[Prophylaxis of thromboembolic complications in gynecological surgery (author's transl)]. Eight prospective, controlled, randomised studies on the incidence of postoperative thrombosis in gynaecological patients receiving various drugs for prevention of thromboembolism are analysed. In all patients diagnosis had been established by objective means. The rate of thrombosis in patients without drug prophylaxis has been found to vary between 14 and 29%. Infusions of dextran as well as administration of low-dose subcutaneous heparin significantly reduce the incidence of deep vein thrombosis, even as compared to postoperative oral anticoagulation with cumarins. No difference has been found between dextran and oral anticoagulants, when cumarin adminstration was started before operation, nor between dextran and heparin. Aescin did not show any prophylactic effect. High age, severe leg-vein varicosis as well as surgery for malignant disease increase the risk of thrombosis. No significant influence of overweight, previous deep venous thrombosis, epidural anaesthesia or vaginal operation as compared to abdominal approach could be demonstrated. There are no properly controlled, prospective, randomised studies on the incidence of postoperative fatal pulmonary embolism as influenced by drugs in gynaecological surgery.


[Clinical experience with fetoscopy (author's transl)]. A fetoscope with a trocar of an external diameter of 3.9 and internal diameter of 2.9 mm was used. The optical equipment of the fetoscope had lenses with external diameters of 2.2 and 2.7 mm. The fetoscope can be inserted into the uterine cavity through the abdominal wall with local anaesthesia and insertion controlled by ultrasound. This type of insertion is uncomplicated and relatively free of risks. Thus an essential prerequisite for a successful fetoscopy is fulfilled. For the success of the fetoscopy, it is important to know what the diagnostic value of the procedure is and what can be seen through the fetoscope. The direct intrauterine visualization of the fetus or parts of the fetus is with the fetoscope under evaluation possible and was successful in 23 of 26 fetuses. The field of visualization is limited to 50 degrees by the optical system and only small parts of the fetus can be seen at a time. The extent of visualization of the fetus depends besides the optical system, on the quality of the amniotic fluid and the optimal timing of the fetoscopy in the second trimester between 15 and 18 weeks. Success is also dependant on the endoscopic experience and the technical training of the observer. After 13 of 26 fetoscopies the improvement was approximately 70%. Inspection of some parts of the fetus, for intance, the face is successful in every detail but still more or less fortuitous. Fetoscopy can only be deemed to be successful when a more or less total visualization of the fetus has heen accomplished. This was the case in 39% of the cases. Fetoscopy was used for diagnostic purpose in one case with the term delivery of a healthy infant. Fetal blood sampling by puncture of placental vessels under visualization is in its infancy. Fetoscopy is a justified procedure at this time in cases with a high genetic risk and for the avoidance of an abruptio.


[Results of the treatment of lower urinary tract fistulas and stenoses in gynaecology and obstetrics (author's transl)]. The results of the treatment of 40 vesico-vaginal fistulas, 13 uretero-vesical fistulas, 2 ureto-uterine fistulas are 44 lower ureteral stenosis are reported. These developed following operative and radio-therapeutic treatment in gynaecology and obstetrics. The vesico-vaginal fistulas were operated through the vagine according to Fueth-Mayo. Even after failed primary operation a repeat vaginal operation was successful. In uretero-vesical fistulas a spontaneous healing cannot be expected later than 8 weeks after the primary operation and an operation for the fistula is then indicated. The results of 13 operations for uretero-vesical fistulas are described. In 12 cases a uretero-cystoneostomy was performed and in one case Boari plastic was done. Two ureto-uterine fistulas were treated by end to end anastomosis of the ureters which was successful. The treatment of post-operative stenosis of the ureter was primarily conservative and resulted in marked improvement on 18 of 24 cases. In 5 of 6 cases a ureto-cystonestomy or ureterolysis yielded good results.


[The problem of economic and population development (author's transl)]. The question is raised whether the apparent complexity and differentiation excludes chance. Generally a chance occurrence is without prior determination. The laws established by economics and demography with mathematical methods are therefore not capable to determine all facts because of their hypothetical arrangement. Reality can only be expressed in a categorical judgment. It is possible to arrive from hypothetical judgments--when there is A so there is B to an existence of a categorical B. Any theory of economic balance and any calculation in a demographic model to arrive at a balanced population development are methods which correlate facts with facts and allow conclusions when the correlation is actually existent. However, no conclusion as to the idea of determination of the generative behavior by economic production can be arrived at. Revorsely the conclusion that sociologie developments and generative behavior are completely independant of economic production is not possible. Hypothetical type of thinking in a model does not exclude chance and each fact has an element of chance in it. This appears to be a heuristic circle. Noncircular conclusions for the practice of life in order to advise, decide and act, do not exist without assumptions and without value judgments. In order to influence the development of the population continued scientific reflection, observation and argumentation is necessary. Correct technical functioning is translated into social realms. New reflections and interpretations are constantly required.


Radiographic evidence for acceleration of skeletal growth in adult hamsters by exercise. Voluntary exercise permanently elevates body weight in adult hamsters (Borer, K.T. Physiol. Behav. 12:589, 1974). Possible effects of such exercise on skeletal growth were examined in female hamsters in the asymptotic phase of growth, 14 of which had a 34-day access to horizontal disc exercisers, while 14 others remained sedentary. Skeletal measurements were taken from radiographs obtained at the start and at the end of exercise and on day 29 of retirement. Exercise was associated with more pronounced growth of axial than appendicular skeleton. Vertebral column, skull, humerous and femur of excercising hamsters grew 5.61 +/- 0.75 (p less than .001), 1.26 +/- 0.49 (p less than .05), 1.96 +/- 0.81 (p less than .02) and 2.80+/-1.34 (p less than .05) percent more, respectively, than the corresponding bones of sedentary hamsters. Appendicular skeleton continued to grow during retirement. Humerus and femur grew 1.96+/-0.65 (p less than .02) and 1.67+/-0.59 (p less than .02)% more, respectively, during retirement in exercised than in sedentary hamsters. Significantly greater weight gain was seen in active than in sedentary hamsters during both exercise (25.62 + 2.68%, p less than .001) and retirement (6.43 + 2.23, p less than .02). These data indicate that disc exercise accelerates skeletal and ponderal growth in adult hamsters and that axial and appendicular skeleton respond to this stimulus differently.


Regulatory phenomena and the data of growth. The specific growth rate of a population of cells is proposed to be a kinetic expression of the regulatory responses prevalent in the population. The proposal is justified by generalizing from the dependence of the specific growth rate of cells on the concentration of a nutrient to the regulatory response of the cells to the nutrient or to any other substance which can modify the rate of growth of the population. A previously unrecognized pattern of regulation of growth is demonstrated for the chick embryo by use of a novel method of obtaining specific growth rates. The method for specific growth rates is based on derivatives of orthogonal polynomials, and does not require that the data fit a preconceived equation of growth.


A comparison of gain and carcass characteristics of straightbred and crossbred steers. Post-weaning growth and carcass characteristics of 318 straightbred (139 Angus and 179 Hereford) and 77 crossbred steers (beef X beef, dairy X beef, and 3-way crosses) were compared under three different feeding regimes. Feeding the steers with a high concentrate ration increased the rate of gain and produced carcasses with higher dressing percentages, more fat but less high-priced cuts as compared to rations lower in the amount of concentrate. Crossbred steers were heavier at weaning, gained more in feedlot, and produced heavier carcasses with less fat but larger loin-eye areas and higher proportions of high-priced cuts. When compared to straightbred steers, beef X beef, dairy X beef, and 3-way crosses were significantly heavier at weaning and produced heavier carcasses with larger loin-eye area, less amount of fat and higher proportions of predicted retail yield. However, differences among the three crossbred groups for weaning weight, carcass weight, dressing percentage, fat thickness, and retail yield were not statistically significant.


Age and sex related changes of hematologic parameters in Sinclair(S-1) miniature swine. Venous blood samples were collected monthly from 60 male and 60 female Sinclair(S-1) miniature swine from 1 through 36 months of age. Hematologic parameters evaluated included: erythrocyte count, packed cell volume, hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, leukocyte count and differential leukocyte counts. Mean erythrocyte count increased from 3 through 9 months of age and declined thereafter. Mean packed cell volume and hemoglobin concentration decreased from 1 to 3 months of age, increased from 3 through 10 months of age and remained stable thereafter. From 7 through 36 months of age, females had greater mean packed cell volume and hemoglobin concentration than did males. Mean corpuscular volume and mean corpuscular hemoglobin increased linearly from 3 through 24 months of age and remained stable thereafter with females having greater mean corpuscular volumes and mean corpuscular hemoglobins than did males. Mean corpuscular hemoglobin concentration increased linearly from 1 through 30 months of age. Mean leukocyte count decreased from 1 through 9 months of age and remained stable thereafter. From 10 through 36 months of age, mean leukocyte count was greater for males than for females. From 6 through 24 months of age, mean per cent lymphocytes was greater for females than for males; whereas, mean per cent neutrophils was greater for males than for females.


Evaluation of body composition of young obese and lean Zucker rats. The growth and development of total body water, fat, ash and protein were examined in lean and obese Zucker rats (fa/fa) from 13 to 31 days of age. The obese rats began depositing significantly more fat compared to the lean controls by day 13. At this time the obese had 3.8% more carcass fat than the lean, with this difference increasing to almost 13% by day 31. Per cent ash and protein were significantly lower in the obese rats throughout the 18 day experimental study. However, when the absolute grams of these two parameters were expressed on a fat-free weight basis, no differences were recorded between the genotypes. There were also no differences when the slopes of the linear log-log growth equations for fat-free weight versus ash and protein were compared. These data do not lend support to the contentions that skeletal stunting and decreased protein deposition are present early in the development of the obese rat. A technique to identify obese rats at an early age without the necessity of killing them, by determining total body water with injected tritiated water was also examined. The method correctly identified obese and lean rats at 2 weeks of age. Further refinement of this technique is necessary before it may be used to precisely predict the genotype of a rat.


