Changing attitudes in the management of cancer of the breast. Opportunity to assess changes in the management of cancer of the breast over the past 7 years was afforded by analysis of responses to questionnaires that were part of an annual questionnaire course. Comparison of responses to questionnaires conducted in 1971 and 1977 identified important features of approaches to this disease and indicated the way in which changes have occurred. Diagnostic needle aspiration increased from 24% (1971) to 54% (1977). In both surveys surgeons reported employing mammography infrequently. Use of modified radical mastectomy increased from 15% (1971) to 60% (1977). Employment of classical radical mastectomy decreased from 83% (1971) to 37% (1977). Surgeons considering biopsy of the contralateral breast to be unnecessary decreased from 47% (1971) to 14% (1977). Skin grafting, after a mastectomy, decreased from 40% (1971) to 24% (1977). Though oophorectomy is still the preferred initial treatment for premenopausal patients with advanced disease, preference for chemotherapy in postmenopausal patients increased from 5% (1971) to 23% (1977). Surgeons approving of reconstruction with implants after mastectomy for carcinoma increased from 30% (1971) to 49% (1977). Following mastectomy in patients with positive axillary nodes, 58% of our respondents employ chemotherapy with several drugs and 34% prefer irradiation.


Vagal innervation of the bypassed stomach following gastric bypass. Gastric bypass, a 90% gastric exclusion, has been used successfully for surgical treatment of morbid obesity since 1967. Early concern as to its ulcerogenic potential has not materialized, but the physiological activity of the excluded stomach has not been studied fully. To determine whether the excluded segment retained any vagal innervation, 25 patients underwent preoperative Hollander tests of their intact stomachs. The test was repeated after operation, after the patients had resumed normal oral intake. Postoperative specimens were collected from a gastrostomy placed in the excluded stomach at the time of the gastric bypass. Percentage changes in volume and total acid for both the intact and excluded stomachs followed the same pattern with insulin injection after 45 minutes at both testings, pH values were identical. These observations, which indicate vagal innervation of the excluded stomach, together with previously published histalog acid-response data and the observed marginal ulcer incidence of one per 193 years of patient follow-up, demonstrate that normal gastric physiology is maintained after bypass and confirm that it is not an ulcerogenic procedure.


Cardiovascular risk factors in patients with peripheral vascular disease. Cardiovascular risk factors in 566 patients with peripheral arterial disease undergoing major vascular operations were analyzed by chi-square analysis. There were 37 postoperative deaths, for a mortality rate of 8.5%. Cardiovascular complications were responsible for 23 deaths (62%). Five risk factors--congestive heart failure, prior myocardial infarction, prior stroke, arrhythmia, and abnormal electrocardiogram--showed significant individual associations with postoperative cardiovascular complications. A multivariate analysis of these five risk factors and angina led to the development of an equation which predicts the probability of a postoperative cardiovascular complication. The number of complications observed corresponded closely to that predicted by the equation. There was a significantly higher incidence of complications in patients predicted to be at high risk than in those at low risk.


The effects of malnutrition on variables of host defense in the guinea pig. Studies were conducted in young guinea pigs to determine the effects of malnutrition on selected variables of host resistance. Malnutrition was produced differently in two experiments. In the first the quantity of a standard, normal diet was reduced progressively so that test groups were fed 25% less each week over a 4 week period. Control groups were fed ad libitum. In the subsequent experiment, animals were fed defined guinea pig diets containing 5%, 30%, and 60% casein, respectively, which were similar in caloric content, vitamins, and minerals. Measurements of phagocytic bactericidal activity, serum opsonization, serum IgG and C3 levels, and mitogenic response of lymphocytes were made at weekly intervals. Results obtained from both experiments were comparable. There was a significant decline in phagocyte function by the third week in malnourished animals while the numbers of phagocytes per milliliter of peritoneal washings were similar to controls at all time periods. A depression of serum opsonization was observed when animals became moribund even though serum IgG levels remained unchanged. Serum C3 levels in malnourished animals were significantly lower than controls. Mitogenic response of lymphocytes to phytohemagglutinin was 85% lower in the 5% casein group after the third week. These results indicated that a marasmus-like condition and protein malnutrition depress critical functions of resistance.


Aneurysms of the renal artery: problems of prognosis and surgical management. The clinical course of 29 patients bearing 36 renal artery aneurysms was reviewed. The majority of the lesions (30 of 36 or 83%) were detected incidentally in the course of angiographic examination, mostly in the study of peripheral atherosclerotic arterial disease. Twenty-five lesions 2.0 cm or less in diameter, treated conservatively and observed during a period of time of from 1 to 17 years, remained clinically silent. In 10 patients (with 11 lesions) surgical treatment was employed. For eight patients the surgical treatment consisted of reconstructive excision and repair, with excellent results in all cases but one for a period of observation of from 1 to 17 years. In one patient aneurysmal dilatation of a vein bypass graft resulted in nephrectomy 2 years following operation. In the remaining two patients nephrectomy was required. Unless hypertension or pregnancy complicates the clinical picture, renal arterial aneurysms 1.5 cm or less in diameter can be observed safely by periodic angiography. Surgical repair of an aneurysm is recommended regardless of size if pregnancy cannot be avoided and hypertension is uncontrolled, and in aneurysms 1.5 cm or less in diameter which show an increase in size. A number of reconstructive vascular procedures have proved successful. Ex vivo repair may be an organ-saving technical aid.


Investigation of the effect of hydroxyurea on the cell cycle and the development of necrosis in the embryonic CNS of mice. On day 10 of gestation pregnant mice (strain NMRI) were given an intravenous injection of 500 mg/kg Hydroxyurea (HU). Simultaneously either 5 muCi/g or 10 muCi/g 3H-thymidine (3H-Tdr; specific activity 5Ci/mmol) was administered to the animals. At various times after treatment embryos and electron microscopy. Two hours after administration of HU condensations of the chromatin structure could be detected electron microscopically in some cells. Thirty minutes later the nucleolus became smaller and denser, the cytoplasm shrank, and the cell organelles moved closer together. Three hours after application of the drug break-down of the involved cells set in. As in the autoradiograms about 98% of the counted necroses were labelled, and since labelled thymidine is almost exclusively incorporated during the S-phase, it can be stated the HU influences only metabolic processes which take place during the S-phase. From the morphological findings it can be concluded that in the case of the S-phase-specific metabolic pathway, which is influenced by HU, we are primarily dealing with DNA synthesis.


Effects of salicylamide and protein restriction on the skeletal development of the rat fetus. Salicylamide has previously been shown to be teratogenic to the rat. Aims of the present study were to examine separate effects and interactions of salicylamide administration and protein restriction on development of the rat fetus. In experiments using Holtzman rats,the percentage of fetal resorptions was significantly increased by drug treatment and by protein restriction. Malformations were seen in fetuses from dams given the drug from the fifth to eleventh days of gestation; the inicdence of these malformations being independent of the diet. Factors affecting appearance of ossification centers included drug dosage, placental and fetal weight and litter size. Protein restriction had no significant effect on the development of centers of ossification. It is concluded that salicylamide, as well as protein restriction, produces adverse effects on pregnancy outcome in the rat.


Aortic aneurysm associated with cardiac defects in theophyline stimulated chick embryos. Theophylline(1 ml 0.02 M in 0.15 M saline) was administered to embryonic chicks (Hamburger-Hamilton developmental stages 24.27). The drug was topically applied to the surface of the chorioallantoic membrane in the vicinity of the embryonic heart. At necropsy, 63% (44/70) of the theophylline-exposed embryos demonstrated an aneurysm in the ascending aorta. Among the cases exhibiting aortic aneurysm, 48% (21/44) of the embryos demonstrated ventricular septal defects. Four cases of truncus arteriosus were also observed. The morphogenesis and mechanism of theophylline-induced cardiac defects with accompanying aortic aneurysm may be related to the development of the conotruncal region of the heart.


Teratogenic and cytogenetic effects of some plant-derived antitumor agents (vincristine, colchicine, maytansine, VP-16-213 and VM-26) in mice. The teratogenic effects of three new plant-derived antitumor agents, maytansine, VP-16-213 and VM-26, were compared to the effects of vincristine and colchicine in pregnant Swiss albino mice that received a single ip injection of drug on day 6, 7 or 8 of gestation. Cytogenetic studies were also performed using maternal bone marrow and embryos obtained 48 hours after injection of maytansine, vincristine, VP-16-213, VM-26 and colchicine on day 6, 7 or 8 of gestation. A close correlation between teratogenic and cytogenetic effects was not noted among the compounds tested. Vincristine had greater embryotoxic and teratogenic activity than maytansine at equimolar doses (0.36 mu moles/kg), with the peak effects appearing after injection on day 7 of gestation. Colchicine, VP-16-213 and VM-26 were comparatively less potent than maytansine and vincristine, since doses of 2.5 mu moles/kg (colchicine and VP-16-213) and 1.5 mu moles/kg (VM-26) were required to elicit embryotoxic effects. At their teratogenic doses, all compounds induced various cranial abnormalities including exencephaly, hydrocephalus, anophthalmia and microtia, as well as major skeletal malformations. The teratogenic dose of vincristine is comparable to its effective antitumor dose in transplantable rodent tumor systems; in contrast, the teratogenic dose of maytansine in approximately 10-fold higher than its antitumor dose. Of the compounds studied, VP-16-213 and VM-26 exerted the most consistent cytogenetic effects in embryonic tissue. Alarge proportion of the structural chromosome aberrations induced in embryonic cells by VM-26 were stable and are most likely capable of surviving at least one cell division.


Teratogenic potential of blighted potato concentrate in rabbits, hamsters, and miniature swine. Freeze-dried preparations of potatoes infected with phytophthora infestans or Alternaria solani were fed to pregnant hamsters, rabbits, and miniature swine. No evidence was observed that these diets or the extracts of respective blights were capable of producing teratologic effects in hamsters. Lesions of neurulation and anencephaly were noticed in rabbits and swine, respectively. The need for further pharmacological and toxicological evaluation in sensitive species is emphasized.


