DNA replication in the sex chromosomes of the pronghorn and the Rocky Mountain goat. The X chromosomes of the male pronghorn (Antilocapra americana) is larger than the "original" type and carries a large segment of late-labelling chromatin. The Y chromosome has a late-labelling segment that appears to duplicate synchronously with that of the X. Both chromosomes have segments that label throughout the period of observation; that the X is about 4.7% of the haploid complement and approaches "original" proportions. The X chromosomes of the Rocky Mountain goat (Oreamnos americanus) appear to be of the "original" type, without marked late-labelling regions, and the Y chromosomes is small. The structure and origin of extra-large sex chromosomes are discussed.


Supernumerary chromosomes in the black rat (Rattus rattus) and their distribution in three geographic variants. Supernumerary chromosomes have been examined in 352 black rats, covering three geographic variants, by use of conventional and C-band staining techniques. Metacentric supernumerary chromosomes, one to three in number, were found in Malayan black rats (Rattus rattus diardii), with 2n=42, in Indian black rats (R. rattus rufescens), with 2n=38, and in Ceylonese black rats (R. rattus kandianus), with 2n=40. The supernumeraries had similar morphology and stained heavily along their entire length by C-band staining. These findings suggested that the supernumeraries had originally developed in the Asian-type black rats and then were sequentially transmitted to the Ceylonese and Oceanian-type black rats, probably in southwestern Asia. A subtelocentric supernumerary chromosome found in one Japanese black rat seemed to have developed independently from the above metacentric supernumeraries.


The ratio of pulmonary arterial pressure to pulmonary vascular obstruction: index of preembolic cardiopulmonary status. The magnitude of embolic obstruction by pulmonary angiographic studies has been shown to be directly related to the hemodynamic status after pulmonary embolism in patients free of prior cardiopulmonary disease; however, in patients with prior cardiopulmonary disease, the hemodynamic status after embolism may be determined either by the preembolic hemodynamic status, the magnitude of embolic obstruction, or both. No reliable index has been available to help determine the relative roles of embolism and preembolic hemodynamic disturbances in the postembolic hemodynamic status. The present study suggests that the ratio of the mean pulmonary arterial pressure to the pulmonary angiographic obstruction may effectively distinguish those patients in whom pulmonary embolism is the primary determinant of the postembolic hemodynamic abnormality from those in whom the preembolic hemodynamic abnormalities play the dominant role.


The endocrinometabolic effects of beclomethasone dipropionate in asthmatic patients. The endocrinometabolic effects of the aerosol administration of beclomethasone dipropionate (100 microng four times daily) were evaluated in 20 asthmatic patients (11 corticodependent and nine noncorticodependent) during one month. In the noncorticodependent group, aerosol administration of beclomethasone had no statistically significant effect on the results of the glucose tolerance test and the plasma levels of insulin; there was a slight decrease in basal levels of cortisol, but the response of the cortisol level to administration of ACTH remained quite normal. In corticodependent patients, after substitution of aerosol therapy with beclomethasone for the oral therapy with steroids, the depression of adrenal function disappeared, usually quickly (in less than one month), whereas the abnormalities in the results of the glucose tolerance test persisted. Thus, at the dosage used, beclomethasone dipropionate might have minor systemic endocrinometabolic effects.


Peripheral pulmonary wedge angiography in chronic obstructive pulmonary disease. Relationship to pulmonary function, chest x-ray film, and hemodynamic data. Peripheral pulmonary wedge angiographic studies can investigate only limited areas of the pulmonary vascular bed; nevertheless, this technique is very useful in emphasizing the morphologic changes of small vessels (less than 1 mm in diameter) in pulmonary emphysema. The aim of this work is to determine the relationship between peripheral wedge angiographic appearances and pulmonary function, the chest x-ray film, and hemodynamic data in patients with chronic obstructive pulmonary disease. Three healthy subjects, four patients with type-A chronic obstructive pulmonary disease, and eight patients with type-B chronic obstructive pulmonary disease were studied. Among the tests of pulmonary function, only a marked reduction (less than 60 percent of predicted) of the diffusing capacity for carbon monoxide is always indicative of severe widespread emphysema. No relationship was found between hemodynamic data and peripheral wedge angiographic findings. Some agreement resulted between the chest x-ray film and peripheral wedge angiographic abnormalities only in patients with type-A chronic obstructive pulmonary disease; on the contrary, in patients with type-B chronic obstructive pulmonary disease, both false-positives and false-negatives were noted.


The metastatic spread of bronchogenic carcinoma in relation to the interval between resection and death. Information from autopsy was obtained for 125 men who had had lung cancer resected. Metastases were most common among men whose carcinoma was undifferentiated, while the prevalence among those with squamous cell carcinoma and those with adenocarcinoma was about the same. Among men whose cancers were of the latter two types, extrathoracic metastases were more common among men with adenocarcinoma than among those with squamous cell carcinoma. In 44 cases with postoperative death, metastases were found in 36 percent (16 cases). With the passage of time, the incidence of metastases rose rapidly to 85 percent (17/20) 6 to 11 months after resection. These data support the concept that metastatic disease is often present  at the time of diagnosis.


