Carotid endarterectomy: a perspective.

Carotid endarterectomy: a perspective. Carotid endarterectomies have been performed for over a decade now. To review the knowledge derived from this surgical experience, i studied 18 reports on the subject, giving attention to four specific phases of patient care: the diagnostic, preoperative, intraoperative, and postoperative periods. Emphasis was placed on studying the causes of postoperative morbidity and mortality and how they are approached through radiologic, surgical, and medical technics.


Induction of labor with prostaglandin E2 administered orally. The effectiveness of orally administered prostaglandin E2 in inducing labor was studied in 60 patients with uncomplicated, full-term pregnancies, using three dosage schedules. Although 40 patients did deliver, 11 patients' amniotic membranes ruptured at a time considered by the investigators to introduce an undesired variable in attempting to evaluate the drug. Twenty (33%) failed to deliver despite adequate Bishop scores. Side effects were noted in 45% of patients. No significant advantage for induction of labor occurred with the three dosage schedules used.


Combined chemotherapy (COP) in treatment of mycosis fungoides: report of four cases. Four consecutive patients with mycosis fungoides received cyclic chemotherapy using cyclophosphamide, vincristine, and prednisone (COP). In one case, there was complete remission of disease for 15 months. In another, there was 50% regression of tumors with healing of the ulcerated surfaces. The third patient showed complete clearing of scaling and redness of the skin. In the fourth patient, the lesions progressed.


Medicine among the ancient Maya.

Medicine among the ancient Maya. Medicine among the ancient Mayas was a blend of religion and science. It was practiced by priests who inherited their position and received extensive education. The Mayas sutured wounds with human hair, reduced fractures, and used casts. They were skillful dental surgeons and made prostheses from jade and turquoise and filled teeth with iron pyrite. Three clinical diseases, pinta, leishmaniasis, and yellow fever, and several psychiatric syndromes were described.


Production of leucocyte migration inhibitory factor by neonatal lymphocytes. Lymphocytes (mononuclear cells) from cord blood of 10 normal placentas and from 10 normal adults were assessed for production of leucocyte migration inhibiting factor (LIF) after phytohaemagglutinin (PHA) stimulation, as a measure of cell-mediated immunity. Mononuclear cells from both adult and cord blood produced adequate quantities of LIF, indicating that neonatal lymphocytes have the ability to manufacture normal amounts of lymphokines.


Renography using the gamma camera and the intertechnique cinescintigraphy system. A review of the current applications. The application and use of radio-isotopes in nephrology have been neglected by clinicians. The indications and techniques used in the renogram and renal scan in the light of our experience over 2 1/2 years are presented. Although these methods are finding ever-increasing applications, the main uses at this stage are the investigation of possible renovascular hypertension, acute obstructive renal failure and postrenal transplant complications.


The hazards of suturing certain wounds of the liver. Suturing of deep ruptures of the liver frequently produces complications of hemobilia, secondary hemorrhage and intrahepatic cavitation with sepsis and liver failure. Such complications require second and third risky operations in already critically ill patients. Such wounds should not be sutured, adequate drainage should be provided, low pressure venous bleeding should be controlled with temporary gauze tampons and arterial bleeding should be stopped by hepatic artery ligation. Such treatment obviates dangerous hepatic resections and morbid thoracoabdominal incisions and prevents hematobilia, secondary hemorrhage, intrahepatic cavitation and sepsis with hepatic failure.


Modification of the endorectal procedure for Hirschsprung's disease. During the last four years, 25 patients have been operated upon using a technical modification of the endorectal procedure for the treatment of Hirschsprung's disease. There have been no major complications, and the ease with which the lower anastomosis was carried out has been quite remarkable. This opinion has been substantiated by surgeons who previously used other techniques for the lower anastomosis and have now adopted this modification.


The hepatorenal syndrome.

The hepatorenal syndrome. The hepatorenal syndrome is defined as the spontaneous onset of progressive renal failure in patients with far advanced hepatic disease, usually on the basis of cirrhosis. The clinical characteristics of the syndrome include azotemia, oliguria, hyponatremia, low urinary sodium excretion and the absence of abnormal findings in the urinary sediment. Although the results of a large number of studies suggest that abnormal histologic features in the kidneys are infrequent, changes such as glomerulosclerosis, degeneration of tubular cells and alterations in the basement membranes have been described. Theories on the pathophysiologic aspects of the syndrome, including reduced plasma volume, inferior vena cava hypertension and active renal vasoconstriction, are presented. The last of these is currently the most widely accepted theory in which there is a selective redistribution of blood flow away from the cortical nephrons to the medullary nephrons on the basis of selective cortical vasoconstriction. The role of the synpathetic nervous system, as well as that of plasma renins in the cause of this condition is explored. Therapy for the hepatorenal syndrome generally has failed to ameliorate extremely unfavorable mortality rates. Such factors as the effects of plasma volume expansion; various pharmacologic agents, including dopamine, Octopressin and metaraminol; portacaval shunt; transplantation of the liver, and steroids are discussed. Regardless of specific therapy, the few patients who do survive tend to demonstrate a significant reversible component with respect to hepatic disease.


Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: a double-blind study. A controlled double-blind study was performed on patients with injury to the head and face which had caused rhinorrhea or otorrhea. The patients were treated, at the time of the admission to the hospital, with penicillin (20 mega-units daily) or a placebo. A total of 52 patients was studied, 26 in each treatment group. Meningitis developed in one patient in the placebo group. Staphylococcus epidermidis (sensitive to penicillin) was the causative pathogen in this patient who also had a retained intraventricular foreign body. The frequency of extra-neurological infections and of asymptomatic pulmonary bacterial colonization was similar in both groups, but frequency of asymptomatic bacteriuria was higher in the placebo-treated patients.


A new method for reconstruction of major defects in the cranial vault. A new method for reconstruction of cranial vault defects is described. A combination graft made of both alloplastic and autogenous materials combines several advantages to produce adequate strength and a smooth contour.


Randomized clinical trial of antithymocyte globulin in cadaver renal allograft recipients: importance of T cell monitoring. Despite incontrovertable evidence demonstrating the unique immunosuppressive capabilities of antihymocyte globulin (ATG) in animals, its value in clinical transplantation has remained inconclusive. A multicenter, prospective study was undertaken in an attempt to determine this value. Cadaver renal allograft recipients were randomized into two treatment groups: prednisone and azathioprine only, or prednisone, azathioprine, and ATG. Four to 36 month follow-up of our first 50 recipients, supported by results in over 200 patients from other centers, permits the following observations. (1) Allograft survival can be improved by nearly 20 percent in recipients treated with active ATG preparations. (2) Presently available assays performed in vitro and on subhuman primate allograft survival, though capable of excluding inactive preparations, cannot quantitate precisely the immunosuppressive capacity of active batches of ATG. (3) Monitoring circulating T cell levels in patients receiving ATG appears to offer the best means of defining immunosuppressive potency and the variation in response to the agent among identically treated individuals. It is concluded that ATG therapy can be beneficial in renal transplantation; but monitoring of recipients' T cell level is desirable during therapy to determine the dosage required. Furthermore, the optimal immunosuppressive protocol can be approximated by modifying the regimen according to individual variations in response, thus limiting the infectious complications of excessive immunosuppression.


Alterations in body composition following intestinal bypass for morbid obesity. The efficacy of the jejunolieal bypass operation, performed as a weight-reducing procedure in the morbidly obese patient, was assessed by measurements of body composition. In 20 patients measurements were performed by multiple isotope dilution, before and following jejunoileal bypass. Prior to bypass the excess body weight was due primarily to an increase in body fat (BF), which accounted for 52 percent of body weight. The nonfatty component of body composition, the lean body mass, although slightly increased in size, was essentially normal. Two distinct patterns were observed following bypass. In 12 patients followed for 8.4 +/- 1.5 months, there was a 21 percent decrease in body weight, resulting entirely from a loss of BF. The total exchangeable potassium and intracellular water volume, both measures of the body cell mass (BCM), were unchanged. In the second group of eight patients followed for 13.9 +/- 2.1 months, the mean body weight decreased by 27 percent or 38.8 Kg., due to a 26.6 Kg. reduction in BF and a 13.0 Kg. decrease in the BDM. This was accompanied by a relative expansion of the extracellular mass. As a result, the mean Nae/Ke ratio increased significantly (p less than 0.05) from a normal prebypass value of 0.95 +/- 0.7 to 1.46 +/- 0.11 following bypass. Thus in eight of the 20 patients following jejunoileal bypass, there was an undesirable loss of BCM with a relative expansion of extracellular supporting component of body composition, a pattern characteristic of malnutrition.


Circadian rhythmicity in heart rate and duration of cardiac cycle (P-P interval) in donor and recipient cardiac tissue of heart homograft patients. Chronobiologic analyses of data collected during one or more continuous 72-hr spans from 3 heart-transplant patients adhering at diurnal activity (0700-2230) and nocturnal rest (2230-0700) reveal statistically significant circadian rhythmicity in the P-P time interval of recipients (P-P)R and the donor (P-P)D, as well as in the reciprocal measure of the latter, the heart rate. The circadian acrophase for (P-P)D and (P-P)R differ slightly (the 95% confidence arcs overlap). For the group, the acrophases for (P-P)D and heart rate at 0344 (2056 to 0528) and 1656 (0940 to 2100) agree in anti-phase, as expected. For 1 patient studied during 3 separate occasions -1,5 and 12 months post-transplant--the period of the rhythm for the (P-P)R time interval progressively elongated from 23.7 hr (1 month post-transplant) to 26.1 hour (5 months post-transplant) and finally to 32.3 hr (12 months post-transplant and 4 months prior to death) while the (P-P)D remained around 24.0 hr (range 23.8 to 24.6 hr). Change in the rhythm's period in (P-P)R may reflect events associated with rejection, continuing necrosis of cardiac tissue and/or medications, among others.


