[A new method for rapid determination of blood L-lactate using an enzymatic lactate sensor (author's transl)]. We determined the lactate concentration in 112 samples of arterial blood, simultaneously by two-different technic: 1) The usual enzymatic technic (plasmatic and intracellular lactates). 2) A new technic using an enzymatic lactate sensor ("lactate analyzer 5400") which measures the plasmatic lactates only. The data obtained with the two technics were very similar (r = 0,982). The small volume of blood used and the handiness and rapidity of the new procedure are to be noted.


[Bumetanide, a new diuretic active during chronic renal failure (author's transl)]. Bumetanide is a new diuretic, which acts in the ascending limb of Henle's loop. The use of very high doses (5 to 40 mg/24 h) in 32 patients with advanced chronic renal insufficiency gave a clear diuretic effect in half the patients with a creatinine clearance of less than 3 ml/min and in 2/3 of the cases with a creatinine clearance between 3 and 10 ml/min. The efficacy of high doses of bumetanide, as well as their good tolerance shows an action of this new diuretic similar to that of furosemide.


Nosocomial transmission of group B streptococci. Group B streptococci are an important cause of infant septicemia and meningitis. A prospective study of group B streptococcal colonization in a 300-bed community hospital disclosed rates of 29% of 297 third-trimester women, 37% of 242 newborn infants, and 45% of 22 hospital personnel. Colonized parturients were more frequently black and anemic on admission for delivery. Infant colonization was statistically associated with a positive maternal genital culture, low birthweight, and prematurity. Nosocomial transmission of group B streptococci was strongly suggested by observations that 41% of colonized infants were born to culture-negative women and such infants became colonized later in their hospital stay than did colonized infants born to colonized women. Furthermore, hospital personnel working in the labor-delivery and nursery areas had a significantly higher prevalence of the organism than did personnel from other areas. Clearly, more information is needed about the epidemiology of group B streptococcal disease before appropriate and rational control measures can be recommended.


Immunologic reconstitution in severe combined immunodeficiency following transplantation with parental bone marrow. A 9-month-old girl with severe combined immunodeficiency was transplanted with BM cells from her father. The child had complete restoration of cell-mediated immune functions. Humoral immune functions remain absent nine months after transplant. Child and father were HL-A identical and their lymphocytes were nonreactive in mixed lymphocyte culture. The parents of the child were first cousins and shared an HL-A haplotype. In countries like Lebanon, where there is a high incidence of first-cousin marriages (15%) and where villages are relatively isolated, the search for histocompatible graft donors should extend beyond the siblings to other members of the family.


Use of the Beery Visual-Motor Integration Test with partially sighted students. The purpose of this research was to determine the difference in performance of partially sighted and sighted students on the Beery Visual-Motor Integration Test. Since this test is only standardized on sighted students, there are no norms for partially sighted students. 60 partially sighted students, ranging in age from 6 to 18 yr., were tested on Beery's Visual-Motor Integration Test. These students did not achieve as well as Beery's norms indicate his sighted population did. The average age of the partially sighted students was 3 yr., 8 mo. below that of Beery's seeing students. Partially sighted students had greater difficulty with certain test items than Beery's normal subjects. A special test which would rank geometric forms by development stages seems needed for partially seeing students.


Sport-related attitudes and the-Philosophies of Human Nature Scale. The revised Philosophies of Human Nature scale was presented to 94 females and 94 males to develop normative data. There were no significant sex differences in the norms. A questionnaire about sports was presented at the same time to determine relationships between the two scales. Females who claimed frequent sports participation were less likely to have an internal locus of control and were less likely to believe that human beings are complex than females who claimed infrequent participation. A comparison of those who like and dislike sports gave no significant difference for either sex on the sub-scales of Philosophies of Human Nature. The findings are consistent with previous research which generally shows little or no effect of interest or participation in sports on personality traits.


Field-dependence and facial expressions. Facially expressive and nonexpressive subjects (40 undergraduate women) were compared on a measure of field-dependence--independence. Expressives were significantly more field-independent than non-expressives. It was suggested that both social development and the situational context play important roles in determining the effects of perceptual style on nonverbal behavior.


Bibliography: supplement to Piaget's theory and exceptional children, 1963-1973. A 59-item supplement to the bibliography which appeared in Perceptual and Motor Skills, 1975, 41, 225-261.


Reaction times and Digit Symbol Test scores of girls identified as daydreamers by their teachers. Reaction times and Digit Symbol scores of 14 9-yr.-old girls identified as "daydreamers" by their teachers were compared with those of 14 9-yr.-old girls not so identified. Daydreamers tended to have longer mean reaction times under all test conditions but the differences were small. The daydreamers completed significantly less of the Digit Symbol test than did the non daydreamers and also recalled significantly fewer symbols. The daydreamers had significantly larger variances for three of the four measures of outcome of the Digit Symbol test. These data support the hypothesis that girls identified as daydreamers on a questionnaire completed by their teachers did less well on certain tests of attention than girls not so identified.


Personality dimensions measured by projective techniques: a formulation based on structural analysis. It is suggested that a better understanding and more effective use of projective techniques can be achieved by viewing each test in terms of the depth of personality assessed and its unique amalgamation of emotional and intellectual aspects of personality. With these considerations in mind, a refurbished definition of a projective test is presented and implications for the phenomenon of projection are discussed.


Field dependence in visually and nonvisually involved learning disabled children. 39 visually and nonvisually perceptually impaired 8- to 11-yr.-old boys with learning disabilities were compared with a control group of 35 "normal" learners on the Rod-and-frame and Children's Embedded-figures Tests. Previous findings of greater field dependence of learning disabled children are confounded because the experimental tasks involved visual perception. In our study the 27 "visuals" were more field-dependent than either the 12 "nonvisuals" or the controls. The latter groups did not differ significantly from one another, which may in part be a function of the small sample of nonvisual children identified. Alternative explanations, e.g., the visual nature of the field-dependence measures and the lack of reading difficulty of the nonvisual group, are considered. For the visually disabled Ss only Vocabulary scores, suggesting that among such children those with higher verbal intelligence may be more field-independent.


Copulatory behavior of pine voles (Microtus pinetorum). 7 male and 6 female pine voles, Microtus pinetorum, were observed in a total of 26 tests of copulatory behavior. They displayed a pattern with no lock intravaginal thrusting, ejaculation possible on a single insertion, and multiple ejaculations. The first ejaculatory series required approximately 5 min, with a mean of five intromissions and 36 thrusts. Post-ejaculatory intervals following the first series averaged 16 min. and increased in successive series.


Cytochalasin B: evidence for a membrane-directed action in B-cells from rat pancreatic islets. In the presence of cytochalasin B (CCB) concentrations from 50 to 200 mug/ml there is a dose-dependant inhibition of insulin release from isolated rat pancreatic islets. Inhibition is unspecific with respect to glucose, leucine, tolbutamide or theophylline and is reversible. Production of 14CO2 from uniformly labeled D-glucose is decreased. Islets pretreated with an high (200 mug/ml) or low (10 mug/ml) CCB dose release more insulin in response to a subsequent glucose or leucine stimulus in a CCB free medium compared with controls. The data are compatible with a membrane-directed action of CCB.


An examination of the xenon clearance method. A definition of cortical and juxta-medullary regions is suggested based on a grouping of nephrons of common flow characteristics. A possible error is suggested in the xenon clearance method of measuring the regional flows. Experiments to test the source of error and its magnitude are described. It is concluded that while the error is present its effect on conventional component analysis is small.


The bulbar respiratory centre in the rabbit. II. Responses of respiratory neurons to intermittent electrical bulbar stimulation during in- or expiration. In anesthetized rabbits, spirogram and diaphragmatic activity were examined during electrical stimulation of the bulbar lateral reticular formation. The activity of bulbar respiratory neurons was recorded contra- or ipsilaterally to the stimulation site. One volley of repetitive stimuli per breath was delivered during either inspiration of expiration. 1. Each volley of about 120 ms duration at 100 pulses per second, delivered early in inspiration, caused an immediate and transient inhibition of the diaphragmatic activity. An inspiratory rebound comprising lengthening of inspiration and increase in tidal volume occurred. a) "Inspiratory" and "expiratory-inspiratory" phase-spanning neurons exhibited inhibition during the volley. The burst discharge was lengthened and the spike density increased after stimulus. The same was true of some "inspiratory-expiratory" phase-spanning units. b) The discharge of most of the "inspiratory-expiratory neurons was not inhibited. "Expiratory" units were excited. In both types of cells activation occurred which outlasted the volley. 2. When applied during expiration, the volley caused a short inspiratory twitch. a) "Inspiratory" and "expiratory-inspiratory" neurons exhibited a short post-stimulus firing and the spike density was increased. In some units of the latter type, however, the burst discharge was shortened. b) Most of the "expiratory" and "inspiratory-expiratory" neurons were not inhibited by the volley. Cells of the former type often produced post-stimulus after-discharge; the burst discharge of units belonging to the latter type was shortened. The effects of expiratory stimuli upon neuronal activity, however, were less consistent than those elicited by inspiratory volleys. 3. During spontaneous irregularities of single inspirations (short interruptions), EI and I neurons exhibited comparable burst pattern changes. The changes in pattern of IE and E units were also comparable and differed distinctly from the behaviour of the EI and I cells. No major differences in behaviour were observed between neurons which were inhibited during lung inflation (alpha units) and those which were activated during inflation (beta cells). The findings are in accord with the effects observed during electrical bulbar stimulation, suggesting that EI and I units are inspiratory-activating cells, whereas IE and E neurons may have an inspiratory-inhibitory function. 4. The conclusion is drawn that the effects of bulbar stimulation on the respiratory movements are the result of manipulation on intrinsic rhythmogenesis.


Methylation of chromatin DNA.

