[Visual processing of 12,000 electrocardiograms according to the USPHS code and comparison of visual and automatic processing of about 6,000 electrocardiograms in accordance with the USPHS code]. Multistage screening in Hesse (W. Germany) and the visual processing of about 12,000 ECG's in accordance with the USPHS (Riedel programme) are reported. A good fit was found with data obtained from a similar study in another part of the country. Comparison is then made with the visual and computerised processing of about 6,000 ECG's in accordance with the same code, using four classes: "normal", "conditionally within the limits of normal", "suspect" and "definitely pathological". The encouraging result on comparison between "normal" and "pathological" in the 6.3% consisting of false negatives (only 2.1% definitely pathological) suggests that "normal" and "conditionally normal" ratings by the computer can be accepted, whereas considerable possibilities for cardiological diagnosis would remain in the case of pathological traces, which would always be accepted, where as considerable possibilities recognised standards set down by the USPHS code are considered reliable. They can be used under hospital or screening conditions. On the other hand, the "scale of values" programme offered as a model requires further checking. Notes on future development are also offered.


[Effect od amygdalectomy on memory and learning in patients treated surgically for epilepsy]. The results of neuropsychological investigations of 40 patients with severe epilepsy and behaviour disturbances treated by stereotactic methods are presented. In all cases memory disturbances were found before the operation, in 45% of the cases mental sluggishness was present. After amygdalotomy, together with a reduction of emotional tension and psychomotor agitation, the range of direct memory extended and difficulties in learning verbal material decreased. In some patients a tendency was observed also for a rise in intelligence quotient.


[Graphic analysis of electrocardiograms with the exercise test]. The effort ECG is one of the most useful and most commonly employed methods for the early diagnosis of coronary disease in patients with a normal ECG at rest. Perfection of a computerised method for this purpose is reported. An effort test is run on the cyclergometer and the ECG is read for 2 min at rest, during the test, and for 3 min afterwards. The chest bipolar leads are used. The diagnostic possibilities are greatly improved by computerisation and interpretation of the effort ECG.


[On-line analysis of the exercise electrocardiogram]. A programme of on-line automated analysis of ECG exercise graphs relative to the CB5 derivation is described. The various operations may be subdivided into the following phases: 1) performance; 2) mean complex; 3) identification; 4) calculation and print-out of parameters; 5) filing. Automatic analysis of exercise ECG's eliminating artifacts present in graphs and obtaining parameters that are not respectively assessable, facilitates the development of rigorously objective diagnostic guidelines. The filing of indices on magnetic tape opens the way to subsequent statistical analysis of extreme usefulness in testing extensive populations.


[Differentiation of infarct patterns in the computerized ECG and confirmation with clinical and coronarographic findings and cardiac catherization]. With a view to assessing the validity of ECG criteria for a personal computerization programme, definite external features have been introduced as controls to provide objective data on the patient's disease apart from the ECG picture. To analyse the reliability of this programme, the ECG infarction component of the following groups of patients was considered. 1) 84 ECGs of patients who have suffered myocardial infarction in the more or less distant past and the diagnosis of which was confirmed at the time by chemical and laboratory data. These patients were also submitted to angiocardiography. 2) 120 ECGs of patients who have suffered myocardial infarction in the comparatively recent past and diagnosis of which was confirmed by chemical and laboratory data. These patients were not submitted to angiocardiography. 3) 85 ECGs of definitely not coronaropathic patients in whom angiocardiography was performed. In these clinically well documented cases, computer diagnoses were well correlated with those of treating physicians. It should however be pointed out that in 18% of patients with myocardial infarction, the ECG did not confirm the lesion. In the control group also, ECG alterations were recorded in 18% cases. This is a high percentage because in numerous patients the presence of rheumatic or shunt valvulopathies or myocardiopathies was encountered.


[A program of combined ECG and VCG automatic diagnosis. Note I. The atriogram]. In this paper a new computer aided ECG and VCG data handling is analized. It is based on an optimum estimation of dipole moment, which is used as the main diagnosis parameter. Already known diagnostical methods (available in present literature) are compared with this new technique. The available diagnostical range has been increased widely. The sensitivity of such a program is being analyzed both for normal and abnormal cases.


[Plan for installation of an automatic system of analysis of electrocardiograms for a group of hospitals and a regional cardiological record office]. In view of the present state of the Central ECG Department serving the "San Giovanni" group of hospitals in Turin and in consideration of the ever growing number of ECG's required daily, a reorganization of the department has become necessary. Such a reorganization must be based on the latest facilities offered by electronic engineering, namely by means of automating the entire system. Various manufacturers offer proven equipment and the only problem is one of choosing that most suitable for requirements. Personally, the on line system is considered to be best although many are opposed to it, because it is the only system that makes it possible to answer urgent demands in real time. The material collected by this Centre and by others that must of necessity arise in the Region of Piedmont, should not be dispersed but filed so that it can be employed for further controls and for statistical and epidermiological research. It therefore becomes necessary to set up a large central file at Regional level capable of storing ECG findings and all historical, clinical and laboratory data pertaining to patients who come into contact with the System. On request, it must also be capable of processing stored data and furnishing print-outs of data through video terminals for the purposes of subsequent examinations and continuations of treatment, as well as for clinical or statistical research reasons. Such a file would represent a veritable cardiological register for Piedmont and the first step on the way to the impellent creation of a Sanitary Register of the whole population.


[Clinical testing of the Sicard system for automatic evaluation of electrocardiograms]. Appraisal of the Sicard (Siemens) system for the automated evaluation of ECG's is reported. 528 ECG's were simultaneously recorded on paper and magnetic tape and examined by a group of specialists and the 404/3 computer forming part of the system, followed by a check on an IBM computer. A very high percentage of fits was noted and a favourable judgment is passed on the system.


[Automatic analysis of electrocardiogram with the Sicard system]. An assessment was made of the accuracy and practicability of the Sicard system (Siemens). This employs the Minnesota and USPHS codes. A series of 64 ECG's was examined. Results obtained automatically were compared with those given by a cardiologist and a second processing on the computer. The only differences of importance consisted of classification discrepancies, particularly in the case of arrhythmia and atypical pictures during the ventilogram recovery stage. While further improvement of the system is to be hoped for, it nevertheless makes valuable work of long-term significance possible.


[Data on experience with automated diagnostic systems]. This study highlights the various parameters considered for experimenting automatic equipment correctly. By applying such parameters to experiments with the "Sicard" system (Siemens) for automatic ECG reading, the usefulness of the system for its declared purpose, i.e. mass screening and epidemiological research, has been demonstrated.


[Results of mass ECG studies with the use of the Sicard automatic system]. The purpose of the present research is to assess the reliability of the Sicard (Siemens) system in mass screening. Experiments showed it is suitable for this use, although reservations are expressed regarding a few types of diagnosis.


[Controlled clinical trial of parsalmide]. A double-blind, between-patients comparison between parsalmide (a new drug) and phenylbutazone in 55 patients with postraumatic joint and muscle pain showed that the two compounds possessed about the same anti-inflammatory and analgesic activity, though parsalmide gave greater relief of pain and local swelling. Tolerance was excellent for both drugs. Slight gastric disturbances noted in 2 subjects with both compounds were easily corrected by symptomatic management.


[Controlled clinical trial of parsalmide in patients with subacute and chronic arthro-neuro-mypathies]. Controlled experiments were carried out to compare the anti-inflammatory, analgesic, muscle-relaxing and anxiolytic-tranquillizing activities of a new compound, parsalmide, and indomethacin. The study was conducted on 40 patients of both sexes suffering from syndromes involving neuromotor deficiency of various origin and the double blind between patient, technique was used. Overall evaluation of the activities of the two drugs did not reveal statistically significant differences although parsalmide was more effective with "pain", "tumefaction" and "anxiety" symptoms. This latter finding is particularly interesting owing to the frequent association of neuroanxiety disturbances in such patients. General and local tolerance was good with both drugs.


[Controlled clinical trial of parsalmide, a drug with analgesic and anti-inflammatory activity]. A controlled clinical trial of the anti-inflammatory, analgesic, muscle-relaxing and anxiolytic activity of a new compound (parsalmide) was compared with that of phenybutazone in 40 patients with acute or exacerbated inflammatory or degenerative processes randomly distributed into two treatment groups. Parsalmide was more effective in the relief of joint swelling and anxiety and gave better motility. On an overall evaluation, however, it was on a par with phenylbutazone. Treatment had to be suspended in two cases treated with phenylbutasone, whereas tolerance was good with parsalmide and no suspensions were required.


[Report of a controlled clinical trial of a new synthetic drug, parsalmide, in rheumatic arthropathies (inflammatory and degenerative)]. The anti-inflammatory, analgesic and tranquillizing activity of a synthetic compound called parsalmide was investigated in patients suffering from inflammatory and degenerative rheumatic arthropathies. The study was carried out in 30 subjects using the controlled experiment technique according to the "between patient" pattern, attributing parsalmide and indomethacin at random to two groups. Both preparations were found to possess good anti-inflammatory and analgesic action, comparable clinically and statistically. Tolerance was very good, particularly at gastroenteric level (no side and/or undesired effects were observed) and at the level of haemopoietic, renal and hepatic function.


[Controlled clinical trial of a new synthetic preparation (parsalmide) in the treatment of inflammatory and degenerative arthro-myopathies]. A double-blind, between-patients trial of a new drug (parsalmide) against indomethacin in the relief of inflammation and pain in 68 patients with exacerbated inflammatory and-or degenerative arthromyopathy resulted in 76% of successful results with both drugs. Tolerance was good, though side-effects, albeit slight, were more common with indomethacin.


[Parsalmide, a new synthetic substance, in inflammatory and arthrosic arthropathies. Double-blind controlled clinical trial]. The double-blind, between-patient experimental technique was employed to investigate the anti-inflammatory, antalgic and myorelaxant activity of a new synthetic compound, parsalmide. 30 patients suffering from arthrosic and inflammatory arthropathies in various sites and in newly acute phase, were treated with the substance which was assigned at random to 2 experimental groups; phenylbutazone was adopted for comparison purposes. Both substances under study proved to have good anti-inflammatory and antalgic action, although in the case of certain parameters, parsalmide was definitely superior to the control drug. The antalgic and myorelaxant activities of parsalmide were statistically superior to those of phenylbutazone. Tolerance was "very good" in 93% of cases treated with parsalmide "very good" or "good" in 86.6% of the cases treated with phenylbutazone.


