Altered metabolism of androstenedione by hepatic microsomes from streptozotocin-diabetic male rats. The total metabolism of androstenedione by hepatic microsomes from streptozotocin-diabetic male rats was decreased from corresponding control values. Microsomal androstenedione 7alpha-hydroxylase activity was increased, while 16alpha-hydroxylase activity was decreased in the diabetic animals. The effects are similar to previously reported changes in the hepatic microsomal metabolism of aniline and aminopyrine, respectively, and suggest similar regulatory mechanisms. Insulin treatment of diabetic animals antagonized all abnormalities of androstenedione.


Seasonal variation of aryl hydrocarbon hydroxylase inducibility in human lymphocytes in culture. The aryl hydrocarbon hydroxylase (AHH) inducibility in lymphocytes from peripheral blood of 92 healthy young subjects was tested during a period of 8 months (November - June). The average AHH inducibility was found to be higher from March to June than from November to February, indicating a seasonal variation. Various other features of lymphocytes in culture also appeared to change with the season.


Inhibition of two human tumor cell lines by antimetabolites of coenzyme Q10. 5-Chloro-2,3-dimethyoxy-6-octylmercapto-1,4-benzoquinone (NSC 252188) and 2,3-dimethoxy-5-hydroxy-6-phytyl-1,4-benzoquinone (NSC 277818) inhibited the human cell lines 4265 and K 562c, and the experimental animal tumor line W256; they also showed antitumor activity against Walker carcinosarcoma 256 in rats with cures; they also inhibited the mitochondrial coenzyme Q10-enzymes, succinoxidase and NADH-oxidase. 5-Chloro-2,3-dimethoxy-6-n-dodecylmercapto-1,4-benzoquinone (NSC 220334) and 5-chloro-6-omega-cyclohexylhexylmercapto-2,3-dimethoxy-1,4-benzoquinone (NSC 238136) were also active against the K 562c cell line and showed cures against the Walker carcinosarcoma 256 in rats.


Renal arterial infusion of cyclophosphamide in dogs. Cyclophosphamide, a nitrogen mustard derivative, has been reported to induce antidiuresis in man and water diuresis in dogs. In order to determine whether the drug acts directly on the kidney, we have infused the drug into one renal artery of hydropenic dogs and compared the responses with those observed following i.v. administration. Renal artery infusion of two different doses in ten dogs induced no unilateral or bilateral, hemodynamic or excretory responses. Intravenous administration of similar doses (16 mg/min for 120 to 160 min) in five dogs induced a progressive increase in the clearance of para-aminohippurate (PAH) (P less than 0.05), creatinine and urea (P less than 0.01), and a natriuresis and kaliuresis (P less than 0.05). The excretion of phosphate increased but was not statistically significant. There was a significant decrease (P less than 0.01) in the clearance of free water. The lack of response to intrarenal infusion of a drug which acts systemically to alter renal function is unusual. Possible explanations are inactivation of drug by renal tissue or rapid excretion by the kidney. In either case, removal rate must approximate renal blood flow in order to prevent the systemic response to the drug.


Albumin and alkaline phosphatase as factors involved in the regulation of tyrosine phenol-lyase activity. Holotyrosine phenol-lyase (EC 4.1.99.2), a pyridoxal-5'-phosphate (PLP)- requiring enzyme, was shown to rapidly dissociate when injected into BDF1 mice. The holoenzyme dissociated when incubated in plasma but not 0.01 M potassium phosphate (pH 7.4) buffer at 37 degrees C. A nonspecific alkaline phosphatase from calf intestine was found to inactivate the holoenzyme at pH 7.4 and 37 degrees C. This inactivation was inhibited in the presence of 0.5 M potassium phosphate buffer. Two other PLP-requiring enzymes, aspartate aminotransferase (EC 2.6.1.1), and alanine aminotransferase (EC 2.6.1.2) were inactivated by alkaline phosphatase in a similar manner. Incubation of holotyrosine phenol-lyase in the presence of bovine serum albumin also resulted in a reduction of holoenzyme activity but partially protected the enzyme from inactivation by alkaline phosphatase. A nuclear fraction having PLP-hydrolyzing activity also inactivated holotyrosine phenol-lyase. A regulatory function for alkaline phosphatase in the metabolism of PLP-requiring enzymes is suggested by these data.


Effects of multiple treatments of isoxicam on organ weights and serum SGPT, AP, and BUN in adjuvant-induced polyarthritic rats. Isoxicam at 25 mg/kg/day x 28 days significantly inhibited the multiple alterations with the developing polyarthritis. In rats, this drug did not induce any changes in the relative liver weights or serum SGPT, AP, or BUN in polyarthritic rats. Isoxicam absorption was similar in normal and arthritic rats.


Pattern and concentration of free amino acids in the plasma and liver tissue of phenobarbital-treated rats. The pattern and concentration of free amino acids in the plasma and liver tissue of phenobarbital-treated rats was investigated. In phenobarbital-treated rats, there was a significant plasma increase of the total concentration of free amino acids. No significant change in liver free amino acid concentration was observed because of the contemporaneous and general increase in liver size which does not allow observation of any percentual variation in amino acid concentration.


Effects of phenformin and alpha-bromopalmitate on fatty acid and glucose oxidation in muscle. Hemidiaphragms removed from fasted rats which were treated with the fatty acid oxidation inhibitor, alpha-bromopalmitate (125-250 mg/kg, i.p.) oxidized less glucose to CO2 than vehicle-treated rats. Hypoglycemia was noted and was preceded by reduction of muscle palmitate oxidation and by increased plasma free fatty acids (FFA). However, phenformin (100 mg/kg, i.p.) lowered plasma FFA and diaphragm oxidation of both palmitic acid and glucose, without altering glucose levels. These results fail to support the hypothesis that phenformin lowers blood glucose secondary to inhibiton of fatty acid oxidation.


Identification of pyrrolizidine alkaloids (Senecio longilobus). Pyrrolizidine alkaloids derived from Senecio longilobus have been rapidly isolated and identified. The potential of isolating individual pyrrolizidine alkaloids utilizing high pressure liquid chromatography is discussed. The utilization of a single 10 mu CN column to isolate closely related pyrrolizidine alkaloids suggests a marked improvement in pyrrolizidine alkaloid chemistry.


Is thioridazine-induced ejaculation failure peripheral in origin? The contractile response of rabbit vas deferens to the field stimulation was almost equally depressed by thioridazine and chlorpromazine. Phenoxybenzamine in a dose of 10(-7) g/ml augmented the response slightly, while in a dose of 10(-6) g/ml slightly depressed. The contractile response to exogenously administered noradrenaline was remarkably depressed by thioridazine and chlorpromazine and completely abolished by phenoxybenzamine. Almost equal potencies of sympatholytic effects of thioridazine and chlorpromazine may exclude the possibility that thioridazine-induced ejaculation failure, which is higher incidence than the failure induced by chlorpromazine, is due to its inhibitory action on peripheral adrenergic mechanism.


Alteration of brain chromatin and nuclear synthetic activity in morphine-tolerant rats. 3H-UTP incorporation by endogenous RNA-polymerase of intact, isolated rat brain nuclei was enhanced by chronic morphine treatment. Analgesic tolerance using the hot-plate assay was also evident. Fractionation proflies for brain chromatin on hydroxylapatite from morphine and vehicle-treated rats was different. These results suggest that morphine-tolerance in the rat may be accompanied by enhanced nuclear synthesis of a new species of RNA.


Effects of mineral buffers on the rumen flora of sheep fed grain diets. The structure of the microbial population of rumen liquor froom sheep fed diets of roughage and of whole wheat grain with and without mineral buffer additives was studied. Addition of either 2 per cent of a mixture of 1/1/1/1 sodium bicarbonate, potassium bicarbonate, disodium hydrogen phosphate and calcium hydrogen phosphate or of 1 per cent of aluminium hydroxide to grain diets acted to increase microbial concentration, allow persistance of a rumen flora of predominatly Gramnegative staining characteristic, and to increase the proportion of rods. Animals consuming these diets had an improved production performance. In the absence of dietary buffers the microbial population shifted towards a Gram-positive population with no reduction in the proportion of coccal forms.


Experimental toxoplasmosis in young piglets. Piglets eight to 10 days old and one day old were infected with a cyst-forming strain of Toxoplasma gondii of low virulence. The older piglets developed an immunological response to the infection and survived, although inflammatory lesions were demonstrable in a variety of tissues. Some of the one-day-old piglets died; they exhibited more severe inflammatory lesions and lymphoid depletion in the lymph nodes, spleen and thymus. The tissue reaction resembled infection with a high-virulence strain of the organism. Control animals showed a delay in maturation of the lymphoid system during the first week of life. The virulence of the organism in therefore modified to a certain extent by the competence of the animal to develop an immunological response to the infection.


Haematological, serological and pathological effects in chicks of one or more intravenous injections of Salmonella gallinarum endotoxin. Abnormalities appeared a few hours after groups of 14-day-old chicks (Gallus domesticus) were injected intravenously with 15 mg/kg of endotoxin (LPS) from Salmonella gallinarum. Clinical illness without mortality was accompanied by significant (P less than 0.05) falls in body temperature, bursa weight, the main haematological parameters, serum iron (SI) and transferrin saturation (TS) and a significant increase in unsaturated iron-binding capacity. All responses, apart from bursa weight, SI values and total and differential white-cell counts, returned to normal within 24 to 48 h. LPS given daily for three consecutive days did not cause changes in the main haematological parameters during the 48 h period following the third injection. However body and bursa weight and heterophil counts were significantly depressed, whereas body temperature, SI and TS were affected biphasically, being first depressed and then raised above normal. Chicks injected with LPS daily for six consecutive days showed broadly similar responses but a persistent microcytosis was also present.


Magnesium transport by isolated rumen epithelium of sheep. The mechanism of transfer of magnesium across isolated rumen epithelium was studied in vitro using 28Mg. Isolated pieces of rumen epithelium developed a transmural potential difference of 8.2 +/- 2.3 mV, lumen side negative, during the first hour of incubation when mounted between the two halves of an incubation chamber. A significant net transport of magnesium from lumen to blood was measured when the initial concentration of magnesium in the solutions bathing both surfaces of the epithelium was 2.5 mM. Net flux of magnesium took place against an electrical gradient and was dependent on the presence of the transmural potential difference. The process was saturable at magnesium concentrations of about 5 mM and was markedly reduced by lowering the temperature of the bathing solution, by addition of 10(-4) M ouabain and by extending the time of incubation. The findings strongly support the view that magnesium absorption from the rumen is mediated by an active transport process.