The role of factor XI in the coagulant activity of platelets. Washed platelets were ruptured by freezing and thawing; a coagulant activity was released which would correct the clotting time of factor XI (FXI)-deficient plasma only in the presence of kaolin. Platelets from a FXI-deficient patient treated in a similar fashion also released a coagulant activity which could be absorbed onto Sepharose-heparin and eluted similarly to plasma FXI. Collagen was employed to induce a coagulant activity in platelet-poor plasma (PPP) and platelet-rich plasma (PRP) in the presence and absence of antibodies developed to purified FXI and FXII. The presence of FXII antibody had little effect on the activity induced in PRP. However, the presence of FXI antibody eliminated the difference between PPP and PRP. An activity was induced when FXI-deficient PRP was incubated with collagen and none with PPP. One type of collagen failed to induce a coagulant activity.


Platelet activation in haemostasis: role of thrombin and other clotting factors in platelet-collagen interaction. The mechanism of activation of platelets by collagen was examined. Hirudin interfered with the initial collagen-platelet interaction and both hirudin and heparin inhibited collagen-induced release of platelet granular contents. Hirudin completely inhibited the release of both [3H]5HT and beta-glucuronidase whereas heparin completely inhibited release of beta-glucuronidase but only partly inhibited release of [3H] 5HT. beta-Glucuronidase and maximal [3H] 5HT were only released when plasma was present. The results are compatible with an essential intermediary role for thrombin in collagen activation of platelets. Evidence was also obtained that von Willebrand factor may participate in this reaction.


[A new catheter system for percutaneous transluminal angioplasty (PTA) of carotid artery stenoses]. A new catheter system for the dilatation treatment of carotid artery stenoses was developed consisting of a dilatation catheter with a second lumen for simultaneous carotid artery perfusion. This catheter system was efficient in dilating experimental carotid artery stenoses in dogs.


[Dura transplantation. Multi-sequential transplants of solvent dehydrated dura mater. Animal experiment studies on the question of sensitization]. After the excision of 7 X 5 mm abdominal muscle sections in an experiment using rats, a total of 4 xenogenic, solvent dehydrated dura mater of the same size were implanted at 4 week intervals each. The transplant areas were continuously examined under a light and electron microscope for a period ranging from 7 days up to 3 months after the last transplant. Spontaneous layers of absorbent granulation tissue, rich in cells and blood vessels, surrounded the grafts in the beginning. Subsequently the grafts were gradually decomposed from the periphery to the center through macrophages like biological foreign matter and replaced with endogenous, poorly vascularized, collagenous connective tissue. The tissue reaction to the multi-sequential, xenogenic grafts was consistently the same as after single transplants. Immuno-competent cells do not increase. The solvent preserved dura mater is suited for multisequential transplants due to lacking sensitization, i.e. immunological rejection reaction.


[Pancreatic colon stenoses].

[Pancreatic colon stenoses]. Benign colonic stenosis may be caused by pancreatitis. Colonic obstruction arising during the acute stage of pancreatitis is mostly found to be reversible. Persistant colonic stenosis after acute or relapsing pancreatitis may point to an adjacent abscess. Two patients with pancreatitic colonic stenosis illustrate those different courses of the disease.


[Treatment of burns].

[Treatment of burns]. Because of the unsatisfactory results hitherto achieved in the bactericidal and bacteriostatic local therapy of burns, Betaisodona ointment was tested and, in view of its good effect, put to further therapeutic use. The advantages of the preparation, apart from the good local tolerance and absence of effect on metabolism, are the good bactericidal and tanning effects on the wound eschar. In no case were smearing coats observed; the necrotic skin remained dry and firm. Except in two patients with second degree burns, epithelization was not influenced by clinically visible infection. In third degree burns accumulation of exudate in the zone of demarcation was only observed in two cases. Bacteriological examinations of the wound surface revealed sterility in several cases; in the other patients the bacterial count did not exceed 10(5)/cm2. In view of the comparative tests, this result must be considered very positive. The above trial has, however, not made use of all testing possibilities. In further studies an iodine absorption test for determining the penetration depth as well as a bacterial count in the tissue will be developed. Furthermore the use of Betaisodona solution for instillation in the zone of demarcation will be examined.


[Psychological and physical reactions following cosmetic breast surgery]. Women with only minor anatomical deviations may request plastic surgery in an attempt to compensate a feeling of inadequacy or humiliation. Psychological evaluation may be warranted to preclude a number of possible sequels: feeling of cold, shivering and shaking, lasting for days, with or without conjunctivitis and rhinitis vasomotorica; hypochondriacal and paranoid tendencies, mistrustfulness and misunderstandings in regard to the doctor. The doctor's assent to the operation and performing of the operation may increase the feeling of humiliation instead of alleviating it.


The Wyatt standards: an administrative viewpoint. The author, the fifth superintendent of Alabama's Bryce Hospital since the Wyatt v. Stickney order was issued in 1972, discusses the major problems faced by an administrator in complying with the court-set standards. They relate to qualified mental health professionals, staffing ratios, staff attitudes, individualized treatment plans, and the hospital's negative image. He also discusses the role of the human rights committee and the hospital's goal of providing treatment of sufficient quality that the court order will be lifted.


The treatment program at Searcy Hospital before and after Wyatt. Long before the Wyatt litigation began, staff at Searcy Hospital were aware of and concerned about changes that needed to be made in order to improve the quality of care at the institution; adequate funding was not available to make the changes. However, the staff did initiate some change. They moved into the same buildings with patients to increase contact and used a team approach to treatment. They organized discharge planning teams and tried to interest families in caring for patients at home. During an 11-month period before the Wyatt litigation began, the patient census decreased by about 21%. It was the Wyatt litigation that provided the legal impetus for the implementation of changes that resulted in enhanced treatment programs, a decrease in patient population, and an increase in staff.


Factors in the utilization of mental health centers and state hospitals. Several studies have found a relationship between the distance that must be traveled to receive a mental health service and the rate of utilization of the service. In the study of admission rates to mental health centers and state hospitals reported here, the author examined the relationship of admission rates to distance and to three other factors: urban-rural differences, the complexity of the community referral network, and the availability of outpatient services. The study showed that rates of admission to the centers tended to be higher as the counties became more urban, but that use of center services was not related to distance. However, a strong relationship was found between distance and rates of admission to the state hospitals.


Bf polymorphism: another variant (S0.8). A "new" variant band in the Bf system has been found in the serum of three individuals belonging to a tribe of Brazilian Indians (Karaja--Bananal--Goias) and in the serum of a Caucasian individual from the area of Strasbourg. It is highly probable that the band represents another allele at the Bf locus BfS0.8.


Translocation D/D involving two homologous chromosomes of the pair 15. A translocation between two homologues of chromosomes 15 was identified in a phenotypically normal female with the R-banding technique. The C-banding technique demonstrated an abnormally large band on the translocation chromosome. This finding suggests a possibility that the translocation might be due to breaks in the short arms or to fusion at telomeric ends. The patient had four spontaneous abortions and no normal pregnancy.


Partial trisomy of the long arm of human chromosome 1 as demostrated by in situ hybridization with 5S ribosomal RNA. In a newborn boy with multiple malformations, a tandem duplication was detected at the distal end of the long arm of one human chromosome 1. The Giemsa bands, 1q31 to 1q43--44, were repeated serially. Since 5S rRNA genes are located at 1q42--43, in situ hybridization of 125I 5S rRNA with fixed chromosome preparations was used to confirm the chromosomal duplication. The infant exhibited numerous developmental and clinical abnormalities as might be expected with an abnormality of chromosome structure relating to a ribosome component.


On consanguineous marriages and the genetic load. It has been reported that studies of the genetic consequences of inbreeding should adopt a different strategy in populations having a relatively old inbreeding history and where inbreeding levels have varied over time. This contention is tested with a series of 39,495 single-birth records from Bombay, India, collected in a World Health Organization survey on congenital malformations. Our analysis reveals that: 1. the incidence of major malformations is significantly higher among the inbred offspring (1.34%) as compared to that among non-inbred ones (0,81%)--a finding at variance with a previous study in the same area; 2. the inbreeding effect on perinatal mortality (stillbirths and mortality during the first few days of life) is also found to be significant. In view of the above findings, the genetic load as disclosed by inbreeding is computed for perinatal mortality, major malformations and pooling these together. A + B, the measure of the number of lethal equivalents per gamete, is found to be at variance with other reports. Such variability can be ascribed to non-genetic factors. Supporting evidence collected from Brazil and Malaysia in the same survey is also presented.


Elevated sister chromatid exchange rate in lymphocytes of subjects treated with arsenic. An elevated sister chromatid exchange (SCE) rate was found in the lymphocytes of six patients treated with arsenic. All had stigmata of arsenic use as well as biopsy-proven skin cancers. The arsenic exposed patients had a mean of 14.00 SCE/mitosis while 44 normal controls had a mean of 5.8 SCE/mitosis. Chromosome breakage analysis revealed no difference between the two groups. SCE rate has been shown to be elevated in a variety of systems where cell cultures or experimental animals were exposed to known mutagens and carcinogens. We suggest that the relationship carcinogen exposure-elevated SCE rate-cancer may also be valid in humans treated with arsenic.


Genetic studies of the Macushi and Wapishana Indians. I. Rare genetic variants and a "private polymorphism' of esterase A. Blood samples from 509 Macushi and 623 Wapishana Amerindians of of Northern Brazil and Southern Guyana have been analyzed with reference to the occurrence of rare variants and genetic polymorphisms of the following 25 systems: (i) Erythrocyte enzymes: acid phosphatase-1, adenosine deaminase, adenylate kinase-k, carbonic anhydrase-1, carbonic anhydrase-2, esterase A1,2,3, esterase D, galactose-1-phosphate uridyltransferase, isocitrate dehydrogenase, lactate dehydrogenase, malate dehydrogenase, nucleoside phosphorylase, peptidase A, peptidase B, phosphoglucomutase 1, phosphoglucomutase 2, phosphogluconate dehydrogenase, phosphohexoseisomerase, triosephosphate isomerase and (ii) Serum proteins: albumin, ceruloplasmin, haptoglobin, hemoglobin A2 and transferrin. Fifteen different rare variants were detected, involving 11 of these systems. In addition, a previously undescribed variant of ESA 1,2,3 which achieves polymorphic proportions in both these tribes is described. Excluding this variant, the frequency of rare variants is 1.1/1000 in 12510 determinations in the Macushi and 4.7/1000 in 15396 determinations in the Wapishana. The ESA 1,2,3 polymorphism was not observed in 382 Makiritare, 232 Yanomama, 146 Piaroa, 404 Cayapo, 190 Kraho and 112 Moro. Irregularities in the intratribal distribution of this polymorphism in the Macushi and Wapishana render a decision as to the tribe of origin impossible at present. Gene frequencies are also given for previously described polymorphisms of 5 systems: haptoglobin, phosphoglucomutase 1, erythrocyte acid phosphatase, esterase D, and galactose-1-phosphate-uridyl-transferase.


