Pathogenicity of equine herpesvirus: in vivo persistence in equine tissue macrophages of herpesviuus type 2 detected in monolayer macrophage cell culture. Equine macrophages from the mammary glands of a yearling filly and an 18-year-old barren nonlactatind mare formed cell monolayers in continuous cultures. There was absence of viral cytopathic effect (CPE) in early cell culture passages. The cells from the early cell culture passages having no CPE failed to show evidence of virus or viral antigen by electron microscopic and immunofluorescence studies. Foci of CPE first appeared in the monolayer cell cultures from the filly and the mare in the 3rd and the 4th serial passages respectively, and the CPE increased on subsequent serial passages. Equine herpesvirus type 2 (EHV 2) cultures showing CPE. The macrophage monolayer culture established from the mare produced CPE foci more consistently than did the culture from the filly, and they were more numerous. Conversely, the peripheral blood mononuclear cells from the filly on cocultivation with an equine embryo kidney monolayer cell culture produced more EHV 2 CPE foci than did those from the mare. This study indicated that tissue macrophages may be a site for latent and persistent herpesvirus infections in horses.


Effects of gastrin on emptying and composition of digesta of the omasum of sheep. Three adult sheep were prepared with a denervated pouch of fundus of the abomasum and a reentrant fistula system that connected the remaining proximal and distal portions of the abomasum. The proximal cannula of the reentrant system was close to the omasoabomasal orifice, allowing for easy collection of fluid leaving the omasum. Intravenous injection of 0.5, 1.0, or 2.0 microgram/kg/hr of synthetic human gastrin I caused a marked decrease in flow rate of fluid from the omasum. The concentration of particulate matter in the digesta was inversely related to rate of omasal outflow. An increase in acid output from the denervated abomasal pouch during gastrin injection indicated that the hormone was given at pharmacologically effective doses. Results indicate that gastrin has a modulating effect on the flow of ingesta through the ruminant forestomachs. Actual sites of action were not identified.


Efficacy of monensin against coccidiosis in lambs. Lambs fed monensin mixed in a complete fattening ration at concentrations of 5, 10, or 20 ppm were protected against death, impaired body weight gain, and diarrhea due to infections of Eimeria ninakohlyakimovae and E ahsata. Monensin given at the concentration of 10 ppm reduced oocyst passage and, at the concentration of 20 ppm, almost completely controlled oocyst passage. Protection was afforded by monensin given at the concentration of 5 ppm, although oocyst passage was excessive and body weight gains were suboptimal. Infected control lambs were severely affected, with mortality rate of 30% to 50% on days 14 to 18 and oocyst passage averaging 286,000,000 oocyst/lamb, Oocyst production peaks on days 12 to 15 and 21 to 27 correlated with the appearance of oocysts of E ninakohlyakimovae and E ahsata, respectively. Body weight gains and feed consumption of lambs fed monensin at the concentration of 10 or 20 ppm indicated that the drug was well tolerated at these dose levels and this route of administration. The compound was efficacious in Dorset and Suffolk X Hampshire lambs, and caused no problems when fed to pregnant ewes.


Studies on metabolism and concentrations of immunoglobulin G in the newly hatched turkey poult. Persistence of maternal IgG in the hatched turkey poult was studied using 125I-labeled egg yolk IgG injected at hatching. Determinations were made of the half-life of IgG in the total plasma pool, and results indicated half-life for IgG of 4.08 +/- 0.33 days. Elimination of the injected IgG (comparable with maternal IgG) was described as the percentage of the injected dose remaining in the plasma with 30.53%, 10.31%, and 3.48% of the injected dose at 7, 14, and 21 days, respectively, after injection.


Metabolism and passive transfer of immunoglobulins in the turkey hen. Aspects of the metabolism and passive transfer of radioactive 125I-labeled IgG, IgM, and IgA from the turkey hen to the egg were studied. The half-life of 125I-labeled IgG in plasma was calculated to be 5.91 +/- 0.81 days, and the time of maximal passage of radioactivity from hen into eggs was 6.5 +/- 1.3 days. The following IgG determinations were made: plasma concentration (8.54 +/- 1.2 mg/ml), total plasma pool (0.518 +/- 0.07 g/kg), total turnover rate (0.062 +/- 0.01 g/kg/day), or 11.92 +/- 0.01% of the plasma pool per day. The overall passage of IgG into sequentially laid eggs of individual hens was at a constant rate over an observation period of 46 days; loss to egg yolks accounts for less than 1% of total daily irreversible loss of IgG from the hen's body. The IgG concentrations in egg yolks assayed in 3 hens ranged from 72.1 +/- 6.7 to 104.5 +/- 6.9 mg/yolk, with significant (P less than or equal to 0.01) differences observed between birds not accounted for by differences in egg weights. The IgG was detectable in egg whites, but at a low concentration. The biological importance of egg white IgG is questionable. In 2 hens examined, 125I-labeled IgM had a half-life of 2.69 and 2.74 days, with fractional turnovers of 25.76% and 25.29% of the plasma pool/day. The IgM-associated radioactivity in egg material was considered unimportant in overall immunoglobulin transfer into eggs. In 2 hens examined, 125I-labeled IgA (biliary) had a half-life of 1.92 and 1.68 days, with fractional turnovers of 36.09% and 41.25% of the plasma pool per day. Like IgM, IgA-associated radioactivity in egg material was considered unimportant in overall immunoglobulin passage into eggs.


Life cycle of Mesocestoides corti in the dog (Canis familiaris). Ten Beagle pups were each inoculated per os with 2,000 tetrathyridia of Mesocestoides corti from mice. The dogs were necropsied at 5-day intervals and the small intestine of each dog was divided into 3 equidistant sections. Adult cestodes were counted and characterized morphologically. The M corti reproduced asexually in the Beagles by longitudinal splitting of the parent scolex, separation of a new individual, and subsequent regrowth of 2 additional suckers on both the parent and newly formed scolices. Five days after the tetrathyridia were given, evidence of parent scolex division was present. The ability of M corti to reproduce asexually in the definitive host enabled rapid proliferation of new organisms, with approximately 53,000 present 45 days after inoculation.


Electron microscopic observations on canine mixed mammary tumors, with special reference to cytoplasmic filamentous components. Three chief cell types were studied in 8 canine mixed mammary tumors--luminal epithelial cells, myoepithelial cells, and filament cells, the last being the "stellate" cells recognized by light microscopists. Most cytoplasmic filaments in the myoepithelial cells were 5 to 8 nm thick, whereas another type of filaments were scattered, 8 to 10 nm thick. Almost all cytoplasmic filaments in the filament cells were 8 to 10 nm thick. In the adenomatous parts of the tumors, myoepithelial cells were chiefly seen, along with luminal epithelial cells. Filament cells were rarely observed without intercellular accumulation of mucoid. The filament cells were largely confined to the myxomatous and chondromatous parts of the tumors. The presence of cells of transitional forms in adenomatous areas suggested that the filament cells were derived from the myoepithelial cells.


Antibiotic-induced lethal enterocolitis in hamsters: studies with eleven agents and evidence to support the pathogenic role of toxin-producing Clostridia. Clindamycin-induced enterocolitis in hamsters was studied, using a tissue culture assay to detect clostridial toxin. It was found that animals with lethal enterocolitis had a cytopathogenic substance in cecal contents and blood that was neutralized by clostridial antitoxins. Cultures of the cecal flora yielded numerous species of clostridia, but only 1 organism was detected which produced a toxin which was cytopathic in tissue culture. This organism, Clostridium difficile, was consistently present in high concentrations, and the cell-free supernate of these strains caused enterocolitis if injected intracecally into hamsters. Ten additional antimicrobials were tested ih hamsters. Ampicillin, vancomycin, erythromycin, cephalosporins, and oral gentamicin caused lethal enterocolitis in most recipients, and all animals which died had evidence of clostridia toxin in cecal contents at necropsy. Tetracycline and metronidazole were well tolerated, and the animals given these antimicrobials had no evidence of the toxin. We conclude that toxin-producing clostridia are responsible for lethal enterocolitis due to a variety of antimicrobials in hamsters.


Live streptomycin-dependent Pasteurella multocida vaccine for the prevention of hemorrhagic septicemia. A type B Pasteurella multocida was used for the development of a streptomycin-dependent (StrD) vaccine. Pasteurella multocida R-473, a hemorrhagic septicemia strain, was mutagenized with N-methyl-N'-nitro-N-nitrosoguanidine to increase the likelihood of encountering a StrD mutant and was plated on agar containing 400 microgram of streptomycin/ml. Replica plating was used to differentiate dependent from resistant colonies. Mice and rabbits were vaccinated with a StrD mutant and 21 days later, were challenge exposed, along with unvaccinated controls, with the wild type R-473. Protection of greater than 4 logs was shown for the vaccinated mice. All vaccinated rabbits were protected and all nonvaccinated controls succumbed to a challenge exposure of 500 or 1,000 LD50.


Determination of fetal sex in cattle by cytologic examiantion of amniotic fluid. Amniotic fluid smears (n = 134) of bovine fetuses (69 males, 65 females) at various stages of gestation were stained by the Papanicolaou method. Percentage counts of eosinophilic, orangeophilic, and cyanophilic cells were determined by examining 500 cells per sample. The cyanophilic cell count was significantly (P less than 0.001) higher for the females (37% +/- 3% to 47% +/- 3%) than for the males (19% +/- 2% to 32% +/- 3%). Significant differences, however, were not recorded with the eosinophilic and the orangeophilic cell counts. The percentage cyanophilic count could therefore be used as a method of prenatal sex determination.


Percutaneous drill pulmonary biopsy in the dog. Percutaneous drill pulmonary biopsy was performed 41 times in 5 dogs with a 51% rate in obtaining gross pulmonary tissue and 4% mortality from endobronchial hemorrhage. This pulmonary biopsy technique was not recommended for use in the dog.


A case study of canine panosteitis: comparison of radiographic and radioisotopic studies. A dog with recurrent active panosteitis was monitored with weekly skeletal radiographs and radioisotopic bone scintigrams performed on the same day. Comparison of results obtained by the two techniques indicated that scintigrams were more sensitive in revealing early lesions. Radiography was more specific and essential to establish a positive diagnosis. The sensitivity of radiographic and scintigraphic evidence was comparable during the midportions of the disease while bone resorption and deposition were most active. In late stages of panosteitis, after disappearance of clinical signs, the scintigrams were negative, whereas radiographs continued to reveal the presence of sclerotic lesions.