133Xenon washout patterns during diaphragmatic breathing. Studies in normal subjects and patients with chronic obstructive pulmonary disease. Studies of the washout of radioactive 133xenon were performed in six normal subjects and six patients with chronic obstructive pulmonary disease during normal and diaphragmatic breathing. Subjects were unable to change the distribution of ventilation with diaphragmatic breathing. In all normal subjects and in three of the six subjects with chronic obstructive pulmonary disease, overall washout improved with diaphragmatic breathing. It is suggested that this change was related to the slower, deeper tidal volumes used by these subjects during diaphragmatic breathing.


Pulmonary arteriovenous fistulas with pulmonary hypertension. Two cases of pulmonary arteriovenous fistulas associated with pulmonary hypertension occurring in young multiparous women are described. Both cases suggest the development of pulmonary arteriovenous fistulas subsequent to and as a consequence of the onset of pulmonary hypertension. Etiologic factors resulting in the development of the pulmonary hypertension in these patients, including the possible role of estrogens, are considered. The possible causal relationship of the pulmonary hypertension to the development of the pulmonary arteriovenous fistulas is discussed, and the importance of detecting the presence of pulmonary hypertension is stressed, since resection of the arteriovenous fistulas would be contraindicated in this situation.


Reproducibility of data on steady-state gas exchange and indices of maldistribution of ventilation and blood flow. The reproducibility of data on steady-state gas exchange and arterial blood gas levels was examined in 45 patients with similar pathophysiologic abnormalities (idiopathic scoliosis) by comparing the data obtained during two sequential periods breathing air. Comparison in all patients of 12 variables by paired t-test demonstrated statistically significant differences in the following three variables: the ratio of physiologic dead space to tidal volume (Vd/TV), the alveolar-arterial oxygen pressure difference (P[A-a]O2), and the arterial oxygen tension. By excluding four patients whose respiratory quotient was greater than two standard deviations from the mean value and one patient with a marked change in the pattern of ventilation, only the Vd/TV was significantly different (P less than 0.05). The range of the coefficients of variation was wide. The highest, which was for P(A-a)O2, was 18.8 percent; the majority were in range of 6 to 13 percent (minute ventilation, TV, frequency, oxygen consumption and carbon dioxide production, respiratory quotient, Vd/TV, dead space, and alveolar ventilation), and the coefficients of variation of partial pressure of oxygen and carbon dioxide in the arterial blood were, respectively, 3.6 and 3.4 percent.


Pericarditis mimicking tricuspid valvular disease. A patient with rheumatoid disease initially had the physical findings of isolated tricuspid stenosis. Postmortem examination demonstrated adhesive pericarditis with localized hemopericardium which compressed the atrioventricular groove in the area of the tricuspid valve. Historical, physical, electrocardiographic, and cardiac catheterization features which suggested the diagnosis are discussed.


Pseudo-tricuspid stenosis: a rare entity. A case is presented in which features of constrictive pericarditis and a pericardial pseudotumor coexisted. Preoperative cardiac catheterization revealed a gradient across the tricuspid valve. Exploratory surgery revealed a blood-filled cavity within the thickened pericardium overlying the right atrium and right ventricle and a normal tricuspid valve. After pericardiectomy, right cardiac catheterization revealed normal pressures and no gradients.


Acute tuberculous pneumonia.

Acute tuberculous pneumonia. A case of acute tuberculous pneumonia diagnosed by transbronchial biopsy is presented. We postulate that the unusually rapid progression was due to an exudative hypersensitivity reaction to aspirated tuberculoprotein.


Regional pulmonary function in scimitar syndrome. Analysis of regional pulmonary function distribution using radioactive 133xenon gas and eight scintillation detectors was performed in a patient with scimitar syndrome. Zonal ventilation per unit of lung volume within the slightly hypoplastic right lung was normal. The pulmonary blood flow to the lower right zone was significantly reduced due to aberrant systemic arterial supply to the right lower lobe. The 133xenon technique provides a simple nontraumatic method of evaluating the functional integrity of the right lung in this cardiopulmonary syndrome.


Treatment of allergic aspergillosis with triamcinolone acetonide aerosol. The successful management of a patient with allergic asperillosis with triamcinolone acetonide for one year is reported. This patient had been maintained previously on systemic attempt to withdraw systemic corticosteroids continuously for eight years. An initial attempt to withdraw systemic steroids after initiation of aerosol therapy was unsuccessful; however, following bronchoscopic removal of mucus plugs, the transfer to maintenance therapy with triamcinolone aerosol alone was uneventful.