Pachytene mapping of the C9 and acrocentric bivalents in the human oocyte. Provisional maps are presented for all acrocentric bivalents and bivalent 9, according to their chromomere patterns at pachytene in the human oocyte. Each G band is subdivided into several sub-bands whose numbers varies according to the degree of chromosomal compacting. Chromomere number and sequence are in basic agreement with those observed in late prophase mitotic chromosomes. Thus, metaphase G bands of mitotic chromosomes result from progressive compressing together of smaller chromomeres whose individuality disappears as chromosomal condensation increases with progression of prophase.


[Regional localization of the genes for human IDHs, MDHs PGK, alphaGAL, G6PD by interspecific hybridization (author's transl)]. 22 independent man-hamster (HGPRT-) hybrids using male human cells with balanced reciprocal translocation t(X;2)(p22;q32) were analysed for human genes localized on chromosome 2 (IDHs, MDHs), on chromosome X (PGK, alphaGAL, G6PD) and for the different chromosomes in relation with the balanced reciprocal translocation (chr.2, chr.2q-, chr.Xp+). The following results were obtained: The chromosomes 2 and 2q- are absent in the 22 hybrids. In 9 hybrids, the absence of MDHs in spite of the presence of the chromosome Xp+ indicates that the gene for MDHs is not localized on this chromosome (or that the gene for MDHs is not on the segment 2q32--2qter translocated on X). In 14hybrids, the three markers of X (PGK, alphaGAL, G6PD) and IDHs are expressed in the presence of the chromosome Xp+. This result indicates that  the genes for these markers are on Xp+ or that the genes PGK, alphaGAL, G6PD are on X without the Xp22--Xter segment, translocated on the chr.2, and that the gene for IDHs is on the 2q32--2qter segment translocated on X. In 8 hybrids, in the absence of the intack chromosome Xp+, the higher percentage of the presence of G6PD (7 hybrids) and the lower percentage of the presence of IDHs (3 hybrids) are explained by the fact that these hybrids selected in HAT medium had to retain a segment of Xp+ bearing the human gene HGPRT. G6PD appeared very close to HGPRT and IDHs very distant from HGPRT. The study of the different correlations between the presence and the absence of these four markers on Xp+ in the different hybrids indicates the following order on the chromosome Xp+ from p to q: IDHs -- PGK --alphaGAL -- G6PD.


Erythrocyte superoxide dismutase in different racial groups in Malaysia. A variant in a Filipino. A rare electrophoretic variant of superoxide dismutase (SOD) was found in one Filipino of 146 Filipinos, 1382 Malaysians and 816 Indonesians examined. The variant consists of two usual bands and two slower migrating bands similar to those reported earlier. Superoxide dismutase variants are common among people of certain localized regions in Europe, however, this is the first report of such a variant occurring in people of non-European origin.


The 11q-- syndrome: another case report. The clinical findings and developmental progress of a female infant with karyotype 46,XX,del(11)(q23) are described. Comparison is made with five other reported cases, and the suggestion of a new syndrome del 11q--is supported.


Autosomal recessive microcephaly associated with chorioretinopathy. Two sisters and their brother affected with microcephaly, microphthalmia, chorioretinal degeneration, and optic atrophy were studied. Besides the clinical features derived from the main abnormalities, nanosomy and cutis marmorata were found in the three patients. Both parents and three other sibs were normal. Possible intrauterine non-genetic etiologic factors (X-rays, toxoplasmosis, cytomegalovirus) which can lead to phenocopies were investigated with negative results. Based on these and previous observations, it seems clear that a distinct form of autosomal recessive microcephaly associated with chorioretinal degeneration can be separated from the heterogenous group of entities which presents microcephaly.


[Ways of microbial contamination in hospital and their importance for hospital infection (authors transl)]. Transmission of micro-organisms in hospitals may occur by the air as well as by direct or indirect contact with infected patients and through germ reservoirs where an additional multiplication of germs takes place. Depending on the kind of infections of the respiratory system, germs are mainly transmitted by the air. Sources of germs are, besides people, mainly medicotechnical equipment, as for instance cold atomisation devices for inhalation. In case of wound infections, smear infections do have the greatest share, however, there are also transmissions by air. Urinary tract infections mainly follow contact infections. The same is true for infections via catheters and similar devices or for infections of the gastrointestinal tract.


[Ways to an efficient and practicable hospital hygiene from the point of view of a hospital hygienist (author's transl)]. Hospitalepidemiology means surveillance, prevention andocntrol of nosocomial infections. Trying to succeed he has to search for possiblities which are both practical as well as efficient: 1. The infection control nurse (one for 300 beds), 2. a bacteriological labor is for the epidemiologist, which is able to perform routine control on certain areas in the hospital (kitchen, sterilisation etc.), 3. encironmental examinations if necessary to find sources and for teaching purposes, 4. training of hospital personal in prevention, recognizing nosocomial infections, performing methods of desinfections etc., 5. trying to cooperate with the clinician in chemotherapy (selection of antibiotics, prophylaxis etc.), 6. to develop a programm to collect datas about nosocomial infections by a computer and to analyse those datas afterwards, 7. collaborativ work in a infection control commitee.


[Hygienic risks associated with sanitary installations and medical equipment in hospitals (author's transl)]. The risk of transmission of nosocomial infections associated with technical installations in hospitals probably is not very important. The way of infection (e.g. airborne particles, droplets, fluids, fomites, contact with persons) must be considered and an estimation as to their importance should be tried. Transport systems and air-conditioning plants are discussed as possible transmitters of infectious particles by air and UV-radiation and air-locks in their role as preventive measures. Fluides which can allow a microbial growth are part of many sanitary installations and medical equipment. They may cause transmissions of great numbers of pathogenes to susceptible patients. In this context, ultrasonic inhalators, irrigators, dialysis equipment and faucet aerators are discussed. Concerning transmission by contact, bed-pan washers, endoscopes and anaesthetic tools are mentioned and finally the role of industrial procedures, the extent and function of which can't be supervised by the medical personn,el, must be submitted to adequate microbiological controls. Physicians should pronounce more clearly then before their interest in equipment which can easily be sterilized.


Seat belts: a study of their use by the victims of road traffic accidents. This paper reports a study of 266 patients who were admitted to an Accident Service after being involved in road traffic accidents during the four-month period from February to May in 1976. There were 216 front-seat occupants, of whom 21 per cent were wearing seat belts: 156 patients were treated as outpatients and 105 patients were admitted to the wards. Five patients were dead on arrival, none of whom had been wearing a seat belt. There was a significant reduction in the likelihood of being admitted as an impatient (P less than 0.05) if a seat belt was used. There was an 11 per cent increase in the use of seat belts compared with a similar study carried out in 1971 and random roadside surveys also showed a 10 per cent increase. The implications of these findings are discussed.


The role of free fatty acids in pulmonary fat embolism. Pulmonary embolism was produced in rabbits by the intravenous injection of 0-5 ml/kg body-weight of glycerol trioleate and mineral oil. Lung weight, pulmonary total lipid, esterified and free fatty acids content increased in both groups, but the concentration of free fatty acids increased only in the animals injected with neutral fat. Mineral oil injection produced stasis and haemorrhage; neutral fat produced exudation of serous liquid into the alveoli and an inflammatory reaction. There are definite differences between the pulmonary effects of mineral oil embolism and neutral fat embolism. The observations support the assumption that pulmonary changes in fat embolism are due to the toxic effect of free fatty acids liberated from the embolized neutral fat.


A conservative approach to traumatic intrarenal arteriovenous fistulae: experience with 13 cases. Thirteen patients with traumatic intrarenal arteriovenous fistulae due to blunt, penetrating and iatrogenic injury are reported. The major clinical feature in this series was renal haemorrhage. Conservative treatment resulted in spontaneous closure of the fistula and cessation of bleeding in 6 patients. Nephrectomy was performed in 3 patients for refractory haemorrhage, but a conservative operation would have been preferable. Renal segmental artery ligation was effective in controlling renal haemorrhage and promoting closure of the fistula in 4 patients. No adverse sequelae occurred following segmental artery ligation. The initial management of traumatic intrarenal arteriovenous fistulae should be conservative. Segmental artery ligation is recommended for the relief of persistent pain and control of renal haemorrhage.


Traumatic lesions of the duodenum.

Traumatic lesions of the duodenum. Injuries of the duodenum are relatively uncommon on account of the organ's size and position. Since most of it is retroperitoneal, lesions involving it give rise to such subtle physical and radiological signs that the diagnosis is often overlooked in the early phase after injury. Twenty-six cases of duodenal injury are reviewed, 18 of which were due to penetrating wounds and the remaining 8 to blunt trauma. Anterior penetrating wounds were usually associated with other intraperitoneal lesions which caused more obvious physical signs and thus drew attention to the necessity for exploration. On the other hand, both blunt trauma and posterior stab wounds frequently caused isolated retroperitoneal duodenal lesions where the diagnosis was not evident on admission, but in which the insidious and progressive development of symptoms and signs drew attention to the need for laparotomy. Early repair combined with drainage of the retroperitoneal space resulted in a good result in 23 of 26 cases, 4 of whom, however, developed a temporary lateral duodenal fistula. Two of the 3 deaths were in patients who presented late and had associated pancreatic injuries while the third was due to an abdominal vascular injury.


A new flexible design of drop-foot orthosis. The use of polypropylene thermoplastic has caused a revolution in the design of ankle and foot orthoses in recent years. There are many variants in design to suit individual needs. A lively orthosis has been developed at this centre for those patients with weak or absent dorsiflexion of the foot and free passive ankle movements. This design overcomes problems of fatigue failure found in conventional designs and greatly enhances the dynamic cosmesis of this type of orthosis.