Methylation of chromatin DNA. E. coli DNA methylase has been used to methylate chromatin DNA in vitro. At saturation only 50% of the chromatin DNA becomes methylated. The methylated regions of chromatin correspond to that fraction of the chromatin which is sensitive to staphylococcal nuclease. Using in vitro methylated chromatin followed by nuclease digestion movement of chromatin proteins along the DNA can be detected. By this criterion, sonication of chromatin or precipitation with MnCl2 causes 10% of the previously uncovered methylated regions to become covered by protein. Reconstitution of methylated chromatin results in the randomization of the  chromatin proteins. Using nuclei which were methylated in vitro we have demonstrated that a small degree of protein sliding does occur during the preparation of chromatin from nuclei. Finally, we have prepared open region DNA by polylysine titration. This procedure does not cause displacement of chromatin proteins.


The separation of ribonucleic acids from Escherichia coli on lysin-agarose. Lysine-agarose provides a simple means of separating RNA species of different moleecular weight. When RNA from Escherichia coli is added to a small column of lysine-agarose and elution is carried out at neutral pH with a shallow linear gradient of NaCl the RNA species are eluted according to size; 4S and 5S RNA species are completely separated and after a delay the 16S and 23S species are eluted as separate peaks. The process is very reproducible and the different species are eluted at a fixed salt concentration even when changes are made in the gradient, provided other conditions, under which the column is run remain constant.


A clinical investigation into the effects of prednisolone treatment on ovarian function in heifers. Four heifers displaying regular oestrus were treated daily with 30 mg prednisolone per 100 kg body weight from day 2 after oestrus (i.e. the day after ovulation) until slaughter. Two of the heifers were slaughtered on day 13 and the remaining two on day 26 after last oestrus. Three heifers that had regular oestrus cycles served as untreated controls. Both the treated and the untreated heifers were inspected and examined by rectal palpation during the period of treatment and the findings were compared. The control heifers had all normal ovarian function. In the prednisolone treated heifers, the corpora lutea were found to be small in size compared to the controls. Follicular activity also seemed to be increased. In spite of small corpora lutea and increased follicular activity, none of the prednisolone treated heifers showed signs of oestrogen influence, and the two animals slaughtered 26 days after the start of treatment, did not ovulate or show signs of oestrus. The effect of long-term treatment with corticosteroids on the development and function of the corpus luteum and on follicular activity, and the importance of corticosteroids in the pathogenesis of anovulatio and follicular cysts are discussed.


The validity of the total myocardial blood flow determination by means of 133Xe in regional ischemia. Regional MBF in the ischemic and healthy left ventricular myocardium was measured in 21 mongrel dogs by means of locally injected 133Xe and its washout one week after ligation of the left anterior descending coronary. Simultaneously the total MBF was calculated from the precordial washout determination of 133Xe injected into the left coronary artery. The 133Xe measurements were compared with the regional 86Rb uptake. The values of total MBF determination after left coronary artery injection did not diminish adequately to the size of the ischemic area; these values were usually higher as compared with the calculated mean MBF evaluated from the regional left ventricular blood flow and did not agree with regional MBF in the intact left ventricular myocardium. The difference of perfusion between the necrotic and the healthy left ventricular myocardium determined from the local 133Xe washout was higher in comparison to 86Rb uptake. The method of total MBF determination by means of precordially determined 133Xe washout injected into the coronary artery yields artificially higher values in cases with greater ischemic areas. This may be accounted for by a low initial radioactivity of the hypoperfused areas and their negligible contribution to the total radioactivity changes produced predominantly by the well perfused areas. The relatively low 86Rb uptake difference in the healthy and the necrotic left ventricular myocardium may be caused by affected extraction coefficients of 86Rb in the necrotic tissue.


[The 57Co-excretion and absorption test in the diagnosis of iron deficiency anemia]. 1971 Sorbie et al. described a simple 57Co-excretion test (16) as an aid in the diagnosis of iron deficiency anemia. The authors found that renal excretion of a tracer dosis of 0,5 muCi 57CoCl2 was significantly elevated in patients with iron deficiency anemia (31% of the administered dose in 24 hours' urine) as compared with the controls (18%). Between 1972-1974 we performed the 57Co-excretion test in 29 patients with different kind of anemia and in 10 healthy volunteers. The test was modified by measurement of the serum activity 1, 2, 3, 7, 11 and 24 hours after the oral administration of the test dosis. In all anemias as well as in the control group we found the maximum of serum activity three hours after the oral administration of the tracer. The three hours serum activity was elevated only in patients with iron deficiency anemia (5,53%/1 serum) as compared with the control group (1,92%/1) and renal, tumor and infectious anemia (1,20%/1). p less than 0,001. The 57Co excretion was moderately elevated in most of the patients with iron dificiency anemia (average 31,5% 57Co-activity in 24 hours' urine) in comparison to the healthy controls (average 25,30%). Contrary to the results obtained by Sorbie et al. we found a wide range of fluctuation of the Co-excretion test in each group of patients with a poor statistical significance of p greater than 0,005.


[Salmonella bacteria in double cream (author's transl)]. In June 1974 a serious outbreak salmonellosis was reported from the southeast of Sweden. The epidemic was caused by Salmonella typhimurium and spread by infected cream, packed in one-way paper-plastic containers. Ordinary pasteurization of cream purposely infected with the strain in question at 60 degrees for 38 sec or 67 degrees C for 4,5 sec, resulted in a reduction by more than 7 decimal logs (Table I). The decimal reduction time at 60 degrees in cream was estimated to roughly 1.3 sec. The cream, which caused the outbreak, was pasteurized at 90 degrees C for 2-3 sec, which should destroy all salmonella in raw cream. In Sweden pasteurized cream has to be stored at a temperature not higher than 8 degrees C. The isolated salmonella strain was not able to grow at + 8 degrees or at + 10 degrees C during 17 days in pasteurized or UHT-treated cream. During this storage the viable counts were reduced by 79% at 8 degrees and 54% at 10 degrees C. Minimum growth temperature of the strain was 11-12 degrees C. The mean generation time in pasteurized cream at 12 degrees was 9.4 hours and at 15 degrees C 3.4 hours (Fig. 1 and 2). The salmonella strain was able to grow in competition with other bacteria in pasteurized cream even at low levels of infection (Table II). An exposure to a higher temperature, followed by storage at + 8 degrees C did not cause a further growth of salmonella at the low temperature (Fig 3). To avoid a recurrence, the possibility of reinfection of the cream with salmonella has to be further decreased and the cream has to be stored at a low temperature during all the storage period.


[Technetium uptake in the parotid gland. Value of functional parameters in Sjögren's syndrome]. Studies of the parotid function were performed on 22 subjects comprising 11 patients with Sjögren's syndrome and 11 normal controls using an Anger camera with digital data processing facility. After injection of 2 mCi of 99mTc-pertechnetate digital scintigrams of the face region were collected and stored onto magnetic tape. 50 minutes after injection the parotid glands were stimulated by administration of Pilocarpin. By subsequent processing of the data uptake curves were obtained for both parotid glands. In allowing for vascular activity three different methods were compared. The most satisfactory method with respect to discriminating the groups under study was using a background region located in the falx cerebri. From the corrected uptake curves a number of parameters were derived and their respective selectivity was investigated by statistical analysis. It is shown that the most suitable parameter characterizing the parotid function is given by the difference of maximum uptake before Pilocarpin stimulation and minimum uptake after stimulation.


Narcotic antagonists. Treatment tool for addiction. Narcotic antagonists have recently gained attention through research aimed at evaluating both biochemical effects and treatment potential for opiate addiction. Narcotic antagonists are a classification of drugs which block the euphoric (and all other) effects of opiates. Naltrexone is the most promising narcotic antagonist based on ability to produce blockade, length of duration, and relative absence of side effects. The narcotic antagonists offer an adjunctive or alternative method of treatment for opiate addicts based on Wikler's biobehavioral theory of conditioned abstinence. Narcotic antagonists are presently being investigated at seven research centers throughout the United States and may be available for clinical use in the future.


[Comparative tests of tetracian and of the new local anesthetic carticain in spinal anesthesiasa double placebo study]. Onset of effect, degree of effect and duration of effect of Tetracain (Pantocain) and Carticain (Ultracain) in hyperbaric solutions were compared on 60 subjects with spinal anesthesias. In the double-blind trial with individual randomization, no difference was found regarding the onset of action (latency period), the intensity of analgesia and the extent of the muscle blocking. With 151 +/- 48.9 min., the duration of analgesia with Carticain was distinctly and significantly shorter than in the case of Tetracain with 278 +/- 108.9 min., but thoroughly sufficient for the nature and duration of the surgical operations on pour patients, even in the postoperative phase.


[Contralateral comparison between diflucortolone valeriante and flumethasone pivalate in ointments. Double-blind study]. Double blind study with contralateral comparison, between diflucortolon valerianat, 0.1% and the flumetason pivalat, 0.02% in pomades (ointments). Selection of 52 patients both sexes and variable ages with bilateral dermatological inflamatory lesions and with simetric preference: Psoriasis, "eczema vario" and neurodermatitis. In psoriasis, diflucortolon offered better results: the same occurred in the cases of eczema, and in neurodermatitis. The efficacy was similar. There were no appearances of negative secondary effects because of the used doses and time.


Hypothyroidism.

Hypothyroidism. We found biochemical evidence of hypothyroidism (low T3 and T4 and elevated TSH) in azotemic patients. Hemodialysis did not correct the hypothyroidism but renal transplantation did. The hypothyroidism is probably a consequence of impaired thyroidal elaboration of thyroid hormone, as well as decreased peripheral conversion of T4 to T3. The impaired thyroidal gland function may be secondary to the increased concentration of aryl acids found in chronic renal disease.


Preformed cytotoxic antibody in patients subjected to thoracic duct drainage. 1. Patients subjected to TDD prior to transplantation had a 4-yr graft survival rate of 65% compared to a comparably HL-A-matched group in which the survival rate was 35%9 2. Patients classified as non-responders to tissue antigens have a much higher graft retention rate than responders. Responders subjected to TDD have a 1 yr graft survival rate of 62% compared to a comparably HL-A-matched group with a survival rate of 28%. 3. Individuals with a positive crossmatch or receiving second or third transplants and subjected to TDD do much better than such individuals not subjected to TDD.