Abnormal septal motion in cardiac tamponande with pulse paradoxus. Echocardiographic and hemodynamic observations. In a patient with cardiac tamponade and pulses paradoxus the echocardiogram showed markedly abnormal septal motion, consisting of posterior displacement during inspiration. This displacement resulted from an increase in right ventricular size and a decrease in left ventricular volume, not attributable to a change in position of the heart. The correlation of this finding with hemodynamic events showed that the inspiratory drop in arterial pressure followed septal displacement. These observations support the hypothesis that pulsus paradoxus may be caused by competition of the ventricles for  filling within a relatively rigid pericardial space. Displacement of the interventricular septum could be the mechanism by which this completition takes place.


Progressive hypereosinophilia with lung nodules due to thyroid carcinoma. An elderly woman had dyspnea, a thyroid mass and multiple lung nodules on chest radiographs. She developed hypereosinophilia over a three-month period in which multiple diagnostic procedures were performed, without definition of the disease process. At post-mortem examination, the primary lesion was found to be a poorly differentiated carcinoma of the thyroid, metastatic to lung. This is the second case of hypereosinophilia related to metastatic thyroid carcinoma. The intensity of the hypereosinophilia in this case was increased by the administration of thyroid-stimulating hormone and by the development of necrosis of the lung nodules.


Cavitation in large multinodular pulmonary disease a rare manifestation of sarcoidosis. Multiple large pulmonary nodules are an uncommon manifestation of sarcoidosis. Cavitation of these nodules has not previously been reported. An asymptomatic young white man had this unusual roentgenographic finding. Open-lung biopsy for diagnosis revealed noncaseating granulomata but did not elucidate the pathogenesis of the cavitation.


Biliary excretion of ampicillin: experimental and clinical study. The biliary excretion of ampicillin was studied in various conditions. Using an isolated perfused rabbit liver preparation, 4.1% of the amount of ampicillin added to the circulating blood (10 mg) was recovered in the bile where the maximum antibiotic activity (mean: 104 +/- microng/ml) was 4 times higher than in the serum (mean: 24.1 +/- 3.4 microng/ml). In man, provided with T-tube drain, the oral or intravenous administration of 500 mg ampicillin resulted in a biliary excretion of 0.10% of the administered dose. The biliary concentrations thus obtained equalled or exceeded for several hours the minimal inhibitory concentration of the organisms included in the antibacterila spectrum of ampicillin justifying thus the use of this antibiotic in the treatment of biliary tract infections. Per-operatory assays showed that in patients with gallbladder disease or with cystic duct obstruction, ampicillin levels in the gallbladder bile were markedly lower than in the common duct bile.


Fatty acid in cerebrospinal fluid of congenital hydrocephalus. In this presentation the analysis of fatty acid composition in cerebrospinal fluid (CSF), by gas-chromatography, in 40 cases of congenital hydrocephalus before and after shunting operation is discussed. Each fatty acid content was determined by the method which uses arachidic acid as an indicator. The total fatty acid value was found to be significantly higher than normal in the preoperative period in hydrocephalus. The concentration of the total and of the short chain fatty acids (less than C16) in the CSF was higher in the high ventricular CSF pressure group of hydrocephalic patients (above 150 mm H2O) than in the low pressure group. The concentration level of all these fatty acids in the CSF was higher in the cases showing poor prognosis than in those with good prognosis 3 weeks after operation.


Natural history of postparoxysmal hemiparesis in childhood. In a period of 4 years, 43 children with postparoxysmal hemiparesis (PH) were observed. Two of them had tumors, five Sturge-Weber's disease, and 36 were "primary". The natural history of these is as follows: PH appears more frequently in children than in adults, girls more frequently suffer from PH than boys. The seizure which precedes the PH is most frequently unilaterally clonic with loss of consciousness. PH lasts mostly between 1 h and 2 weeks and recedes slowly, the type is mostly of the deficitary or pseudoflaccid, and rarely spastic. EEG changes are, in the majority, focal. Most children with PH have got a positive case history of a prenatal, perinatal or postnatal disorder. It weems therefore that PH appears in children with an already disturbed brain structure. The type of hemiparesis points to a pure lesion of the corticospinal tract, which matures slowly and relatively late.


Growing skull fracture of childhood with reference to the importance of the brain injury and its pathogenetic consideration. It is recognized that the presence of a dural tear is essential in the development of a growing skull fracture. We present nine cases of growing skull fracture, stressing the importance of parenchymal injury beneath the skull and dural defects as pathogenic factors, and two cases which showed pathological conditions similar to those of growing skull fracture. According to our clinicla analysis, all of these cases followed head trauma in the first year of life. The area of cranial defect varied in size among the individual cases but was progressive in all instances. Convulsions were the most frequent symptom. With both radiologicla examinations and operative findings, it is recognized that dural tears and local cerebral injury are usually severe, and various localized ventricular enlargements are always found beneath the fracture. In many cases fibrous granulation was found filling in the bone defect and adhering to the contused cortex. The mechanism of the enlarged bone defect can be explained by classifying the lesions into three groups according to the type of tissue present: (1) granulation type; (2) cyst type, and (3) mixed type. Each type prevents the bone edge from spreading out, offering a suitable means to transmit mechanical pulsations of brain and cerebrospinla fluid. The formation of granulation tissue and dense scarring is an important factor in the growing skull fracture.