Antibody to Corynebacterium parvum in normal human and animal sera. Using a microtiter bacterial agglutination test, we have estimated antibodies to Corynebacterium parvum in "normal" human and "normal" and immune animal sera. Widely differing levels of C. parvum antibodies were found in the normal human sera. The median titer for all 310 human sera was 1:128, whereas that for the 1- to 17-year and 18- to 50-year subgroups was 1:64 and 1:512, respectively. Antibody titers in the various animal species were generally much lower.


Intestinal fluid accumulation induced by oral challenge with Vibrio cholerae or cholera toxin in infant mice. The diarrheal response of orally inoculated infant mice to viable Vibrio cholerae and purified cholera toxin was quantitated by means of a fluid accumulation (FA) ratio. The FA ratio is defined as the gut weight/remaining body weight. FA ratios were determined in relation to time of exposure and dose. Onset of fluid accumulation with viable cells of strains CA401 and 569B occurred 8 h postinoculation and reached a near maximum of 16 h. A dose of 4 x 10(6) colony-forming units of strain CA401 was required for a positive response 16 to 18 h postinoculation. Several other classical cholera strains demonstrated a similar dose-related response. Strain 569B, however, required a 100-fold higher dose to give a positive response. Several mutant cholera strains were decreased virulence in other model systems elicited FA ratios decreased from wild-type values. Onset of fluid accumulation which cholera toxin occurred 6 to 8 h postinoculation and reached a maximum by 10 h. A dose of 0.5 microng was required for a positive response 10 to 12 h postinoculation. The positive response to toxin could be inhibited by preincubation with specific antitoxin.


Infectious virus-antibody complexes of sindbis virus. Infectious virus-antibody complexes were formed when Sindbis virus was reacted with antibodies raised against purified viral envelope glycoproteins E1 and E2 as well as against preparations of intact virus. Results from rate zonal centrifugation in sucrose gradients of the complex formed with anti-E1 sera showed this complex to be about the same size as virions. A test of virus neutralization, based on direct plaque assay, by antibodies raised in rabbits and mice given virus in complete Freund adjuvant indicated the presence of antibodies able to complex but not neutralize virus. Conditions were found in which most of the virus was complexed and protected fron neutralization, suggesting that these sera may contain a mixed population of antiviral antibodies with different specificities and different avidities.


Production and properties of a staphylococcin genetically controlled by the staphylococcal plasmid for exfoliative toxin synthesis. Previous data from this laboratory showed that certain phage group 2 staphylococci contain a large 56S virulence plasmid containing genes that code for both exfoliative toxin (ET) and a specific staphylococcin. Optimal cultural conditions for bacteriocin production were similar to those found for ET production. The bacteriocin is an extracellular product produced in small quantities that can be neither extracted from cell pellets with 1 M NaCl nor induced with mitomycin C. The staphylococcin is active against a wide variety of gram-positive organisms and also against group 2 staphylococcal strains that have been cured of the plasmid carrying the staphylococcin marker. The bacteriocin is not inactivated by oxidation, mechanical agitation, or boiling for 15 min. It is sensitive to the action of trypsin and Pronase but not lysostaphin and is stable within a pH range of 4 to 9. It has an isoelectric point of approximately 7.7. Removal of the ampholytes and glycerol from electrofocused staphylococcin preparations resulted in total loss of bacteriocin activity.


In vitro lymphocyte responses of coccidioidin skin test-positive and -negative persons to coccidioidin, spherulin, and a coccidioides cell wall antigen. The biological activity of C-ASWS, an alkali-soluble, water-soluble cell wall antigen isolated from mycelial-phase cells of Coccidioides immitis, was compared with that of a commercial coccidioidin (CDN; Cutter Laboratories); CDN-TS, a toluene-induced lysate of mycelial-phase cells; and spherulin, a spherule-derived extract of C. immitis. Lymphocytes obtained from healthy CDN skin test-positive donors (group I), healthy skin test-negative donors (group II), and patients with active coccidioidomycosis (group III) were assayed for lymphocyte transformation and production of macrophage inhibitory factor in response to the Coccidioides antigens. C-ASWS, CDN CDN-TS, and spherulin were each effective in eliciting blastogenic responses in lymphocytes of group I subjects. However, only C-ASWS and CDN-TS were effective in eliciting macrophage inhibitory factor production. The responses of group III subjects (patients) were depressed and, in most instances, were indistinguishable from those obtained in lymphocytes of group II subjects.


Effect of protein A on staphylococcal opsonization. To study the effect of wall protein A on bacterial opsonization, phagocytosis of 10 strains of Staphylococcus aureus with high and low protein A contents was measured. Those strains that contained the highest concentrations of protein A were phagocytized by human neutrophils at a slower rate than strains with little or no protein A when normal human serum and purified immunoglobulin G (IgG) were used as opsonic sources. When IgG-deficient serum was used as an source, however, protein A-rich strains were phagocytized more rapidly than protein A-deficient strains. Extracellular (purified) protein A decrease the opsonic activity of all sera tested including IgG-deficient serum. It is proposed that when IgG is not present in the opsonic medium, cell wall protein A is capable of activating complement at the bacterial surface and thereby opsonization is promoted.


Adoptive transfer of immunity from mice immunized with ribosomes or live yeast cells of Histoplasma capsulatum. This investigation was designed to compare the role of lymphoid cells and immune serum in protective immunity induced by immunization with ribosomes or live yeast cells of Histoplasma capsulatum. Spleen cells, peritoneal cells, and serum from C3H mice immunized with Histoplasma ribosomes or live cells were transferred intravenously to separate groups of syngeneic recipients. All recipients along with a set of immunized and control mice were challenged intravenously with 4 x 10(6) yeast cells of H. capsulatum, and protection was assessed. Immunization with ribosomes or live cells provided 90 to 100% protection. Mice receiving filtered spleen cells or peritoneal cells from donors immunnized with live cells showed 90 to 100% protection; 80 to 90% protection was observed for mice receiving cells from ribosome-immunized donors. In contrast, no evidence of protection was seen in mice receiving serum from either live-cell- or ribosome-immunized mice. Peritoneal cells were far more efficient than spleen cells in adoptive transfer of immunity. The adoptive immunity in recipients persisted for at least 3 weeks after transfer, the longest period tested in the present study. These results indicate that the immunity elicited by immunization with Histoplasma ribosomes or live cells is mediated by a cellular mechanism.


Experimental Bacteroides fragilis endocarditis in rabbits. A serum-resistant strain of Bacterioides fragilis that did not produce heparinase was used to study the characteristics of B. fragilis endocarditis in the rabbit experimental model. The infective dose required to produce endocarditis in 50% of rabbits was significantly lower for rabbits with left-sided intracardiac catheters (log10 6.3 colony-forming units +/- 0.6/ml) as compared with right-sided intracardiac catheters (log10 7.7 colony-forming units +/- 0.8/ml). After 3 days of infection, bacterial titers of the tricuspid vegetations were significantly lower than titers of aortic vegetations (P less than 0.01), although at 5 days the titers were similar (P greater than 0.05). The weights of tricuspid vegetations, although similar at 3 days (P less than 0.05). There were no spontaneous deaths during 12 days of infection. In rabbits with the catheter removed before infection, bacterial titers were similar to those titers in rabbits with the catheter continuously in place. This model will permit study of various drug regimens for treatment of this disease.


Immune response in rabbits to virion and nonvirion antigens of the Flavivirus kunjin. The nature of the antibodies formed in rabbits in response to the following Kunjin virus antigens was examined: infectious suckling mouse brain (SMB), purified virion or rapidly sedimenting hemagglutinin (RHA), slowly sedimenting hemagglutinin (SHA), and envelope fragments prepared from RHA disrupted by 0.1 or 0.2% sodium deoxycholate (DOC). The hemagglutination-inhibiting (HI) and neutralizing antibody responses to SMB, RHA, and large envelope fragments (0.1% DOC) were remarkably uniform, antibodies appearing at the same time, attaining similar HI titers (lowest to envelope), and being of similar avidity early and late in the respone. The 19S (immunoglobulin M) antibodies to all antigens were always relatively type-specific, whereas the 7S (immunoglobulin G) antibodies were always broadly cross-reactive in HI tests. These results confirm that the envelope antigen is the principal antigen involved in the stimulation of protective neutralizing antibodies and contains both type- and group-specific antigenic determinants. The results also establish that there is no significant advantage in using purified RHA or SHA either for immunization or as hemagglutinin antigens in attempts to obtain greater specificity in the HI test. No differences were detected in the antibody responses to infective Kunjin virus, within the range 1,400 to 10(9) plaque-forming units (PFU). Below 1,400 PFU, there was no detectable response. Inactivated virus (10(6) PFU) also stimulated the normal antibody response. In contrast, small envelope fragments (derived with 0.2% DOC) and a detergent-solubilized extract of infected cells were unable to stimulate a detectable antibody response and the small envelope fragments may have induced low dose tolerance in one of two rabbits.


Bacteriophage deoxyribonucleic acid-induced mutation of Streptococcus mutans. A cariogenic strain, Streptococcus mutans PK 1, has been demonstrated to have prophage by observation of phage particles with an electron microscope and by induction with mitomycin C. The phage particles could not be detected in a mutant strain which lost the characteristic adhesive nature on glass surfaces and exhibited diminished ability to synthesize insoluble polysaccharide. By infecting the mutant cells with the phages or with free phage deoxyribonucleic acid isolated from the parent strain of S. mutans PK1, the mutant cells were transformed to the cariogenic strain with adhesive nature. The transformants retained the general characteristics of S. mutans PK 1, but in addition all transformants showed a new character; namely, the transformant cell could produce ammonia from arginine, whereas neither the parent nor mutant strains of S. mutans PK 1 had such a property;


Development of arthrospores of Trichophyton mentagrophytes. Arthrosporogenesis of the dermatophyte Trichophyton mentagrophytes was examined by light and by scanning and transmission electron microscopy. Sabouraud dextrose agar plates were inoculated with microconidia and incubated in an atmosphere of 8% CO2. Typical germination and hyphal branching continued to day 4, when hyphae began to be increasingly coated with granular-fibrillar material. Multiple replication of nuclei and formation of segregating septa followed. By day 6 the thick surface mesh sometimes was restricted to protruding rings, probably over septa. Between days 6 and 7, after thickening of outer and septal walls, units began to round and separate. Triangular gaps, which developed at the junction of septa and outer wall layers, enlarged so that spores were held together at their poles and along a tangential ring. With elongation of the spore to its barrel shape, the halves of the septum separated and the ring pulled apart, leaving a jagged, circular flange originating from the outer layer of cell wall extended toward the poles, covering the apparently exposed inner wall layer. Newly formed arthrospores, which measured 2.0 to 3.3 by 2.9 to 3.8 micronm and possessed walls of about 0.33-micronm thickness, has smooth sides but somewhat rough poles.