Relation of alpha-1-antitrypsin phenotype to the performance of pulmonary function tests and to the prevalence of respiratory illness in a working population. Individuals with severe alpha-1-antitrypsin (alpha1AT) deficiency (phenotype Pi ZZ) are abnormally liable to develop emphysema, but it is uncertain whether those with partial alpha1AT deficiency (phenotypes Pi MS and MZ) are similarly susceptible. This study was undertaken to determine the frequency of the various Pi phenotypes in a working population in Northern Ireland and to compare the performance of simple pulmonary function tests and prevalence of respiratory symptoms and chest illness between different phenotypes. The population sample consisted of 1995 working men and women aged between 35 and 70 years. The MRC Questionnaire (1966) was used to assess respiratory symptoms, a forced expiratory spirogram was recorded, and a blood sample was analysed for alpha1AT phenotype by acid starch gel electrophoresis and antigen-antibody crossed electrophoresis in every case. The percentage frequencies of the alpha1AT phenotypes were: Pi MM 86-5; MS 7-97; MZ 3-86; IM 0-6; FM 0-4; SZ 0-25; M 0-15; SS 0-1; Z 0-05; MP 0-05; FS 0-05. Respiratory symptoms and a history of previous chest illness occurred with similar frequency among the Pi M, MS, and MZ phenotypes, and a comparison of the regression coefficients for FEV1, FVC, and MMF on age for each phenotype group showed no significant differences between them overall, or when subdivided according to smoking habits or dust exposure. These findings provide no evidence that individuals of phenotype Pi MS or MZ are more than usually liable to develop chronic airways obstruction.


Distribution of plasma cells and other cells containing immunoglobulin in the respiratory tract of normal man and class of immunoglobulin contained therein. The anatomical distribution of plasma cells and other cells containing immunoglobulin in the respiratory tract, and the relative proportions of the immunoglobulin classes have been estimated on necropsy tissues from nine adult human subjects without respiratory disease, five non-smokers and four smokers, none of whom had cough or sputum. Cell counts on multiple sections stained by immunofluorescent methods for the presence of immunoglobulin were carried out on the upper trachea, main bronchus, and lower lobe bronchus. Cells containing immunoglobulin were found mostly in the submucous glands but were also present in the lamina propria of the tracheal and bronchial epithelium. These cells were present in the greatest concentration in the main bronchus and were always present in the lobar bronchus and, in most subjects, in the upper trachea. The cells were not always present round small bronchi and bronchioles and were virtually absent from alveolar walls. Cells containing IgA were much more numerous than those containing other immunoglobulin classes in all subjects except one, in whom IgG and IgE cells were equally numerous. Two subjects appeared to be significantly different from the rest. One non-smoking subject had a marked deficiency of IgA cells at all sampling sites, and one smoker had a marked excess of IgA cells. In spite of these two subjects there was no significant difference between smokers and non-smokers except in the lobar bronchus where the smokers had significantly more IgA cells than the non-smokers.


Aortocoronary graft flow and reactive hyperaemia in relation to postoperative myocardial infarction. Blood flow through aortocoronary venous grafts and its response to a brief period of arterial occlusion--reactive hyperaemia--were studied in relation to the development of postoperative myocardial infarction. In 40 patients with intractable angina due to obstructive coronary artery disease, 72 aortocoronary venous grafts were constructed. In 18% of the grafts there was no response to the flow to temporary occlusion, due to absence of reactive hyperaemia. In the remaining grafts the flow increased from 17% to 26%. In 17-5% of the patients postoperative myocardial infarction was diagnosed. No relation could be established between this control flow through aortocoronary grafts and postoperative myocardial infarction. A significant difference was found in the magnitude of the reactive hyperaemia following occlusion of the graft between patients who developed myocardial infarction (13-0%) and those who did not (26-8%). Some of our observations suggest that the myocardium is in a state of reactive hyperaemia after coronary surgery. With certain technical precautions the flow changes caused by reactive hyperaemia can be used as an indicator of the result to be expected from bypass surgery.


Hypertrophic pulmonary osteoarthropathy and its occurrence with pulmonary metastases from renal carcinoma. The literature of hypertrophic pulmonary osteoarthropathy is reviewed with special reference to its occurrence with pulmonary metastases from extrathoracic tumours. The present theories on aetiology are discussed, and the relationship to finger clubbing and bronchogenic carcinoma is reviewed. A case is reported of hypertrophic osteoarthropathy as the presenting feature of pulmonary metastases from renal carcinoma, and of its relief by pulmonary resection.


Carcinoid lung: diffuse pulmonary infiltration by a multifocal bronchial carcinoid. A 20-year-old student presented with diarrhoea and miliary mottling in the chest radiograph. Biopsy specimens of lung and cervical lymph node showed diffuse multifocal carcinoid tumour. No deterioration in clinical state, radiographic appearances or lung function has occurred after two years' treatment with melphalan.


Left ventricular aneurysm of unusual aetiology: report of two cases. Two young patients aged 14 and 25 with left ventricular aneurysms are described. In both, a clinical picture initiated by attacks of supraventricular tachycardia led to the discovery of the condition. In the first patient the clinical picture clearly suggested a traumatic aetiology. In the second, the angiographic and histological findings strongly favoured a congenital origin. Both patients underwent successful aneurysmectomy. The literature on the incidence and aetiology of traumatic or congenital ventricular aneurysms is discussed.


Opportunistic pulmonary strongyloidiasis complicating asthma treated with steroids. A man aged 57 years who had lived most of his life in London, suffered from asthma which had begun during army service in Burma 37 years previously. Latterly he was treated with increasing doses of corticosteroids but his symptoms continued to worsen and he died of asthma. Necropsy revealed a heavy opportunistic infection of the bronchi and lungs by the nematode Strongyloides stercoralis which he had presumably acquired while on service abroad. The case illustrates the need, even in non-endemic areas, to suspect opportunistic pulmonary strongyloidiasis when a patient's asthma worsens despite treatment with increasing doses of corticosteroids. Although it is a potentially lethal iatrogenic opportunistic infection, it is amenable to treatment with anthelminthic agents if recognized in time.


An investigation of the chest radiographs in a controlled trial of busulphan, cyclophosphamide, and a placebo after resection for carcinoma of the lung. A standard series of radiographs of 588 patients allocated at random to treatment with busulphan (B patients), cyclophosphamide (C patients), or a placebo (P patients) for two years after surgery for bronchial carcinoma were viewed in three stages (following procedures which avoided bias) by an independent assessor, unaware of the allocated treatment of any patient, with a view to identifying pulmonary changes due to busulphan. Radiographic appearances consistent with busulphan lung were not reported in any of the 195 B patients (receiving a mean dosage of 464 mg of busulphan over 301 days) or of the 192 C patients but were present in one of the 201 patients receiving placebo.


Long-term beclomethasone dipropionate aerosol therapy in juvenile asthma. Following a short-term clinical trial reported elsewhere, beclomethasone dipropionate aerosol has been given to 15 children with asthma for between 2 1/2 and 3 years except for a short placebo period after the first year. Month-by-month records of wheezing, peak flow rate, and other treatments used are presented for the first 17 months, adrenocortical function tests are reported for the first 2 years, and growth is recorded for 2 1/2-3 years. The short-term clinical benefits of the treatment are confirmed in the longer term, adrenocortical function appears to be unchanged, and growth proceeds along expected lines. The main disadvantage seems to be worsening of eczema and allergic rhinitis in those children who have ceased using corticotrophin or oral steroids for the control of asthma. It is concluded that in the long term beclomethasone dipropionate aerosol provides safe and effective day-to-day control of asthma in children, although occasional recourse to systemic steroid therapy cannot be avoided. Oral candidasis has not been a clinical problem.


The difference in hereditary susceptibility to three mastitis agents between two daughter groups. Daughter groups of two sires A and Z were kept under equal conditions during 3 lactations. Experimental infections with mastitis agents gave different responses in both groups. The evident difference in susceptibility to mastitis between the A- and Z-daughters is based upon genetic differences. The results of this experiment indicate the possibility of selecting AI-bulls with respect to mastitis in descent and offspring. In this experiment staphylococci were less pathogenic than Str. agalactiae and Str. dysgalactiae. The most severe reactions were produced by the infections with Str. dysgalactiae.


Anomalous origin of the left coronary artery from the pulmonary artery with coronary artery steal in adults. Report of two cases and review of the literature. Patients with anomalous left coronary artery arising from the pulmonary artery rarely survive to adult life. Those who attain adulthood may present with angina indistinguishable from coronary artery disease and are liable to sudden death. Myocardial infarction, though rare in young adults, may occur and may be due to coronary artery steal. Accurate diagnosis requires coronary arteriography. Two further cases of coronary artery steal in adults with anomalous origin of the left coronary artery from the pulmonary artery are presented. In both patients aortocoronary bypass grafting using a reversed autogenous saphenous vein with closure of the origin of the anomalous left coronary artery was successfully performed. This operation provided complete symptomatic relief and may protect patients against the risk of sudden death.


Extraction and purification of a substance with luteinizing hormone releasing activity from the leaves of Avena sativa. Attempts were made to purify the LH-releasing substance extracted from the leaves of Avena sativa by means of two-step chromatographic procedures using a weakly acidic ion-exchange resin (CG-50,type II) and DEAE-Sephadex A-25 (coarse) with successful results. For preliminary fractionation of such starting materials as dried leaves, fresh leaves, and acetone-extracted powder(crude extracts), 5% acetate-buffered active carbon proved to be more effective than starch zone electrophoresis. From its behavior on chromatography with weakly acidic ion-exchange resins as well as Sephadex gel filtration, the active fraction extracted from the leaves of Avena saliva was assumed to be different from the LH-RH present in the hypothalamus. This partially purified material, however, was demonstrated to have an LH-releasing activity by the ovarian ascorbic acid depletion method using Wistar-Imamichi strain rats. Evidence was presented that its site of action is in the adenohypophysis.