The calcifying epithelial odontogenic tumor. A review and analysis of 113 cases. A review of the world literature has revealed 113 cases of the calcifying epithelial odontogenic tumor. The clinical, radiographic, and histopathologic features are analyzed. Various treatments that have been carried out are related to the frequency of recurrence. The theories of histogenesis are discussed and an attempt is made to explain the nature and origin of the amyloid-like substance.


Substrate metabolism and renal function. Glucose metabolism is related to two major renal functions. Glycolysis may be related to an energy requiring function--fine adjustment of renal sodium absorption. Gluconeogenesis may be related to controlling intracellular pH and salvation of energy otherwise wasted in acidosis. Ammoniagenesis is related to gluconeogenesis in the metabolic acidosis, but the individual phenomena are not necessarily dependent on each other.


Syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH consists of hyponatremia and hyposmolality, continued urinary loss of sodium, excretion of an inappropriately concentrated urine, and absence of dehydration, usually in the presence of normal renal and adrenal function. The retention of excess water caused by the inappropriate secretion of antidiuretic hormone is central to the development of the syndrome. In pediatrics, SIADH is most commonly seen in patients with meningitis or postoperatively. Fluid restriction is vital in such patients to prevent the development of symptomatic SIADH. Fluid restriction alone will also result in the correction of serum electrolyte composition in patients with SIADH. Hypertonic saline should be used only in severely symptomatic patients.


Induction of abnormal immunoglobulin maturation and antibody production by persistent embryonic mumps virus infection. Intramuscular inoculation of 19-day old chickens with heterologous erythrocytes elicited significantly lower levels of agglutinins in embryonically infected birds when compared with control birds (reciprocal ha titer 10 vs. 100, respectively, P less than 0.01). The IgG component of this antibody was substantially less in experimental chickens, 25% vs. 70% in controls. Subsequent anamnestic antibody response in experimental birds was also significantly less than control chickens (reciprocal ha titers 25 vs. 512, respectively, P less than 0.02), with continued predominance of IgM antibody in experimental chickens (70% IgM-ha) vs. controls (60% IgG-ha). Induction of cell-mediated immunity by footpad inoculation of 46-day-old birds with diphtheria-tetanus toxoid in complete Freund's adjuvant failed to discern suppression of T cell function in previously infected chicks. Before hatch, the bursae of experimental and control embryos possessed a few IgM-producing lymphoid cells in equivalent numbers. There was also no difference in the relative population of IgM-producing cells in the medullary area of bursal follicles of 7-day-old hatchling chickens, approximately 70%. However, the mean density of IgG-producing cells in the bursae of experimental chickens was less than that of control chickens, 10% vs. 19%, respectively. Consistent with persistent embryonic viral infection and altered bursal function, only IgM-producing cells were detected in the spleens of 7-day-old experimental birds. These observations suggest that persistent embryonic viral infection disturbs the function of bursal-dependent immunopoiesis in the avian host.


Is continuous transpulmonary pressure better than conventional respiratory management of hyaline membrane disease? A controlled study. The influence of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) on mortality and complication rates in severe hyaline membrane disease (HMD) was evaluated in a randomized, prospective study. Patients were admitted to the study if the Po2 was less than 50 mm Hg with FiO2 greater than 0.6. Twenty-four patients in each of three weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6 to 14 cm H2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea or hypercapnia (Pco2 greater than 65 mm Hg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or Po2 less than 50 mm Hg with FiO2 greater than 0.8. Oxygenation improved after the start of CPAP or PEEP; however, Pco2 rose after CPAP was initiated. There was no significant difference between treatment and control groups in mortality, requirement for mechanical ventilation, or incidence of pulmonary sequelae. The incidence of pulmonary air-leak was increased with Peep. the findings suggest that CPAP and PEEP have not significantly altered the outcome of HMD.


Skin lesions in association with beta-hemolytic Streptococcus group B. A full-term male infant delivered by caesarean section following a prolonged rupture of the amniotic membranes of 30 hours' duration manifested peculiar skin lesions at the time of birth consistent with the healing phase of bullous impetigo. He was colonized with beta-hemolytic Streptococcus group B that was also cultured from the mother's cervix. It is possible this infant became infected in utero since the healing stage of the lesions suggest that they were present sometime before birth.


Pneumoesophagus as a sign of H type tracheoesophageal fistula. Two patients with H type tracheoesophageal fistulae demonstrated prominent pneumoesophagus and gaseous distention of the bowel after endotracheal intubation and positive-pressure ventilation. This report discusses the pathophysiology of these events and emphasizes the significance of these findings.


[Diagnosis of Pneumocystis carinii pneumonia by indirect immunofluorescence. Technic, value of limitations of the method]. The diagnosis of Pneumocystis Pneumonia can be established by indirect immunofluorescence test performed on the sera of the patients. This investigation has proved to be valid since it gives 50 p.cent of positive results in 16 confirmed cases. The false negative results can be imputed in some patients, to the extreme severity of the immune deficiency.


[Heart transplantation in the dog. One case of survival for 7 years]. A survival of 7 years was obtained in a dog cardiac transplant, treatment having been stopped one year after operation. Morphological study of the graft showed the existence of a fibrous type rejection reaction, involving the vessel walls and the autonomic nervous system areas of the graft, resulting in episodes of ventricular tachycardia. This case shows that a rejection reaction may progress slowly and inexorably for several years whilst long term tolerance of the graft may nevertheless be obtained, perhaps by induction due to transfusion during the operation of blood of the donor to the recipient.


The 5' ends of yeast killer factor RNAs are pppGp. The 5' nucleotides of the double-stranded RNAs of yeast killer factor have been isolated by digestion with pancreatic, T1 and T2 RNase followed by two-dimensional electrophoresis. They were identified by bacterial alkaline phosphatase and snake venom phosphodiesterase digestions. Both the larger double-stranded RNA (L, of 2.5 x 10(6) daltons) and the smaller double-stranded RNA (M, of 1.4 x 10(6) daltons) have the 5' end groups pppGp. These 5' ends are dissimilar to those of the double-stranded RNAs of animal viruses but may be characteristic of the 5' ends of the double-stranded RNAs of fungal viruses.


Mechanisms of chain folding in nucleic acids. The (omega, omega) plot and its correlation to the nucleotide geometry in yeast tRNAPhe1. The (omega', omega) polot depicting the internucleotide P-O bond rotation angles in yeast phenylalanyl transfer RNA has established the interdependence of the phosphodiesters and the nucleotide geometries in the folding of the polynucleotide backbone. The plot distinguishes the regions characteristic of secondary helical structures and tertiary structural loops and bends. The folding of the polynucleotide chain is accomplished either solely by rotations around the P-O bonds or in concert with rotations around the nucleotide C4'-C5' bond with or without changes in the sugar ring pucker. In spite of differences in nucleotide sequence and intraloop tertiary interactions in the anticodon and pseudouridine loops, a characteristic repeating structural unit is found for the sugar-phosphate backbone of the tetranucleotide segment around the sharp turns.


Specific replacement of Q base in the anticodon of tRNA by guanine catalyzed by a cell-free extract of rabbit reticulocytes. Guanylation of tRNA by a lysate of rabbit reticulocytes was reported previously by Farkas and Singh. This reaction was investigated further using 18 purified E. coli tRNAs as acceptors. Results showed that only tRNATyr, tRNAHis, tRNAAsn and tRNAAsp which contain the modified nucleoside Q in the anticodon acted as acceptors. Analysis of the nucleotide sequences in the guanylated tRNA showed that guanine specifically replaced Q base in these tRNAs.


Medical therapy of colonic diverticular disease. Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addition of vegetables, fruits, and cereals (bran) to the diet. Foods with undigestible residues should be avoided. When dietary manipulations are not well tolerated, hydrophilic bulk laxatives are a useful alternative. Treatment of acute attacks consists of bowel rest and administration of intravenous fluids and antibiotics. Side effects of anticholinergics may outweigh their questionable usefulness. Nonabsorable oral sulfonamides have little or no place in the treatment of the acute attack (peridiverticulitis).


Pathogenesis of colonic diverticulitis and diverticulosis. Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. Another surprising finding in pathologic studies was that one out of three sigmoids resected for "diverticulitis" showed no inflammation in or around the diverticula, but the wall of the sigmoid was impressively thickened. This type of diverticulosis, which is frequently symptomatic, has been referred to as painful diverticular disease or spastic colon diverticulosis. Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.


Hepatic transplantation, 1975.

Hepatic transplantation, 1975. This report reviews experience with 97 patients given liver transplants. We regard out survival statistics as unsatisfactory, but fell they should encourage further work since 22 patients have survived at least one year with a maximum survival of 5 13 YEARS. The Achilles' heel of liver transplantation os bile duct reconstruction. We presently rely upon Roux-en-Y reconstruction, or alternatively, duct-to-duct anastomosis with a T-tube stent. The prime indication for liver replacement is non-neoplastic liver disease, but a favourable malignancy for treatment may prove to be small intrahepatic duct cell carcinomas.


Hyperbilirubinemia in infants with urinary tract infection. In the light of a retrospective analysis of 213 case records of infants with urinary tract infections, hyperbilirubinemia was disclosed in 19 cases. In 7 cases jaundice was the main cause of admission of these children to the hospital. It was observed mainly in the youngest age group up to 3 months. Jaundice was hemolytic in some cases and hepatic in others. Urinary tract malformations had no effect on the frequency of jaundice in urinary tract infection or on its intensity.