Effect of beta-adrenergic blockade, pertussis vaccine and Freund's adjuvant on reaginic antibody response in mice. IgE synthesis has been reported to be inhibited by theophylline and dibutyryl cyclic adenosine monophosphate and increased by pertussis vaccine. This study was done to determine if chronic beta-adrenergic blockade affects IgE antibody production. 72 C57BL/10J mice were sensitized with egg albumin (EA, 125 microng). Groups included: (1) EA alone; (2) EA + complete Freund's adjuvant (FA); (3) EA + B. pertussis (8 X 10(9) organisms); (4) EA + propranolol (0.5 mg/kg) 3 times/day; (5) EA + FA + propranolol; (6) saline alone. Booster was given on day 49. Group 1, given EA alone, failed to develop any passive cutaneous anaphylaxis (PCA) antibodies even after booster, whereas the 72-hour PCA titers ranged from 1/64 to 1/256 for groups treated with propranolol and propranolol + FA, respectively. The results suggest that chronic beta-adrenergic blockade enhances IgE antibody formation.


Placebo and its importance in medicine.

Placebo and its importance in medicine. Placebo can be defined as "a therapeutic effect, drug or non-drug, or a part of it which, in the condition being treated, objectively does not have any specific pharmacodynamic action." Even today when powerful drugs are available placebo is important and present in therapy. Effective therapeutic agents are also sometimes used as placebo, mostly inadvertently. In clinical pharmacological investigations placebos are used deliberately to discriminate the pharmacodynamic action of drugs from psychic and other factors which can influence the objective of the drug evalution. The use of placebo in therapeutic trials is justified only when no effective treatment is available or the symptom or disease is trivial. Placebo effect is especially pronounced in diseases where pain is an important symptom as well as in psychosomatic diseases. The extent of placebo reaction depends on patient's characteristics (reactors and non-reactors), drug presentation, as well as on personality and attitudes of the prescriber. Deliberate use of placebo other than in clinical therapeutic investigation is justified in mild mental depression and in situations where the diagnosis is known, no drug is necessary, but the patient's pressure to get a prescription is irresistible (?). Every doctor should cultivate the induction of placebo reaction in treatment of his patient, but not to the extent that the belief of the former in the action of an inactive medication starts.


Cell wall studies of Histoplasma capsulatum and Blastomyces dermatitidis using autologous and heterologous enzymes. Enzymes capable of hydrolyzing cell walls of Blastomyces dermatitidis and chemotypes I and II of Histoplasma capsulatum were prepared in the laboratory or obtained from commercial sources. They included chitinases, beta-1,3-glucanases, beta-1,6-glucanase, and Pronase. Monosaccharides and disaccharides of glucose released from the cell walls by the enzymes were determined qualitatively by paper and gas-liquid chromatography, and monosaccharides were quantitated by the latter technique as well. An enzyme system isolated from Streptomyces sp. containing both chitinase and glucanase released maximum amounts of glucose and N-acetylglucosamine from the cell walls of H. capsulatum chemotype I. A chitinase preparation, free of glucanase, from Serratia marcescens released only chitobiose and N-acetylglucosamine from chemotype I cell walls, but the total quantity of N-acetylglucosamine released was about 60% less than that released by the Streptomyces system. A beta-1,3-glucanase from Bacillus circulans hydrolyzed the cell walls of H. capsulatum chemotype I, but a beta-1,6-glucanase failed to release glucose from the same walls. Autolytic enzymes, viz., beta-1,3-glucanases and several glycosidases were detected as constitutive enzymes in both yeast and mycelial phases of B. dermatitidis and H. capsulatum chemotypes I and II. No difference in the amount of activity was found between cell sap and culture filtrate preparations. The beta-glucanases prepared from the Histoplasma and Blastomyces strains were active on the cell walls of the yeast phases of H. capsulatum chemotypes I and II, releasing laminaribiose and glucose, but were essentially inactive on the cell walls of B. dermatitidis. Chitinase, beta-1,6-glucanase, alpha-glucanase, and alpha-glucosidase activities were absent from these fungal enzyme preparations.


Experience with amoxycillin in neonates and premature babies. Amoxycillin, a semi-synthetic penicillin, resembles ampicillin in many respects. There is cross-resistance between the two antibiotics. Numerous Gram-positive and Gram-negative organisms are sensitive to amoxycillin at relatively low dosage. Investigations using oral amoxycillin, 50 mg/kg body weight were carried out in neonates and premature babies in the first days of life. Peak values of 38 microng/ml and 59 microng/ml at 4 1/4 hours were obtained for the neonates and premature babies respectively. The 10-hour value for the first group was 13 microng/ml and for the second 19 microng/ml. With a single dose of amoxycillin, serum levels of 0.9 microng/ml were still obtained after 24 hours. In children who received the same dose twice daily, the serum values were 6.5 microng/ml after 24 hours. The urinary excretion of amoxycillin was, on an average, 41% in 24 hours. Amoxycillin was also found in the meconoium, but the quantity in the different portions showed a large dispersion. Amoxycillin can, therefore, be recommended as an effective and well tolerated antibiotic for use in the neonatal and premature period. In general the drug should be administered 12-hourly at a dose of 50 mg/kg body weight. Only in severe illnesses is 8-hourly administration required.


Canine renal glomerular ultrastructural changes after preservation and autotransplantation. Glomeruli of canine kidneys were studied by light and electron microscopy to determine whether significant structural alterations occur during 24 hr of hypothermic perfusion. The kidneys of eight dogs were preserved by continuous pulsatile perfusion with cold cryoprecipitated plasma; they were subsequently reimplanted as autographs and contralateral nephrectomy was performed at that time. Biopsies of the experimental kidneys were taken before nephrectomy, after 24 hr of perfusion, and at 1 hr postanastomosis. Tissue samples from two animals were studied at autopsy. Structural changes observed in the glomeruli after preservation were: margination of nuclear chromatin, nuclear pyknosis, and dilation of smooth and rough endoplasmic reticulum membranes. These changes were observed in all cell types, but were more severe in the endothelial cells. The basement membrane in four cases was edematous and thickened. At 1 hr postanastomosis the glomerular ultrastructural appearance was greatly improved. Blood urea nitrogen, serum creatinine, and the ability of the kidney to sustain the life of the recipient were used as criteria for determining the viability of the preserved kidneys. Blood urea nitrogen and serum creatinine returned to a normal range in five dogs. The physiologic tests and the length of survival attest to the functional capability of the preserved kidneys. Study of tissue samples at autopsy indicated that, although a number of the structural alterations observed after preservation were reversible, some changes persisted.


Immune reactions following desiccation surgery of the canine prostate. An initial report. Desiccation surgery of the canine prostate induces a chronic inflammatory cell infiltrate that persists at the site for more than 1 year. Specific autoantibody was demonstrated by direct immunofluorescence with prostatic tissue only. The mononuclear cell infiltrate occurring in large focal aggregates within 2 months after surgery was similar to the lesions seen in certain chronic inflammatory diseases. Precipitating antibody was not demonstrable by agar double diffusion techniques. The possible therapeutic effect of the induction of such a lesion in cancerous prostatic tissue is discussed.


Pacemaker system in the control of ureteral peristaltic rate in the multicalyceal kidney of the pig. Temporal and distributive properties of ureteral peristaltic contractions in the anesthetized pig have been examined. Interperistaltic time intervals have been recorded, and their frequency during different urine flow rates has been compared. The results show that ureteral peristalsis is increased at high urine flow rates to a maximum of approximately 0.06 Hz. It is further shown from the interperistaltic histograms that ureteral contractions are not clustered into a discreet multimodal spectrum. This represents the first evidence that the multicalyceal kidney has a system of pacemakers of differing fundamental frequencies, tending toward synchronism as urine flow increases.


Intrarenal hemodynamics and ureteral pressure during ureteral obstruction. Renal blood flow was measured in bilateral ureteral obstruction (BUO) and unilateral ureteral (UUO) obstruction. Renal blood flow of BUO and UUO rats before release of 24-hr obstruction was approximately 69 per cent and 77 per cent of control values, respectively. No redistribution of intrarenal blood flow was noted in UUO and BUO rats. Prerelease ureteral pressure of BUO rats (27.6 +/- 1.60 mm Hg) was significantly higher than that of UUO rats (14.4 +/- 1.30 mm Hg, P less than 0.001). Although the blood urea nitrogen of UUO rats with urine reinfusion was similar to that of BUO rats, the ureteral pressure was 14.8 +/- 1.93 mm Hg. Therefore, the higher ureteral pressure of BUO rats is not due to elevation of blood urea nitrogen. It is concluded that decreased renal blood flow during obstruction and high ureteral pressure may result in more severe tubular damage in BUO than in UUO. The decreased renal perfusion is probably due to changes in intrarenal vascular tone rather than due to intersitial pressure.


Dynamics of upper urinary tract. I. An electrophysiologic in vivo study of renal pelvis in pigs: method and normal pattern. Under halothane anesthesia, peroperative electromyography of the pelvis and ureter together with intrapelvic pressure and urine flow were recorded in 11 pigs; the electromyography was by bipolar extracellular leads. Pressure waves of low amplitude, synchronous with action potentials from leads placed most proximally in the pelvis, preceded action potentials registered by distally placed leads. Transmission of the action potentials from the pelvis to the ureter took place with a constant transmission velocity but the transmission ratio varied from 1:1 to 6:1. Ureteral electric activity was time-related to the urine bolus. The transmission velocity was smaller in the pelvis than in the ureter and seemed to accelerate caudally. Thus, there is electromyographic evidence that the renal pelvis controls ureteric activity and that this pacemaker function is mediated high up, most proximally, in the renal pelvis.