Limb anomalies produced by 2,2'-dipyridyl in rats. The teratogenicity of 2,2'-dipyridyl (DIP), a chelator for ferrous iron, was investigated by administration of single dose of 60 or 75 mg/kg intraperitoneally to pregnant SD rats on days 11.5-14.5. Fetuses examined on day 21 were decreased in weight, and had defects chiefly in the limb. The type and incidence of limb defects differed according to day of treatment. Digital malformations in the forelimb and long-bone defects in the hindlimb were produced with high incidence by treatment on day 12.5, and the frequency of digital malformations in the hindlimb was increased by treatment on day 13.5. Light and electron microscopic examinations revealed the delay of mesenchymal condensation and destruction of mesenchymal cells in the forelimb bud in the early stage after day 12.5 treatment. The normal increase of DNA, protein, collagen and glycosaminoglycan contents in the forelimb bud was markedly inhibited by the treatment. The incorporation activities for [14C]proline and [14C]glucosamine of the forelimb bud were reduced to 50-60% of the control. These results indicate that DIP has potent teratogenic and cytotoxic effects on the development of the rat limb bud.


Limb development in mouse embryos. II. Reduction defects, cytotoxicity and inhibition of DNA synthesis produced by cytosine arabinoside. Various morphological and biochemical parameters were used to study the mode of interference by cytosine arabinoside (Ara-C) in critical phases of embryonic limb development. Inhibition of embryonic DNA synthesis occurred immediately after injection of Ara-C into the mother. The inhibition was dose-dependent and was substantial even after the nonteratogenic dose (2 mg/kg) of Arc-C. The pattern of limb bone deficiencies in Ara-C treated fetuses was specific for each developmental stage at which the treatment was given; the site of affect moved distalwards along the limb as the development advanced. The teratogenic dose was cytotoxic to mesenchymal cells with a high proliferation rate but did not affect others such as the future cartilage cells in which the rate of proliferation was lower. The existence of this differential susceptibility at each stage of development, together with information about the pattern of bone defects at the same stage, permitted us not only to define with some precision the cellular basis of origin of limb defects but also to infer the relative level of cell differentiation pertaining to each successive stage. Deoxycytidine, if injected simultaneously with and at doses eight times larger than Ara-C, afforded virtually complete protection against teratogenic effects. Deoxycytidine also prevented cell death in the  limbs of Ara-C treated embryos. However, a dramatic increase in the frequency of polydactyly was found in the protected fetuses. The fact that the frequency of ectrodactyly in the protected fetuses decreased in inverse proportion to the frequency of polydactyly strengthened the notion that there may be a common cellular basis underlying these two types of digital defects. Striking changes were found in the structure of AER at 24 hours after Ara-C treatment; it was abnormally thickened into a gland-like structure and its inner edge facing the mesenchyme thickened into a gland-like structure and its inner edge facing the mesenchyme was thrown into several folds. This may constitute a response to impairment in the underlying mesenchyme with which AFR has long been considered to have an interdependent relationship.


Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. For the success of anatomical correction of transposition of the great arteries (TGA) it is essential to transfer the coronary ostia to the posterior vessel without undue tension, torsion, or kinking of the proximal coronary arteries or their early branches. This requires thorough understanding of the different modes of origin and early branching of the coronary arteries in TGA. Based on observations made during anatomical correction, a classification of the coronary arteries in TGA is suggested. In type A the right and left coronary ostia arise from the middle of the right and left posterior aortic sinuses and curve forwards to reach the right atrioventricular groove or anterior interventricular groove respectively. In type B both coronary arteries arise by a single ostium, while in type C the two coronary ostia are situated posteriorly, very close to each other, in a position similar to that in type B. The origin of the coronary arteries in type D is similar to that of type A. However, the right coronary artery gives origin to the circumflex coronary artery that curves round the posterior (pulmonary) vessel to reach the atrioventricular groove. In type E the right coronary artery arises in common with the left anterior descending artery from the left posterior sinus, while the circumflex artery arises separately from the right posterior sinus. Three techniques for the transfer of the different types of coronary arteries during anatomical correction are described.


Is bird fancier's lung associated with coeliac disease? Precipitin responses to different avian serum antigens occur in bird fancier's lung (BFL) and coeliac disease. Failure to distinguish between them could encourage an erroneous diagnosis of BFL in patients with coeliac disease, and the recent suggestion that these two disorders are strongly associated may be questioned, partly for this reason. In the present study small bowel biopsy specimens were obtained from 12 of a series of 14 patients proved to have BFL by inhalation provocation tests. None was suggestive of coeliac disease. Of a further 61 patients with biopsy-proved coeliac disease, seven were found to be exposed currently and 33 formerly to birds. As a result of clinical evaluation, BFL was considered a possible cause of undue breathlessness reported by three of the current bird fanciers only, and all underwent inhalation provocation tests. One alone gave positive results. We conclude that if a real association does exist between these two disorders, its clinical importance has been greatly exaggerated.


The cardiorespiratory response to exercise in thoracic scoliosis. Twenty-six subjects with thoracic scoliosis due to various causes have been investigated. They all performed a progressive exercise test under standardised conditions, and their maximum oxygen uptake (VO2 max), blood gases, and ventilatory and heart rate responses were observed. The VO2 max was significantly below normal and was proportional to the forced expiratory volume in one second (FEV1) and maximum exercise ventilation (VE max). Exercise was limited by ventilatory factors in 80% of the subjects who exercised maximally. VE max was diminished, but the dyspnoeic index was normal. The minute ventilation (VE) at any given VO2 was about 20% greater than normal. This hyperventilation taken with the low VE max explains why exercise is usually ventilation-limited in these subjects. Tidal volume (VT) increased linearly with ventilation until VT max was reached. The tidal volumes at any given ventilation were less than normal, but when expressed as a percentage of vital capacity (VC) they were above normal. The heart rate increased more rapidly than normal, but this appears to be a physiological result of the small muscle mass of these subjects and not a pathological response.


Hypercalcaemia and hypokalaemia in tuberculosis. In two patients with extensive pulmonary tuberculosis who developed hypercalcaemia and hypokalaemia the hypercalcaemia appeared related to the use of small doses of vitamin D, which suggested patients with tuberculosis were hypersensitive to vitamin D. They were thus similar to patients with sarcoidosis, and it is interesting that the Kveim test result was positive in both cases. The hypercalcaemia was quickly suppressed with steroids. Hyperparathyroidism, thyrotoxicosis, Addison's disease, and multiple myeloma were excluded on clinical grounds and by the appropriate tests. The hypokalaemia was associated with increased renal excretion of potassium, and was probably due to distal tubular damage from hypercalcaemia.


Management of penetrating stab wounds of the chest: an assessment of the indications for early operation. Haemothorax, haemopneumothorax, and pneumothorax were the most common complications in 85 patients with penetrating stab injuries of the chest. These complications were amenable to conservative treatment by aspiration or drainage of the pleural space. Immediate operation was indicated in 30 cases. Indications for surgery were haemorrhage from a major systemic or pulmonary vessel or the heart, cardiac tamponade, diaphragmatic penetration, oesophageal and bronchial tears, and sucking chest wounds. The need for immediate operation was clinically obvious at presentation in most cases. It should have been suspected from the situation of the entry wound, the nature of the weapon used, the size of the haemothorax, and the clinical findings in the others. All 11 deaths occurred in that group in which early operation was indicated, and some could have been averted had the need for operation been suspected early. Seven patients developed an empyema; five were in the group that required immediate surgery and in the other two infection occurred in a clotted haemothorax. Early repair of the associated visceral injuries and complete evacuation of a haemothorax, either fluid or clotted, could reduce the incidence of empyema.


Bronchodilatation after inhalation of the antihistamine clemastine. H1 receptor blocking antihistamines administered by mouth have not found a clear place in the management of bronchial asthma. We investigated the possibility that higher concentrations of these drugs, administered directly to the bronchial tree, might produce bronchodilatation. Twelve asthmatic patients inhaled aerosols generated from solutions of clemastine (0.05%), salbutamol (0.5%), and placebo. Bronchodilatation was assessed by changes in the forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) over four hours. Both clemastine and salbutamol caused significant bronchodilatation. The mean maximum percentage increases in FEV1 for clemastine and salbutamol were 21.1% and 29.2% respectively. The mean maximum percentage increases in PEFR were 31.2% and 35.2% respectively. There was no significant difference in the maximum bronchodilatation produced by the two drugs. Clemastine, when administered by aerosol inhalation, appears to be an effective bronchodilator.


Diaphragm and body weight in emphysema.

Diaphragm and body weight in emphysema. The weight of the diaphragm has been investigated in 103 male patients and 81 female patients, and the relationship between body weight and emphysema has been assessed in 662 male and 431 female patients. Diaphragm weight is related to body weight in both male (r = + 0.76) and female patients (r = +0.77) and is relatively larger in the former. Dissecting the diaphragm free of fat or freeze drying it does not appreciably improve the relationship between body weight and diaphragm weight. Diaphragm weight is better related to body weight than body length and is diminished in emphysema. Patients with emphysema weigh less. This is apparent with only moderate grades of emphysema, and there is no further loss of body weight as emphysema in the lung becomes more severe. The loss of diaphragm weight not only reflects the loss of body weight that occurs in emphysema, but the diaphragm is also less in weight than predicted from body weight. The diaphragm also appears abnormal on gross inspection in some patients with emphysema. Heart weight and diaphragm weight are related, probably because both are related to body weight.


Closing volume during normal pregnancy.

Closing volume during normal pregnancy. Serial lung function studies were performed in ten healthy, primiparous women aged 21--28. Measurements were made at two-monthly intervals during pregnancy and included functional residual capacity (FRC), total lung capacity (TLC), vital capacity (VC), specific conductance (SGaw) and closing volume (CV) on each occasion. Closing volume expressed as formular: (see text), showed a progressive rise during pregnancy in all subjects with a linear relationship to time (P less than 0.001, P greater than 0.01, respectively). No consistent changes in lung volume could be shown during pregnancy over the study period. It is suggested that the increase in closing volume during pregnancy might result in abnormalities of distribution of ventilation sufficient to explain the maternal blood gas disturbances of pregnancy.