Pilot study with antilymphocyte globulin in the treatment of multiple sclerosis. Twenty patients with multiple sclerosis, in whom treatment with azathioprine and steroids had not altered the progression of the disease, were given additional treatment with either antilymphocyte globulin (ALG) (seven patients), thoracic duct drainage (TDD) (five patients) or a combination of both (eight patients). Four of the seven patients treated with the addition of ALG showed remarkable improvement which has lasted little improvement. In the eight patients receiving both had severe allergic reactions to ALG which prevented adequate dosage. TDD alone was performed in patients sensitive to ALG. These five patients showed little improvement. In the eight patients receiving both ALG and TDD there was marked improvement in four patients which has again lasted several years. The main side effect of ALG therapy is allergic reactions. Major infections or tumour formation did not occur in any patients.


Evaluation of antibodies, antigens and immune complexes present in antilymphocyte serum. This paper reviews the rosette inhibition test for the evaluation of antilymphocyte serum potency and reappraises the biological significance of the assay. Evidence is also presented which indicates the presence, in antilymphocyte serum, of immune complexes.


The clinical problems of dosage and the route of administration of antilymphocyte globulin. The production and quality control of ALG are outlined. The advantages and disadvantages of the various routes of administration of ALG are discussed. We tend to use a short duration high dose course of ALG in renal transplantation, myasthenia gravis and polyarteritis nodosa.


Past experience and future studies with antilymphocyte globulin in recipients of kidney homografts. We remain convinced that antilymphocyte globulin (ALG) is a potent immunosuppressive agent in humans. For that reason, we have used it in essentially every case of renal transplantation since May of 1966; now, however, we are about to embark on a controlled clinical  trial of ALG in kidney transplantation and await with tremendous interest the results of other such trials from other centres around the world.


Antilymphocyte globulin and renal transplantation. ALG was used in 87 patients undergoing cadaveric renal transplantation. These patients were grouped into five different groups according to the batch of ALG which was given. In addition to receiving ALG prepared by immunization with cultured lymphoblasts our most recent patients (Group V) also received a shorter duration of ALG therapy in much higher doses. These variations may explain the differences in three month transplant survival which was seen with the various groups. (Group I 68% survival, Group II 80%, Group III86%, Group IV 47% and Group V 83%.) Is is suggested that the results are predictabe on the basis of skin graft prolongation in monkeys.


Experience with antilymphocyte globulin in 144 renal transplant recipients. In patients receiving cadaveric kidneys and treated with antilymphocyte globulin (ALG) the one-year graft survival 59%. The corresponding figures with living related donors were 87% and 83%, respectively. Side effects of ALG, of which allergic reactions were the most common, prompted its withdrawal in 33% of the cases. All patients studied developed antibodies against horse gammaglobulin when tested with a passive haemagglutination inhibition technique. ALG seems to act upon the T-cells since the number of cells forming rosettes with sheep red blood cells was reduced.


Controlled trial of antilymphocyte globulin in cadaveric transplantation. Since January 1974, alternate cadaveric renal transplants were treated with antilymphocyte globulin (Behringwerke) om addotopm to prednisone and azathioprine. Thirty patients were treated in this way. 53% of patients receiving ALG had a functioning graft at six months as opposed to 40% in the control group. This difference is not significant. All other parameters were approximately equal in the two groups. No serious side effects of ALG treatment were observed.


A randomized prospective clinical trial of antilymphocyte globulin in 100 cadaveric renal transplants. In controlled randomized study of antilymphocyte globulin (ALG) in 100 cadaveric renal transplants, 15 patients receiving a second transplant were excluded. Ofthe first transplants, 42 were in the control and 43 in the ALG group. The two groups were similar. The ALG used was either prodduced in our laboratories or obtained from a commerical source. It was observed that ALG produced a significant lymphopenia, that the oliguric phase of the ALG group was half that of the controls, and that the ALG group although less likely to suffer rejection episodes responded significantly better when treated than did those in the control group.


New experiences with antilymphocyte globulin in human organ transplantation. This is a retrospective analysis of 100 consecutive primary renal allotransplantations using cadaver kidneys exclusively. Seven patients were sensitive to horse globulin and were therefore not treated with ALG. In all the other 93 patients ALG was given for the first postoperative weeks in addition to standard immunosuppressive therapy. In this group, the one year survival with functioning primary transplan is 73%. The control group is also doing fairly well (5 out of 7 surviving), but it is too small for statistical analysis. Several possible explanations are given for the divergent results in this field.


The use of antilymphocyte globulin in renal allograft rejection. A controlled study. A controlled clinical investigation of the effect of equine anti-human-lymphocyte globulin (ALG) on established rejection after transplantation was carried out. In comparison with a control group, the treated group showed a significantly positive effect of ALG in the form of a faster reversal of rejection episodes (P less than 0-05). Leucocytes, lymphocytes, erythrocytes, thrombocytes and immunoglobulins were unaffected by the treatment, but there were signs of a complement consuming process and an influence on blast transformation tests. No rise in antibody titre against equine globulin was seen.


Steroids in the assessment of prenatal development. Methods for identifying the fetus at risk and monitoring fetal well-being as pregnancy progresses are now an established part of prenatal care in the Western World. In this short review the use of steroids in the assessment of prenatal development is discussed. The metabolism of oestrogens, progestogens, corticosteroids and androgens during pregnancy is outlined and the relative merits, in terms of usefulness and practicability, of urinary and plasma steroid assays are discussed.


Steroids and the eye--indications and complications. Corticosteroid therapy is of great value in many types of eye disease. The indications are briefly discussed, together with the choice of agent and mode of administration. The dangers of steroids are now widely recognized, and the complications are discussed, particularly cataract and glaucoma. Reference is also made to optic neuritis and thyroid ophthalmopathy, where the role of steroids is uncertain. Particular stress is laid on the need to keep steroid dosage as low as possible, so as to avoid systemic side effects. There are unfortunately many situations where treatment of doubtful efficacy has produced severe side effects. Despite the overall benefit of steroids in ophthalmology, there is a pressing need to find alternative treatment for a variety of blinding disorders.


Experimental procedure for testing the effects of low level antibiotic feeding and therapeutic treatment on Salmonella typhimurium var. copenhagen infection in broiler chicks. Procedures are described for determining the effects of low level antibiotic feed additives in broiler chick rations when chicks are artificially infected with Salmonella typhimurium var. copenhagen and the effectiveness of the same antibiotics used therapeutically for salmonellosis. These procedures also permit study of development of antibiotic resistant enteric flora related to antibiotic feeding and the transferability of the resistance. Measures should be taken to monitor and assure minimal extraneous bacterial contamination of eggs, chicks, feed and facilities and minimize baseline antibiotics resistance. Facilities and equipment should be fumigated extensively, chicks should be from primary breeder flocks off antibiotics for two generations, handled minimally, and fed all-vegetable protein rations. Optimum procedures for oral induction of salmonellosis with a chick-virulent strain of Salmonella typhimurium var. copenhagen are reported. Effects of low level antibiotic feeding and subsequent therapeutic level feeding of infected and control birds are measured by mortality, feed efficiency and weight gain, and microbiological analyses of fecal samples, intestinal samples and necropsied dead chicks. Gathering all data possible from all facets of the trials is imperative for ascertaining antibiotic effects.


Preliminary study of the effects of feeding ethyl mercury chloride on four breeds of chickens. Different breeds of chickens namely Single Comb White Leghorn (S.C.W.L.), New Hamsphire (N.H.), Iraqi (IRQ) and a cross (CRS.) S.C.W.L. X N.H. X IRQ. were housed in small pens (20 females and 2 males each) and given, in the diet, 40% wheat treatmed with ethyl mercury chloride, for 88 days. Throughout the whole experiment all birds remained active and showed no symptoms of toxicity. The Iraqi breed was significantly higher than the other breeds with respect to egg production. The results also indicated that mercury in egg white is almost three times as much as that in the yolk, although there was no significant difference between the breeds. The liver and kidney of the four breeds tended to accumulate the highest amount of mercury. Significant differences appeared between sexes according to liver and kidney. White Leghorn and local breeds behaved the same, but N.H. had the highest concentration of mercury in most tissues.


A simple transporting and maintenance medium for Mycoplasma synoviae. A simple technique for preserving and transporting Mycoplasma synoviae, which involves suspending the cells in a 20 percent glycerol medium, is described.


Mianserin in the treatment of depression in general practice. In a double-blind study in general practice, both mianserin ('Bolvidon') in an average dose of 40 mg a day, and imipramine, in an average dose of 100 mg a day, were found to be significantly more effective than placebo after two to three weeks' treatment. No significant differences in antidepressant effect could be demonstrated between mianserin and imipramine. There was no significant difference in side-effects between the three treatments.


[Topical treatment of various dermatosis with difluocortolone valerianate. (ointment) Double blind comparative study]. The trial preparation, diflucortolone valerate, was tested clinically in the form of fatty ointment on 27 patients: 4 with psoriasis, 4 with neurodermatitis, 4 with contact dermatitis, 2 with actinodermatitis, 10 with eczema, 2 with cutaneous reticulosis and 1 with radiodermitis. In 89% of the cases the results were good; in 11% were they regular.


[Investigation of a new product (HK 183 MB) in various dermatoses]. The new trial preparation, diflucortolone valerate, was tested clinically in the form of a cream on 41 patients with weeping dermatitis. 34 cases were treated without a dressing, 5 with a dressing and 2 with an occlusive dressing. A complete cure or a distinct improvement was obtained in 100% of the cases. No undesired side effects developed.


[Soluble proteins of the vegetative cells and spores of Clostridium botulinum type B and their toxicity]. By disc microelectrophoresis in polyacrylamide gel proteins of vegetative cells and spores of Clostridium botulinum type B were investigated at different growth phases and toxicity of protein zones was measured. Protein components of vegetative cells varied in their electrophoretic mobility, depending on the growth phase, and differed significantly from spore proteins. Spores contained 1% toxin of vegetative cells. Electrophoregrams of intrasporal proteins showed a toxic zone with an approximate molecular weight of 10(5)-10(6).


