[Cystic lymphangioma of the neck in childhood (author's transl)]. Over a period of seventeen years (1960--78) we have collected twenty two cases of cystic lymphangioma of the neck out of ten thousand patients admitted to our Department. Of these cystic lymphangioma cases, thirty three per cent occurred in the neo-natal period. All these tumours were operated upon with only two fatalities. In only one case the operation was done in two stages due to a huge mediastinal prolongation. We discuss here the embryology, the clinical evolution, the pathology, the diagnosis and the treatment of this type of cystic lymphangioma.


[Mesenteric cystic lymphangiomas (report of three cases) (author's transl)]. Three cases of mesenteric cystic lymphangiomas in children are reported. All of them were found during laparotomies for acute abdomen, and their pathology was rather similar, except for the contents which was chylous in the two cases located in the jejunum and serous in the remaining ileal case. One of these tumours contained calcified material, a fact which makes diagnostic suspicion possible. The literature on this topic is up-dated.


[Socio-psychological concepts of status, role and norm, and systemic mechanisms in the psychotic family]. Socio-psychological contributions can improve the systemic approach to family therapy. For instance, the notions of "role", "status" and "norm" discussed in this paper, can be applied to the concept of "identified patient". This appears to be the only pathological designation, as role assignment per se is not necessarily abnormal. It is suggested that pathogenic mechanisms playing a part in psychotic families, can also be used therapeutically. Family therapy tends to confirms the principle that small group norms are more readily modified than those of single individuals.


[Transsexualism].

[Transsexualism]. According to the literature, the transsexual phenomenon can be assessed as a distinct psychiatric illness. Transsexualism, a rare but spectacular disorder, realizes a gender identity reversal raising questions regarding systems of psychiatric diagnosis, nosology and treatment. A better clinical knowledge of this "experiment" and its follow-up allow studying processes contributory to marked deviation of gender identity and furthering concepts of development of masculinity and feminity. Current research deals with hypotheses that can be stated as testable propositions about underlying dynamics in various fields: learning factors, psychoanalytic components and psycho-biological data. Focusing on the early infantile development and the environmental influences reflects a variety of non specific psychogenetic precursors. The treatment of "gender dysphoria syndrom", i.e. hormonal treatment, sex-reassignment surgery and psychotherapic processes, aims towards réduction of psychic pain and social adjustment in the cross-gender role. Transsexual phenomenon largely overlaps the psychopathological area; beyond surgical and medical aspects, social implications and legal positions refer to an ethical problem.


[The management of corrosive oesophagitis (author's transl)]. Regardless of the treatment used against corrosive oesophagitis, the laryngologist must play a role from the beginning and throughout the course. The fibroblasts and collagen fibres which results are the natural agents of healing but, at the same time, are responsible for virtually inexorable stenosis if the corrosion has passed through to the muscular layers. Infection is constant and contributes to stenosis. The effectiveness of antibiotics is certain. They must be used from the beginning and continued for as long as necessary. As far as fibroiss is concerned, dilatations remain the basic treatment, their application requiring great experience and much patience and tenacity. Replacement surgery is attractive. It comes up against the stenosing perioesophageal inflammatory process which tends to die down in time but remains active for a long period. The nENT specialist must therefore pay careful attention from the very end of the postoperative period onwards. The gravity of oesophageal burns justifies intensification of preventive measures. Since it impossible to complete eliminate corrosive oesophagitis, efforts must be directed towards the discovery of substances capable of inhibiting collagen synthesis. Corticosteroids used in the treatment of shock do not prevent stenosis. In the laboratory, B.A.P.N. has shown its effectiveness in the rat. Also in the rat, particularly difficult experiments are in progress using penicillinamine. Although such methods have as yet to be extended to human clinical use, there are nevertheless grounds for hope.


[Preventive treatment in caustic stenosis of the oesophagus (author's transl)]. The authors review the varioux forms of treatment used experimentally and clinically in an attempt to prevent oesophageal stenosis following ingestion of caustic substances. Corticosteroid therapy is still used by certain authors though its effectiveness is far from obvious. However, promising results have been obtained experimentally using substances such as amino-nitriles, which alter the properties of newly formed collagen.


[Experimental model for the study of caustic stenoses of the oesophagus. Trial of d-penicillamine (author's transl)]. The aim of this article is above all to describe a new experimental protocol of caustic stenosis of the oesophagus in the rat, a protocol leading to regular stanoic scarring and offering and experimental model for the trial of anti-collagen substances. Initial research with d-penicillamine appears to offer encouraging results which justify its continuation.


[Early surgical management of severe corrosive burns of the oesophagus (author's transl)]. The authors have treated, as an emergency, 120 adults with corrosive burns. Thet were 22 patients among them checked as severe burns, i. e. who underwent surgical operations. Most of them tried to kill themselves by swallowing great quantities of acid or lye. Subsequently, gastric associated burns were frequent. Critical analysis of these observations, compared with the findings of pathology and in the literature permit one to get through the early management: -- Total fiberendoscopy is a true emergency, but for the patients who actually swallowed a glass or more of strong acid and have to undergo an immediate laparotomy. -- The place ofmajor surgical operations is discussed in relation to further specialist investigations of the appearance of complications. -- The results are assessed in 13 patients who were followed up for a long period.


[Malignant change affecting stenotic scarring (caustic) of the oesophagus (author's transl)]. The authors report four cases of carcinoma of the oesophagus developing at the site of old burns. They review the classical features of this type of lesion, found in their own cases: the role of trauma from dilatations and the very long time elapsing before malignant change occurs (29 to 57 years, according to the individual cases). They discuss the prophylactic value of oesophagectomy with oesophagoplasty following severe burns with stenotic scarring. Finally, they note that whilst the treatment of these forms of carcinoma of the oesophagus is in general palliative, curative surgery may nevertheless be envisaged.


[Phlebectasia of the internal jugular vein post injury (author's transl)]. The authors present the case of a 14 year-old girl having the cervical deformity developed on the background of influenza and sore throat and was caused by an apparently minor sports injury, with vertebrocervical lesion and rupture of the inner wall of the jugular vein. The painful onset symptomatology, initially attributed to exacerbation of the anginous process and cervical adenitis, evolved towards phonation, deglutition, nervous and final respiratory disturbances. The progressive evolution and gravity of the clinical picture imposed craniocervical surgery, with exclusion of the lateral intramastoid sinus and resection of the extensive ectatic cervicoprevertebral pouch. The authors discuss the mechanism of the vascular lesion, the clinical picture, evolution, diagnosis and therapy, which totaly differed from classical descriptions of phlebectasia of the jugular vein.


A redescription of Trypanosoma cotti Brumpt and Lebailly, 1904 and its development in the leech, Calliobdella punctata. Trypanosoma cotti Brumpt and Lebailly, 1904 is redescribed from Brumpt's blood slides prepared from the sea scorpion (Enophrys bubalis). Developmental stages occur in the intestine of the marine leech Calliobdella punctata, which acts as the vector. Division occurs only in the amastigote stage which subsequently changes into a sphaeromastigote and epimastigote forms. Yellow pigment granules characterize all developmental stages except slender epimastigotes. No metatrypanosomes were observed.


[Epidemiology of free-living amoebae in the waters of Strasbourg (France) (author's transl)]. 164 strains of free-living amoebae were isolated from public drinking water supplies, swimming pools and official swimming ponds in Strasbourg; 11 genera and 16 species were identified. Some strains of Acanthamoeba are pathogenic for mice by intracerebral inoculation. Among the two strains of Naegleria found none is pathogenic. The results concerning free-living amoebae are compared with the level of chlorine and bromine and with the presence of bacteria in swimming pools.


[Hexabothriidae (Monogenea) from Selachii (Sphyrna mokarran) in the Red Sea. Description of a new species Erpocotyle septistoma (author's transl)]. The study of the Hexabothriidae, from Selachii in the Red Sea reveals two different species in the Hammerhead shark Sphyrna mokarran (Rüppel, 1835): Erpocotyle sphyrna (MacCallum, 1931) et Erpocotyle septistoma n. sp. The host specificity and the geographical distribution of E. shyrna are discussed.


[Life cycle of Paramphistomum togolense n. sp. (Trematoda, Paramphistomidae)]. Mature worms were obtained from a sheep experimentally infested with metacercariae issued from cercariae emitted by naturally infested snails: Bulinus (Bulinus) forskalli collected near Lomé (Togo). Miracidia were used for infection of these laboratory-reared snails which gave numerous cercariae. Larval stages are studied. Morphological and histological characters of the adult and the very peculiar shape of the sporocyst distinguish this trematode from the other known species of the genus. The superficial argentophilic structures of the miracidium and cercaria are described in detail because, to our point, they constitute the best criteria for the taxonomy of this group.


[First results of an investigation on trichinosis in wildlife in France (1976--1977) (author's transl)]. 201 red foxes, 18 brown rats, 1 muskrat, 1 red squirrel, 1 wood mouse, 8 hares, 3 rabbits, 2 wild boars, 4 roe deers, 1 chamois, 3 reindeers (for farming) were examined by peptic digestion to detect trichinosis. Eight Foxes captured in the east and south-east of France were found infested by this parasite.


Blood pressure changes during and after anaesthesia in treated and untreated hypertensive patients. The blood pressure responses of 34 unselected hypertensive patients with and without preoperative antihypertensive therapy during thiopentone-N2O-O2-relaxant-analgesic anesthesia and the immediate postoperative period were studied. The blood pressure fluctuations, expressed as differences between the highest and lowest levels of both systolic and diastolic pressure during anaesthesia were significantly (p less than 0.01) greater in untreated hypertensive patients than in treated ones. A significant decline (p less than 0.01) of the mean blood pressure values from the initial level was seen in both treated and untreated patients during the first 24 postoperative hours. Urinary output was greater (p less than 0.05) in treated than in untreated hypertensive patients during a postoperative follow-up of 4 hours. The results show that hypertensive patients treated with antihypertensive drugs until the day of operation endure the anesthesia and the operation better than untreated patients.