Further observations on the effect of different levels of larval intake on the output of eggs of Ostertagia circumcincta in lambs. Three groups of lambs were given 50, 250 or 2800 infective larvae of Ostertagia circumcincta per day for a period of six weeks. All groups then received 25,00 larvae per day for a similar period and observations were continued for a further six weeks. Egg output following the initial infection varied directly with the level of larval intake, but fell to a low during the second period of infection and decreased still further in the final six weeks of the observation. The investigation suggests that, provided high levels of residual larval infection on pasture are avoided, there appears to be considerable merit in exposing lambs to a low level of initial infection.


Effects of experimental excision arthroplasty of the hip joint. The experimental results are reported on a series of sheep in which unilateral hip excision arthroplasty was performed. These sheep were slaughtered at regular postoperative intervals. Radiography and histology were performed on the normal and excised hip joints of the experimental sheep to provide information of the formation of the pseudarthrosis that develops following excision arthroplasty. The efficiency of the false joint that develops is good, judged on a clinical basis. Continuous remodelling of the acetabulum and resected face was noted throughout the experimental period. A sequence of degenerative changes in the acetabular cartilage was observed followed by filling in of the acetabular favity with new bone. New bone also developed on the cemoral component of the pseudarthrosis in the form of osteophytes situated around the perimeter of the resected surface. Growth deformities of the contralateral, nonoperated limb were induced.


Intestinal adenomatosis in the pig: histochemical and electron microscopic studies of the mucosa. Histochemical studies of normal and adenomatous intestinal mucosa of the pig showed the adenomatous epithelium to be deficient in enzymes normally found in mature absorptive cells. Electron microscopic studies confirmed that the adenomatous cells closely remsembled the crypt cells of normal mucosa.


Glomerular capillary endotheliosis in sow kidney. A high incidence of proliferative renal glomerular lesions was found in sows from a breeding herd. All the sows had a very similar lesion, which was characterised by swelling of endothelial cells, with varying degrees of obstruction of the capillary lumina, and an increase in the number of mesangial cells. By differential diagnosis the condition was found to conform most closely with the renal lesion of human pregnancy toxaemia (pre-eclampsia syndrome). It is suggested that this nephropathy may play a part in limiting the useful breeding life of affected sows.


Stressor effects of adrenaline on the immature fowl. Chicks were injected with L-adrenaline (500 microgram/kg) thrice weekly from hatching for one, two or three weeks. The growth rate of treated chicks was depressed, particularly in the first week. When four-week-old chicks were given nine injections of adrenaline over a three-week period, growth rate was also depressed but less severely. The greater sensitivity of the younger chicks is thought to result from an immature blood-brain barrier. Relative adrenal mass (mg/kg) was generally increased but adrenal cholesterol depletion occurred only in three-week-old birds treated with adrenaline throughout. Plasma glucose and cholesterole concentrations were within the normal range after three weeks of treatment but there was a significant hypolipacidaemia in the younger birds treated for two or three weeks.


The pathogenicity of four avian influenza viruses for fowls, turkeys and ducks. Groups of 10 two-week-old chicks, turkey poults and ducklings were each infected by the intranasal route with one of four avian influenza viruses: a/fowl/Germany/34 (Hav 1N))--Rostock, A/FPV/Dutch/27 (Hav 1 Neq 1)--Dutch, A/fowl/Victoria/75 (Hav 1 Neq 1)--Australian, and A/parrot/Ulster/73 (Hav 1 N1)--Ulster. Eight hours after infection 10 birds of the same age and species were placed in contact with each group and allowed to mix. The clinical signs of disease and onset of sickness and death were recorded. Ulster virus was completely avirulent for all birds. Rostock, Dutch and Australian viruses were virulent for fowls and turkeys causing death in all birds with the exception of 3/10 in contact fowls from the Rostock virus group and 2/10 in contact fowls from the Australian virus group. Only Rostock virus caused sicked sickness or death in ducks, 9/10 intranasally infected and 6/7 in contact birds showed clinical signs and 2/10 intranasally infected and 3/7 in contact ducks died. Intranasal and in contact pathogenicity indices were calculated for each virus in each bird species and indicated quantitatively the differences in virulence of the four virus strains. Virus isolation and immune response studies indicated that surviving in contact fowls in the Rostock virus group had never been infected but that surviving Australian virus in contact fowls had recovered from infection. Infection was not established in Ulster virus in contact fowls and Australian virus intranasally infected and in contact ducks. The birds in all other groups showed positive virus isolations and a high incidence of positive immune response. The last virus isolation was made at 22 days after intranasal infection of ducks with Ulster virus.


Induction of delayed hypersensitivity to turkey herpesvirus in fowls. Delayed hypersensitivity, as determined by the wattle skin reaction, to turkey herpesvirus developed in chickens sensitised with the infected cell antigen. A significant increase in skin thickness occurred in the sensitised wattles as compared with the controls.


Serological and histological studies on adult rabbits with recent, naturally acquired encephalitozoonosis. Twenty adult rabbits were killed two to 12 weeks after antibodies to Encephalitozoon cuniculi were first detected in their sera. Specimens of urine were examined for E cuniculi and sections of kidneys and brains were examined both for organisms and lesions consistent with encephalitozoonosis. Organisms were observed in the kidneys from two weeks after the appearance of antibodies, and histological lesions in the kidneys were observed after five weeks. However, organisms were rarely seen in the brain and lesions in this organ were infrequent and, generally, not present until at least eight weeks after the first detectable antibody. The results indicate the course of natural infection of encephalitozoonosis in rabbits and show that serology is the most sensitive procedure for its early diagnosis.


Intestinal bacterial flora of the household lizard, Gecko gecko. A total of 114 isolates was recovered from the intestines of 43 househould lizards, Gecko gecko. Among the important ones were Staphylococcus aureus, Salmonella typhimurium, Pseudomonas aeruginosa, Proteus mirabilis and Edwardsiella tarda.


Immunoglobulin concentrations in Scottish Blackface lambs on a hill farm. The serum immunoglobulin concentration in one- to 11-day-old Scottish Blackface lambs born outdoors on a hill farm were very similar to those in Scottish Blackface lambs born indoors on an experimental lowland farm. The concentrations were significantly higher in single lambs than in twins, and in lambs which survived for six months than in lambs which died, and showed significant annual variations which could not be related to the weather. They were significantly correlated with the ages of the dams, the lambs' gains in weight to weaning, but not with the weights or ratios of weights of the lambs and ewes after lambing, nor with the birth-coat types of sexes of the lambs. There were wide variations in the capacities of the abomasums at birth.


Deep pectoral myopathy: an experimental simulation in the fowl. Surgical occlusion of the subclavian artery of domestic fowls has been found to induce a condition closely resembling, in location and histopathology, the deep pectoral myopathy of turkeys. The operative procedure is described and the significance of the collateral blood supply in the pathogenesis of the lesion is briefly discussed.


[The recessive Hm phenotypes].

[The recessive Hm phenotypes]. The survival of "Bombay" erythrocytes as well as that of "para Bombay" red cells (first and third class according to Race and Sanger classification) has been studied among non compatible and "para Bombay" individuals. This shows not only the heterogeneity of these phenotypes (as already described by Salmon and co workers) but also the presence of highly differenciated ABH formed antigens. H deficient recessive phenotypes are not explained by the presence of an amorphe h gene. They arise from the activity (or better from the non activity) of the regulation genes of which the recessive alleles x and z in double dose do not enable a normal functioning of the H gene. The appelation Hxx for "Bombay" phenotypes (1st classe) and the appelation Hzz for Hm recessive (3d. class) phenotypes are proposed. Genetics as well as the synthesis of Ah, Bh (AHm, BHm) phenotypes have not yet been clarified. Interaction of zz and sese genes, or accomplementation in the "trans" position have to be looked at.


[Thermodynamic study of the allohemagglutinins of the ABO system]. Many thermodynamic assays on natural allohemagglutinins ABO were undertaken by different authors. Our experiment concerns anti-A and anti-B. The allohemagglutinins level was determined by the Probit Method, using bromelin red blood cells and methyl cellulose, with an autoanalyser. This thermodynamic assay was carried out in almost the same conditions as those used by Wurmser. The data reveal an intraphenotypic (anti-A) or intra genotypic heterogeneity (anti-B) in the repartition of affinities. Average enthalpy changes are, in this methodology, interphenotypic (anti-A) and intergenotypic (anti-B) features. For Wurmser every genotype has a typical feature: so this author concludes a natural agglutinin homogeneity. Heterogeneity showed by our experimentation seems bound to the specific IgM and IgG repartition of each serum. Specific anti-A or anti-B IgM are more exothermic than specific IgG. The apparent disagreement must be interpreted owing to the fact that in N4 Wurmser's method, the only agglutinins determined are specific IgM.


[An acquired B antigen in a subject of A2 group]. Almost all cases of acquired B antigen have been found in individuals. This report concerns a group A2 patient with acquired B antigen. The family was not available for genetic studies. Nevertheless two facts were in favour of A2 genotype: 10 after acetylation of the patient's red cells the A1 reactivity which usually reappears or is increased on acquired B cells, did not appear. 20 The study of the serum alpha-N acetyl galactosaminyl transferase showed an optimal activity at pH7, as it is usually found in A2. The respective roles of anti acquired B antibodies, group A specific structures and bacterial enzyme properties in the occurrence of acquired B antigen are discussed.


[A family with an "Hm" phenotype transmitted over 3 generations]. Hm phenotype represents a dissociation between a normal salivary expression of H substance and a very weakened expression of the antigen on red blood cells. Genetic analysis of the reported family reveals a dominant inheritance: Some members (Marie K..., Francette, Carmen) present a phenotype marked by a normal H enzyme but a deficient H antigen in erythrocyte membrane. Others Alice, Mathilde) have no expression of A1 antigen due to H substrate deficiency. H substance in salivary secretion is normal. In the other branch of this pedigree without consanguinity, Herbert presents an H substance deficiency, though quite different, as A1 antigen is expressed. In this family, Hm phenotype can be explained, without resorting to a Zm allele, by the expression of an exceptional allele at the H locus (like Am is an ABO allele). This hypothesis supports the possible polymorphism of H locus.