Dynamics of upper urinary tract. II. An electrophysiologic in vivo study of renal pelvis in pigs: analysis of the modality of pelvic activity during normal hydration and diuresis. Renal pelvic function of Danish Landrace pigs under anesthesia was analyzed during "normal" and forced diuresis. Measurements were made of intrapelvic pressures, electromyogram recordings were taken from the pelvis and ureter, and bolus formation was followed. During constant diuresis, pelvic activity displayed a dominant frequency which varied between individuals. When pressure rose or fell, pelvic activity increased or decreased in proportion to the speed rather than the extent of the pressure change. Thus, after furosemide administration urine flow increased and pelvic pressure rose; and in association with the pressure rise, pelvic activity increased significantly when mean pelvic activity in the phase of steep pressure rise was compared with the mean activity over the last 5 min of the observation period before induction of diuresis. Thereafter, pelvic activity decreased despite maintenance of a higher pressure plateau than that in the initial low diuresis observation period. This mode of function can be explained by reference to the characteristics of smooth muscle. Postulation of a specific pacemaker is unnecessary.


An autoradiographic study of smooth muscle hyperplasia in the swine ureter. Autoradiographs of healing ureteral defects demonstrated significant uptake of tritiated thymidine in pigs sacrificed during the first 2 weeks after ureterotomy. The earliest and most heavily labeled tissue was epithelium followed by proliferation of subepithelial connective tissues and smooth muscle of the muscularis. The labeling of significant numbers of myocytes within the muscularis was indicative of smooth muscle replacement by hyperplastic means. The fact that most mitotically active smooth muscle cells were seen in the muscle remnant adjacent to wound margins suggests this as the primary source for new muscle.


Urogenitodynamics of the male bladder neck. 2. During voiding. The dynamic activity of the male bladder neck during voiding was studied by electromyography in dogs and rabbits. On vesical filling, increased electrical activity in the form of high voltage biphasic potentials was recorded from the anterolateral segment of the bladder neck. With the onset of voiding these high voltage potentials disappeared completely and only a low voltage base line activity was recorded. This indicates muscular relaxation of the anterolateral bladder neck. Concurrently, the posterior segment of the bladder neck showed insignificant electromyographic changes. We conclude that opening of the vesical outlet during voiding is achieved by the muscular relaxation of its anterolateral segment. The dynamic activity of the bladder neck is reciprocally coordinated with the detrusor muscle to produce continence and voiding of urine.


Differential effect of 2-thiouracil on synthesis of two plant viruses in the same host. In cowpea leaves singly or doubly infected with cowpea chlorotic mottle virus (CCMV) and/or southern bean mosaic virus (SBMV), treatment with 2-thiouracil increased the accumulation of CCMV particles and strongly decreased the accumulation of SBMV particles. Thiouracil prevented the usual inhibition of synthesis of CCMV particles at about 6 days after inoculation, and 2-3 times as many CCMV particles accumulated as in water-treated plants. A single treatment of thiouracil 48 h before, at the time of, or 24 h after inoculation caused at least 90% decrease in the amount of SBMV particles extracted from inoculated leaves for at least 15 days. When virus particles were extracted from plants treated with thiouracil, the specific infectivity of CCMV was increased 2.3 times and SBMV was decreased 0.46 times as compared to virus from control plants.


Pigment analysis in the identification of "Flavobacteria". Spectral properties of the intracellular pigments of flavpbacteroa were studied by "scanning" ultrasonic preparations, methanol extracts, MF preparations, slide cultures and whole cell suspensions. No genus-specific Amax were demonstrated with methanol extracts. In situ analyses of pigment, using ultrasonic preparations or whole cell suspensions, demonstrated that all strains of Flavobacterium spp. surveyed showed a discrete Amax between 418 and 421 nm. This peak was absent from scans of other yellow gram negative rods". Amplitude of Amax was accentuated by variation in incubation parameters.  Good resolution was obtained by repositioning cuvettes in "conventional" spectrophotometers and attaching opal glass plates to the "detector suface" of cuvettes. The presence of a genus-specific Flavobacterium pigment, or pigment fraction, detected through in situ analysis, adds another feature to keys or schema used for characterization and identification of the organisms comprising this presently ill-defined taxon.


Comparison of zinc protoporphyrin and free erythrocyte protoporphyrin in whole blood. The recent change in emphasis from blood lead to erythrocyte protoporphyrin as the primary diagnostic test for screening for childhood lead poisoning has made it desirable to develop the quantitative relationship between the two protoporphyrins, free erythrocyte protoporphyrin (FEP) and zinc protoporphyrin (ZP), that are now widely used for screening purposes. ZP was found to be equal to 1.4 EP, thus permitting the measurement of either parameter, and its conversion to the other.


Filter paper-disc method for the determination of zinc protoporphyrin in blood. Zinc protoporphyrin, an abnormal metabolite resulting from undue lead absorption, can be quantitatively determined in blood that has been spotted and dried on filter paper. This procedure, which yields values that correlate well (r = 0.96) with those obtained by direct determination in whole blood, offers advantages in convenience of collection, storage, and transportation that recommend it for field use. The light sensitivity of the zinc protoporphyrin, however, mandates that the specimens be protected from excessive light exposure until analyzed.


An analysis of cost studies performed in public health laboratories. From 1973 to 1976, 23 public health laboratories performed cost accounting studies with the assistance of the Laboratory Management Consultation Office, Center for Disease Control. Cose data obtained in 16 of these laboratories were used as the basis of a discussion on the identification of indirect expenses and the method of reapportioning these costs to the diagnostic testing sections of the laboratories. Calculations of cost-per-weighted units and cost-per-test of some laboratory diagnostic sections are presented. A laboratory administrator can gain some insight into the effectiveness of resource utilization within his own laboratory by identifying cost center expenditures and considering differences in cost-per-weighted unit among the various revenue-producing sections. With the currently available data, no significant relationship between indirect costs and overall laboratory cost-per-weighted unit was demonstrated. It is hoped that additional data can be gathered and other indices developed which will help laboratory management to more precisely identify and then control indirect costs.


Use of gaming simulation by health care professionals. Gaming-simulation is being developed foruse in a variety of aspects of health care. A mental health diagnostic and therapeutic application is described for problems in parent-teenager relations; it features gaming, videotaping of interactions, and extensive discussion. Two applications which elucidate the nature of discord between couples and two applications for work-group problems are also described. Gaming-simulation is used in basic and continuing education of health professionals for such issues as problems of dying patients and the aged, and prevention of coronary heart disease. Patients rights issues provide a potential focus for opening dialogues between patients and professionals about all facets of health and illness care.


Learning outcomes in a simulation game for associate degree nursing students. Learning outcomes of a simulation game designed to have one-to-one correspondence between behavioral objectives and game plays is reported. The behavioral objectives were core concepts in psychiatric mental health nursing taught to associate degree nursing students. Decisions to use the simulation game method method grew out of difficulties inherent in the community college nursing program, as well as the need for self-paced, efficient, learner-centered learning and evaluative tools. After the trial and revision of the game, a number of research hypotheses were tested. Simulation gaming was found to be an effective mode of learning, and students who acted as teachers for other students learned significantly more than those who were taught. Some of the recommendations for further research were to study varied nursing populations, to add a control group, to test the long-range learning effects of  playing the game, to decrease experimenter bias, to study transfer of learning to actual nurse-patient situations and changes in attitudes toward psychiatric patients, and to develop more simulation games for nursing education.


The use of Metro-Apex in health administration and planning education and training. Metro-Apex is a computerized gaming-simulation designed to give practitioners and students an understanding of the environment of health care delivery systems. The exercise allows participants to explore the interaction of health roles and the health system's interaction with the larger community system. Originally developed as an air pollution control exercise, it has evolved to be a game about communities and how they operate. In 1972, the Department of Health, Education, and Welfare funded the Center for Multidisciplinary Educational Exercises (COMEX), of the University of Southern California to modify Metro-Apex for use with health service planners, health care administrators, and students in programs leading to these positions. The game runs in several rounds of from three to eight hours for groups of from 40 to 120 persons. Used in both educational and training settings, Metro-Apex is found to be a flexible addition to the health educator's tools.


Gaming-simulation and health education an overview. Simulation entails abstraction and representation from a larger system in terms of process as well as structure. Central features are identified and simplified, less important elements are omitted from the model. In medical and health education, simulation enables learners to practice in an environment where mistakes are not costly, such as with simulated patients. Gaming-simulation incorporates role-playing into a defined system of interaction simulating a real world system and is characterized by the degree of structure of the roles and the focus on role interactions. Employment of gaming-simulation is embryonic in health education. Examples included in this Monograph concern problems of aging, hemophiliacs, and the dying; teaching interpersonal skills in psychiatric nursing; interactions of health care systems with their communities; and several other topics. Evaluation is discussed in a separate paper. A variety of health care gaming resources are described.


Designing simulations and games: a workshop for health care professionals. This article describes the important elements of a five-day workshop for teaching health care professionals to design and use simulation/gaming activities. Suggested guielines are identified for planning and conducting a workshop. The importance of early planning is emphasized by identifying the specific objectives of the workshop and preparing the staff to facilitate the attainment of each objective. The selection of staff and participants is discussed. A day-to-day description of a typical workshop is presented. Also included is a description of several content presentations which teach the workshop participants the required skills and knowledge in design, selection, research, and evaluation of simulation/gaming activities.


Evaluation of simulations and games: a comprehensive procedure and a case history. This article deals with the dimensions of evaluating simulations and games in health education, provides a procedural model which incorporates these dimensions, and illustrates this model with a case history of the evolution of a game through repeated evaluation. The four major dimensions of evaluating a game are the purposes of evaluation, sources of evaluative data, emphasis on main or side effects, and timing of evaluation. The procedural model incorporates these dimensions of evaluation and is divided into stages of self-evaluation, expert appraisal, informal player tryouts, typical-use testing, field testing, and long-term evaluation. The case history illustrates the application of each of these stages to a short game in consumer health education.