Maternal and foetal plasma bupivacaine concentrations in labour with segmental epidural analgesia. Maternal and foetal plasma bupivacaine concentrations were assayed following segmental epidural analgesia during the first stage of 14 normal labours. Analgesia was accomplished with 20 mg of 0.5% bupivacaine. 10 mothers received only one dose and four mothers two doses. The maternal and foetal plasma bupivacaine levels remained very low and the foetomaternal ratios were about 1:4 during the labour. At delivery, the foeto-maternal ratio increased, showing that the decline of bupivacaine concentrations is slower in foetal than in maternal plasma.


Hernia through the foramen of Winslow.

Hernia through the foramen of Winslow. An incarcerated internal hernia through the foramen of Winslow is an extremely rare cause of intestinal obstruction and about 105 such cases have been reported. An additional patient, in whom a part of jejunum was incarcerated through the foramen into the lesser sac and who was successfully treated surgically, is reported. The etiology, diagnosis, treatment and prognosis of this rare condition are discussed.


Ectopic pregnancy. Relationship to the preceding contraception. The incidence of extrauterine pregnancies in all the deliveries in this clinic has increased from 1.3% in 1968 to 2.5% in 1976. Of 163 consecutive extrauterine pregnancies during a ten month period in 1976, 40% had an intrauterine contraceptive device in situ at the time of conception. 650 healthy women who had had an IUD inserted in 1973 were follow-up for an average of 3 years and all extrauterine and intrauterine pregnanices registered while the device was in situ. 27 intrauterine and 4 extrauterine pregnancies occurred over 1,572 women-years of use. From these data it was calculated that 99.5% of all possible intrauterine implantation and 93.5% of tubal implantations were inhibited by the device. This difference is apparently the reason for the increased risk of extrauterine pregnancies in IUCD users.


The effect of tranexamic acid on the fibrinolytic activity of vein walls. 16 patients were treated with the fibrinolytic inhibitor tranexamic acid in an initial i.v. dose of 1 g followed by an oral dose of 4 g a day for one week and 3 g a day for two weeks. Biopsy specimens of superficial veins were obtained before and on the last day of treatment and examined histochemically for their fibrinolytic activity. Tranexamic acid did not suppress the fibrinolytic activity in the vessel walls, which is the most important link in the fibrinolytic defence system against thrombosis.


Tourniquet ischaemia. Clinical and biochemical observations. The duration of tourniquet ischaemia was recorded in 1000 consecutive operations on extremities under a bloodless field, the average ischaemia time was 74.11 +/- 29.52 minutes. The duration of tourniquet ischaemia in meniscectomies was 58.47 +/- 15.91 minutes, in osteosynthesis of malleolar fractures 88.46 +/- 23.33 minutes and in operations for endoprosthetic replacement of the knee joint 131.19 +/- 11.24 minutes. In 85 cases the commonly accepted two hour limit for tourniquet time was exceeded without clinical complications. LDH and CPK levels in venous blood were studied in 15 operations. No significant changes were seen in LDH levels when recorded up to 24 hours following release of the tourniquet. CPK levels increased significantly (p less than 0.05) and highly significantly (p less than 0.005) when measured three hours and 24 hours after the release of the tourniquet, respectively. The results of the study suggest that two hours of ischaemia of the extremities is relatively well tolerated.


Concomitant groin hernia.

Concomitant groin hernia. The incidence and significance of concomitant groin hernias were evaluated in a prospective study of 278 adult patients with an inguinal or femoral hernia. The material was collected in the three years 1975--77 and consisted of 290 electively operated groin hernias. The incidence of various combinations of primary inguinal and femoral hernias was 14%. Three of the 37 recurrent hernias (8%) were evidently caused by a concomitant hernial sac missed in the first operation.


Liver hilus dearterialization. A standardized surgical method in dogs. A standardized and angiographically controlled liver hilus dearterialization was performed in 21 harrier dogs with (7) or without (14) cholecystectomy. Six sham-operated dogs were used as controls. All dogs had repeat laporatomies performed on the first and seventh postoperative days. Seven dogs died, only one from the group with added cholecystectomy. If the gall bladder was left in place following dearterialization it was found to be gangrenous in all animals by the next day. On the seventh day gall bladder perforation and bile peritonitis occurred in four of the eight surviving dogs. Cholecystectomy associated with the dearterialization had a striking effect on the incidence of intra-abdominal complications. The basic microscopic structure of the liver was not affected by the operation. Selective hepatic angiograms before the dearterialization proved to be useful in detecting all tributaries from the hepatic artery. Angiograms immediately after the dearterialization effectively located possible unnoted arterial tributaries which could then be ligated. A method of control was thus achieved by angiograms before and after the liver hilus dearterialization.


Liver blood flow after liver hilus dearterialization. Changes in liver blood flow immediately after and during one week after a standardized liver hilus dearterialization were studied in a series of 16 dogs. An additional six dogs were sham-operated and used as controls. The liver blood flow was measured using Xe133 injections administered by two methods in every animal: into the liver parenchyma, and into the portal vein. The measurements were taken immediately before, and 15, 30, 60 minutes, and one and seven days after the operation. Xe133 wash out from the liver was found to be reduced 15 minutes after the dearterialization, measured both by liver parenchymal and portal venous injection routes (p less than 0.05). Return to normal took place rapidly thereafter. On the next day some increase in the liver blood flow was observed in both dearterialized and sham-operated dogs. The aleration was significant in the dearterialized animals as measured by portal vein injections, and in the sham-operated dogs as measured by liver parenchymal injections (p less than 0.05). On the seventh day normal Xe133 liver wash out was recorded in all animals. It can be concluded that after liver hilus dearterialization in the dog liver blood flow was decreased for a very short period of time only. Increased flow was noted as early as the next day, not only in the dearterialized, but also in the sham-operated animals. The use of adequate controls is important.


Transient liver hypoxia after liver hilus dearterialization. Dearterializaton of the liver causes changes which have been thought to be ischaemic in nature. Previous reports of direct measurements of liver tissue gas tensions have been confined only to the acute postoperative phase. In this study 15 dogs underwent a standardized and angiographically controlled liver hilus dearterialization with (6 dogs) or without (9 dogs) cholecystectomy. Six dogs underwent a sham operation and were used as controls. Liver respiratory gas tensions were measured with a Silastic tonometer intraoperatively during the first 90 minutes after dearterialization and on the first and seventh day postoperatively. Six dogs died, only one of these being in the dearterialization and cholecystectomy group. Liver pO2 decreased from the mean of 33.2 mmHg to a level of 15--20 mmHg in 20 minutes (p less than 0.05) during room air breathing. On the next day the liver pO2 values were normal. There was no difference in pO2-Values between the cholecystectomy and the noncholecystectomy groups. Liver pCO2 increased from the mean of 26.4 mmHg to 55--60 mmHg in the same time (p less than 0.05). However, on the first postoperative day normal values were seen only in the cholecystectomy group. 60% oxygen breathing prevented the changes in both liver pO2 and pCO2. No changes were noted in the liver gas tensions of the sham-operated dogs, not in the systemic arterial pO2 and pCO2 of the dearterialized animals. Thus a transient hypoxic state developed after this operation, which lasted for less than one day. This hypoxia may be prevented by 60% oxygen breathing postoperatively.


Treatment of Chlamydia-positive and Chlamydia-negative nonspecific and postgonococcal urethritis. Chlamydial and non-chlamydial nonspecific or postgonococcal urethritis in 132 men was treated with different regimens of chlortetracycline and doxycycline. Chlortetracycline 250 mg four times daily for 12.5-18.5 days given to 70 men resulted in a clinical cure of urethritis in 80% of cases (56/70). There was no difference in the cure rate between chlamydia-positive (40) and chlamydia-negative (30) cases. In no instance was the treatment failure, i.e., re-appearance of urethritis, associated with re-isolation of C. trachomatis. Forty-two men received 4-10 days treatment with chlortetracycline and their cure rate was 67% (28/42). In this group 29 men were initially chlamydia-positive and among this group 12 relapsed. In four cases this relapse was associated with re-isolation of C. trachomatis. In a group of 20 men treated with doxycycline (100 mg daily up to 20 days) the cure rate was 45% (9/20)) only.


Reproductive performance after the repair of obstetric vesico-vaginal fistulae. Between 1966 and 1976, 148 out of 162 patients with obstetrically acquired vesico-vaginal fistulae were successfully repaired in Lagos University Teaching Hospital. The reproductive performance of these patients after repair has been reviewed with special regard to menstruation, satisfactory coitus and childbearing. Before the repair of the fistulae 66 patients (40.6%) had secondary amenorrhoea ranging from 4 months to 15 years. There were 3 cases each of oligomenorrhoea and cryptomenorrhoea. After repair menstruation returned within 6 months in 58 patients. Secondary amenorrhoea is thought to be due to a combination of severe malnutrition, anaemia, endometritis, psychological upsets and occasionally endocrine malfunction due to focal anterior pituitary necrosis. Repair of the fistulae worsened gynatresia in 17 cases. Twelve patients had dyspareunia and 3 others had apareunia. Thirty-one patients achieved 38 pregnancies after repair. Thirty-two infants were delivered by lower segment Caesarean section. There were 5 vaginal deliveries and one abortion. The average birth weight was 2.96 kg. The corrected perinatal mortality was nil. Five cases had a recurrence of the fistulae after delivery and 2 others had stress incontinence. Electric lower segment Caesarean section is the ideal method of delivery.


Postprandial serum bile acids in cholestasis of pregnancy. Serum concentrations of cholic (C), chenodeoxycholic (CD) and deoxycholic (D) acids were determined both in the fasting state and after a meal using a gas chromatographic method in 14 patients with cholestasis of pregnancy. A significant rise was found in the levels of all these three bile acids, especially of C and CD. The peak level occurred 60 minutes to 3 hours from the beginning of the meal. Fasting and postprandial bile acid levels in the patients were compared with those obtained in a control group of 13 pregnant women without any evidence of disturbed maternal liver function. In the cholestasis cases, the values, especially of C, were highly elevated and increased more after the meal than in the control group. Measurement of postprandial levels of serum bile acids gives further confirmation of the presence of cholestasis particularly in those pregnant patients with a suspected disturbance in liver function whose fasting bile acid levels are only slightly elevated.