Human cadaver kidney preservation using hypothermic hyperosmolar, intracellular washout solution. The utilization of a hypothermic, hyperosmolar, intracellular washout solution for human kidney preservation was shown to be successful in 18 kidneys obtained from 9 heart beating cadavers. The ischemic interval ranged from 2 hrs and 57 mins to 39 hrs and 48 mins. All 18 kidneys functioned within 3 hrs of revascularization. Acute tubular necrosis with oliguria was noted in 4 of 6 patients with ischemic intervals longer than 20 hrs but not in the 12 patients obtaining kidneys preserved for 19 hrs or less. All patients with acute tubular necrosis required hemodialysis for one to 16 days post-transplantation with eventual recovery.


The influence of protein concentration of the perfusate on weight gain and kidney transplant outcome. We have described a technique to compare parameters of perfusion using canine kidneys. Using this system, we observed that weight gain during pulsatile perfusion varied inversely with perfusate albumin concentration. The weight gain was more rapid with albumin concentration below 4.0 Gm%. Perfusion characteristics deteriorated in association with early rapid weight gain, indicating greater ischemic damage to the kidneys perfused with the low protein perfusate. Finally, the protein concentration of cryoprecipitated plasms is low enough to cause a rapid increase in kidney weight, a condition predisposing to poor function upon re-implantation of the kidney.


Prolongation of allografts in animals with a new agent: tilorone. Tilorone, a synthetic amino-alkoxyflorenone, has been demonstrated to prolong allografts in rats and dogs. Tilorone, in combination with low dose non-specific immunosuppression, appears to have an additive effect. Tilorone's mechanism of action is unclear at this time but may involve a combination of specific T lymphocyte depletion and interferon induction.


Sexual dysfunction in uremia.

Sexual dysfunction in uremia. A retrospective study of 50 chronic home hemodialysis patients and 20 transplant recipients revealed: 1) sexual dysfunction occurs with the development of renal insufficiency and does not appear to improve during chronic hemodialysis; 2) recovery may follow successful renal transplantation, but not always; 3) drug therapy appears beneficial in the treatment of uremic hypogonadism and sexual dysfunction; 4) professional couselling is of paramount importance and recommended during all phases of treatment.


Characterization of 80-million-year-old mollusk shell proteins. Fossil glycoproteins of the soluble organic matrix are present in an 80-million-year-old mollusk shell from the Late Cretaceous Period. Discrete molecular weight components, as determined by gel electrophoresis, are preserved. The fossil organic matrix was compared with the organic matrix of a living representative species of the same superfamily. A particular repeating amino acid sequence, found in contemporary mollusk shell proteins, was identified in the fossil glycoproteins. The ultrastructure, mineralogy, and chemistry of the inorganic components of the fossil and contemporary shells provide information on the state of preservation of the fossil. The use of fossil shell proteins to further our understanding of molecular evolution is discussed.


In vitro system for induction of delayed early RNA of bacteriophage T4. Concentrated lysates of Escherichia coli that had been infected with bacteriophage T4 in the presence of chloramphenicol show the same restriction of transcription in vitro as is found in vivo. Restricted lysates can be complemented with lysates from infected cells to induce production of delayed early RNA. Complementation takes place between the RNA polymerase of the restricted lysate and the DNA of the unrestricted lysate. We present evidence that delayed early RNA in these lysates is initiated at quasi-late (middle) promoters, and that such recognition is related to changes in the state of the template DNA.


Organization and energy-dependent growth of microtubules in cells. The organization and growth of microtubules in cultured mouse macrophages and fibroblasts were examined by indirect immunofluorescence microscopy with antibodies to microtubule protein. In macrophages, microtubules converged at a samll region at the cytocenter. During depolymerization, and repolymerization, this region acted as a microtubule organizing center. Microtubule growth was energy-dependent, but unaffected by dibutyryl-adenosine 3':5'-cyclic monophosphate, cholera toxin, or dibutyryl-guanosine 3':5'-cyclic monophosphate. Fibroblasts, which did not show such a simple microtubule organization as macrophages, contained mainly one or two, but occasionally as many as four, organizing centers during repolymerization. These microtubule organizing centers often appeared as fluorescent rings with a dark center.


Recombination in Saccharomyces cerevisiae: a DNA repair mutation associated with elevated mitotic gene conversion. A mutant haploid strain of Saccharomyces cerevisiae has been isolated that is sensitive to the alkylating agent methyl methanesulfonate at a concentration of 0.01% (vol/vol). The strain also shows sensitivities to x-rays and ultra-violet light, which cosegregate with sensitivity to methyl methanesulfonate as a single gene defect. An analysis of the sensitivity to ultraviolet light indicates that the mutation interferes with the excision of pyrimidine dimers. Diploids homozygous for the mutant gene exhibit elevated frequencies of spontaneous mitotic recombination at the ade6 locus. The results indicate that all the events are due to gene conversion. Mitotic recombination was also found to be elevated for three loci other than ade6. Thus, the recombinational effect seems not to be locus specific. Linkage and allelism tests indicate that the mutation is an allele of the known radiation-sensitive gene rad18. The various effects of this new rad18 allele (rad18-3) are discussed in terms of a defect in DNA repair mechanisms.


Abnormal response to minor histocompatibility antigens in Obese strain chickens. Obese strain chickens, which spontaneously develop autoimmune thyroiditis, were tested for their ability to tolerate skin allografts. Several procedures known to prolong graft survival in normal strains were employed. These included the use of skin matched at the major histocompatibility locus, grafting on the day of hatching, thymectomy, and x-irradiation. A dramatic difference between the Obese and the normal Cornell strain (the strain from which Obese was derived) was detected when both were thymectomized and grafted at hatching. Under these conditions eight of 13 normal but only one of 16 Obese strain birds retained their grafts for 50 days. This suggests the presence of an abnormal thymus or thymus-derived suppressor T cells in Obese strain chickens.


Clinical value of selective serial sectioning of laryngectomy specimens. A simple routine pathology method for examining laryngectomy specimens has been presented which (1) gives the clinician information regarding the probability of total excision of the tumour; (2) allows more accurate staging of laryngeal tumours; (3) will act as a basis for evaluation of preoperative investigations and future clinical trials of treatment.


Origins of British geriatrics.

Origins of British geriatrics. We may see from the foregoing account that British physicians have played a major part in the history of geriatric medicine. Other countries have no counterpart to J H Sheldon of Wolverhampton, whose work on the social medicine of old age was so fundamental, or George Adams of Belfast, to whom we owe such a debt of knowledge about cerebrovascular disease in the aged, or to Marjory Warren and the other pioneers mentioned above. Long may this tradition continue.


Stability of injection solutions of vitamin B1. Part 2: Influence of lipoic acid. DL-alpha-Lipoic acid at low concentrations increases the stability of thiamine hydrochloride solutions, however, at higher concentrations the degradation rate of the vitamin is enhanced. The optimum concentration of lipoic acid at which its stabilizing efficiency is maximum is shifted on the addition of 20 ppm of copper, from 0.5 to 1.0 mmole/1, indicating that this optimum concentration is dependent on heavy metal ions concentration in the solution. In the presence of copper, the degradation rate of the vitamin in solutions containing lipoic acid at concentrations higher than its optimum concentration is lower than that in corresponding solutions in the absence of added copper. On the other hand, below the optimum concentration, the degradation rate of thiamine hydrochloride solutions in the absence of copper is lower than that of the corresponding solutions to which 20 ppm copper have been added. This indicates that the presence of either free copper ions or an excess of lipoic acid is deleterious to the stability of the vitamin.


Breast reconstruction after a radical mastectomy. A method of breast reconstruction, following a radical mastectomy, used a tubed flap of the tissue usually discarded during an abdominal lipectomy. This places the donor scar in an unnoticeable position. After migration, maneuvers such as denuding portions for insertion and overlap, and using a wrist attachment, have been of benefit in supplying adequate cover for an implant and in recreating an anterior axillary fold. The areola and nipple are obtained from the opposite breast. When indicated, a subcutaneous mastectomy of the opposite breast and insertion of an implant there equalizes the breasts and comforts the patient.


The early vascularization of onlay bone grafts. On the basis of this work, several conclusions may be drawn. (1) Autogenous iliac crest onlay bone grafts in the rat vascularize as early as 3 days. (2) The presence or absence of periosteum transferred with the graft has no significant effect on the rate of vascularization. Neither was a difference noted when grafts were placed above or below the host periosteum. (3) The onlay bone grafts in this study appeared to be revascularized by vessel ingrowth. (4) Factors other than the ones controlled in this experiment may influence rate, quantity, and quality of the vascularization of bone grafts.


Bilateral reconstruction of the nipple-areola complex. We present a method for reconstructing the nipple and areola bilaterally in one stage, one which produces a corrugated, elevated nipple and a glabrous pigmented areola. A satisfactory appearance has been maintained in 4 cases during a follow-up period of up to two years.


The location of the blood supply in random flaps. The blood supply of random skin flaps in the pig is mainly in a microvascular plexus in the deeper layer of the dermis. However, there is vasculature in both the dermis and the subcutaneous fat, with good collaterals between the two systems.


Sensory skin flaps for coverage of pressure sores in paraplegic patients. A preliminary report. Sensory skin flaps represent a possible solution for the paraplegic who has the problem of recurrent pressure sores. An intercostal neurovascular island flap has been used in 3 cases to provide coverage for sacral ulcers. Sensation was retained to a variable degree in both adults and children. An attempt at coverage of an ischial ulcer with an intercostal neurovascular free flap is also reported. The practical and theoretical aspects of these procedures are discussed.


Reconstruction of eyelids and eyebrows in burned patients. The records of 283 consecutive patients treated for facial burns were reviewed. Eighteen percent of these patients had significant deformities of the eyelids or adnexal structures and underwent surgical correction. Our experience in managing these patients is presented and discussed.