Lanosterol 14alpha-demethylase. Similarity of the enzyme system from yeast and rat liver. The chemical synthesis of 24,25-dihydro[32-14C]lanosterol is described. The incubation of this material with a cell-free system from Saccharomyces cerevisiae or with a microsomal preparation from rat liver resulted in both cases in the release of [14C]formic acid. This result suggests that in the biosynthesis of ergosterol in yeast, as well as in that of cholesterol in higher animals, the 14alpha-methyl group of lanosterol is removed as formic acid. In both systems, the measurement of the rate of release of [14C]formic acid from 24,25-dihydro[32-14C]lanosterol provides a simple and direct assay of lanosterol 14alpha-demethylase. Carbon monoxide inhibited both yeast and liver 14alpha-demethylase.


[Prosthetic treatment of micrognathism following cleft lip and cleft palate surgery]. Delayed treatment of a patient having micrognathia after surgical correction of gnathopalatoschisis, using a bar joint between the telescopic devices on the remaining teeth, a maxillary cover denture and a supported mandibular model-cast prosthesis.


Lack of demonstrable H-2 antigens on the surface of teratocarcinoma 402AX of the mouse maintained in vivo. Teratocarcinoma 402AX of strain 129/J mice leaks any detectable histocompatibility antigens on its surface when examined by immunofluorescence or cytotoxicity assays utilizing highly specific anti-H-2-histocompatibility alloantisera.


The risk of renal allograft rejection following angiography. In a retrospective study of 173 immediately functioning primary kidney transplants, correlation between agiography and renal allograft rejection was studied during the first 14 days. It was found that rejection was more frequent in kidneys undergoing angiography than in those not undergoing angiography. It was also found that in kidneys undergoing angiography an overwhelming number of the rejections started the day after angiography. These differences in rejection frequency could not be explained by differences in HLA matching or the origin of the kidneys. These findings suggest a possible connection indicating that the angiography might elicit an acute rejection episode. A possible mechanism for starting this reaction might be activation of the complement system which was found in 50% of the patients undergoing angiography in peripheral blood and in 100% when studied in vitro.


Immunosuppressive drugs and the foetus.

Immunosuppressive drugs and the foetus. Two infants born to mothers who had been given a renal transplant and who were receiving azathioprine and prednisone have been followed up for over 2 years. Initially both had lower than normal lymphocyte counts and cortisol levels. Chromosomal aberrations similar to those found in the lymphocytes of the mothers were present at birth but had disappeared by 32 and 20 months, respectively. The significance of these findings is discussed.


Importance of the autocontrol crossmatch in human renal transplantation. The killing of donor cells in the standard lymphocyte crossmatch is considered strong evidence for preformed antibodies in the recipients's serum. Moreover, it is generally accepted that presensitization has occurred if any of the stored sera kill the donor cells. In our hands, if either the current or the stored sera kill the donor cells, it precludes transplantation. In nine cases we discovered that the recipient's sera also killed the recipient's own lymphocytes, a positive autocontrol test, indicating that factors other than conventional preformed cytotoxic antibodies were responsible for the positive standard crossmatch. The nine patients who demonstrated a positive standard crossmatch and a positive autocontrol for those sera received cadaver allografts. None of the kidneys were rejected hyperacutely and all are functioning adequately. We conclude that the autocontrol crossmatch is an important adjunct for uncovering false positive reactions in the standard lymphocyte crossmatch test.


Circulating immune complexes after kidney transplantation. Sera from patients who had received renal allografts were studied for the presence of circulating immune complexes by using platelet aggregation technique combined with density gradient centrifugation. A simple and highly reproducible modification of the platelet aggregation technique, employing the use of relatively small amounts of blood from pretested donors as the source for platelets, is described. Immune complexes were detected in post-transplantation sera from 3 out of 16 patients. The development of a persistent immune complex state as a consequence of grafting was concluded in one patient.


Complement origin determines lytic activity of antibodies to nucleated target cells. Comparison of common complement sources. The effects of complement from different species of animals were measured in a variety of antibody assays by using 51Cr-labelled target cells. Sheep antibodies were measured in samples of lymph and serum obtained from animals immunised with allogeneic lymphocytes, transplanted with allogeneic kidney grafts, or immunised with mouse tumour cells. Mouse (C57BL) antibodies were measured after immunisation with allogeneic tumour (P815) or after transplantation of allogeneic thyroid grafts (BALB/c). Different species of complement gave quantitative and sometimes qualitative differences when used to assay the same samples of antibody. In all systems tested, rabbit complement caused lysis of target cells at low antibody concentration when guinea pig and rat complements gave negative results, in some antibody-target cell combinations sheep complement was as effective as rabbit complement in mediating lysis. The different complement sources showed no selective lytic affinity for either IgM or IgG1 antibody subclasses purified from immune sheep lymph. Lysis of P815 target cells occurred more quickly when mediated by rabbit or sheep complement than when mediated by guinea pig or rat complement. Complement-dependent lysis sometimes occurred in systems where antibody, target cells and complement were obtained from the same species.


Comparison of indirect fluorescent antibody (IFA) with complement fixation (CF) tests for diagnosis of Babesia spp infections in Colombian cattle. A total of 372 serum samples were collected from Colombian cattle before and during the course of natural Babesia spp. infection on the North Coast of Colombia. The serum samples were used to compare indirect fluorescent antibody (IFA) with complement fixation (CF) tests for diagnosis of babesiosis. The IFA technique detected Babesia argentina antibodies an average of 4.0 weeks earlier than the CF test and Babesia bigemina an average of 2.5 weeks earlier. Both IFA and CF were capable of differentiating B. argentina and B. bigemina infections, however in some cases cross reactions were observed. In general IFA titers were at relatively high levels of 1:640 to 1:5120 in comparison with CF titers of trace to 1:80. In cases of mortality due to babesiosis, both IFA and CF serologic techniques were very useful in indicating the cause of death. Although both IFA and CF are laboratory tests, the IFA technique had advantages over the CF in simplicity, economy and speed of performance.


The Plasmodium berghei-infection in isogenic F1 (C57B1 x DBA)- mice. III. neonatal thymectomy and cell transfer experiments. In neonatally thymectomized F1(C57BL X DBA)-mice the course of an infection with Plasmodium berghei, strain K 173, was unaltered if compared with the course in normal animals. No shortening of the survival time was observed. Cell transfer experiments were carried out. In numerous trials it was not possible to convey the protective immunity of immune animals to non-immune animals by the transfer of lymphoid cells. If an acquired immunity was destroyed by heavy x-irradiation it could be restored by the injection of immune spleen and lymphnode cells.


Bancroftian Filariasis in Togo 1. a comparative field study of the membrane filtration concentration technique and conventional blood films. The membrane concentration filtration technique which has proved very successful in use in areas of subperiodic filariasis in the Pacific, has been used to study an area of nocturnally periodic in Togo. The results obtained were similar to those from areas of low endemicity in the Pacific. The method was easy to apply under field conditions in Africa and the taking of venous blood samples proved competely acceptable to a rural population in south-eastern Togo.


[An electron microscopic study of the interaction between shigellae and cell cultures. II. Structuro-functional response of the chief cytoplasmic organoids of infected cells]. The initial mobilization of the protective power of amniotic cells under the influence of the intracellular parasite Shigellae Flexner was shown using qualitative and quantitative methods of electron microscopy. This mobilization is seen in the appearance and then concentration of membrane elements of the endoplasmic reticulum around the bacteria. The character of some degenerating changes confirms the opinion about the presence of an excreting endotoxin fraction in Shigellae Flexner.


[The problem of intranuclear protein synthesis]. This review deals with the analysis of the conflinting situations that appear during the study of the translational apparatus in cell nuclei. Experimental approaches used to unravel this problem are surveyed.


[Somatic polyploidy in animal embryogenesis]. The evidence provided in our laboratory on somatic polyploidy is reviewed. The development of some embryonal cell populations being taken as an example, the main problems of somatic polyploidy are discussed: somatic polyploidy and proliferation, growth, cell differentiation and specialization, the significance of polyploidy in the development of embryonal populations, in the realization of development programs etc. The term "somatic polyploidy" is not thought to involve the complex of phenomena it designates. A new, more precise and general concept is proposed--"hyperreplication of DNA", which seems to cover indeed the whole complex of phenomena characterizing the increase of DNA content in the nuclei of somatic cells including the polyploid ones.


[Analysis of the Quastler--Sherman method and several questions concerning cell kinetics]. Examination of the Quastler--Sherman method revealed its non-correctness to measure the duration of G1-period and of mitotic cycle due to two points. First, the Quastler-Sherman method defines the duration of mitotic cycle period in an unnatural direction. Second, the method is based on the assumption of the equality in durations of the mitotic and cell life cycles. Therefore, the duration of presynthetic period and mitotic cycle appears to be extended. The data obtained show the temporal link between the kinetics of the mitotic cycle and the kinetics of the diurnal rhythm. It is suggested that the duration of mitotic cycle is equal to the period of diurnal rhythm of mitotic activity.


A comparative study of daily and twice-weekly continuation regimens of tuberculosis chemotherapy, including a comparison of two durations of sanatorium treatment. Further results are presented of a controlled clinical trial carried out in Czechoslovakia of chemotherapeutic regimens in pulmonary tuberculosis in which, following 3 months of standard triple chemotherapy, 3 continuation regimens allocated at random for up to 18 or 24 months were compared. These were PAS plus isoniazid daily, streptomycin plus isoniazid twice a week and streptomycin plus isoniazid twice a week up to 1 year and then streptomycin plus isoniazid once a week. After 3 years the results of all 3 continuation regimens were highly satisfactory and it was concluded that they were equally effective, but that the intermittent regimens have the advantage of stricter control over the patient's chemotherapy.