Three cases of pulmonary sarcoidosis associated with aspergilloma. Three cases of parenchymal sarcoidosis with aspergilloma are described. Emphysematous bullae due to the basic disease were thought to predispose to aspergillomas. The roles possibly played by disturbances in cell-mediated immunity, associated with sarcoidosis, and by corticosteroid therapy are discussed. Antimycotics were effective in this difficult combination of diseases. Although the aspergillomas were not completely cured, a decrease in the amount of sputum and in the frequency of haemoptysis was noted for long periods. These drugs may also be useful as protective medication against invasive aspergillosis during corticosteroid therapy in patients with aspergilloma.


Effects of anaesthesia on the psychological function of patients. The psychological effects of halothane, methoxyflurane, combined analgesic-relaxant anaesthesia, and epidural anaesthesia were assessed before one, and seven days after anaesthesia in 72 patients having operations for varicose veins. Subjective anxiety evaluation (Hamilton Anxiety Rating Scale) and personality tests of self-appraisal (Minnesota Multiphasic Personality Inventory) as well as of superficial (Wartegg's test) and profound (Rorschach's test) projection showed no significant differences among these methods of anaesthesia. Performance tests measuring memory for designs (modified Graham-Kendall memory for designs), short-term memory (digit span of Wechsler Adult Intelligence Scale), learning (nonsense word series), perception (symmetry-drawing), speed of observation (Bourdon-Wiersma) and visualization also revealed no significant psychological changes compared to the control (epidural anaesthesia) group. The methods of anaesthesia used therefore showed no harmful psychological effects and are in this respect safe in clinical use.


Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones. In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.


Feasibility of early mobilization after acute myocardial infarction. The purpose of the study was to determine the proportion of patients with acute myocardial infarction (AMI) for whom an early programme of mobilization, independent of sex and age was possible, and the main reasons for delay of mobilization. Mobilization according to the programme (sitting on day 2 and standing on day 3) succeeded for 49% of the 241 patients alive and conscious after the 1st day, and there were no significant difference with regard to age and sex. The main reasons for delayed mobilization were prolonged chest pain, conduction disturbances and pulmonary oedema. Discharge on day 10 was feasible for 58% of the 241 patients alive and conscious after the 1st day. The mean hospital stay of the patients discharged later than that was 17.3 days. The reasons for the delayed discharge were delayed mobilization, chest pain persisting while in the ward, reinfarction, social, and other reasons. Early programmed mobilization was thus feasible for almost half the patients, and mobilization had been started in over 90% of the patients by the 5th day. Nevertheless, the remarkably high proportion of readmissions (13.3% of all discharged patients) and reinfarctions (6.9%) within the 30 days following discharge may indicate disadvantages in the early mobilization of some patients.


Occurrence of risk factors in newborn infants. A study of 22359 consecutive cases. All the 22359 deliveries in 1971-1974 at the Institute of Midwifery, Helsinki, were analyzed for risk factors. 1196 infants (5.35%) had one or more risk factor at birth, the most common being an Apgar score of 6 or less at 5 or 15 minutes, hyperbilirubinaemia, and a birth weight of 2000 g or below. The other risk factors registered were neurological symptoms, respiratory difficulties, hypoglycaemia, newborn infants of diabetic mothers and cases with sepsis. 124 infants in the risk group died during the first week. This was 83% of the total neonatal mortality. Except for hyperbilirubinaemia, which was less frequent in 1974, there was no marked change in the composition of the risk group from 1971 to 1974.


[Effect of spironolactones on aldosterone synthesis and adrenal metabolism]. The authors study antialdosterones action on several enzymatic systems in subcellular fractions of animal adrenals. They report an inhibition of aldosterone synthesis located at the corticosterone 18 hydroxylation step but also at the following step of oxydation of 18 hydroxycorticosterone into aldosterone (in the duck as well as in the sheep). In contrast, these drugs do not modify the activity of several enzymes not involved in aldosterone biosynthesis. In addition, anti-aldosterones have decoupling action on mitochondrial respiration. This effect, observed by many authors on adrenal mitochondria can be considered as an illustration of competition between two electron transport chains (phosphorylative oxydation and hydroxylation) and not as a toxic effect. These in vitro results are of clinical interest as they are obtained with antialdosterones concentrations similar to that found in plasma of subjects treated with these diuretics and could explain the absence of secondary hyperaldosteronism in these subjects.


[Hypoparathyroidism in adults (author's transl)]. The authors studied the clinical characteristics of primary and post-operative hypoparathyroidism in 39 patients. Laboratory follow-up data were compared under two different treatment programs using either AT 10 or 25 Hydroxycholecalciferol (25 OHCC). Clinical analysis revealed the atypical characteristics of primary hypoparathyroidism. From a therapeutic standpoint, AT 10 and 25 OHCC were equally effective in provoking a return to normal plasma calcium levels, except in complex cases of vitamin D resistance. 25 OHCC proved much easier to manipulate than at 10 and offered a higher security with respect tothe risk of hypercalcemia. The biological activity of 25 OHCC seems to differ from that of AT 10, especially regarding phosphorus metabolism.


Relative increase of serum reverse T3 in patients with hypothyroidism. In 17 hypothyroid patients serum T3: rT3 ratio was 7.5 /+- 1.1 which was significantly lower than in control subjects (12.2 /+- 0.6; p less than 0.001). The data suggest that in hypothyroidism the organism might shift conversion of T4 from biologically active T3 to biologically inactive rT3 which may not be a defense mechanism of the body, as it was found in chronic systemic illness.


[Androgen activity of dysgenesic rats' testis. Histochemical, ultrastructural studies and radioimmunoassay of testosterone]. Androgen activity of rat testis submitted to a radiomimetic, Misulban, during prenatal development has been explored with different technics. Histochemical method shows the presence, in the interstitial cells, of delta5-3beta-hydroxysteroid dehydrogenase (delta5-3beta-HSD), and others enzymes of cellular metabolism, particularly the glucose-6-phosphate dehydrogenase (G6PDH) which is a glucidic enzyme implicated in the specific metabolism of steroidogenesis. From ultrastructural point of view interstitial cells contain the organels proper to steroidogenetic cells (important smooth endoplasmic reticulum, many voluminous mitochondria with tubular cristae). The plasma testosterone concentration measured by radioimmunoassay, confirms the androgenic function of interstitial tissue in dysgenesic testicles.


The genetic and demographic impact of immigrants in a largely endogamous community. Historical demographic data extending back approximately 300 years were analysed to determine the demographic and genetic impact of in-migrants to an endogamous Swiss Alpine village. In-migrants were involved in only 14% of the marriages recorded in the village. In addition, only slightly more than 50% of the in-migrants were represented in the 1970 gene pool of the village. However, in-migrants accounted for nearly 38% of this gene pool. This seemingly anomalous situation can be explained by the fact that while the fertility of in-migrants and the marriage rate among their children are reduced (accounting for the near 50% "drop-our rate" of in-migrants from the gene pool), the fertility of the children of in-migrants and the marriage rate among the grandchildren of in-migrants are increased relative to village natives (accounting for the high proportion of genes in the gene pool ultimately attributable to in-migrants). Our results clearly demonstrate that although this community forms an endogamous population, it is definitely not a genetic isolate. Other investigators are cautioned against automatic invocation of the simplifying (and, thus, extremely tempting) assumption that endogamy is equivalent to genetic isolation.


Patterns of childhood mortality and growth status in a rural Zapotec community. Infant and childhood mortality (birth to 14 years), and growth status of 143 schoolchildren (5 to 14 years) are considered for a rural, Zapotec-speaking community (population, 1703) in the Valley of Oaxaca, Mexico. Mortality statistics are based on civil records from 1945 to 1970. Growth status is based on weight and height for age, and weight for weight for height. In the Zapotec community, about 59% of all deaths occur in children under 15 years of age; thus, a considerable percentage of individuals die before reaching reproductive age. Children under 5 years of age, however, account for approximately 54% of all deaths, and mortality in children 1 to 4 years of age is especially high (27% of all deaths). The latter figure suggests chronic malnutrition, frequent disease and generally poor circumstances in the community. This suggestion is supported in the heights and weights of schoolchildren, survivors of the rigorous selection processes of the pre-school years. The majority of children are below the 5th centile for stature in well-nourished American children. Weight for height, however, approximates that of the USA reference data.


Sex dimorphism in adult stature in four Chilean populations. The sex dimorphism for adult stature is compared in four Chilean populations which differ in their Amerindian ABO blood group composition. Statistical analysis revealed a significant association between sex dimorphism and Amerindian admixture in these populations. Assuming, on one hand, that sex chromosomes have an influence on adult stature and human growth and considering, on the other, that the four populations differ in their X and Y chromosome composition as a consequence of an asymmetrical inter-racial marriage practice, it is postulated that the observed association between sex dimorphism and Amerindian gene composition is a result of this peculiar mating structure.


Finger and palmar dermatoglyphics of a Yoruba (Nigeria) sample. Finger and palm prints of 126 male and 55 female Yoruba are reported using both quantitative and qualitative procedures. In general, the Yoruba fit into established geographical gradients for sub-saharan African populations. Whorl frequencies on the digits are relatively low, as is the frequency of palmar patterning. Finger ridge-counts, those of males in particular are high by African standards, and much higher than the previously reported data from Nigeria. Due to the lack of data on patterns of geographic variation in total finger ridge-count, little can be made of these findings at present.


The use of discriminant analysis to define obesity in children aged 7-11 years. All the elementary schoolchildren (ages 7-11 years) in the city of Aosta were diagnosed clinically for obesity and measured for height, weight and triceps and subscapular skinfolds. A statistical discriminant analysis revealed that, on the basis of these measurements, this population of children could be divided into a group of normal children and one or more distinct populations of obese children. To the extent that these groups reveal qualitative phenotypic differences, they should simplify genetic studies of obesity.


A study of some genetic characteristics of the population of the Sudan. 300 random blood samples collected from residents of Khartoum, Sudan, were analysed for 5 blood group systems, 4 serum proteins, 9 red cell enzymes, abnormal haemoglobins and beta-thalassaemia. The results suggest varying degrees of admixture of the local tribes by migration from the surrounding regions. Two samples showed a probable new variant of glucose 6-phosphate dehydrogenase (? GdB Khartoum) with normal red cell activity. In spite of the presence of a high degree of consanguinity in the population, there was no significant deviation from Hardy-Weinberg equilibrium in any of the polymorphic systems.