Limberg flap coverage for axillary defects resulting from excision of hidradenitis suppurativa. After excision of the apocrine gland containing tissue, we advocate wound closure with a Limberg flap. Our results to date suggest that this approach, which combines definitive treatment with surgical economy, warrants an aggressive attitude toward even early cases of axillary "apocrinitis".


Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Case report. We present a successful clinical case (perhaps the first) of primary reconstruction of the breast after radical mastectomy by use of a free skin-fat-muscle flap.


Reconstruction of the oral cavity with a free flap. Free groin flaps were used successfully within the oral cavity in 4 patients after ablative operations for cancer. Preoperative or postoperative radiation (cobalt therapy) had no apparent detrimental effect on the survival of these free flaps.


The management of decubitus ulcers by muscle transposition. An 8-year review. Our 8-year experience with the management of decubitus ulcers by means of muscle transposition and skin cover is reviewed. The role of infection and its management are discussed. Some modifications of our previous techniques and newer operative approaches are detailed. Our complications and follow-up results are presented.


[Oskar Vogt, founder of the Moscow State Institute for Brain Research. History of German-Soviet scientific relations in the field of neurology]. Basing on not yet published archival documents the German neurobiologist Oskar Vogt is shown as a poineer in developing early cooperational connections in the field of neuro-sciences between Germany and Soviet-Union. On the historical background new aspects emerge for evaluating this progressive bourgois scientist, who devoted his energy to the young Soviet power.


The quarterly review of biology.

The quarterly review of biology. In recent years, the evidence suggesting that honey bees communicate with a "dance language" has been stronly attached on both theoretical and experimental grounds. An alternative theory has been proposed by which bees are supposed to use only odors to locate sources of food. A review of the evolution of the controversy isolates and analyzes the main issues. Early experiments which she fundamental problem in this important dispute has been that dancing bees advertise a food location with site-specific odoer information as well as symbolic distance and direction coordinates. A new technique has overcome this problem and demonstrated that von Frisch's dance language theory is, on the whole, correct. The apparently contradictory results of Wenner and his colleagues are shown to be due to their techniques for training bees. The dance-language controversy raises issues beyond how bees communicate. These include whether and when "evolutionary" arguments are useful, and to what extent Kuhn's scientific revolution paradign fits the dispute.


Mammals in which females are larger than males. Females are larger than males in more species of mammals than is generally supposed. A provisional list of the mammalian cases is provided. The phenomenon is not correlated with an unusually large degree of male parental investment, polyandry, greater aggressiveness in females than in males, greater development of weapons in females, female dominance, or matriarchy. The phenomenon may have evolved in a variety of ways, but it is rarely, if ever, the result of sexual selection acting upon the female sex. The most common selective pressures favoring large size in female mammals are probably those associated with the fact that a big mother is often a better mother and those resulting from more intense competintion among females for some resource than among males. It appears that, in general, more than one such pressure must affect the females of a species, and that their combined effects must not be countered by even stronger selective pressures favoring large size in males, before the result is that of larger size in the female sex. Sexual selection may often be operating upon the male sux in mammals even when it is smaller. Present knowledge about the species of mammals in which females are lager than males is quite rudimentary. Much more information is needed before we will be able to speak of the selective pressures accounting for the phenomenon with any reasomable degree of certainty. Perhaps the most fruitful approach would be a series of field studies of groups of related species in which females are larger in some species and males are larger in others.


[Identification of Candida albicans from various materials]. We examined 300 stipes of leavens coming from various material. Among these we identified 264 brances belonging to Candida king, utilizing the test for pseudomicelio production. Combininb with this test that of clamidospore production, the auxonogramma, culture media, we arrived to the classification of the species: C. Albicans 71%, C. Tropicalis 15.8%; C. Pseudotropicalis 0.6%; C. Krusei 0.3% C. Parapsilosis 0.3%. An analysis of the experiments utilized for the classification of the kind, proved that the test of germination is the most simple, rapid and safe method of ascrive the branches belonging to Candida kind to Albicans species.


[Evaluation of electronic counting of platelets using the thrombocounter C]. The electronic counting of platelets can be nowadays performed by the Thrombocounter-C, which meets the requirements of a simple and fast use and yields the directs platelet concentration of whole blood. Preliminary experiences made with Thrombocounter-C showed the considerable accuracy of the method as well as  its reproducibility which is superior to phase-contrast microscopic evaluation.


[Experimentation with a new simplified proof of the classic Rantz and Randall technic and of an automatic titrator for rapid determination of the antitreptolysin titre]. One thousand human sera have been tested for O-streptolysin antibodies, using classic Rantz and Randall technic and a simplified proof, based upon a single initial serum dilution 1 : 200 and the determination of five titers, corresponding to 250-332-500-666-1000 antistreptolysin units/ml. The semplified proof has the advantage over the classic technic, to lower down to a half, routinary work. The use of Titrator Sclavo, greatly reduces the time involved in the performance of both tests.


Modifications of gamma-ray sensitivity of bacterial membrane by pre-exposure to light. The exposure of E.coli B/r cells to ultraviolet (UV) or to visible light prior to irradiation with gamma-rays modifies the sensitivity of the cell membrane to the radiation damage responsible for the loss of intracellular K+ content. The experiments reported in the paper have shown: 1. exposure of bacterial cells to sublethal doses of UV light increases their sensitivity to gamma-ray-induced membrane damage, while exposure to visible light has the opposite effect; 2. in combined exposures, the visible light, either given before or after the UV always produces a strong photoprotective effect. In either case, the photosensitizing effect of UV is completely suppressed; 3. the photoprotection decays with time if cell suspensions are left in the dark before gamma-irradiation. At 0 degrees C, the half-life of the photoprotective effect is 25 min at pH 7 and 100 min at pH 7.5. The decay is due to the presence of oxygen; 4. the light band responsible for the induction of photoprotection has been estimated to lie in the wavelength region between 540 and 580 nm.


Microcalorimetric investigation of the metabolism of yeasts. V. Influence of ploidy on growth and metabolism. Microcalorimetric experiments on growth and maintenance metabolism of Saccharomyces strains ranging from haploid to hexaploid are described. During growth, the mean dry weight, the mean volume and the maximum heat flux of the cells are nearly linear functions of ploidy. These parameters are correlated with the cell concentration in such a manner that the weight-specific heat production and the grown biomass are independent of ploidy. For the metabolism of maintenance, two levels of the specific heat flux are found, the lower of which is occupied by the haploids, diploids and triploids. The higher polyploids exhibit the higher level.


[Combined echographic and echoscopic examination of the upper abdomen (author's transl)]. A method for examination of the upper abdomen with a combination of real-time and stored B-mode technique is described. Some pathological findings are demonstrated. The combination of the methods considers the mechanical-technical advantages of these two apparatus. The complementary use can enhance the diagnostic accuracy.


Quantification of exercise capability and evaluation of physical capacity in man. (1)Every type of exercise is in a sense a unique situation. However, all forms of muscular work do increase the metabolic rate and therefore it is of particular interest to analyse the involvement of the oxygen transport system. The oxygen uptake gives an accurate measure of the aerobic power, and it is highly related to the cardiac output. The VO2 max is under standardized conditions a highly reproducible characteristic of the individual's aerobic fitness. It is however, subject to variations under certain conditions (i.e., after prolonged inactivity, after training, as a consequence of cardiac diseases). The main factor behind such variations in VO2 max is proportional changes in the stroke volume. Therefore a recording of the heart rate during exercise at a given oxygen uptake will reflect these variations in longitudinal studies. Generally speaking, a high heart rate is usually associated with a low stroke volume. However, from this information it is not possible to tell whether this (poor) exercise response was caused by genetic factors, lack of training, impaired heart function, or other factors. (2) Data have been presented suggesting that the maximal transport of oxygen (cardiac output X oxygen content of arterial blood) is limited by the central circulation rather than by the tissues' ability to utilize the oxygen. (3) A multi-stage exercise test on a treadmill or bicycle ergometer will provide a measurement of the rate of work an individual is able to tolerate without symptoms or electro-cardiographic abnormalities...


[Sterilization by ionizing radiations (author's transl)]. The first part summarizes the general characteristics of ionizing radiations and their activity on microorganisms: lethal and mutagenic effects, sensitivity conditions. Different microbial species have different sensitivities: gram negative bacteria are more sensitive (D10 approximately 5-10 Krads), bacterial spores and viruses are more resistant (D10 approximately 1 Megarads). The second part considers the main applications of radiosterilization: some are at present in full development (medical and surgical disposable equipment); others are still at the experimental stage. Practical aspects, determination of sterilizing doses and control of radiosterilization are also described.


Effect of the thymus on erythropoietin production in response to hypobaric hypoxia in mice. Thymectomized, irradiated and syngeneic bone marrow-repopulated (TIR) mice, after hemopoietic recovery, were more effective in producing erythropoietin than normal controls in response to hypobaric hypoxia. Mice which were only thmectomized responded to hypoxia with more erythropoietin production than controls but less than TIR animals. It is suggested that lymphoid elements of thymic origin may produce inhibitors of the erythropoietic system. This may play a role in the anemia of lymphomas and certain other clinical syndromes.


Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10. Eighteen patients with periodontal disease and measurable pockets were treated on a double-blind basis with coenzyme Q10 and a maching placebo. The treatment was significant (p less than 0.01). Before decoding, all 8 patients receiving coenzyme Q10 and 7/10 patients receiving placebo were correctly assigned. Of the remaining 3 placebo patients, the status of one was borderline and could have been assigned to either group, and two improved due to better hygiene. Crevicular fluid flow as a measure of inflammation was newly monitored. Pocket-depth, periodontal health, calculus and plaque scores provided the most valuable data for evaluation.