Biochemical construction of specific chimeric plasmids from ColE1 DNA and unfractionated Escherichia coli DNA. A series of chimeric plasmids was constructed using colicinigenic factor E1 (ColE1) DNA as the replicon and DNA fragments carrying the galactose or tryptophan operons from E. coli. Restriction endonuclease EcoRI digests of ColE1 DNA and various DNAs containing the trp or gal operons were joined by T4 polynucleotide ligase [polynucleotide synthetase (ATP), poly(deoxyribonucleotide):poly(deoxyribonucleotide) ligase (AMP-forming), EC 6.5.1.1]. Chimeric plasmids carrying the desired genes were selected after transformation of Trp- or Gal- cells with ligated DNA. By using this method, we constructed ColE1-gal and ColE1-trp chimeric plasmids in which the source of the bacterial gal and trp operons was an unfractionated EcoRI digest of total E. coli DNA. The frequency of recovery of such chimeric plasmids is 10 to 20 colonies per mug of ligated DNA used in the transformation step. The method utilized in this report for constructing specific chimeric plasmids from total E. coli DNA is very simple. It requires only endonuclease R-EcoRI and T4 polynucleotide ligase, both of which are commercially available. The yield of transformants suggests that this method will be useful for cloning and amplifying a wide variety of functionally defined genes from E. coli and other prokaryotic organisms.


Recombination promoted by superhelical DNA and the recA gene of Escherichia coli. When a mixture of superhelical DNA (RFI) of phage phiX174 am3 and fragments of single-stranded DNA from wild-type phiX174 was added to spheroplasts of E. coli carrying an amber suppressor, several percent of the progeny phage were recombinant. The yield of wild-type progeny was 10(3) to 10(4) times lower when the fragments came from phiX174 am3 or phage G4 am+, or when fragments were absent. Fewer recombinants were produced in proportion to the decrease in the fraction of RFI in samples treated with S1 nuclease, whereas the total yield of phage did not decrease. Transfection by fragments and superhelical DNA produced 20 to 100 times more recombinants than transfection by fragments and either nicked circular DNA or relaxed closed circular DNA. Transfection of a recA- strain by RFI DNA and fragments yielded 5-10% as many recombinants as transfection of a rec+ strain. This partial requirement for recA was bypassed by transfection with complexes of RFI AM3 DNA and am+ fragments made in vitro.


Hydrolysis and transpeptidation of peptide substrates by acetyl-pepsin. Treatment of swine pepsin with acetylimidazole to acetylate approximately five of its 16 tyrosyl residues causes a significant enhancement of catalytic efficiency (kcat/Km) toward substrates such as dansyl-glycyl-glycyl-L-phenylalanyl-L-phenylalanine 3-(4-pyridyl)propyl ester and benzyloxy-carbonyl-(glycyl)n-p-nitroLphenylalnyl-Lphenylalanyl-L-tyrosine (where n = 0, 1,2). Stopped-flow kinetic studies, under conditions of enzyme excess, with the dansyl peptide have shown that, as with untreated pepsin, the rate-limiting step in the over-all catalytic process is associated with the decomposition of the first detectable enzyme-substrate complex, whose dissociation constant is approximately equal to the Km found in steady-state kinetic experiments. With substrates of the type benzoyl-(glycyl)n-nitro-L-phenylalanyl-L-tyrosine, an increase in the chain length of the peptide leads to an increase in the value of kcat/Km, supporting the view that secondary enzyme-substrate interactions may produce at the extended active site conformational changes that are reflected in higher catalytic efficiency. This effect is more marked with acetyl-pepsin than with untreated pepsin, and suggests that the conformational mobility of the active site is increased by partial acetylation. Acetyl-pepsin is less effective than untreated pepsin in catalyzing transpeptidation reactions in which acetyl-L-phenylalanyl-L-tyrosine and benzyloxycarbonyl-(glycyl)n-p-nitro-L-phenylalanine are the reactants; this finding is consistent with the more rapid hydrolysis of the product of transpeptidation.


Acitivity of yeast extracts in cell-free stimulation of DNA replication. Extracts of the cytoplasm of disrupted spheroplasts of Saccharomyces cerevisiae (bakers' yeast) stimulated DNA synthesis in a cell-free system consisting of nuclei from spleen cells of the frog Xenopus laevis, The stimulation required Mg++8 ATP, and the deoxynucleoside triphosphates, was saturated by an excess of nuclei or extract, and had kinetics resembling those obtained previously with extracts from mammalian and avian cells. After addition of the yeast extract, replication "eyes" were formed in the DNA from the nucleochromatin of the frog, suggesting that the extract stimulated the initiation of DNA replication. The activity was susceptible to heat, was nondialyzable, and was abrogated by tryptic digestion. Temperature-sensitive mutants of the cell division cycle (cdcmutants 4,7,8, and 28) grown at permissive temperature (23 degrees) yielded extracts that were capable of stimulating DNA replication. When the cells were incubated for one generation at the nonpermissive temperature (36 degrees), their extracts showed very low or no activity. All of these mutants are deficient in events of the dependent pathway leading to initiation of DNA synthesis in the yeast cell cycle. A ts mutant, cdc10, deficient in the separate pathway for cytokinesis, showed little or no loss of activity at the nonpermissive temperature. These data indicate that the "initiation" activity, as assayed in vitro, is subject to control in the yeast cell cycle, and its appearance may be one of the terminal events in the pathway leading to DNA synthesis. The finding that extracts from yeast cells can stimulate DNA synthesis in nucleochromatin from frog cells, and the fact that the cdc mutants 4,7,8, and 28 describe a dependent pathway terminating in development of "initiation" activity, are in accord with the hypothesis that the function of proteins in the dependent pathways of the cell cycle is conserved during evolution.


Purification and characterization of a putative sigma factor from Chalamydomonas reinhardi. Two proteins with sigma-like activity have been isolated from the alga, Chlamydomonas reinhardi. One protein, sigma 2, has been partially purified and appears to have a molecular weight of 51,000. The interaction of this protein with a heterologous (Escherichia coli) and homologous (Chlamydomonas, chloroplast rifampicin-sensitive) core RNA-polymerase (RNA nucleotidyltransferase, nucleosidetriphosphate: RNA nucleotidyltransferase, EC 2.7.7.6) was studied. Sigma 2 protein appears to stimulate the formation of open (rapid starting) binary complexes by both of the core enzymes. Stimulation of transcription by sigma 2 on chloroplast DNA was greater when Chlamydomonas core enzyme was used. Moreover, in vitro transcription on a variety of templates using RNA polymerases I and II from Chlamydomonas was not stimulated by this protein.


Identification and radiochemical purification of the recA protein of Escherichia coli K-12. The product of the recA gene of E. coli has been identified by labeling proteins synthesized in UV-treated cells after infection with specialized transducing phages carrying the recA gene. Following infection of UV-treated cells by lambda precA, which carries the recA+ gene, a major protein with a molecular weight of 43,000 is detected on polyacrylamide gels containing sodium dodecyl sulfate. This protein is also made after infection of suppressing hosts by lambda precA99, which carries an amber recA- mutation, but is not synthesized after infection of nonsuppressing hosts by this transducing phage. A spontaneous recatrevertant of lambda preca99 induces synthesis of this protein after infection of a nonsuppressing host. The product of the recA gene is a soluble protein found in a complex with a molecular weight of approximately 150,000 after mild detergent lysis of cells.


Analgesic evaluation of butorphanol in patients with postoperative wound pain. Two agonist/antagonist analgesics, butorphanol tartrate (test) and pentazocine hydrochloride (standard), were compared in volunteer informed patients experiencing postoperative wound pain. The relative potency (p) is 0.04 (1 mg butorphanol equals 24.3 mg of pentazocine lactate) with upper and lower confidence limits of 0.01 and 0.07 respectively. Butorphanol tartrate in the higher dose appears to have longer duration of effect. The side effects were comparable in the population studied.


Plug-holder unit for implanting stimulating or recording electrodes. Thh design of a plug-holder unit for electrode implants is described. The plug-holder attaches to the stereotaxic and facilitates the insertion of the electrode contact pins into the plug by retaining the connector plug in a fixed rigid position. In addition, it prevents the accidental breakage of contact lead wires which can normally occur during the contact pin insertion procedure. The unit is inexpensive and simple to construct.


Psychotropic effects of androgens: a review of clinical observations and new human experimental findings. In a review article, clinical literature concerned with the psychotropic effects of androgens is presented, and the results of experimental clinical work from biochemistry, electrophysiology and psychoexperimental tests are reported. The conclusion that androgens do have psychotropic properties similar to those of well known psychotropic substances is based on evidence from a number of sources: Clinical observations of patients with androgen deficiency or excess, observations of the effect of androgen therapy, and lastly experimental work with methods developed especially for testing psychotropic substances.


Demonstration of extrahypothalamic peptide secreting neurons. A morphologic contribution to the investigation of psychotropic effects of neurohormones. Visualized by immunocytochemistry vasopression and neurophysin are observed in perikarya of the supraoptic and paraventricular nuclei and their fibers going to the neurohypophysis. In addition to these classical sites, vasopressin and neurophysin are located in perikarya of the organum vasculosum of the lamina terminalis and of the suprachiasmatic nuclei. Outside the hypothalamus, neurophysin-positive perikarya are found in the triangular nucleus of the septum which is a part of the limbic system. Vasopressin and neurophysin are contained in two types of extrahypothalamic fibers. Large caliber fibers are found in the amygdala, small caliber fibers in the septum and thalamus. The presence of neurosecretory perikarya and fibers outside the hypothalamus may be related to psychotropic effects of peptide hormones.


[Phlebitis of infectious etiology].

[Phlebitis of infectious etiology]. Various infections are sometimes at the origin of phlebitis. Because of the different therapeutic consequences, this etiology should be considered whether it is a case of deep phlebitis of a limb, migratory recurrent phlebitis, or the type of phlebitis called "iron wire". The principal diseases that may lead to phlebitis are : tuberculosis, typhoid fever, rickettsiosis, and streptococcal, staphylococcal, and pneumococcal infections. Certain viruses may have a role but so far there is no formal proof. Focal pathology of dental or tonsillar origin involves in some cases an aseptic venous lesion. Bacterial or mycotic suppurative thrombophlebitis related to an intravenous catheter is the price paid for the use, often unnecessarily, of this method of perfusion.