Pulmonary and systemic aneurysms in a case of widespread arteritis. A patient in whom asthma preceded the development of multiple pulmonary and systemic artery aneurisms died after dissection of the aorta. At necropsy he was found to have widespread arteritis of unknown aetiology affecting many large and medium-sized pulmonary and systemic vessels as well as a few microscopic ones. Endarteritis obliterans was present in some of the vasa vasorum. The clinical and histopathological findings are discussed in relationship to other known causes of arteritis, and it is concluded that this condition has not previously been described.


Prolonged circulatory support with the intra-aortic balloon pump after myocardial infarction. Circulation was supported by intra-aortic balloon counterpulsation for 30 and 38 days respectively in two patients with cardiogenic shock after acute myocardial infarction. One was flown 1400 km to Cape Town for heart transplantation but died after being weaned from the pump while awaiting a suitable donor. The other underwent successful surgical closure of a ruptured ventricular septum on the 30th day, allowing time for the edges of the ventricular septal defect to fibrose. Neither significant damage to circulating blood elements nor infection occurred, confirming the feasibility of prolonged circulatory support.


Staged bilateral lobectomy for synchronous bilateral squamous cell carcinoma of lung. The history, diagnosis, and treatment by staged bilateral lobectomy of synchronous bilateral squamous cell carcinoma of the lung occurring in a 61-year-old man is presented. Histological diagnosis of pulmonary lesions suspected of being carcinomas should always be obtained, and extrathoracic metastasis should be excluded by all available means before planning treatment. The side showing evidence of greater malignancy on histology, or the one with the larger carcinoma, should be operated on first. Conservative, staged, bilateral resection is recommended.


Adjunct treatment with yoga in chronic severe airways obstruction. Eleven patients with severe chronic airways obstruction were given training in yogic breathing exercises and postures. A matched group of 11 patients were given physiotherapy breathing exercises. Both groups of patients were followed up at monthly intervals for nine months with pulmonary function tests, tests of exercise tolerance, and inquiry into their symptoms. After training in yoga the mean maximum work increased significantly by 60.55 kpm; whereas no such rise occurred after training in physiotherapy. This objective improvement was associated with symptomatic improvement in a significantly higher number of patients given training in yoga.


Excision of tricuspid valve with later replacement in endocarditis of drug addiction. Staphylococcal endocarditis in a drug addict was controlled only after excision of the tricuspid valve. Total absence of the tricuspid valve was tolerated well for 18 months, at which time deteriorating liver function prompted the insertion of a bioprosthetic valve into the tricuspid ring. The haemodynamic and clinical results after two years of follow-up have been excellent.


Giant fibromyxoma of the parietal pleura. A 23-year-old Nigerian man with a giant (8.5 kg) benign intrathoracic fibromyxoma presented in respiratory distress with what looked clinically and radiologically like a massive left-sided pleural effusion. The correct preoperative diagnosis was suggested by an almost 'dry tap' together with a solid resistance to the aspiring needle at chest aspiration. Complete removal was successfully accomplished through an extended left thoracotomy. The pathology, clinical features, and treatment of localised pleural fibromas are briefly discussed.


Aneurysm of internal mammary artery.

Aneurysm of internal mammary artery. A fusiform non-sclerotic aneurysm of the left internal mammary artery was found in an otherwise healthy young woman. Aneurysms such as this seem to be extremely rare since no published case could be found.


An original technique for surgical stabilisation of traumatic flail chest. The treatment of chest wall injuries with severe paradoxical movement remains controversial. Intermittent positive-pressure respiration may be appropriate, but in some, especially those requiring exploratory thoracotomy for a visceral lesion, surgical fixation is desirable. We present a simple method using two or three stainless Kirschner wires placed in the chest wall. Results in five cases have been good.


[Tissue antigens and bacterial infection (author's transl)]. Rejection of tissue- and organ-grafts is due to the existence of tissue- or transplantation-antigens which are present in principle on every nucleated body-cell. These tissue antigens represent the phenotypical expression of a complex system of genes which are localized on an autosomal chromosome: the histocompatibility system. These systems may usually be compared with bloodgroup systems. Besides the successful use of tissue typing in transplantation, it became apparent that histocompatibility systems may have another function. Among others, tissue typing may be correlated with resistance to and susceptibility to particular diseases. However, it is not clear so far whether tissue antigens play a role themselves or only serve as genetic markers in this regulation of the immune response. The two possibilities are introduced, together with some instances. Finally, on the basis of possible veterinary and economic importance, studies on histocompatibility systems in pets and farm animals are reviewed, a number of possible uses being suggested.


[Nalidixic acid intoxication in two pregnant bitches (author's transl)]. To ensure prolonged survival, dogs with cyclic neutropenia should be protected against bacterial infection of exogenous or endogenous origin, particularly during the neutropenic episodes. One of the methods available to minimize the risk of infection in these dogs, is selective decontamination of the gastrointestinal tract by using antibiotics and/or chemotherapeutic agents, in conjunction with housing in a laminar-flow cabinet. Two pregnant bitches, some of the offspring of which were expected to be homozygous for the cyclic neutropenia allele, were decontaminated with nalidixic acid. Fourteen days after initiation of the antibacterial treatment, the two dogs died. Jaundice and seizures had been apparent in both animals prior to death. Histopathological examination revealed changes primarily in the liver, which were consistent with toxic hepatic necrosis and were characterized by severe centrilobular haemorrhage and disappearance of hepatocytes. Multiple haemorrhages were observed in other organs. Further clinical investigation in two other dogs strongly suggested that nalidixic acid was the cause of death in the two pregnant bitches.


[Type B botulism in cattle, caused by feeding grass silage. Report of a case (author's transl)]. An outbreak of type B botulism in cattle, caused by feeding grass silage, is reported. The clinical features were completely identical with those in cases of type B botulism, which occurred when abnormal brewers' grains were fed. 36.5 mouse LD50 type B toxin was found to be present in each gramme of grass silage, the bacterial count being 10(4) Cl. botulinum type B per gramme.


[Studies on the possibility of producing broilers free from Salmonella (author's transl)]. The results of the present study show that the only method by which broilers could be reared free from Salmonella would be to adopt a number of radical measures at the same time. These measures include the production of Salmonella-free one-day chicks, decontaminating the feed, thorough cleansing and decontamination of the houses and preventing the introduction of Salmonella from the environment. Adopting separate measures was found to have a very slight effect.


[Malformation of laminae omasi in cattle (author's transl)]. Ten bovine omasa showing more or less deformed laminae omasi are described and classified into two groups: one group (I) without and one (II) with macroscopically perceptible inflammation. The possibility that groups II and I are two successive stages of the same process in which necrotizing inflammation plays an important role, is pointed out. The malformation of the bovine omasum described in the literature as aplasia or hypoplasia, bears a resemblance to the malformation in group I, and, in this case, necrotizing inflammation also was the probable cause.


[Use of radiography in the diagnosis of atrophic rhinitis (author's transl)]. In 126 gilts of the Netherlands Landrace breed and eighty-one gilts of the Large Yorkshire breed, slaughtered when they had attained a weight of 100 kg., radiography of the nasal cavities was carried out, followed by post-mortem studies of these cavities. Macrocopic examination of the transverse section at the level of the first premolar tooth showed that the incidence of atrophy as well as of hypertrophy of the turbinate bones was higher in pigs of the Large Yorkshire breed than it was in those of the Landrace breed. The ventral coils of the ventral conchae were most commonly affected in the two breeds. When the X-rays were assessed using the system suggested by Done (3), a discrepancy between the X-rays and the post-mortem findings was observed in a large number of cases. Possible causes of this discrepancy are discussed. The results do not warrant the development of a radiographic technique which can be used in field conditions in the Netherlands to examine the nasal cavities in establishing a diagnosis of atrophic rhinitis.


[Findings on infectious bovine rhinotracheitis (author's transl)]. Findings on infectious bovine rhinotracheitis (IBR) since this disease was diagnosed for the first time in the province of Gelderland in 1973, are reported. The clinical picture varies markedly, unmistakable symptoms are followed by a period of impaired health in a number of cases. There is no evidence to suggest that this impaired state of health is due to the causative virus of IBR. The number of infected herds is constantly increasing and is currently estimated at approximately 20 per cent. The disease also shows an increasing incidence in veal-calf herds. Intranasal vaccination will afford adequate protection of other members of the herd in the event of IBR but the immunity produced is short-lived.


[The purchaser's veterinarian and latent defects (author's transl)]. When the purchaser of an animal is dissatisfied with the animal bought, the question may arise whether the animal has any latent defect. The purchaser's veterinarian should see to it that he retains the initiative in this matter so that he can calmly and carefully decide whether a certificate of latent defect can or cannot be issued. The various possibilities are reviewed.


[Survey of the incidence of Dictyocaulus arnfieldi infections in donkeys in the Netherlands (author's transl)]. The results of an investigation into the incidence of Dictyocaulus arnfieldi in donkeys in the Netherlands show that 51 per cent excrete larvae in the faeces. This infection was not detected in animals under five months. The proportion of infected animals did not increase with age. However, the level of excretion was found to increase with age. There was no correlation between the excretion of lungworm larvae and pulmonary symptoms.


[Coarctation of the aorta: surgical management in infancy--results in 72 patients (author's transl)]. Early and late results of a total of 72 infants operated for coarctation of the aorta are reported. Operative repair included various methods (End-to-End, Vossschulte, Clagett, Shumaker, Waldhausen, Blalock). Isolated coarctation was present in 6 infants, 17 also had patent ductus arteriosus, 39 patients had additional associated cardiac anomalies, part of which were combined with PDA. Out of the 72 infants 17 died (early mortality: 11, late mortality: 6). The highest mortality rate was found among the 0 to 3 months age group (11 patients). Fourteen out of the 17 deceased patients had additional cardiac anomalies. Out of the 55 survivals, 37 patients showed good results, restenosis was found in 13 patients, 5 patients had to be reoperated due to severe restenosis.


[Corrected transposition of the great arteries: surgical treatment of associated cardiac defects (author's transl)]. Corrected transposition of the great arteries is often associated with other cardiac anomalies. We report our experience with the correction of the associated cardiac defects in 13 cases: ventricular septal defect with pulmonary hypertension (5 cases), ventricular septal defect with obstruction of pulmonary outflow tract (5 cases), obstruction of pulmonary outflow tract (2 cases), ostium primum defect (1 case). The possible surgical approaches for repair of the cardiac anomalies are described and the results of the operative correction are communicated. Precise diagnosis, the knowledge of the unusual disposition of the conducting tissues and new surgical approaches are prerequisite for successful correction.