Bioenergetics in clinical medicine. VIII. Adminstration of coenzyme Q10 to patients with essential hypertension. Coenzyme Q10 has been administered to five patients having essential hypertension and deficiencies of activity of succinate dehydrogenase-co-enzyme Q10 reductase in leucocyte preparations ranging from 20-40%. For a 74-year old male, the systolic pressure was reduced (p less than 0.001), the diastolic pressure was reduced (p less than 0.05), the specific activity of the coenzyme Q10-enzyme was increased (p less than 0.001), and the deficiency of coenzyme Q10 activity was negated (p less than 0.01). Four patients receiving CoQ10 for 3-5 months showed reductions (p less than 0.05 to p less than 0.001) of diastolic pressure, and 3 of these 4 showed reductions (p less than 0.05 to p less than 0.01) of diastolic pressure. Initial deficiencies of enzyme activity were reduced (p less than 0.01 to 0.05) in two patients. Three other patients did not show the high level of deficiency on treatment as initially observed. These effects of CoQ10 on  the reduction of systolic and diastolic blood pressures, increase in CoQ10-enzyme activity, and reduction of CoQ10-deficiency are presumably due to improved bioenergetics through correction of a deficiency of coenzyme Q10.


Successful treatment of acute respiratory distress syndrome with prolonged continuous positive-pressure ventilation. A 37 year-old man was admitted in severe acute respiratory failure after a surgical procedure. He was ventilated mechanically (FIO2 - 0.60), and had a Pa,O2 of 34 mmHg. Continuous positive-pressure ventilation was started and the Pa,O2 rose to 74 mmHg. This procedure was required for 18 days. During the period of the greater derangement of gas exchange, the venous admixture on inhalation of 40% oxygen was 80% and later 43%, whereas on inhalation of 100% oxygen it was 52% and later 35%. He was weaned from the respirator on the nineteenth day. If unevennes of ventilation--perfusion due to regional hypoventilation disappear on inhalation of 40% oxygen, a decrease of shunt on inhalation of 100% oxygen suggests impairment of diffusion.


O2 transport in the alpaca (Lama pacos) at sea level and at 3,300 m. Five male alpacas native to high altitude, of approximately 40 kg, were studied first at 3,300 m and again after a 3-month sojourn at sea level. Measurements were made with the animals standing, unsedated and breathing air. Cardiac output was measured by the dye dilution technique. Blood gas tensions and contents were measured in arterial and mixed venous blood. Blood samples were also equilibrated with different oxygen tensions to construct O2-Hb dissociation curves. The P50 was 17.8 and 19.7 torr at 3,300 m and at sea level, respectively. The higher P50 values at sea level were associated with higher values of base excess. PaO2 was lower at 3,300 m but SaO2 was always above 90%. No significant changes in [Hb], Hct, Q, CaO2 and CvO2 with changes in elevation were observed. PaCO2 tended to be lower at altitude indicating a mild hyperventilation. The values of PvO2 were lower than those reported for other mammals but similar to those of the llama. A higher PvO2 was measured in the alpacas at sea level. The alpaca under conditions of chronic hypoxia presents only minor cardiorespiratory adjustments suggesting the possibility of tissue characteristics well suited for life at high altitude.


[Progressive pseudomyopathic spinal amyotrophies (author's transl)]. Genetic, elettromyographic, enzymological and histological aspects of two cases of proximal pseudomyopathic spinal amyotrophy are described. The former is related to a typical Wohlfart-Kugelberg-Welander syndrom with characteristics of recessive autosomal heredity. It is related to a fifteen-years old patient who, since he was ten has been affected by progressively increasing muscular hypotrophy. It was localized mostly on the scapular girdle and less on the pelvic girdle, with tendency to extend to the distal muscles of the limbs, without fasciculations or sensory symptoms. Serum enzyme levels were normal. Both muscular biopsy and electromyographic tests yield reports testifying a spinal amyotrophy. The later is related to a spinal pelvic girdle amyotrophy arisen in a thirty-three-year old subject who since twenty-nine has started to present weakness and hypotrophy of pelvic girdle muscles and of the roots of the thighs particulary involving the adducent muscles. There were neither amyotrophies in other districts nor fasciculations. Serum enzyme levels were normal. Muscular biopsy clearly proved a neurogenic amyotrophy. E.M.G. showed signs of myogenic and neurogenic sufference. Problems concerning the nosographic delimitation of different spinal muscular atrophies are discussed on the ground of literature, too.


[Outcome of Parkinsonism after two years of levodopa plus R04-4602 (author's transl)]. Twenty-one patients suffering from Parkinson disease were treated with L-Dopa together with an extra-cerebral dopa-decarboxylase inhibitor (Ro4-4602) and with triesyphenidyl. Seven assessments of the patient's clinical condition were carried out over a period of two years with a number of neurological and psychometric tests. At the beginning of the second year of treatment, the signs and symptoms of Parkinson disease began to worsen with an increased disability. In the present paper two possibilities are discussed, namely whether the deterioration was the consequence of L-Dopa administration or whether this was simply the outcome of inadequacy of drug treatment during a period of natural worsening of the disease.


[The efficacy of cytostatic therapy for malignant tumors as determined by x-rays]. Cytostatic or hormone therapy for malignant tumors has made some progress during the last few years. Total or, at least, extensive recession of bronchial carcinoma, metastasizing breast tumors and lymphogranulomatosis in Stage IV as the result of chemotherapy or hormone therapy was presented which was substantiated by x-rays.


[Food protein quality. III Enzymatic ultrafiltrate digest (EUD) aminoacid index (author's transl)]. An aminoacid index for protein quality evaluation is presented, using a new model of enzymatic digestion of proteins in vitro. The EUD index is obtained determining on the ultrafiltrate the available aminoacids after digestion with pepsin, trypsin, pancretin and erepsin in an Amicon ultrafiltration cell. A very high correlation is obtained between EUD index and the biological values of 10 protein or food protein samples. The experimental validity of this in vitro method allow his utilization for direct evaluation of protein quality instead of the more complicated and time consuming biological tests.


[Alterations caused by yeasts in vegetable flavoured soft drinks: effects of the manufacturing water (author's transl)]. Possible sources of yeast pollutions of soft drinks added with vegetable flavours and the factors affecting their magnitude were examined. The greatest role is played by the minerals contained in the manufacturing water. Pasteurization is the most useful practice for their control.


[The use of gamma radiations for the radicidation of dried egg albumen (author's transl]. The authors carried out an investigation on samples of dried egg albumen of industry and on experimental samples artificially contaminated, irradiated with gamma radiations, in view of defining the D10 value and the survival curve for the enterobacteriaceae and salmonellae in eff albumen. The results were discussed in view of a practical application of irradiation doses experimentally defined to the radicidation of this product.


Anaerobic and aerobic bacteriological studies in biliary tract disease. Thirty-eight patients without biliary tract disease, 68 patients with gallbladder stones or acalculous chronic cholecystitis, 30 patients with common duct obstruction due to stones or strictures, and 28 patients with common duct obstruction due to tumors or chronic pancreatitis were investigated. Gallbladder bile or common duct bile was cultured anaerobically and aerobically. Anaerobic culture procedures were based on the use of a glove-box and prereduced, anaerobically sterilized media. Transportation of samples was based on evacuation of atmospheric air with oxygen-free carbon dioxide and transportation-time less than 30 minutes. Patients with biliary tract and patients with common duct obstruction not due to stones or strictures did not yield bacteria on culture. Twenty-two per cent of patients with disease of the gallbladder but normal common ducts and 87% of patients with common duct stones or strictures yielded bacteria on culture of the bile. Among 41 patients with infected bile, 39% yielded anaerobic bacteria, either in pure culture (12%) or in mixed culture with anaerobic bacteria (27%). B. fragilis and other non-sporing anaerobic bacteria were most frequently isolated, whereas Clostridium species were found in three patients only.


Immunohistochemical characterization of local immunoglobulin formation in Crohn's disease of the ileum. Paired direct immunofluorescence was used to localize and differentially enumerate immunocytes containing the various immunoglobulin (Ig) classes in ileal bowel walls of patients with Crohn's disease. In slightly inflamed mucosa the total number of Ig-containing cells of an average "tissue unit" increased threefold compared with normal controls, but only minor changes occurred in class ratios. In severely inflamed mucosa with persisting glands, the total immunocyte number was increased by a factor of 12.2 compared with the control unit. For IgA, IgM, and IgG cells this increase was 9.0, 12.0, and 60.9, respectively. The immunocyte ratios for these three major Ig classes were 57.5:14.7:27.7 in the inflamed mucosa, and 83.1:11.4:5.4 in the histologically normal control mucosa. When severely inflamed specimens from the ileum and from the colon were compared, there was no statistically significant difference in absolute immunocyte counts or class distributions. IgD and IgE immunocytes were extremely rare, and no consistent increase was found in the inflamed mucosae. In both the ileum and the colon fairly dense immunocyte populations with a marked IgG-cell predominance were encountered in the deeper layers of the inflamed bowel wall. The possible pathogenetic consequences of the pronounced local "over-production" of IgG in inflammatory bowel disease are discussed.


Effect of a pepsin-inhibitory pentapeptide upon the peptic activity and acidity of gastric secretion. The effect of a pepsin-inhibiting pentapeptide, pepstatin, upon the peptic activity and gastric acidity was investigated in 9 men with ulcer dyspepsia and a high acid output. Subtotal inhibition of peptic activity was obtained, basally as well as after broth stimulation, as early as 15 minutes after the method of administration, and the inhibition remained almost unchanged during the 60 minutes of the experimental period. The acidity was not affected by pepstatin. No side-effects occurred. The results confirm preliminary reports on the pepsin-inhibitory activity of the drug. It is concluded that pepstatin ought to be investigated with regard to its clinical effect upon peptic ulcer.


Antral gastrin cells. A correlation between the number of gastrin cells and the total concentration of gastrin in serum and in antral mucosa. A pilot investigation. Correlation between the gastrin cell number of delineated by immunohistological staining and the gastrin content in blood and antral mucosa has been studied in biopsies from the antral region of the human stomach. With a semiquantitative score system of the antral gastrin cells, we found correlation between the number of cells and the gastrin content in mucosa and serum and the grade of atrophic pyloric gastritis in 52 patients with different gastric diseases. It is concluded that further studies will be necessary before it is possible to estimate the total mass of gastrin cells and thereby compare different clinical groups.