High-resolution scanning-densitometry of photographic negatives of human chromosomes. III. Determination of fluorescence emission intensities. Principles and techniques are discussed for measuring with high topological resolution local emission in fluorescing objects, using photographic negatives. Determination of fluorescence intensities is only possible when an unequivocal relation between the original local fluorescence emission intensities of the object, and the transmittances or densities recorded in the microfluorophotograph is known. This relation is formulated in the theoretical part. From this relation it can be concluded that the recorded intensities can be measured optimally when the optical density values produced by the fluorescence emission fall in the range of the linear portion of the Hurter and Driffield curve. In order to obtain this situation, a uniform low-level pre-exposure of the film emulsion to (white) light is carried out prior to the actual fluorescence emission exposure. This pre-exposure acts to elevate the signal exposure to the linear (steeper) part of the H.D. curve. Inhomogeneity of the excitation beam in the object field, or differences in film emulsion response to the light exposure, will result in erroneous optical densities recorded in the photographic negative. Correction for such artifacts could be obtained by addition of a low concentration of fluorophore to the mounting medium of the microscopic preparation. The overall fluorescent background produced in this way, enabled calibration of local fluorescence intensities in different parts of one fluorophotographic negative, and also of the intensities in different negatives taken from one microscopic preparation. The validity of this approach was checked by comparing data obtained from several photographic negatives of the same quinacrine-stained metaphase, taken with different exposure times to imitate fluctuations in excitation illumination, after conversion of the scanning data into emission intensity values with an alogarithm based on the proposed theoretical relation. In another experiment, fluorescence emission intensities of Feulgen-stained chromosomes which had been measured with a cytofluorometer, were compared with results obtained by conversion of the scanning data measured in the fluorophotographic negatives of the same metaphases. Both types of experiment confirmed the applicability of the procedure described.


The influence of freezing and freeze-drying of tissue specimens on enzyme activity. In the presented study the influence of freezing and freeze-drying on enzyme activity is described. Attention is paid to 16 enzymes which can be used for quantitative enzyme histochemical techniques. With the exception of succinate dehydrogenase only, no significant inactivation during freezing and freeze-drying procedures could be demonstrated with lactate dehydrogenase, malate dehydrogenase (NAD+), malate dehydrogenase (decarboxylating) (NADP+), isocitrate dehydrogenase (NADP+), glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, NADH-oxydoreductase, mitochondrial glycerol-3-phosphate dehydrogenase, cytochrome c oxidase, phosphoglucomutase, glucosephosphate isomerase, glucose-6-phosphatase, acid phosphatase, beta-glucuronidase and non specific aryl esterase. Therefore, the results supply a sound foundation for those quantitative enzyme histochemical techniques in which tissue specimens are frozen or frozen-dried before enzyme estimations are performed.


Extended application of flow microfluorometry by means of dual laser excitation. A dual laser beam excitation device for flow analysis of biological particles has been developed. The aid of this arrangement is to increase the range of fluorescent agents employed so far in quantitative and qualitative cytochemistry. Combining an argon ion and a helium-cadmium laser two color fluorescence measurements were performed employing propidium iodide as a DNA stain and fluorescamine which stains total protein in fixed cells. Energy transfer processes between the antibiotic and DNA specific dye mithramycin and propidium iodide both being bound to nuclear chromatin were analyzed. Utilization of energy transfer processes is generally discussed as a mean to extract information about the structure and conformation of nuclear chromatin in situ. The application of a crypton ion laser with three lines near 400 nm and a single line at 350 nm having a light output in each range of nearly one Watt gives the opportunity of utilizing DNA fluorochromes which have an excitation maximum in the deep blue region, DNA spectra are shown employing mithramycin, the benzimidazol derivative 33258 (Hoechst) and the indol compound DAPI which has a high DNA specificity combined with a great stability under UV illumination. By separating two focussed laser beams at their intersecting points with the liquid sample stream the trajectory of each flowing cell crosses the beams sequentially, which causes a solitary dual excitation of each cell. The advantages of a solitary excitation device compared with a simultaneous one is discussed.


[Innervation of the anterior byssus retractor muscle (ABRM) in Mytilus edulis L. III. Histochemical localisation of the terminal nerves through 5-hydroxytryptamine (author's transl)]. Detection of nerve structures containing 5-HT were described in the anterior byssus retractor muscle (ABRM) in Mytilus edulis L. after using the fluorescence microscope technique of Flack. We are able to confirm our previous results and assumptions given by histology and electron microscope studies: the neuromuscular "en passage" junctions, largely distributed within the ABRM, contain 5-HT.


A disease in dogs resembling human subcorneal pustular dermatosis. A pustular eruption similar to subcorneal pustular dermatosis of man occurred in 10 dogs. The disease was characterized by pustules of the trunk, which ruptured to form annular or gyrate lesions with irregular, scaling borders. Biopsies revealed subcorneal pustules with occasional acantholytic cells. All 10 dogs improved after daily administration of diaminodiphenylsulfone (dapsone).


Evaluation of a polycarbonate filter for the detection of microfilaremia in dogs in central Michigan. Several diagnostic techniques were used in determining the prevalence of microfilaremia in 479 dogs entering the holding facility for research animals at Michigan State University. The modified Knott test and cellulose filter procedures were initially applied, but persistent difficulties with the cellulose filter system prompted evaluation of the use of clear polycarbonate filters. This procedure was found to be equally as sensitive as the modified Knott test and more sensitive than the microhematocrit tube method. Microfilariae trapped on polycarbonate filters were easy to detect, and there were no problems with clogging of the filter pores. Losses of up to 3.5% of the microfilariae occurred with 8-micron pore size filters, but no more than 1% passed through 5-micron pore size filters. Identification of microfilariae was based on size and shape of the parasites. In questionable cases, the diagnosis was confirmed by means of the histochemical test for acid phosphatase distribution. Satisfactory results were obtained when the latter test was applied to microfilariae of Dirofilaria immitis trapped and fixed on filters. Twenty blood samples in the surgery (4.2%) contained microfilariae, all of which were classified as D imitis.


Prevalence of Dirofilaria immitis infection in dogs from a humane shelter in Ohio. Hearts of 500 dogs more than 1 year old from a humane shelter in Columbus, Oh, were examined for Dirofilaria immitis infection. Peripheral blood from dogs with worms in the heart was examined for microfilariae. Dirofilaria immitis adults were found in 24 (4.8%) hearts. The number of worms in infected hearts were: 19 (1 dog), 6 (2 dogs), 5 (1 dog), 4 (2 dogs), 3 (1 dog), 2 (9 dogs), and 1 (8 dogs). Of the 24 infected dogs, 4 had only male worms, 8 had only female worms, and 12 had worms of both sexes. Microfilariae were found in 12 dogs--11 dogs having D immitis microfilariae, and 1 having only Dipetalonema reconditum microfilariae. The dog with D reconditum microfilariae had only 1 male D immitis adult in its heart.


Reproductive function in stallions treated with cambendazole. Twenty stallions were used to determine if the anthelmintic cambendazole affected seminal characteristics, spermatogenesis, concentration of testosterone in blood serum, or weights of the reproductive orgrans. With minor exceptions, significant differences were not found between values for 10 control and 10 stallions treated with a single oral dose (40 mg/kg body weight) of cambendazole. The treatment did not affect reproductive function and it was concluded that the drug should have no effect on the fertility of stallions.


Dysphagia resulting from unilateral rupture of the rectus capitis ventralis muscles in a horse. Dysphagia developed in a 2-year-old Quarter Horse filly following an incident in which it fell over backward while exercising on a mechanical horse walker. Hyperextension of the neck at this time apparently caused unilateral rupture of the longus capitis (rectus capitis ventralis major) and the rectus capitis ventralis minor muscles at their insertion. An existing mycotic lesion involving the dorsomedial wall of the left guttural pouch may have weakened the area of insertion of the involved muscles. Tearing of the tendinous insertion of these muscles caused damage to the IX, X, and XI cranial nerves and left guttural pouch, with subsequent development of mild transitory epistaxis, laryngeal hemiplegia, pharyngeal paralysis, and dysphagia. Gangrenous pneumonia eventually developed because of inhalation of ingesta, and the filly was euthanatized.


Sequential differentiation of retinal cells in the mouse studied by diaphorase staining. During retinal development in mice the early stages of differentiating of ganglion, amacrine and horizontal cells are characterized by high diaphorase activity in the perikarya. The reaction in the ganglion cells, which start differentiation at day 12 of gestation when the layer of nerve fibres is developing, was first localized near the axonal end, but later, in the period of dendritic growth, it shifted to the scleral side. Amacrine cells were first detected on day 16, and showed a transient activity at the initial stage of their differentiation. A variety of large amacrine cells with long bifurcating processes appeared at day 7 after birth, and showed particularly high TPN diaphorase activity. The horizontal cells could be followed from the 16th day of embryonic life. Their activity increased during the period of formation of the outer plexiform layer. Along the outer limiting membrane diaphorase activity was marked from day 13 of embryonic life, and seemed to concentrate later in the rod inner segments. Activity in the bipolar cells first appeared at day 7 after birth, and increased therafter, coinciding with the period of synaptic development in the outer, plexiform layer. Activity in the Müller cells appeared around 14 days after birth, and was most pronounced in the inner processes and basal end feet. The sequential differentiation of retinal cells and cellular interrelationships during retinal histogenesis are discussed.


The fine structure of developing elastic cartilage. The fine structure of the elastic cartilage of the pinna has been examined in young rabbits aged from 1 day to 1108 days. Changes associated with growth and development are related not only to age but also to the actual situation in the pinna. In the midline, progressive changes are seen from the tip to the base. The changes in the chondroblasts with time are compared with those described in hyaline cartilage. Structures occur that, except for the presence of crystals, are apparently morphologically identical with the matrix vesicles of calcifying cartilage. These matrix vesicles, however, become very prominent with age, and aggregations of them appear to be released into the intercellular tissue from vacuoles at the periphery of the chondroblasts. There is no obvious association with calcification. Occasional single cilia, desmosomes and giant mitochondria are seen. Elastica is present at birth, and eventually every cell is separated from its neighbours by a partial investment of elastica. The quantity of matrix seems to increase with time, and with distance from the tip of the ear. This is accompanied by a marked increase in cell size with time.