The distribution of immunoglobin allotypes in two Tlaxcaltecan populations. The distribution of Glm(f, z, a, and x), G3m(b0, b1, b3, b5, c3, c5, g, s, t and v), A2m(1 and 2) and Km(1) (formerly Inv(1)) allotypic determinants has been examined in specimens from the inhabitants of two transplanted Tlaxcaltecan villages (Cuanalan and Saltillo). The results indicate that Gmza;g Am1, Gmza;g Am2, Gmzax;g Am1, Gmza;bst Am1, Gmza;bst Am2, Gmf;b Am1, Gmza,b Am1, Gmza;b Am2 and Km1 are polymorphic or marginally polymorphic in both populations, while Gmza;bc3,5 Am2, Gmza;bs Am2, and Gmzax;g Am2 were detected only in Saltillo. Two related individuals from Saltillo have either a Gmf;g Am1 or Gmf;-Am1 haplotype while a third unrelated individual had either a Gmf;g Am1 or Gm-;g Am1 haplotype. The frequencies observed for "residents" of Cuanalan are similar to those for other Indian populations in Mexico. Estimation of Caucasian and African admixture within the two communities indicates significant heterogeneity among the inhabitants of Cuanalan, in that Tlaxcaltecan residents have no detectable African admixture and significantly less Caucasian admixture than recent immigrants, with Tlaxcaltecan-immigrant hybrids intermediate, while no significant variation was observed among the subdivisions of Saltillo. However, Saltillo has greater Caucasian and African admixture than Cuanalan. Admixture estimates based on Gm haplotypes appear to agree much better with known historical events than those generated by blood groups, indicating that Gm is a better estimator of admixture than blood groups under certain circumstances.


Estimation of body fat and lean body mass from anthropometric dimensions in adult Indian women. Mean values and standard deviations of body fat and lean body mass of 65 young Indian women aged 20-25 years were 9.00 kg, SD 6.14 and 36.02 kg, SD 3.99 respectively. Body fat per cent was 18.72 SD 10.48. On selective stepwise multiple linear regression analysis, the measurements selected for predicting body fat % were maximum thigh girth, chest diameter, height up to gluteal furrow and shoulder diameter, all four together giving a multiple correlation coefficient of 0.88. For predicting lean body mass, the measurements selected were stature, upper arm length, lower thigh girth and chest diameter, all four together giving a multiple correlation coefficient of 0.84.


Peripheral nerve ischemia: Part 2. Accumulation of organelles. Following simultaneous ligation of the aorta and femoral artery in the cat, organelles accumulated in distal portions of the sciatic nerve and in lower portions of the tibial and peroneal nerves. The accumulations were located in the proximal and distal ends of the nerve infarction and delineated the borders of the necrotic area. Topographical analysis of the necrosis and organelle accumulations following ligation of these main arteries showed the larger nerve fascicles to be more sensitive to ischemia than the smaller ones. The center of a nerve fascicle was more sensitive than the periphery. The organelles accumulated in ischemic nerves during the first hours after arterial ligation, presumably as a result of lack of energy for fast axoplasmic transport. Later accumulations reflected mechanical block of axoplasmic transport due to focal necrosis of the nerve. The content of organelle accumulations was similar to that found in lesions resulting from transection except for the presence of 60 to 70 A filaments at the distal end of the infarction.


Impaired refractory periods of peripheral sensory nerves in multiple sclerosis. Maximum conduction velocity and relative refractory period (RRP) of median nerve sensory fibers were studied in 36 patients diagnosed as having multiple sclerosis (MS) and in 31 controls. Maximum conduction velocity did not differ in the two groups, but the RRP was significantly prolonged in MS patients. Increased RRP is observed mainly when peripheral nerve myelin is abnormal or damaged. Our findings support the assumption that peripheral nerve myelinated fibers are usually involved in MS.


Introduction of automated systems to evaluate touch-pressure, vibration, and thermal cutaneous sensation in man. Systems for automatic assessment of cutaneous touch-pressure, vibratory, and thermal sensation have been developed. These systems use stimuli which are quantified and reproducible, a two-alternative forced-choice technique, and programmed steps to test, score, and report. If normal responses from series of healthy persons have been measured, percentile values specific for test, site, age, and sex can be determined. Abnormality, as in neurological disease, can then be defined as the response which has a value greater than that of the 95th (or other) percentile. These systems may be used to detect and validate abnormalities of sensation in neurological disease and in persons at risk from new medications or from industrial toxins, and to monitor worsening or improvement of sensation in follow-up of a patient or in evaluation of therapeutic regimens.


The splanchnic autonomic outflow in Shy-Drager syndrome and idiopathic orthostatic hypotension. Since splanchnic outflow is important in the maintenance of postural normotension in man, we performed a quantitative analysis of preganglionic autonomic neuron cell bodies of the seventh thoracic spinal cord segment and their corresponding axons in 2 patients with Shy-Drager syndrome (SDS) and 1 with idiopathic orthostatic hypotension (IOH) and compared these values to control data. The intermediolateral column (ILC) neuron cell body counts were reduced to 17% of control levels in SDS and 52% of control levels in IOH. The B fiber counts in the corresponding ventral spinal root were reduced to 21% and 41% in SDS and IOH, respectively. From the present study and our previous results of ILC counts with age, we infer that orthostatic hypotension does not develop until half or more of the preganglionic autonomic neurons have degenerated. An additional finding in SDS is that there is involvement beyond autonomic neurons.


Electron microscopic studies of cerebrospinal fluid sediment in demyelinating disease. Cerebrospinal fluid specimens from 31 patients with multiple sclerosis (MS) and 2 with progressive multifocal leukoencephalopathy (PML) were subjected to ultracentrifugation, and the resulting pellets were examined in an electron microscope. Cell types seen in the pellets included lymphocytes, occasional plasma cells, polymorphonuclear leukocytes, monocytes, eosinophils, lipid-laden macrophages, and fibroblasts. The most interesting noncellular elements were extracellular myelin fragments, recognizable by their characteristic alternation of major dense lines and intraperiod lines. Myelin fragments were seen in the CSF from 7 of 9 patients with MS in exacerbation involving areas other than the optic nerve. These fragments were not observed in 4 specimens from patients with acute attacks manifested by optic neuritis. Myelin fragments were present in 1 of the 2 patients with PML. These observations indicate that a portion of the myelin destruction seen in MS and PML occurs extracellularly, with release of myelin fragments and degradation products into the CSF.


Cerebrospinal fluid findings in asymptomatic patients with reactive serum fluorescent treponemal antibody absorption tests. It is common to examine the cerebrospinal fluid in untreated or inadequately treated asymptomatic patients with a reactive serum fluorescent treponemal antibody absorption (FTA-ABS) test before initiating antibiotic therapy for syphilis. This prospective study evaluated the usefulness of such examination. Four hundred thirty-two patients over 40 years old, reporting for annual physical examination, had a serum FTA-ABS test. Thirty-seven (8.6%) patients and 2 of 4 spouses were reactive repeatedly. Of the 39 patients with reactive tests, 7 had a history of penicillin therapy for syphilis, 5 had received heavy metal therapy, and 27 had no history of syphilis. These 39 patients had a neurological examination, serum VDRL, Treponema pallidum immobilization (TPI), and repeat FTA-ABS tests by two other laboratories. The TPI test was reactive in 30 (77%). Four had nonspecific neurological signs. Routine CSF examination (cells, total protein, VDRL, glucose, IgG%) on 30 patients with a history of inadequate treatment had a low diagnostic yield. Two patients had an unexplained total protein elevation (57 and 61 mg/dl) and 1 had a mildly increased IgG% (15%). All cell counts, VDRL tests, and glucose levels were normal. Agarose electrophoresis demonstrated one or more CSF immunoglobulin bands in 10 (36%) of 28 patients, possibly representing an immunological marker of past or latent central nervous system infection.


Clinical and electroencephalographic correlates of the multiple independent spike foci pattern in children. The multiple independent spike foci (MISF) pattern on electroencephalograms occurred in 4.2% of 1,500 recordings obtained from patients between the ages of 6 months and 15 years. Among the 63 patients with MISF, 53 (84%) had a seizure disorder and 48 (76%) had generalized motor seizures. Half the study group had daily seizures and half had more than one type of attack. Sixty-eight percent of MISF patients were intellectually subnormal. The intellectual status varied according to age at seizure onset, findings on clinical neurological examination, incidence of spikes in the recording, number of spike foci, and presence of excessive delta activity.


Recovery from primary pontine hemorrhage. A patient with primary pontine hemorrhage showed typical ocular bobbing with only mild alteration of mental status. Serial CT scans showed resolution of the hemorrhage and correlated with clinical improvement.


Carnitine deficiency: acute postpartum crisis. A 16-year-old girl, previously in good health, developed progressive generalized muscle weakness following her first parturition. The neck and proximal limb muscles were especially weak and painful. Carnitine (4-trimethylamino-3-hydroxybutyrate) was markedly decreased in muscle, plasma, and urine. Dietary carnitine supplementation, 2.0 gm daily, was followed by clinical improvement and decreased lipid droplets in muscle biopsy. Together with previously reported cases, 2 fatal, the patient's illness emphasizes the risk of pregnancy in women with carnitine deficiency.


"Glial bundles" in the spinal cord late after paralytic anterior poliomyelitis. "Glial bundles" in the proximal portion of the anterior spinal roots, identical to those in Werdnig-Hoffmann disease, were observed in 3 patients many years after attacks of acute paralytic anterior poliomyelitis. These structures should therefore be considered a nonspecific astrocytic reaction secondary to the destruction of motor neurons and their axons rather than a malformation specific for Werdnig-Hoffman disease.


The L-dopa on-off effect in Parkinson disease: treatment by transient drug withdrawal and dopamine receptor resensitization. It has been suggested that patients with Parkinson disease partially compensate for neuron loss by developing denervation supersensitivity, and, if so, that prolonged levodopa (L-dopa) therapy might lead to desensitization. As a preliminary test of this hypothesis, and in order to study whether it was possible to "resensitize" a patient who had already presumably been desensitized by previous L-dopa therapy, a patient who had become unpredictably responsive to L-dopa was investigated. The patient had been taking L-dopa for eight years and had exhibited severe dyskinesia-akinesia oscillation ("on-off" phenomenon) before the study. There was no consistent response to his hourly doses of Prolopa (L-dopa and benserazide in a 4:1 ratio). He was first lowered, over 33 days, to 20% of his original Prolopa dose. The dosage was then increased until a consistent response was observed. The three main results achieved were, first, overall reduction by 64% of the daily requirement for L-dopa; second, conversion from a previously unpredictable to a predictable response to each dose of L-dopa; and, third, change in his movement fluctuations to a pattern more typical of "end-of-dose" akinesia than the "on-off" phenomenon. The results support the idea of dopamine receptor resensitization upon reduction of the L-dopa dosage.


