a significant relation between the number of bowel motions and the level of antibody titre was recorded. An auto-immune mechanism in Schistosoma mansoni has also been shown in this work but it needs further proof. On the other hand two diagnostic tests were performed namely the intradermal test and the indirect haemagglutination test. The former gave 84% positivity while the latter gave 94% positivity. In comparing the wheal size of the intradermal test and the titre of haemagglutination, it has been found that the wheal increases in size with rise of the titre. Therefore the wheal size can roughly suggest the level of immunity of the patient.


Effect of schistosomal infection on some functional activities of blood platelets. The present study deals with the quantitative and the qualitative platelet functions and their relation to the different stages of hepatosplenic schistosomiasis. The work has been carried on 40 subjects as non-bilharzial control, and 54 patients with schistosomiasis in the different stages of the disease. The statistical analysis of the results obtained, showed no difference in both the quantitative and the qualitative platelet functions in the early active intestinal bilharziasis, when compared to the non-bilharzial control group. The impairment in the platelet functions started to be evident in the group of hepatosplenomegalic bilharziasis and became most obvious in the splenomegalic and ascitic stages. This denotes that there was a correlation between the impairment of both the quantitative and the qualitative platelet functions and the progress of the disease.


Biochemical effects of niridazole. I. In vitro and in vivo effect of niridazole on the rate of gluconeogenesis and oxidation of pyruvate and some Krebs cycle intermediates in mice. The effects of the antischistosomal drug, niridazole, on the rate of gluconeogenesis in kidney cortex slices and on the rate of oxidation of pyruvate and some Krebs cycle intermediates in liver homogenate of non infected mice were determined. In vitro, niridazole was found to inhibit the succinate and pyruvate oxidation at the high concentration tested (10(-3)M). The rate of gluconeogenesis from alpha-ketoglutarate was unaffected. In vivo, niridazole showed a stimulatory effect on the rate of gluconeogenesis from alpha-ketoglutarate and on the rate of oxidation of pyruvate at a dosage level of 100 mg/kg for 5 days. The observed changes were discussed and the differences observed between the in vivo and in vitro work were assumed to be due to exposure of the tissues to the unmetabolized drug in vitro and to the drug and its metabolites in vivo.


Biochemical effects of niridazole. II. In vitro and in vivo effects of niridazole on the rate of gluconeogenesis and the rate of oxidation of pyruvate and some Krebs cycle intermediates in Schistosoma mansoni infected mice. The effects of the antischistosomal drug, niridazole, on the rate of gluconeogenesis in kidney cortex slices and on the rate of oxidation of pyruvate and some Krebs cycle intermediates in liver homogenates of infected mice were described. The effect of schistosoma mansoni infection on the previously mentioned parameters was also described. The infection per se did not affect the rate of gluconeogenesis from pyruvate, succinate and alpha-ketoglutarate when used as gluconeogenic precursors. In case of the rates of oxidation of pyruvate, succinate alpha-ketoglutarate and citrate, the infection decreased them significantly. In vitro, niridazole did not increase the inhibition of the rate of oxidation of different substances studied caused by the infection per se. The rate of gluconeogenesis from alpha-ketoglutarate was also unaffected. In vivo, niridazole did not affect the oxidoreductases more than did the infection per se. In fact in many cases, the drug tended to normalize the inhibitory effect of the infection on some of the enzyme systems, particularly in the case of the citrate succinate and pyruvate. On administration of 100 mg/kg of niridazole for 5 days (i.e. low dosage only) the rate of gluconeogenesis from pyruvate and alpha-ketoglutarate was stimulated. Such effects seem to be related to the presence of metabolites rather than to the parent drug.


A preliminary report on the materno-foetal immunological changes in schistosomiasis. I. Immunoglobulin changes. Twenty five simple bilharzial pregnant females together with eight control non-bilharzial gravid women were included in this study. Quantitation of immunoglobulins G and M was performed on both maternal and cord blood sera. The transmission of IgG through the placenta was suggested by the trend for positive correlation between foetal and maternal IgG levels. Maternal IgG was significantly higher in the active bilharzial group compared with the non-active group. Foetal IgM was significantly higher in the active bilharzial group compared with the control non-bilharzial cases.