Trichuris campanula infection in a domestic cat from Miami, Florida. Based upon measurements and morphologic character, whipworms recovered from a Miami, Florida, cat were identified as Trichuris campanula. Experimental infections in cats indicated that the prepatent period was approximately 62 days.


Effect of feeding on plasma uric acid levels in snakes. The effect of feeding on plasma-uric acid concentrations of the snake was studied. The values were monitored in 2 gopher snakes and 2 black rat snakes which were fed mice. Plasma uric acid values in snakes increased after eating and gradually returned to base line with the digestion of the mice. Uric acid concentrations were greater in snakes eating 2 mice than in those eating only 1 mouse. The base-line plasma uric acid concentration in snakes was approximately 2 to 5 mg/dl. Plasma uric acid concentrations may be useful in making a diagnosis of gout. Presence of gout is usually indicated by increased uric acid concentrations; however, interpretation of these concentrations should be based on information about the feeding schedule.


Preparation of primary cultures of tick cells. Primary cell cultures were prepared from preimaginal bodies from the nymphal ticks, Rhipicephalus sanguineus, Dermacentor andersoni, and Amblyomma maculatum, and from the hemocytes of late-stage nymphal and adult ticks, Ornithodoros coriaceus. The dissection methods for obtaining preimaginal bodies and hemocytes for culture are described. A culture mediu, designated RML 375, was used for both culture methods. Primary cultures were established with minimal contamination. Preimaginal body cultures may be maintained for 2 to 8 months or longer and hemocyte cultures for 1 to 9 months. Cultured cells form incomplete monolayers and tend to grow in clusters. Subculturing these cells is difficult, although A maculatum have been sucessfully subcultured several times. A brief review of arthropod tissue culturing is presented and potential applications of the method are discussed.


Characterization of a Pasteurella multocida bacteriophage. The Pasteurella multocida bacteriophage B939a produces turbid plaques, which suggests infection with a temperate phage. Attempts to induce production of lytic phage by UV irradiation were unsuccessful, however, Bateriophage B932a is highly stable at 4 C and relatively stable at room temperature. It tolerates moist heat at 60 C, but is inactivated at 70 C in 10 minutes. Morphologically, it is a tailed phage with a hexagonal head.


Electromagnetic blood flowmeters and flow probes: theoretic and practical considerations. Electromagnetic blood flowmeters and flow probes are used to measure blood flow in blood vessels throughout the circulatory system. The principle of this measuring device is based on laws of electromagnetic induction discovered in the 19th century. The instrument has been predominantly used in research, but is presently used in human cardiovascular units to measure blood flow in blood vessels, and in prosthesis in conjection with cardiovascular surgical procedures. Electromagnetic flow equipment provides the most accurate measurement (in vivo) of blood flow available, both for acute and chronic implants. This report presents some of the theoretic and practical considerations for effective use of this instrument.


Theophylline disposition in acutely ill hospitalized patients. The effect of smoking, heart failure, severe airway obstruction, and pneumonia. Theophylline disposition (clearance, volume of distribution, and half-life) was measured in 31 normal volunteers and 26 acutely ill patients with airway obstruction within 24 hours of hospital admission and again when intravenous aminophylline was discontinued 2 to 10 days later. Sex, age, race, the diagnosis of asthma, and the diagnosis of chronic bronchitis were not significantly correlated with clearance. Clearance was significantly increased in smokers and significantly decreased in patients with congestive heart failure, pneumonia, and severe bronchial obstruction. The volume of distribution was not correlated with these variables. Within 24 hours of admission, the mean clearance in our patients without congestive heart failure or pneumonia was 44.5 ml per hour per kg of body weight, 40 per cent less than the value on which the widely used 0.9 mg per kg per hour dosage is based. The unexplained interindividual variability of clearance was significantly higher amont patients than control subjects, but intraindividual variability in clearance was not different in these 2 groups after correction for the effects of smoking, congestive heart failure, and so on. Large variability in clearance among patients makes the plasma theophylline concentration resulting from any dosage relatively uncertain. Based on the the results of this study, recommendations are made concerning theophylline dosage computation, and the clinical circumstances calling for determination of plasma theophylline concentrations.


Oxygen-assisted exercise in chronic obstructive lung disease. The effect on exercise capacity and arterial blood gas tensions. Twenty-six patients with severe chronic obstructive lung disease exercised on a treadmill while breathing either room air, supplementary compressed air, or O2. Endurance was significantly increased by O2, but there was no improvement in maximal work rate. No relation was found between increased endurance and the degree of hypoxia, hypercarbia, or acidosis during exercise or the changes in these while breathing O2.


Mucus rheology and mucociliary clearance: Normal physiologic state. Tracheal mucociliary clearance studies, mucus collections, and rheologic studies were performed on a weekly basis in 7 adult purebred beagles in an attempt to correlate clearance rate with rheology of mucus. Clearance rates were determined by a percutaneous transtracheal, radioisotope injection technique. Mucus was collected from dogs equipped with a tracheal pouch, and rheologic determinations were performed on a dynamic microrheometer. Individual analysis of data for each dog failed to reveal any significant relationship between clearance rate and any parameter of elasticity or viscosity. However, when data from all 7 dogs were pooled, covering a much wider range of the measured variables, it was seen that as the elastic modulus increased, the rate of clearance decreased. The mucociliary clearance rate was halved by an approximate ten-fold increase in elastic modulus of mucus.


Physiologic effects of bronchopulmonary lavage in alveolar proteinosis. The clinical and physiologic effects of bronchopulmonary lavage of both lungs at separate times in 14 patients with alveolar proteinosis proved by biopsy were followed for 2 to 96 months. Before lavage, all patients had moderate to severe dyspnea on exertion. Twelve had a nonproductive cough, and 2 had a productive cough; both were smokers. Nine had generalized fatigue, and 4 had weight loss. Twelve of 14 had fine inspiratory rales. All of the patients had abnormal chest roentgenograms, and 13 of 14 had an increased lactate dehydrogenase concentration. After lavage, all patients had loss of fatigue and improved exercise tolerance, with most returning to normal activity. Cough cleared in 12 of 14 and remained only in the cigarette smokers. Inspiratory rales cleared completely in most patients (11 of 12) and partially in one. The rales usually returned during exacerbations. Physiologic measurements that changed significantly after bilateral lavage included: vital capacity, total lung capacity, resting room air PO2, exercise PO2, PO2 while breathing 100 per cent O2, and DLCO. Because all measurements were made within 5 days of the second lavage, one must attribute the acute improvement to the removal of proteinaceous material from the alveoli. The long-term effects varied; some patients required annual or semiannual lavages, wherease others remained in remission after lavage for 36 to 96 months. Exacerbations were accompanied by increased dyspnea, reappearance of rales, and deterioration of the gas-exchange parameters noted previously. Repeat lavage reversed the clinical symptoms and physiologic abnormalities in patients who had recurrences.


Regional lung function in asymptomatic cigarette smokers. Regional pulmonary ventilation and perfusion were studied in the supine posture using xenon-133 in 10 asymptomatic cigarette smokers with normal chest radiographs and no evidence of large airway obstruction. The results were compared with those obtained in age-matched control subjects who were lifelong nonsmokers. The ventilation of the upper zones of the lungs was significantly less than that of the lower zones in smokers but not in control subjects, and perfusion of the upper zones of the lungs was significantly greater than that of the mid-zones in control subjects but not in smokers. It is suggested that the upper zone abnormalities found in the group of smokers were consistent with the development of early emphysema.


Radioisotope scanning in the initial staging of bronchogenic carcinoma. The use of routine radioisotope scanning to screen for subclinical metastatic disease in the initial staging of bronchogenic carcinoma was studied. To define the value of scans, liver, brain, and bone scans were studied prospectively in 111 patients and retrospectively in 114 patients. Among patients with clinical findings suggesting metastatic disease, 14.4 per cent of the liver scans, 12.3 per cent of the brain scans, and 35.7 per cent of the bone scans were positive. All patients free of clinical findings had negative liver and brain scans. Positive bone scans occurred in 8 per cent of the patients without clinical abnormalities. True-positive bone scans occurred in less than 4 per cent of the patients free of clinical abnormalities. The clinical findings noted in the patients pointed to the organ involved in only 76 per cent of the abnormal liver scans, 62 per cent of the abnormal brain scans, and 75 per cent of the abnormal bone scans. Clinical findings associated with positive liver and brain scans were multiple and significant, whereas findings with the positive bone scans could be few or subtle. Routine scanning failed to identify a significant number of patients with clinically unsuspected metastatic disease. Liver, brain, and bone scanning is indicated only in patients suspected of having metastatic disease.


Bronchial hyperirritability in healthy subjects after exposure to ozone. We studied the effect of a 2-hour exposure to 0.6 ppm of ozone on bronchial reactivity in 8 healthy, nonsmoking subjects by measuring the increase in airway resistance (Raw) produced by inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths). Before exposure to ozone, histamine increase the mean Raw from 1.2 to 1.8 cm H2O per liter per sec. Immediately after exposure to ozone, the mean baseline Raw was unchanged, but the mean response to histamine was significantly greater than the pre-ozone response (Raw = 3.3 cm H2O per liter per sec; P less than 0.05). For the group, this increase disappeared 1 day after exposure to ozone, although 2 subjects still had a significantly increased response to histamine for more than 1 week after exposure. In 4 subjects, pretreatment with atropine sulfate aerosol (0.1 to 0.2 mg per kg of body weight) blocked the increase in Raw produced by histamine after exposure to ozone. We concluded that brief exposure to 0.6 ppm of ozone produces bronchial hyperirritability via cholinergic postganglionic pathways, probably by damaging airway epithelium and thereby sensitizing bronchial irritant receptors.


Collateral ventilation and the middle lobe syndrome. The mechanics of collateral ventilation in the right middle lobe of 5 young, normal volunteers were studied using a bronchoscopic wedge technique, and the results were compared with those from an upper lobe of the same subjects. At functional residual capacity, the resistance to collateral ventilation in the right middle lobe was 4,042 +/- 559 cm H2O per liter per sec (mean +/- SE), whereas that of the upper lobes was 799 +/- 168 cm H2O per liter per sec. The time constant for collateral ventilation could not be measured in the right middle lobe of any of the subjects because it exceeded their breath-holding times of 6 to 16 sec. The time constant for collateral ventilation in the upper lobes was 4.5 +/- 1.0 sec. We concluded that collateral ventilation in the right middle lobe of young normal subjects is characterized by a high resistance and a long-time constant relative to the upper lobes. This is probably explained by a greater ratio of pleural surface to nonpleural surface in the right middle lobe as compared to the upper lobes. We suggest that ineffective collateral ventilation is a major factor in the pathophysiology of the Middle Lobe Syndrome.