Pharmacokinetics of mezlocillin in healthy volunteers. Mezlocillin in doses of 1.0, 2.0, and 5.0 g and carbenicillin in doses of 2.0 g were given as bolus injections intravenously to 10 healthy volunteers. For mezlocillin, dose-dependent pharmacokinetics was detected. This is reflected by a more than proportional rise in serum concentrations and a decreased total body clearance as doses were increased. Per dose unit, the areas under serum concentration curves to infinity were 33.5 mug.h/ml for the 1.0-g dose, 47.2 mug.h/ml for the 2.0-g dose, and 54.8 mug.h/ml for the 5.0-g dose. The body clearance fell from 31.2 liters/h with the 1.0-g dose to 17.0 liters/h with the 5.0-g dose. This can be explained mainly by a marked depression of nonrenal clearance, which fell from 12.2 to 3.8 liters/h, compared with a parallel change in renal clearance from 19.0 to 13.2 liters/h. Contributing to the non-linearity may be biotransformation, evacuation via bile, or another process. With dose increments, rising amounts are recovered unchanged in the urine-61% after a 1.0-g dose compared with 69% after a 5.0-g dose. This clearly defines metabolism as a major factor of elimination. Carbenicillin, for which the first-order, two-compartment open model was applicable here as in previous studies, had a longer serum half-life than did mezlocillin. For the 2.0-g doses, the former had a half-life of 1.4 h, compared with 0.8 h for the latter (calculated as if the two-compartment model were fully valid). The relative area under the curve (see above) was 76.1 mug.h/ml after the 2.0-g dose.


Comparison of 5-episisomicin (Sch 22591), gentamicin, sisomicin, and tobramycin in treatment of experimental Pseudomonas infections in mice. Sch 22591 (5-episisomicin), gentamicin, sisomicin, and tobramycin were compared for their ability to protect mice from lethal intraperitoneal challenge with 12 Pseudomonas strains, all susceptible to each of the aminoglycosides (minimal inhibitory concentrations and minimal bactericidal concentrations were </=6.2 mug/ml). Median 50% protective doses were 5.8, 6.4, 7.7, and 17.8 mg/kg for Sch 22591, tobramycin, sisomicin, and gentamicin, respectively. Those for Sch 22591 were significantly lower than gentamicin in five protection tests and significantly lower than both gentamicin and tobramycin in one test. Microbial analysis of the therapeutic effect indicated that protection from lethality by each of the four aminoglycosides was associated with either a complete eradication or a reduction in the number of challenge bacteria in both the heart blood and peritoneum. In rare instances, challenge isolates exhibiting decreased susceptibility to one or more of the aminoglycosides were recovered from animals. However, this in vivo selection of resistance did not appear related to either the aminoglycoside used in therapy or the outcome of therapy, and resistant isolates were recovered as frequently from untreated animals as from those receiving one of the four aminoglycosides.


Piperacillin: human pharmacokinetics after intravenous and intramuscular administration. The pharmacokinetics of piperacillin were studied in a total of 26 Caucasian normal male volunteers. Single intramuscular doses of 0.5, 1.0, and 2.0 g were given to three groups, each containing eight volunteers. Mean peak serum concentrations of 4.9, 13.3, and 30.2 mug/ml were assayed at 30 to 50 min, and measurable levels were present up to 4, 6, and 8 h, respectively, after dosing. Single intravenous bolus doses of 1.0, 2.0, 4.0, and 6.0 g were given to four groups of five subjects, and mean serum concentrations of 70.7, 199.5, 330.7, and 451.8 mug/ml were measured at the end of the injections. The antibiotic had a mean terminal serum half-life of 60 to 80 min after the intramuscular doses and 36 to 63 min after intravenous administrations, depending on the dose. The apparent distribution volume was 20 to 24 liters/1.73 m(2), and distribution volume at steady state was 16 to 19 liters/1.73 m(2). Mean urinary recovery in 24 h was 74 to 89% for the intravenous doses and 57 to 59% for the intramuscular doses. The piperacillin-creatinine clearance ratios indicated that the proportion of renal excretion of piperacillin through tubular secretion was 56 to 73%, and this was confirmed by the renal clearance data from eight volunteers receiving probenecid treatment before the piperacillin dose. Probenecid (1 g given orally before administration of piperacillin) increased peak serum concentration by 30%, terminal serum half-life by 30%, and the area under the plasma concentration curve by 60%, and it decreased the apparent distribution volume by 20% and the renal clearance of the intramuscularly administered (1 g) antibiotic by 40%. Injections of piperacillin by both parenteral routes were well tolerated.


UK-18,892: resistance to modification by aminoglycoside-inactivating enzymes. UK-18,892, a new semisynthetic aminoglycoside, was active against bacteria possessing aminoglycoside-inactivating enzymes, with the exception of some known to possess AAC(6') or AAD(4') enzymes. This activity has been rationalized by using cell-free extracts of bacteria containing known inactivating enzymes, where it was shown that UK-18,892 was not a substrate for the APH(3'), AAD(2''), AAC(3), and AAC(2') enzymes. It was also demonstrated that UK-18,892 protected mice against lethal infections caused by organisms possessing aminoglycoside-inactivating enzymes.


Cation transport alteration associated with plasmid-determined resistance to cadmium in Staphylococcus aureus. Plasmid-determined resistance to cadmium has only been found with plasmids from Staphylococcus aureus. Resistance to cadmium was associated with a lower accumulation of Cd(2+) ions by the plasmid-bearing resistant cells. Cadmium accumulation by susceptible cells was energy dependent and had those characteristics usually associated with a transmembrane active transport system. There was a specific interrelationship between cadmium accumulation and manganese accumulation and retention. Cd(2+) inhibited the uptake of Mn(2+) and accelerated the loss of intracellular Mn(2+) by the susceptible cells, but was without effect on Mn(2+) transport in resistant S. aureus cells. Under similar conditions, there was no differential effect of Cd(2+) on Mg(2+), Zn(2+), Co(2+), Ni(2+), or Rb(+) accumulation or exchange between the susceptible and the resistant strains.


Use of cefoxitin, new cephalosporin-like antibiotic, in the treatment of aerobic and anaerobic infections. Forty-two patients were treated with intravenous cefoxitin, a new cephamycin antibiotic. These patients had postoperative abdominal sepsis (26), intrathoracic infections (6), urinary tract infections (5), gram-negative bacterial meningitis (2), septic arthritis (1), epidural abscess (1) and isolated septicemia (1). The antibacterial spectrum of cefoxitin was found to be one which included all gram-positive organisms except enterococci, most gram-negative organisms except Pseudomonas aeruginosa, and almost all of the important anaerobic organisms. The only five treatment failures included one patient with empyema and one with septic arthritis, both caused by Serratia marcescens, initially only moderately susceptible to cefoxitin, which subsequently developed increased resistance, two patients with contaminated intravenous catheters, and one patient with epidural abscess and cerebritis, who was treated late in the course. There was one serious clinical superinfection with P. aeruginosa. The drug levels noted in the pus and joint fluid were half to two-thirds of the simultaneous serum level. In inflamed meninges, up to 30% of the serum level was noted in the cerebrospinal fluid, and as the process resolved, 10 to 15% was noted. Toxicity of cefoxitin was mild and constituted skin rash in three patients (7%) and phlebitis in eight (19%).


Comparison of the in vitro activities of HR756 with cephalothin, cefoxitin, and cefamandole. The in vitro activity of HR756, a new semisynthetic cephalosporin, was compared with the activities of cephalothin, cefoxitin, and cefamandole against 1,535 isolates of gram-positive and gram-negative bacteria. HR756 was less active than cephalothin and cefamandole and twofold more active than cefoxitin against Staphylococcus. All four of the antibiotics were inactive against the enterococcus group of Streptococcus; however, HR756 was the most active antibiotic against the other isolates of Streptococcus. HR756 was also more active against isolates of Enterobacteriaceae, including 84 to 95% of the isolates resistant to one or more of the other three antibiotics. HR756, at a concentration of 12.5 mug/ml, inhibited 86, 75, and 100% of the isolates of Pseudomonas aeruginosa, other Pseudomonas species, and Acinetobacter, respectively. The minimal inhibitory concentrations and minimal bactericidal concentrations of HR756 were within one twofold dilution for 11 of 21 gram-positive cocci and 119 of 125 gram-negative bacilli tested.


Purification and properties of a bacteriocin-like substance (acnecin) of oral Propionibacterium acnes. Propionibacterium acnes CN-8, isolated from human dental plaque, was grown in a liquid medium, and its bacteriocin-like substance (acnecin) was extracted from the cells by ultrasonic treatment. Acnecin was purified to a homogeneous state with recovery of 47%. Specific activity increased 72-fold in comparison with the crude extract. The properties of acnecin were as follows. (i) Acnecin may consist of five subunits with a molecular weight of about 12,000. (ii) Its isoelectric point was 5.5. (iii) In amino acid composition, aspartic acid, glutamic acid, glycine, and alanine were predominant, whereas cystine was not present. (iv) Acnecin contained 3.3% carbohydrate but was substantially free from lipid. (v) The activity was lost by heating at 60 degrees C or by protease and lysozyme treatments. Acnecin acted bacteriostatically on the indicator strain without killing it. The action spectrum of acnecin was very narrow; it was effective only against strains of non-acnecin-producing P. acnes and Corynebacterium parvum, a species closely related to P. acnes.


Penetration of amoxicillin into cerebrospinal fluid. The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 mug/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 mug/ml at 1.5 h and from 2.6 to 27.0 mug/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.