[Hemodynamic long-term evaluation after total correction of tetralogy of fallot operated upon as adults (author's transl)]. 22 Fallot patients who had surgery after 21 years of age were thoroughly checked on an average of 11 years postoperatively. The mean functional classification according to the New York Heart Association was 1.5. Hemodynamic studies revealed excellent results. The mean systolic gradient across the pulmonary valve (delta p) was 14 mm Hg at rest and 31 mm Hg during exercise. The data assessed during exercise show that one cannot truly speak of a "total correction". Right ventricular systolic and enddiastolic pressures were elevated as well as the enddiastolic and endsystolic volumes. Right ventricular ejection fraction was significantly diminished (45%). Our results show that there was no significant difference between the patients with or without an outflow tract patch. Pulmonary insufficiency apparently bears no negative influence on long-term prognosis up to 11 years postoperatively in patients operated for tetralogy of Fallot.


[Surgical treatment of active infective endocarditis (author's transl)]. Between 1965 and 1976 40 patients underwent valve replacement for active, infective endocarditis. The overall mortality rate was 32,5 per cent. Six patients died early (within 30 days) and 7 within the following 8 years. 11 patients developed paravalvular leckage. Eight of these 11 patients required reoperation. We suggest that all patients with active infective endocarditis who develop progressive heart failure, intractable sepsis or recurrent embolization should be subject to immediate valve replacement despite higher operative risk.


Long term clinical and haemodynamic evaluation of the Ionescu-Shiley pericardial xenograft heart valve. The experience with the Ionescu-Shiley pericardial xenograft used for heart valve replacement over a period of 7 years has demonstrated, in both the aortic and atrioventricular position, excellent long term clinical and haemodynamic results. There were very few valve related complications and none occurred with valves manufactured since May 1976 by Shiley Laboratories. The long term durability of the glutaraldehyde stabilised pericardial xenografts was demonstrated by a rigorous and complete clinical follow-up as well as by histological and haemodynamic investigations. Valve thrombosis or calcification have not been encountered in this series. The embolic rate has been very low in both the aortic and mitral positions in the absence of long term anticoagulant treatment. The superior haemodynamic performance of this valve, even in very small sizes, represents an additional advantage and makes it particularly suitable for use in patients with narrow aortic root and in children. The very good results obtained with the pericardial xenograft fully justify its continued clinical use in the aortic, mitral and tricuspid positions.


[Three years experience with biological heart valve prostheses (author's transl)]. Increasing clinical experience has led to a world wide expansion of glutaraldehyde fixed aortic heterografts for valve replacement in patients. The distinct advantage of this valve is a very low rate of thrombembolic complications during the postoperative course. In our hospital 324 such prostheses of the types Hancock and Carpentier have been implanted in 290 patients. In 154 cases follow-up 6 months to 3 years after the operation have been obtained. Thrombembolic complications occured in 1,4%. Other postoperative complications were hepatitis (13,4%), and valvular endocarditis (1,5%). Postoperative control of patients after isolated mitral or aortic valve replacement revealed improved clinical conditions in 90,9%. Dysfunctions of the valve have not been observed. For aortic valve replacement prostheses of a diameter of 27 and 29 mm have been used. In mitral and tricuspid position generally size 31 mm and 33 mm valves were implanted. The decision to use glutaraldehyde fixed biological valves requires the observation of long time results demonstrating reliable mechanical stability of such valves for some decades.


[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)]. 45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.


[Surgical therapy of postinfarct tachyarrhythmia (author's transl)]. Thirteen patients with ventricular tachyarrhythmias after myocardial infarction underwent surgery at the heart wall or at the coronary vessels. Ten of these patients had an aneurysm of the anterior wall or akinesia of the anterior wall which in some cases was associated with stenosis of the right coronary artery or of the circumflex artery. One patient showed an isolated stenosis of the right coronary artery. One patient died from recurrent ventricular fibrillation during hospitalization, another patient died from reinfarction 4 months later. All the other patients could be discharged and were improved significantly.


[Differential diagnosis of stenoses of the large airways by means of lung function tests (author's transl)]. The different pathophysiological mechanisms involved in producing airflow obstruction at different sites in the tracheobronchial tree enable their differentiation by means of pulmonary function tests. These tests include volume-time measurements at forced in- and expiration, flow-volume measurements forced in- and expiration and flow-pressure measurements in the bodyplethysmograph during quiet breathing. In 23 patients with localized stenosis of the central tracheobronchial tree (12 with extra-thoracic tracheal stenosis, 4 with intrathoracic tracheal stenosis and 7 with main bronchus stenosis) the following parameters proved to be of diagnostic value: In the differential diagnosis of intra-extra-thoracic tracheal stenosis the forced in-expiratory flow-volume curve, in main bronchus stenosis the plethysmographically obtained flow-pressure curve with a large phase lag at zero flow ("trapped air"). In extreme cases the qualitative analysis of the spirogram in connection with the static lung volumes can be diagnostic.


[Laryngeal release for tracheal resection (author's transl)]. Mobilization of the larynx resulting in a 2 to 2.5 cm gain of length can be used in tracheal resection as an alternative to more extensive procedures within the thorax with their specific complications. In the method of Dedo and Fishman the cranial insertions of the thyrohyoid muscle are resected, the thyrohyoid membrane is divided and the two horns of the thyrohyoid cartilage are cut. Difficulties in swallowing may persist for long periods of time but usually can be overcome. In the suprahyoideal method of Montgomery the cranial muscle-insertions at the hyoid are divided and the hyoid bone is transsected leaving the small and large horns. Disturbances of swallowing are not to be expected with this method. Likewise postoperative tube-feeding is not required. The suprahyoid method probably is to be preferred.


[The transmediastinal pleurotomy (author's transl)]. A new surgical method is presented, the transmediastinal pleurotomy. With this technique it is possible to explore the opposite lung from a standard thoracotomy and to perform diagnostic or therapeutic resections in suitable cases. So far we have performed 20 transmediastinal pleurotomies without any complications.


[Assessment of preserving resections in broncho-pulmonary carcinoma (author's transl)]. Postulating that sufficient radicality in operative treatment of all forms of broncho-pulmonary carcinoma is only guaranteed by lobectomy or pneumonectomy 80% of the patients will be inoperable due to anatomical or functional reasons. From the surgical and technical point of view this number can hardly be changed. However, functional limits could be overcome by the use of segmental or subsegmental methods of resection in adequate cases of tumor localization. 88 patients, who had segmental or subsegmental resection more than five years ago were reinvestigated. Out of these patients, one had died postoperatively, 43% had died of their primary tumor disease and 17% of other diseases. 40% had survived the follow-up period. 60% of our patients with tumor stage T1N0 were still alive after 3.5 years. Considering the lack of alternative treatment limited lung resection can be of real advantage when applied critically.


[Behavior of ldh and its isoenzymes after cardiac surgery (author's transl)]. The degree of intraoperative myocardial injury was determined in two groups undergoing different methods of myocardial protection by observing the LDH and its isoenzymes up to the 11th postoperative day. Both groups consisted of patients who underwent mitral- and aortic-valve replacement. In the first group myocardial protection consisted of Kirsch cardioplegia (2) combined with conventional coronary perfusion in cases of aortic-valve replacement. In the second group the same initial cardioplegic procedure was followed by the noncorpuscular, hypothermic and aerobic coronary perfusion by Bleese and Döring (1). No difference was noted among the mitral valve patients. During the 11 days postoperative period, the aortic valve patients in the first group demonstrated a significantly higher LDH activity than the mitral-valve cases whereas LDH activity of aortic-valve patients in the second group resembled that of the mitral valve cases. Since the length of extracorporal circulation and ischemia did not vary significantly, the LDH behavior in the aortic-valve cases of the first group may be explained by the inferiority of the myocardial protection method used. In comparison with the other methods conventional coronary perfusion resulted in more myocardial injury.


Tuberculosis associated with HLA--B8, BfS in a Newfoundland community study. In three adjacent Newfoundland communities comprising some 1500 people, 589 people have been HLA typed. Forty-six of the typed people gave a history of previous clinical tuberculosis which required treatment. Fifty-six percent of the TB patients carried HLA B8 compared with 20% of the remainder of the population. This is a highly significant difference (P less than 0.01). In each community the frequency of B8 as an epidemiological marker correlated with the incidence of tuberculosis. B8 is associated with TB in ths study with a relative risk of 5.2 which compares with combined relative risks in the literature for coeliac disease and Addison's disease of 9.5 and 6.4, respectively, and which is greater than the risks for all the other B8-related diseases. The factor B allele, Bf S, was found on all the B8 haplotypes, but the overall Bf gene frequencies in tuberculosis patients did not deviate from expected values.


HLA--Bw54 (Bw22-J, J-1) antigen in juvenile onset diabetes mellitus in Japan. HLA--B8 and/or Bw15, associated with juvenile onset insulin-dependent diabetes mellitus (JDM) in Caucasians, have a very low frequency in the Japanese population. Thus, we were interested in investigating the association between JDM and HLA antigen in a Japanese population. Eighty-nine patients with JDM and 128 unrelated random controls were HLA-typed by the microlymphocytotoxicity test. The data revealed a significant, positive association between this type of diabetes mellitus and HLA--Bw54 (Bw22-J, J-1) antigen (Japanese-specific split antigen of HLA--Bw22).


HLA--D typing in 72 psoriasis vulgaris patients: distribution of seven HLA--D alleles. The phenotype distribution of seven HLA--D alleles among 72 unrelated Psoriasis vulgaris patients was investigated. Statistically significant deviation from the antigen frequency in healthy donors was found for a new HLA--D allele, locally designated EI, with a relative risk value of 5.97. This observation indicates that Psoriasis vulgaris belongs to the group of diseases with associations to HLA--B as well as HLA--D alleles.