Xe133 elimination from human fat during negative- and positive-pressure breathing. The elimination of Xe133 from a deposit in the subcutaneous adipose tissue outside the anterior tibial muscle was recorded by an external scintillation detector in 16 human subjects during normal breathing, negative-pressure breathing (-20 cm H2o), and positive-pressure breathing (+20 cm H2O). The ambient temperature was kept at 28.0 degrees C +/- 0.1 degrees, which can be considered a neutral temperature. The xenon clearance rate was increased during negative-pressure breathing by a mean of 68% and decreased during positive-pressure breathing by a mean of 73% when compared to normal breathing. The xenon-elimination rates during the different conditions may reflect corresponding changes in adipose-tissue blood flow. Because both negative- and positive-pressure breathing may occur during diving, the uptake and elimination of inert gases in adipose tissue of a diver may be influenced; thus, the risk of decompression sickness might also be affected. The results may therefore be of importance in diving routines and in the construction of breathing apparatus for divers.


Early arabian medicine: contribution to urology. Although a great deal of urology was written and practiced during the early Arabian era, most of it is still uncovered and not translated into the English language or translated by non-physicians. As Arab urologists, who have access to the original Arabic manuscripts, and as a token to our ancestors as well as to the modern urologist interested in Arab history we believe we should translate a part of this treasure.


Granulomatous disease of male genitalia. Five cases of granulomatous disease of the male genitalia are presented. Of these, 3 cases involved foreign-body reactions in which some form of hydrocarbon was the causative agent. In the other 2 cases, idiopathic granulomatous processes were found, and this condition may be secondary to endogenous lipoid degenerative processes.


Use of automated, on-line pyruvate analysis. Normothermic blood perfusions of isolated canine liver were undertaken to determine the most sensitive and reliable indicators of viability. Perfusate flow rates and arterial and portal venous pressures were monitored. Arterial and venous concentrations of potassium, pyruvate, serum glutamic oxaloacetic transaminase, and oxygen were monitored and the values stored on magnetic tape for computerized calculation of outputs. Continuous evaluation of taurocholate concentration in the perfusate allowed adjustment of infusion rate to provide a constant flow of bile across the hapatocytes. Pyruvate output, portal venous resistance, serum glutamic oxaloacetic transaminase output and potassium output provided the earliest indices of deterioration. Bile flow and oxygen consumption remained constant until irreversible outflow block had occured. The earliest and most constant parameter signaling deteoration of the ex vivo liver was pyruvate output. The deteriorating liver released pyruvate into the perfusate, while the functioning organ consumed or maintained the available substrate. Since pyruvate output occurs before the onset of irreversible damage, measures can be enacted to reverse the deterioration. Restoration of the preparation can be evaluated through the cessation of pyruvate output.


A new biomaterial for the control of infection in the burn wound. A synthetic dressing has been developed that isolates the burn wound to protect patients from microbial contamination. This dressing is unique as it is formed from a 2-component system directly on the wound, leaving no voids for microbial proliferation. The synthetic cover, HYDRON Burn Dressing, adheres to the entire wound surface so that additional dressings are not required. It is sufficiently flexible to permit patient mobility. The components used to form the dressing are an ultra-pure, high molecular weight form of HYDRON, a hydrophilic polymer, poly (2-hydroxyethyl methacrylate) and Polethylene Glycol-400. The dressing is intended to be applied directly to the wound immediately post-burn, prior to sloughing or removal of the eschar, a period in the burn therapy regimen for which satisfactory alternative dressings are not readily available. Decreased frequency of dressing changes compared to conventional procedure provides an additional benefit with a corresponding reduction in pain to the patient. Gross examination of the wounds under the dressing has shown that the healing process proceeds similarly to that of wounds under conventional treatment. There is no evidence of fluid accumulation or maceration or desiccation of the eschar. In our series of 32 patients the barrier dressing formed on the wound has offered a new, effective procedure for treatment of the burn wound.


Hyperlipidemia following renal transplantation. In a series of 175 adult renal transplant patients 59% of patients had hyperlipidemia. Hyperlipidemia in these patients was characterized by both hypercholesterolemia and hypertriglyceridemia and on lipoprotein electrophoresis was demonstrated to be a mixture of types IIa, IIb and IV hyperlipoproteinemia. Serum cholesterol and triglyceride levels could both be related to the dosage of prednisone these patients received. Serum triglyceride levels could further be correlated with obesity and negatively with the duration of graft function. The latter relationship was felt to reflect the lower dose of prednisone that was administered the longer the duration of graft function. Hypertriglyceridemia was more prevalent in the 47 transplant patients who received kidneys from cadaver donors than in the 128 patients who received kidneys from related-donors. The cadaver-donor renal transplant patients, however, were receiving a larger maintenance dose of corticosteroids and had had functioning transplants for a shorter period of time. In 17 patients followed for up to 20 wks immediately following transplantation both hypercholesterolemia and hypertriglyceridemia developed within 8 wks of transplantation and persisted for the remaining 12 wks. Both serum cholesterol and triglyceride levels in this early post-transplant phase could be related to the cumulative prednisone dosage.


[Hemorrhage after stomach resection in ulcer disease]. Under observation were over 3 500 patients, subjected to gastric resection for the complicated ulcerous disease. In the early postoperative period hemorrhage was observed in 42 patients, including bleeding in the gastrointestinal tract--in 23, in free abdominal cavity--in 19. In cases, when early profuse bleeding following gastric resection would not respond to intensive conservative measures, then urgent relaparotomy with the aim of haemostasis, replenishment of blood loss and correction of the internal medium seem to be indicated. Bleeding from forcibly remained low duodenal ulcer in Billroth-II gastrectomy can be arrested by means of duodenotomy and suturing of the ulcer bottom with U-shape sutures. For establishing in early diagnosis of hemorrhage into the abdomen its drainage after gastric resection with a rubber strip, brought out through a separate incision in the anterior abdominal wall in the right subcostal space, seems to be rather effective.


[Surgical tactics in hemorrhage from the upper segments of the digestive tract]. The results of surgical treatment of 100 patients with hemorrhage from the upper digestive tract (except gastric cancer and hepatic cirrhosis, complicated with bleeding esophageal varices) are discussed. The role of gastrotomy is emphasized, while vagotomy and drainage operations do not seem to be greatly warranted in treatment of chronic and acute gastroduodenal ulcers complicated with bleeding.


[Surgical tactics in perforating gastroduodenal ulcer]. Under observation were 25 patients with perforation of gastroduodenal ulcers, treated under stationary conditions for other severe affections (cardio-vascular, neurological, urological, oncological, etc). The clinical picture of ulcer perforation against the background of some other grave lesion remains not infrequently vague for a long time. This renders a negative effect on terms of establishing the proper diagnosis and operative intervention. A gravity of the basic lesion frequently necessitates some accessory methods of exploration to establish the correct diagnosis, and dictates a need for consultation of different specialists for the maximum objective estimation of the status of the organism forces, as well as for a solution of the problem concerning a feasibility of surgery, its terms and extent. Among this category of patients the mortality rate was very high (16 of 25 patients died). The surgical policy should consist in the performance of an urgent operative procedure (ulcer suturing and adequate drainage of the abdominal cavity). Gastric resection seems to be warranted only in special cases.


[Microsurgical operations on the nerves]. Employment of microsurgical methods in operations on nerves seems to be essential and inevitable, but it is delayed due to defects in the appropriate apparatus. Microphotography of cross sections of the nerve is absolutely necessary for the well-grounded prognosis and estimation of the results of treatment. The degree of freshening of nerve endings gained during surgery is mostly conditioned by the gravity and extent of intratruncal changes in the nerve. A precise passing of sutures through the epineurium and the corresponding juxtaposition of bundles, especially in joining fine nerves, is most reliably provided by operations with the use of an operative microscope.


[Surgical treatment of burns of the bones of the cranial vault]. In the paper an experience with treatment of 51 patients having burn lesions of the cranial vault bones is reported. The problems of surgical tactics in treatment of subjects with burn lesions such as terms and character of operative interventions, methods of replacement of the resulting wound defects of the cranial vault by means of various technic of skin plasty are discussed.


[Infectious complications after heart surgery]. In the paper the authors report their experience with the prophylaxis and treatment of infectious complications in 393 patients operated upon the heart. An increase of the specific weight of gram-negative bacteria as an etiological cause of infection and also the increase incidence of infection as the main or sole cause of mortality ill patients, operated upon under artifical circulation, were noted. Based on the study of various combinations of antibiotics against principal agents of surgical infection, it was found that a combination of bactericidal drugs such such as ampicillin with gentamycin or carbencillin with gentamycin proved to be the most effective and safe. Tetraolean was shown to be not effective enought against pyocyanic bacillus. Some information concerning the dosage and methods of using various antibiotics and their combinations for prophylaxis and treatment of suppurative complications is reported.


The common diarrhoeas of sheep in Britain. As every sheep farmer knows, diarrhoea is of common occurrence in animals of all ages in his flock. In lambs it can result in sigificant mortality while in older animals growth rates are reduced and weight loss can occur. Although diarrhoea can be an incidental finding in many sheep diseases, particularly in their terminal stages, only on those conditions are commented on in which diarrhoea is the predominant feature of the clinical syndrome. The subject is discussed below on both an age and seasonal basis and, if an initial assumption is made that lambing takes place at the traditional March/April period, animals will be increasing in age as the seasons progress. Thus the sequence commences in the spring with the young lamb and concludes the following winter with the adult.


Humoral immunity in the pig.

Humoral immunity in the pig. The newborn pig relies on colostrum as its sole source for serum antibody and milk for its intestinal antibody during most of the post natal period. Colostrum and milk are well adapted to perform their very different immune functions--immunoglobulin in colostrum being derived from serum, whereas milk antibodies are locally produced in the mammary gland and mirror the immunoglobulin profile of adult intestinal juice. Intramammary vaccination is far superior to intramuscular vaccination because it produces not only a local but a systemic response. Oral vaccination is similarly effective. Vaccination of one mammary gland results in antibody activity in the secretion of all glands. Irrespective of the route of vaccination, antibody activity is found in all immunoglobulin classes. The main site of immunoglobulin-containing cells is the lamina propria of the intestinal tract, suggesting that the gut is a major site of immunoglobulin formation. In the piglet, immunoglobulin producing cells first appear in the gut at the end of the first week of life and reach a mature profile after a month. During this period the piglet is likely to be capable of responding to orally presented antigens.