Evidence for conversion of 5-fluorocytosine to 5-fluorouracil in humans: possible factor in 5-fluorocytosine clinical toxicity. A gas chromatographic-mass spectrometric method for detecting 5-fluorouracil (5-FU) in serum at concentrations as low as 10 ng/ml was used to determine to what extent 5-FU was present in the serum of patients taking oral 5-fluorocytosine (5-FC). Preliminary studies in two patients and two healthy volunteers given an initial 2-g oral dose of 5-FC demonstrated sustained serum 5-FU levels (>100 ng/ml) during the 5 h after ingestion of drug. Pharmaceutical preparations of 5-FC used in these studies were shown to be insignificantly contaminated with 5-FU (<0.03%), suggesting in vivo conversion of 5-FC to 5-FU had occurred. Serum samples from seven patients with cryptococcal meningitis treated with amphotericin B and 5-FC were examined for 5-FU. Five of these patients had experienced hematological or other toxicity attributed to 5-FC at some time during the course of therapy. Of 41 serum samples, 20 were observed to have 5-FU levels greater than 1,000 ng/ml in the range observed with cancer chemotherapeutic doses of 5-FU known to be associated with hematological toxicity. It is concluded that conversion of 5-FC to 5-FU occurs in humans and furthermore that 5-FU may account for some of the toxicity observed with 5-FC.


Simple sensitive microbioassay for adenine arabinoside and hypoxanthine arabinoside in human plasma. Previous methods using low- or high-pressure liquid chromatography and UV absorbance for quantitation of arabinosides in plasma can practically detect only >/=200 ng of adenine arabinoside and >/=100 ng of hypoxanthine arabinoside per ml, and they require expensive equipment and expert technical assistance. We describe in this report a simple quantitative microbioassay for arabinosides in human plasma based on their ability to inhibit the cytopathic effect of vaccinia virus in an adenosine deaminase-free cell culture system. Using prior separation of nucleosides in plasma by thin-layer chromatography, followed by the microbioassay, we quantitated adenine arabinoside with a sensitivity of approximately 4 ng/ml and hypoxanthine arabinoside at approximately 625 ng/ml. This assay method is simple, sensitive, and reproducible, requires small plasma samples, measures biological activity, and is adaptable to routine use. It is an important tool for evaluating the pharmacology of adenine arabinoside and Ara-AMP in patients in current clinical trials.


Materno-fetal cephradine transfer in pregnancy. Cephradine, a semisynthetic cephalosporin, has widespread use. There is, however, a paucity of data on the transfer of this antibiotic in pregnancy. Studies were undertaken after an intravenous dose of 2 g of cephradine was given in two elective situations: (i) therapeutic abortion in the first trimester and (ii) elective cesarean section in late pregnancy. Blood and tissue levels of cephradine obtained showed that the antibiotic is rapidly transferred to the feto-placental unit throughout pregnancy after intravenous administration to the mother.


Anaerobic resistance of clinical isolates of Staphylococcus aureus to aminoglycosides. The anaerobic minimum inhibitory concentration of six aminoglycosides (amikacin, gentamicin, kanamycin, netilmicin, sisomicin, and tobramycin) averaged over 10-fold greater than the aerobic minimum inhibitory concentration for 50 clinical isolates of Staphylococcus aureus. Cultures from osteomyelitis and blood generally showed a somewhat greater increase in minimum inhibitory concentration due to anaerobiosis than did cultures from abscesses and wounds, and amikacin activity was most affected by anaerobiosis.


[Effects of direct laser radiation on human lymphocytes (author's transl)]. In vitro experiments with human lymphocytes showed that if irradiations with coherent light of a He-Ne-laser were performed an immune suppressor effect is obtained. Using incoherent light of the same wavelength, effects only occur (80% compared to the laser) if the light is linear polarized.


[About the regression of psoriasis capitis after mechanical epilation (relations between the psoriatic efflorescence and the follicular proliferation) (author's transl)]. The pathomorphological and pathophysiological reactions of the spontaneous and artificially induced skincycle in psoriasis capitis-lesions were clinically and histologically investigated. 1. After the epilation in the psoriasis capitis-lesion a healing of the psoriatic efflorescence was observed. 2. Histologically a close correlation between the induced anagen and the regression of the psoriasis existed: As a cause of this phenomenon an interaction between the dermis, the follicular proliferation and the epidermal proliferation of psoriasis is assumed.


[The histodynamic of alopecia areata in the dependence on the griseofulvin-induced epithelial proliferation (author's transl)]. The histodynamic of the alopecia areata--without or with the medicamentous induction of the hair growth respectively--was investigated comparatively. 1. Griseofulvin induced an epithelial proliferation in alopecia areata, which is noticeable in the surface epithelium as well as in the follicular epithelium. 2. Under the influence of griseofulvin a deeper penetration of the follicles into the fatty tissue--in connexion with a cutan-subcutaneous volume increase--results; at the same time the supra- and infraseboglandular follicular areas are lengthened. 3. The matter for discussion is that these epithelial changes originate from an increase of metabolic activity or blood supply respectively in the adjacent cutan- and subcutaneous tissue.


Repair of DNA damage in light sensitive human skin diseases. Repair of UV-light induced DNA damage and changes in the semiconservative DNA synthesis were studied by in vitro autoradiography in the skin of patients with lightdermatoses (polymorphous light eruption, porphyria cutanea tarda, erythropoietic protoporphyria) and xeroderma pigmentosum as well as in that of healthy controls. In polymorphous light eruption the semiconservative DNA replication rate was more intensive in the area of the skin lesions and in the repeated phototest site, the excision repair synthesis appeared to be unaltered. In cutaneous porphyrias a decreased rate of the repair incorporation could be detected. Xeroderma pigmentosum was characterized by a strongly reduced repair synthesis.


Suction blister fluid as a model for interstitial fluid in rats. 1. Suction blisters on the skin of rats, obtained with a negative pressure of 150 mm Hg, show a close similarity to human suction blisters, based on histological, electrolyte and protein findings. 2. Pharmacokinetic experiments with inulin and antipyrine have proved that the movement of these low protein binding drugs between blister fluid and serum follows the laws of diffusion. 3. The investigations suggest that blister fluid resembles interstitial fluid and can therefore serve as a model for the estimation of drug concentrations in interstitial fluid.


[Clinical aspects of renal adenocarcinoma]. We present for study a series of 80 patients suffering from renal adenocarcinoma, pointing out that the most frequent reason for consultation was hematuria, observed in 44 patients (57.5%) which constituted at the same time the predominating initial symptom. The period of time which elapsed between its presentation and the diagnosis ranged, in most cases, between 1 and 6 months. There were numerous paraneoplastic findings, of which hyper-alpha2-globulinemia 21/25 patients (60%) and high sedimentation speed 41/80 (51.2%) were important due to their frequency. Metastases were detected in 16 patients with the most frequent location being the bone system, 11 cases (55%). We point out the need for a good knowledge of the varied evolutionary behaviour of this kind of neoplasia and the numerous systemic repercussions, with a view to obtaining an earlier diagnosis in the absence of local symptoms, in order to improve the prognosis.


[Hydraulic distension of the bladder in urology]. The authors discuss the indications and technique as well as the results in four patients successfully treated by means of hydraulic distension for a non-tumoural vesical pathology. H.V.D. is still a new method in spite of the long time which has elapsed since the first descriptions although it is simple with few complications if one follows a correct technique. Its main scope is in the treatment of interstitial cystites, unstable bladders and vesical hematurias following radiotherapy, cancer or cytostatics, apart from its use in vesical tumours in which further experience is required in order to establish correctly its real possibilities and limitations although the first indications are also highly positive.


[Various considerations of endocrine changes in testicular tumors]. The authors discuss the link between testicular tumours and endocrine disorders which may be observed in view of the fundamental testiculo-hypophysial relations and the importance of these as far as dysendocrinias of the tumours, leidigioma, gynaecomasty and prolanuria are concerned. In the section on breast disorder phenomena, the authors make a comparative analysis of those observed in leidigiomas and choriocarcinomas, whilst in the section on prolanuria, they consider the importance of the positive value and essentially limited to the presence of chorial tumours, whilst questioning the frequent negative results -- which never rule out the possibility of a testicular tumour since, in any case, the only thing that it determines is that the claimed neoplasia in not chorial. They also point out that the positive results of prolanuria, even in non-choriomatous tumours, must simply be interpreted as a gonadotrophinuria of solely hypophysial appearance caused by reduced testicle functioning.


[Idiopathic retroperitoneal fibrosis: diagnosis, evolution and therapeutic approach in 8 cases]. Based on 8 cases observed the author attempted to specify the possiblities of diagnosis and therapy of the idiopathic retroperitoneal fibrosis. If the pathogeny is very dark this illness is accompanied by an unspecific chronic inflammatory process. The radiology (U.I.V. and U.P.R.) does permit to affirm the affection. The ureterolysis with bilateral intraperitonization or, in unilateral cases, the extraperitonization of the ureter fixing the peritoneum to the psoas are the most effective surgical methods. They can be combined with the cortico-therapy which permits a recovery of the renal function and improves the ureteral transit.


[Transitional cells carcinoma of the prostate. Contribution of 1 case]. The revision of one case of transitional cell carcinoma of the prostate, studied by the Department of Pathology of the Hospital General y Clínico de Tenerife, comparing the results with those in the foreign bibliography. The authors discussed the possibility that the tumoration had it's origin in the periurethral ducts at the expense of the "basal" or "reserve" cells. Therefore the symptomatology is inespecific, for which we have-special emphasis in the histologic study of the lesion as diagnostic means. The transurethral resection (TUR) is suitable for the diagnosis and estrogenic therapy doesn't seem to give good results.


[Personal experience in the surgical correction of orthostatic or stress urinary incontinence in both sexes]. The authors present their personal experience in the surgical correcting of exertion incontinence in both sexes over the last three years, pointing out the simplicity of the aponeurotic suspension of the neck of the bladder in women and Gregoir and Puigvert's techniques in men, the latter operations being performed first in Alcoy and Almeria, with excellent results. They comment upon the effectiveness of the operations corresponding, in principle, to cervicourethral angulation.


[Renoenterocolic fistula].

[Renoenterocolic fistula]. We present a case of reno-entero-colic fistula which is extremely rare and which, in the face of unspecific clinical pictures requires a detailed examination. Its physiopathology, the surgical problems which it poses and the means of solving these, are explained.


[Transuteral ureterorenoscopy].