The fan flap: an adjunct to ear reconstruction. The development of a fan-shaped flap of temporal myo-fascia and cranial periosteum for use in construction or reconstruction of the external ear is described. This adjunct to ear reconstruction decreases the incidence of exposure of the framework and does not add operative steps. The flap adds pleasing bulk to the helix while maintaining the delicate contours of the framework. Since we have been using this flap, we have had no early or late exposures of these frameworks.


Successful clinical transfer of two free thoraco-dorsal axillary flaps. We present two cases in which we used a new flap from the axilla, based on the thoraco-dorsal artery and vein. In the first case, the flap was used to cover an extensive exposure of the dura mater. In the second case, it was transferred to cover a large area of skin loss in the knee in which there was involvement of the joint. Further investigation is necessary to accurately ascertain the possibilities and the limits of this flap.


Histological investigation of the etiology of capsule contracture following augmentation mammaplasty. Sections obtained from contracted breast capsules were examined by light and electron microscopy. We observed the presence of multiple areas of a particulate foreign material, consistent with the appearance of droplets of dimethylpolysiloxane. An active foreign-body reaction was observed at the interface of the capsule and implant, as well as throughout the tissue subjacent to the deposits of foreign material. Based on these histological observations, we present a theoretical explanation of the etiology of capsular contracture of the breast after augmentation mammaplasty.


A dermal flap for carotid artery protection. We describe a dermal flap for use in protecting an especially vulnerable carotid artery from rupture after a radical neck dissection. We have used this flap successfully in 3 patients in the last 5 years.


Free autogenous transplants in preformed pseudosheath silicone rubber pockets. This investigation suggests that free autogenous grafts, when placed in preformed silicone rubber pseudosheath pockets, will survive as well, if not better, than in delayed or immediate surgical pockets. This supports the clinical assumption that silicone rubber implants can be used and exchanged periodically for larger sizes. At a final exchange, free autogenous tissue could be replaced within the pseudosheath pocket.


Replantations and free flap transfers by microvascular surgery. We have replanted 11 digits and two hands, with only one failure (a digit). Eight free groin flaps and one free dorsalis pedis flap transfer were performed, resulting in 5 complete survivals, two partial necroses, one superficial necrosis, and one failure. One hallux-to-thumb transfer was done, with a good result. We note the essential differences between doing replantations and free flap transfers.


[150 years of psychiatric therapy].

[150 years of psychiatric therapy]. The treatment of insane persons in the last century is briefly described. A more liberal and unrestrained treatment was introduced at the turn of the century, and chiefly agriculturally oriented insane asylums were established at that time. The question of persons trained to care for subjects afflicted with insanity was increasingly gaining in importance, and the aim was to have available a pool of skilled nursing personnel. Treatment by inducing artificial fever is outlined in addition to a brief description of a more activ treatment of patients by the Simon-Gütersloh method. In 1925, a "neuro-psychiatric dispensary" was established in the Soviet Union. Later, there were introduced such methods as insulin shock treatment and electroconvulsive therapy and, more recently, treatment with psychopharmaceuticals, the latter being drugs used in the treatment of emotional disorders in modern psychiatric hospitals. Inpatient and outpatient treatment is further developed with the establishment of day/night hospitals, and the need is pointed out to develop a system of care for mental patients on the model of that which exists in the Soviet Union.


Knightmare in Armor: reflections on Wilhelm Reich's contributions to psychoanalysis. One of the more curious by-products of the political and social unrest of the late 1960s, has been the emergence of and survival of interest in the writings of Wilhelm Reich (1897-1957). In the last few years, new translations of his books have appeared and some of his early work has been translated for the first time. A biography, magazine articles, and various surveys of his work convey the impression that his ideas are timely, or at least that they are historically important. However, I believe that the current enthusiasm for Reich owes more to the problems that interested him than to the light he shed on them. His great appeal for radical youth is based on his advocacy of social and sexual reform, for which he provided ideological support through a Marxist-psychoanalytic synthesis. By the technique of anthropological, economic, and psychological analysis, Reich tried to provide a scientific justification for revolutionary hopes.


Thanatos--a reevaluation.

Thanatos--a reevaluation. Freud's most controversial tenet is the death instinct. Although it appears full blown in 1920, it was doubtless nurtured for years in his mind. In its indissoluble relation to the repetition compulsion and Nirvana principle, Thanatos is the bedrock of much of Freud's later philosophy. This paper is an examination of the motivations for the idea, an exegesis of Freud's writings on the subject, and a review of critical opinion.


Houdini: the mythmaker. Variations on the theme of the family romance. This component of a more comprehensive study of Houdini focuses on the unusual reification of his family romance fantasies, their endurance well beyond the usual boundaries in time, their kinship with mythological themes, and their infusion with the ambivalence that is often addressed toward the true parents.


The case of Arise Evans: a historico-psychiatric study. The life and the ideas of a mentally aberrant figure in mid-seventeenth century England are presented in relation to the sociocultural background of the time and the available clinical information. The material illustrates the need to draw on both sources when applying psychiatric concepts to particular historical epochs.


Life events, depressive relapse and maintenance treatment. Occurrence of life events was recorded in 30 recovered depressed women undergoing clinical relapse in a controlled trial of maintenance treatment with amitriptyline and psychotherapy, and in 30 matched patients who did not relapse. Overall, patients who relapsed experienced significantly more life events in the three months before relapse, and especially in the month immediately preceding it. Undesirable events were particularly implicated. Event rates prior to relapse were closely comparable in treatment subgroups, giving no evidence that differential stress was required to produce relapse. The findings reinforce previous studies indicating an overall relationship between life events of certain types and depression, but do not suggest that the beneficial effects of maintenance treatment are specifically protective against life stress.


The role of culture in psychosomatic disorders. The paper summarizes and evaluates the work so far carried out on the role of culture in determining similarities and differences in prevalence and manifestations of psychosomatic disorders, and attempts to identify the possible cultural elements that account for such variations. It concludes that the evidence is insufficient to support beliefs about the existence of major differences between cultures in psychosomatic disorders as a whole, and that cultural factors provide but a superficial colouration to a primary core of illness common to all cultures; but that, nevertheless, real differences exist in the prevalence of certain conditions in a minority of cultures.


Living dangerously--the effect of chronic pulmonary and renal failure on self-image. Patients with severe chronic obstructive lung disease (COLD) are difficult to interview because of their inability to verbalize freely. The draw-a-person (DAP) and the draw-a-house (DAH) tests were given to COLD patients (n = 14), and to patients on chronic renal dialysis (n = 14). The COLD patients showed significantly more disorganization in the drawings (p less than 0.05 for DAP and p less than 0.001 for DAH) than the renal patients. There were certain other findings specific to the circumstances of each disorder. The DAP and DAH may be clinically useful in rapidly identifying the patients in need of greater psychosocial support.


[Encephalographic findings in tumors of the pineal region (author's transl)]. 6 encephalograms were selected from a series of 31 patients with clinical and radiological signs of a tumor in the pineal region, in order to obtain differential diagnostic criteria concerning space occupying lesions of this area. Neuroradiologically, it is possible only in a very few cases to decide whether a tumor had arisen from the pineal gland or from adjacent structures of the midbrain. At the time of the radiological examination usually the tumor has reached a size that an encephalographic distinction between pineal gland and quadrigeminal plate cannot be made. Computerized axial tomography can contribute essentially to solve this problem as shown by one example.


[Experience with a new hydro-soluble contrast medium (author's transl)]. Report about a very well tolerated new contrast medium Myelografin. The side-effects are being decoded and compared with the side-effects of other contrast-media for lumbar myelography. Spinal or cerebral irritating effects have never been recorded. Due to the low neurotoxicity the patient can be put in supine position immediately after the examination. Therefore the side-effects are diminished and the examination is more tolerable for the patient.


Tetrazolium salts and formazans.

Tetrazolium salts and formazans. The history of the tetrazolium salts and formazans goes back 100 years, to when Friese (1875) reacted benzene diazonium nitrate with nitromethane, to produce a cherry-red "Neue Verbindung". This was the first formazan. 19 years later, Von Pechmann and Runge (1894) oxidised a formazan to produce the first tetrazolium salt. Many hundreds of tetrazolium salts and formazans were prepared in the following years, but only a handful have found applications in biological research. This article has attempted to describe the properties of these compounds, and to illustrate how the tetrazolium salt-formazan reaction has been exploited to serve an extremely wide variety of functions.


Skin grafts on fingers: a simple and effective method for use in the accident and emergency department. A method is described of retaining small skin grafts in place on fingers by means of adhesive paper skin closures, and the results obtained in 20 consecutive cases are analysed. It is suggested that the technique may be of particular value in the Accident and Emergency Department.


Immunohistochemical investigation of gastrin-producing cells (G cells).The distribution of g cells in resected human stomachs. Direct immunofluorescence technique with rhodamine-labelled rabbit anti-gastrin IgG conjugate was used for systematic mapping of the G-cell distribution in 16 resected stomachs (8 gastric ulcer patients and 8 duodenal ulcer patients with uraemia). Along the anatomical border of the proximal part of the antrum there was in both groups of patients a tranzitional zone with a low G-cell number per unit mucosa until the cells abruptly disappeared in the body of the stomach. The proximal end of the duodenum contained considerably fewer G cells than the antrum, and the number was equal in both groups. Within the antrum there was in the duodenal ulcer group a gradual increase in G-cell number from the proximal to the distal end, whereas in the gastric ulcer group no significant difference was found in different parts of the antrum. When corresponding antral parts were compared between the two groups, the only significant difference was that the distal part contained more G cells in the duodenal ulcer patients. In both groups the antral G-cell number showed no difference in circumferential distribution.


Differential demonstration of the motilin-cell and the enterochromaffin-cell. Motilin cells were investigated in the GI-tract of various laboratory animals by immunfluorescence. The distribution of motilin cells was compared to enterochromaffin (EC) cell localization. Simultaneously histochemistry for EC-cells and motilin cells was carried out. The results indicate that motilin is not produced within the EC-cells. Present classification of motilin cells on ultrastructural evidence is therefore not yet possible.