[Streptococcosis in chickens. II. Cultural, morphological and biochemical studies of streptococcal strains]. Isolated were a total of 33 Streptococcus strains during two enzootics in adult and young chickens. Their cultural, morphologic, and biochemical aspects were studied in order to elucidate the biotype to which they belonged. Taking into consideration their capacity to ferment trehalose and the fact that they failed to ferment sorbite along with their beta-hemolytic activity, belonging to serologic group C, these Streptococcus cultures were determined as Streptococcus pyogenes hum. C.


[Félix Kánitz on animal husbandry in northern Bulgaria and the Stara Planina at the end of the Turkish occupation]. The Hungarian geographer, archaeologist, and ethnographer Kánitz Félix, great friend and admirer of the Bulgarian people has left valuable and comprehensive information about North Bulgaria and the Balkan Mountain by the end of the Ottoman oppression in his work La Bulgarie Danubienne et le Balkan (1882). The book contains also valuable references concerning the animal breeding activities within the 1860-1880 period in this part of the world. In the mountainous region in Bulgaria sheep- and goat-breeding were well developed, and this accounted to a large extent for the destruction of forests. Numerous and large flocks of sheep were raised in Dobrouja, a portion of which belonged to the famous shepherds of the town of Kotel. During the winter season a great number of flocks from Transylvania were also kept in this region. The breeding of sheep was the main source of meat supply both for North Bulgaria and the Balkan Mount region and for the markets of the Ottoman Empire. It also yielded a total of 120,000 okas of wool (78 okas = 100 kg) annually to meet the needs of the Empire manufacture as centered at that time in the town of Sliven for the production of textiles for the army. The raising of cattle was also prosperous during the same time. On the other hand, stock breeding was unfavourably influenced by heavy taxing in the form of both cash payment and remuneration in kind, by requisitioning (especially in war time) and the endless thefts and robberies done by tatars and cherkesses that had moved to this country from Caucasus. This exploitation concerned equally Bulgarian and Turkish animal breeders.


[Prognostication of the outcome of surgical treatment of hemorrhagic strokes using a computer]. A new mathematical method is suggested for making the prognosis of the results of surgery for haemorrhagic strokes due to essential hypertension and atherosclerosis. Twenty-two signs characterizing the patient's state are fed into the computer trained on the basis of 124 case reports of patients, both surviving and dying after surgery. The computer operating in accordance with the "Kopa-3" programme works out a vital prognosis for both the medicamental and surgical treatment. The prognosis proved correct in 90% of the cases. The described method permits an objective determination of the indications for surgery in hemorrhagic stroke.


[In vitro susceptibility of the proteins of wheat-protein and bran-protein bread to attack by gastric and pancreatic proteolytic enzymes]. The hydrolysis of proteins contained in the dietetic protein-rich bread with crystalline pepsin, trypsin and chemotrypsin was studied for the first time by using an apparatus devised by A. A. Pokrovsky and I. D. Ertanov and by following procedures as proposed by them (1968). By the end of every hour of the experiment 4.31 and 4.04, 7.88 and 4.90, 9.20 and 6.00, 12.96 and 11.72,19.00 and 12.55, 21.14 and 14.00 per cent of the initial quantity of the proteins contained in these two types of bread were hydrolysed respectively. The susceptibility to the action of enzymes on the part of the study products proved much lower than the theoretical proteinic values of the wheat, rye bread (M. S. Marshak, 1971) and below the results obtained by the analogous tests with the proteolysis of the ordinary bread proteins. Inasmuch as the protein-rich bread is baked according to the 1936 formulation an inference is drawn on the expediency of enriching such bread with dairy protein, rye gluten and belip, which will rresult in a more acceptable ratio of tryptophan/lysine and should, apparently, contribute to a greater intensity of the proteins hydrolysis in case of such a bread when it reaches the stomach and the proximal segment of the small intestine.


Mycoplasma pneumoniae infections of adults and children. Although the hallmark of Mycoplasma pneumoniae infection is pneumonia, the organism is also responsible for a protean array of other symptoms. With an increased awareness of the board clinical spectrum of M. pneumoniae disease and the ready availability of the cold agglutinin and M. pneumoniae complement-fixation tests, interested clinicians will note additional clinical-mycoplasmal associations in their patients.


[Diagnosis, pathology and therapy of malignant melanoma of the skin (author's transl)]. New concepts on early recognition, classification and histopathology of malignant melanoma of the skin are discussed in this review. Melanoma research over the past years has lead to an essential change in attitude with regard to various problems posed by prognosis and therapy.


[Free skin grafts in plastic surgery. Transplantation techniques and indications (author's transl)]. Basic techniques and indications for free split and full-thickness grafts are outlined on the basis of experience gained in surgical management of selected cases at the First Department of Dermatology, University of Vienna. A well-prepared wound bed, correct choice of procedure, good operative and dressing technique and careful follow-up therapy lead to good results which are also aesthetically acceptable to the patient.


Further studies of some "nontypable" group A streptococci. Thirty-two strains of group A hemolytic streptococci which could not be M typed with the available typing sera in Nashville, Tenn., were reinvestigated at the Streptococcus Reference Laboratory in Colindale, England, in order to estimate the efficacy of other antisera not available in Nashville and newer techniques (the opacity factor inhibition test) of typing strains not isolated in England. Fifty percent were eventually typed and all but four contained enough M protein to suggest that they would have been typed had the appropriate typing sera been available. The results indicate that group A streptococci truly lacking M protein were seldom isolated from the Nashville children from whom the streptococci were cultured. Several factors responsible for nontypability were considered, including the nonavailability of the necessary type-specific antisera and loss of M protein due to a change from Matt to glossy colonial types in the laboratory.


Causation and disease: the Henle-Koch postulates revisited. The Henle-Koch postulates are reviewed in terms of their full validity in Koch's day and in light of subsequent developments. The changing guidelines developed for viral diseases, for viruses in relation to cancer and to chronic central nervous system infection, and for causative agents in chronic diseases are discussed chronologically. A set of guidelines for both acute infectious and chronic diseases is presented. The need for recognizing the role of the host and the spectrum of host responses, for sound biologic sense in evaluating causal roles of agents in disease, and for flexibility in adapting our guidelines to new knowledge are emphasized.


[Correlations of the Personal Sphere Model and Rorschach Projection tests. (A factorial examination of the validity of the Personal Sphere Model using the Rorschach Test)]. The most important results of the factor analysis of 11 variables of the Personal Sphere Model and 14 variables of the Rorschach-Test have shown in both tests common radicals appearing in the evaluation as well of the structure of personality as of the behaviour of man. Both tests emphasize the possibility of objectivating pathological traits of personality: the difference consisting in the fact, that this traits are coming out more distinctly in the Rorschach-Test, while in the Personal Sphere Model the psychodynamic factors of the ability of building object relationships of overcoming seperations are appearing more clearly. The most relevant conformity of both tests is the possibility of distinctly projecting the defense mechanism of aggression.


[Effect of diabetes mellitus on a personality development disorder - and its influence on the course of the disease]. Is there an influence of diabetes mellitus on a neurotic development of personality - that is the question of the present research. And specially: Are there special problems in interaction with the patient, who suffers on diabetes mellitus? We strictly have to make a distinction between the somato-psychic and psycho-somatic approach: The influence of diabetes mellitus in development of personality means, that there is an influence of somatic factors on the psyche. The influence of an neurotic personality on formation and development of diabetes mellitus means, that there is an influence of psychological factors on the soma. This difference often will be ignored. Oralic needs also can be the consequence of somatic disorders, and do not have to be originate exclusive from childhood - even if psychoanalytic oriented colleagues will contest this fact.


[The presence of fluorescein-conjugated antibodies in synovial tissues of rheumatic joints]. With a modified Coons technique synovial tissue, anti human IgG, IgA, IgM, anti-coeruloplasmine, anti-transferrin, and anti-fibrin were investigated by means of immunofluorescence and evaluated with reference to place, type, and intensity of fluorescence. It was shown that fibrin deposits in the synovial tissue in rheumatoid synovitis do not only consist of the actual fibrin but often of immune complexes. These were mainly found near vessels and necroses, whereas unspecific fibrin was detected mainly in fibers and limiting areas. Coeruloplasmine and transferrin seem to have a marked affinity to pathogenetically changed fibers, whereas they do not combine with normal fibers. In seropositive RA remarkable immuno fluorescence was observed in vessels. From these facts certain etiological conclusions on rheumatoid diseases can be drawn.


Comparison of antinuclear antibody determinations in unselected sera by consumption test and immunofluorescence. The correlation of the determination of antinuclear antibodies, as shown by consumption tests and immunofluorescence was investigated in a collective of 100 sera of patients suspected for SLE, collagenosis and rheumatoid arthritis, sent for routine screening investigation. The results of both methods correlated in 78% of sera, both results being either positive or negative. No correlation was observed in 22% of sera, one test being positive, the other negative. Statistical evaluation by the X2 test showed that both techniques did not differ statistically in their results. A correlation coefficient r=0,45 indicated furthermore that the results of both techniques correlated significantly. The percentage of positive results obtained with these and other methods is discussed.


[Pathography of 4 famous persons of the Spanish House of Habsburg]. By means of a biographic analysis from historic sources an attempt is made to illustrate the psychopathologically relevant substratum of the life-history of Joan the Mad, Charles V., Philipp II. and Don Carlos. According to the author, it seems that, apart from the psychoanalytical concept, the phenomenological, descriptive-analytical procedure ist particularly suitable for the presentation of the mental aspect in the historiography.


[Continuity resection in tumors of the tube bones, indication and technique]. The continuity resection of benign, semimalignant and malignant tumours above all of the long bones as well as defect bridging of bone substance with bone autograft is a serious ordeal for the patient, a technically difficult procedure with the possibility of various complications. Therefore the indication should be limited specifically. The technique of bridging plastics requires on adequate bone substitute of sufficient stability. Seven typical cases are represented and discussed.