Ganglioneuroblastoma presenting as myasthenia gravis. Neuroblastoma is one of the most common malignant neoplasms in infants and children under 5 years of age. The commonest manifestations are abdominal masses or metastases. The case reported showed unusual manifestations as the presenting features simulated myasthenia gravis in all aspects. He was a child, aged 3 years, who was admitted because of generalized weakness, inability to open his eyes and lethargy. Radiography showed an oval opacity at the right upper zone of the chest. A thorocotomy was performed and a tumour was removed from the posterior mediastinum. Histopathology confirmed diagnosis of ganglioneuroblastoma. There is only one similar report in the medical literature.


Intracranial tumors of children.

Intracranial tumors of children. A report is made on 323 intracranial tumors of children reported to the Cancer Registry in Finland in 1958-1967. The most common sites were the cerebellum, cerebral hemispheres and brain stem. 54% of the tumors were in the posterior fossa. The most common histological types were medulloblastoma, cerebellar astrocytoma and ependymoma. The incidence on the basis of this series was 2.4/10(5)/y. The general outlook for intracranial tumors in childhood was not very good. After a follow-up time of from 5 to 16 years, 31% of the patients were alive. The best prognosis was in cerebellar astrocytomas and cerebral spongioblastomas. In some tumors of the thalamus and third ventricle remissions for over 10 years were achieved by shunt and radiotherapy alone.


Subdural effusion: results after treatment with subdural-pleural shunts. In an unselected material of 22 consecutive patients subdural effusion, which did not respond to repeated taps, was treated with subdural-pleural shunt operation using nonvalve silicone catheters. After a mean follow-up time of 3 years 4 months, 17 patients (77%) were mentally and 15 patients (69%) neurologically normal. The results are certainly not worse than results achieved with craniotomies and membranectomies. A shunt operation is more simple and less hazardous than membranectomy and we agree with the opinion that the latter is an obsolete procedure in the treatment of persistent subdural effusions.


Gamma-encephalography in the diagnosis of subdural effusions in infancy and childhood. The results of the use of gamma-encephalography (GEG) as a diagnostic tool in a group of 28 patients with subdural effusions and 46 membranes confirmed at surgery are presented. 27 patients were submitted to bilateral surgical expolorations and 1 was unilaterally explored. Positive GEG: membranes were present in 34, in 8 the test was nonconclusive and there were 4 false-negatives. Negative GEG: membranes were absent in 6, 1 case was nonconclusive and 2 were false-positive tests. Therefore, from 28 patients with 46 membranes the GEG was correct in two thirds of the cases, it was nonconclusive in 9 cases and the image did not confirm the surgical findings in 6 cases (false-positive or false-negative). The results suggest that the presence of a medium or thick membrane almost always results in a positive image, whereas the presence of a thin membrane leads to a nonconclusive result or in some cases a false-negative one. The general data from the literature correlates well with the present series.


Role of computerized axial tomography in diagnosis, treatment and follow-up of hydrocephalus. Preliminary communication. The authors have summarized their experience in the application of computerized axial tomography to the overall management of hydrocephalus.


Sphenoethmoidal encephalocele: a case report with review of the literature. A rare case of sphenoethmoidal encephalocele with detailed pathological studies is reported. Only a few cases have been documented and were reviewed. The etiology and embryology of the congenital malformation remains speculative with an agreement on their development at an early embryonic stage. The mass presenting in the nasopharyngeal cavity remains often undetected unless causing respiratory embarrassment and is frequently misdiagnosed. Thorough radiological investigations detect the bone defect and outline the extent of the herniated mass and associated cerebral abnormalities. Small lesions have been successfully repaired. Larger ones prove less amenable to surgery and carry a high mortality.


Intracranial ependymomas in children: a review of 43 cases. 43 cases of intracranial ependymomas in children 0-13 years of age have been reviewed with attention given to various clinical aspects, including location, age, duration of history, signs and symptoms, and plain skull film abnormalities. 39 of the patients were treated by intracranial surgical procedures and 30 of these also had radiation therapy. Three patients had needle biopsy only and one died without treatment. The survival rate was below that anticipated and in part felt to be related to the frequent occurrence of malignant tumors in this series.


Spontaneous occlusion of an intracranial arteriovenous malformation. The case of a 2-month-old girl is described in whom an arteriovenous malformation (AVM) was observed in the paramedial region of the right cerebral hemisphere associated with an arachnoid cyst in the right fronto-parieto-temporo-occipital region. The only treatment was evacuation of the arachnoid cyst by trephination. When the child was 3 years old, images of the AVM were not found although all the intracranial vessels were angiographically explored. It is considered that the reduced pressure in the right cranial cavity due to the drainage of the arachnoid cyst may contribute to the occlusion of the AVM by causing a slight displacement of the intracranial structures towards the side of the drained cyst.