Effects of motilin on gastric and pancreatic secretion in dogs. 13-norleucine motilin (13-nle-motilin), a synthetic analogue of motilin, infused intravenously in graded doses (range: 1.5 to 100 mug/kg-h) produced a dose-dependent increase in basal gastric acid and pepsin secretion and in pancreatic bicarbonate and protein secretion in conscious dogs provided with gastric and pancreatic fistula and Heidenhain pouches. When infused in a constant dose against a background stimulation with pentagastrin, histamine or a peptone meal, 13-nle-motilin inhibited both acid and pepsin secretion from the main stomach and the Heidenhain pouch. It also inhibited dose-dependently secretin-induced pancreatic bicarbonate secretion. Since motilin is released by duodenal acidification, it may be involved in the feedback mechanism controlling gastric and pancreatic secretion.


Effect of 13-Nle-motilin in postoperative ileus patients: a double-blind trial. In this study, the effect of 13-norleucine motilin (13-Nle-M) on post-cholecystectomy ileus was assessed in 6 female patients. 13-Nle-M given by continuous i.v. infusion (0.4 mug/kg-h) on the second and third day following surgery did not influence the manifestation and duration of intestinal paralysis in comparison to 6 control patients treated with 0.9% saline. Bowel sounds, however, were more pronounced in the 13-Nle-M-group. Blood pressure and pulse rate were not influenced by the polypeptide, and no other side effects were seen, either.


Potentiation of the macrophage response to migration inhibition factor from fetal calf serum by blood group substances with human H activity. Soluble blood group substances, with human H and A activity, have previously been shown to block the interaction between guinea pig peritoneal macrophages and migration inhibition factor from fetal calf serum (FCS-MIF). Conversely, incubation of macrophages at 37 degrees C for 1 h in the presence of 0.1% blood group substance, followed by thorough washing, potentiates the action of FCS-MIF. The sensitivity of the macrophages is markedly increased, allowing detection of subthreshold levels of FCS-MIF. Blood group substances (BGS) labeled with radioidine are taken up by macrophages, and a proportion remains on the surface. This radiolabeled BGS is lost from the surface spontaneously, and the rate of loss is increased by treatment with trypsin. It is suggested that the BGS mimic the natural macrophage receptor for FCS-MIF and potentiate its effect by incorporating new receptors into the macrophage membrane.


Immunological follow-up of 41 renal allograft recipients. A series of immunological parameters were used to follow 41 necrokidney transplantations, in an investigation of the correlation between these parameters and graft function, rejection and graft survival. The results showed that patient and graft survival were not dependent on the occurrence of rejection, but were related to decrease in lumphocyte counts and IgG in the initial post-operative period. Initial decreases in lymphocyte count, IgG, IgA and IgM were found. There was no correlation between initial donor-recipient MLC response and graft survial. In the post-operative period there were falls in PHA, PWM and PPD responses and in numbers of cells forming T and B rosettes, but no change in MLC response. Lowest measured values for lymphocytes and IgC tended to occur just before rejection, but there was no depression of the measured in vitro immune responses at this time. However, MLC and PHA responses were depressed during rejection. When these results are compared with similar results in the literature, which shows a lack of convincing correlation between existing immunological tests and the course of transplantation, it is concluded that the immunological tests available today are unsatisfactory for use in monitoring immune response as an aid to the adquate immunosuppression of receipients.


The efficacy, as modified by the circadian rhythm of salbutamol administered by different routes. Fourteen asthmatic outpatients participated in a total of 16 trials with salbutamol administered by different routes. Drug dosage was one 4-mg tablet, of two inhalations of 100 mug of salbutamol aerosol or a combination of both, four times daily. During the trial the patients measured their peak expiratory flow (PEF) every day at 1.00 a.m., 7.00 a.m., 10.00 a.m. and 9.30 p.m. The frequency and severity of symptoms and side effects as well as the auxiliary use of isoprenaline inhalation were also recorded. A clear-cut circadian rhythm in bronchial obstruction was observed during both active drug and placebo periods. PEF values during all active periods differed significantly from those during placebo periods at 3 and 2.5 h after drug intake (at 10.00 a.m. and 9.30 p.m.). Moreover, a distinction between the effects of the various active drug forms was possible at 10.00 a.m., salbutamol tablets and the combination of salbutamol tablets and aerosols being then superior to aerosol treatment alone. At night and in the early morning PEF values were generally lower than during the day owing to the circadian rhythm, and bronchodilator response to drugs at these times was also less pronounced. Isoprenaline consumption was highest during placebo periods and lowest during periods of combined active treatment. No serious side effects were seen. Cumulative evidence has shown that this kind of study with outpatients is suitable for comparing the clinical effects of bronchodilator drugs.


Bronchodilatory and circulatory effects of two doses of a beta2-agonist (terbutaline) inhaled with IPPB in patients with reversible airways obstruction. A beta2-receptor agonist, terbutaline (Bricanyl), in doses of 2.5 and 5 mg was inhaled by IPPB with a Bird Mark 8 in a double-blind cross-over randomized study on consecutive days in 12 patients with at least 15% reversibility of PEFR or FEV 1.0. One minute after the inhalation of 2.5 mg, PEFR had increased significantly; the greatest effect (+ 34%) was recorded after 120 min. After 5 mg the increase was more marked, with the greatest recorded effect (+ 43%) after 120 min; FEV1 and VC showed similar changes with a tendency towards greater and longer effects after the larger dose. Heart rate did not change. Systolic and diastolic blood pressures decreased at the most with 9 and 5 mmHg respectively, 30 min after 5 mg terbutaline. One patient reported tremor and palpitations 5 min after inhaling 5 mg. Our patients who were treated with beta-adrenergic drugs showed less systemic effects after the same dose of terbutaline than previously non-treated normal subjects in an earlier study. This may support recent findings of drug-induced tolerance to beta-stimulating agents in the heart and skeletal muscles with preservation of good effect on the airway smooth muscles, here shown as having a good residual bronchodilatory effect with clinically non-important effects on heart rate and tremor.


[Optimation and simplification of clinical tumor cytodiagnosis by means of cytocentrifugation]. Since the introduction of cytocentrifugation, the methods of clinical cytology have become more refined. The following advantages should be stressed: 1. speed and ease of processing, 2. highest possible cellular yield, 3. good preservation of cellular characteristics. In the light of predominantly CSF analyses in the field of pediatric oncology the above mentioned findings are clearly illustrated (ALL, AML, reticulum cell sarcomatosis, Ewing sarcoma, leptomeninx sarcoma, retinoblastoma, Letterer-Siwe's disease, familial erythrophagocytic lymphohistiocytosis, plexus papilloma). Malignancies are clearly distinguishable from benign conditions (toxic glial reactions, virus meningitides, CNS hemorrhages etc.). The higher cellular yield permits very early diagnosis of meningeal leukemia. This qualitative improvement of cytological diagnostic methods may considerably influence the choice of therapeutic procedures in the treatment of malignancies.


[Rosette tests in lymphoproliferative diseases]. The percentage and absolute count of B- and T-lymphocytes in the peripheral blood of 170 patients with various lymphoproliferative diseases was determined. T-lymphocytes were assessed by their capacity to form rosettes with unsensitized neuraminidase treated sheep red blood cells, and B-lymphocytes by their capacity to bind immune-complement complexes. The results in CLL, in non-Hodgkin lymphoma and in Hodgkin's disease are discussed with respect to the immunopathology of these diseases.


[Classification and infectiousness of chronic hepatitis B, defined by the Dane particle in the blood and virus components in the liver]. 55 HBAg seropositive patients with chronic hepatitis B selected from a total of 217 liver biopsies were studied for the presence of HBcAg and HBsAg in the liver tissue and of Dane particles in blood by immunofluorescence and electron microscopy. Among 27 patients with non-aggressive chronic inflammation the following constellations were found: a) 19 patients (13 with nonspecific reactive hepatitis, 6 with chronic persistent hepatitis) had isolated HBsAg expression in the tissue (HBs type) and of these only 2 had rare Dane particles; b)4 patients (all with histologically very active chronic persistent hepatitis) with focal HBc- and HBsAg tissue expression (HBc+s type) and detectable Dane particles in blood; c)4 patients (1 with nonspecific reactive, 3 with chronic persistent hepatitis) with generalized HBcAg (and focal HBsAg) expression (HBc type) and multiple Dane particles in blood. Among 22 patients with aggressive inflammation (19 with chronic aggressive, 3 with "hippie"-hepatitis) focal HBcAg tissue expression (HBc+s type) was found in 17 cases and absence of HBcAg in 5 (3 with focal HBsAg, 2 completely negative by immunfluorescence), all 22 associated with Dane particles in blood, however. In a group of 6 immunosuppressed kidney transplant recipients exhibiting a high concentration of Dane particles in blood 5 patients had generalized HBcAg tissue expression (HBc type) in association with non-aggressive inflammation (1 nonspecific reactive and 4 chronic persistent hepatitis). One patient had chronic aggressive hepatitis in conjunction with focal HBcAg expression (HBc+s type). The consistent association of detectable HBcAg formation in the liver and presence of supposedly infectious Dane particles in blood has a bearing on the evaluation and classification of chronic hepatitis B. On the basis of a positive focal (HBc+s type) or generalized HBcAg tissue demonstration (HBc type and/or the direct identification of Dane particles in blood, discrimination of possibly highly infectious forms from those of low or even no infectivity has been rendered possible. This duality applies mainly to clinically and histologically benign non-aggressive forms of hepatitis presenting with a carrier state or chronic persistent hepatitis. On the basis of these and earlier findings a hypothetical concept of chronic hepatitis is presented which possesses proven diagnostic and prognostic applicability to routine liver biopsies. It is also capable of shedding new light on contradictory findings in the literature and serving as a basis for prospective epidemiologic studies.


[Thrombocyte replacement with HL-A typed non-related single donors]. Thrombocytopenic patients who have become refractory to platelet transfusions from random donors will usually respond to HL-A compatible platelets with normal increments and hemostatic improvement. In our experience with unrelated HL-A typed donors, HL-A identity is unnecessary. Donors without excess antigen are compatible and even many donors with 1 excess antigen can be used, at any rate in immunosuppressed patients. Thus successful substitution of platelet becomes possible in refractory patients when family donors cannot be used.