A preliminary report on materno-foetal immunological changes in schistosomiasis. II. Circulating antigens and antibodies. Twenty five pregnant simple bilharzial patients together with 8 non-bilharzial pregnant women and 14 bilharzial non-pregnant females were included in this study. Circulating bilharzial antigens were tested in all groups by the IHA technique. Both IHA and COP were used for detection of bilharzial antibodies in the same groups. Bilharzial antigenaemia was higher in pregnant bilharzial women than in non-pregnant ones. The bilharzial antibodies were detectable in a smaller percentage of bilharzial pregnant women than in non-pregnant ones. Also, the IHA antibody titers and COP grades were lower in the former than in the latter; a total picture suggestive of depressed humoral immune response in pregnant bilharzial women. The passage of circulating bilharzial antigens and antibodies through the placenta to the foetus is demonstrated.


Prevalence of schistosomiasis among fishermen of Lake Maryut. A survey was carried out to investigate the presence of Bilharziasis among the fishermen of the lake Maryut. Schistosoma mansoni is more prevalent, than S. haematobium among fishermen of lake Maryut. Biomphalaria alexandrina, snails were prevalent around the lake specially in places of low salinity, where fresh water discharges exist. Bulinus truncatus snails were not found during the time of the present survey and more frequent surveys are needed. There is an inverse relation between the number of snails and the salinity of the water. Since the salinity of the water is decreasing by time as a result of the increased discharge of agricultural and domestic waste into the lake, Bilharziasis infection may increase among the fishermen. This situation needs more attention from public health authorities in the area.


Left ventricular dysfunction after intravenous tartar emetic. Left ventricular dysfunction had been reported in many patients suffering from schistosomal cor pulmonale. The nocuous agents affecting the left ventricle have not been defined. Antischistosomal therapy is suspected to contribute in the adverse effects on the myocardium, particularly antimonials and niridazole. In this study, the left ventricular performance was studied in 29 patients suffering from schistosomiasis before and 30 min after i.v. therapeutic dose of a tartar emetic. After the injection, the PEPI and PEPI/LVETI were increased, the LVETI was abbreviated, EF. was reduced, the LVEDP was raised, the peak dp/dt and the Vmax were reduced. Toxic effects of the T.E. on the myocardium and diminished contractility of the left ventricle were presumed to be caused by T.E. Other factors adversely affecting the myocardium in patients suffering from schistosomiasis cannot be excluded.


Effect of some herbicides on the toxicity of certain molluscacides against Biomphalaria alexandrina snails. Studies dealing with the effect of some herbicides on the molluscicidal action of certain molluscicides against B. alexandrina have been carried out. In the first part of the study the toxicity of 3 molluscicides (Copper sulphate, Niclosamide and Frescon) and 3 herbicides (Gramaxone, Preforan and Treflan) was tested individually. Results indicated that the molluscicides were more potent than the herbicides. In the second part, snails were exposed for 24 hr to one of the tested herbicides using LC0 or (Sub. lethal conc) then the toxicity of molluscicides was determined among the same snails. Data indicated that pre-exposure to herbicides caused a synergistic action with copper sulphate, while with Niclosamide and Frescon marked antagonistic effect was observed. In the third part molluscicides and herbicides were mixed in different ratios (1:2, 1:1 and 2:1) and the toxicity of the mixtures was tested. A synergistic effect was observed in the case of copper sulphate plus various herbicides especially with Treflan at 1:2 ratio. With Niclosamide and Frescon slight antagonistic effect was detected.


Interactions of endogenous rhythms during postnatal development. Observations of behaviour and polygraphic studies in one normal infant. The spontaneous sleep-waking behaviour of a male infant, normal with respect to pregnancy, delivery and Apgar score, was observed continuously from birth till the first four months of life. Additionally sleep stages were registered polygraphically during several weeks. The infant was allowed to sleep and awake according to his own schedule. It could be demonstrated that the spontaneous sleep-waking behaviour was mainly driven by 3 endogenous rhythms : The Basic rest activity cycle with a period of about 50 minutes, a 4-hour cycle already established during the first 2 weeks of life and a circadian rhythm which developed during the second month of life. So far the presented results support earlier studies of Kleitman and Engelmann, Sterman and Hoppenbrouwers, Hellbrugge etc. The present study, however, gives further evidence, that these rhythms do not run independently, but constitute a system of interacting oscillators.