[Dynamics of blood coagulation disorders in traumatic-hemorrhagic shock]. Blood clotting tests in 55 polytraumatized patients showed that a lapse in the hemostatic potential may already occur at a very early stage of the traumatic-hemorrhagic shock. The extent of these changes which are complex in their pathogenesis, is closely related to the degree of injury. Coagulation-analysis control of the development shows clearly that shock treatment and maintenance of adequate circulation, starting at the earliest possible moment at the scene of the accident, are important for spontaneous recompensation of the hemostatic defect.


[Intra-abdominal hemorrhage as rare complication of a Meckel's diverticulum. A case report]. A case report of hemoperitoneum following perforation of Meckel's diverticulum as a rare complication is presented. Symptoms and diagnostic problems are discussed.


[Pathogenesis, diagnosis and therapy of the dumping syndrome]. The dumping-syndrome is a severe complication of gastric surgery after operations which destroy or weaken the sphincter mechanism of the pylorus. The pathogenesis involves the release of kinins, the triggering of neurogen reflex mechanisms by distending the jejunum, the massive flow of fluid in jejunal lumen, the loss of the reservoir function of the stomach, and, possibly, the pathologic release of gastrointestinal hormones. Preoperatively, intensive diagnostic efforts are necessary, which must include a psychiatric check-up. For surgical treatment several modifications of reversal operations from Billroth II to Billroth I with reconstruction of duodenal passage have been developed. Our own modification includes, beside testitution of the duodenal passage, the construction of a gastric pouch.


[Possible significance of prostaglandins in the pathogenesis of Crohn's disease]. Prostaglandins (E1, E2, F2alpha) produce and intensify peristaltic contractions in the healthy human intestinal muscle system according to dosage (threshold I-10(-4) microng/ml--maximum effective concentration 1 microng/ml). By subsequent introduction of adrenaline, the intestinal muscle system activated by prostaglandines can be completely relaxed again. Intestinal muscles from patients with Crohn's disease show a marked deviation from this behaviour: 1. The intestinal muscle system is extremely sensitive to prostagladins: maximum concentrations are already reached by about a thousand times smaller concentration than in the intestines. 2. The dose of adrenaline does not lead to dialtion, which is usual, but to contraction of the muscle system. These changes in the contractility of the intestine can explain some components of the clinical symptomatology of Crohn's disease.


[Secondary retroperitoneal fibrosis of scars following rectum exstirpation]. Ureteral abnormalities following excision of the rectum are similar to those found in retroperitoneal fibrosis. Their frequency is surprisingly high (45 out of 53 patients under close supervision approximately equal to 85%). Medial deviation of the lumbar ureter was regularly encountered on one or both sides (most pronounced at L5). Narrowing of the lumen occurred in 31 patients combined with impaired urinary excretion in 12 cases, among these hydronephorosis in 2 cases. As reason for this secondary retroperitoneal fibrosis the retarded healing of the sacral cavity has mainly to be considered. Furthermore, the surgical trauma itself seems to be of importance in this regard. Following surgery for cancer differential diagnosis of ureteral abnormalities should include malignant retroperitoneal infiltration.


[Urologic complications od chronic inflammatory intestinal diseases]. The three most common inflammatory diseases of the bowel, colonic diverticulitis, regional enteritis and ulcerative colitis, involve the bladder or ureter in the advanced stage in about 10%. The colovesical fistula is found more frequently with diverticulitis and less often with regional enteritis, which penetrates predominantly from the ileum into the bladder. On the other hand, if an ureteric stenosis develops, it will be caused on the right side mainly by regional enteritis and on the other side by ulcerative colitis. The vesicointestinal fistulae will close without sequelae after resection of the involved bowel segment. However, the ureteric stenosis will often be followed by nephrectomy despite bowel resection and ureterolysis, if the operation is not undertaken early enough. Frequent rechecks with infusion urography should help to prevent this. Nephrolithiasis, amyloidosis, and a contracted bladder are futher, yet less common complications of chronic inflammatory disease of the bowel.


[Auditory canal hemorrhage as a symptom of mandibular trauma]. Auditory canal hemorrhage is usually a sign of a basal skull fracture. It is commonly unknown that this sign can also be a symptom of combined fracture of the external auditory canal and the mandibular condyle. In our investigations of patients with maxillofacial injuries we found in 15% of 197 fractures of the mandibular condyle within 3 years this combination. In sequence of these results there is a differential diagnostic need for an exact investigation to clear up these various causes in each case as first step toward an accurate therapy. The mechanism of these fractures, their etiology, and therapy are discussed with special reference to possible complications.20


[Pharmacokinetics of methylmethacrylate monomer of bone cements: method for qualitative and quantitative monomer determination in respiratory air]. The methylmethacrylate-monomer deported into circulation from bone cement implantation during endoprothetic operation is subject to unaltered exhalation. Qualitative evidence of monomer excretion in the exhaled air is established in animal experiment. The quantitative determination of monomer in the exhaled air in man undergoing hip-joint replacement are stated and the method is demonstrated. Pharmacocinetically exhalation has priority over metabolisation.