[A new case of Caffey's disease].

[A new case of Caffey's disease]. With reference to a new case of Caffey's disease, or infantile cortical hyperostosis, of maxillary origin, the authors stress in particular the necessity to eliminate the possibility of Silverman's syndrome and the diagnostic problem posed by chronic tumefactions of the angle in children.


Somatostatin inhibits insulin-stimulated gastrin release and gastric secretion of acid, pepsin, and intrinsic factor (IF) in duodenal ulcer patients. The effect os somatostatin (0.6 mg/hour) on insulin-stimulated gastrin release and gastric secretion of acid, pepsin, and IF has been examined in 6 unoperated patients with duodenal ulcer. Gastrin release and gastric secretion of acid, pepsin, and IF in response to insulin alone (0.15 IU/kg bw. iv.) were significantly reduced by simultaneous administration of somatostatin. This finding indicates an inhibitory effect of somatostatin on insulin-induced gastrin release and gastrin secretion in addition to the already known effects of somatostatin.


Effects on exocrine and endocrine rat pancreas of long-term administration of CCK-PZ (cholecystokinin-pancreozymin) or synthetic octapeptide - CCK-PZ. Studies are presented dealing with the effects on exocrine and endocrine rat pancreas of repeated subcutaneous injections for 10 days of equivalent doses (Ivy dog units) of commercial (10% pure) cholecystokinin-pancreozymin (CCK-PZ) and of the synthetic C-terminal octapeptide of CCK-PZ. Both rats treated with the commercial CCK-PZ and the octapeptide had an increase wet weight of the pancreas. Pancreatic concentrations of amylase, lipase, and trypsinogen increased in a parallel fashion after both kinds of hormonal treatment. Rats given the 10-day treatment with the commercial CCK-PZ preparation displayed a lower insulin response following an intravenous glucose load. The glucose tolerance, however, was slightly improved. The octapeptide treatment induced no alterations of the insulin or glucose levels after similar glucose loads. The insulin content and the concentration of protein in pancreatic tissue or glycogen in liver and muscle tissue were unaffected by both ways of treatment. Likewise no difference was found on glucose utilization in muscle tissue in vitro. It is concluded that equipotent doses of the synthetic octapeptide and the 10% pure CCK-PZ preparation induce a similar and parallel increase of the concentration of all three exocrine pancreatic enzymes. The inhibitory effect on glucose-induced insulin release exerted by the 10-day treatment with commercial CCK-PZ but not by the octapeptide is conceivably due to peptide impurities in the commercial CCK-PZ and/or to parts of the CCK-Pz molecule other than the C-terminal octapeptide.


A mechanism of migration inhibition involving components of the coagulation system. Lymph from pigs given bacillus Calmette-Guérin (BCG) and stimulated in the drainage area of a cannulated lymph node with tuberculin (PPD) had potent in vitro macrophage migration inhibitory activity. A similar observation has previously been made in sheep by other workers. In the sheep, part of, and in the pig, almost all of, this inhibitory activity was produced, not by a factor resembling the so-called 'migration inhibitory factor', but by a mechanism involving a protease and fibrinogen. It is suggested that exudate cells, having potent coagulation-promoting activity, can promote the deposition of fibrin about themselves, and thus 'trapped' are unable to migrate.


[Hemisection, tooth separation and root amputation]. It is possible to utilize a segment of multirooted tooth as a healthy abutment even though retention of the entire tooth is impossible due to advanced periodontal disease, carious lesion or endocontic failure. The criteria for success of tooth hemisection, root separation or root amputation is dependent on the following factors: -proper case selection based upon adequate diagnostic tests -periodontal condition (amount of supporting bone) surrounding the remaining segment -condition of the remaining dentition -the ability to establish optimal occlusal relationship with minimal traumatic forces -the ability to perform satisfactory endodontic procedures, using an aseptic technique -stabilization by means of fixed prosthesis -the ability to establish an environment amenable to optimal oral hygiene.


[Biophysical study on the effect of fluorine on calcified tissues]. The effects of ingestion of fluoride on the mineral substance of animal and human bones were studied. The topographical distribution at the microscopic level, and the Ca/P ratio in areas with high and low concentration of fluoride were analyzed by means of electron probe X-ray microanalysis; the crystallographic modification of bone mineral substance was evaluated by X-ray diffraction. The distribution pattern of fluoride was found to be related to bone remodeling, and the Ca/P ratio value tends to increase as a function of the fluoride content of the bone tissue. X-ray diffraction analysis shows a shortening of the a parameter of the bone apatite unit cell as a function of the fluoride content, which indicates the incorporation of fluoride in the crystalline network.


Long-term survival of skin allografts in mice treated with fractionated total lymphoid irradiation. Treatment of recipient Balb/c mice with fractionated, high-dose total lymphoid irradiation, a procedure commonly used in the therapy of human malignant lymphomas, resulted in fivefold prolongation of the survival of C57BL/Ka skin allografts despite major histocompatibility differences between the strains (H-2d and H-2b, respectively). Infusion of 10(7) (C57BL/Ka x Balb/c)F1 bone marrow cells after total lymphoid irradiation further prolonged C57BL/Ka skin graft survival to more than 120 days. Total lymphoid irradiation may eventually prove useful in clinical organ transplantation.


Botulinum toxin: mechanism of presynaptic blockade. The mechanism of action of botulinum toxin was analyzed by the use of calcium ionophores and black widow spider venom. Addition of calcium ionophores to nerve-muscle preparations blocked by botulinum toxin did not increase the frequency of miniature end plate potentials. However, the spider venom elicited a barrage of miniature end plate potentials after blockade by botulinum. Electron micrographs of preparations treated with botulinum toxin and then the spider venom revealed clumping of synaptic vesicles at release sites in the otherwise depleted nerve terminals. These findings indicate that the action of botulinum toxin is not due to deficient storage of acetylcholine in vesicles or blockade of calcium entry into nerve terminals. They suggest that the toxin interferes with the acetylcholine release process itself, possibly by blocking exocytosis at the release sites.


Histologic structures preserved for 21,300 years. Histologic examination of rehydrated tissue samples from late Pleistocene (Alaskan) mammal mummies demonstrates that the preservative effect of freezing and drying extends to remains 15,000 to 25,000 years old. Some muscle and liver tissue retained identifiable histologic structures. Most tissues were completely disintegrated and partly replaced by masses of bacteria, an indication of considerable postmortem decay before the remains were entombed beneath the permafrost zone.


Cytochrome P-450 and drug metabolism in Trypanosoma cruzi: effects of phenobarbital. The epimastigotes of Trypanosoma cruzi hydroxylate drugs at substantial rates. The activity, which is of the mixed-function oxidase type, is increased by phenobarbital and is inhibited by CO, SKF 525-A, and metyrapone. The hydroxylation is paralleled by increases in free and membrane-bound ribosomes.


Connective tissue lysozyme in health and disease. As the lysozyme story continues to unfold, rheumatic disease is one area where the study of this fascinating protein will be most important. The special biochemical features of lysozyme--its hexosaminidase function, its ability to bring about transglycosylation, its homology to alpha-lactalbumin, and its cationic nature--suggest that the connective tissues may prove to be the key to the understanding of the function of lysozyme. As methods for its accurate measurement become standardized, better data on the activity of the enzyme in various tissues and body fluids, in both health and disease, will be forthcoming. As additional studies are done to ascertain which of the hypothetical functions attributed to lysozyme are of significance in vivo, it will be the student of the connective tissues and the diseases thereof who can be expected to profit most from an udnerstanding of the role of lysozyme in mammalian biology.


Surgical management of chronic hidradenitis suppurativa of the perineum. Two cases of chronic hidradenitis suppurativa of the perineum are presented. Both patients suffered through many years of discomfort and social isolation, undergoing multiple temporizing procedures. The treatment course pursued is described in detail. It is hoped that a greater appreciation of the disabling nature of this disease will lead to earlier, definitive therapy.


Practical aspects of assessing and preparing pulmonary cripples for surgery. The problems presented by patients with advanced pulmonary disease both during and after operation are reviewed. Proper evaluation of the degree of respiratory impairment by simple but systematic bedside and laboratory function tests and blood gas studies is essential. Preparing these patients for surgery by postural drainage, intermittent positive pressure breathing, humidification, bronchodilators, and mucokynetics will decrease postoperative morbidity and mortality.


Failure of aspirin to antagonize the antihypertensive effect of spironolactone in low-renin hypertension. Aspirin has been shown to acutely block the natriuretic effect of spironolactone in the mineralocorticoid-treated normal rat, dog, and man. It has been suggested that aspirin is contraindicated in hypertensive patients receiving spironolactone. Five patients with low-renin essential hypertension and two with hypertension due to primary aldosteronism, all of whom have normalized their blood pressure on chronic spironolactone therapy, were cotreated in a double-blind fashion with either aspirin or aspirin-placebo during alternate six-week periods. Aspirin did not appear to alter the effect of spironolactone on blood pressure, serum electrolytes, urea nitrogen, or plasma renin activity.


A comparative study to evaluate three separate computer programs for electrocardiographic interpretation. To compare the efficiency and accuracy of three separate computer programs for interpreting electrocardiograms, 50 EKGs run on patients hospitalized in our institution were transmitted to each of the three participating computer programs. The EKGs were then inspected individually by three cardiologists who later correlated and compared their results with the interpretations provided by the computer. The computer program used by Telemed Corporation provided the greatest frequency of totally correct and clinically acceptable interpretations as well as the least number of unacceptable or incorrect interpretations. The Bonner program was an acceptable second. The Mayo-Smith program had a much larger number of disagreements with the clinical cardiologists, and was far less acceptable for clinical use in their opinion.