Aerodynamic size distribution of metered-dose bronchodilator aerosols. The aerodynamic size distributions of 9 commonly used bronchodilator aerosols were determined by using a new instrument, the single-particle, aerodynamic relaxation time analyzer, which can measure the aerodynamic size of single particles and droplets in real time independent of density, shape, and other physical characteristics. The following commercial preparations were studied: Duo-Medihaler, Medihaler-Epi, Medihaler-Epi Medihaler-Iso, Norisodrine Aerotrol, Alupent, Metaprel, Isuprel Mistometer, Bronkometer, and Asthma-Meter. Count median diameters ranged from 0.62 to 0.82 micrometer, and mass median aerodynamic diameters ranged from 2.8 to 4.3 micrometer. The heterodisperse nature of the aerosols was demonstrated by the relatively large geometric standard deviations, which ranged from 1.5 to 2.1. None of these aerosols had a log-normal distribution; rather, the distribution curves were multimodal.


Differential effects of cyclophosphamide and cortisone acetate on bronchoalveolar phagocytic cell populations. The effects of cyclophosphamide and cortisone acetate on numbers of pulmonary alveolar macrophages (PAM) and on inflammatory response of polymorphonuclear leukocytes to bacterial infection in the lung were studied in guinea pigs. Groups of animals were treated for 7 days with each drug alone or in combination. Bronchoalveolar lavage was carried out on the day after completion of the drug regimens. Selected animals were challenged via the trachea with Pseudomonas aeruginosa 2 hours before lavage. Single-drug therapy did not significantly decrease numbers of PAM in lavage fluids, but combined therapy led to a 60 per cent (P less than 0.01) decrease in numbers of PAM. Normal animals and cortisone-treated animals responded 2 hours after Pseudomonas lung challenge with a 4-fold increase in PMN in lavage fluid, wherease animals treated with cyclophosphamide or the combined-drug regimen failed in this response. The clearance of viable Pseudomonas organisms from bronchoalveolar fluids was inhibited only in animals  treated with both cyclophosphamide and cortisone. Thus, only a combined regimen of cyclophosphamide plus cortisone led to the simultaneous occurrence of decreased numbers of PAM, as well as inhibition of polymorphonuclear leukocyte inflammation in the lung. Combined immunosuppressive drug regimens may result in more severe alterations in lung host defense for the clearance of bacteria than does single-drug therapy.


Defective neutrophil locomotion in human blastomycosis: evidence for a serum inhibitor. Unstimulated or stimulated locomotion, bactericidal, and metabolic activities of polymorphonuclear leukocytes (PMN) from 12 nonimmunosuppressed patients with invasive fungal infections proved by culture, were evaluated before and after treatment of the patients with antimicrobial drugs. The major observation was that PMN from patients with blastomycosis had a defect in stimulated locomotion. The specificity of the defect for blastomycosis was substantiated by the normal stimulated locomotion of PMN from uninfected control subjects or untreated patients with histoplasmosis, cryptococcosis, coccidioidomycosis, or sporotrichosis. The defect was due to a heat-stable, cell-directed, reversible serum inhibitor. In unheated or heated serum from untreated patients with blastomycosis, control PMN had decreased stimulated locomotion. Multiple washing followed by addition of control serum corrected locomotion of PMN from untreated patients with blastomycosis. The abnormality was not present in PMN from patients who had been treated with amphotericin B or had spontaneous resolution of their infections. Inhibition was not due to absence of chemoattractant activity because zymosan-activated patient serum or mixtures of patient and control serum stimulated PMN locomotion normally. The defect did not correlate with age, sex, neutrophil count, nitroblue tetrazolium reduction, serologic reactivity, or duration or severity of infection. No defect was found in bactericidal or metabolic activities of various combinations of PMN and serum from untreated or treated patients with blastomycosis or the 4 other fungal infections tested, indicating that the inhibitor was specific for stimulated locomotion.


A comparative study of cell renewal after exposure to ozone or oxygen. Response of terminal bronchiolar epithelium in the rat. Cell renewal patterns of the terminal bronchiolar epithelium of rats were examined during 7-day exposures to either 0.8 ppm of ozone or 80 per cent O2. Terminal bronchiolar epithelial cells were classified and counted in ciliated, nonciliated secretory (Clara), and nonciliated, nonsecretory categories. Thymidine labeled with hydrogen-3 was used in conjunction with light microscopic autoradiography to obtain labeling indices in exposed rats at 6, 24, 72, and 168 hours compared to control rats at 6 and 168 hours. Results indicated that both ozone and O2 initiated a proliferative response of terminal bronchiolar epithelium, but that the response to O2 insult was delayed in onset and of lesser magnitude. Most importantly, the differential cell counts revealed that nonciliated secretory cells were the primary proliferating cell type at all periods after oxidant insult. This proliferative response continued with persistence of the insult through 168 hours. Shifts in proportions of cell types and labeling indices during exposure supported the view that nonciliated secretory cells are the reparative bronchiolar cells and that new ciliated cells are mainly derived from them.


Cytotoxic effects of nickel on ciliated epithelium. Studies were conducted to measure the effect of graded concentrations of nickel on ciliary activity in an in vitro model system using isolated hamster tracheal rings, and to compare the in vitro findings with in vivo exposures using an organ culture system. Dose-response experiments were conducted for various Ni concentrations and for various lengths of exposure. In the in vitro model, significant decreases in ciliary activity occurred at concentrations as low as 0.011 mM nickel (0.65 microgram of nickel per ml). A dose-response relationship between the concentration of nickel and ciliary action was demonstrated. A range of effects from a significant decrease of 26 beats per min (0.65 microgram of nickel per ml) to complete ciliostasis (65 microgram of nickel per ml)) was observed after 24 hours of exposure. Validation of the in vitro results occurred when hamsters were exposed to a nickel chloride aerosol at concentrations of 100 to 275 microgram of nickel per m3. Immediately after the cessation of a 2-hour in vivo exposure, a decrease in ciliary activity of 60 and 140 beats per min was observed for animals exposed to 100 and 275 microgram of nickel per m3, respectively. The length of time required for recovery from the in vivo exposure to nickel aerosol was determined. Histologic examination of the epithelial cells also showed dose-related effects. It is apparent that nickel, either administered to the whole animal or to the tracheal epithelium directly, can significantly decrease the ciliary beating frequency and interfere with the normal functioning of respiratory defense mechanisms, thereby increasing the risk of the host to respiratory infections.


Gallium-67 citrate scanning in the staging of idiopathic pulmonary fibrosis: Correlation and physiologic and morphologic features and bronchoalveolar lavage. Idiopathic pulmonary fibrosis is a fatal disorder characterized by interstitial fibrosis and parenchymal inflammation. Current concepts of this disease suggest that the inflammation precedes and probably induces the fibrotic state. To evaluate the extent and relative activity of the inflammatory process, we scanned patients with idiopathic pulmonary fibrosis using gallium-67, a radionuclide known to concentrate in regions of inflammation. To quantify the amount of isotope in the lung parenchyma, the 67Ga-index was developed, a parameter derived from estimates of the size of regional pulmonary uptake, the uptake intensity, and its texture. Evaluation of 67Ga scans in 30 patients with idiopathic pulmonary fibrosis and 19 control subjects demonstrated that the 67Ga-index in the group with idiopathic pulmonary fibrosis was significantly higher (P less than 0.001) than that in the control group. When compared with lung biopsy morphologic studies in 22 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the degree of interstitial cellularity (P less than 0.05) and the degree of alveolar cellularity (P less than 0.005). When compared with cellular analysis of bronchoalveolar lavage fluid in 17 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the differential percentage of neutrophils (P less than 0.05), but not lymphocytes, eosinophils, or macrophages. These studies indicate that 67Ga accumulates in the lungs of patients with idiopathic pulmonary fibrosis and is probably associated with the active inflammatory state. The associations of the 67Ga-index with morphologic features and bronchoalveolar lavage analysis suggest that quantitative evaluation of these scans may be useful in staging the activity of idiopathic pulmonary fibrosis and following responses to therapy.


Effect of atropine on mucociliary transport velocity in anesthetized dogs. We recently described a radioactive tracer method of measuring mucociliary transport rates (MCTR) in vivo in dogs. The distance from larynx to carina is measured on inserting a calibrated fiberoptic bronchoscope into the trachea. A small volume (0.04 to 0.1 ml) of a suspension of radio-labeled albumin microspheres 5 to 7 micrometer in diameter is then deposited on the mucosal surface at the carina via a catheter placed through the inner channel of the bronchoscope. The rate of movement of these sphere towards the larynx is visualized sequentially by means of a gamma scintillation camera with a large field of view and is recorded as polaroid images during 10 to 30 min. By using this technique, transport rates were determined in the tracheas of 10 anesthetized dogs (17 experiments) before and 10 min after intravenous infusion of 0.4 mg of atropine sulfate; each animal served as its own control subject. Baseline MCTR values were determined by using microspheres labeled with 140-KeV technetium-99m. After infusion of atropine, MCTR values were again determined using micropheres labeled with 390-KeV indium-113m. Because of their widely differing energy spectrums, both test agents could be used in rapid succession by adjusting the spectrometer of the scintillation camera. MCTR increased in 13 experiments, did not change in two, and decreased in two. The percentage increase in MCTR after infusion of atropine was significant as compared to baseline values (30.0 +/- 0.6 per cent, mean +/- SE; P less than 0.05 by paired t test), as was the absolute change in MCTR after infusion of atropine (P less than 0.05 by 2-way analysis of variance). Therefore, the effect of atropine in improving mucociliary clearance was quantitatively similar to that previously reported for beta-adrenergic agonists.


Miconazole treatment of relapsed pulmonary blastomycosis. Two patients with second relapses of pulmonary blastomycosis after successful treatments with adequate doses of amphotericin B were retreated with miconazole. One patient had experienced an acute intrabronchial spread of disease to the contralateral lung before miconazole therapy. Marked clinical and roentgenographic improvement occurred with treatment, followed by mycologic relapse 1 month later. The other patient sustained a more indolent relapse of disease. A favorable response to treatment with miconazole was demonstrated by improvement in abnormalities noted on a chest roentgenogram and a [67]gallium-citrate scan.