HLA--B27 homozygosity in ankylosing spondylitis: relationship to risk and severity. The observed frequency of apparent homozygotes for HLA--B27 (15.5%) was significantly greater than the estimated expected frequency (4.2%) among 58 B27-positive Caucasian patients with ankylosing spondylitis (AS) (P less than 0.0005). Search of the literature uncovered four other studies in each of which the frequency of apparent homozygotes was shown by our analysis to be greater than expected. These analyses indicated that B27 homozygotes are more susceptible to developing AS than are B27 heterozygotes. Comparison of the clinical features of AS showed no differences between heterozygotes and apparent homozygotes except for a higher frequency of involvement of peripheral joints in the latter group.


Anti-H-2Dd antibodies cross-react with HLA--A11 and Aw31. Significant correlation was found between the cytotoxicity scoring grade (CSG) of an alloimmune mouse anti--H--2Dd serum with the presence of HLA--A11 and HLA--Aw31 on human lymphocytes. The finding shows a new type of H--2/HLA cross-reactivity and a hitherto unknown relationship (XENO-CREG) between two HLA antigens.


Idiopathic hemochromatosis: linkage with HLA. Forty-eight unrelated patients with idiopathic hemochromatosis were found to have a significantly higher frequency of three HLA antigens (A3, B7 and B14) than 591 healthy controls. A significant association between HLA haplotypes and disease segregations was demonstrated in 14 family studies. A recessive inheritance of a strongly A3-linked disease gene responsible for abnormal iron stores in the heterozygote state is postulated. The lod score value (4.415 for theta = 0.025) is compatible with this hypothesis. However, the excess of HLA-identical pairs of affected sibs does not exclude the possibility of a pseudo-recessiveness due to two codominant genes both HLA-linked. For the first time, a means of screening for high risk subjects is available and therefore offers the possibility of a preventive approach.


HLA association studies in black sarcoidosis patients. The frequencies of HLA antigens were determined in 32 black sarcoidosis patients and in 89 normal black controls. Aw23 was found in 23.6% of controls as compared with a lower frequency (6.2%) in patients (P = 0.06). No other associations were found.


The major histocompatibility complex of chimpanzees: identification of several new antigens controlled by the A and B loci of ChLa. The serology and genetics of 17 serologically defined tissue antigens of chimpanzees is described. Analysis of their distribution in 200 unrelated chimpanzees and their segregation in a large number of chimp families suggests that 14 of the antigens are controlled by two closely linked loci: seven by the A and seven by the B locus of ChLA. Typing of chimpanzees with human alloantisera revealed that several of those A and B locus antigens of ChLA are the chimp's serological counterparts of A and B locus antigens of the human HLA system, respectively. One of the newly discovered chimp antigens may be defined by a "third series" of ChLA, most likely the chimp's analogue of the human HLA-C series. The probable existence of a ChLA-linked D locus of chimpanzees and similarities between D-locus and Ia-locus (DRw) antigens of chimpanzee and man, are also briefly discussed.


HLA in systemic lupus erythematosus: influence on severity. Forty-four patients with systemic lupus erythematosus (SLE) were classified as mild or more severe on the basis of renal biopsy changes and the degree of proteinuria. The HLA phenotype A2 plus B7 was associated with the mild cases, while A1 plus B8 was associated with more severe disease. These findings suggest that immunogenetic factors are important in determining the severity of SLE and that combinations of HLA-A and -B locus antigens may be significant in HLA disease associations.


Individual mice of one inbred strain produce anti-H-2 and anti-HLA antibodies of different specificities. During the course of a routine H-2 alloimmunization, individual mice within a group of inbred animals produced anti-MHS antibodies of differing specificities. These different antibody populations were directed against various but probably cross-reacting components of complex HLA and H-2 gene products.


Fragmentation of human albumin with proteolytic enzymes and its antigenicity with special reference to human-specificity. Human albumin prepared by the trichloroacetic acid method was treated with bromelin, ficin, papain, pronase or trypsin. Pronase- or trypsin-treated albumin showed four fragments on polyacrylamide disc electrophoresis. When rabbit antiserum to pronase-treated albumin was adsorbed with monkey albumin, antibody with human specificity was completely abolished, whereas anti-albumin serum adsorbed with pronase-treated albumin retained the antibody to human albumin. It was considered that antigenic site with human specificity in albumin structure was inactivated by pronase.


Pathology of malignant nephrosclerosis with special reference to the difference between histologic manifestations of pure and exacerbated forms. Fourteen autopsied cases of malignant nephrosclerosis were classified into 6 of pure form in which syndrome of malignant hypertension developed from the beginning of the disease, and 8 of exacerbated form with appearance of the syndrome in the course of essential hypertension. Pathohistological study of these cases elucidated the differences in histologic manifestations between pure and exacerbated forms of malignant nephrosclerosis as to which little had been known as yet. In the pure form arterioles and small arteries characteristically demonstrated acute or recent lesions such as fibrinoid necrosis and hemorrhage into intima, and intimal cellular hyperplasia of somewhat longer duration, whereas in the exacerbated form coexistence of vascular lesions of various intensities and durations, acute (fibrinoid necrosis and hemorrhage), intermediate (intimal cellular hyperplasia) to chronic (sclerosis and lamellar elastosis), and superposition of more recent vascular lesions on more advanced or older ones were noted. Superposition of vascular alterations was interpreted to be not necessarily specific for exacerbated form but histologic manifestation of recurrence which is liable to be the case more frequently in exacerbated form than in pure form in the longer course of essential hypertension or of malignant hypertension. Some other related problems were also considered and discussed.


Risk of systemic infections associated with umbilical vessel catheterization. The purpose of the present study is to determine the risk of infections associated with umbilical vessel catheterization. During a period of recent four years, 97 catheters were inserted into the umbilical vessels of 94 newborn infants in a newborn nursery. Thirty percent of the catheter tips were colonized upon removal with pathogens (11%) and contaminants. The rate of catheter colonization was not dependent on sex, gestational age, birth weight and duration of catheterization. Bacteria were isolated from blood specimen drawn via the catheter upon removal in one patient, but blood sample from peripheral artery and catheter tip yielded no organisms in this patient. One patient (1%) was found to be septicemic while the catheter was in place. Culture of the catheter tip and blood drawn via the catheter proved unreliable in the diagnosis of subsequent systemic infection. Judicious surveillance for systemic infection by peripheral blood culture is necessary.


Elevated plasma renin activity in patients with acute pyelonephritis. Thirty-three patients with acute pyelonephritis were studied with regard to the changes in plasma renin activity (PRA) along the clinical course of the disease. 1) Abnormally high PRA was found in 64% of patients in the active stage of acute pyelonephritis; they showed a decrease in urinary output of sodium, a reduction in creatinine clearance, and high indices of inflammatory activity. 2) The changes of PRA in the course of acute pyelonephritis were negatively correlated to the urinary sodium excretion and creatinine clearance, but positively to the activity of inflammation, serum sodium concentration and the number of E. coli in the urine. PRA returned to normal with the improvement of pyelonephritis. 3) Concerning the mechanism of hyperreninemia in the active stage of the disease, the following three factors may be considered; renal ischemia, negative sodium balance in the body, and inflammation. Of these, the negative sodium balance seems to be the most important. The patients could not take enough foods to maintain their energy and sodium balance because of fever and pain. 4) The significance of resting PRA in acute pyelonephritis might be to reflect the sodium status in the body, but not to be related to hypertension.


Alterations in surface glycoproteins and level of sialyltransferase activity of human embryo kidney cells infected with oncogenic adenovirus type 12. Human embryo kidney (HEK) cells infected with adenovirus type 12 and its cytocidal mutants (Cyt) synthesized different glycoproteins respectively on the cell surface at the early stage of infection. Furthermore, a less and a highly tumorigenic Cyt mutants synthesized different glycoproteins. The level of sialyltransferase activity in the microsomes of HEK cells was increased when cells were infected with adenovirus type 12. It was confirmed that there was a positive correlation between the sialyltransferase activity in the microsomes and tumorigenicity.


Immediate changes of the electroencephalograms after intravenous injection of clonazepam and their relation to its effect on clinical fits in children with minor seizures. Immediate EEG changes after intravenous administration of clonazepam and a correlation between the EEG changes and the effect of oral administration of the drug were studied in 21 children with minor seizures whose interictal EEG showed a paroxysmal abnormality. In 13 cases of infantile spasms whose EEG showed hypasrhythmia, paroxysmal discharges were completely or remarkably suppressed in 4 cases, partially suppressed in 3 cases, but not improved in 6 cases. Suppression bursts pattern was less improved. In 5 cases of Lennox syndrome, paroxysmal discharges were markedly improved in 3 cases. In a case of petit mal absence, parxoxysmal discharges were completely suppressed. In all 5 cases whose EEGs were completely improved, paroxysmal discharges reappeared 7 to 30 min after the intravenous injection. In 2 out of the 5 cases, paroxysmal discharges became severer at reappearance than before the injection. Among 12 cases whose EEG showed an improvement after the intravenous injection, their clinical seizures were improved in 9 cases, but the clinical effect was mostly transient. In the majority of the cases whose EEGs were not improved, no clinical effect was observed. There was a highly significant correlation between immediate EEG changes and clinical effect of clonazepam (p less than 0.02 by the chi-square test).


Autopsy findings in a case of acute paraquat poisoning with extensive cerebral purpura. An autopsy case of paraquat poisoning in an adult male died on the 6th day of intoxication was presented. Histological and electron microscopic observations demonstrated interstitial pneumonia with distinct interstitial fibrosis and the initial stage of alveolar fibrosis with coexisting edema and hyaline membrane formation. Striking hemorrhagic leukoencephalopathy, i.e. 'purpura cerebri,' was noted throughout the central nervous system involving almost exclusively the white matter. It consisted of focal hemorrhages of various stages accompanied by demyelinating processes of various extent. Globular and/or amorphous proteinaceous materials of uncertain nature were demonstrated in the vascular lumina throughout the brain.