The histopathologic diagnosis of leprosy. The objective of this paper is to encourage histopathologists to recognize and diagnose leprosy so that it can be treated effectively at the earliest stage possible, before irreversible deformities result. Recognition of the earliest form of leprosy-indeterminate-is emphasized. Histopathologic descriptions are made and illustrated for the principal types of leprosy. Emphasis is placed on (1) the need for dependable acid-fast staining of leprosy bacillus, (2) the non-specific infiltrate in indeterminate leprosy, and (3) the involvement of nerves in all types of leprosy.


The doctors who came to the Cape with the 1820 settlers. Such information as can be found in the references given is set out regarding those doctors who emigrated form Britain with the British Settlers of 1820. It is regretted that so little information is obtainable as as they lived in strenuous times and must have done good work without the aids which seem indispensable to modern medicine.


Cross-matching assays of cell-mediated immunity for transplant patients. Assays of cell-mediated immunity before transplantation were performed on 34 patients who were defined as being at high risk by the presence of preformed lymphocytotoxic antibodies and/or HL-A incompatibilities at FOUR locus. Assays for cell-mediated lympholysis type I (cml I) were performed in donor serum, and for CML II in recipient serum, to assess the possible effect of blocking factors in the patients' sera. A positive (greater than 5% specific Cr release) and in particular a greater than 10% Cr release correlated strongly with graft rejection. The correlation between CML II and graft survival was unimpressive. No clinically beneficial blocking factor was demonstrable in the patients's sera in that 5 of 6 patients with a positive CML I but a negative CML II rejected their grafts. Conversely, 6 of 8 patients with a positive CML II and a negative CML I had excellent long-term courses. The use of CML I assay in the selection of grafts for patients at high risk is recommended.


HL-A and cadaver kidney transplantation. 7-year experience at Johannesburg General Hospital. The role of HL-A matching in the clinical outcome of 159 consecutive first cadaver renal allografts at the Johannesburg General Hospital has been analysed over a 7-year period, April 1968-May 1975. Over-all actuarial graft survival was 69% at 1 year and 57% at 7 years. When all cases were considered together there was a trend towards improved graft survival with better grades of matching, but this was not statistically significant. Presensitisation had an adverse effect on graft survival. Donor-recipient combinations with no demonstrable FOUR locus mismatches provided a significantly superior graft survival rate of 82% 1-6 years after transplantation. The majority of these compatible for HL-A 7, 8 OR 12, and therefore may have been matched indirectly for lymphocyte activating determinants. Relatively inferior graft survival was observed with FOUR locus incompatibility in patients who had been presensitised, and when donor-recipient combinations had no serologically determined antigens in common, particularly in the donor "full house" situation. Despite these unfavourable immunogenetic circumstances, approximately 50% of grafts functioned well for long periods, and not infrequently clinical considerations took precedence over immunological considerations in the selection of recipients. This policy is justified by over-all results, the critical shortage of cadaver organs in relation to clinical requirements and the rare occurrence of combinations with superior HL-A matching. Specific allograft tolerance remains the goal of clinical organ transplantation.


Coagulation studies in long-term survivors after renal allograft transplantation. Screening coagulation studies were carried out on 69 long-term survivors who had received renal allografts. Fibrinogen levels were significantly raised in this group. Factor VIII activity was increased in 7 of the 11 patients studied. Six long-term survivors of renal allografts demonstrated arterial thrombotic phenomena. The onset of the thrombotic episode occurred at a relatively young age. It is considered that the hypercoagulable state may contribute to the observed increased tendency towards arterial thrombotic phenomena.


Pregnancy in renal transplant recipients. Of the 48 female patients attending the outpatient clinic of the Johannesburg General Hospital Transplant Unit between January 1971 and December 1974, 10 became pregnant. Fifteen pregnancies were recorded, 6 of which ended in abortions. Ten infants were born from the remaining 9 pregnancies and 4 (40%) died in the neonatal period. The main cause of neonatal death was prematurity. One major congenital anomaly, a diaphragmatic hernia, was found. Maternal complications were mild and easily controlled, urinary infection being the commonest. One patient showed a moderate reduction in renal function. Obstruction of labour by the transplanted kidney was not encountered, and the two Caesarean sections were performed for obstetrical reasons unrelated to the renal transplant.


Hyperlipidaemia in renal transplant patients. The prevalence, nature and possible aetiology of post-transplantation hyperlipidaemia were studied in 94 renal allograft recipients. Sixty-five per cent of the group had hypercholesterolaemia or hypertriglyceridaemia, and types IIb and IV were the commonest forms of hyperlipoproteinaemia encountered. The pathogenesis of post-transplantation hyperlipidaemia is complex. Hypertriglyceridaemia was maximal in the first year after transplantation and could be correlated with high corticosteroid dosage during this period. Thereafter hypertriglyceridaemia was less marked and was related to obesity, corbohydrate intolerance and basal insulin levels. Mean cholesterol levels were elevated throughout the post-transplantation period, varied little and could not be related to corticosteroid dosage, body weight, carbohydrate intolerance, basal insulin levels or renal dysfunction.


Angiography after renal homotransplantation. The role of angiography in the investigation of problems encountered among 181 patients who received renal transplants at the Johannesburg General Hospital is analysed. In all, 23 patients underwent arteriography or venography after transplantation for the investigation of problems such as renal dysfunction, hypertension and suspected renal vein or iliofemoral venous thrombosis.


Kaposi's sarcoma in an immunosuppressed renal allograft recipient. A 47-year-old White man developed a buccal Kaposi's sarcoma 15 months after receiving a renal allograft. Atypical clinical and histological features were noted. A previous viral infection might have played a role in the occurrence of this patient's tumour but other possibilities of tumour induction in the immunosuppressed host are discussed. Although the condition is lethal when diagnosed after renal transplantation, this case report demonstrates that prompt diagnosis and radiotherapy may result in permanent cure.


Strongyloides stercoralis hyperinfection in a renal allograft recipient. A patient who had received a renal allograft required intensive immunosuppression for a severe rejection episode. Four months after the graft he died of septicaemia and respiratory failure caused indirectly by a Strongyloides stercoralis hyperinfection. Patients from endemic areas who are to undergo a renal transplant should be screened for the parasite before receiving immunosuppressive therapy. Should this infection occur after transplantation, early diagnosis and treatment with thiabendazole is essential to prevent the high mortality rate associated with Strongyloides hyperinfection.


Factors affecting plaque formation by Candida albicans infecting the chick chorio-allantoic membrane. The numbers of plaques formed by Candida albicans in replicate inocula on the chick chorio--allantoic membrane (CAM) was not related to the size of the inocula. Washing the CAM with saline 1 h after inoculation recovered only 10% of the inoculum. After 5 h cells could not be recovered by washing. By contrast, counts on serial dilutions of homofenised eggs after inoculation showed that the organisms had retained their viability within the egg. Failure of the inoculum to recover in spite of survival of the organisms appears to be due to adhesion of the inoculum to the CAM and cohesion of the inoculum to form clumps. We suggest that clumps of a least 20 organism are needed to stimulate the CAM to proliferate and produce visible plaques. The clumping is random and this accounts for the variation in the number of plaques. The production of plaques by the CAM may depend on the clumping of a sufficient number of organisms to produce a critical concentration of extra-cellular enzymes which aid penetration of the CAM by the invading hyphae. The relevance of this to the lesions of mucocutaneous candidiasis has been considered.


Vaccine and Mycostatin in treatment of cryptococcosis of the respiratory tract. Three cases of respiratory crytococcosis are described, one diagnosed only after thoracotomy and two after cytology. All were confirmed by cultures, biological and biochemical tests. The patients are alive and well 14 years, 5 years, and 5 years after treatment with crytococcal vaccines and mycostatin. Vaccines proved very effective when given intradermally in small doses and no dangerous reactions were encountered. Cytology of the sputum appears to be a very useful tool in diagnosis of fungal infections of the respiratory tract, especially when supravital staining is used. Difficulties in diagnosis, treatment, and significance of positive sputum findings are discussed.


Atigenic similarity between Ceratocystis species and Sporothrix schenckii as observed by immunofluorescence. Antigenic properties of Sporothrix schenckiii and 2 species of Ceratocystis (C. stenoceras and C. ulmi) were compared by indirect immunofluorescent staining technique. Both species of Ceratocystis and 2 strains of S. schenckii reacted equally well with the unabsorbed antisera against 2 strains of S. schenckii, indicating that these three species share common antigen. The absorption experiments showed that only S. schencki human strain demonstrated a unique antigen. These results support the hypothesis of Ceratocystis-Sporothrix complex in the point that both species have one major common antigen.


Pulmonary embolism.

Pulmonary embolism. Pulmonary embolism is a common and often fatal postoperative complication. Dyspnea is the most common clinical manifestation in pulmonary embolism, and other signs are frequently inconsistent and often vague. The chest film and electrocardiogram may be helpful in excluding other cardiorespiratory diseases but they are frequently unreliable in establishing an objective diagnosis of pulmonary embolism. Documentation of a decreased arterial saturation provides suggestive evidence of pulmonary embolism. Lung scanning is a safe, sensitive procedure for the initial evaluation of symtoms suggestive of pulmonary embolism, and pulmonary arteriography may be necessary to confirm the diagnosis in certain patients. Anticoagulation is effective in the prevention and treatment of pulmonary embolism and proves successful in the vast majority of patients. Emboli that are not fatal gradually resolve in the pulmonary circulation. Vena caval interruption is occasionally beneficial in selected patients, especially those with septic emboli and cor pulmonale, but should only be performed when the indications are quite clear. Under certain selected circumstances pulmonary embolectomy may be indicated. Patients with massive embolism occluding more than one-half of the pulmonary arterial system and prooducing a markedly elevated pulmonary arterial pressure and severe hypoxemia may die in acute right heart failure. Intractable shock unresponsive to aggressive medical therapy in these patients represents an indication for pulmonary embolectomy. The hazards of these surgical procedures demand that a definite diagnosis of pulmonary embolism be made and a systematic approach to the diagnosis and treatment should be followed in all patients with the disorder.