[Australia antigenemia and hepatitis after kidney transplantation]. The clinical significance of Australia-antigenemia following kidney transplant has been studied in 18 patients. In 12 of these infection occurred after kidney graft. Sixteen allograft recipients had positive tests for Hbs-AG for 15-89 months. Development of chronic persistent hepatitis was observed in 7 cases; chronic aggressive hepatitis was not seen. Findings in the literature and the practical implications are discussed.


[Gynecologic diseases in the diabetic woman]. Gynecologic affections such as diabetic vulvitis, vulvo-vaginal mycosis, some dysfunctions of the ovary, recurrent abortion, secondary frigidity and sometimes carcinoma of the endometrium, may be the first signs of a disorder of carbohydrate metabolism. Contraception is particularly indicated in diabetic women. The methods are discussed.


A comparison of amitriptyline and a fluphenazine/nortriptyline preparation in anxiety-depressive states. Patients suffering from mixed anxiety/depressive reactions, referred to the out-patient department of a large psychiatric hospital, were treated with either amitriptyline tablets or fluphenazine with nortriptyline (f/n) tablets for a period of four weeks. The study utilized a double-blind, completely randomised design, and patients' progress was assessed by means of the Wing Present State Examination, the Wakefield Self-Assessment Depression Inventory, and a side effects inventory. Both the symptom rating scales showed that purely depressive symptomatology improved significantly in each treatment group, but the patients' self-ratings showed that only f/n produced a significant alleviation of anxiety symptoms and panic attacks. The patients receiving f/n rated themselves as significantly (p less than 0.05) less irritable, as well as less anxious, after 4 weeks treatment, than those receiving amitriptyline. The PSE schedule did not differentiate between the 2 treatment groups, but self-rating, which is a more sensitive method of eliciting drug effectiveness in patients suffering from mild psychiatric disorders, did demonstrate patient preference for f/n. This should have important implications for compliance with treatment.


Titanium (III) citrate as a nontoxic oxidation-reduction buffering system for the culture of obligate anaerobes. An oxidation-reduction buffering system based on titanium(III) citrate eliminates any traces of oxygen in a culture medium, serves as an indicator for low oxidation-reduction potentials, and prevents the growth of facultative anaerobes, which frequently contaminate anaerobic cultures.


Colonic polyps: antecedent- or associated-lesions of large bowel cancer. Many pathologists, gastroenterologists, and oncologists agree that villous (papillary) adenomas of the large bowel are at risk for the development of large bowel cancer. The role of adenomatous polyps (tubular adenomas) in the genesis of large bowel cancer is not a point of agreement. Future studies with molecular biologic techniques of colon polyps and adjacent mucosa and of the colonic mucosa of animals under treatment with colon carcinogens may clarify the role of colon polyps and other factors in the genesis of large bowel cancer. Polyps larger than 1.0 cm should be removed thrugh the proctosigmoidscope or the colonoscope.


Clinical manifestations of cancer of the colon and rectum. Cancer of the large bowel produces a background of abdominal pain, bleeding, and altered bowel function. The anatomy, physiology, and pathology of the bowel modify this basic pattern to emphasize certain features and minimize others, so that disease in different locations produces different patterns.


The effect of salicylate on the leucocyte migration inhibition test. The effect of sodium salicylate on peripheral blood leucocyte migration is described. At a concentration of 3,5 mmol/ml, no effect on leucocyte migration was seen, but this concentration appears to influence the leucocyte migration in the presence of specific antigen, either by increasing or by decreasing leucocyte migration inhibition.


Experimental microsurgery in peripheral nerves. A surgical technique for the reconstruction of severed peripheral nerves is described. This technique reduces the mechanical manipulation and trauma to the nerve during suturing. Histological studies revealed that scar formation at the suture site was reduced to a minimum. The suture material did not prevent the downgrowth of regenerating axons. Nerves in which suturing was either inaccurately or accurately done, were compared. Histological examination of these nerves revealed that axonal regeneration in nerves with 8 or more sutures was superior to that in nerves with only 2 sutures.


Congenital musculoskeletal malformation in South African Blacks: a study of incidence. Ten thousand South African Black neonates were examined on the day after delivery for assessment of the frequency of congenital malformation of the musculoskeletal system. In 15 neonates it was found that the hip joints could be dislocated by the Ortolani or Barlow techniques. This instability persisted to 1 week of age in only 3 instances. This incidence figure is approximately 10% of the average reported for White's neonates. Talipes equinovarus deformity was found in 35 infants, an incidence of 3,5/1 000, or approximately three times the incidence cited for Whites. Calcaneovalgus deformity, however, was found in 3 infants only-- a much lower incidence than that found among Whites. There was a similar infrequency in the incidence of spina bifida aperta (cystica), which was noted in 7 infants. This figure correlates with reports from North America, but is substantially lower than the cited incidence in Wales and parts of England. Polydactyly, usually consisting of a postaxial pedunculated skin tag only, was the most common deformity found, the incidence being 8,8/1 000.


Different degrees of morbidity, in the white mouse, induced by Nocardia brasiliensis, Nocardia asteroides and Nocardia caviae. The respective degrees of morbidity induced by 6 strains each of Nocardia brasiliensis, N. asteroides and N. caviae were investigated by the method of inoculation in the plantar pad of the white mouse, using a suspension of these nocardiae at a concentration of 10 mg/0-1 ml., and inspecting the animals one month, two months and three months following inoculation. All of the strains of N. brasiliensis produced attack greater and more consistent than that of the other species, N. caviae and N. asteroides showing patterns of attack similar to each other, but substantially lower than those obtained with N. brasiliensis. The 6 strains of N. brasiliensis showed different rates of infection at different times of observation, but it was constantly high for all of them; on the other hand, the infectiousness of the different strains of N. caviae and N. asteroides was low, and there were no substantial differences between them. To sum up, these results with 6 strains of each species confirm those that were published in 1973 which dealt with only one strain of each species.


Caprine mastitis due to Cryptococcus neoformans. The isolation of Cryptococcus neoformans from milk and its demonstration by direct microscopy has been reported in a case of caprine mastitis. This is believed to be the first instance of caprine mastitis in which C. neoformans has been implicated as the etiologic agent.


Cryptococcus neoformans in the crops of pigeons following its experimental administration. Cryptococcus neoformans (5 X 10(6) yeast cells) was given per os to 10 pigeons (Columba livia) proved to be free (crops and excreta) of C. neoformans prior to experimentation. The yeast was recovered from the droppings of 9 pigeons the day after ingestion but was still present in the droppings of 1 pigeon on the 22nd day after ingestion. The crop was much more constantly positive than the droppings and for a much longer time since positive in 9 pigeons on the first day it was still positive in 2 pigeons on the 86th day at the end of the observation period. The results of the experiment presented here and the results of previous work, indicate that C. neoformans can survive and could so be carried in the crop of pigeons.


Postoperative alkaline reflux gastritis. 1. The syndrome of reflux gastritis is produced by the actions of bile and upper intestinal and pancreatic secretions alone or in combination on an altered gastric mucosa. 2. The triad of epigastric pain unrelieved by antacids, bilious vomiting, and weight loss, particularly after a gastric operation should make one suspect this syndrome. Anemia due to loss of blood and dysphagia occur less frequently. 3. The definitive diagnosis is made by endoscopy. Barium studies are of less value. Acid secretory studies are not diagnostic and are of academic interest. 4. Medical treatment utilizes antacids and cholestyramine alone or together. Good, long-lasting results with these are infrequent. Despite these results, medical treatment should be tried first. 5. Surgical treatment consists of diversion of the biliary and upper intestinal secretions from the stomach and doing a vagotomy with or without a distal gastric resection to prevent a marginal ulcer from developing. 6. The two most popular operations are a Roux-en-Y diversion or interposed peristaltic jejunal limb. The simplicity of the former has made this more popular with most American surgeons. 7. The results of surgery are good to excellent in 75 to 95 per cent of cases. Relief of symptoms, improvement in histologic and secretory studies, and weight gain should be anticipated. 8. Less than optimal results are reported when the surgical diversion has not been total, gastric stasis persists, or other postgastrectomy sequelae accompany reflux gastritis.


Stress ulcers: their pathogenesis, diagnosis, and treatment. Stress ulcers are multiple, superficial erosions which occur mainly in the fundus and body of the stomach. They develop after shock, sepsis, and trauma and are ofter found in patients with peritonitis and other chronic medical illness. Stress ulcers should be differentiated from reactivation of chronic duodenal or gastric ulcers. Cushing's ulcer following head injury, or drug-induced gastritis. Digestive symptoms are usually absent, hemorrhage is the most common manifestation, and perforation and obstruction are rare. The presence of luminal acid and ischemia are necessary for the production of stress ulcer, while disruption of the gastric mucosal barrier by refluxed duodenal content may contribute to the pathogenesis. Endoscopy is the mainstay of the diagnostic procedure, and angiography should be used if endoscopy fails to identify the bleeding lesions. Medical management should include volume replacement, nasogastric aspiration, and the use of antacid. Selective intraarterial infusion of pitressin has shown encouraging preliminary results. Surgical treatment is reserved only for those patients who continue to bleed despite all medical management. The operation of choice is open to question. We prefer vagotomy, pyloroplasty, and oversewing the ulcers as an initial operation. Since the result of all forms of therapy has been poor, it seems resonable to try to prevent ulcer development. The use of vitamin A, hyperalimentation, and growth hormones is still in an experimental stage. Large clinical studies with case control are necessary before recommendations can be made. The use of potent and frequent antacid to buffer the gastric content has shown promising results; however, these observations need to be confirmed in a properly controlled and randomized study.


Rejection of isolated pancreatic allografts in patients with with diabetes. Four patients with diabetes mellitus of juvenile onset but without uremia have been treated with segmental transplantation of the body and tail of pancreas. The indications were hyperlabile diabetes or progressive loss of vision. The grafts were procured from cadaveric donors four to 16 minutes after circulary arrest and were subsequently stored in the cold for approximately four hours. In one patient, the pancreatic duct was ligated, while in the other three, drainage was attained by suturing the transected end of the pancreas into a jejunal Roux-en-Y loop. Three of the grafts failed within six weeks as a result of irreversible refection, and one graft failed because of the early onset of venous thrombosis. The first sign of graft rejection was an increase in the postprandial blood sugar level, an increase in the fasting blood sugar level occurring several days later. Neither hyperamylasemia nor fever was observed. Radioisotope scans and angiograms were of great value in establishing the diagnosis of graft rejection. All of the patients survived after graft removal.