[Paternity index. Application to a sample of 48 trios presumptive father-mother-child. Study of the relationship between the probability of paternity and the percentage of exclusion]. Two different indices are of interest in paternity diagnosis. 1. The proportion of men whose paternity is excluded by mother and child phenotypes. 2. The posterior probability of paternity, obtained by a bayesian process from the phenotypes of putative father, mother and child. These two indices are different, and it is proposed that the first one be used for gauging the value of the second. Two examples of the method are given: first, a sample of 48 putative father-mother-child trios, observed in the probability of paternity versus proportion of excluded men plane at different steps on the laboratory examinations, second, the figure obtained for a child for whom two putative fathers were at examination.


[Modifications of genetic markers during malignant blood disease]. Genetic marker changes in malignancy are related to an acquired disfunction of the genetic material in stem cells. This disfunction always leads to the lack of antigen; whenever we evidenced a new specificity it was an unconverted substrate. In malignant states modifications are multiple, polyclonal and independent. This least feature explains the extent of the process giving that disfunction. The evidence of a genetic defect is supported by the simultaneous decrease of the primary gene product: the glycosyl-transferase (ABO locus). In some other malignant carcinoma, blood group specificities were observed, their meaning is not well explained. Blood group specificities associated to carcino embryogenic antigen (CEA) or to some mucins could be related to the structure of macromolecular carriers.


[MNSs system, erythrocyte membrane and false paternity exclusion]. The modification of the red cell membrane first observed by Darnborough and co-workers in En (a-) and EnaEn heterozygous persons, and characterized by a) exaggerated agglutinability of the cells by various serological reagents, b) decrease of their electric surface charge, and c) reduction of their sialic acid content, is shown to be regularly and, to all appearances, directly associated with weakness or absence of MN antigenic substance; it is not seen in comparable "variants" of the Ss antigens. This type of modified cell membrane is thus found in the presence of Mg, of weak forms of M or N (N2 with or without a positive direct antiglobulin test, or as produced by the gene complexes MS.Sta, Ms.Sta, MsMi.V or NsMi.V) and when antigen production at the MN locus is inhibited, completely or almost completely, by the "operator" genes En or Mk. Apparent exclusions of parentage due to some of the genes involved, particularly Mg, En and Mk, are presented. On the other hand, the NNSs genotypes of members of the 3 known families with an En(a-) propositus are discussed and a revised interpretation of them is given, based on renewed serological studies of the persons concerned. A genetical scheme of the MNSs system, comprising four "structural" loci-Ena MN, U Ss-and three "operators", is proposed.


[Epidemic focus of Q fever in a rural location in the Suceava district]. A Q fever epidemic focus with 46 cases was detected in a rural locality among the workmen of livestock farms. In 33 cases, the subclinical and inapparent form of the disease was detected by serologic tests, performed in the focus. Complement fixation antibody titers persisting in very high titers, a retrospective diagnosis of infection may be established even 3-4 months after the onset of the disease.


[Risks of therapy in infectious shock].

[Risks of therapy in infectious shock]. On the basis of their experience in the intensive therapy unit, correlated with modern pharmacokinetic data, the authors discuss the adverse effects induced by polyvalent therapy in septic shock, and which may be listed in the group of iatrogenic pathointerference. To the biochemical and functional alterations of shock may be added the possible effects of antibioticotherapy, corticotherapy, plasma expanders, lipid emulsions, crystalloid solutions, alkaline correcting solutions, osmotic diuretics, oxygenotherapy, vasoactive drugs, heparin and epsilon-amino-caproic acid. The possible summation of these effects should be indicated in the rules for observance by the medical staff of intensive therapy units.


[Varicella associated with Lyell's syndrome after administration of sulfametin]. A case of chickenpox associated with Lyell syndrome, which appeared after the administration of sulfamethine, is reported. Quantitative determination of the immunoglobulins showed marked immunologic changes in the course of the syndrome. Antistaphylococcal treatment, without corticotherapy led to clinical recovery.


[Normal values of the spontaneous cytochemical NBT test in adults]. The description is given of a working method adapted after Park, Fikrig and Smithwick, for testing the capacity of neutrophils to reduce tetrazolium nitroblue salts spontaneously. In contrast to the original technique, the present method uses : 10-20 units indigenous heparin/ml blood, leukocyte concentrate, other reaction times at 37 degrees C, contrast staining with a week Giemsa solution. Applied to young healthy subjects, the mean proportion of NBT-positive neutrophils was of 4.3 +/- 3.09 and the absolute number approximately less than 700/ml blood. The results obtained were consistent with the published data.


[Possibilities and significance of computer tomography in non-tumorous space-occupying intracranial lesions (author's transl)]. Based on the experience collected in 108 patients from a series of more than 7500 CT examinations, the possibilities and limitations of computed tomography in non-tumorous space-occupying lesions are discussed. Serious problems of differential diagnosis are encountered mainly in the case of cerebral abscesses and acute demyelinization, as well as granulomas. Cystic processes are usually easier to classify. Anamnesis will often be helpful in the case of parasites. Old intracerebral hemorrhages can simulate tumors and calcifications. The same applies to giant angiomas and giant aneurysms. In cerebral infarction, too, an occasional confusion with a tumor in the blood-brain barrier disturbance phase cannot be excluded.


[Computer tomography in children (author's transl)]. The determination of the density of a lesion is important in infant computer tomography. The authors show examples of hematomas, tumors and pericerebral collections, as well as the experimental determination of the density of the CSF with increasing protein content.


[Comparison of the results of computer tomography and isotope diagnostics in pathologic processes of the infratentorial range (author's transl)]. 1. Computer tomography is much more clearly superior to cranial scintigraphy with regard to the identification and localization of pathologic infratentorial processes, than in the supratentorial range. 2. Computer tomography alone solves many diagnostic problems relating to the infratentorial range, but it cannot by any means solve all the problems. 3. The diagnosis identifying the kind of infratentorial growing and displacing tumors cannot be safely established either by computer tomography alone or by a combination of computer tomography and cranial scintigraphy. 4. Cranial scintigraphy and CSF scintigraphy can supply additional informations, support the diagnosis, or contribute towards establishing the final diagnosis, in cases where computer tomography alone supplies ambiguous, questionably positive or discrete answers. In such cases, the emphasis is on the etiologic grouping of unclear forms of hydrocephalos.


[Diverse findings in cranial CT and scintigraphy in space occupying lesions (author's transl)]. Incongruent statements in CT and scintigraphy may disturb therapy planning. Many years of scintigraphy have presented here an established method. Cranial CT was performed here with 2000 persons in one year. Parallel CT and scintigraphy was performed in about 350 cases. There were some cases with positive findings in CT and negative in scintigraphy and vice versa. These cases will be compared with the definite diagnosis, we will discuss the different findings and the relevance of both methods as a diagnostic aid for the neurosurgeon and therapeutic radiologist.


[Diagnosis and differential diagnosis of intracranial calcifications (author's transl)]. An accurate analysis of calcifications and of their localization enables a tentative diagnosis, not as rarely as is often assumed, especially if anamnestic and clinical findings are utilized for better interpretation. However, an accurate determination of the area covered by the disease, and of the kind of process, is possible only via neuroradiologic contrast medium diagnostics and computed tomography.


[Clinical problems in extracranial vascular processes (author's transl)]. About 20 to 30% of the cerebral circulatory disturbances caused by arteriosclerosis depend on extracranial angiostenoses and vascular occlusions. Most frequently they are found in the region of the A. carotis interna, more seldomly the A. vertebralis or the A. subclavia and the aortic arch. The blood supply of the cerebral vascular regions concerned depends on the constitution and caliber of the collateral vessels, on their wall condition and elasticity, the blood pressure in the collateral circulation and the factor of time, the localization and the extension of the arterial disease. With regard to their effect asymptomatic stenoses and occlusions are differentiated from the transitory cerebral ischemia, the manifest encephalomalacia and the defective states. The clinical symptoms in extracranial angiostenoses and vascular occlusions, the necessary additional examinations to localize the process and to establish the differential diagnosis are discussed.


[Angiography in extracranial vascular processes (author's transl)]. Anatomy and technique in angiography of extracranial vessels is discussed based upon 1321 own cases. Most frequently catheter technique is used. Main indication is cerebral vascular insufficiency, less often aneurysm, trauma and tumor. Results of angiography are discussed.


[Findings in extracranial arteries ensuring cerebral blood supply in patients with peripheral and generalized disturbances of blood flow (author's transl)]. Attention is drawn to the incidence rate of the various types of obliterations of the carotid artery in the extracranial area. The evaluation is based on 242 carotid stenoses from a total of 1283 angiograms. Over and above this, the paper presents initial results of computertomography in 15 patients with obliterations of the carotid arteries in the cervical region.


[The surgical treatment of cerebral ischaemia due to vertebral artery and subclavian artery insufficiency (author's transl)]. Results of reconstructive vascular surgery in 86 patients with vertebral artery and subclavian artery insufficiency are reported. 1. The neurologic symptomatology can be improved effectly and persistend by an astonishing small risk of operation. 2. The basic disease remains untreated and reduces life-expectancy. 3. The The valuation of reconstructive vascular surgery for the human rehabilitation is missing biometric facts. The advantage can't be described according to the statistics, it helps patients to a worth living life.


[Anastomosis between carotis externa and carotis interna circulation (indication and results) (author's transl)]. An extra-intracranial anastomosis operation was carried out in 60 stroke patients in order to bypass the occlusion or severe stenosis in the internal carotid or middle cerebral artery. Postoperative angiographical follow-up studies showed a well functioning extra-intracranial bypass in more than 90 % of the patients. In many cases repeat angiography done weeks or months following surgery revealed an enlargement of the caliber of the extracranial artery used for constructing the bypass and also of the cerebral arteries that were irrigated by the bypass. Furthermore we noted that the new collateral channel was able to fill a steadely increasing part of the cerebral circulation and that it was also found to irrigate territories of the brain that were previously well perfused by leptomeningeal anastomosis or retrograd flow through the ophthalmic artery etc. resulting in a reversal of the direction of blood flow in these collaterals. The neurological follow-up examinations revealed that the increase in cerebral blood supply following the extra-intracranial anastomosis operation resulted in a considerable improvement of the post-stroke neurological deficits.