[Vaginal impalement-injury with intraperitoneal foreign body in a 5-year-old child]. In case of childish haemorrhage it is  absolutely necessary to consult a gynaecologist without delay, who has special knowledge of anatomy and physiology of the still unripe genital organs. The following publication informs about a rare hurt by a stick causing a perforation of the abdominal cavity of a five-year old girl, who was taken to a gynaecological hospital in a bad peritoneal shock only about six hours later.


[Post-hysterectomy vesicovaginal fistulae; surgical treatment, results]. Four methods of fistulorrhaphy used by us in 96 cases of vesicovaginal fistulas after hysterectomy are described. Obtained results are presented.


[Progress in the prevention and control of urologic complications of the cervix carcinoma. I. Urinary tract infections]. An investigation was made on patients with cervical carcinoma to test the efficiency of a general administration of antibiotics and chemotherapeutic drugs which are commonly used in urology. The study has been made to analyze the frequency of pathological findings in the urinary tract, in general, and, in particular, the pattern of bacteriological findings as well as antibiogramms at different times of carcinoma therapy. Additionally, consideration was given to the bacteriological situation before the onset of carcinoma therapy and to manifest urologic complications during and after carcinoma therapy. In cases of primary absence of bacteria in urine the therapy preferably used in this clinic was that with chloramphenicol and nifurantin administered up to the 4th week after operation and this was sufficient in two thirds of cases. Conversely, in patients with primary bacteriuria the results of treatment after 4 weeks were satisfactory in only one third of the cases. This poses the necessity of making a more subtle selection of drugs including broad spectrum penicillins. Moreover, therapy has to be continued mainly for women with a previous urological history and for women in whom infections of the urinary tract were observed on release from the hospital. In addition to prevention of chronic pyelonephritis improvement of postoperative wound healing as well as restriction of ureteral fibrosis, hydronephrosis and uremia, as a result of general control of infection are also of considerable importance.


[The role of the water factor in the spread of dysentery on river vessels]. Results of epidemiological and statistical analysis of the indices of dysentery morbidity and bacteriological examination of drinking water pointed to the significant role of the water factor in the spread of dysentery on the river vessels.


[Temperature-dependent mutants of Hly plasmid and their use for the purpose of confirming the cytotoxic activity of E. coli hemolysin]. Two different mutants of Hly 212 plasmide induced by diethyl sulfate were isolated; one of these was characterized by temperature-dependent synthesis, and the other--by temperature-sensitivity of hemolysin produced. In difference from bacteria possessing wild parental plasmide, E. coli K12 bacteria which contained the mutants produced no cytotoxic action on the MK2 cell culture. This correlated with the absence of the hemolytic activity in growing them even at permissible temperature on medium No 199. After crossing the mutant plasmides there were obtained clones with completely restored wild phenotype of the hemolysin production and the cytotoxic activity. The data obtained pointed to the relationship between the cytotoxicity and hemolysin.


[A new variant, for the USSR, of enteropathogenic escherichia 0151:K--, isolated from acute intestinal diseases under the conditional name "Crimea"]. A study was made of enteropathogenic escherichia "Krym" isolated in the USSR from patients with acute enteric diseases; their antigenic structure was unknown. Also cultures of new serological groups officially recorded as standard test-strains were investigated. By its antigenic structure "Krym" escherichia corresponded to the standard strain of the international set 0151:K--. Along with the H10 antigen described earlier "Krym" escherichia proved to possess H11 antigen; these two serological types of escherichia were revealed in the USSR, i.e. 0151:K--: H10 and 0151:K--: H11. The statement on the presence of a new H50 antigen described in escherichia 880-67 with an antigenic formula of 0151:K--: H50 should be revised due to its complex identity with the 0151: K--: H10 strain. For proper serological identification the conditioned name "Krym" should be replaced by "escherichia of serological group 0151:K--".


[Biological characteristics of salmonellae isolated from different clinical disease forms]. The same types of salmonellae with the same antigenic structure could be the causative agents of various clinical forms of diseases. Two groups of strains of 11 serological types isolated from the patients were studied on 4 biological models: in the keratoconjunctival test on guinea pigs, on a pulmonary model, on an isolated loop of the rabbit intestine and on chick embryos. Results demonstrated that the form of the disease could be a reflection not only of the state of the macroorganism reactivity, but also of the characteristics of the strain of the causative agent. Thus, of 23 strains isolated from the patients with dysentery-like and typhoid form of salmonellosis, 6 caused keratoconjunctivitis and demonstrated a high virulence on all the models in comparison with the 22 strains isolated from patients with the gastrointestinal form.


[Effect of antitissue serum antibodies cross reacting with microbial antigens on the course of the infectious process]. Administration of rabbit and mouse antirenal and antihepatic sera, containing antibodies to the vaccines of streptococcus group C and Candida albicans, to CBA mice 24 hours before infection intensified the severity of the course of the streptococcus and candida infection. On the contrary, antibodies isolated from rabbit and mouse antirenal and antiskin sera cross-reacting with the microbial antigens attenuated the course of an infectious process caused by the corresponding causative agent, when these antibodies were administered to the animals.


[Humoral factors in the stimulation of immunogenesis in a toxic lesion of the liver]. The work was aimed at the study of possibilities of passive transfer of the immunostimulating effect (with the aid of blood serum) observed in various pathological conditions of the liver. Investigations were carried out on rabbits poisoned with carbon tetrachloride (primary serum donors), healthy rabbits (primary recipients and secondary donors of the serum), and healthy rabbits (secondary serum recipients). Crude and heated (for 30 min at 56 degrees C) sera of rabbits poisoned with carbon tetrachloride stimulated production of antibodies induced with the antigen in the intact animals. Under the effect of trasilol, a polyvalent proteinase inhibitor, the sera of rabbits poisoned with carbon tetrachloride lost their immunostimulating properties. The sera of rabbits given injections of the sera obtained from the poisoned animals produced an immunostimulating action which failed to disappear under the effect of trasilol.


[Use of the VShS elective-differential medium in the diagnosis of dysentery and other acute intestinal infections]. Results of trial of the VShS medium under conditions of direct seeding feces of patients suffering from dysentery and other acute intestinal disturbances demonstrated that by the efficacy of Sh. sonnei isolation it failed to differ from Ploskirev's bactoagar, was less effective in comparison with Levin's medium with levomycetin (the incidence of Shigella isolation was 49.7, 52.6 and 60.3%, respectively) and was the most effective in Sh. newcastle isolation. In seeding feces after their enrichment in selenite broth the VShS medium proved to be much more effective than Ploskirev's bactoagar by the incidence of isolation of Shigellae (90 and 65.7%).


[Utilization of the swarming phenomenon for the purpose of isolating pure cultures of salmonellae from feces. II]. A comparative study of the efficacy of two methods of isolation of salmonella from feces was conducted; it was shown that the method based on the capacity of these bacteria to swarming on special elective media was more sensitive than the conventional one. The swarming method proved to be less time consuming and less expensive, because two stages of conventional examination--i.e. enrichment of material and isolation of salmonellae--coincided in time and were carried out on the same media.


[Biological properties of Salmonella typhimurium mutants with an altered sensitivity to erythromycin]. S. typhimurium mutants with altered sensitivity to erythromycin (more resistant or more sensitive than the original culture) were selected. Some of the properties of the mutants studied were found to be changed: morphology, character of growth in the liquid nutrient medium with aeration (increased generation time and number of generations in log-period), sensitivity to ionic detergent--sodium dodecyl sulfate (its decrease). Some of the mutants acquired cross resistance or sensitivity to other antibiotics. The mutants studied had decreased virulence for albino mice. As the mutants were selected by increased resistance or sensitivity to erythromycin, which acted upon the 50 S ribosomal subunits, the pleiotropic changes of their properties were possibly due to some alterations in the ribosomes.


[Clinico-genetic classification of muscular dystrophy]. The authors have given a critical review of existing classifications of myodystrophies from 1884 till 1973. They propose a new systematization based on the formula of muscular lesions during different phases of the disease and on the formula of a generalization of the myodystrophical process. It is assumed that the formula of muscular atrophies and the direction of the generalization of the myodystrophical process is genetically conditioned and should be considered as an important sign of hereditary neuro-muscular diseases. The authors believe that the facio-scapulo-limb type of myodystrophy both clinically and genetically is not homogenous. This form of dystrophy should be divided into 2 variants: a gradually descending one and a descending one with a "jumping" of muscular atrophies from the upper half of the body (face, shoulder) to the peroneal group of muscles on the skin.


[Our experiences in the treatment of bleeding duodenal ulcer by means of proximal gastric vagotomy]. Gastric Vagotomies were performed on fifty four patients suffering from bleeding Duodenal Ulcers. Forty-three cases were operated on following a spontaneous cease in hemorrhaging, and necessary examinations. The remaining eleven patients were opereted on immediately as conservative measures would not be able to stop the bleeding. The procedure used following the admittance of a patient with a bleeding ulcer to the hospital was discussed. A detailed explanation of the technical procedure used in handing the bleeding duodenal ulcer was also presented. The authors believe that a Duodenotomy performed without cutting the pylorus has its advantages inasmuch as hemostasis has been successfully accomplished. All the cases had good clinical results, however, bleeding did recur in a few instances. There were no recidive ocurrences. Ever though many patients were chronically ill ie; Diabetes Mellitus, Myocardiopathia, secondary anemia, exitus lethalis did not occur. P.V.G. in the treatment of bleeding ulcers has a definte advantage over the other radical procedures.


Osmotic resistance of leukocytes in patients with onset of diabetes before twenty-five years. Osmotic resistance of leukocytes has been studied with the Storti-Pederzini method in 30 young healthy subjects and in 30 diabetics of the juvenile insulin-dependent type with variable duration of the disease and variable degrees of metabolic control. Reduced osmotic resistance, above all in the polymorphonuclear cells, has been found in diabetics. This finding did not appear to correlate with the duration of diabetes or with blood glucose level. This reduced osmotic resistance of polymorphonuclear leukocytes of diabetic patients might contribute to the deficiency in leukocyte migration and phagocytosis observed by some authors in diabetics.