Restrictive ventilatory defect in a patient with primary pulmonary hypertension. A patient with the classic features of primary pulmonary hypertension developed a severe restrictive ventilatory defect that worsened during the clinical course. Histologic examination of the lung showed vascular changes consistent with primary pulmonary hypertension and no evidence of pulmonary parenchymal fibrosis. We suggest that severe progressive pulmonary hypertension caused a restrictive ventilatory defect in this patient.


Empyema with Trichomonas species.

Empyema with Trichomonas species. A 35-year-old alcoholic male patient developed an empyema secondary to presumed aspiration pneumonia. Trichomonads were demonstrated on wet mounts and Wright-Giemsa-stained, air-dried smears of pleural fluid. Treatment with metronidazole, other antimicrobial drugs, and drainage was successful in curing the empyema.


Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium. A case of mesothelioma, apparently arising in the pericardium, is reported in a patient who, 15 years previously, had been treated for angina pectoris by dusting of the pericardial cavity with a mixture of fibrous dusts. At autopsy, transparent fibers and ferruginous bodies were present within the pericardium. Electron diffraction and microprobe analysis indicated that approximately two thirds of the fibers were tremolite and anthophyllite asbestos, and the remainder, fiber glass. Development of mesothelioma in laboratory animals has been reported after intrapleural deposition of asbestos and other fibers, but in humans, the link between exposure to asbestos and mesothelioma has always been based on epidemiologic data and the retrospective finding of asbestos in tissues. To our knowledge, this is the first example of a malignant mesothelioma in a human associated with direct mesothelial contact with fibrous dusts.


Identification of a receptor for complement on the guinea pig alveolar macrophage membrane. The present study was undertaken in an attempt to demonstrate the presence of a receptor for complement on the membrane of guinea pig alveolar macrophages (PAM). When target cells were prepared using mouse serum as the complement source, no attachment or ingestion of the target cell by guinea pig PAM was observed. When fresh autologous guinea pig serum was used as the complement source, attachment and ingestion of the target cell by PAM were observed. The results of additional experiments demonstrated that the attachment of these target cells was mediated by a complement receptor. These results demonstrated that like human PAM, guinea pig PAM do possess a membrane receptor for complement.


[Hypertrophic pyloric stenosis. Review of 314 cases (author's transl)]. Three hundred fourteen patients with hypertrophic pyloric stenosis have been operated from 1969 to 1976. The different etiologies are discussed. Clinical and analytical data are evaluated. Radiology is employed in 99 per 100 of the cases with no complications. Medical treatment used is exposed clearly as well as the surgical procedure (Monereo's modification of the classical Fredet-Ramstedt technique). Postoperative results and complications such as vomiting, wound infection (4.4 per 100), eventration (0.6 per 100) and fatal outcome (0.6 per 100) are thouroughly detailed as well as the associated pathology.


[Prognostic value of neonatal paroxyistic electroencephalogram (author's transl)]. Twenty full-term newborns showing acute neurologic symptoms of different etiologies, with neonatal paroxistic EEG tracings are reported. Clinical and electroencephalographic follow-up at three and twelve months confirmed in every case the presence of severe neurologic sequelae. A review of the literature is made, comparing the results of other investigators with those obtained in the present study specially from an ethiologic, clinical, electroencephalographic and evolutionary points of view.


[Sturge-Weber syndrome. Findings in 22 infantile cases (author's transl)]. Twenty two infants, 13 females and nine males, with Sturge-Weber syndrome are reviewed. Facial "nevus flammeus" is found to be located unilaterally in 13 cases and bilaterally in nine cases. Twenty infants presented seizures with generalized type being most frequent. E.E.G. alterations appeared in 18 cases. The I.Q. was normal in five infants although somewhat lower than the inferior limits of a normal I.Q. range. The major radiological alterations seen were an increased thickness of the skull cap; intracranial calcification (11 cases), unilateral in eight and bilateral in three; cerebral hemiatrophy (10 cases), arterial and venous hypoplasia and tortuosity in the entire extension of the carotid artery. One of the infants died with no apparent cause. This death cannot be attributed to the orignal syndrome. Computerized tomography offers early adequate data concerning the intracranial calcifications and cerebral hemiatrophy. Based on this study there does not seem to be sufficient motives to separate the Sturge-Weber and the Klippel-Trenaunay syndromes into two different entities.


[Pediatric bibliometrics: I. Descriptive statistics on pediatric books and pamphlets (author's transl)]. A descriptive statistic analysis of general pediatric books and pamphlets, mentioning the number of titles in circulation at international level, and their distribution by languages, places of impression and countries with the main index of production is exposed.


[Pediatric bibliometrics: II. Descriptive statistics on pediatric periodicals and papers (author's transl)]. A descriptive statistic study about journals and pediatric articles at international level is presented. Three of the main international repetories of medical bibliography, have been used as sources, collecting a total of three hundred periodical pediatric publications. A distribution of these publications by languages, places or impression, periodicity of appearance and percent of sub-specialization is made. In relation with pediatric papers, we have studied their presence in non medical scientific journals, medical but non pediatric journals and in those of the speciality, analizing the percentage of these papers in each one of them.


[Obese children. Psychical aspects studied by Rorschach's test (author's transl)]. A group of obese children comparatively to a control group of normal children using Rorschach's protocols is studied. Quantitatively it doesn't appear significant differences, although a serie of characteristics in obese children (a proportional increase in answer of small detail and human movement, less number of answer of colour-form and animal contents), is found. Cualitatively some differences (desvitalitation phenomenous and shock in front of grey colours) are also found. The present work deduces that it doesn't exist reasons to think about an specific structure and dynamic in personality of obese children.


[Psychological aspects of childhood obesity. Lavik's questionaire (author's transl)]. A group of obese children between 6-12 years of age is compared with Lavik's questionaire which serves as base for statistical analysis (critical ratio). Meaningful differences appear in several behavioral areas: aggressiveness, interest in sexuality, impaired interpersonal relations, increased anxiety and depressive tendencies. Important differences are to be noted also comparing obese boys and girls.


[Indications of vascular exploration in the diagnosis of abdominal neuroblastoma (author's transl)]. The criteria on the indications of angiography are shown in the diagnosis of abdominal neuroblastoma, stressing its' utility in situations where conventional procedures do not supply an accurate diagnosis. Angiography happens to be fundamental for diagnosis retroperitoneal tumours which eventually result in a silent kidney as well as for the differential diagnosis of some hepatic tumours and Pepper's syndrome.


[Acute poisoning by I.M. iron. Report of a fatal case (author's transl)]. The case of a five months-old child who received 44 mg/Kg of Fe-sorbitol I.M. by mistake is reported. That dose is about ten times the usual standard dosage. After an initial vague symptomatology, followed by transitory improvement, she developed a serious metabolic acidosis, renal and hepatic failure and generalized convulsions. The clinical picture could not be controlled by general supportive treatment, desferroxamine administration and exanguino-transfusion.


[Congenital monomorph adenoma of the parotid gland (author's transl)]. Congenital monomorph tubular adenoma is a very infrequent tumor. Usually diagnosis is an operative finding. Together with its' infrequency, rapid rate of growth, differential diagnosis with other vascular tumors, specially cystic lymphangioma, and its surgical excision avoiding lesion of the facial nerve, account for this publication.


[Diagnosis and treatment of bronchiolitis (author's transl)]. In this paper we review the current facts in the diagnosis and treatment of bronchiolitis. Etiological diagnosis,, clinical features and major problems of differential diagnosis are also discussed. A classification of the patients according to the seriousness of the clinical picture is proposed. Proper treatment requires the adoption of specific therapeutical measures for each degree of the disease. Recent reports have demonstrated the occurrence of residual pulmonary lesions after bronchiolitis. Therefore, strict controls during the course of the acute disease are required, in order to prevent these complications.


[Growth rate and bone maturation in celiac disease (author's transl)]. The growth and bone maturation of 43 celiac patients were analyzed. A significant correlation between gluten intake and growth rate was found. The authors suggest this is a good parameter to advise the best moment to make the control biopsie and the provocation test.


[Salmonella infection in children. Epidemiological and clinical considerations (author's transl)]. An analysis of data on Salmonella infection treated at the Children's Hospital "La Fe", in Valencia, from 1974--75 is presentd. A patient population of 211 selected cases were divided into two groups: Gastroenteritis (GEC), 155 cases, and typhoid-paratyphoid fever (T-P F), 56 cases. Hospitalization was required in 79% of the cases. The following parameter were studied: Locality and district of origin with respect to residence, conditions of hygiene, size of family: age, sex, seasonal incidence, previous time of illness, presenting symptoms and physical sings and complementary studies. The following conclusions were obtained: Salmonella infection are and endemic problem in Valencia. Their incidence is maximal during the months of June to October. Epidemiological environment was positive in 15% of the cases. Higher morbidity in children less than two years of age. Most frequent presenting symptoms: Diarrhea, fever and vomiting as often in GEC as in T-P F. In 38.7% of GEC cases, the diarrhea was bloody; 21.9% of GEC cases began with fever. Salmonella paratyphi B was the agent most frequently responsible. Data concerning sex, family size, conditions of hygiene and white blood cells offer little discriminatory information. Results obtained are concordant with those described in the literature.


[Chronic gastritis in children (author's transl)]. The gastric mucosa in 113 children from 6 months to 14 years old was studied from a histopathological point of view. Samples were obtained by means of a multiple biopsy technique during an endoscopic examination. The patients were divided into two groups. Group A was composed of 97 children with abdominal pain of an unknown etiology. Group B was formed of 16 patients with extragastric pathology in whom it was possible to take biopsies during an endoscopic exam. All of the biopsies were normal, and therefore were used as the control group. 49 patients from group A were histologically normal. In the other 48, lesions of chronic gastritis ranging in severity, were found in the antrum and/or in the gastric body. An analysis of the histopathological findings, and of the lesional sings of activity was done in accordance with Whitehead's criteria. Macroscopic objective features observed during the endoscopical examinations, were also evaluated and compared with the existence or nonexistence of chronic gastritis lesions. In the gastric body, the existence of endoscopic features such as enlarged folds, erosions or friable mucosa, were found to be coincident with the presence of histologic lesions of chronic gastritis. The same relationship was found in the antrum between the granular mucosa and/or irregular coloration and the lesions of chronic gastritis. In the same time, acid secretion studies (BAO, MAO and PAO) from 40 patients from group A were done using pentagastrin as a stimulant. It was demonstrated that both basal acid output and maximal acid were significantly lowered in cases of advanced lesions of chronic gastritis located in the gastric body. Finally the importance of this entity is emphasized in the gastrointestinal pathology in children.