[Radiobiological problems in the radiotherapy of brain tumors (author's transl)]. Clinical findings on the unsatisfactory results of radiotherapy of glioblastomas, and on the genesis of cerebral necrosis, are analyzed in the light of modern radiobiologic research. It is concluded that, usually from unjustified fear of exceeding the "tolerance limit", radiotherapy of glioblastomas is underdosed.


[SI-units in radiotherapy and radiation protection--an addendum (author's transl)]. As an extension of a recent paper, this addendum conversion tables between the new SI-unit Sievert (Sv) for the dose equivalent and the unit Rem (rem) used previously, as well as the relations of the corresponding dose rates.


Microfiling and automatic filing of radiographs. When advantage is taken of the newest qualities of microfilms and copy films and when using their special developers and developing machines, it seems today that the microfilming of radiographs on 35 mm film is successful. Equipment in the price range of 67 000 DM is available. It includes automated filming and developing, but slipping microfilms onto the punch card jackets is semi-automatic. The advantage of the equipment is its low price, its small size compared to the Delcomat system, and thus its smaller filing space need. Also, the automation of filing is possible with this system. The system seems to be quite suitable for at least creating and maintenance of teaching files.


[The failures of D penicillamine].

[The failures of D penicillamine]. On the basis or a study of 50 cases of rheumatoid polyarthritis treated with D penicillamine comments are made on the failure of this form of treatment by comparison of the apparent and real efficacy. Taking account of withdrawals the percentage of true success is no more than a quarter of the patients treated with D penicillamine. Failure are due to overall inefficacy, dropouts from treatment and intolerance. The practical data on the indications and contra-indications of treatment, its conduct and supervision are defined.


[Kinetics of salicylates from the blood to the articular fluid]. A study was made of the salicylate concentrations in samples of blood and articular fluid from 30 patients treated with acetylsalicylic acid. The data were divided in groups according to the diagnosis of the articular diseases and showed no significant differences as regards the salicylate kinetics in the blood. A concentration of 0.3 mg/1 was reached in 6 minutes on the average and the "near maximum" concentration was 23.0 mg/1 on the average. In the articular fluid a concentration of 0.3 mg/1 the salicylates was reached in 10 to 31 minutes. The average maximum concentration as 14.8 mg/1. The findings support the hypothesis that diffusion was the dominant factor in the passage of salicylates from the blood to the articular fluid. The transport varied with the characteristics of the articular diseases. Histopathological changes in the various types of synovitis would alter the biophysical properties of the internal part of the articularcapsule and would thus alter the kinetics of salicylates.


[Osteochondritis dissecans of the knee]. For more than 10 years the authors have had a rather differentiated attitude to osteochondritis dissecans. The indication depends on the age, topography of the lesion, its volume and stage of evolution. The results of three techniques are discussed: simple ablation of the sequestrum, re-implantation of the sequestrum after treatment of the niche and cortico-spongiosa grafting.


Mammalian O-phosphorylethanolamine phospho-lyase activity and its inhibition. The activity of the enzyme O-phosphorylethanolamine phospho-lyase, metabolizing O-phosphorylethanolamine to acetaldehyde, orthophosphate, and ammonia in vitro, was studied in human liver biopsy and autopsy material, and leucocytes. Only in the liver biopsies enzyme activity towards O-phosphorylethanolamine could be found, and in amounts corresponding to one tenth of the activity found in rat liver examined under identical conditions. The enzyme activity of the liver biopsies was confined to the post-microsomal fraction, the activity amounting to 35 +/- 7 (SD)  micromicron/mg protein. The results suggest the presence of an inhibiting factor of protein character. Inhibition was not due to competition from alkaline phosphatase (E.C. 3.1.3.1.) or O-phosphorylethanolamine cytidylyl-transferase (E.C. 2.7.7.14).


Efficiency of the Frank-Starling mechanism at various levels of inotropy and afterload during aortic insufficiency in the dog. Reversible aortic insufficiency was produced in six dogs before and during aortic contrictions at control myocardial inotropy, during high and low inotropy induced by calcium infusion and propranolol administration, respectively. Myocardial chord lengths (MCL) of the left ventricular wall were continuously recorded by ultrasonic technique. Activation of the Frank-Starling mechanism during aortic insufficiency was verified by an increase in end-diastolic length and systolic shortening of MCL. Efficiency of the Frank-Starling mechanism was calculated as the quotient between the rise in systolic shortening and the rise in end-diastolic MCL. At control blood pressure, the efficiency of the Frank-Starling mechanism was 59 +/- 3, 76 +/- 6 and 53 +/- 6% at control, high and low inotropy, respectively. After raising systolic ventricular pressure 30-40 mmHg by aortic constriction, the efficiency of the Frank-Starling mechanism decreased at control inotropy to 41 +/- 7 and at low inotropy to 32 +/- 9% but did not decrease significantly at high inotropy (70 +/- 6%). During periods with aortic insufficiency, left ventricular afterload is increased and it is concluded that the apparent greater efficiency of the Frank-Starling mechanism at high than at low inotropy. At either level of inotropy and afterload examined and at constant heart rate, the Frank-Starling mechanism was activated on a beat to beat basis.


Renal plasma flow and cardiac output during hydralazine and propranolol treatment in essential hypertension. Eleven patients with essential hypertension were given hydralazine (25 mg b.i.d.) for 2 weeks, hydralazine and propranolol (80 mg b.i.d.) for the next 2 weeks, and propranolol alone for the last 2 weeks. The changes in the renal and systemic circulation elicited by the drugs were studied before start of medication and bi-weekly during the treatment, using non-invasive radioisotope techniques. Hydralazine alone did not alter mean arterial blood pressure (MAP), heart rate (HR), cardiac index (CI), effective renal plasma flow (ERPF), peripheral renin activity (PRA) and plasma aldosterone (Aldo) but when propranolol was added MAP fell 15.2%, HR 22.5% and CI 18.4%, while ERPF was unchanged. When hydralazine was withdrawn and propranolol was given alone, ERPF decreased 13.2%. Plasma aldosterone was unchanged, whereas PRA decreased during propranolol treatment. The reduction in ERPF elicited by propranolol, was highly significant (P less than 0.01). From the test sequence it appears that dihydralazine prevents this effect of propranolol on kidney function. These findings might have a direct bearing on the choice of antihypertensive treatment.


The influence of acute blood volume changes on plasma renin activity in man. The effect of an acute 10% blood volume reduction on plasma renin activity (PRA) was examined in seven patients with minor heart diseases during haemodynamic investigation and in five healthy subjects after 3 days furosemide administration. PRA was not significantly changed. Blood pressure remained constant, atrial pressures decreased. The effect on PRA of an acute 10% blood volume expansion with albumin infusion was studied in thirteen patients with liver or heart diseases. A slight reduction of PRA after albumin did not exceed the expected decrease due to plasma dilution. Blood pressure was unchanged, atrial pressures increased. Renal blood flow increased after albumin in all of the five patients investigated. The effect of PRA of an acute 10% blood volume expansion with whole blood flow increased after albumin in all of the five patients investigated. The effect on PRA of an acute 10% blood volume expansion with whole blood was then investigated in five healthy subjects, pretreated with furosemide for 3 days. A significant decrease in PRA was found. Blood pressure remained constant. It is concluded that an acute blood loss of 10% and an acute blood volume expansion of 10% with albumin have little influence on PRA in supine man, whereas an acute blood volume expansion of 10% with whole blood induces a significant PRA suppression.


Renin stimulation by passive tilting: the influence of an anti-gravity suit on postural changes in plasma renin activity, plasma noradrenaline concentration and kidney function in normal man. Plasma renin activity (PRA), plasma noradrenaline concentration, heart rate, blood pressure, and clearances of para-aminohippurate and inulin were measured in twelve normal subjects (clearances in only three subjects) before and after 40 min of 60 degrees upright tilting. The tilting experiments were repeated after inflation of an anti-gravity suit to 60 mmHg on the lower extremities. Inflation of the anti-gravity suit caused an abolition of the postural PRA increase, a marked reduction of the postural increases in plasma noradrenaline and heart rate, and elimination of the decreases in pulse pressure, inulin and para-aminohippurate clearances and sodium excretion. The results suggest a decisive role of the sympathetic nervous system for postural renin increase, probably mainly activated by stretch receptors in the low-pressure cardiopulmoanry area.


Lower leg blood flow in intermittent claudication. Lower leg blood flow was measured at rest and both during and after graduated bicycle exercise in five healthy men and in seventeen patients suffering from various degrees of obliterating arteriosclerosis of the lower limbs. A thermodilution technique was used for flow determinations. The subject exercised in the sitting position and the work load was increased stepwise from a starting load of 100 kpm/min (100 kpm/min load increment every second minute until exhaustion). Three flow phases were depicted during and after the exercise: the aerobic phase, the phase of relative ischaemia and a postexercise phase. During exercise, lower leg blood flow increased approximately twenty times in healthy subjects, while in the arteriosclerotic subjects there was a two-fold to ten-fold increase in flow. In patients with serious distal and proximal stenoses a proximal steal phenomenon was demonstrated during submaximal and maximal exercise. A close correlation was found between maximum individual work load capacity and maximum lower leg blood flow (r = 0.71, P less than 0.001). In the patient group lower leg blood flow at a certain work load was 45% (P less than 0.001) higher in the sitting than in the supine position.


Maximal work performance test in middle-aged women: results from a population study. Based on sampling from official census lists a sample of middle-aged women was obtained in five different age strata; 38, 46, 50, 54 and 60 years. Based on date of birth a sub-set was sampled for maximal exercise testing. The participation rate was 81% and 194 women underwent the test. In sixteen women the test was interrupted due to poor cooperation or clinical contra-indications against continued loading. 54% of the women considered the maximal load to be at least very straining according to a standardized scale for perceived exertion. The average maximal load decreased from 113 to 98 W with advancing age. In the highest age group only 16% exceeded 130 W compared to 43% in the youngest group. Maximum heart rate decreased with age but maximum respiratory frequency and perceived exertion did not. Systolic blood pressure 2 min after maximal work increased with age. Minnesota Code items 4:1-3 and 5:1-3 were demonstrated in 30% of the women, mainly in the older age strata. Other ECG-abnormalities were uncommon. Despite the widely differing incidence of myocardial infarction these ischaemic ECG-abnormalities were as common in women as in a comparative sample of men. This observation questions the traditional interpretation of the exercise induced ECG response in women.