Rhythmometry gauges treatment of mesor-hypertension in the seventh and eight decades of life. Autorhythmometry of blood pressure by an individual over an age-span of 67 to 72 years showed a strong circadian rhythm superimposed upon significant circaseptan and circannual rhythms. Automatic BP monitoring with an Arteriosonde throughout 24-hour spans on 4 separate occasions, before and during treatment, also indicated a prominent circadian BP rhythm and a treatment-related reduction in circadian mesor. The concept of a blood pressure mesor reference for the antimesor-hypertensive treatment constitutes a valuable guideline in the control of "familial" mesor-hypertension.


Chronobiological aspects of stereotyped motor behaviour in mentally retarded children. Normally developed children show many diverse patterns of behaviour. By contrast, the behaviour of severely mentally retarded children is restricted mainly to primitive motor acts called stereotypes. Due to the severity of the mental retardation, these children are also markedly reduced in their susceptibility to environmental influences. Systematic observations of the pathological motor patterns of these children make it feasible to investigate possible endogenous mechanisms related to these primitive motor activities. The stereotyped motor behaviours of six severely mentally handicapped children were observed continuously for several days. Each child performed at least two forms of stereotyped behaviour. Using spectra of variance and cross-correlation analysis, the data were investigated with respect to underlying periodicities. A 2.5-hour cycle was consistently found in every stereotyped activity observed. Furthermore, stable phase relationships were revealed between the periodic variations of different stereotyped movements in one and the same child. Thus the temporal courses of hand and oral stereotypes were synchronous, whereas head and whole-body stereotypes were delayed by half a phase with respect to stereotyped hand waving. A possible relationship is discussed between the 2.5-hour periodicity of stereotyped behaviour and Kleitman's "Basic Rest Activity Cycle".


Schedule shifts, life quality and quantity--modeled by murine blood pressure elevation and arthropod life span. During the span from 50 to 100 days and beyond, the male stroke-prone Okamoto rat develops systolic blood pressure measures in excess of 200 mm Hg. In the course of developing such a marked elevation in systolic blood pressure mean, this intermittently handled male Okamoto rat exhibits a statistically significant circadian rhythm with large amplitude. This amplitude may represent, at least in part, a response to intermittent handling; it is several times larger than the amplitude for spontaneously mesor-hypertensive (but not stroke-prone) female animals of the same age.


[Prognosis of diaphragmatic hernia through Bochdalek's foramen during the neonatal period (author's transl)]. The authors analyse 46 cases of congenital diaphragmatic hernia through Bochdalek's foramen, discovered during the neonatal period. An autopsy study showed the various causes of postoperative mortality, and the authors studied pre, per and postoperative prognosis. A search for the causes and mechanisms of the complications suggested measures liable to improve survival. The authors tried from this data to determine the best management of this malformation.


[Primary gastric non-Hodgkin malignant lymphoma. Report of 38 new cases (author's transl)]. 38 cases of primary gastric non-Hodgkin malignant lymphoma operated on between 1961 and 1978 are reported. They note two changes in the study of this localisation of malignant lymphomas: a diagnostic difference as the latter is more and more often made with certainly although histological difficulties persist, and a therapeutic difference as surgical removal is now associated with radiotherapy and chemotherapy. The relative importance of these three methods depends on each case, and in the future will depend on careful assessment of the lesions, of which classification is now accepted by everyone.


[Interest and limits of estimation of the carcinoembryonic antigen in colonic and rectal (author's transl)]. An attempt is made to define the usefulness and limitations of carcinoembryonic antigen (CEA) radioimmunoassay for evaluation of diagnosis, tumor resection and detection of tumor relapse in 108 patients with colorectal carcinoma. Preoperative CEA levels were correlated with pathological stage and tumors localisations. Increasing levels of CEA were found with advanced stage of disease (Stage C and D lesions). Our results indicate: 1) that an incomplete drop in circulating CEA level one month after surgery was a bad prognostic sign; 2) that relapses of colon and rectum carcinoma can be detected by increased CEA levels months before the appearance of any clinical evidence.