[The unrecognized thyroid neoplasm].

[The unrecognized thyroid neoplasm]. During the last 10 years the authors operated upon 8 patients with illnesses beginning with different lung alterations. In all cases the basic illness was a papillary or papillo-follicular cancer of the thyroid gland which later was found indirectly after other operation and histologic examination. By evaluation of clinical symptoms, operative and morphologic findings conclusions as well as the results of reexamination the authors draw conclusions as to the biological attributes of this tumor type. They recognize that the carcinomas of the thyroid gland cause metastases of regional lymph nodes or distant lung metastases approaching the TO stage. Lung metastases appeared in different shapes and were in all cases the fist clinical sign of the basic illness. Considering the biological attributes of this tumor the authors emphasize that it is not inoperable or untreatable.


[Problems of the so-called spontaneous intestinal perforation]. Among 250 cases of perforation of the large and small bowel during the past 5 years there were 11 patients in whom the cause of the perforation was not clear at first and which were labeled spontaneous. After thorough investigation a satisfactory explanation for the perforation of the apparently normal bowel could be given for all patients. The most frequent causes were distention of the bowel wall, particularly of the cecum, and ischemic enterocolitis. We consider the incidence of really spontaneous bowel perforations very unlikely.


The dilemma of pilonidal disease: pilonidal cystotomy, reappraisal of an old technique. A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed. One hundred twenty-four were treated using local anesthesia with supplemental diazepam or Innovar. Most patients spent only three days in the hospital, with healing occurring in less than two months. Recurrences occurred in 20.9 per cent of the patients. The recurrences were treated by office procedures in all but one instance. Most patients were pain-free and back to work within two weeks after operation.


The importance of the perianal connective tissue in the surgical anatomy and function of the anus. The anatomy of the perianal connective tissue has been reviewed. The most important element is the conjoined longitudinal coat, the axis of the connective-tissue system. Fibers of the longitudinal coat penetrate the internal and external sphincter, interlacing with each other as well as the perimysium and endomysium and forming a fibroelastic network. The fibers and bundles of the internal and external sphincters lie in the meshes of this network with innumerable attachments to it. The fibroelastic network continues through the perianal fat to the pelvic wall and is connected to the lower levator fascia and the perianal skin, insuring the firm anchoring of the anus. During sphincter contraction the fibroelastic network moves together with the sphincters. Thus, the sphincter function is the integration of the contraction of the muscle fibers attached to the web. The elastic elements of the network pull the anal canal slightly apart, but the muscle tone overcomes this and keeps the anus closed. Surmounting the elasticity of the web causes the muscle function to be elastic as well. Surgical procedures such as stretching, transecting the sphincters, whether sharply or gradually, can lead to scar formation with loss of elasticity or mobility in that part of the sphincter and secondary impairment of function.


Volvulus of the colon.

Volvulus of the colon. We have reviewed the records of 48 patients who had colonic volvulus. Volvulus occurred in the sigmoid colon in 27 (56%) and in the right colon in 19 (40%). Volvulus elsewhere in the colon is rare, requiring unusual anatomic circumstances of a long mesentery and a mobile colon. The clinical history is characterized by a long history of bowel dysfunction followed by an episode of acute intestinal obstruction. The patient is often aged and is plagued by mental disorders and a number of degenerative diseases. Distention of the abdomen is the most significant finding, and tenderness may indicate peritonitis due to ischemic changes in the bowel. Three-positional films of the abdomen are most valuable, showing great distention of the colon and air-fluid levels in the bowel with regularity. Barium-enema studies will more accurately reveal the site and nature of obstruction. The barium-enema examination must be done carefully. It is omitted when peritonitis is present. Operative treatment is necessary for volvulus of the right colon. Non-operative reduction is effective for nonstrangulating volvulus of the sigmoid colon as an emergency procedure. Sigmoidoscopic examination and insertion of a long rubber tube will give dramatic relief to a substantial number of patients. Operative intervention is necessary when conservative measures fail. When gangrene is found at operation, exteriorization resection of the colon may be life-saving. Elective resections are recommended for patients who are in otherwise good health in order to prevent recurrences. The mortality rate in this series of 48 cases was 12.5 per cent. Cecal volvulus was present in each of the six patients who died. Sepsis and cardiopulmonary diseases were common in patients who died.


Pilonidal sinus: a claim for simple track incision. Ninety-six patients treated surgically for pilonidal sinus were examined in a two-part study. In the first part, 36 patients were randomly allocated according to the surgical techniques employed: marsupialization, incision, and excision without primary closure. Healing times and recurrences a year after operation were studied. The healing times of patients treated by excision were longer in comparison with those treated by incision or marsupialization. The recurrence rates were similar for all techniques used. In the second part of the study 60 patients were randomly allocated according to times of returning to work. Twenty-nine of these patients returned to work before their wound healed; 31 resumed work a week after epithelization of the wound. The wounds healed more quickly in patients who started working before they were closed. Incision of the sinus track, carried out using local anesthesia in the outpatient clinic, allowed the patient to return to work without pain sooner.