Enzymatic determination of triglycerides with a system Olli 3000 analyser. We describe a totally enzymatic method for determining serum triglycerides adapted for a System Olli 3000 analyser. In this procedure triglycerides are determined by measuring free glycerol enzymatically after hydrolysis of a sample with lipase and esterase. The method utilizes two standards for calibration, includes a blank correction and requires 20 microliter of serum. Forty serum samples can be analysed in about 30 min. The procedure is linear up to a concentration of 8 mmol/l of triglycerides. The precision and sensitivity of the method are good. A comparison of this method with another enzymatic method gave the correlation coefficient 0.988 and the regression line y = 1.02x + 0.02 (n = 95).


Evaluation of the double antibody-solid phase radioimmunoassay technique in plasma LH and FSH and urinary LH measurements. Double antibody-solid phase (DASP) radioimmunoassay methods for plasma LH and FSH and urinary LH were developed and carefully evaluated as to their reliability and practicability. The peptide hormones were iodinated enzymatically with immobilized lactoperoxidase which resulted in pure and stable products of unchanged immunoreactivity. The sensitivities of these assay methods are 0.02, 0.17 and 0.20 mIU/tube for plasma LH (MRC 68/40) and FSH (MRC 68/39) and urinary LH (IRP-HMG, urinary), respectively. Interassay coefficients of variation obtained over a 6-18 month period were 14.2, 14.7 and 12.8%, respectively. The latter values for plasma LH and FSH assays were obtained from one level pool samples, and the value for urinary LH is the mean of those obtained from two pools of different levels. Plasma reference values for LH and FSH obtained using these methods are about 1.8-2.9 times higher than those cited for other types of radioimmunoassay. However, the values obtained for LH in urine are similar to those reported in the literature. It is suggested that the DASP technique is less influenced by interference from plasma proteins and because of this gives plasma values closer to the true ones. It is concluded that the methods are well suited for use as routine clinical assays in laboratories with a high work load.


Immunological family studies in Hodgkin's disease. Is the immunodeficiency horizontally transmitted? 27 consanguineous and non-consanguineous relatives to 12 patients with Hodgkin's disease (HD) have been studied. The lymphocyte DNA synthesis induced by concanavalin (ConA) was depressed in 6 patients. 7 out of 15 tested relatives (3 first degree relatives and 4 spouses) showed a profound impairment in lymphocyte response to ConA stimulation. None out of 12 relatives to ConA normal patients was defect in this respect. In relatives to ConA hyporesponsive patients there was a small but statistically significant decrease in lymphocyte response to pokeweed mitogen (PWM) and PPD in vitro. No differences in lymphocyte subpopulations were seen. The findings strongly support an exogenous factory (probably a virus) causing the depressed mitogen response in relatives to immunodeficient patients with HD. A possible linkage between the immunodeficiency and the pathogenesis of HD is discussed.


Prognostic factors in Hodgkin's disease. II. Role of the lymphocyte defect. Purified blood lymphocytes from 81 consecutive and previously untreated patients with Hodgkin's disease were studied in vitro. The patients were evaluated 23 to 52 months after institution of therapy and were divided into two prognostic groups: 1. Complete remission with or without previous relapse/relapses. 2. Uncontrolled relapse or decreased from Hodgkin's disease. Lymphocyte activation by concanavalin A, pokeweed mitogen or phytohaemagglutinin was impaired and spontaneous DNA synthesis was high in patients with poor prognosis as compared to the good prognosis group. The prognostic information increased if the four lymphocyte tests were combined in a score (range 0-8). All 8 patients with pronounced lymphocyte defects (score 7-8), died, while all patients with score 0 and 1 were in complete remission. In contrast, total lymphocyte and T-lymphocyte counts and lymphocyte stimulation by PPD were of no prognostic value. The ability of certain lymphocyte functions to predict prognosis was equal or better than that of age and better than clinical staging, histopathology and symptoms.


Cytochemistry of marrow and extramedullary adipocytes in monolayer cultures. The behavior of isolated, disaggregated white adipose cells obtained from marrow and extramedullar sites in the rabbit was compared in monolayer cultures. Both cell types transform within 2 weeks into fibroblast-like cells which can be maintained in subcultures. Both in freshly isolated state and in fibroblast-like state the marrow adipocyte contains esterase activities reacting with naphthol AS acetate and D-chloracetate. These activites are not present in extramedullary cells. In addition, alpha-naphthyl butyrate-reacting esterase, present in both cell types, is fluoride-resistant in marrow adipocytes but labile in extramedullar cells. These differences are consistent with heterogeneity of white adipose tissue and suggest different potentials for marrow and extramedullary adipocytes.


The exchangeable splenic platelet pool in response to intravenous infusion of isoprenaline. 8 healthy volunteers and 4 asplenic subjects, in whom autologous platelets had been labelled with radioactive sodium chromate, received i.v. infusions of isoprenaline in a dose of 0.03 microgram x kg-1 x min-1 over a period of 6 min. In the former group these infusions caused a significant decrease in the concentration of labelled as well as unlabelled platelets in the peripheral blood. Body surface countings showed that a significant increase in the count rate over the spleen occurred concomitantly with the decrease in the circulating platelet-bound radioactivity (PBR). In the group of asplenic subjects no change in PBR occurred. It is concluded that adrenergic beta-receptor stimulation causes a transitory trapping of platelets in the exchangeable splenic platelet pool.


Circulating megakaryocytes in blood from the antecubital vein in healthy, adult humans. A total of 21 healthy, adult men and 30 healthy, adult women aged 21-73 years were investigated for circulating megakaryocytes in the antecubital vein using the saponinhaemolysis leucoconcentration technique. In the males, the number of megakaryocytes in 1.5 ml blood varied from 1 to 20, the arithmetic mean being 10 megakaryocytes. In the females the number varied from 0 to 29 megakaryocytes and the arithmetic mean was 7.6 megakaryocytes. No significant difference was found between the values for the two sexes. There was no correlation between the number of megakaryocytes and platelets or leucocytes. 99% of the observed megakaryocytes were naked nuclei or had sparse cytoplasm and 1% had copious cytoplasm. Megakaryocytes without copious cytoplasm may be regarded as normally occurring cells in the peripheral venous blood.


Platelet activation: a new biological activity of guinea-pig C3a anaphylatoxin. 3H-serotonin-release from labelled gp-platelets is established as a sensitive method for testing a new biological activity of gp-C3a anaphylatoxin in an autologous situation. Time-, dose- and temperature-dependent release reactions as well as specific inhibition by carboxypeptidase B and anti-C3a antibodies show that C3a is a potent and specific inducer of platelet activation. Inactive C3a does not induce 3H-serotonin-release but specifically inhibits the action of C3a on platelets.


IgA in blood and thoracic duct lymph: concentration and degree of polymerization. Lymph fluid and serum samples from four mammalian species were studied forthe concentration and degree of polymerization of IgA. The results suggest that in the mouse, in the rat and in the dog circulating IgA represents only a small fraction of all IgA entering the blood stream from the lymph vessels. A majority of the input IgA of oligomeric type (13S, 11S and 9S) in these species is cleared rapidly. Monomeric IgA, and in the mouse and the dog the dimeric (9S) variety, dwell much longer in the blood; and because of this they form the majority of the circulating IgA. Blood concentration of IgA is high in man, a species whose blood seems to receive mostly monomeric IgA. It is much lower in the rat, mouse and dog, and in these species most of IgA entering the blood is probably oligomeric.


Mononuclear leucocyte chemotaxis in Boyden chambers: inhibition by subantimitotic concentrations of antitubulins. The chemotaxis of Lymphoprep -isolated human mononuclear leucocytes (L-MNs) from peripheral blood was inhibited by subantimitotic concentrations of the antitubulins demecolcine, podophyllic acid ethylhydrazide, vinblastine and griseofulvin. It is suggest that L-MN chemotaxis, like polymorphonuclear leucocyte (PMN) chemotaxis, is composed of a direct antitubulin-insensitive chemotaxis and a leukocyte-induced antitubulin-sensitive chemotaxis.


The phagocytosis-associated chemotaxis of human mononuclear leucocytes from peripheral blood is not antitubulin-sensitive. Lymphoprep-isolated and glass-adherent mononuclear leucocytes (L-MNs) from the peripheral blood of healthy donors appeared to display directional locomotion towards sparsely distributed yeast cells during continuous observation in coverslip preparations and during observations by means of time-lapse filming in Rose chambers. The phagocytosis-associated L-MN chemotaxis was not inhibited by antitubulin concentrations which were antichemotactic thesis that a direct antitubulin-insensitive chemotaxis exists in L-MNs, besides the antitubulin-inhibited L-MN chemoataxis reported in a previous study.


Specific antibodies are responsible for the low dose suppression of the immune response to thymus-independent antigens. Animals primed to the thymus-independent antigen native dextran B512 could not respond to the FITC hapten after immunization with native FITC-dextran. The degree of suppression of the anti-FITC response paralleled the increase of the anti-alpha1-6 PFC after priming with different doses of dextran. Suppression could be passively transferred with serum from dextran primed animals. Young animals that are very low-or non-responders to the alpha1-6 epitope of dextran B512, failed to suppress the anti FITC PFC response after priming with native dextran. We conclude that antibodies against the dextran carrier were responsible for the suppressed response to the FITC epitope in FITC-dextran immunized animals that had been primed with low doses of the dextran carrier.


D-penicillamine and macrophages: modulation of lymphocyte transformation by concanavalin A. Pretreatment with D-Penicillamine of rat peritoneal macrophages markedly influences their ability to modulate Concanavalin A stimulated [3H]thymidine incorporation in non-adherent rat lymph node cells. Untreated macrophages added in high numbers to the lymphocytes (ratio lymphocytes/macrophage 7.5 : 1) depress their [3H]thymidine incorporation. Pretreatment with D-Penicillamine further reduces this response. Lower proportions of untreated macrophages (ratio 15 : 1) exert a stimulatory effect on the lymphocytes. This response is reversed by pretreatment of macrophages with D-Penicillamine. Addition of untreated macrophages in very low proportions (40 : 1 and 75 : 1) is without effect on the [3H]thymidine incorporation by the lymphocytes. This response is markedly stimulated by pretreatment of the macrophages with D-Penicillamine. The culture of macrophages in the presence of D-Penicillamine increases their incorporation of [3H]D-glucosamine, but it is without effect on their incorporation of [3H]L-leucine. It is suggested that D-Penicillamine enhances the functional activity of the macrophage in the regulation of the lymphocyte response to mitogens.