[Histochemical demonstration of acetylcholinesterase activity applied to the study of human biopsies. I. Rectal suction biopsy in the diagnosis of congenital megacolon]. The application of the histochemical demonstration of AChE activity to the diagnosis of congenital megacolon (Hirschsprung's disease) is discussed, both from the point of view of the technical aspects as well as the interpretation of the results obtained, using the method of Karnovsky and Roots, as modified by El Badawi-Schenk, applied to rectal suction biopsy. The authors adhere to the original ideas of Meier-Ruge et al., that the diagnosis of Hirschsprung's disease can be done solely with the evaluation of the AChE positive parasympathetic network of the lamina propria, with the additional consideration of the submucosal plexus to include cases of hypoganglionar megacolon, where that plexus is clearly diminished. The use of phase contrast is also emphasized.


[Fast atrial rhythms (author's transl)]. The authors present their experience on fast atrial rhythms. Fourteen patients were studied in the first three months of life, nine of them having congestive heart failure. The electrophysiological basis of the reentrance tachycardia at A-V junction is discussed. The pharmacological treatment is reviewed, emphasizing the usefulness of verapamil. They comment on the good prognosis of the disorder, provided there is not associated congenital heart disease.


[Favism (study of 8 families)].

[Favism (study of 8 families)]. This paper presents ten cases of total glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in individuals with hemolytic crisis after exposure to products of the fava been ("Vicia faba"). Three other cases of total G-6-PD deficiency and eleven partial deficit cases of the enzyme, without associated hemolysis were detected in a total of forty individuals belonging to eight families of the province of Seville examinated for G-6-PD levels. Important differences were noted in the G-6-PD enzyme dosage taken during the crisis and six and twelve months after. This fact was interpreted as a secondary effect to the elimination of the enzymopenic cells because of hemolysis. Data suggests the existence of a relatively stable form of G-6-PD that could explain the dissociation between the incidence of deficit in G-6-PD level in the general population and the reduced casuist of favism reported in our literature.


[Kinsbourne's disease. Study of four cases (author's transl)]. Four children who at ages from five months to three years developed an acute (one case), subacute (two cases) and chronic form (one case) clinical picture of ataxia, myoclonus, ocular dyskinesia and behaviour disorder are reported. In one of them there was, in addition mental retardation. Response to treatment with ACTH was successful. Clinical and evolutive characteristics of this process as well as the variety of ocular manifestations are emphasized.


[Congenital type I fiber hypotrophy myopathy (author's transl)]. Five cases with type I fiber hypotrophy myopathy from two families are reported. The first two cases belong to the type I fiber hypotrophy and central nuclei. Six cases have already been published. In addition to hypotonia, obvious thoracic anomalies are associated. The three other cases are members of the second sibship and belong to the type I fiber hypotrophy without central nuclei nor myothony and show the typical phenotypic characters: elongated face and adynamic appearance. Out of these three brothers, two show no progress and the other is getting worse slowly. The pathological findings together with the evolutive-clinic pattern of these patient are confronted with those published by other authors and sugestions are made to differentiate these two forms and to establish their relationships with the other types of congenital myopathies, mainly with centronuclear myopathy and congenital fiber type disproportion.


Sequential radionuclide assessment of left and right ventricular performance after acute transmural myocardial infarction. Ventricular performance was evaluated sequentially in 31 patients with uncomplicated acute transmural myocardial infarction (13 anterior and 18 inferior). Left ventricular ejection fraction, ejection rate, regional wall motion, and right ventricular ejection fraction were ascertained using first-pass radionuclide angiocardiography on four occasions during hospitalization. Inferior infarction resulted in a greater reduction in right ventricular ejection fraction than anterior infarction (mean +/- SEM; 48 +/- 2 versus 56 +/- 2%, P less than 0.01). In contrast, in anterior infarction there was greater depression of left ventricular ejection fraction than in inferior infarction (34 +/- 3 versus 50 +/- 3%, P less than 0.01). From initial to discharge studies, there was no significant change in global performance or regional wall motion in either group. These data show that the location of transmural infarction has a profound effect upon the magnitude of right and left ventricular dysfunction. In addition, ventricular systolic performance remains relatively stable during the hospital phase of uncomplicated transmural myocardial infarction.


[Value of the C reactive protein, urinary lactic dehydrogenase and renal capacity of concentration in the topographic diagnosis of the urinary infection in infancy (author's transl)]. In 39 children with urinary infection renal capacity of concentration, serum C-reactive protein and presence of urinary lactic dehydrogenase are studied pointing to the establishment of the topography of the damage. C-reactive protein levels higher than 20 micrograms/ml are 100 per 100 reliable in the diagnosis of pyelonephritis. Moreover, value of this test is confirmed as a guide of therapeutic efficacity. Difficulty of concentrating urine above 800 mOsm/l is 70 per 100 reliable and is a useful method for demonstrating parenchymal damage. The urinary lactic dehydrogenase was superior to 20 units/l in 64 per 100 of the cases, but other studies are necessary for interpretation of these data. These findings are similar to those obtained in the study of the isoenzymes.


Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. In 14 healthy men we assessed the effects of smoking marihuana cigarettes containing 6 mg of delta-9-tetrahydrocannabinol on ultrasound measures of left ventricular function. Four of this group and four additional subjects also had measurements of plasma norepinephrine. Both heart rate and left ventricular performance (mean rate of internal diameter shortening [mean Vcf]) were significantly increased for at least 1 h after drug exposure compared with these values after placebo cigarettes. The immediate tachycardia and increase in mean Vcf were not accompanied by raised plasma norepinephrine levels. However, by 30 min after marihuana exposure, sympathetic neurotransmitter levels were significantly greater than both control values and those after placebo cigarettes, and they remained elevated for at least 2 h. Excessive sympathoadrenal discharge, as evidenced by augmented left ventricular function and prolonged catecholamine release, could adversely affect patients with heart disease.


[Cystine-lysinuric lithiasis].

[Cystine-lysinuric lithiasis]. Cistin-lisinuria is not a unfrequent etiology of lithiasis in children. Six patients have been studied as well as their families, being a total of 45 patients. Lithiasis was present in ten of our patients, and hyperaminoaciduria, without lithiasis in ten, affecting in both cases (with or without litiasis) either all the four amynoacide (cystine, lysine, arginine and ornithine) or only one or two of them. Authors have not found any correlation between clearance of cystine and the presence or absence of lithiasis; on the other hand the best index to correlate the presence of lithiasis is to reach a value, equal or superior to 300 mgr of cystine excreted in the urine per 1 gr of creatinine excreted in urine. The correct treatment in cystinuric patients with lithiasis is to alcalize the urine maintaining a constant urinary pH between 7-8, giving a sufficient dose of sodium bicarbonate per os. In case of resistance to this treatment or if a great calculi is present, D-penicillamine would be an efficient treatment to disolve the calculi. These treatment when carried out under analytical control presents no problems or complications in their experience.


[Secondary carbohydrate intolerance. Evolutive follow-up (author's transl)]. This study reports 70 children suffering from malabsorption and/or carbohydrate intolerance followed for at least twelve months. Mono and dysaccharide overload curves are considered as very valuable tests together with the clinical signs. These must be carefully observed during the tests and after supression of the malabsorbed sugar. Reliability of the overload tests in the follow-up is pointed out. Variations in the normalization time of the curves for each carbohydrate are determined. Finally 90 min. is considered as an advisable end-point for overload tests.


Tracheostomy and hemodynamic changes in sleep-inducing apnea. Because pulmonary hypertension and systemic hypertension occur during sleep-induced obstructive apnea, six patients underwent overnight hemodynamic monitoring before and after tracheostomy. Variables studied included heart rate, pulmonary artery pressure, femoral artery pressure, and arterial oxygen tension (Po2). After tracheostomy, significant reductions were noted during sleep in mean pulmonary artery pressure from 45 +/- 6 mm Hg (mean +/- SEM) to 22 +/- 2 mm Hg (P less than 0.05) and in mean femoral artery pressure from 137 +/- 6 mm Hg to 97 +/- 3 mm Hg (P less than 0.005). There was also a significant increase for the group in arterial Po2 recorded during the apneic episodes from 38 +/- 3 mm Hg before tracheostomy to 71 +/- 2 mm Hg (P less than 0.001) after tracheostomy. We conclude that tracheostomy improves the hemodynamic abnormalities and hypoxemia that occur during sleep in patients with sleep-induced obstructive apnea.


Bronchoalveolar lavage in interstitial lung disease. Cellular and immunoglobulin components of bronchoalveolar fluid recovered by bronchoscopic lavage were evaluated in 32 control patients, 10 normal volunteers, and 60 patients with the following interstitial lung diseases: idiopathic pulmonary fibrosis, pulmonary fibrosis associated with collagen-vascular disease, eosinophilic granuloma, sarcoidosis, and hypersensitivity pneumonitis. The percentage of lymphocytes distinguished two general disease categories: those with increased lymphocytes (sarcoidosis and hypersensitivity pneumonitis); and those with normal lymphocytes (idiopathic pulmonary fibrosis, pulmonary fibrosis associated with collagen-vascular disease, and eosinophilic granuloma). Patients in all five disease categories had elevated IgG levels and percentages of neutrophils compared with control patients, with the highest proportion of neutrophils found in idiopathic pulmonary fibrosis. Immunoglobulin levels also helped distinguish among patient groups, in that patients with hypersensitivity pneumonitis had lavage IgG/albumin ratios greater than 1, whereas patients with sarcoidosis had ratios less than 1; and with infrequent exceptions, the finding of IgM in lavage fluid was limited to patients with hypersensitivity pneumonitis.


[Venous aneurysms of the neck in childhood (author's transl)]. Three children with four fusiform venous aneurysms in the neck are described. A correct referral clinical diagnosis had not been established in any of these children. The diagnosis should be made generally on the basis of the physical examination, including the test of the "digital pressure", which is particularly useful to rule out a laringocele. Three of the aneurysms have been treated by surgical removal. Histological examination showed microscopic changes which were related to the time elapsed since the mass was first noticed. Areas of thinning out and sclerosis of the venous wall were evident in one case. The patient with the remaining aneurysm is being followed closely.


Familial Turner syndrome.