Early identification of alcoholism in Navy psychiatric outpatients. This study compares Navy outpatient alcoholics, inpatient alcoholics, and a general outpatient psychiatric population on a number of demographic and clinical variables. Compared to inpatients, the outpatient alcoholics were younger, more often married, and were more frequently given favorable discharges. Compared to nonalcoholic outpatients, the outpatients were older, had lower socioeconomic origins, and were more often given favorable discharges. The characteristics of outpatient alcoholics are discussed, and an attempt is made to lay the groundwork for early case finding and prevention of alcoholism in the service.


Deficits in the regulation of ethanol intake by alcoholics. In an appropriate experimental paradigm, loss-of-control drinking can be demonstrated when an individual consumes sufficient ethanol over time to cause his blood alcohol level (BAL) to rise progressively above a previously established, designated range. For this study, 10 alcoholics were exposed to a training session and provided accurate feedback of their blood alcohol level at ten 15-minute intervals. On following days, they were then exposed to three exposed to three experimental sessions during which they were instructed to maintain their BAL within the established training session range by relying primarily on interoceptive cues. The experimental sessions were characterized by distorted or no feedback concerning blood alcohol levels as the basis for drinking-decision behavior. The results indicated that 60% of alcoholics displayed loss-of-control (LOC) (by our criterion) in a least one session, the greatest percentage in the "No Feedback" session. The results were interpreted to support our theory of a neurophysiologic feedback dysfunction associated with LOC drinking.


Successful treatment of a benign solitary rectal ulcer by temporary diverting sigmoidostomy: report of a case. A rare case of a solitary benign rectal ulcer in which conservative medical therapy was unsuccessful is described. Diversion of the fecal stream by temporary sigmoidostomy resulted in rapid healing of the ulcer. This entity presents diagnostic and therapeutic problems, which are discussed. The use of temporary sigmoidostomy in such cases is recommended.


Dizziness, epilepsy and the EEG.

Dizziness, epilepsy and the EEG. EEGs were done on 97 patients with the complaint of dizziness and were compared to a normal control group. In patients with dizziness of a syncopal-like type there was a small but significant increase in the incidence of bitemporal sharp wave discharges. Another group, consisting of 48 patients with seizures was evaluated; 71% had noted dizziness, significantly more than a control group. Most seizure patients experienced dizziness as a syncopal-like sensation with an abrupt onset just before their clinical seizures. The majority also experienced identical episodes of dizziness unassociated with their seizures, possibly as an abortive epileptic phenomenon. Dizziness described as rotational (vertigo) was uncommon in these epileptics.


Determinants of placement outcome in the Foster Community Project. The Foster Community Project was established to reintegrate chronic psychiatric patients into the community through the combined efforts of the hospital staff, the patients and the citizens of two rural Missouri towns. Data collected over a seven year period was analyzed in order to determine which factors were associated with successful community adjustment following long term hospitalization. Results indicated that length of premorbid functioning, sex, and level of social functioning differentiated successful from unsuccessful participants. Additionally, Foster Community patients were older and had generally been hospitalized longer than patients who did not complete the program. Implications for future research and rehabilitation plans are given.


Does the sex of the psychiatrist influence attitudes toward the patient's family? The authors sought to verify the hypothesis that the physician's sex would influence the evaluation of the parents of this patients. Based on a study of the case histories of 100 male and 100 female patients who were examined with equal frequency by male and female physicians, the authors conclude that no significant differences are demonstrated by this investigation.


Calcium metabolism in amyotrophic lateral sclerosis. Calcium metabolism was studied prospectively in 12 patients with amyotrophic lateral sclerosis. Two patients showed mild hypocalcemia, malabsorption of calcium, and elevated plasma parathyroid hormone concentrations. Serum 25-hydroxyvitamin D was decreased in one and low-normal in the second. These two patients and a third showed aminoaciduria on thin layer chromatography. Calcium metabolism was apparently restored to normal by dihydrotachysterol, a vitamin D analog, but no improvement in neurologic function resulted. Bone radiographs taken in search of metabolic bone disease showed a significant increase in the incidence of congenital vertebral anomalies in the ALS patients (50% versus 8%). The relationship of the abnormalities in calcium metabolism and in vertebral structure to the etiology of motor neuron disease is not known.


The L-D Trend Oriented Psychiatric Record. A sixty-five item psychiatric inventory was developed to comply with the requirements for trend oriented medical record keeping for psychiatric patients. The inventory is set in a clinically practical format, and severity rating allow for the ojectification and standardization of clinical data. A preliminary study indicated high interrater reliability and interrater agreement. A description of the L-D Trend Oriented Psychiatric Record, instructions for its use, and its relative advantages for clinical and research purposes are presented.