The affinity of soluble immune complexes for concanavalin A. Con A-Sepharose affinity chromatography may be used in the analysis and classification of immune complexes. Experiments with model immune complexes suggest that the degree of affinity of an immune complex for Con A-Sepharose is determined by the antigen rather than the IgG antibody of the complex. It is possible that partial characterization of unknown antigens linked to IgG in immune complexes may be achieved in many diseases. Preliminary explorations with selected human sera indicate that the IgG containing immune complexes in Burkitt's lymphoma and nasopharyngeal carcinoma have affinity for Con A-Sepharose. By contrast IgG containing immune complexes in chronic hepatitis B seem to lack affinity for Con A-Sepharose.


Airways obstruction in asthmatics induced by body cooling. Pulmonary and thermoregulatory reactions to body cooling were studied in eight asthmatic and five normal subjects. The cooling was achieved by a cold shower at water temperature (T) of 15 degrees C for 1 min, followed by exposing the wet body to a high wind generated by a fan for another minute. The skin T, oral T and pulmonary functions were measured before and after cooling. After the cooling, skin T fell a mean of 7 degrees in all subjects and the oral T fell 0.5 degrees in the normals and 0.7 degrees in the asthmatics. In asthmatics, the post-cooling forced expiratory volume in 1 s (FEV1) and maximal mid-expiratory flow (MMEF) fell significantly (P less than .05) to a mean of 79% and 72%of baseline, respectively, and thoracic gas volume (TGV) and airway resistance (Raw) increased significantly to 133% and 198% of baseline, respectively. In normal subjects a small but significant increase in Raw was found. No obstruction developed in the asthmatics after a warm shower at 37 degrees or after breathing the cold shower mist. It is suggested that it is body cooling which leads first to vasoconstriction and then cooling of respiratory mucosa that initiates bronchoconstriction in asthmatics.


Intralobar pulmonary sequestration. A report of 12 cases. Intralobar pulmonary sequestration signifies an abnormal and non-aerated mass in the lung, supplied by a systemic artery. Twelve cases are submitted, 10 treated by surgery and two conservatively. There was a male preponderance 11:1, and half the patients were over 25 years. In 66% the abnormality was situated basally on the left side A definite diagnosis can be made only by arteriography, visualizing the number, site, and size of the anomalous vessel(s). Clinically, the symptoms may range from no symptoms at all (four of the present patients) to recurrent pneumonia, cough, and haemoptysis (five of the present patients). In two patients the excised tissue showed epithelial proliferations, tumourlets and slight epithelial dysplasia, but no manifest malignancy. Surgical resection is the only curative treatment for intrapulmonary sequestration. In "silent" cases it is felt justified to apply conservative treatment should primary surgery be contra-indicated.


Small airways function in pulmonary sarcoidosis. Closing volume and maximal expiratory flow-volume curves were performed in a group of 25 patients with pulmonary sarcoidosis in stages I and II and with normal spirographic results. Although the mean values of these tests were mostly within the limits of predicted values, 48% of the patients had an increased slope of the alveolar plateau and 40% had decreased maximal expiratory flow at low lung volumes. Abnormal test results were found even in patients with normal static lung compliance. Our results suggest that functional abnormalities in small airways may occur early in the course of sarcoidosis.


Obstructive lung disease in Behcet's syndrome. Obstructive lung disease in two patients with Behcet's syndrome is presented. In both cases increased airways resistance, impaired PEF and FEV1.0 were found. In addition, diffusion capacity was slightly decreased in spite of enlarged total lung capacity and increased residual volumes. Both patients had mild hypoxaemia despite slight hyperventilation; a normal chest X-ray, and a decreased serum complement C3 level. Corticosteroids had a beneficial effect on VC in one of the two cases but failed to have any significant effect on the impaired ventilatory function in the other.


HLA-antigens and pulmonary upper lobe fibrocystic changes with and without ankylosing spondylitis. A report of seven cases. Seven patients with remarkably similar progressing pulmonary apical fibrocystic disease are presented. Active tuberculosis was excluded, antituberculous chemotherapy had no effect on the pulmonary lesions. One of the patients had the typical clinical picture of Reiter's syndrome, the other that of ankylosing spondylitis. HLA-antigens were determined in all seven cases, only two patients, one with Reiter's syndrome and another with ankylosing spondylitis, had the HLA-B27 antigen.


[Medicine, health and prevention].

[Medicine, health and prevention]. Health problems far exceed the potentialities of medicine as conventionally practised in Switzerland and elsewhere. Only a health policy directed primarily towards prevention will ensure a more harmonious development for all, both individually and collectively. "Passive" preventive medicine (vaccinations, regular check-ups, etc.) has already been shown to be important, and will remain so in the future, but "active" prevention should be employed more generally. In order to motivate the public to assume co-responsibility for its own health, education in human biology and behaviour, customs, risk factors, environment, social conditions and the economic situation of the community should be dispensed at a very early age, as should the elementary measures necessary for maintaining good health. Education on suhc a general scale is only possible by a constant exchange of information and close collaboration between experts in various health-related fields, politicians, laymen, adults and children. Health is not a right as such, but is the result of daily care and a long learning process.


[A newly discovered kinship with hereditary amyloidneuropathy. Demonstration of increased enteral deconjugation of bile acids]. In a hitherto undescribed German kinship, 6 cases of slowly progessing peripheral polyneuropathy have been observed. The polyneuropathy affected all peripheral sensory qualities to a similar degree; the mode of inheritance seemed to be autosomal dominant. Four of the six cases had diarrhea, while two had steatorrhea and increased enteral deconjugation of bile acids. Amyloid was found in biopsies of peripheral nerves, arteries and gastric mucosa. This amyloidosis resembles the so-called Portuguese form of the hereditary amyloid polyneuropathies, except that the sensory loses were not dissociated. Increased enteral deconjugation of bile acids as demonstrated by an abnormal 14C-glycocholate breath test appears to contribute to the chronic diarrhea characteristic of this disease.


[Hypersensitivity reaction to allopurinol]. Major hypersensitivity reactions to allopurinol are rare. They are characterized by systemic vasculitis associated with a grave clinical picture. 20 days after beginning treatment with allopurinol, a 70-year-old patient presented with a maculo-papular, erythemato-squamous eruption which developed into erythroderma with fever, edema, polyadenopathy, marked eosinophilia, cholostatic jaudice, and aggravation of preexisting renal insufficiency. Skin biopsy showed vasculitis with fibrinoid necrosis and a chiefly lymphocytic infiltrate suggestive of a malignant lymphoma-type process. As soon as allopurinol was discontinued, and without steroid treatment, the patient spontaneously recovered. A lymphocyte transformation test was positive for this drug. The poorly know mechanism is immunological, with formation of immune complex deposits on the endothelial cells and at the dermo-epidermal junction, fibrinoid necrosis of small vessels and cellular reaction which is lymphocytic. It is not a toxic reaction related to the dose administered, though most authors have emphasized that preexisting renal insufficiency could favor hypersensitivity to allopurinol.


[Trombotic endocarditis and its correlation to disseminated intravascular coagulation]. 6275 autopsies performed at the Institute of Pathology of the University of Zurich in the period 1973--1976 included 47 microscopically verified cases of thrombotic endocarditis. Thirty of these patients harboured a neoplasm, most often of the gastro-intestinal tract. Twelve died from arterial emboli, particularly to the central nervous system, although valvular disease of the heart was not manifest clinically. The association of thrombotic endocarditis and histologic evidence of disseminated intravascular coagulation was seen in a different group of 30 cases. Patients with carcinomas and thrombotic endocarditis exhibited microthrombi to a significantly higher degree than a comparable control group with carcinomas but without thrombotic endocarditis. There results confirm that hypercoagulability may well be the denominator common to both thrombotic endocarditis and disseminated intravascular coagulation.


[The enlarged diagnosis of the fatal penicillin accident. Immunehistologic demonstration of antigen-antibody complexes and of antibodies against the tubular basement membrane after administraiton of depot penicillin]. In a case of fatal penicillin allergy it proved possible at autopsy to demonstrate (by immunohistological examination of basal membranes of proximal renal tubuli) antigen-antibody complexes belonging to the penicillin (BPO) group and to an anti-penicilloyl antibody of the IgG type. In addition, complement C3 was detected. Antibodies against the basal membranes or renal tubuli were also demonstrated in material eluted from the kidney, although an inflammatory reaction ot the immunoligical changes had not yet been observed in light microscopy. It is undecided whether this discrepancy is due to the low dose of penicillin administered or the relatively short time lag between first injection and time of fatality. It is assumed that, pathogenetically, a reaction of the serum sickness type is probably involved. For etiological clarification the use of immunohistological methods in addition to serological procedures provides further indices for an antecedent sensitization to penicillin, because assay effectiveness does not decrease even after a lengthy postmortal time-lapse. On the other hand, tissues and serum for examination should be frozen at low temperatures immediately after autopsy.


[Isolated ulcer of the small intestine. Abnormal structures in the intestinal wall]. Four years after abdominal trauma, an intestinal loop was resected in a 19-year-old male due to persistent abdominal pain, rectal bleeding, and the suspicion of tumor. A typical ischemic ulcer was found. The resected loop showed, moreover, two peculiar histological features which, to the best of our knowledge, have not been described in the literature: 1. smooth muscle sleeves surrounding intraparietal arteries; 2. entero-mesenteric smooth muscle bands. It is suggested that these muscular structures could, when contracted, provoke arterial stenoses and contribute to the formation of the ulcer.


[When to discharge a patient after myocardial infarct]. The evidence suggest that its possible on the fourth day after myocardial infarction to identify a group of patients with near-zero mortality during the next 14 days. These patients can leave hospital on the fifth day if adequate home care is available. Since 66 of our series of 255 patients belonged to this fortunate group, a notable cost reduction was achieved.


[Linearity and blank value in the serum creatine phophokinase MB-fraction determination by means of the inhibition test]. The inhibition test shows elevated creatine kinase MB (CK-MB) activity if the test volume is reduced. Hence, sera with considerably increased serum protein values may produce negative CK-MB results. What is involved here is an apparent blank phenomenon dependent on the serum proteins. This effect is not derived from the Inh-CK-M antibody but is directly connected with the CK-reagents, since analogous relationships are also shown with the conventional CK-method. In order to produce reliable inhibition test results, a reflectant blank versus test-volume and serum protein level must be taken into account.