Effect of anticonvulsant therapy on serum 25-hydroxyvitamin D level. Serum 25-hydroxyvitamin D levels in young patients receiving anticonvulsants were assayed. They had neither retardation of physical and psychomotor development nor malnutrition. The patients treated with phenobarbital alone revealed rather high levels of serum 25-hydroxyvitamin D during 2 months after institution of the therapy, then they gradually returned to the normal level by the end of 3 to 5 months and thereafter decreased further, while a marked decrease of serum 25-hydroxyvitamin D levels was observed in patients receiving combined anticonvulsant (phenobarbital, diphenylhydantoin and others) therapy even during 1 to 2 months after initiation of the treatment. Our results suggest that the patients who have combined anticonvulsant therapy will have more tendency to suffer from osteomalacia than those who have phenobarbital alone.


Inhibition of the electrical and mechanical activities of the intestinal smooth muscle by pentagastrin. Spontaneous electrical activity of the intestine smooth muscle of the cat consisted of slow waves and spikes. The spike activity and the slow wave generation were inhibited by pentagastrin and tetragastrin. Phasic contraction corresponding with the electrical activity was also abolished by pentagastrin and tetragastrin. Adrenaline showed the inhibitory action on the spike activity and phasic contraction, but slow waves persisted against adrenaline. Propranolol depressed this inhibitory action produced by adrenaline, while it did not block the inhibitory action by pentagastrin. The inhibitory effect of pentagastrin was not influenced by caffeine or theophylline. Imidazole depressed slightly the inhibitory action of pentagastrin. Verapamil inhibited the spike activity. Additional application of pentagastrin after verapamil produced further inhibition of both slow wave generation and phasic contraction. These results suggest that the inhibitory action produced by pentagastrin on the electrical and mechanical activities is directly on the smooth muscle cell membrane mediated through a mechanism other than via beta-receptors. It is also suggested that the primary action of pentagastrin is to inhibit the generation of slow waves of the intestinal smooth muscle.


Serum vitamin B12 levels of patients with rheumatoid arthritis. To elucidate the role of vitamin B12 in the formation of anemia in patients with rheumatoid arthritis serum B12 levels were investigated in patients with rheumatoid arthritis, patients with osteoarthritis and normal subject. Serum B12 level in patients with rheumatoid arthritis was significantly higher than that in patients with osteoarthritis and normal subjects. Serum B12 level increased in proportion to Steinbrocker's stages, and was related more closely to hemoglobin concentration than to erythrocyte count and had a high correlation with alpha1- and alpha2-globulin.


Absorption of 5-fluorouracil through gastric epithelium. We examined the amount of 5-Fu absorbed through the gastric epithelium after oral administration in both dogs and patients with bladder tumors. The concentrations of 5-Fu in the serum, bladder wall, tumor mass and regional lymphnodes were sufficiently high to suppress the growth of tumor cells.


The comparative short-term mammalian toxicology of phenarsazine oxide and phenoxarsine oxide. Phenoxarsine oxide (PXO) and phenarsazine oxide (PZO) are organic arsenicals used as industrial biocides. The acute LD50 (in mg kg-1) for PZO was 83 (rat) and 77 (guinea pig) and for PXO 40 (rat) and 24 (guinea pig). PXO was more irritant to the gastrointestinal tract. Liver pathology did not occur in PZO-guinea pigs, but PZO was more hepatotoxic than PXO in rats. The acute inhalation L (ct)50 values were 12830 mg min m-3 for PXO and 13650 mg min m-3 for PZO in guinea pigs; death was due to asphyxia. The guinea pig acute L(ct)50 given as a divided dose over 30 days to guinea pigs and rats did not produce toxic signs, but mononuclear cell infiltration of the portal tracts occurred. PXO and PZO were found to be primary skin and eye irritants; PXO produced more severe effects. The no-effect concentration for keratitis with solutions was 0.25% PZO and 0.1% PXO; both compounds caused concentration dependant transient increases in intraocular pressure, the proportionate increases being significantly greater with PXO. Thus, although PXO and PZO are equitoxic by acute inhalation, PXO is more toxic orally and more irritant to the skin, eye and gastrointestinal tract but PZO is more hepatotoxic.


A short term peroral study of the food colour, Ponceau 6R in pigs. Ponceau 6R (the tetrasodium salt of 1-(4-sulpho-1-naphthyl-azo)-2-naphthol-3,6,8-trisulphonic acid) was fed to pigs at dietary levels of 0 (control), 100, 500 and 1500 mg/kg body wt./day for 102--105 days. In the 1500-mg group a decrease in weight gain and food utilization was seen, and 1 pig died with a hemolytic anaemia. Dose dependent discolouration was seen of the connective tissue in the groups given 1500 and 500 mg/kg body wt. For this effect the no-effect-level was 100 mg Ponceau 6R/kg body wt. per day.


Treatment and prothrombin responses during warfarin toxicosis in rats and mice. Efficacy of whole blood, vitamin K-3 and vitamin K-1 treatment during warfarin feeding was investigated in rats and mice. Prolonged prothrombin times were observed in mice after 9--12 h of warfarin feeding. Prothrombin times greater than 300 sec were consistently observed in mice on continuous warfarin feeding and receiving whole blood or vitamin K-3 treatment. Withdrawal of warfarin resulted in normal prothrombin times after 96 h in mice receiving no treatment, 48--72 h on whole blood and 48 h in mice treated with 72 mg vitamin K-3/kg of body wt./day. Marked protection against warfarin induced hypoprothrombinemia and mortality occurred in mice treated with 5 mg vitamin K-1/kg/day. Treatment with 72 mg vitamin K-1/kg/day resulted in rapid alleviation of hypoprothrombinemia and prolonged protection against warfarin toxicosis. Intraperitoneal administration of 72 mg/kg/day of vitamin K-1 or vitamin K-3 were not toxic to mice. Mortality was consistently higher in mice given warfarin continually and in those receiving the greater number of treatments. Frequent handling appears to aggrevate warfarin toxicosis.


Methods for precisely trimming block faces for ultramicrotomy. Two devices are described to aid in trimming block faces of embedded tissue for ultramicrotomy. The first, a reticle to fit the ocular of a stereomicroscope, can be manufactured by the ultramicrotomist and is designed to outline the edges of the block face so that it can be trimmed to a standard size and shape with the area of interest centered in it. The second, a rectangular "trimalign" block mounted in the knife holder of the ultramicrotome, is, with the block face, aligned to the plane of sectioning, and aids in retrimming the top and bottom edges of the block face. This is the simplest trimming device yet described and the first which will, from any sort of embedded material, produce a block face with parallel top and bottom edges even if the block face is not perpendicular to the axis of the specimen holder. If the edge of the diamond knife used for sectioning is parallel to the axis of rotation of the knife holder, the block face has also been automatically aligned to the kinfe as a consequence of this aligning and trimming procedure. As a result, sectioning can begin immediately without further adjustments.


Carotenoid and pterin pigment localization in fish chromatophores. The classical sulfuric acid method for the histochemical detection of carotenoids has been adapted to give a reliable cytological localization of these compounds in fish chromatophores. This procedure consists mainly in fixing skin fragments in glutaraldehyde and dehydrating in a 50% solution of glycerin followed by exposure to air. It is essential that the preparation permit direct contact of the sulfuric acid with the pigment cells. Under these conditions, carotenoid containing cells stain green or blue. When associated with the extraction of the carotenoids by acetone, the procedure permits the distinction between pterin and carotenoid in fish chromatophores.


[Causes and differences of recurrences in lymphogranulomatosis following primary radiation therapy (author's transl)]. A retrospectively explored group consisting of 62 patients with lymphogranulomatosis Stage I to III, who had undergone primary radiation therapy, revealed recurrences in 23 cases (37%). (he recurrences are more frequent in unfavorable histological subclassifications and in advanced stages. 76% appear during the first two years, almost 90% of them in the region of lymphatic chains, preferably in the cervical or mediastinal region, in the hili and the contiguous lung. 75% of the recurrences are attributed to insufficient dosage. Typical recurrences, therefore, develop at the border of irradiation fields and are due to an incorrect calculation of the dose when applicating extended fields and individually shaped lead blocks. Other 25% are found in nonirradiated lymphatic areas.


[Experimental demonstration of occult blood in the stool after sole abdominal irradiation or chemotherapy or a combination of both (author's transl)]. Using Heglostix-Ames test strips, it was possible with normally fed animals, to furnish evidence of occult blood in spontaneous droppings of mice. The mice were exposed either to partial irradiation encompassing the abdomen and using different exit doses between 100 R and 1100 R, or were injected intramuscularly with doses between 120 and 900 mg/kg Endoxan or, instead, 110 and 840 mg/kg Proreside. The moment of the beginning and also the duration of positive reactions could be proved to depend on the dose. In simultaneous as well as alternating radiation- and chemotherapy evidence was given of cumulation effects. Reactions were always negative in nontreated controls.


[Measurement of the radiation load to bladder and rectum in gynecological brachytherapy with a mobile radiation source (author's transl)]. Measurement of the maximal radiation dose in bladder and rectum in intravaginal radiation therapy using a mobile source (afterloading technique) is only possible integrating with a multichannel dosimeter. For this purpose we apply a 5 mm plastic probe being equipped with five semiconductor dosimeter crystals; the latter are fixed within the probe at equidistances of 2 cm from each other. The dose maximum can be obtained by graphic interpolation using the five different values measured. The dosimeter employed is read immediately and permits observation of the doses delivered to the bladder and rectum during radiation therapy.


[Influence of serum content of the culture medium upon growth and microtubule-microfilament system of Ehrlich ascites tumor cells in monolayer culture (author's transl)]. Withdrawal of serum from the medium of monolayer cultures of the Ehrlich ascites tumor within their phase of exponential growth resulted in a nearly complete inhibition of growth during a 25-hour incubation, but cells were not dying off. In the course of this serum-free incubation no significant alteration of the cellular glycolytic rate was seen. Addition of serum to cultures which previously had been incubated without serum led to a resumption of cell proliferation. The microtubule-microfilament system of cells cultivated without serum as compared to cells cultured in presence of serum was significantly reduced concerning the number and length of microtubules as well as the diffuse, bunchy or reticular arrangement of the microfilaments. The lesser development of the microtubule-microfilament system corresponds well to the reduced pinocytosis activity (ascertained by former studies) which is caused by a lack of serum. The present experiments altogether give support to the concept that serum factors as exogenous stimuli are necessary not only for cell growth but also for the probably closely interrelated development of the microtubule-microfilament system needed e.g. for the organization of cell surface structures and activities.