Familial Turner syndrome. Seven women in three generations of a family have been affected by Turner syndrome. Turner phenotype in this family is the result of deletion of the entire short arm of one X chromosome. The short arm deletion is transmitted by carriers of a balanced X-1 translocation. Autoradiographic findings showed that the deleted X chromosome was late labeling in those persons with Turner syndrome, whereas the normal X chromosome was late replicating in carriers of the balanced translocation. The results of Xga typing of erythrocytes suggest that the Xg locus is on the short arm of the X chromosome. Because of the clinical implications, we believe that families of persons with structural chromosomal abnormalities should be studied to exclude familial transmission.


Renal artery embolism: clinical features and long-term follow-up of 17 cases. Spontaneous renal artery embolism is not rare, but a correct diagnosis and appropriate treatment are often delayed. Clinical features and follow-up of 17 cases are reported. Cardiac disease or arrhythmias pre-existed in 16 patients. Initial symptoms included flank pain (seven cases), abdominal or chest pain alone (seven), and nausea and vomiting (eight). Fever (greater than or equal to 37.5 degree C) occurred in 10 cases and flank tenderness in only eight. Laboratory findings included leukocytosis, proteinuria, hematuria, and elevated levels of lactic dehydrogenase, serum glutamic-oxalacetic transaminase, serum glutamic-pyruvic transaminase, and alkaline phosphatase. Serum creatinine level exceeded 1.3 mg/dl in 88% and 4.0 mg/dl in 65%; four patients required dialysis. The diagnosis, made by scintiscan, arteriography, or both was often delayed. Renal embolization was bilateral in seven patients and unilateral in 10, with serum creatinine level above 4.0 mg/dl in five of the latter. Emboli to other organs caused early death; cardiovascular disease led to later death. With anticoagulants, renal function returned in patients surviving more than 1 month, even those with bilateral emboli. Thus, renal embolism is recognizable if the disease is considered, and a favorable outcome is common with long-term anticoagulants.


Experimental zinc deficiency in humans.

Experimental zinc deficiency in humans. The effects of a mild zinc-deficient state in humans were studied. Four male volunteers received restricted zinc intake for several weeks under strict metabolic conditions. As a result of dietary zinc restriction, a decrease in zinc concentration of plasma, erythrocytes, leukocytes, and urine was observed. Changes in the activities of zinc-dependent enzymes in the plasma such as alkaline phosphatase and ribonuclease were also related to the dietary zinc status. An adverse effect of zinc restriction on total protein, total collagen, ribonucleic acid, and the activity of deoxythymidine kinase (a zinc-dependent enzyme) in the sponge connective tissue of the two volunteers in whom this test was done was noted. During the zinc restriction period, the ammonia level in the plasma was elevated. Weight loss occurred in all subjects as a result of dietary zinc restriction. Inasmuch as the zinc-deficient state was mild, this study provides a basis for developing diagnostic criteria for zinc deficiency in humans.


Plasma zinc and copper in obesity and after intestinal bypass. Plasma concentrations of zinc and copper were measured in 15 obese patients before intestinal bypass surgery, in 27 patients after intestinal bypass surgery, and in 52 lean control subjects. Preoperatively, the obese patients had zinc concentrations that were significantly lower than in the lean control subjects (76 +/- 3 versus 89 +/- 2 microgram/dl) (+/- SEM) and copper levels that were significantly higher (147 +/- 10 versus 119 +/- 3 microgram/dl). After intestinal bypass, plasma zinc and copper concentrations were significantly lower (zinc, 62 +/- 2 microgram/dl; copper, 90 +/- 5 microgram/dl; P less than 0.001) than in prebypass patients. One patient developed leukopenia associated with a plasma copper concentration of 36 microgram/dl. Leukocyte count and plasma copper level rose with oral copper sulfate replacement therapy. Intestinal bypass surgery may produce clinically significant decreases in plasma concentrations of zinc and copper. Careful observation and replacement therapy are indicated in all patients who develop deficiences after intestinal bypass surgery.


Hepatitis from intravenous high-dose oxacillin therapy: findings in an adult inpatient population. A retrospective review of all patients who received oxacillin intravenously in doses greater than 6 g/day was done. Eight patients in whom oxacillin-associated hepatitis developed were found and compared with a control group of 46 patients who had received high-dose oxacillin and in whom oxacillin-associated hepatitis did not develop. The latent period to development of typical symptoms of hepatitis varied from 2 to 21 days. Laboratory abnormalities were compatible with anicteric hepatitis and reverted to normal after withdrawal of the drug. Oxacillin hepatitis most like represents a hypersensitivity reaction. We recommend that routine liver chemistries be done regularly in all patients receiving high-dose intravenous oxacillin.


Bullets, lead poisoning and thyrotoxicosis. A patient with a retained bullet developed lead poisoning in association with thyrotoxicosis. The clinical and laboratory data suggest that lead was mobilized from an increased mobile bone pool during the hypermetabolic period with resultant poisoning. The findings give factual support to earlier concepts that lead poisoning may occur during periods of metabolic change in an individual with an increased body lead burden.


Immunity in Hodgkin's disease: importance of age at exposure. A relatively common viral agent of low virulence and infectivity might be of etiologic importance in Hodgkin's disease. Age at initial exposure is a major determinant of the outcome of infection (immunity versus clinical disease) and the different epidemiologic patterns for this lymphoma observed internationally. Early exposure, particularly when it occurs in persons from high birth ranks, is associated with a relatively durable immunity. In contrast a delay in initial exposure, also mediated by family factors, results in higher clinical disease-to-immunity ratio. The large male excess in childhood Hodgkin's disease might be due to some sex-linked environmental factor operating early in life and the greater frequency of an asymptomatic carrier state in this sex.


[A model of biological structure adequate for a dynamic organicist concept of psychiatry]. A "dynamic organicist" conception of the psychiatry is credible only with a pattern of biological encephalic structure corresponding with the complexity and lability of the psychology and psychopathology features. The author reports the results of researches of his group by electron microscopy concerning the human cerebral cortex, permitting to elaborate adequate pattern. The encephalic structures are very complex, changeable, labile, therefor her variations can correspond with the "psychologics" variations.


Stability of R plasmids belonging to different incompatibility groups in Vibrio cholerae "Eltor". Twenty two resistance plasmids belonging to fourteen incompatibility groups have been transferred by conjugation into two sensitive strains of Vibrio cholerae "Eltor". Only five plasmids were stably inherited in these strains: four of these belong to group incC, and one to group incJ. All other plasmids were lost at high frequency when the bacteria were grown in drug-free medium. These facts might explain why very few multiresistant strains of V. cholerae have been isolated so far but do not exclude the possibility that epidemics of V. cholerae carrying pecular R plasmids might be observed in the future.


Antimicrobial susceptibility of rhamnose-positive Yersinia enterocolitica. Agar dilution antimicrobial susceptibility tests were carried out against rhamnose-positive Y. enterocolitica strains isolated from various origins. All the strains were susceptible to aminoglycosides, chloramphenicol, tetracycline, minocycline, rifampicin, trimethprim and sulfamethoxazole. All but two strains were susceptible to polymyxin. Resistnace to ampicillin, carbenicillin and cephalothin was noted with the majority of the strains.


The role of cryotherapy in the management of early lesions of retinoblastoma. Cryotherapy alone has destroyed as isolated retinoblastoma lesion in the fellow eye of a proven case of retinoblastoma. Follow-up for 14 months revealed no evidence of recurrence. Literature review has shown that cryotherapy has unique advantages in the treatment of retinoblastomas.


Ocular abnormality in myotonic dystrophy. A 61-year-old white woman with terminal myotonic dystrophy exhibited advanced peripheral and central retinopathy. Retinal lesions were characterized by hyperpigmentation, common, though nonspecific, in myotonic dystrophy. They resemble both heredo (tapetoretinal) and idiopathic involutional degenerations but rarely cause severe visual impairment. Neither the type nor degree of retinopathy appears to correlate with other ocular features or with the stage of the underlying disease. Our histologic observations confirm and extend those previously described. Electron microscopy suggests a primary disorder of mitochondria which may also affect smooth muscle and the myocardium.


Charcot-Marie-Tooth disease mimicking ocular myasthenia gravis. The purpose of this report is to alert the ophthalmologist and neurologist to the fact that intermittent ocular symptoms may herald the onset of chronic progressive external ophthalmoplegia and therefore resemble the weakness produced by myasthenia gravis. In addition, chronic progressive external ophthalmoplegia may complicate the course of Charcot-Marie-Tooth disease.


Responsiveness of the rabbit eye to adrenergic and cholinergic agonists after treatment with 6-hydroxydopamine or alpha-methyl-para-tyrosine: Part I--Pupillary changes. The responses of rabbit pupils to graded doses of both adrenergic and cholinergic drugs after chemical sympathectomy with 6-hydroxydopamine have been examined. For comparison, similar data were obtained in rabbits treated chronically with the norepinephrine synthesis inhibitor, alpha-methyl-para-tyrosine. While quantitative differences were apparent, the effects of these 2 treatments were qualitatively similar. In both cases, a marked reduction in the responsiveness of the iris to cholinergic agonists accompanied the development of supersensitivity to adrenergic amines.


Unusual course and long-term follow-up in malignant glaucoma. One man and 2 women, aged 67, 63 and 68 years, observed for 8, 6, and 2 years, developed a classical postoperative malignant glaucoma. After a second operation, the use of atropine drops was continued for 2 years in one case, whereas in the other 2 cases miotics and later acetazolamide (Diamox) were necessary in order to maintain normal intraocular pressure. All 3 patients refused a preventive operation in the fellow eye and the use of miotics proved both necessary and effective in maintaining normal intraocular pressure, normal visual acuity, and normal visual fields.


Peripheral photocoagulation in the treatment of disc neovascularization. Forty-two eyes in 30 patients with disc neovascularization were treated by the method of extensive photocoagulation of the retinal periphery (ablation). Total obliteration of disc neovascularization was accomplished in 76% of eyes treated. Partial regression was noted in 21% of eyes treated. There were only 2 major complications--traction retinal detachment and one major hemorrhage--in this series. Feeder-frond treatment was necessary to obliterate recurrent disc neovascularization in 2 eyes. It is concluded that therapy is efficacious in the treatment of papillary neovascularization.


Trabeculectomy.