[Traumatic rupture of the diaphragm. Report of 21 cases (author's transl)]. The authors study 21 cases of traumatic rupture of the diaphragm. All were due to road accidents and were associated with multiple injuries. They emphasise the importance of clinical and radiological examination and the often negative results of peritoneal dialysis. Assessment of the lesions should be carefully carried out by a medical and surgical team familiar with these problems. The mortality remains high in spite of rapid and early surgical treatment.


[Two cases of benign liver tumour in women on oral contraceptives (author's transl)]. Two benign liver tumours are described in women who had taken oral contraceptives. These were cases of focal nodular hyperplasia and a liver cell adenoma. These lesions are benign, and were discovered on routine examination as they were not responsible for any clinical sign, as is usual except in cases of peritoneal rupture, where the patient presents with a dramatic hemoperitoneum. Oral contraceptive were found to be associated as in many recent cases. Oestro-progestins were found to be responsible for an increase in hepatic metabolism, which gave rise to biochemical, histological and sometimes clinical changes in the form of jaundice or a tumour. There is no proof of this mechanism but the supervision of women on contraceptives should include a search for a hepatic tumour for which surgical treatment is necessary to prevent complications.


[Treatment by a direct surgical approach of a false arterio-venous traumatic aneurysm between the vertebral artery and the internal jugular vein at the level of the atlas (author's transl)]. The authors report a case of traumatic arteriovenous fistula between the vertebral artery and the internal jugular vein at the level of the atlas, treated successfully by a direct surgical approach which permitted exclusion after simple dissection. The relative ease of the surgical approach of the suboccipital segment of the vertebral artery may permit one to extend this technique to other more common indications, in particular due to atheroma.


[The organisation of perinatal care in a rural area. An enquiry into the Limousin Region (author's transl)]. Improvement in mortality and perinatal morbidity in rural areas is the result of: The appointment of qualified obstetricians. The provision of modern methods of obstetrical monitoring. The fact that "'avoidable" mortality and morbidity persist in these same rural districts is related to: Premature deliveries and the difficulties of transporting the premature babies. The survival of "country deliveries". We propose three solutions to improve perinatal care in these regions: Transformation of rural maternity units which are under-equipped into Centres where pregnancy can be monitored properly. Avoidance of transfer of the newborn by making it easier to transport the mother to Centres that have a good obstetric and paediatric unit. Provision of a real liaison between the unit that has the obstetrician and paediatrician in it and the district rural maternity services.


[Early amniocentesis, 1061 punctures and 1000 pregnancies]. The authors analysed 1061 early amniocentesis carried out during 1000 pregnancies. The indications were as follows: chromosomal abnormalities (79,6 p. 100), fetal karyotypes for X-linked diseases (4,7 p. 100), metabolic disorders (5,9 p. 100), amniotic fluid alpha-foetoprotein (9,8 p. 100) in neural tube defect or congenital nephrosis. Amniotic fluid was obtained on the first attempt in 98.2 p. 100 and on the second attempt in 100 p. 100. The fluid was heavily blood-stained in 1,7 p. 100, sanguinolent in 3,8 p. 100 and brownish in 2,40 p. 100. Cells were grown on the first attempt in 98 p. 100 and on the second attempt in 100 p. 100. The outcome of pregnancies was correlated with the indications of amniocentesis. The rate of spontaneous abortion is 1,7 p. 100, but only 6 of them can be due to amniocentesis (0,6 p. 100). Perinatal mortality was 1,8 p. 100: mortinatality (1,2 p. 100) and neonatal mortality (0.6 p. 100). All this fetal deaths have other causes. The fetal loss was 3,9 p. 100. Fetal morbidity was low: none fetal injuries, none cutaneous scar, few premature deliveries (1,6 p. 100), some malformations more or less serious (2,6 p. 100) with 4 congenital luxations of the hips (0,45 p 100). Maternal morbidity was limited at a greater cesarean section rate: 21 p. 100 (30 p. 100 in women 40 years old and more), none feto-maternal rhesus immunization was observed because immunoprophylaxis was strictly performed. The rate of therapeutic abortion was 4,6 p. 100 without any diagnostic error. Diagnostic accuracy was 100 p. 100. Several conditions are necessary to be the procedure safe accurate and reliable: appropriate genetic counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid (uterus size: 12 cm), gynecologic examination by operator himself, perfect echography to localize the placenta and detect multiple gestations, adequately trained obstetrician, use of 20 gauge spinal needle, stric asepsis, experimented laboratory and experienced staff.