[Study of membrane potentials in cells of human squamous cell carcinoma during exposition to ionizing radiation (author's transl)]. The individual membrane potentials have been studied in just excised cells of human squamous cell carcinoma (n = 16). The physiological level of the membrane potential amounted to 10.3 mV. The cellular tissue was excised at the region of the rectum. In another experimental group (n = 16), the tumorous tissue was exposed to ionizing radiation by Co-60, and the decreasing membrane potential of individual cells was recorded. The findings are discussed in view of experimental investigation technique for irradiated cells.


[Limits of exactness in dosing and sources of error with routine techniques in Co-60 teletherapy (author's transl)]. The routine techniques of dosing in Co-60 teletherapy are critically examined in view of radiobiological requirements. A comparison was made between data from the manufacturer and our own measurement results, and also between different conceptions of the reference depth for base measuring.


[Homogenization of the dose to the target volume in case of irregular body-surface by means of compensation (author's transl)]. Irregular body-surface contours in the treatment part of high-energetic photon fields are producing an inhomogeneous dose distribution within the target volume. Homogenization of the dose is necessary in order to avoid over- or underdosage. A technique of making compensators is described. These are individual compensation filters substituting tissue layers which are lacking, they are correctly scaled down and optimally corrected in view of absorption and scattering according to the actual irradiation conditions. A simple mechanical device makes possible the production of a mould for heavy-metal compensators immediately in the course of scanning of the body-surface. A universal semi-automatic version of this method is appropriate to clinical practice; it records optically, and therefore without contact and quickly, all body-contours desired. By means of the image of moiré contour-lines thus obtained can be made the mould for the compensator in a second operation using an electronically controlled copy-milling machine.


Proposal for a practical dose calculation scheme for neutron irradiations. Dose calculations for neutron therapy irradiations should be based on the dosimetrically best accessible parameters "total absorbed Dose Dt" and "gamma ray absorbed dose Dgamma". By adequate standardization it should be possible, that only one single reference parameter contains all deviations of calibration, while a table of relative factors, only once to be determined, gives all long-term constant dependencies for all field sizes and phantom depths. A standardization is proposed for the irradiation technique with fixed fields at a constant focus-skin distance, giving rise to especially simple equations for the absorbed doses Dt and Dgamma. It is as well easy to get by these doses and mean relative biological effectivenesses rn for neutrons and rgamma for gamma rays the "total effective absorbed dose De", being an opportune quantity for the biologically weighted absorbed dose. The practical application of equations and tables is demonstrated for an opposing field irradiation as example. Adequately standardized "reference tissue air ratios" and corresponding equations are given for isocentric fixed or rotating beam irradiations and used for the example of a dose calculation within a phantom at the isocentre.


[Possibilities of dose reduction in extramammographic xeroradiography (author's transl)]. The soft radiation within the inhomogeneous spectrum of bremsstrahlung, being unable to penetrate the object and not contributing to the build-up of the xeroradiographic picture, only being the cause of additional radiation exposure, is considerably reduced by means of added filters, copper filters in particular. This effect can be demonstrated qualitatively by means of the recorded X-ray spectra. In comparison with the standard record it is possible by hardening of the radiation to reduce the surface dose by a factor 8 at a tube voltage of 120 kV, and by a factor 10 at a tube voltage of 130 to 150 kV if a 0.5 mm thick copper filter is added. The surface dose measured with high-filtration in xeroradiography is within the same order of magnitude as the dose obtained with a conventional film-foil-combination (Cronex 4/Cawo high-definition foil, 75 kV, automatic exposure control, time of development 90 s) and amounts to circa 0.1 R. A loss of information in so-called high-filtration xerograms as compared to conventional xerograms could be excluded, at least with regard to the test object. The practicability of this method e.g. for angiography, particularly angiographic exploration of the limbs, needs further clinical examination.


Influence of steroid aerosol treatments on the clearance of inhaled gold particles. Female Long Evans rats were used to test the hypothesis that in haled triamcinolone acetonide accelerates the rate of clearance of particles from the lung. Three groups of animals inhaled a radioactive gold aerosol, which functioned as a tracer of respiratory tract clearance, and then were subjected to various inhalation treatments. The group treated with triamcinolone acetonide aerosol showed a significant acceleration in the rate of early clearance, but the total amount of tracer particles cleared in the first day was not significantly increased. Inhaled triamcinolone acetonide appears to accelerate the translocation of foriegn particles from small airways to larger ones, but stimulation of clearance does not appear to be a large effect.


The effect of the administration of spironolactone on the concentration of plasma testosterone, estradiol and cortisol in male dogs (1). The effect of the administration of spironolactone, deacetylspironolactone, aldadiene or soldactone on the concentration of plasma testosterone, estradiol, and cortisol was examined in male dogs. Decreases of 60 to 75% in plasma testosterone and estrodiol occur only at high doses (100 mg/kg) of spironolactone or deacetylspironolactone but not at low doses of spironolactone (5 to 10 mg/kg); they occur concomitantly with similar decreases of androgen formation by the testis. No decreases were detected with aldadiene or soldactone. Treatment of dogs with spironolactone (100 mg/kg) also lowered by 50 to 65% the concentration of cortisol in adrenal venous plasma.


Solubilization and partial purification of steroid sulfatase of human placenta. Steroid sulfatase of human placenta has been solubilized by treatment of the microsomal fraction with an amphoteric surface active agent, Miranol H2M and ultrasound. Criteria of solubility include non-sedimentation of the activity following centrifugation at 160,000 x g, its retention on Sepharose 6B and a single peak of activity after polyacrylamide gel electrophoresis. Enzyme activity was located in the same gel fractions for the two substrates tested; cholesterol sulfate and dehydroisoandrosterone sulfate. The addition of dithiothreitol was found necessary to maintain the stability of the enzyme indicating the presence of sulfhydryl groups in the molecule. A molecular weight of approximately 330,000 has been estimated from the elution volume of the enzyme system on a column of Sepharose 6B. It is believed that this protein represents a sulfatase enzyme complex composed of subunits with different specificities. From kinetic studies, a Km of 6.2 x 10(-5)M for the cleavage of dehydroisoandrosterone sulfate and a Km of 2 x 10(-6)M for the cleavage of cholesterol sulfate have been calculated.


Bile acid and cholesterol excretion in the pregnant guinea pig: studies on the hypercholesterolemia of pregnancy. The relationship of bile acid and cholesterol excretion to changes in plasma cholesterol during pregnancy were studied in guinea pigs. Plasma cholesterol level increased in the first trimester of pregnancy, reached to a peak during the second trimester and decreased in the third trimester reaching the lowest level at one week prior to parturition. Cholesterol level returned to the control level after parturition. Plasma triglyceride level followed a similar trend attaining peak values at second trimester and gradually returned to the control level at the third trimester of pregnancy. Bile acid and total sterol excretion were significantly higher in guinea pigs during the last phase of pregnanccy while they remained unchanged during early stage of pregnancy.


Effect of taurocholate on the conversion of 3alpha, 7alpha, 12alpha-trihydroxy-5beta-cholestan-26-oic acid into cholic acid. To determine if the conversion of the intermediate, 3alpha, 7alpha, 12alpha-trihydroxy-5beta-cholestan-26-oic acid (THCA), into cholic acid is influenced by taurocholate, two rats were infused intravenously with [3H] THCA until they reached a steady state. Taurocholate was then added and infused at a rate of 1 mumole/min/rat for 48 hours. The percentage of [3H] THCA recovered in the bile did not increase indicating that taurocholate does not suppress the conversion of THCA into cholic acid.


Minor and trace sterols in marine invertebrates V. Isolation, structure elucidation and synthesis of 3beta-hydroxy-26,27-bisnorcholest-5-en-24-one from the sponge Psammaplysilla purpurea. The free sterol mixture of the sponge Psammaplysilla purpurea was shown to contain aplysterol as the major constituent. In addition to other sterols such as 5,7-cholestadien-3beta-ol, cholesterol, 5alpha-cholestan-3beta-ol, 24epsilon-methylcholesta-5,22-dien-3beta-ol, 24epsilon--methylcholesterol, 24epsilon-ethylcholesta-5,22-dien-3beta-ol and 24,28-dehydroaplysterol, a new minor sterol was isolated and shown by spectral analysis as well as partial synthesis to be 3beta-hydroxy-26,27-bisnorcholest-5-en-24-one. The sterol mixture contains no other short side chain or 24-keto sterols except for small amounts of 3beta-hydroxypregn-5-en-20-one and 3beta-hydroxy-5alpha-pregnan-20-one.


The effect of progesterone analogues, naturally occurring steroids, and contraceptive progestins on hypothalamic and anterior pituitary delta4-steroid (progesterone) 5alpha-reductase. The effects of a number of steroids on the conversion of progesterone to 5alpha-dihydroprogesterone by hypothalamic and pituitary progesterone 5alpha-reductase have been investigated. Using enzyme preparations from female rats and 3H-progesterone as substrate, 5alpha-reduced products (5alpha-dihydroprogesterone and 3alpha-hydroxy-5alpha-pregnan-20-one) were analyzed by reverse isotopic dilution analysis. The amount of total 5alpha-reduced products formed was compared in the presence and absence of the test steroid. Derivatives lacking the delta4 and/or the 3-keto moiety were without effect. Corticosterone had no effect. 16beta-Methylprogesterone inhibited progesterone 5alpha-reduction in both tissues by at least 65%, while the 2alpha-, 6alpha-, and 7alpha-methylated derivatives had lesser effects. 3-Oxo-4-pregnene-20beta-carboxaldehyde and 21-fluoroprogesterone were potent inhibitors. 17-Hydroxyprogesterone was a competitive inhibitor (substrate) with Ki's of 0.27 micrometer (pituitary) and 0.29 micrometer (hypothalamus). Medroxyprogesterone exerted little inhibitory effect. Of the 19-nor-steroids examined, only norethindrone appreciably inhibited the 5alpha-reduction. These results suggest that some natural delta4-3-ketosteroids can modify enzymatic activity. Also, inhibitory analogues may be useful for studies on the role of this 5alpha-reduction of progesterone.