[Transuteral ureterorenoscopy]. The endoscopy has come a long way since the first works by BOZZINI in 1806 and considering that the eye guides all the other senses and confirms their impressions, with the introduction of the transurethral ureterorenoscopy, the urologist can now see the entire ureter, the renal pelvis, the infundibuli and calices, thus enabling him to confirm or rule out the pathology in a non-aggressive way in cases in which only a surgical operation would have done this.


[Retrovesical hydatid cyst].

[Retrovesical hydatid cyst]. This paper explains the clinical study and the resulting treatment carried out on a patient suffering from a retrovesical tumour which proved to be a cyst of hydatidic origin. Special mention is made of the course of study which should be followed in these cases, above all as far as radiological studies are concerned as well as the special features of the removal and in situ treatment of the cyst.


[Incrusted cystitis].

[Incrusted cystitis]. Five cases are presented of incrusted, alkaline cystitis and the authors point out the pathogenic aspects and the etiology of this illness and comment upon the two forms of endoscopic presentation and the treatment of the general and local kinds.


[Therapeutic embolization of renal tumors]. We present our casuistry of 17 embolized kidney adenocarcinomas with fibrin sponge and/or metal spirals. In 13, the embolization was preoperative and in 4 palliative. In two out of the latter group a control aortogram revealing no rechanneling of the renal artery, was performed several weeks later. We mention the clinico-biochemical disorders caused by embolization and the advantages of the different kinds of emboles used and we come to the conclusion that the procedure considerably facilitates the surgical removal and is of value as a palliative method in certain circumstances.


[Closed cystostomy by puncture. Modified translumbar puncture technic for the treatment of single renal cyst]. Due to the frequent relapses in the treatment of kidney cysts by simple aspiration, the authors present a technical variation of the same, which may avoid the use of intracystic sclerosing substances. Owing to the simplicity of the method which may be performed in a clinic, its low morbility and probable effectiveness, we feel that it may be a useful procedure as a first step in the treatment of simple kidney cysts.


[Evaluation of gammagraphy in the differential diagnosis of cysts and renal tumors]. In view of the problems posed by the diagnosis of intrarenal masses, the authors review 16 cases of patients with this pathology who have undergone renographic and gammagraphic studies. They obtain a high level of coincidence between the gammagraphic diagnosis and its subsequent surgical confirmation, a fact which indicates that the kidney gammagraph is of great diagnostic value. This may be due to the different vascularization of the pathological area which would allow for a greater indication by the tracer, rejecting the theory of parenchymatous intoxication by toxic tumour substances.


H-Y antigen in testes of XX(BALB)/XY (C3H) chimaeric male mouse. Among experimentally produced BALB/C3H aggregation (Blastocyst fusion) chimaeras of the mouse, one fertile XX (BALB)/XY (C3H) male was identified who maintained 50% or more female cells in many parts of his body. Results of H-Y antibody absorption tests revealed an XY to XX transfer of testis-organizing H-Y antigen among testicular Sertoli and Leydig cells, but not among spleen and epidermal cells.


Sperm antibody testing in infertile men. Six hundred male patients were examined for circulating spermagglutinating antibodies by the Kibrick sperm-agglutination test and 20% demonstrated autoantibodies. The high incidence of positive findings may be explained by the select population studied. Of 80 men tested who demonstrated more than 10% agglutination in their semen, but were otherwise normospermic, 41% demonstrated positive titers by the Kibrick method. Of 300 men examined for circulating sperm-immobilizing antibodies by the Isojima sperm-immobilizing test, 6% had autoantibodies. This high incidence of positive findings demonstrates the need for these tests in males who otherwise appear normospermic or demonstrate an unexplained infertility.


Corrective surgery of obstructive azoospermia. Obstructive azoospermia was corrected surgically in 233 cases of vasovasotomy and 97 cases of post-inflammatory epididymovasostomy. Good results were obtained for groups of: younger age; shorter duration of obstruction; bilateral vas-to-vas anastomosis level; bilateral end-to-end anastomosis technique; bilateral oozes; no splint; and vasovasostomy patients hospitalized for seven days. Satisfactory results were obtained for groups of: nontuberculous epididymal obstruction; side-to-side anastomosis technique; and bilateral vas-to-epididymal head anastomosis level in epididymovasostomy. Reversibility of post-vasectomy azoospermia averaged 82% for patency, and 34% for pregnancy, and for post-inflammatory azoospermia, 31% for patency, and 13% for pregnancy. Failure of operation was due mainly to fibrosis and sperm granuloma on the anastomosed site.


Cellular interrelationships in the fetal rabbit testis. The types and patterns of arrangement of membrane interrelationships in the fetal rabbit testis were studied, using coordinated freeze-fracture, lanthanum tracer and standard transmission electron microscopic techniques. The testicular cords contain a mixture of large spherical germ cells and oval to elongated Sertoli cells. Desmosomes are present between germ cells and Sertoli cells and between adjacent Sertoli cells. Tight junctional specializations of the type found between Sertoli cells in the adult are not seen. In freeze-fracture replicas, short strands of particles of two different size populations are found on the surfaces of Sertoli cells. Similar short strands of particles  are present on the membranes of peritubular myoid cells. In lanthanum preparations, the tracer passes freely between peritubular cells and through intercellular spaces within the seminiferous cords, indicating lack of a barrier to its passage throughout the testicular tissue. Prominent macular gap junctions similar to those found between adult Leydig cells are readily observed on the surfaces of fetal Leydig cells. The presence of gap junctions in the fetal testis may be important in coordinating the active testosterone production which occurs during this period of development.


Subunit structure of Eutherian sperm chromatin. The beta-mercaptoethanol induced decondensation of spermatozoon cell nuclei from several Eutherian species has been followed from the intact spermatazoon cell to the solubilized linear unit sperm chromosomal fiber using fluorescence and electron microscopy. Data from nuclease digestion studies in conjunction with electron microscopic evidence indicate that the gross structure of the unit Eutherian sperm chromosomal fiber consists of DNA folded around sperm specific histone multimers spaced regularly along the fiber generating a linear array of sperm nucleosomes connected by short stretches of uncomplexed DNA. The sperm nucleosomes, 80 A in diameter are separated by 20 A filaments of DNA. This structure is remarkably similar to the structure of somatic chromatin although the protein components of the two chromosomes are markedly different. It seems likely that chromosomal fibers, similar to those described herein, may be present in the male pronucleus following fertilization.


Effects of prostaglandins and indomethacin on rat epididymal responses to norepinephrine and acetylcholine. Prostaglandins E2 and F2alpha tromethamine salt caused an increase in amplitude and frequency of rat epididymal contractions. Moreover, they caused a significant potentiation of contractile responses of epididymal smooth muscle to stimulation by norepinephrine or acetylcholine. Indomethacin treatment caused no changes in the spontaneous motility, and this inhibitor of prostaglandins synthesis decreased the responses of epididymis to norepinephrine or acetylcholine. Spontaneous motility of epididymis is possible in the presence of smaller amounts of endogenous prostaglandins, and sudden contraction occurring during ejaculation, induced by sympathetic and parasympathetic nerves stimulation, could be influenced or modulated by prostaglandins.


Prolactin in seminal plasma of infertile men. Twenty-one fertile and 103 infertile patients with oligospermia, azoospermia, impaired sperm motility and hypogonadism were evaluated for prolactin concentrations in serum, seminal plasma and split seminal plasma of two fractions. Prolactin concentration in the seminal plasma was two to three times higher than serum prolactin levels in fertile and infertile men. Prolactin concentration of the fraction 2 of the split ejaculate was higher than that of the fraction 1 and of the serum. Excessive high levels of serum prolactin and/or seminal plasma were found only among infertile patients with oligo- and azoospermia, impaired motility and hypogonadotropic hypogonadism. Prolactin is selectively accumulated in fraction 2 of the split ejaculate and affects the constituents of the seminal vesicular fluid, and excessive high prolactin concentrations of either seminal plasma or serum may be associated with male infertility.


Characterization of rat spermatocytes after plastic embedding. Rat testicular tissue, perfused with glutaraldehyde, post-fixed with osmium and stained with toluidine blue, was studied to obtain information which could be used to characterize spermatocytes (also type B gonia and Step 1 spermatids) with the light microscope. Measurements of relative cell, nuclear sizes and absolute nuclear size are presented in graphic form, demonstrating the progressive growth found for spermatocytes. Early prophase spermatocytes (preleptotene, leptotene, zygotene) gradually increased in size. Pachytene cells showed no growth until Stage IV, at which point a dramatic size increase began and continued until the diplotene phase. Guidelines to identify a particular phase of meiosis were established for spermatocytes using primarily nuclear traits. Examination of longitudinal sections through Stages XIII, XIV and I were useful for comparing cells from Meiotic divisions (meta-, ana-, and telophases) I and II and also for differentiating secondary spermatocytes from Step 1 spermatids.


Carnitine levels in human accessory sex organs. Carnitine concentration was measured in human tissue obtained at surgery or autopsy. In all patients, the concentration of carnitine (nMol. g-1 tissue) was higher in epididymis than in testis, vas deferens, prostate, and seminal vesicles. There was no correlation between the tissue levels of testosterone in the testis and the concentration of carnitine in epididymis. As in the rat and baboon, carnitine is also found in high concentrations in the human epididymis.


The effect of human spermatozoa on antigen and mitogen induced blastogenesis. In an attempt to identify factors capable of specifically or nonspecifically modulating results in an in vitro blastogenic assay system, studies were performed evaluating cell mediated immune response to human spermatozoa. Spermatozoa were capable, on a dose dependent basis, of both inhibiting and stimulating normal lymphocyte DNA synthesis as well as suppressing mitogen-induced response. Pretreatment of spermatozoa with neuraminidase and alpha-methyl-D-mannoside abrogated suppressive properties on spontaneous and/or mitogen-induced stimulation. Such suppressive activity on mitogen-induced response was observed using B and T-cell enriched populations. Inhibitory properties were not evident using intact cell populations stimulated by specific antigen. It is suggested that: (1) receptors on spermatozoa bind lectin; and (2) such receptors can be inactivated by enzymes having glycoprotein specificity.