[Thrombo-embolic disease and pregnancy. The prevention of pulmonary emboli by placing a clip on the inferior vena cava (author's transl)]. The authors, having had a case of deep pelvic phlebitis occurring in a young primiparous woman who was treated prophylactically against the occurrence of a pulmonary embolus by placing a clip on the inferior vena cava discuss: the etiology of the condition: the difficulties of the diagnosis. They point out the value of phlebo-cavography which is an essential investigation in which no more than 4 films are taken, because it is on this that the indication for surgery rests. They point out the value of anticoagulant treatment, especially that using Calciparine which permits the patient to lead a more or less normal life at home. As far as the surgical procedure is concerned, a median approach seems to them the best way to carry out the operation.


[Grave obstetrical phlebitis. Physiopathology, diagnosis and treatment (6 case histories) (author's transl)]. The authors detail their concepts of the physiopathology, the diagnostic methods and the treatments of grave puerperal phlebitis, having seen six cases in their two departments recently. They consist of 5 cases of iliofemoral thrombosis, 2 of whom were diagnosed during their pregnancies and 3 others whom were diagnosed after delivery. One of these died of pulmonary embolus: and there was one case of thrombosis of the right ovarian vein during post-partum. Over and above the classical factors that predispose to this condition in pregnancy, the authors draw attention to the anatomical constitutional factors that have been observed by Cockett in the physiopathology of these cases. The diagnosis is made using non-invasive methods: Doppler, plethysmography, labelled fibrinogen and isotope phlebography after delivery, supplemented when the results are positive by radiography of the iliac and vena caval systems which alone gives a precise diagnosis of the site. Therapeutic possibilities change according to the time that the condition is perceived, according to the topography of the lesions, and according to the existence or non-existence of moving thrombi. The treatment is directed to avoiding the complications of emboli and to preventing secondary functional sequellae. Finally the gynaecological problems of contraception and of further pregnancies are considered.


[An analysis of 65 cases of salpingostomy carried out using microsurgical techniques (author's transl)]. 65 salpingostomies were carried out using microsurgical techniques between 1976 and 1978. The patency rate was 89 p. 100. There were 30 p. 100 intra-uterine pregnancies and 4 p. 100 ectopic pregnancies. The authors emphasize the prognosis that can be obtained from hysterosalpingography, laparoscopy and histological examination of the tissues and the very poor results that are obtained even using these methods when a second operation is undertaken.


[Six-monthly administration of medroxyprogesterone acetate (MPA) (author's transl)]. For more than six years the authors have studied the acceptability and the effectiveness of Medroxyprogesterone Acetate (450 mg) as a long acting contraceptive (six months). With a Pearl index of 0.85, the method was considered as effective whereas its acceptability was adversely influenced by the bleeding irregularities that take place during the first year of use. A good patient-doctor relationship could lessen this influence.


[A case of meningitis due to Acinetobacter calcoaceticus]. Meningitis due to Acinetobacter calcoaceticus is rare. These rare bacteria were isolated from culture fluid in patient resembling to Neisseria meningitis with clinical and laboratory findings. The patient was treated with sensitive antibiotic.


[Drug fever due to isoniazid].

[Drug fever due to isoniazid]. Drug fever is an uncommon manifestation of isoniazid intolerance. A patient with tuberculous peritonitis is presented with a diagnostic problem, because of continuous and spiking fever, while she was on isoniazid. The fever disappeared after discontinuation of the drug. For confirmation of the drug fever, isoniazid was given on two occasions. Fever respond was demonstrated on rechallenge. This case calls attention to uncommon adverse reaction of isoniazid in patients who are treated with isoniazid.