[Fever of long standing in atrial myxoma]. A 39-year-old man is described who presented with the unspecific signs of systemic disease (elevated erythrocyte sedimentation rate, increased gamma-globulins, positive rheumatoid factor; clubbing, splenomegaly) and with fever whose origin remained undiagnosed for 8 years despite numerous investigations. Later in the course of the disease, the signs of mitral stenosis appeared, suggesting left atrial myxoma even in the absence of arterial embolization. This diagnosis was established by echocardiography and confirmed by angiocardiography as well as at operation, after which all the systemic signs and symptoms disappeared.


[Current aspects and prospects of preventive pediatrics in France]. Preventive medicine perhaps achieved its earliest and most complete successes in the field of pediatrics. Work on the problems of main concern in the last third of the century has reached a stage where preventive medicine has virtually mastered those of nutrition and infection in our countries. The current problems are malformation, accidents, and suicide, and this has meant a major shift of interest for preventive activity. In some fields, prevention-detection of neonatal affections takes place in the prenatal period: here, the pediatrician joins hands with the geneticist and the obstetrician. In other fields, such as accident prevention, the pediatrician's role is of particular importance to the authorities, industry, and the family. Finally, and this is new, the pediatrician is responsible for the prevention of diseases occurring in the adult. His role in this was a matter of course in nutritional diseases such as malnutrition and rickets, and in infections such as tuberculosis. It is assuming increasing importance in the detection and prevention of certain risk factors and common affections of the adult such as obesity, hypertension and atheroma.


[Humoral and cellular immune mechanisms in venous occlusive lung diseases]. In a 73-year-old female patient, pulmonary veno-occlusive disease was diagnosed by the typical histological findings in the lung. Immunofluorescence studies showed granular deposits of IgG and C1q in the lung, suggesting immune complex deposition and complement activation by the classical pathway. Furthermore, the presence of lymphocytes sensitized against collagen was demonstrated using the leukocyte migration inhibition system. These results demonstrate the significance of humoral and cellular immune mechanisms in the pathogenesis of this disease.


[Does room air humidification prevent respiratory diseases in winter? An epidemiologic study on 1321 office workers]. An epidemiological study was carried out from January 15th to March 31st 1976 among 1321 clerical workers of the Administration of the Canton of Geneva. This study was intended to determine whether indoor humidification during winter prevents respiratory infections. The results obtained show that air-conditioning, in spite of an average relative humidity (RH) of 52%, has an unfavourable influence on respiratory infections which are significantly more numerous among people working in air-conditioned offices. Humidifiers did not have a significant influence on the incidence of respiratory diseases, but the trifling difference of average air humidity between offices equipped with humidifiers (RH:33%) and offices without humidifier (RH:30%) shows that these appliances, as at present commonly used, are inefficient. After a review of the literature on the subject, the authors reach the conclusion  that no convincing evidence supports the theory of the effectiveness of indoor humidification in the prevention of respiratory diseases.


[Gas gangrene. The files of the Swiss Accident Insurance Company 1963-1975]. The clinical histories of 28 cases registered as gas gangrene by the Swiss National Accident Insurance (Schweizerische Unfallversicherungsanstalt) from 1963 to 1975 are reviewed. According to the classification of Altemeier (1. gas gangrene, 2. clostridial cellulitis, 3. simple contamination of a wound by Clostridium, and 4. gaseous infection without Clostridium) only 5 cases were assignable to group one (1 survivor), 2 cases to group two, 9 to group three and 9 to group four. Typical cases from each group are discussed to illustrate the advantages of this classification, the dangers of treatment based on wrong diagnosis, and the necessary prophylaxis. The more serious prognosis in gas gangrene in comparison to the other groups is emphasized.


[Paralysis of the trapezius muscle].

[Paralysis of the trapezius muscle]. Four cases of paralysis of the trapezius muscle occurring during the last 15 years are reported. The characteristics of this lesion, which is usually of iatrogenic origin, are outlined. Among the alternatives in treatment, Eden's operation is the method of choice. Major handicaps are usually corrected from both an esthetic and functional point of view.


[Sertoli-cell-only-syndrome. Histology and pathogenesis]. The Sertoli-cell-only syndrome is characterized histologically by complete loss of the germinal epithelium in testicular tubules, and clinically by aspermia, i.e. lack of spermatozoa and their earlier stages in the ejaculate. In our opinion the term Sertoli-cell-only syndrome should be used exclusively for these lesions, although some authors also use it for cases with oligo- or azoospermia in which the tubules still retain some remnants of germinal epithelium. The etiology of the Sertoli-cell-only syndrome is obscure. Maldevelopment, with failure of the primordial germ cells to migrate into the future gonads, and secondary destruction of the germinal epithelial layer are discussed. In the hope of finding distinct histologic differences that would indicate either malformation or an acquired lesion, we examined 53 cases of Sertoli-cell-only syndrome out of a series of 2700 testicular biopsies from our Institute. All 53 patients had aspermia, and no remnants of germ cells were identifiable in the testicular biopsies. The microscopic lesions in all cases were more or less identical. Two small groups could be distinguished in which the histologic alterations appeared to fulfil the criteria for germ cell aplasia and germ cell atrophy respectively. The majority, however, belonged to an intermediate group showing all states of transition between these lesions. It is likely that the varying histological patterns simply represent different grades of testicular destruction with loss of germinal epithelium, rather than different etiologies. Our study does not allow conclusions as to the cause of the Sertoli-cell-only syndrome.


[Peroral poisoning with isocyanate and methylenechloride]. Despite worldwide use of organic isocyanates and methylene chloride, little is known of oral intoxication with these substances in human beings. Two suicide attempts and their subsequent clinical course are reported. Coma, shock, relative bradycardia, leukocytosis and metabolic acidosis were ascribed to the effect of methylene chloride. The causes of the necrosis in the gastro-intestinal tract (as demonstrated endoscopically and histologically) of hemolysis and of intravascular clotting are discussed. The prognosis is good after survival of the acute phase. Untoward reactions in cases of pregnancy have not been observed.


[Mortality rates and causes of death in the "Basle study"]. The Basle Study of cardiovascular diseases (CVD) from 1960 to 1973 showed, in the original cohort, a mortality rate of 6% in 4858 men aged 15-65 at entry and of 2.2% in 1471 women aged 15-55. In the male cohort, the age-specific 10-year mortality is lower than in the general Swiss population, due to a smaller number of fatal accidents and a low incidence of various diseases with fatal outcome. This is not true of cardiovascular mortality, which accounted for 40%, or of tumors, which accounted for 35% of the observed mortality. In females, 59% of the fatal events were caused by tumors and 16% by CVD. The autopsy rate was 61% and allowed confirmation of the death certificate. Myocardial infarction was the cause of death in 51% of all males dying from CVD. A comparison of findings at the entry examination between subjects who died from CVD and those who died from other causes showed a significantly higher incidence of CVD in both the family history and the personal history in the cardiovascular mortality group. Cigarette smoking was more prevalent. Blood cholesterol, betalipoproteins, and blood pressure were significantly higher than in the non-cardiovascular mortality group. Our findings demonstrate that no measurable preventive action against CVD was taken even in a group of presumably healthy subjects interested in health maintenance. The necessity of increased efforts toward prevention of CVD is evident.


The hydrophobic effect and the organization of living matter. Biological organization may be viewed as consisting of two stages: biosynthesis and assembly. The assembly process is largely under thermodynamic control; that is, as a first approximation it represents a search by each structural molecule for its state of lowest chemical potential. The hydrophobic effect is a unique organizing force, based on repulsion by the solvent instead of attractive forces at the site of organization. It is responsible for assembly of membranes of cells and intracellular compartments, and the absence of strong attractive forces makes the membranes fluid and deformable. The spontaneous folding of proteins, however, involves directed polar bonds, leading to more rigid structures. Intercellular organization probably involves polar bonds between cell surface proteins.


A harvester ant venom: chemistry and pharmacology. The mammalian toxicity of the potently algogenic venom of the ant Pogonomyrmex badius is greater than that reported for any other insect venom. This enzyme-rich venom contains high concentrations of phospholipase A2 and B, hyaluronidase, acid phosphatase, lipase, and esterases. This hemolytic secretion from the poison gland products unusual symptoms in mammals and appears to have been evolved as a deterrent for vertebrate predators.


Effect of oxygen pressure during culture on survival of mouse thyroid allografts. A marked increase in the percentage of mouse thyroids that retained function 20 days after transplantation across a major histocompatibility barrier and the percentage that lacked generalized infiltration was observed when the grafts received hyperbaric oxygen during a 4-day culture period. Perfusion of the donor animal before thyroidotomy and the addition of fetal calf serum to the culture medium did not have a significant effect on graft survival, but the percentage of grafts lacking generalized infiltration was slightly increased by the addition of hydrocortisone to the culture medium.


Magnetic microspheres prepared by redox polymerization used in a cell separation based on gangliosides. A facile method is described for making magnetic microspheres that bind specifically to cell surfaces, in order to separate cells magnetophoretically. Control over the sizes of the spheres is effected by using their magnetic cores as part of a redox polymerization system. The use of the microspheres is demonstrated with a separation involving C-1300 neuroblastoma cells, 10% of which express the ganglioside GM1 in their membranes. The GM1-containing cells were separated with better than 99% purity, while the deficient cells were obtained at least 98% pure. The separation, which was carried out under sterile conditions, required only 6 minutes.


Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans. Eight chronic alcoholics received repeated computed tomography scans. Four, who maintained abstinence and functionally improved, showed partially reversible cerebral atrophy. Two nonabstinent patients and two abstinent patients who had completed functional improvement before the first scan showed no change in atrophy.


Postpartum amenorrhea: how is it affected by maternal nutritional status? The average length of postpartum amenorrhea reported by breast-feeding women in rural Bangladesh in 1975 was 18 to 20 months. Its duration was found to be only slightly related to maternal nutritional status. There was no evidence of a threshold of weight for height necessary for the resumption of menses postpartum. Factors related to the duration of postpartum amenorrhea were maternal age, socioeconomic status, and supplemental feeding of the infant.


Amino acid sequence of the Fc region of a canine immunoglobulin M: interspecies homology for the IgM class. The amino acid structure for the Fc portion of a canine immunoglobulin mu chain was determined. The sequence was compared with those of two human mu chains, and a high degree of interspecies homology was observed. The preservation of primary structure between species is probably reflective of the unique functions associated with the immunoglobulin M class.