Reconstruction of the heel pad by muscle transposition and split skin graft. Reconstruction of the pad of the heel by transposition of the flexor digitorum brevis muscle and split skin graft has proved to be quite durable, padding of the heel is adequate and protective pressure sensation has returned to the area. This procedure offers a simple one stage alternative to the cross-leg or local skin flaps for management of this difficult problem.


Idiopathic chronic gastritis.

Idiopathic chronic gastritis. Idiopathic chronic gastritis is an autoimmune disease and the cause of this gastritis probably act through a final common immunologic pathway. Specific gastric antibodies are diagnostic of this gastritis and the tissue of the gastric mucosa is characterized by infiltrations of mononuclear cells damaging the glandular parenchyma with concomitant loss of gastric secretory function. With suitable predisposing factors operating, the patient with simple chronic gastritis can have pernicious anemia develop. Chronic gastritis is frequently associated with chronic gastric ulcer and carcinoma of the stomach but not with duodenal ulcer. Chronic gastritis clinically presents with vague dyspeptic symptoms. Females are more commonly affected than males and the incidence rises with advancing age. Treatment of chronic gastritis is supportive in nature and also similar to the treatment of other autoimmune diseases. The author has suggested a new treatment of duodenal ulcer whereby the patients are immunized against mucosal antigen with a view to induction of chronic gastritis. The resulting biochemical damage of the parietal cells will produce hypochlorhydria.


Microsurgery in anterior approach to cervical discs. Removal of intervertebral discs and osteophytes with the aid of an operating microscope was performed in ten patients suffering from cervical spondylotic radicular or radiculomyelopathic syndromes, using an anterior approach. The method permits more complete removal of disc, posterior and lateral osteophytes, without the necessity of drilling or otherwise injuring the vertebral bodies. In five patients, a bone graft was inserted into the vacated space after disc removal. Clinical improvement in most cases was immediate and maintained during a two and a half year follow-up.


Embryonic susceptibility of Microtus ochrogaster (common prairie vole) to phenyl mercuric acetate. Pregnant M. ochrogaster received single intraperitoneal (i.p.) doses of 0.06, 0.125, 0.25, 0.5, 1,2, or 5 mg phenyl mercuric acetate (PMA/kg of body weight on day 8, 9, or 10 of gestation or 0.5 mg PMA/kg on day 7, 8, 9, 10, 11, or 12 of gestation. No toxicity was exhibited, and no abnormal fetuses were observed in any group. An embryocidal effect that depended on dose and stage of development was determined by increased numbers of resorption sites; resorption sites were dose-dependent, and the embryocidal effect decreased as the embryo matured. A dose of 0.06 mg PMA/kg of body weight produced no resorptions when given on day 8 or day 10 of gestation; 0.125 mg/kg produced no resorptions if given on day 10; 0.5 mg/kg resulted in live fetuses and resorptions in the same uterus when given on days 7 through 11; the same dose on day 12 produced all live fetuses; and 1, 2, or 5 mg PMA/kg given on day 8, 9, or 10 of gestation caused total embryo resorption. The i.p. LD50 of PMA in Microtus ochrogaster adult females was 10 mg/kg of body weight.


Exchange, balance, and formal organization in psychotherapeutic interactions. Psychotherapeutic interactions in crisis situations are analyzed in terms of the "sociodynamic" concepts of exchange, balance, and formal organization. It is argued that psychodynamic interpretations of crisis intervention therapy tend to be incomplete and nonsystematic and, thus, fail to produce adequate predictions, explanations, and control of psychotherapeutic outcomes. Small-group principles and methods are applied to selected crisis cases to illustrate gains in prediction and control over psychiatric approaches.


A haemolytic spot test for the estimation of alloantibody against antigens of the major histocompatibility complex. A haemolytic technique for the assay of alloantibody has been developed. Titration of alloantiserum was accomplished by placing microdroplets of serum dilutions on agarose layers containing the appropriate erythrocytes. Complement-mediated lysis was procured after the addition of rabbit serum. The assay appeared specific for products of the major histocompatibility gene complex in the rat and in the mouse.


Orthotopic renal transplantation in the rabbit. A technique of orthotopic renal transplantation in rabbits is described. The technique has been evolved in an experience of over 400 grafts, and difficulties encountered in producing satisfactory anaesthesia and techniques of anastomosis and in obtaining reliable graft function postoperatively have been defined and overcome. These difficulties are discussed and detailed results of the last 100 grafts are given.


Specific allograft reactivity in the sea star Dermasterias imbricata. Transplantation studies with the sea star Dermasterias imbricata revealed that this echinoderm rejected most first-set allografts after prolonged chronic reactions. All control autografts remained intact and fully viable. The greatly accelerated rejection of subsequent second- and third-set allografts demonstrated that these reactions were not only highly specific, but that these animals possess at least short-term immunological memory. The specific nature of the allograft response was confirmed by the prolonged survival of unrelated third party allografts placed at the same time as second- or third-set allografts. Animals in these experiments were maintained in sea water at temperatures of 14-16 C. Since this low temperature is required for successful maintenance of this species, temperature-dependence studies could not be undertaken. The rejection reaction was characterized by loss of pigmentation, edematous swelling, and necrosis. Histologically, the allograft tissue was heavily infiltrated by lymphocyte-like cells and phagocytic cells, causing disruption of the normal cytoarchitecture of the dermis. Deposits of fibrous material were also in evidence. Autografts, on the other hand, remained fully viable with no signs of rejection. We conclude that this asteroid, a representative of the echinoderms, has a well-developed, cell-mediated immune response analogous to that of vertebrates.


The time of appearance of Ia antigens during spermatogenesis in the mouse. Ia specificities were studied on germinal cells from C3H and 129 mice by using an AT.H anti-AT.L antiserum. By absorption experiments and immunofluorescence studies on sections of testes from mice of various ages, we were able to detect Ia specificities on cells of the germinal line from primary spermatocyte to spermatozoa. Ia specificities were not detectable on gonocytes or spermatogonia.


Use of rabbit antithymocyte globulin in cardiac transplantation. Relationship of serum clearance rates to clinical outcome. Serum rabbit globulin (RG) clearance rates were determined in 30 consecutive cardiac transplant recipients by radioimmune assay of serum RG levels after completion of an initial postoperative course of rabbit anti-human antithymocyte globulin (RATG). Twenty patients, who exhibited rapid RG elimination rates (average half-life, 1.6 days), had a rejection onset time of 16.2 days rejection frequency of 3.9 episodes/100 patient days, and a 1-year survival rate of 59%, respectively, as compared with 28.3 days, 1.9 episodes/100 patient days, and 80%, respectively, for the 10 patients with more prolonged initial RG elimination rates (average half-life, 11.4 days); Nineteen patients received one or more repeat courses of RATG. In 16 of these a progressive increase in RG half-life during subsequent RATG administration could be demonstrated. A close correlation was observed between total RATG doses given in the initial course and peak serum levels of RG obtained (r = 0.82) and between onset of rejection and initial t1/2 RG (r = 0.69). This latter correlation was improved by the elimination of one of the 30 patients (r = 0.81) or by considering only those patients treated from a single RATG batch (r = 0.85; n = 15). No significant relationship was detected between any of the parameters assayed and (1) total RATG dose, or (2) rosette inhibition titers of RATG administered. Survival and rejection parameters of the first 30 patients receiving RATG were compared with the previous 20 receiving equine antithymocyte globulin; these 50 comprising the entire population in which rejection was confirmed by cardiac biopsy. Rejection onset was 20 versus 12 days, rejection frequency was 3.1 versus 5.0 episodes/100 patient days, and graft survival at 1 year was 66 versus 41% for the RATG-equine antithymocyte globulin-treated patients, respectively. From these data it was concluded that (1) RATG administration favorably affects transplantation outcome; (2) RATG half-life, as reflected by RG clearance rates, was the most important variable governing RATG effectiveness, (3) variation in rosette inhibition titers within RATG batches made in the same fashion from large rabbit pools were of minimal clinical importance; and (4) monitoring of serum RG levels provided a necessary and rational basis for effective modulation of immunosuppressive therapy.


Massive post-transplant proteinuria. Biopsy proven nil disease. A case of massive proteinuria following an A-match living donor transplantation is described. All attempts to define the cause of the proteinuria failed. The proteinuria resolved while the patient was on triple-drug therapy. Presently, the patient remains well with minimal proteinuria and excellent renal function.


Preferential decrease in thymus dependent lymphocytes during storage at 4 C in anticoagulant. Human lymphocytes stored at 4 C either as leukocyte concentrates (LCs) in citrate-phosphate-dextrose (CPD) or as whole blood anticoagulated with CPD show a rapid and marked decrease in the relative and absolute numbers of thymus derived (T) lymphocytes. Determinations were made on cells recoverable on a Ficoll-Hypaque (F-H) gradient. In evacuated LCs, the relative percentage of T cells dropped to less than 10 per cent within 72 hours with a concomitant increase in the relative percentage of bone marrow derived (B) cells to  80 per cent or more. LCs opened to the air and subsequently stored at 4 C displayed an even more precipitous decline in the relative percentage of T cells, reaching a 10 per cent level within 72 hours. The relative percentage of T cells in CPD-anticoagulated whole blood samples stored at 4 C displayed similar decreases, reaching 20 per cent levels within 24 hours. The change in the relative percentage of T cells at the Ficoll-Hypaque interface was shown to reflect a decrease in the total numbers of T cells placed on the F-H gradient with time, since determinations of T and B cell numbers in NH4Cl-treated whole blood showed a 65 to 80 per cent decrease in the numbers of T cells within 24 hours in anticoagulated whole blood held at 4 C. Thus, it may be inferred that the T cell decrease is mediated via some interaction of anticoagulant, storage time, and some component(s) present in both LCs and whole blood.