[Regional incidence of intestinal parasites in Turkey]. Turkey, seems to be an appropriate environment for parasitic diseases in respect to its geographical and social-economical situations. In this communication, the incidence of intestinal parasites according to the regions is given and discussed in detail.


[Immunologic aspects of the nephrotic syndrome]. Evidence that immunological mechanisms playing a major role in certain forms of nephrotic syndrome are obtained from immunopathologic observations, by analogy to certain form of experimental renal disease and by alterations in serum complement and complement component levels. This group of disease includes a variety of glomerulonephritis in which antigen-antibody-complexes and anti-glomerular basal membrane antibodies play a role in their pathogenesis. There are also evidences that the alternate complement pathway may be involved in certain forms of immune related glomerulonephritis. The precise etiology of idiopathic nephrotic syndrome having unique characteristics separating it from nephrotic syndrome associated with glomerulonephritis, is yet unknown. However, there are some circumstantial evidences depending on clinical observations that it may be an immunological disorder. It is possibly produced by a systemic abnormality of T-cell function resulting in the secretion of a circulating chemical mediator, toxic to the glomerular basement membrane; but there is not yet direct proof to substantiate this hypothesis.


[The role of enteric bacteria in childhood urinary tract infections and their in vitro response to antimicrobial agents]. In this study, 154 cases of suspected bacterial urinary tract infection were examined bacteriologically. Urine cultures yielded, E. coli in 84 patients Citrobacter in 22 (C. freundii: 9, C. diversus: 9) Proteus in 21 (P. vulgaris: 6, P. morgani: 4, P. rettgeri: 2. P. mirabilis: 4, lactose fermenting strains: 5), Pseudomonas in 12 (P. aeruginosa: 5, other strains of Pseudomonas: 7), Klebsiella in 9 (K. aerogenes: 3, K. pneumonia: 6) and Enterobacter in 6 patients (E. aerogenes: 1, E. cloacae: 5). In vitro antibiotic sensitivity tests showed that gentamicin, nalidixic acid, bactrim and gantrisin were the most effective antibacterial agents respectively. Multiple resistances was found in 39 strains of E. coli out of 84. In other species multiple resistance was found in varying degrees. It is concluded that. Every measure should be taken to eradicate the causative organisms in the urinary tract in children.


[The effect of parasites on enteric bacterial flora]. In this paper, the intestinal bacterial flora is described and the functions of permanent bacterial flora and its individual members is discussed. The pertinent publications about the factors which effects the bacterial flora and specially relations between intestinal parasites and bacterial flora is reviewed. Among these parasites giardia, amoebae, B. coli and Ascaris may change bacterial population by causing malabsorption syndromes. Some drugs used in treatment of parasitic infestations may have harmful effects on normal intestinal bacterial flora. In parasitic diseases the probable floral changes could be looked for and taken into the consideration for a successful treatment of the patients.


[The role of ointment bases in the formulation of 2 antifungal drugs. II. Liberation studies on 5-fluorocytosine and tolnaftate ointment bases by the microbiological agar plate method]. In this study a microbiological in vitro agar plate method was developed to measure the liberation of two antifungal agents; 5-Fluorocytosine and Tolnaftate; comparatively from six different type ointment bases. The effect of dimethylformamide to the liberation of these two antifungals was also studied. Cetyl alcohol ointment and Emulsion ointment (B.P. 1968) bases gave the best results for the two active agents. Dimethylformamide accelerated the release of these antifungals from the emulsion type bases (Emulsion Ointment and Simple Ointment).


[The importance of estimating the individual acetylation rate in modern tuberculosis treatment]. Modern tuberculosis treatment suggests the intermittent regimens of isoniazid twice or once weekly. To be able to use this procedure, one would require to know the acetylation rate of patients. The advantages of the sulfamethazine acetylation test are, firstly, the method of estimation is simple, requiring only colorimeter or a visible range spectrophotometer. Secondly, the results are available on the same day. Thirdly, specimens do not require cold storage. The findings of the present study indicates that, 62.5 percent of subjects were slow acetylators and 37.5 percent of subjects were rapid acetylators.