C1q precipitins in human seminal plasma. Seminal plasma was tested against purified C1q by double diffusion. Precipitation reactions were frequently observed in the seminal plasma of patients with normozoospermia and patients with azoospermia; most of these reactions were not due to soluble immune complexes binding to C1q. A factor resistant to DNAse and RNAse (mol wt: 25,000--150,000 daltons) was found to precipitate C1q. Its discovery adds to the list of substances which may interfere in C1q precipitation tests.


Sex-related changes in the population of lymphocytes in the bone marrow of the mouse. An electron microscope study. Lymphocytes in the bone marrow were qualitatively and quantitatively examined by electron microscopy in dd-mice of both sexes at various ages. In males, marrow lymphocytes represented 4% of all the nucleated blood cells in the marrow at 4 days of age, 14% at 20 days and 21% at 35 days. From 60 days to one year of age they remained about 8%. In females, marrow lymphocytes were almost similar in proportion to those in males in early life until 35 days, and the proportion of lymphocytes, unlike that in males, remained almost unchanged thereafter until one year of age. Thus marrow lymphocytes were significantly greater in proportion in females than in males after puberty. The marrow lymphocytes were mainly small lymphocytes. The marrow small lymphocytes could be classified, by ultrastructural features, into two types: dark and light small lymphocytes. Dark small lymphocytes constituted about 90% of all the marrow small lymphocytes in early life in both sexes, but they then underwent a decrease especially in males. Light small lymphocytes were few in early life, but they increased with age in both sexes. The two types of small lymphocytes were discussed in relation to the lymphocyte subpopulations which have been generally accepted.


Scanning electron microscope study on the mechanism of obstructive jaundice in rats. The possible communication between the bile canaliculus and the space of Disse was examined by experimentally inducing obstructive jaundice in rats. Blood bilirubin levels were measured and the morphological changes in the liver were observed with the scanning electron microscope (SEM); Golgi's silver impregnation was also applied to demonstrate bile canaliculus. The normal bile canaliculus issued side branches but these ended blindly and showed no communication with the space of Disse. The pericapillary space of Disse frequently extended between the liver cells forming a paracapillary space. This space reached close to the bile canaliculus but never connected with it. Seven to 14 days after bile duct ligation, when a maximal level of bilirubin was reached, direct connection of bile canaliculi and pericapillary or paracapillary spaces could be found in many places. Two routes of bile leakage were discerned: One was formed by the side branch of the bile canaliculus directly connected to the pericapillary or paracapillary space, and the other was a communication of the laterally extended bile canaliculus to the paracapillary space, the junctional complex being overrun (Fig. 12).


Early changes in the structure of rat sciatic nerves by ligation. In order to find any morphological changes that might occur in the accumulation of catecholamine synthesizing enzymes following ligation of the sciatic nerve, light and electron microscopic studies were made in segments both proximal and distal to the ligature of the rat sciatic nerve from the initial period up to 4 days. The earliest changes were observed in the larger myelinated nerve fibers at 0.5 and 1.0 mm segments distal and proximal to the ligature, while little if any changes occurred in smaller myelinated nerve fibers. The non-myelinated fibers showed an increased electron density of axons due to the increase in density of the matrix, increased numbers of microtubules and/or microfibriles and of vesicles and vacuoles of varying size in addition to the enlarged size of the axon. These types of changes in the non-myelinated fibers seem to be more marked in the proximal segments, and are probably responsible for the accumulation of axoplasm containing some enzymes.


Freeze-fracture images of the zonula occludens in the mouse oviduct epithelium. Freeze-fracture images of zonulae occludentes of the oviduct epithelium of adult mice were observed in the electron microscope. The structure of zonulae occludentes varies depending on the types of oviduct epithelial cells. Those between two secretory cells consist of 5--14 (9.2 +/- 2.0) strands interposed between the luminal and the lateral plasma membrane. The strands run irregularly making well developed anastomoses with one another. The tight junction between two ciliated cells consists of 4--14 (8.5 +/- 2.3) strands. Among them the upper 3--9 strands are unique in shape. The strands run regularly, compactly and parallel to the luminal surface and to each other with a few anastomoses. The distance between the adjacent strands is about 40 nm. Under this characteristic part several strands are very loosely distributed and run irregularly. The pattern of the strands in the zonula occludens between a secretory cell and a ciliated one resembles that between adjacent ciliated cells. The junction consists of 4--13 (8.3 +/- 2.0) strands. The characteristically dense and parallel arrangement of the strands demonstrated in this study is presumed to be related to the ciliary movement. All the zonulae occludentes in the mouse oviduct epithelium are "very tight" in type. No large gap junctions are seen in the mouse oviduct epithelium.


Personality, sexuality, and demographic differences between volunteers and nonvolunteers for a laboratory study of male sexual behavior. Personality, sexuality, and demographic differences were examined in volunteers and nonvolunteers for a laboratory study of male sexual arousal. Subjects were 108 participants in a questionnaire study entitled "Personality and Sexuality", who were then asked to volunteer for a second study which necessitated watching sexually explicit films, being partially undressed in an experimental chamber, and having penile diameter measured via a strain gauge device. Volunteers for the second study were found to be less guilty, less sexually fearful, more sexually experienced, and older than nonvolunteers. Volunteers also reported a higher incidence of past erectile difficulties and tended to be White or of mixed racial heritage, as opposed to being Oriental. Other personality variables did not discriminate between the two groups. The results indicate that future research in human sexuality using the laboratory analytic method must impose strict limits on generalization from the research data.


Psychosexual material in the stories told by children: the fucker. The spontaneously reported narrative fictions collected from 5- to 11-year-old children were examined for the presence of overt psychosexual elements. Two developmental hypotheses were advanced: (1) that the children's expressions would become more inhibited and therefore more indirect with age (Wolfenstein) and (2) that their expressions would not be more inhibited with age but simply more complex and wide ranging (Legman). The data are interpreted as supporting the latter proposition. The older children in the present sample give a wide-ranging display of psychosexual material stated just as directly as is the case with the narrower array for the younger children. Freud's dictum that the higher a joke rises in polite society the more indirect must be its form of expression is thus not supported in the present elementary school. The cultural relativity of the hypothesis is suggested. A folktale analysis of these materials shows that they are most appropriately described as typical of the "trickster" figure in folkloric genre. The Fucker appears to be a subcategory of this genre as well as an enduring folk figure.


Cross-cultural analysis of students' sexual standards. Our purpose was to investigate, cross-culturally, university students' premarital sexual standards. A number of predictions were derived from the work of Cristensen, Reiss, and Burr. Data were collected via self-administered questionnaires from over 1100 English-speaking respondents in five "cultures" (four countries). These cultural contexts had a strong effect on the attitudes and behavior of individual respondents. As predicted, the difference in the standards held by males and females was small in highly permissive societies. Negative consequences of premarital intercourse (i.e., guilt) were reported by the highest proportion of sexually experienced respondents in the most restrictive society. An unsuccessful effort was made to predict how the correlation between permissiveness and such variables as religiosity would change in different cultures. Across all five cultures, greater courtship participation, less religiosity, greater physical attractiveness, and spending less time with one's family were associated with greater permissiveness. Finally, students from high-status backgrounds were generally more permissive.


Development of masturbation in college women. To elucidate a number of hypotheses about the development of sexual responsivity in women, a random sample of 100 undergraduate women was interviewed about their masturbation histories, techniques in masturbation, and the relationship of masturbation to intercourse. Masturbation had been practiced by 74%. It began most commonly as an accidental discovery. Learning the sexual nature of masturbation from peers and written sources seemed to result in methods more imitative of heterosexual activities and to increase the enjoyment and goal-directedness of the behavior. The view that experiencing sexual pleasure depends on social transmission of scripts was thus supported. Several techniques were related to orgasm ability in masturbation and intercourse. Women who were orgasmic in masturbation and who masturbated with that goal were more likely to continue the behavior than those with other goals. Frequency of masturbation and frequency of intercourse were not related, failing to support the notion of a unitary "sex drive". Nor was "clitoral fixation" documented by any relationship between reliance on clitoral stimulation in both masturbation and intercourse. Masturbating to orgasm was not related to orgasm ability in intercourse.


Heterosexual experience, marital status, and orientation of homosexual males. The penile volume responses of homosexual males to pictures of nude women and men were measured and related to the subjects' marital status and experience of heterosexual intercourse. Single subjects with no experience of heterosexual intercourse and married subjects with a history of intercourse with only their wives showed significantly greater response to pictures of men compared to pictures of women than did single subjects with experience of heterosexual intercourse and married subjects with experience of intercourse with women additional to their wives. It was concluded that extensive experience of heterosexual intercourse with one partner did not reduce homosexual responsiveness as measured by subjects' penile response to pictures of nude men and women. It was further concluded that some homosexual males showed physiological evidence of a degree of bisexuality in addition to the behavioral evidence that they sought heterosexual physical relationships.


Men's and women's reactions to sexually explicit films: a serendipitous finding. We proposed that men and women would be "turned off" by watching men and women like themselves engaged in sexual activity and ""turned on" by watching someone of the opposite sex engaged in the same activity. We tested this hypothesis by showing college men and women eight films: films depicting male and female homosexuality, male and female masturbation, and males and females engaged in heterosexual intercourse. We assessed men and women's reactions via the Byrne-Sheffield (1965) Feeling Scale and Griffitt's (1975) Physiological Arousal Scale. We found support for our hypothesis. We also attempted to determine whether men and women differed in how easily they became aroused by sexually explicit films. We found that they did not.


Group vs. couple treatment of sexual dysfunctions. Results of a study comparing the effectiveness of two formats for treating men with premature ejaculation and their female partners with orgasmic dysfunctions are described. In one treatment format, a couple was treated by a male and female cotherapy team once a week for 12 sessions. In the second treatment format, which also consisted of 12 weekly sessions, three or four couples were treated simultaneously in a group led by a cotherapy team. The five couples treated alone and the ten couples treated in the group format all received a standardized therapy program consisting of sex education, attitude restructuring, and specific suggestions for acquiring ejaculatory control for the men and an increased range of orgasmic response for the females. The results showed significant improvement for couples in both treatment formats. The group format initially showed a slight tendency toward more rapid progress than did the couple format, but by the 2-month follow-up there were no significant differences. The study demonstrates that couple group treatment is a cost-effective means for treating common male and female sexual problems.