Trabeculectomy. Trabeculectomy as first choice of treatment has been performed on 100 consecutive cases in Africans. During the follow-up period ranging from 2 to 12 months, 79 eyes had a postoperative intraocular pressure of less than 21 mm Hg without any antiglaucomatous medications. Fourteen eyes operated upon (14%) had a postoperative intraocular pressure between 22 and 26 mm Hg. Seven cases (7%) showed an intraocular pressure higher than 28 mm Hg. Hypotony and hyphema encountered in 8 cases were a minor postoperative complication. Protrusion of the iris in the surgical wound occurring in 2 cases was a major complication. A correlation between the intraocular pressure one week and 28 weeks postoperatively showed that in most cases the intraocular pressure was higher after the longer follow-up. However, out of a group of 25 eyes operated upon showing an intraocular pressure of 14 mm Hg or less, one week postoperatively, only one eye (4%) showed an intraocular pressure higher than 20 mm Hg on the longer follow-up.


Late hyphema due to vascularization of the cataract wound. Nineteen patients with hyphema due to fibrovascular tissue in the cataract wound were seen. In 3 patients the hyphema occurred after closure of an unitentional filtering bleb. Two patients receiving anticoagulants before and after the hyphema occurred did not have recurrence of the bleeding. In one patient the hyphema was induced by scleral depression. This benign condition is frequently misdiagnosed. When erythrocytes are seen in the anterior chamber of an aphakic patient, vascularization of the cataract wound should be suspected and confirmed by gonioscopy.


Keratoconus and atopic diseases.

Keratoconus and atopic diseases. In a survey of 162 keratoconus patients, we set out to investigate individual conditions, such as asthma, hay fever, connective tissue syndromes, and eye rubbing, and to determine their relationship of keratoconus. It was found that the prevalence of asthma rises from 0.4% to 1% in the control group to 17.9% in the keratoconus group, or an eighteenfold increase. In addition, the incidence of hay fever in keratoconus patients was found to be 35.7%. As multifactorial disorders, keratoconus and asthma may share some of the multiple genes necessary for the expression of the disorder. Previous findings of excessive eye rubbing in keratoconus patients were confirmed in this study. Finally, we found that the incidence of connective tissue disorders associated with keratoconus was negligible.


Burns of the eyes and eyelids.

Burns of the eyes and eyelids. One hundred and ten lid and eye burn cases are reviewed in a series of 552 severe body burn cases. The causes, location, handling, and end results of these cases are described.


[The reconstitution of the digestive epithelium in Lymnaea (Galba) truncatula Müller infested by larval forms of Fasciola hepatica L (author's transl)]. In L. truncatula at the end of parasitic cycle, the reconstitution of the digestive gland consists in development of peripheral tubules with strait diameters. The tubular epithelium--like stomach and intestine epithelia--show cellular hyperplasia with anisocaryosis. The cellular activity--normal at first--increases then along the infestation period.


[Neoparasitylenchus megabothridis n. sp. (Tylenchida: Allantonematidae) parasite of Megabothris tubidus (Siphonaptera: Ceratophyllidae); observations on fleas tylenchides in the S.W. of Europa (author's transl)]. A number of nematodes (Tylenchida, Allantonematidae) were observed in 11 species of Siphonaptera from the South-West of Europe. The fleas belong of 4 differents families (Pulicidae, Vermipsyllidae,Hystrichopsyllidae, Ceratophyllidae). Neoparasitylenchus megabothridis n. sp., parasite of the flea Megabothris turbidus (Rothschild, 1909), is described and the life cycle given. It shows little pathogenicity to tis host. Psyllotylenchus sp. parasite of Nosopsyllus fasciatus (Bosc, 1801), appears to be a teratogenic and causes a feminisation of parasitised males and a masculinisation of females. A generic determination cannot be made with any certainty in the material collected from others fleas.


[Description of P. cyclopsi n. sp. a parasite of the microchiropteran bat Hipposideros cyclops in Gabon (author's transl)]. P. cyclopsi sp. nov. is characterized by the small size of the asexual stages and by gametocytes belonging to the type "malariae". It is related to P. anomaluri and the hosts of both species share the same habitat: hollow trees of the tropical forest. By the ancientness of its vertebrate host and its relationship with the "malariae" group of Haemosporidia P. cyclopsi is interpreted as a primitive species.


Repair in acute and chronic ulcers.

Repair in acute and chronic ulcers. The process of ulcer healing is still incompletely understood and the cause of delayed healing in chronic ulcers is unknown. The work described here is concerned with certain aspects of epithelial repair in experimental ulcers--that is, mitotic activity, cell migration, and cell re-establishment with differentiation, using light and electron microscopy. The findings have been compared with similar observations on human gastric and venous ulcers. The results have shown that increased mitotic activity and attempted cell migration are able to persist throughout epithelialisation of experimental lesions and that the chronicity of human ulcers cannot be explained by a lack of new epthelial cell production or failure of these cells to assume a migratory form. Some other basic defect in the healing process must therefore be present.


[A new Typhloceras from Catalonia (author's transl)]. T. favosus claramuntae, parasitic on the shrew Crocidura russula russula is described from Isle Meda Gran, Girona (Spain). This subspecies can be separated by morphology and chaetotaxy of sternit VIII. Only the male is actually known.


Fibreoptic choledochoscopy in common bile duct surgery. Fibreoptic choledochoscopy permits visual examination of the interior of the bile ducts during operations for gallstones. But it does not replace operative cholangiography, and the common bile duct should not be opened simply to perform choledochoscopy. Operative choledochoscopy following conventional exploration and removal of stones ensures that the ducts are clear before insertion of a T tube and closure, avoiding the problem of the retained stone. Exploratory choledochoscopy with stone retrieval under direct vision is less traumatic to the ducts than conventional blind methods, and visual confirmation that the lower end of the duct is clear and the papilla patent may allow the common bile duct to be closed without a T tube, shortening the patient's convalescent period.


Incisional treatment of obstruction of the female bladder neck. Obstruction of the female bladder neck has been treated in 9 cases by endourethral incision of the bladder neck anteriorly through an operating nasal speculum with very satisfactory results which compare very favourably with those of Y-V plastic reconstruction of the bladder neck in 8 similar cases. The advantages of the incisional technique are simplicity of the procedure, shorter operative time and postoperative stay, and absence of the need for blood transfusion; its complication rate is very low and the procedure may be repeated if necessary.


[Life cycle of the trematode Echinostoma caproni Richard, 1964 (Echinostomatoidea) (author's transl)]. The life cycle of the Trematode Echinostomatoidea Echinostoma caproni Richard, 1964, develops under natural conditions in Madagascar in a bird Falco newtoni and in a Gastropod Biomphalaria pfeifferi. Metacercaries encyst in other Molluscs and in the kidney of an Amphibian Ptychadaena mascareniensis. The cycle has been reproduced experimentaly in France. The defivitive hosts are the white mouse, the rat and the chick. Biomphalaria galbrata is the first and the second intermediate host. Metacercaries encyst in different Molluscs and in the kidney of tadpoles of Rana esculenta. The larval stages are described. The cycle pattern and the morphology of larval stages are quite similar to those of Echinostoma liei Jeyarasasingam and coll., 1972.


Role of resection in typhoid perforation. Typhoid perforation is a surgical emergency and the treatment should be prompt and energetic; the role of conservative treatment is limited. The surgical procedure depends on the general health of the patient and the extent of ileum involved. Resection is preferable, but lesser procedures have their place in appropriate cases. Indecision kills; so does undue delay. The mortality in active intervention is low.


Excretory patterns of urinary free 11-hydroxycorticosteroids and total oestrogens throughout the normal menstrual cycle. The excretion of urinary free 11-hydroxycorticosteroids and total oestrogens was studied daily in morning urine specimens throughout the menstrual cycle of six normal women (age range 18-24 years). The follicular phase of the cycle was characterised by apparently random fluctuations in the excretion of urinary free corticosteroids. However, after the mid-cycle oestrogen peak there occurred a significant drop in corticosteroid excretion, which then rose to a peak eight to 10 days after ovulation and was synchronous with the second oestrogen peak during the luteal phase.


Significance of blood cadmium concentrations in patients with renal disorders or essential hypertension and the normal population. Cadmium concentrations in whole blood have been determined in normal control subjects, in patients with untreated essential hypertension or with treated essential hypertension, and in those with acute or chronic renal disorders. High cadmium concentrations were not found in the patients with untreated essential hypertension. Most tobacco smokers were found to have high blood cadmium concentrations. When the mean cadmium concentrations from each group of patients were compared with those of the control subjects no significant differences were found. When the four groups were divided into smokers and non-smokers, however, a significantly higher mean value was found for the non-smoking renal patients in comparison with the non-smoking normal subjects. The marked increases in blood cadmium concentration in the patients with renal disorders may be attributed to impaired excretion.


Discrepancies in thyroxine measurement in pregnancy between radioimmunoassay and competitive protein binding (Oxford StaT4). The StaT4 test is a technically simple test of thyroxine measurement, which apparently gives results in good agreement with those derived by radioimmunoassay in most patients. In pregnancy, however, falsely low serum thyroxine values were found with the StaT4 test when compared with either a radioimmunoassay or the Thyopac-4 test. Detailed studies showed that the discrepancy resulted from the extraction technique used in the StaT4 test, which appears to allow the patient's thyroxine binding proteins to remain in the assay system. Similar method discrepancies were observed in other clinical conditions associated with elevated thyroxine binding globulin concentration. This study, as well as being of practical clinical importance, has implications for the design of competitive protein binding tests of thyroid function.


Measurement of acetate in aqueous solutions and plasma by gas phase chromatography using a porous polymer stationary phase. A method of acetate determination by gas phase chromatography using a porous polymer stationary phase is reported that is suitable for use with aqueous and plasma samples. It is linear up to 100 mmol/l and has a coefficient of variation of less than 4% for acetate values of greater than 1 mmol/l. The recovery of acetate from plasma is 92% and sample retention time is 3 minutes. The reference range of plasma acetate in a group of 40 apparently healthy subjects was from less than 0.1 to 0.35 mmol/l. The frequently encountered problem of absorption and ghosting of volatile fatty acids is overcome without the addition of formic acid vapour to the carrier gas.


An on-line work scheduling and ward requesting pattern information system. The organisational efficiency of sample admission to the routine laboratory and the allocation to test methods has been improved by a scheduling system based on an on-line mini-computer. A flexible system has been constructed using multiple visual displays, which produce work allocation lists. Computer techniques have been developed which enable maximal use of the on-line system while retaining the general flexibility of high-level language coding, as implemented on an unsophisticated 12-bit processor. The file structure has been designed to provide cumulative information on the requesting patterns appropriate to any of the many sources of samples to the laboratory, and to allow the automatic merging of worksheet and laboratory data, the latter being generated and transmitted from a second mini-computer system.