Cohort mortality for prostatic cancer among United States nonwhites. In recent decades, age-adjusted mortality rates from prostatic cancer have risen precipitously among blacks, remaining unchanged among whites. It is now the most common cancer among United States black males. When nonwhite mortality rates were examined by age and birth cohort, it was found that peak rates occurred at every age in the cohort of 1896 to 1900, and declined thereafter. This presages an arrest and reversal of the time trend in summary mortality rates as more recent nonwhite cohorts reach the ages of maximum risk.


Striatal nondopaminergic neurons: possible involvement in feeding and drinking behavior. Intracaudate injections of kainic acid destroy striatal neurons containing acetylcholine and gamma-aminobutyric acid but leave dopaminergic nerve terminals in this brain region intact. Rats injected with the drug are aphagic and adipsic, and have other behavioral abnormalities strikingly similar to those seen in animals with lesions in the dopaminergic nigrostriatal bundle.


Receptors for glucocorticoids in the lens epithelium of the calf. The calf lens epithelium contains a specific cytoplasmic receptor for glucocorticoids. This binding protein has a high affinity for dexamethasone (average dissociation constant, 8 x 10(-9) mole per liter), a low capacity (average, 550 femtomoles per milligram of protein), extreme heat sensitivity, and exhibits a pattern of competition similar to that of glucocorticoid receptors in other tissues. This provides direct biochemical evidence that these tissues may function as a target organ for glucocorticoids.


Risk factors in surgical correction of congenital heart defects in early childhood. The technique of surface-induced hypothermia, circulatory arrest and limited extracorporeal circulation was used in the surgical correction of congenital heart defects in 125 young children. Hospital mortality was 18% and no death could be attributed to the surgical technique. An analysis of risk factors demonstrated that successful corrective surgery was not significantly related to age, body weight or pulmonary vascular obstructive disease. In transposition of the great arteries, the presence of a ventricular septal defect was associated with an increased mortality. Emergency operations performed because of severe hypoxaemia carried a high mortality, especially in patients with tetralogy of Fallot.


Long-term effects of kwashiorkor on psychomotor development. The long-term effects of kwashiorkor on psychomotor development were assessed by means of 3 tests. A group of 31 children aged from 6 to 12 years, who had been hospitalized for the treatment of kwashiorkor during infancy, was age-matched with 2 control groups, consisting of a group of siblings and a group of yardmates, none of whom had been exposed to acute infantile malnutrition. The test scores for the groups were not significantly different. The results are discussed in the light of suggestions that marasmus has a more damaging effect on human development than kwashiorkor.


The radiological signs of acute appendicitis in infancy and childhood. The radiological findings in 93 children operated on for acute appendicitis were reviewed retrospectively; acute appendicitis was confirmed in 76 (81%). These children were compared with 40 children with abdominal pain, but without appendicitis. Pre-operative radiographs in the children with appendicitis showed a significantly higher incidence of scoliosis, properitoneal line displacement, caecal dilatation with air/fluid levels and terminal ileal dilatation with air/fluid levels. The incidence of radiologically demonstrable faecaliths was not statistically higher in the children suffering from acute appendicitis. In children under the age of 4 years, in whom the diagnosis of acute appendicitis is often difficult, the radiological signs are helpful.


Repetitive ventricular ectopic activity in chronic ischaemic heart disease. The characteristics of repetitive ventricular ectopic activity in 175 ambulatory patients after myocardial infarction are analysed. A total of 1 500 magnetic tape recordings were made on these patients over a period of up to 8 years. In the group of patients exhibiting few ectopic beats, i.e. less than 8/h, the incidence of ventricular salvoes and tachycardia was 9% and 4% respectively, whereas in the group exhibiting many ectopic beats, i.e. greater than or equal to 8/h, the incidence of ventricular salvoes and tachycardia was 60% and 30% respectively. Even though only 1 patient in the first group, exhibiting repetitive ventricular ectopic activity, died, in contrast to 10 in the second group, this is not of statistical significance. The coupling intervals between preceding normal sinus beats and beats which led to repetitive ventricular discharge were clustered between the shortest and the longest coupling intervals which did not lead to salvoes and tachycardia.


The value of serum drug concentration assays in clinical practice. The value of serum drug assays in clinical practice is assessed, and it is concluded that, except in neonates, elderly persons or patients with hepatic and renal dysfunction, such assays are of little clinical value. However, research projects to obtain clinically applicable pharmacokinetic data are of great value. Routine clinical drug assays should be discouraged on clinical, practical and economic grounds.


Intermittent exposure of gravid rats to 1% nitrous oxide and the effect on the postnatal growth of their offspring. Three groups of pregnant rats were exposed to 1% nitrous oxide 6 hours a day, 5 days per week for the first, first and second, and all 3 weeks of gestation. The offspring were weighed and measured at weekly intervals. The following variables were evaluated in control and experimental groups: litter size, body weight, tail length and body length. Litter sizes in animals exposed for the first and second weeks of gestation were significantly smaller than the controls. A two-way nested statistical analysis of the data revealed that over an 8-week period the experimental rats were significantly smaller than the control rats of the same age. Analysis of the 95% confidence intervals revealed no particular pattern related to the timing of the exposure to nitrous oxide.


Lung biopsy--a review of 3 years' experience. The results of 140 percutaneous lung biopsies by 3 different methods and 37 transbronchial biopsies through the fibre-optic bronchoscope are presented. The indications for each procedure, their diagnostic accuracy and ensuing complications are discussed. We conclude that each method has its place and that skill with several techniques permits the selection of the most appropriate method in each individual case.


The role of radiology in urinary tract infection in children. Of 758 children examined by uroradiography at the Transvaal Memorial Hospital for Children, 232 (30%) had been referred for the diagnosis of urinary tract infection. The incidence of radiological anomaly or abnormality in these children was an overall 30%; in the first 3 years of life this figure rose to 40%. Radiological investigation of these children should be undertaken routinely. Excretory urography alone is a satisfactory screening procedure in children over the age of 3 years; under this age, formal voiding cysto-urethrography is of immense importance. The incidence of 70% of underlying radiologically detectable abnormalities associated with Pseudomonas infection was statistically significantly higher than the 30% found in association with all other infecting organisms.


A profile of general practitioner obstetrics. The pattern of obstetrics as practised by general practitioners in a small country town over a period of 22 years is reviewed. The importance of dedicated nursing staff is emphasized, and an appeal is made for the establishment of maternity units distinctly separate from general hospitals.


The alternative to colostomy for the injured colon. In 34 patients with penetrating colon wounds which were considered to be liable to dehiscence, the sutured wounds were exteriorized. There were several 'high-risk' factors, i.e. operative delay of more than 6 hours after injury, faecal contamination of the peritoneal cavity, marked contusion of the bowel wall, and severe associated visceral haematoma which is deemed liable to infection. Additional considerations were thoraco-abdominal penetration and combined colonic and renal injuries. The operative technique is described in detail, and the morbidity of the procedure, which is low, is analysed. Comparison is made with a similar group of patients in whom colostomy was performed with subsequent closure. Exteriorization and closure of the penetrating colon wound appear significantly superior to colostomy in terms of mortality, septic complications and period of hospitalization.


Skin tumours in White South Africans. Part I. Patients, methods and incidence. A survey of all skin tumours recorded in Whites in a dermatological practice in the southern Transvaal is presented. Nearly a quarter of the 15 000 consecutive patients seen over a period of 7 years complained of skin tumours. They were considered to be a representative sample of the population, since their occupations compared well with those of White South Africans in general. The relative frequency of skin tumours is shown in detail. Sun-induced tumours are common, solar keratoses occurring in 10% of all patients, basal cell carcinomas in 4%, kerato-acanthomas in 1% and squamous cell carcinomas in 0,5%. Seborrhoeic keratoses, cellular naevi, polyps, cysts, angiomas and histiocytomas are also commonly seen; patients with these complaints often seek medical advice for cosmetic reasons.


Skin tumours in White South Africans. Part II. Age and sex distribution. The incidence of skin tumours according to age and sex is analysed. Sun-induced tumours occur most commonly in persons between the ages of 50 and 69 years. One half of malignant melanomas are seen at ages following the decline in incidence of junctional and compound naevi. Squamous cell carcinomas occur earlier in males. Histiocytomas are seen earlier and spider angiomas later in females. Tumours occurring predominantly in males include squamous and basal cell carcinoma, kerato-acanthoma and pyogenic granuloma. Histiocytoma and spider angioma are seen more often in females.


Skin tumours in White South Africans. Part III. Distribution of skin tumours on the body. The distribution of the commoner skin tumours is detailed according to body site. Cutaneous horns, keratoacanthomas, Bowen's lesions and squamous and basal cell carcinomas occur mainly on exposed areas, confirming the importance of sunlight in their causation. However, a quarter of the Bowen's and over half the superficial basal cell carcinoma lesions are seen on covered areas, indicating that these tumours are both distinct entities. That seborrhoeic keratoses, intradermal and compound naevi, haemangiomas and lentigines were most often seen on the face may simply reflect the fact that patients often seek cosmetic help for these complaints. Distributional analysis suggests that cellular naevi on the trunk are much more likely to cause malignant melanoma than those on exposed areas.


Amniotic fluid infection at term.

Amniotic fluid infection at term. The incidence of amniotic fluid infection, determined by histological examination of the placenta and cord and cytological examination of gastric aspirate, was found to be high (52%) in term deliveries. A detailed histological system of grading the inflammatory response was used. No relationship was found between maternal nutritional factors or the baby's weight and inflammatory response, as judged by histological examination. The presence of pus cells in the gastric aspirate was of only limited diagnostic value. The absence of clinically obvious infection in the infants suggested amniotic fluid colonization without spread to the fetus.


The orbital muscle of Müller.

The orbital muscle of Müller. The orbital muscle consists of smooth muscle fibres interspersed with blood lacunae and is therefore both contractile and erectile. Contraction is under sympathetic control, whereas erection appears to be under parasympathetic (pterygopalatine) influence. Apart from its possible effect on the position of the eyeball in the orbit, the muscle seems to be mainly concerned with directing facial venous blood to or away from the cavernous sinus which acts as a heat exchanger for internal carotid blood.


Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report. A patient who presented with incomplete abortion developed severe persistent haemorrhage from the genital tract after evacuation of the uterus, as a result of erosion of a major vessel in a sacculus in a previous caesarean section scar. Detection and management of this condition are discussed.