In vivo evaluation of nylon suture material by the scanning electron microscope. Sixty common carotid arteries in rats were divided and anastomosed with four needles that differed in suture to needle diameter ratios. Scanning electron microscopic observations of the suture revealed endothelial bridges with associated fibrin, platelets and leukocytes arising from needle holes to adhere to the sutures within two hours of anastomosis. These earliest reported observations of suture endothelialization merit further investigation regarding the possibility of an arterial thrombosis occurring after suture.


The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication. Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.


Experience in the application of the transconjunctival route for surgical exposure in the orbital region. The transconjunctival approach for surgical exploration of the orbital region is a simple, direct and uncomplicated method. It is in accordance with the desired goals of the surgeon, which is the avoidance of a conspicuous incision. Usually, the resulting scar is barely noticeable. This special approach can be used for a variety of clinical problems. A small number of complications may arise through the use of the transconjunctival approach, but with experience, appropriate maneuvers can be learned to avoid these minor problems. The transconjunctival approach to the orbital region should be used in carefully selected patients by those physicians who are well acquainted with the surgical anatomy of the orbit.


The high incidence of persistent secondary hyperparathyroidism after renal homotransplantation. Sixty-eight patients were observed for a period of up to seven years after transplantation. Serum parathyroid hormone levels were measured in 41 patients; 17 patients had persistent hypercalcemia for a period of from one to seven years. Serum parathyroid hormone levels were elevated in seven of these 17 patients. Serum parathyroid hormone was elevated in 11 of the other 24 patients with normocalcemia. The function of the kidney was not affected either by the state of hypercalcemia or persistent hyperparathyroidism. Aseptic necrosis was significantly present in those of the hypercalcemic group. It is suggested that persistent hypercalcemia is an important precipitating, if not the main, cause of an aseptic necrotic condition of the bones.


Technique for operation upon recurrent varicose veins. At the time of a secondary operation, every effort should be made to avoid scar tissue from the previous operation. The procedure is relatively simple, if carried out through clean tissue. If an attempt is made to mobilize an incompetent saphenofemoral junction through scar tissue, the procedure can be time-consuming and exceedingly difficult because of the thick scar tissue and thin, friable recurrent varices. In the majority of secondary operations, it was found that the long saphenous vein had not been ligated flush with the femoral vein. In some patients, the long saphenous vein had been ligated properly, but the short saphenous vein or incompetent perforators had been missed. If all venous insufficiency is eliminated at its source, the surgical result should be excellent. Any postoperative residual varices can be eliminated by injections of sclerosing solution. Annual examinations are essential so that if any new varices appear, they can be obliterated by injections.


Acute respiratory failure and intravascular coagulation. The possible association between acute respiratory failure and disseminated intravascular coagulation was examined in eight patients with severe acute respiratory failure--a condition characterized by tachypnea, right to left intrapulmonary shunting of blood greater than 30 per cent of cardiac output, increased pulmonary artery pressure with low or normal pulmonary artery wedge pressure and roentgenologic interstitial pulmonary edema. Treatment consisted of mechanical ventilation with positive end expiratory pressure sufficient to minimize intrapulmonary shunting. There was no abnormality in platelet concentration fibrin split product concentration, fibrinogen concentration, prothrombin time or activated partial thromboplastin time during the period of most severe respiratory failure in any patient. However, mean platelet concentration fell to 90,000+/-9,000 per cubic millimeter, less than 0.001, and mean fibrin split product levels rose to 60+/-10 micrograms per milliliter, p less than 0.05, the fourth day after the onset of acute respiratory failure. No significant change occurred in other coagulation parameters. Disseminated intravascular coagulation developed in none of the patients nor was there any correlation between coagulation abnormalities and severity of acute respiratory failure that would suggest a cause and effect relationship.


A rationale for intraperitoneally administered antibiotic therapy. A satisfactory clinical response occurred in 96.7 per cent of 210 patients with proved bacterial peritonitis following appropriate surgical intervention and an antimicrobial regimen of 1 per cent cephalothin administered intraperitoneally, with supplementary antibiotics as indicated. Instillation of cephalothin achieves the therapeutic benefits of high intraperitoneal levels with an antibiotic of broad activity and minimum toxicity and permits flexibility in the choice of additional antimicrobial therapy. Adjuvant therapy with cephalothin did not result in peritoneal adhesions or significant abdominal pain. Clinical experience suggests that it may promote healing of anastomotic leaks. The results of this study indicate that intraperitoneally administered cephalothin is a significant factor in lowering the death rate in peritonitis.


Continuous positive airway pressure in the prophylaxis of the adult respiratory distress syndrome. After an operation upon the abdomen, certain patients have a high risk of developing acute respiratory failure or the adult respiratory distress syndrome. These patients at high risk have been mechanically ventilated during the postoperative period in an attempt to prevent the onset of respiratory insufficiency. As a method of prophylaxis, continuous positive airway pressure has the advantages of increasing the functional residual capacity with minimal effects on the cardiac output, low potential for barotrauma and simplicity of equipment. Alternate patients at risk following an operation on the upper part of the abdomen were placed on 8 centimeters of water continuous positive airway pressure for the first 24 hours postoperatively. Fifty-six controls and 56 patients receiving continuous positive airway pressure were studied. In ten controls, adult respiratory distress syndrome developed, and three died in respiratory failure. Only one of the group receiving continuous positive airway pressure met standard criteria for the diagnosis of adult respiratory distress syndrome. In addition, in 25 patients serving as controls, respiratory complications other than adult respiratory distress syndrome developed compared with the development in only 11 receiving continuous positive airway pressure9


Single layer anastomosis in the gastrointestinal tract. Anastomotic leakage, often followed by serious morbidity or death, is an important complication of resection of the intestine. If surgical technique and judgment are sound, anastomotic leakage seldom occurs. In 205 elective, single layer anastomoses of stomach to duodenum, of small intestine, of colon and of colorectum, clinically apparent leakage did not occur except in one of 52 patients after colorectal anastomosis. After resection of the intestine performed as an emergency procedure, anastomotic leakage occurred but was infrequent and could clearly be attributed to poor judgment or technique. The results are presented to support a conviction that anastomotic leakage need seldom occur if surgical technique and judgment are sound and to draw attention anew to the efficacy and safety of single layer anastomosis.


Modification of the Hill technique for repair of hiatal hernia. The major modification of this technique allows accurate placement of sutures through the median arcuate ligament and eliminates the dissection required to expose the aorta at the origin of the celiac artery. Use of a separate row of sutures to create a sling at the esophagogastric junction maintains the desired intraluminal diameter when the esophagogastric junction is secured to the median arcuate ligament.


Some fundamental applications of the Law of La Place in Neurosurgery. The Law of La Place is a simple principle of physics, applicable to any fluid-filled vessel, relating stress on the wall of the vessel to the radius and transmural pressure. This principle has major implications for neurosurgery and examples are provided relating La Place's Principle to the genesis and treatment of hydrocephalus, the surgical clipping of cerebral aneurysms and the technic of surgical sponge hemostatis.


Anterior anastomosis of the rectosigmoid colon: an experimental study. Leakage in anastomoses below the peritoneal reflection after resection of the upper rectum and lower sigmoid colon has been studied in an experimental model in the dog. With blood alone or with blood and E. coli in the pelvis about the anastomosis, there was no significant increase in the frequency of leakage. With dead space about the anastomosis created by removal of pelvic fat and anterior tacking of the prostate and urinary bladder to the abdominal wall to simulate the human subject with a wide removal of intestine, mesentery, and pelvic fat for carcinoma, there was a high incidence of leakage. When the dead space about the anastomosis was filled with a pedicle graft of viable omentum, there was a significant decrease in the incidence of leakage. In this model dead space about the low anastomosis limiting contact with viable tissue that could adhere to, seal off, and finally revascularize the endangered intestine seemed to be a major cause of leakage. A pedicle graft of viable omentum that filled the dead space reduced the chance of leakage.


Computer-based consultation in "care" of the critically ill patient. Despite far-reaching progress in all areas of surgery, methods of medical data analysis and communication have not kept pace with the increased rate of data acquisition. The needs to organize and communicate these data and to provide a medium for continuing education are great in critical-care areas where the amount and the diversity of data collected are enormous, and the number of surgical team members involved in patient care has grown proportionately. The computer-based Clinical Assessment, Research, and Education System (CARE) is a time-shared computer system now available on a national basis designed to provide a management and education aid for the treatment of critically ill surgical patients. An initial clinical assessment and operative note are entered by the surgeon from which an estimation of the initial fluid, blood, and electrolyte deficits are calculated. Daily doctor's progress notes, shift nurses' summaries of vital signs, clinical information, intake and output data, and drug administration, biochemical, cardiovascular, blood gas, and respiratory information are entered for each shift. From these, a metabolic balance is calculated; fluid, electrolyte, and caloric requirements are determined; cardiorespiratory parameters are computed; and various therapuetic suggestions and cautions are given to alert the physician to problems that may be arising. The surgeon-user is assisted in making the best critical-care decisions through computer-directed, interactive prompting which focuses on the most important clinical conditions and correlations and metabolic considerations and relates the important problem to the relevant literature.


Visually evoked potentials: theory, techniques and clinical applications. The visually evoked potential (VEP), the recording of which has recently been made possible by the development of computer averaging techniques, is a gross electrical signal generated by the occipital region of the cortex in response to visual stimulation. It is more specific than the electroencephalogram (EEG) and more sensitive to changes in the visual stimulus; thus, it can provide ophthalmologists and vision researchers with information about the human visual system that is unavailable by other methods. Clinically, the VEP is of special value in the areas of refraction, infant acuity, diseases of the optic nerve, color blindness, amblyopia and field defects. Theory, techniques and instrumentation are described, and applications of the VEP to clinical situations and to vision research are discussed.