Stimulation by estradiol benzoate of hepatic beta-hydroxy-beta-methylglutaryl coenzyme a reductase in normal and ovariectomized rats. The effect of estradiol benzoate on beta-hydroxy-beta-methylglutaryl coenzyme A reductase activity and plasma cholesterol level has been studied in normal and ovariectomized rats. Daily administration of estradiol benzoate (25 microgram and 100 microgram) for 21 days resulted in a 1.7 and 2.5 fold increase in reductase activity in normal and ovariectomized rats, respectively. Plasma cholesterol levels were increased by 18% in normal rats and 38% in ovariectomized rats. The observed changes for the two treatment groups were similar even though the body weight for these groups were significantly different.


The suppressive effect of the catatoxic steroid, pregnenolone-16alpha-carbonitrile, on liver microsomal cholesterol-7alpha-hydroxlyase. The effect of the catatoxic steroid, 3beta-hydroxy-20-oxo-5-pregnene-16alpha-carbonitrile [pregnenolone-16alpha-carbonitrile (PCN)] on hepatic microsomal cholesterol-7alpha-hydroxylase, the probable rate-limiting enzyme of bile acide biosynthesis, has been studied. Short term administration (3 days) of PCN in the diet of rats resulted in a significant decrease in the liver microsomal cholesterol-7alpha-hydroxylase activity, in contrast to a marked stimulation of microsomal cytochrome P-450 and ethylmorphine demethylase activity. PCN significantly depressed the cholesterol-7alpha-hydroxylase activity in the livers of rats with elevated levels of the enzyme produced by cholestyramine feeding. The results indicate the presence of separate control mechanisms in the regualtion of bile acid synthesis and drug metabolism.


Estimating the effects of contraceptive use on fertility: techniques and findings from the 1974 Philippine National Acceptor Survey. Survey data on contraceptive use-effectiveness and on the fertility of family planning acceptors can provide a useful basis for estimating the fertility effects of a family planning program. The 1974 Philippine National Acceptor Survey (NAS), a sample survey of nearly 3,000 family planning acceptors reported by clinics in 1970--72 and interviewed in 1974, provided data for such an evaluation of the Philippine family planning program. The program's effects on the fertility of acceptors were estimated utilizing a series of analytical techniques, which are described in this article. Data from the NAS on continuation, pregnancy, and fertility following acceptance, as well as estimates of fertility decline associated with acceptance and continuing use of contraception, are analyzed. Findings are presented for acceptors of the four major program methods--pills, and the IUD, rhythm, and condoms. An appendix presents special procedures employed in estimating fertility effects.


Improving management through evaluation: techniques and strategies for family planning programs. Evaluation aimed at providing managers with the information needed for day-to-day decision making has generally received less emphasis in family planning programs than evaluation of long-term programmatic and demographic achievements. A series of evaluation techniques are reviewed that are applicable to the key management areas of operational target setting, administrative monitoring, measuring interim achievements, and cost concerns. Barriers to such evaluation inherent in the training of and relationship between managers and evaluators are reviewed, and means to ease the barriers are proposed.


Correlates of contraceptive behavior among unmarried U.S. college students. The contraceptive behavior of 213 sexually active never-married U.S. college students was examined using multiple regression analyses. The type of relationship--casual or steady--was a major determinant of contraceptive use: 77 percent of the respondents involved in steady relationships reported using condoms or the pill, compared with 58 percent of the respondents involved in casual relationships. Frequency of intercourse was the best predictor of contraceptive method used within steady relationships. Several variables emerged as predictors of contraceptive method used within casual relationships, including method used at first coital experience, age, and frequency of intercourse. Situational and background factors were found to have an important impact on adolescent contraceptive behavior and to warrant further research.


The certification of suicide in eleven western states: an inquiry into the validity of reported suicide rates. From Durkheim's time to the present social researchers interested in the problem of suicide have relied upon officially reported rates of suicide to develop and test their theories. Despite the fact that the validity of any theory rests upon the accuracy of its underlying data, the relative accuracy of reported suicide rates have rarely been questioned or systematically evaluated. This paper investigates the process of death certification as practiced by a sample of 191 coroners in 11 western states. Findings indicate extensive variation in the backgrounds, professional resources, operating procedures, and governing statutes of coroners and coroners' offices and in policies concerning the use of the suicide mode. Since the coroner is generally charged with the official responsibility for certifying the mode of death when unnatural mode is suspect, the extent of variation found here calls into question the validity and comparability of reported suicide rates.


The confrontation with death and the renewal of life. Several writers have argued that a majority of suicidal acts are "gambles with death". A distinction is made between cases where the gamble with death is merely consequential (i.e., arising from ignorance, apathy, indifference) and cases where it is the very essence of the act. Typically in these latter cases others are excluded from possible intervention. The individual is thus playing a game of "pure" chance. Death is summoned and challenged in order that life may continue. It is argued, from an interactionist perspective, that such acts are desperate efforts to confirm existance in situations of extreme uncertainty and represent a distinct form of what Shneidman has called "egotic" suicide.


Suicide: the psychosocial dimension.

Suicide: the psychosocial dimension. This paper explores the relationships among culture, character, and suicide. It draws on the author's research in Scandinavia and his studies of suicide among United States urban blacks and college students. The differences in motivation and significance of suicide in Sweden and Denmark are illustrated. The United States is an amalgam of subcultures which must be studied separately to identify the psychosocial determinants of behavior. The varying rates and motivations of suicide in different cultures and subcultures, the differences between men and women, between young and old, differences in ways of coping with love and loss, life and death make clear that suicide is part of a culture's possibilities. The varying psychodynamic ways in which the suicidal individual in differing cultures and subcultures conceives of, uses and absorbs death also has much to tell us about how we live.


[DNA synthesis and mitotic division of myocytes of the ventricles, atria and conduction system of the heart during the myocardial development in mammals]. The degree of differentiation of various types of muscle and non-muscle cells that synthesize DNA in myocardia of mouse embryos and suckling rats was estimated by means of electron microscopic autoradiography with 3H-thymidine. No morphologically undifferentiated myoblasts were observed. DNA synthesizing capacity and mitotic activity are typical of numerous moderately differentiated myocytes in all myocardial compartments studied. As judged from proliferation kinetics studies, ventricular myocytes proliferate at embryonal stages and during the 1st postnatal week more actively than do atrial ones, specialized muscle cells from the conductive system replicating much less intensely as compared with both these kinds of myocytes. However, at the 2nd postnatal week, the withdrawal of myocytes from the mitotic cycle proceeds more rapidly in ventricles than in other heart compartments which results in a relatively more active proliferation of myocytes in atria and conductive system beginning from the end of the 2nd postnatal week. By the 17--18th days of the postnatal life, practically all the myocytes, irrespective of their topology, cease to proliferate. Nevertheless, even after this term, up to 0.1--0.5% of atrial and/or conductive system myocytes still go on entering periodically the mitotic cycle. The duration of S and G2 + 1/2 M periods is similar in both the ventricular and atrial myocytes of suckling rats. Probable causes and significance of the observed asynchrony of the myocyte proliferation rates in different heart compartments is discussed.


[Effect of an erythrocyte inhibitor on the in vitro incorporation of thymidine into the DNA of bone marrow cells]. The effect of an erythrocytic inhibitor obtained from patients with second polycythaemia, on the synthesis of DNA in bone marrow cells has been studied in vitro. The erythrocytic inhibitor was shown to have a specific effect. The decrease of DNA synthesis under erythraemia occurred with the dose of the inhibitor 2-3 times higher than with the dose applied in norm or under anemia. According to the results of gel-filtration and disc-electrophoresis, the inhibitor in question is a component of fraction II of polycythaemia erythrolysate with a low molecular weight. The electrophoresis mobility of this fraction in respect to albumin lies between 0.5 and 0.7. It is supposed that the inhibitor is a physiological regulator (chalone) of the erythron's cell proliferation.


[Repair of damage to cells in an SPEV culture after exposure to mitomycin C]. The action of mitomycin C on a porcine embryo kidney culture (in dose of 0.5-1.5 mkg/ml in the course of 24-72 hours) is accompanied by significant changes in the ultrastructure and morphology of cells. Moreover, mitomycin C sharply inhibits DNA synthesis, mitotic activity and much more weakly suppresses protein and RNA syntheses. After a prolonged (48 hours) washing of the antibiotics only the mitochondrial ultrastructure is restored in the fresh cultural medium. DNA synthesis and mitotic activity remain suppressed, while protein and RNA syntheses increase sharply, which leads to protein accumulation in cells, and to the enlargement of nuclei, nucleoli and cells. Such changed cells are unable to keep on living and perish.


[Changes in the mitotic activity of corneal epithelial cells under the influence of pyruvic acid]. 92 specimens of rat's corneal epithelium were studied to estimate the effect of pyruvic acid on cell division characteristics. 0.1 M solution of pyruvic acid decreases the mitotic activity of rat corneal epithelium, the portion of prophase increasing the number of metaphase decreasing. These results support a hypothesis on the possible role of low molecular acceptors in the cell division regulation "in vivo", and suggests the effect of pyruvic acid both during the period prior to cell division, and the prophase-metaphase stage.


[Procoagulant and fibrinolytic activity of fractions of a rat brain homogenate]. In all subcellular fractions the rat's brain homogenate active thromboplastin, activators and inhibitors of fibrinolysis were detected. Nuclear fraction contains factors II, VII, X, XIII. The mitochondrial fraction-factors II and VII, and postlysosomal supernatant demonstrated the presence of factor V of blood coagulation. The results obtained are of importance for the explanation of control mechanisms of blood coagulation and fibrinolysis.


[Karyologic study of transplantable cell lines. II. Comparative analysis of lines HEp-2, FL and RH]. A comparative karyologic analysis of three continuous cell lines of different origin (HEp-2, FL and RH) has shown them differing from each other both in the number of chromosomes, and in marker chromosomes. In cultures HEp-2, the modal class consists of cells possessing 58-59 chromosomes, cells in cultures Fl and RH have 60 and 66 chromosomes, resp. Marker chromosomes both similar and not similar, i.e. characteristic of a given cell line only were found in all the investigated cell lines. The data obtained do not exclude a possibility of contamination of studied continuous cell cultires with HeLa cell line.