Intracerebral transplantation of the genital tubercle in the rat: the fate of the penile bone and cartilages. Genital tubercles of 70 newborn male and female rats were transplated into the brains of unrelated infant rats. Seven other tubercles were placed subcutaneously. All female, and some male, hosts were injected with testosterone propionate. After surviving from 2-24 days,, histological study of 49 successful grafts showed survival of the urethral and balano-preputial epithelia and growth of the preputial glands, which formed secretion-filled cysts and became the major component of the graft. The fate of the mesodermal tissues witin the glands varied between remaining in an undeveloped state, with only pale fibrouw tissue and an area of granular degeneration and giant cells, and achieving an incompletely differentiatel state in which erectile tissue and the anterior process of fibrocartilage had formed and the glans had grown but the penile bone and its secondary growth cartilage failed to appear. Grafts could reach this degree of differentiation of the glands irrespective of transplantation site, attachment to the host dura, the sex of donor or host, and whether or not male hosts were given exogenous hormone.


Some ultrastructural observations on the intestinal mucosa of the toad (Bufo melanostictus). An ultrastructural study of the mucous membrane of the small intestine in the toal (Bufo melanostictus) has shown that in the epithelium, besides the typical epithelial lining cells, non-epithelial cell types, including lymphocytes, macrophases, plasma cells, eosinophils and neutrophils are present. These non-epithelial cell types are also encountered in the lamina propria, which also contains numerous fibroblasts, smooth muscle cells and mast cells. The ultrastructural features of toad intestinal mucous membrane thus resembles that in mamals in many of its features, The intraepithelial localization of macrophages and of mature plasma cells is unusual. The observations suggest that the toad intestinal mucous membrane may function as a lymphoepithelial organ.


Intra-uterine growth retardation and limb deformities produced by neuromuscular blocking agents in the rat fetus. Intra-uterine growth retardation and limb deformities, resembling clubfoot, were produced by tubocuararine chloride, and by toxiferine, when administered to the rat fetus between the 16th and 19th day of gestation. These effects were associated in some fetuses, but were not sex-linked. Fetuses in the middle part of the uterine horn were observed to be more vulnerable. Placentae of the affected fetuses were smaller in size and weight at birth. Direct toxic effects of the drug on the fetus and/or on the placenta, along with immobilization of the fetus in utero due to the neuromuscular blocking action of the drugs, seem responsible for these effects. These finding warrant proper caution and care in administering such drugs to women, even as late as the third trimester of pregnancy.


Biomechanical and ultrastructural studies on the elastic wing tendon from the domestic fowl. The interaction between collagen and elastin networks under conditions of load-extension  has been studied in the elastic wing tendon of the domestic fowl. The load-extention curves obtained could be divided into two regions, the first region representing the ability of the tendon to undergo great extension at low tension, the second representing a limit region where the collagen of the tendon appears to become fully extended. Following removal of the elastin network with pure elastase only the second region of the curve persisted, indicating that elastin is largely responsible for the mechanical event represented by the first region of the curve. The collagen network of tendons apparently is normally held in a folded conformational state by elastin, for elastase treatment results in elongation of tendons even in the absence of loading. Complete removal of elastin, and alignment of collagen bundles were confirmed ultrastructurally in the elongated tendons. The breading load of the elastase-treated tendons was also significangly reduced, indicating that an elastase-sensitive component is a limiting factor in determining the ultimate strength of the tendon.


Some effects of tenotomy on adult striated muscles. The effect, after prolonged survival, of tenotomy on the length of the muscle bell of tibialis anterior and the isometric tensions it exerted was investigated in adult rabbits. When regeneration of the tendon was prevented by its diplacement of bell length decreases by about 20% and, if the tendon of extensor digitorum longus was cut as well, by about 40%; the decrease was only about 10% when the tendon was allowed to regenerate. Tenotomy did not affect the length of the muscle fasciculi relative to that of their belly. The range through which the experimental and comtrol bellies exerted the same proportion of their maximum developed tension was approximately proportional to their maximum developed tension was approximately proportional to their respective length. The maximum tension the muscle exerted fell to as low as 10% of the normal after prolonged severance of its tendon, wheras after prolonged tendon regeneration in was about 80% of the normal. The ratio of the tension to the weight/length of the belly was reduced after tenotomy.


The suspensory muscle of the duodenum and its nerve supply. The gross anatomy, microscopic structure and nerve supply of the suspensory muscle of the duodenum and Hilfsmuskel have been studied in cadavers of 88 adults, 5 children, 1 infant and 6 neonates. The suspensory muscle of the duodenum, consisting of plain muscle fibres, arose from the connective tissue around the stems of the coeliac and superior mementeric arteries. It was inserted into the third and fourth parts of the duodenum in 53%, and into the duodeno-jejunal flexure in addition in 40%. It was innervated by non-myelinated fibres arising from the coeliac and superior mesenteric plexuses. Although both the longitudinal and circular muscle coats of the duodenum extended into the suspensory muscle, it was not supplied by Auerbach's plexus. The Halfsmuskel, which is a slip of the diaphragm is attached above to the margin of the oesophageal hiatus and below to the connective tissue in the region of the stem of the coeliac artery, sometimes extending to the stem of the superior mesenteric artery. The Hilfmuskel and the suspensory muscle of the duodenum are separate entities.


Radiographic assessment of calf muscle growth in the rat. The growth of the calf muscle of the rat has been examined using a non-destructive,, radiological procedure. The growth was followed longitudinally in one set of rats from 3-228 days of age. A second group containing 165 animals was examined cross sectionally. In these animals the weight as well as the width of the muscle was recorded. It was concluded that growth of the calf muscle in width is more complex than the grwoth of the tibia, as a second growth peak was seen between 28 days and 35 days in the muscle but not in the tibia. It was observed that in animals greater than 150g body weight the muscle radiological shadow of the female was greater than that of the male, but this difference was not seen in muscle weight. The relationship between muscle size and muscle weight was not uniform: if the lightest animals were excluded then a logarithmic relation appeared, and if the heaviest animals were excluded, a cube relation was found. Variation in weight was always greater than in width, and it was concluded that muscle width could not be used for accurate estimation of muscle weight.


Development of acinar cells in the rat submandibular gland. Three types of cells - terminal tubule cells, proacinar cells and acinar cells - have been observed during the development of acini in the rat submandibular gland. The terminal tubules are lined by terminal tubule cells which show PAS-positive, dark granules. From the terminal tubules pouches develop which are lined by similar cells to those lining the terminal tubules. These pouches give rise to the next generation of terminal tubules. The last generation of terminal tubules, whose cells lose their dark, PAS-positive granules, develop into secondary tubules lined by proacinar cells. At 14 days of age large coarse granules appear in the cytoplasm of the proacinar cells lining the secondary tubules as well as in the cells of intercalated ducts. These granules are discharged into the lumen of the tubule and the proacinar cells become foamy-looking acinar cells, while the secondary tubule becomes an acinus. Thus the terminal tubule cells give rise to proacinar cells which become acinar cells and cells to the intercalated duct cells. The development of acini in the rat submandibular gland thus takes place in three stages: (1) development of terminal tubules by continuing pouch formation up to 12 days of age, (2) conversion of terminal tubules into secondary tubules tined by proacinar cells from 6 to 12 days of age, and (3) development of large coarse granules in proacinar cells and their excretion into the lumen of tubules, resulting in the transformation of proacinar cells into acinar cells between 14 and 21 days.


The collagen fibril organization in human articular cartilage. In this scanning electron microscopic study blocks of collagen fibrils were prepared from human articular cartilage, using two techinques which selectively removed either the proteoglycans alone, or both the proteoglycans and the collagen fibrils, of the non-calcified cartilage layer. Amino acid analysis of the fibrils confirmed the purity of the collagen after proteoglycan extraction. The cartilage was scanned in four different ways: (1) normal to the articular surface, (2) in superficial sections, (3) on surfaces of blocks which had been broken in planes parallel to artificial splits make by the insertion of a pin, and (4) on fracture surfaces which traversed the calcified cartilage and the subchondral bone. Five features of the organization of the collagen fibrils were specially noted: (1) Individual fibrils within the trabeculae joined to form small fibre bundles which became grouped into larger bundles at the calcified/uncalcified interface. (2) Fibrils in the deep and middle zones which, exhibiting the characteristic surface periodicity of collagen, were generally oriented towars the articular surface in large bundles approximately 55 micronm across. (3) In the superficial zone, fibrils ran parallel to the surface. (4) The surface fibrils had random orientation, even at the bases of empty lacunae vacated by chondrocytes during specimen preparation. (5) The collagen fibrils of the lacunar walls appeared to be thinner and more closely packed than thos between the lacunae. The fine collagen fibrils associated with the lacunar walls were frequently observed to pass through a large lacunar space, resulting in the formation of two or more compartments, each of which was presumably filled with a chondrocyte in the living cartilage.


Surface structure of tooth germs from newborn infants: a light and scanning electron microscopical study. Tooth germs from the mandibles of 5 stillborn infants were examined by scanning electron microscopy and light microscopy in order to investigate the surgace structure at different stages of mineralization. The surface of the completed enamel of the incisal third of the incisors was smooth, indicating that amelogenesis was at an end. The interface relief between ameloblasts and enamel matrix on the remaining part of the incisors, and on the forming cusps, was characterized by numerous deep pits caused by the Tomes' processes of the ameloblasts. When parts of the organic matrix were removed by sodium hypochlorite, the crystals were exposed as needle-shaped structures. Towards the bases of the cusps the pits gragually smoothed out, continuing as a narrow even surface zone corresponding to the first formed aprismatic enamel. In this zone circular holes 1 micronm were encountered which the light microscope studies showed were dentinal tubules passing into the enamel. At the bases of the cusps there was a rather abrupt demarcation toward a surface zone exhibiting countless slender villi. The light microscope observations indicated that these villi represented the first formed dentine after the basement membrane had disappeared.