[The allergic focal reaction phenomenon. Significance for the testing, therapy and theory of clinical allergy. Study in bronchial asthma and other allergic diseases]. On the basis of examinations of 654 cases of clinical allergy (487 cases of bronchial asthma) a new allergenic phenomenon is described: "The allergic focal reaction phenomenon". It is associated with the demonstration of a regularly reproducible, clinical, allergic initiating effect of very small doses of specific antigen only on the allergically diseased tissue (focus). The findings made it possible to elaborate a new method for allergy testing and therapy without any danger, and offers quite new ideas for the interpretation of allergic mechanisms. The authors tried to integrate this phenomenon into the picture of clinical allergy, and some so far unclear problems of allergy may, on this basis, have found a probable solution."


Treatment of vasomotor rhinitis with intranasal beclomethasone dipropionate (Becotide). Results from a double-blind cross-over study. The effect of beclomethasone dipropionate (Becotide) intranasally in vasomotor rhinitis has been studied on 39 adult volunteers in a double-blind cross-over study during 9 weeks in February-April 1975. The dose of beclomethasone dipropionate was 300 mug/day. Twenty-five patients preferred the beclomethasone dipropionate period, 5 patients the placebo period, and 9 patients had no preference. About three-quarters (74 per cent) of the patients considered themselves free of symptoms or greatly improved after the treatment with beclomethasone dipropionate. Statistical calculation of the daily nasal symptoms score confirms the improvement. The speediest effect was registered for sneezing, followed by nasal catarrh, nasal itching, and blocking. No changes in the levels of cortisol occurred during the treatment. The bacteriological and mycological findings (analysed with regard to Candida albicans) were fairly constant.


Intra-nasal beclomethasone dipropionate in vasomotor rhinitis. Twenty-one patients with vasomotor rhinitis, with no relevant allergens known, completed a special double-blind trial of beclomethasone dipropionate aerosol (BDA) and placebo intra-nasally. Each patient took 200, 400 and 800 mug BDA and placebo during four consecutive 2-week periods and in different sequences. The symptom scores of the last week of each period of nasal blockage, watery secretion and sneezing were significantly reduced by all doses of BDA as compared with placebo. There were no differences between the effects of the different doses of BDA except for secretion, which was reduced more by using 800 than 200 mug. Cortisol in serum and 17-hydroxycorticosteroids in 24-hour urine were not significantly changed by BDA treatment and no increased frequency of pathogenic bacteria or fungi could be demonstrated in the nasal secretion. For treatment of patients with vasomotor rhinitis, intra-nasal BDA in a daily dose of 200 mug can be recommended when antihistamines, sympathomimetic drugs and sodium cromoglycate are not sufficiently effective.


Immunoreactive LRF neurosecretory pathways in mammals. Using antisera to synthetic luteinizing hormone-releasing factor (LRF) and antisera labeled with fluorescein isothiocyanate or peroxidase, it was possible in various physiological and experimental conditions to determine the topography of the LRF secretory cells in the guinea pig. The axons of these cells form a preoptico-infundibular LRF pathway, which controls the prehypophyseal gonadotropic secretion, and various "extrahypophyseal pathways". These latter suggest that LRF, in addition to its prehypophysiotropic action, may have a neuromodulator function.


Effect of glucagon on the principal islets of a fresh-water fish, Channa punctatus (Bloch). Intramuscular administration of crystalline mammalian glucagon (0.5-2.0 mg/kg body weight) evokes significant cytological alterations in the principal islets of Channa punctatus, a fresh-water fish. Initially there is degeneration of the alpha-cells but later the beta-cells are also atrophied. Regressive changes in some of the alpha-cells have been interpreted to reflect their possible role in glucagon secretion. The degeneration of beta-cells appears to be secondary to the fluctuations in the blood glucose level, induced by exogenous glucagon.


A new (?) Clinical headache entity "chronic paroxysmal hemicrania" 2. A headache disorder with shortlasting, frequently occurring (6-18/24 hours) head pain attacks is reported. The pain is excruciatingly severe, unilateral (always on the same side), unaccompanied by visual phenomena, nausea/vomiting, but accompanied by nasal congestion and lacrimation on the symptomatic side. The maximum pain is felt in the temporal region, although during severe attacks the entire hemicranium is involved through the neck, shoulder and homolateral arm in a diffuse way. The attack pattern differs clearly from that of cluster headache both with regard to atrack frequency and the long term temporal pattern. In addition to blood and urine parameters and supplementary neurological/neuroradiological investigations, the following parameters were studied: Urinary histamine excretion (partly increased), kinin parameters (occasionally increased blood kinin and reduced blood kininogen), and corneal indentation pulse amplitudes (attack-induced increase, as in regular cluster headache). The following parameters rendered normal results: prostaglandins, cerebral blood flow, fluorescein appearance time, intrathecal pressure during and between attacks, and muscle biopsy with immunological investigation. The pain attacks can be abolished by continuous indomethacin medication. In spite of the ocular findings it has in common with cluster headache, this headache seems to differ from cluster headache.


Controlled trial of intravenous aminophylline in acute cerebral infarction. In a double-blind trial intravenous aminophylline was compared with placebo in 79 patients with acute cerebral infarction. Immediate improvement in the neurological evaluation score was significantly more frequent in patients receiving aminophylline (38 per cent) than in those on placebo (15 per cent); only patients with mild or moderately severe strokes responded to the injection. After 3 weeks, however, the treated patients did not fare significantly better than the controls in terms of neurological score and residual disability. Survival rate, length of stay in hospital, and social readaptation were similar in the two groups. It is concluded that intravenous aminophylline in patients with ischaemic strokes can bring about an immediate symptomatic relief, but without appreciably influencing the ultimate recovery.


The reaction of the cerebral cortex to chronically implanted plastic needles. Plastic (araldite) needles were implanted in the cerebral cortex in order to evaluate changes produced by an indwelling and relatively inert foreign body. The implants were removed together with surrounding cortex after 4-723 days and the implant-CNS boundary analyzed by light and electron microscopy. Three border conditions were observed at the surface of the implant and were related to the degree of implantation trauma. Type I is characterized by little or no gliosis and synapses within 1-5mu of the implant; type II contains a pronounced zone of reactive astrocytes; and type III is typified by a zone of connective tissue near the implant surface. The type I border predominates, but all three conditions may exist around a single implant. The fact that the implant-CNS boundary is stable following an initial period of readjustment suggests that intracortical implants fabricated from inert materials would be well tolerated and could be used as part of neuro-prosthetic device. Multinucleated giant cells were observed at the boundary of some implants. Their cytology, intercellular relations, and similarity to foreign body giant cells are discussed.


The treatment of glaucoma with propranolol (Inderal). A clinical trial. The effect of propranolol (Inderal) on the intraocular pressure (IOP) in glaucoma has been measured. Twenty-two patients completed the clinical trial. Propranolol in doses of 160 mg/d effectively lowered IOP in eyes with various types of open angle glaucoma. The test periods lasted from 4 to 6 days. The ocular hypotensive effect of propranolol was also registered in patients efficiently treated with pilocarpine and acetazolamide (Diamox), and in glaucomas not satisfactorily controlled by this therapy. High positive correlations between mean pretreatment pressure (P1), and pressure fall (delta P) were found (P less than 0.001), and the pressure decrease induced by propranolol treatment tended to be proportional to the pressure gradient between the anterior chamber and the episcleral veins. This pressure gradient was reduced by an average of about 50% following propranolol treatment. There was no change in scleral rigidity after propranolol.


The value of low dosage heparin for the prophylaxis of thromboembolism in patients with transcervical and intertrochanteric femoral fractures. One hundred and ten female patients, over the age of 60, with intertrochanteric or transcervical fractures were included in a controlled, randomized, clinical trial investigating the value of low dosage heparin in the prophylaxis of deep vein thrombosis. There were 50 completed pairs. Eight (16 per cent) deep vein thromboses occurred in the heparinized group compared with 23 (46 per cent) deep vein thromboses in the control group. The incidence of pulmonary embolism was also reduced. The diagnosis of deep vein thrombosis was made on clinical grounds, supplemented by phlebography and autopsy. There was no difference in the wound hematoma or infection rate. The heparin was commenced on admission to hospital and it is suggested that in this group of patients low dosage heparin prophylaxis should start on admission and not wait until surgery.


Peripheral nerve repairs by the funicular suture technique. Sixty-one peripheral nerve repairs in 48 patients sutured by the funicular suture technique were followed up for a minimum of 2 years after operation, the average follow-up period being 48 months. Useful recovery was obtained in 100 per cent of cases with radial and musculocutaneous nerve repairs. Seventy-five per cent of cases with median, 82 per cent with ulnar and 88 per cent with digital nerve lesions attained "useful" grade recovery. In the lower extremity, the motor recovery was excellent, whereas the sensory recovery was poor. In two out of three cases where cable grafting was performed between important funiculi the result obtained was excellent. To obtain satisfactory neurological recovery, the funicular suture, technique using the surgical microscope is the method of choice for primary and secondary nerve suture and cable grafting.


Classical conditioning of the stapedius muscle. A delayed conditioning paradigm was employed to condition the stapedius muscle. While many previous attempts have failed using loud sound as the unconditioned stimulus(UCS), this paper presents evidence of successful conditioning of this muscle when the unconditioned stimulus was a mild electrocutaneous stimulation of the external ear canal. Using a weak tone as the conditioned stimulus, conditioned responses were readily obtained in eight of ten subjects after only 30 or fewer toneshock pairs. Temporal con ditioning was also demonstrated. A parallel is shown to exist between attempts to condition the pupillary and stapedius reflexes.