[The effects of intestinal parasites on enteric bacterial flora]. Intestinal parasites, can cause malabsorption syndromes and shifts in intestinal bacterial flora. In this study 200 cases with parasitic infestations were examined in regard to their intestinal flora. The series included 96 giardiasis. 58 Ascariasis, 20 Oxyuriasis and 17 H. nana 14 T. trichiura, 8 Tenia cases. The stool cultures yielded mainly E. coli, Strep. faecalis and other gram negative enteric bacteria, yeasts along with uncommon species as B. subtilis, Herellea, Shigella at low frequencies. The control group of 50 patients without parasitic infestations had the same distribution ratio for the same species. The observed frequencies of the isolated bacterial species showed no significant differences between the parasite positive and control cases.


[Brettanomyces strains and the Salmonella 0:7 antigen]. In this publication some Brettanomyces strains that have common antigenic factor with Salmonella 0:7 antigen and other Brettanomyces strains that don't have this common factor are shown together.


[The antigenic relationship between Salmonella 0:7 antigen and Debaromyces hansenii and its synonym strains]. In this publication antigenic relationship between Salmonella 0:7 antigen and Debaryomyces marama, Debaryomyces hansenii and some synonym strains of Debaryomyces hansenii are shown together.


Strabismus in the aphakic patient.

Strabismus in the aphakic patient. Fifty patients with aphakia and strabismus were studied. The chief complaint was diplopia following full optical correction. Prism therapy was recommended if the diplopia persisted after 3 to 4 months. When prism therapy was ineffective or impractical, surgery was recommended. The result of therapy was not influenced by the cause of the cataract treatment was considered successful in approximately 80% of patients. Patients who had convergence insufficiency did well with prism therapy alone. Half of the patients who had divergence excess needed extraocular-muscle surgery. One fourth of the patients had esotropia, nearly half associated with lateral rectus palsy. While prism therapy resulted in fusion, a reduction in prism power was not tolerated in this group. For this reason, surgery was suggested for all patients who had esotropia.


A new look at pleoptics.

A new look at pleoptics. Sixty-four patients who did not respond adequately to passive conventional occlusion were treated with active pleoptic therapy, and followed with orthoptic therapy when fusion potential was demonstrated. Patients ranged in age from 4 to 17 years, and ranged in visual acuity from 20/30 to 20/100. Seventeen patients had some fusion prior to starting pleoptics. All 64 patients achieved an immediate post-therapy acuity of 20/30 or better; 25 were fusing and demonstrated some stereopsis. Twenty-seven patients were followed for a period of one to ten years, including the 25 patients who were fusing at completion of therapy. Twenty-four (88%) maintained visual acuity of 20/30 or better. All fused either normally or with ARC. Three patients, whose visual acuity dropped to 20/50, had no fusion. Only one patient who had fusion at the completion of therapy was unable to maintain it. We conclude, therefore, that pleoptics retains values in the treatment of amblyopic patients with steady and unsteady central fixation, in those situations where conventional occlusion in unsuccessful.


Ocular causes of abnormal head postures. A prospective study was undertaken to analyze the different causes of abnormal head postures on ocular bases. Eight basic mechanisms were found in a series of 188 patients. Incomitance accounted for 62.7% of the head postures and nystagmus for 20.2%. Important diagnostic criteria for evaluating patients with head postures are discussed.


Restricted lees screen fields in patients with asthenopia, with and without psychogenic disorders. Lees screen restrictions of non-specific origin, including apparent restrictions of the SR, IR, and LR muscles, were reported last year by Labow et al. In this complementary study, the authors examined eight apparently healthy subjects who had no history of ocular or psychiatric problems, eight psychiatric patients, and eight who had had a CNS disorder or had suffered cerebral trauma. Comparison of the Lees screen findings, visual fields, and accommodative defects of these patients revealed significant restriction of the Lees screen fields in only those patients who had symptoms of asthenopia (including all in the third group). Thus, such restriction does not depend on emotional state.


The effect of preoperative convergence exercises on the surgical outcome of primary exotropia. In a retrospective study of 89 patients with exotropia, the authors investigated the influence of active convergence exercises in the postoperative angle of deviation and found that convergence exercises do not increase the incidence or the size of the esodeviation post-operatively.