Induction of suppressor cells in mice by cyclophosphamide. The injection of a single sublethal dose of cyclophosphamide (CY) into adult C3H/He mice induced splenic atrophy followed by considerable hypertrophy. During the phase of splenomegaly, the in vitro reactivity of spleen cells to the mitogens phytohaemagglutin and lipopolysaccharide was drastically decreased. Furthermore, the spleen cell population from CY-treated mice contained suppressor cells capable of inhibiting the in vitro reactivity of normal lymphocytes to these mitogens. After the removal of adherent cells, the suppressive activity was completely absent from the remaining fraction. The suppressive activity was also abolished after treatment of spleen cells with anti-immunoglobulin antiserum plus complement (C). After treatment with anti-Thy 1-2 antiserum plus C, the suppressive activity was not modified. Nude mice, B mice, young and old NZB mice, also developed suppressor cells with similar functional characteristics when treated with CY. However, in Nude mice the suppressor cells were not adherent and did not bear surface Ig. After fractionation of spleen cells by velocity sedimentation, the suppressive activity was detected in the fastest fraction with a velocity over 5 mm/h.


Transaqueous diffusion of acetylcholine to denervated iris sphincter muscle: a mechanism for the tonic pupil syndrome (Adie syndrome). The accepted hypothesis for the pathophysiology of tonic pupil syndrome (Adie syndrome) was reexamined in light of recent developments concerning denervation supersensitivity of cholinergically innervated smooth muscle. Kinetic analysis suggests that enzymatic hydrolysis is unimportant relative to convective diffusion in the turnover of acetylcholine in the aqueous humor. We postulate that the greater response to near stimuli than to light stimuli and the delay in iris sphincter contraction and relaxation can be explained by release of acetylcholine from the neuromuscular junction of the ciliary muscle followed by transaqueous diffusion to receptor sites on denervated, supersensitive iris sphincter muscle.


Pseudoxanthoma elasticum: a review of neurological complications. A case of pseudoxanthoma elasticum with multisystem involvement is described. Neurological complications, as reported in the literature, are reviewed. These include cerebrovascular insufficiency, multiple lacunar infarcts, aneurysms, subarachnoid and intracerebral hemorrhages, progressive intellectual deterioration, and psychic and mental disturbance which may be due to cortical atrophy. Seizures occur more frequently than in the general population. Hypertension and alteration of cerebral vessels are the two basic pathophysiological mechanisms responsible for the neurological complications of this disease.


The effect of a water soluble adjuvant on the immune response to synthetic polypeptides. The effect of a water soluble adjuvant (WSA) extracted from mycobacteria on the immune response to synthetic polypeptides has been studied in rabbits and inbred mice. WSA increased the antibody response of rabbits to the synthetic polypeptide poly(Tyr,Glu)-poly(DLAla)--poly(Lys) designated (T,G)-A--L when injected together with either incomplete or complete Freund's adjuvants (FIA or FCA). As compared to the respective controls, the effect of WSA was more pronounced when injected with FIA. No detectable antibody titre was observed in rabbits immunized with (T,G)-A--L and WSA administered in an aqueous medium. WSA had no enhancing adjuvant effect on the antibody response of C3H.SW high responder mice to (T,G)-A--L when given either with FIA or with FCA. However, the antibody titres of C3H/HeJ and SJL low responder mice to (T,G)-A--L were increased by WSA when injected in combination with FIA or FCA. The immune responses of mice to two other synthetic polypeptides poly(Phe,Glu)-poly(DLAla)--poly(Lys), designated (Phe,G)-A--L, and poly-(Tyr,Glu)-poly(Pro)--poly(Lys), designated (T,G)-Pro--L, were not affected by the addition of WSA. Thus, WSA "corrects" selectively the genetic defect of low responder mice to synthetic antigens.


Nemaline (rod) myopathy: the need for histochemical evaluation of affected families. Histochemical changes in the mother of a patient with nemaline myopathy were used to identify her as the gene carrier even though rod-bodies were not present in her muscle biopsy and she was not weak. The patient and her mother both had marked type I fiber predominance with large groups of type I fibers present. Histochemical changes known to occur in nemaline myopathy include smallness and predominance of type I fibers. Such changes support the concept that this disease may result from subtle defects in innervation since fiber types are determined by innervation. Although this disease is thought to be transmitted by autosomal dominant mode, lack of male-to-male transmission and a predominance of female cases in the literature suggest that this may be (1) an X-linked dominant, (2) a sex-influenced autosomal dominant, or (3) an autosomal dominant which is semilethal in males. The family described here is the first in which a presumably affected parent showed only the histochemical change without rod-bodies, thus emphasizing the importance of histochemical evaluation of relatives' biopsies for genetic counseling.


Computed tomography in late-infantile metachromatic leukodystrophy. Computed tomography of 2 patients with late-infantile metachromatic leukodystrophy (MLD) demonstrated generalized white matter lucency and moderate ventricular enlargement. CAT scan findings in other white matter diseases likely to be confused clinically with MLD are sufficiently dissimilar to allow differentiation.


Interference between two immune responses. II.--Conferrability by the serum of the influences exerted by a response to horse RBC on the subsequent response to sheep RBC in the mouse. Serum taken from mice responding to HoRBC and given to syngeneic mice influences the kinetics of a subsequent anti-SRBC response. The serum taken at the 36th of the anti-HoRBC response exerts after transfer an accelerating effect on the anti-SRBC response while this of the 7th day has an inhibitory effect. Both effects are especially demonstrative on mice irradiated and restored with spleen cells from a single donor because of the low variation coefficient of their anti-SRBC response.


Radiation myelopathy in children.

Radiation myelopathy in children. Three children, 1 with medulloblastoma, 1 with anaplastic cerebellar tumor, and 1 with acute lymphocytic leukemia, received craniospinal irradiation with an estimated cord dose between 1,100 and 1,200 rets. All 3 patients after a latent period of seven to eight months developed subacute transverse myelopathy. The myelopathy was cervical in 2 patients and thoracic in 1. Spinal fluid examination showed high protein levels in 2 patients. Myelography demonstrated a swollen cord in 2 patients and normal appearance in 1. Autopsy in 1 patient disclosed a necrotizing myelopathy. The findings suggest that children tolerate less well than adults what previously have been considered safe doses of radiation to the spinal cord.


The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms. Fifty-two patients with acute and subacute transverse myelopathy (TM) were evaluated at the Massachusetts General Hospital between 1955 and 1975 and followed for 1 to 23 years (average, 5). Nineteen had symptoms of a recent acute infectious illness, 3 had cancer, and 1 had undergone a recent operation. There were four types of initial symptom. Twenty-four patients had paresthesias at the onset of the illness, 18 had pain, usually interscapular, 7 had leg weakness, and 3 had urine retention. Prognosis depended on the nature of the onset of TM. An acute catastrophic onset was generally associated with back pain and led to a poor outcome in 7 and a good outcome in only 1 of 11 patients. A subacute progressive onset over several days to four weeks, generally with ascending paresthesias or leg weakness, was associated with a good outcome in 15 and fair outcome in 17 of 37 patients. Preceding febrile illness, treatment with corticosteroids, and the nature of CSF abnormalities had no effect on outcome. Multiple sclerosis evolved in 7 patients during the follow-up period. Because of the frequency with which mass lesions were missed, the need for myelography in the diagnosis of TM is emphasized. The distinguishing clinical characteristics of TM provide guidelines for diagnosis and prognosis.


Predictive control of eye movements in Parkinson disease. Four parkinsonian patients who had shown evidence of an impairment of predictive manual control and 4 age-matched normal subjects were tested for the predictive control of eye movements. Subjects tracked a target with their eyes as it moved in either irregular "noise" or regular (predictable) linear ramp or sine waveforms. Eye movements were monitored by electrooculography, and the overall tracking time lag for each condition was determined by cross-correlation. Both normal and parkinsonian subjects showed prediction in eye tracking on the regular waveforms (zero time lag or anticipation of the target track), indicating that (1) the parkinsonian loss of predictive control in manual tasks is not due to defective control of eye movements, and (2) there may be separate predictor mechanisms in the brain for eyes and hands.


[The rabbit's appendix: an immunological model applied to the study of epithelial immunity (author's transl)]. The rabbit's appendix is a pecular lympho-epithelial formation as it includes both areas of thymus-dependent lymphocytes (the interpolated sieved lamina) and non-thymus-dependent lymph nodes. The epithelium joining the intestine lumen and the lymphatic tissue contains cells that become permeable at the contact of lymphocytes. These "tranformed" enterocytes are crossed by antigenic molecules, bacteria, yeasts and evolutive forms of coccidia. Lymphocytes within--as well as reticular cells below the epithelium--catch large molecules, especially antigens, thus having a share in humoral immunity. Just as those of the intestine, the enterocytes of the appendix glandular area are informed at the level of the areas of epithelial mitosis and become resistant to certain infections such as coccidosis. This particular form of immunity we have named "epithelial immunity". Thick sections provide ultrastructural views physically showing information exchanges. Intercellular exchange by contiguous endoplasmic reticular canaliculi at the interface of two cells have thus been demonstrated. They have been as clearly observed between two epithelial cells at between two cells of connective origin and again between an epiethelial cell and a lymphocyte.


[Delayed local reaction (DLR) after BCG vaccination in mice. II.--Correlations with the immune response (author's transl)]. The occurrence and intensity of the DLR were correlated with different parameters of the specific and non-specific immune response induced by the inoculation of viable BCG into the footpad. A good parallel exists between the occurrence of the DRL and effector mechanisms which tend to limit the growth of BCG in the draining node, and also with the appearance of tuberculin hypersensitivity measured in vivo by skin-test. Nonspecific immunity induced in mice after subcutaneous BCG injection was measured using the relative spleen weight, and this correlates well with the onset of the DLR. Delayed type hypersensitivity (DTH) to varying doses of sheep red blood cells (SRBC) injected intravenously in normal or in subcutaneously BCG-pretreated mice indicated a functional increase of the reticuloendothelial system activity, 14 days after BCG injection. Lastly, the degree of adjuvanticity induced by BCG vaccination to DTH against SRBC which were injected in the same footpad, was strictly correlated with the kinetics of the DLR. The value of measuring DLR in mice is discussed concerning the evaluation of the immunogenicity of BCG vaccines and slso the host's capability to mount an immune response after subcutaneous BCG injection.