Baclofen (Lioresal) in the treatment ofneuroleptic-induced tardive dyskinesia. A double-blind cross-over trial of the effects of baclofen and placebo was carried out in 20 female patients suffering from neuroleptic-induced tardive dyskinesia. After 14 days of treatment 15 patients showed improvement of baclofen, whereas none showed improvement on placebo; baclofen was thus significantly more effective than placebo. Baclofen is a GABA-like drug which passes through the blood-brain barrier and which reduces the neuroleptic-induced increase of dopamine turn-over. In tardive dyskinesia is found dopaminergic hypersensitivity, and baclofen is supposed to exert its action by inhibiting the dopamine activity. Side effects, although temporary, were observed in the form of sedation, muscular hypotonia, dizziness, vomiting, and muscular rigidity. One patient developed a depression. Baclofen or other gabergic drugs used in the treatment of dyskinesias do not increase the dopaminergic hypersensitivity, which is part of the pathogenesis of these conditions; gabergic therapy must therefore be preferred to treatment with dopamine receptor blocking drugs.


Computer tomography of traumatic intra- and extracerebral lesions. Computer tomography was performed in 29 patients with intra- or extracerebral lesions and the results evaluated retrospectively and compared with angiography, operation or autopsy findings. Many subdural haematomas were difficult to distinguish and in two cases it was impossible. Angiography proved to be more certain. In all cases the intracerebral heamatoma was considerably more evident at computer tomography than at angiography and for contusions, the information provided is fully comparable with that by angiography.


Computer tomography in cerebral death.

Computer tomography in cerebral death. Computer tomography has been applied in a material of six patients meeting the criteria for cerebral death. The primary intracranial pathology, haemorrhages, infarction and contusions were demonstrable. No generalized reduction of the attenuation characteristic of infarction was found in spite of angiographic arrest of the intracranial circulation. Compression and obstruction of small brain vessels may in some cases be the primary cause of arrest of the brain circulation in cerebral death and not an increase of the intracranial pressure to levels approaching or surpassing the mean systemic arterial pressure.


Computer tomography compared with spectrophotometry of cerebrospinal fluid in cerebrovascular diseases. Eighty patients with cerebrovascular diseases were examined by computer tomography and spectrophotometry of CSF, most cases being followed by repeat examinations. Specific diagnoses were obtained in 76 per cent of the cases at tomography and in 95 per cent at spectrophotometry, generally at one examination. In cases examined angiographically or by isotope encephalography, the corresponding figures were 60 and 58 per cent. Twenty patients with confirmed haemorrhage or infarction examined only at tomography further indicated the high diagnostic significance of this method. The combination of tomography and spectrophotometry, being complementary to each other, obviously means a break-through in the diagnosis of cerebrovascular diseases, which is a prerequisite for a more rational therapy of these common and frequently disabling disorders.


Computer tomography for diagnosis of intracranial tumours compared with other neuroradiologic procedures. The diagnostic effectiveness of computer tomography has been assessed in a series of 361 patients with the primary clinical problem of a possible intracranial neoplasm. Of these patients, 171 were shown to have a tumour, confirmed at microscopy in 115 instances. Computer tomography was compared with other established neuroradiologic procedures, such as encephalography, angiography and isotope scanning, all of which were frequently used in this series of patients.


Quantitative estimation of intracerebral and intraventricular hematoma by computer tomography. A method to quantify the size of intracerebral hematoma by computer tomography was tested experimentally. The size of the lesion could be calculated with an error of +/- 3 to 9 per cent. By correlating the volume of the hematoma to the level consciousness in 62 patients, it was found that the volume which induced coma was rather specific, corresponding to about 6 to 7 per cent of the intracranial volume. This observation may lead to a reassessment of present therapeutic concepts.


Computer tomography in post-mortem examination of the brain and other specimens. A technique is described for post-mortem examination of brain specimens employing computer tomography, for accurate comparison with in vivo scanning, including subsequent cutting of specimens in sections corresponding to tomographic layers measured. Potential application of this technique to diagnosis of mammary tumours is discussed.


Computer intravenous angiography.

Computer intravenous angiography. Computer tomography could be useful in demonstrating lesions of intracranial vascular structures. Experimental methods aimed at achieving this are presented and clinical examples using intravenous angiography are given. The factors involved by the demonstration of intracranial vessels are discussed.


Size of the intracerebral ventricles as measured with computer tomography, encephalography and echoventriculography. Ventricular size in a total of 192 patients was determined with computer tomography (CT), encephalography (Enc) and echoventriculography (echo-VG). There was good correlation (greater than or equal to 0.80) between the values for the size of the lateral ventricles obtained with all three methods. Correlation between values for the width of the third ventricle: CT/Enc and CT/echo-VG: poor; Enc/echo-VG: good ( = 0.85). Both at computed tomography and encephalography there was poor correlation between anterior horn index and the width of the third ventricle.


[Analytical study of 510 cases of surgical lymph node biopsies]. 510 cases of surgical lymph node biopsies during a five year period are reviewed with the following conclusions: The lymph node biopsy constitutes 5% of all the surgical biopsies. The cervical and axillary lymph nodes are the most commonly biopsied nodes due to their easy accessibility and due to the fact that they drain the lymph from many vital organs; the next most commonly biopsied nodes are the sub-clavicular, grains, mesentric and mediastinal nodes. Among all the lymph node affections the metastatic tumours occupy the first place (23%) followed by the primary tumours (malignant lymphomas 16%) and the specific inflammatory lesions (10%). Among the metastic nodes squamous cell carcinoma occupy the first place (8%) followed by digestive tract, lung, thyroid glands, breast, testicular, pancreatic, ovarian and gall bladder tumours.


The characteristics of glucose transport across the blood brain barrier and its relation to cerebral glucose metabolism. The evidence suggests that glucose transport across the blood brain barrier (BBB) in the dog is normally not a rate-limiting step in cerebral metabolism; however, transport may become rate-limiting under conditions of extreme hypoglycemia or anoxia. Studies on the mechanism of glucose transport from blood to brain do not at this time permit us to distinguish between active transport and facilitated diffusion; however, a decrease in the rate of unidirectional transport during anoxia suggests that an energy-dependent process may be involved. In spite of this evidence, glucose transport across the BBB is similar to the facilitated diffusion of glucose into the red cell in terms of the structural requirements of the glucose molecule, the pattern of inhibition by phlorizin, phloretin and cytochalasin B, and the lack of sensitivity to Na+ or insulin.


Energetics of low affinity amino acid transport into brain slices. It appears possible to dissect and study some of the potential energy sources for amino acid transport in brain slices despite the apparent complexity of the tissue in comparison to that of isolated bacterial vesicles23. The uptake capability of the tissue may be inadvertently damaged in some experimental protocols so that very special controls must be used to ensure that the treatment did not somehow inactivate the very mechanism that thereafter will be tested. We have presented some evidence that brain slice amino acid transport may not be obligatorily linked to glycolysis, ATP levels, Na+, K+-ATPase activity, K+ levels or direction of flux, or to Na+ flux. However, the energy source linkage for different amino acids appears to be rather specific, so that further generalizations are difficult to sustain. For instance, the incubation media and conditions we describe here were experimentally adjusted to maximize uptake of D-glu or alpha-AIB in the absence of glucose, or in lowered K+ or Na+. Therefore, these procedures, the results of which directly challenge some common assumptions regarding the energy basis for active transport in brain slices, probably will not be universally extensible to all other actively transported amino acids.


Pathological aspects of brain transport phenomena. The aim of this paper has been to review and discuss the past and the recent investigations concerned with the study of cerebral transport phenomena in pathological conditions which have been divided into two main parts: (1) the effects of experimentally induced blood brain barrier (BBB) injury by (a) HgCl2 or (b) hyper-osmolar intracarotic perfusate; and (2) the effects of ischemia or of an altered oxygen saturation and pCO2 tension on glucose and/or amino acids and/or protein transport across the BBB, in the syanptosomes and cerebral capillaries. The most important observations were as follows: (1) HgCl2 or hyperosmolar perfusates produced an increased BBB permeability to protein tracers but the brain uptake of glucose analogues was found decreased following the former, and increased (except for lactamide) after the latter treatment. (2) (a) In ischemia, the noted increased vesicular transport of peroxidase, as well as the increased saturable and non-saturable passage of glucose analogues across the BBB depended on the duration of cerebral deprivation of blood supply which never resulted in degeneration of endothelial cells of the brain vessels. (b) The progressively decreased specific 2-deoxy-D-glucose uptake in the synaptosomes seen during cerebral ischemia of 30-180 minutes returned to the level of controls 1 hour after reestablishment of cerebral circulation. (c) A decrease in brain uptake of glucose analogues and amino acids (with few exceptions) was observed in severe hypoxia and hypercapnia while an increase or no change in the brain uptakes was seen in hypocapnia. (d) Preliminary investigations of the 2-DG uptake by the cerebral capillaries obtained by fractionation of the brain from animals subjected to normal or altered oxygen saturation and pCO2 tension suggested that cerebral glucose uptake may be directly related to its capillary function.


Synthesis and turnover of brain phosphoglycerides- results, methods of calculation and interpretation. The important problem of membrane assembly and disassembly can be studied by measurements of rates of tunrover of labeled components. After intracerebral injections of ethanolamine and glycerol into mice, we have found rapid and slow turnover pools of 1,2-diacyl-sn-glycero-3-phosphorylethanolamine (diacyl-GPE) and 1,2-diacyl-sn-glycero-3-phosphorylcholine (diacyl-GPC). We have described the methods for calculation of half-lives for two or more pools and for the calculation of the relative size of the pools. For mice injected between 5 and 8 weeks of age, the rapid turnover pools have a half-life of 1.5 and 1.8 days for diacyl-GPC and diacyl-Ge respectively. Corresponding half-lives for the slow turnover pools are 20 and 27 days. The slow turnover pools include 74% of the diacyl-GPC and 86% of the diacyl-Ge. These turnover rates are in agreement with the flux of fatty acids through the diacylglycerol pools. We have proposed that the rapid turnover pool may be the phosphoglycerides that are exchangable with cytosol carrier proteins and that the slow turnover may represent the catabolism of membrane segments including the intrinsic proteins.