Occlusion therapy for exodeviations occurring in infants and young children. The authors treated 38 patients with exodeviations by occlusion of the preferred eye for three to six hours daily for an average of 15 months. This treatment resulted in a significant improvement in the latency of the deviation as well as a decrease in the size of the strabismic angle. The majority of those patients responding to this method of therapy initially had good central and maintained fixation in each eye, an exodeviation of 20 prism diopters or less at both 6 and 1/3 m, and the presence of fusional vergence amplitudes.


[Amebic liver abscess. Treatment with metronidazole by the intravenous route]. This is a report of the clinical characteristics and therapeutic response to treatment of 51 patients with hepatic amebic abscess, studied at a general hospital in a two year period. In this group of patients without complications, the 100% cure was achieved in 5.5 days with metronidazole I.V.; the next effective regimen was metronidazole. I.V. plus emetine I.M., that gave a 100% cure in 7.4 days, so it became obvious that other kind of treatment or the addition of antibiotics are of no benefit and are potentially dangerous. The response to the different therapeutic regimens in this study, agree with what is known about the effectiveness of metronidazole used either by the oral or I.V. route in hepatic amebic abscess.


Circannual rhythm of arterial and venous thromboembolic disease. This study confirms previous reports of a seasonal variation in morbidity and mortality from coronary and cerebral arterial disease; these disorders are much less common in summer (e.g. July and August) than in winter (e.g. December and January). In coronary disease the shape of the curve for the annual morbidity is different from that for annual mortality and possible reasons for this are discussed. A similar circannual rhythm has been shown for venous thrombo-embolic disease.


Elemental diet therapy in the management of complicated Crohn's disease. The purpose of this report was to study the types of complications of Crohn's disease which may benefit from the use of elemental diets. The elemental diet Vivonex was used in the management of patients with Crohn's disease with local complications but without nutritional deficiency. Sole treatment of this kind was found to be of value in promoting healing of perianal or anal ulceration and anal fissures; it was also of value in allowing subacute ileal obstruction to settle, thus postponing surgery and allowing better bowel and nutritional preparation for surgery. Patients with bile acid-induced diarrhoea associated with severe ileal Crohn's disease noted improvement in the diarrhoea on the elemental diet, and the treatment was also useful in reducing ileostomy output and helping ileostomy skin lesions to heal in a patient with severe skin excoriation related to leakage of excessive ileostomy fluid output.


[Adult-onset Still's disease].

[Adult-onset Still's disease]. Sixteen patients with adult onset Still's disease are reported and compared to 42 previously reported cases. The onset of this illness is sudden and is characterized by quotidian fever, evanescent rash, arthritis, leukocytosis and with variable frequency abnormalities of the liver function tests, adenopathy, splenomegaly and loss of weight. The response to anti-inflammatory therapy is satisfactory and the majority of patients will have a good functional prognosis even though they may require corticosteroids to suppress the signs and symptoms of the disease. It is stressed that Still's disease should be considered one of the diagnostic possibilities in cases of fever of unknown etiology and in cases of seronegative arthritis in adult patients. The pertinent clinical, laboratory, radiological and histological features of this illness are reviewed.


Campylobacter enteritis-an in-patient study. During the first eight months of 1978, 26 patients were admitted to the Communicable Diseases Unit at King's Cross Hospital, Dundee with a diagnosis of campylobacter enteritis. The variety of clinical features encountered is described. Although diarrhoea occurred in all cases, it was preceded or accompanied by abdominal pain in the majority of cases and by fever in over half of the patients. The article emphasises the need to consider campylobacter infection in patients presenting with bloody diarrhoea, acute abdominal pain or pyrexias of unknown origin.


The danger of hallucinogenic mushrooms.

The danger of hallucinogenic mushrooms. There has been a revival of interest amongst young people in the raw consumption of "wild" Psilocybin mushrooms, because of their hallucinogenic properties. Seven cases of mushroom overdosage are described. Whilst the hallucinogenic mushrooms are relatively harmless, the dangers from inadvertent ingestion of commonly occurring poisonous varieties are emphasised.