Conjunctival melanoma, a retrospective study. During the period 1954 to 1974 inclusive, fourteen patients with melanoma of the conjunctiva were observed in the Department of Ophthalmology, University of Amsterdam. Frequency, etiology and treatment are discussed. No statistically proven conclusions may be drawn from this investigation; not at any rate, in regard to the treatment due to lack of homogeneity of the approaches used in recent years.


Structure alterations and the spectral law of light diffusion during corneal edema. The quantity D of light scattered by a layer is proportional of the n th power of the wavelength. This has been checked with five rabbit corneas at different stages of hydration and the corresponding values of n have been calculated. It appears that, during the progress of edema, D and n remain connected through the linear relation:n=aD+b. The constants a and b are determined as well as the correlation coefficients. That physical link between n and D throw a light on the nature of ultra-structure alterations occuring in the edematous stroma.


Effect of visual environment on refractive error of cats. 33 eyes of 18 cats raised in cages or in small rooms under conditions of near vision were compared with 22 eyes of 11 street cats. Refraction of the caged cats showed that three quarters of them were myopic (average:-0.8 D) while 87.5 percent of the street cats were hypermetropic (average: +1.4 D). The antero-posterior diameter was practically equal in both groups (20.4 mm) and in both myopic and hypermetropic eyes. The site of the permanent refractive changes is suggested to be the lens.


[Familial asymmetrical septal hypertrophy with and without obstruction: clinical findings in patients with echocardiographically confirmed diagnosis (author's transl)]. Obstructive and non-obstructive asymmetrical septal hypertrophy (ASH) is a relatively common disease which has no characteristic clinical symptoms. In only 14 of 71 patients in whom the diagnosis had been confirmed echocardiographically had it been possible to make the diagnosis by clinical means alone. Most of the patients had no specific clinical symptoms (angina, dyspnoea, systolic murmur, non-specific ECG changes) indicating a cardiomyopathy. Every patient with such uncharacteristic signs should therefore be studied by echocardiography in order to exclude ASH. In 17 patients there were no clinical symptoms at all, the diagnosis being made entirely by echocardiography.


Evidence against a role for prolactin in osmoregulation in the rat: water balance studies. Adult rats were subjected to hydration and dehydration experiments. Blood samples were obtained via indwelling jugular cannulae or after rapid decapitation. In the experiments attention was given to the avoidance of stress. Intravenous infusion with 5 ml distilled water in 50 minutes in males and lactating females did not affect the plasma prolactin (PRL) concentration, although it caused a significant drop in plasma osmolarity. Dehydration obtained by injecting furosemide, while resulting in a marked increase in plasma osmolarity, had no effect on the plasma PRL level in male rats. Thirst experiments for 2, 3 and 4 days, which likewise caused a rise in plasma osmotic value, had no significant influence on plasma PRL. It is concluded that PRL in the adult rat is not important in water retention or for the regulation of plasma osmolarity.


Subcutaneous melatonin implants inhibit reproductive atrophy in male hamsters induced by daily melatonin injections. Daily afternoon (at 7 p.m.) injections of melatonin (25 microng in oil) into adult male hamsters for 50 days led to atrophy of the testes and accessory sex organs (seminal vesicles and coagulating glands) and in a significant depression in pituitary LH and prolactin content and concentration. These actions of melatonin were prevented if the animals had been pinealectomized before the daily melatonin injections were begun. Likewise, if hamsters received a weekly subcutaneous implant of melatonin in beeswax (1 mg melatonin in 24 mg beeswax) the daily melatonin injections failed to inhibit the growth of the reproductive organs and to depress pituitary LH and prolactin levels. Beeswax by itself had no such effect.


Progestins of mink gestation: the effects of hypophysectomy. Progesterone and 20alpha-hydroxypregn-4-ene-3-one (20alpha-ol) were determined from plasma samples taken weekly beginning 10 - 18 days before implantation in Pearl variety mink. Progesterone was low ( less than 8 ng/ml) until approximately five days prior to implantation when it increased and remained elevated (congruent to 30 ng/ml) through the early portion of postimplantation pregnancy. A subsequent decline was observed toward parturition. Mean concentrations of 20alpha-ol were relatively constant through gestation with a trend toward a greater proportion of progestin represented as 20alpha-ol during the preimplantation delay. Hypophysectomy prevented implantation, reduced progesterone levels and increased the concentration of 20alpha-ol relative to progesterone in plasma. These data suggest that prolactin (PRL) is a component of the luteotrophic complex in mink. Further, the corpus luteum of delay requires hypophyseal support for normal function.


The relationship of cortisol and cortisone to saturated lecithin concentration in ovine amniotic fluid and fetal lung liquid. Cortisol and cortisone concentrations in ovine amniotic fluid and fetal lung liquid were analyzed with respect to gestational age and fetal lung maturation as reflected by saturated lecithin concentration. In amniotic fluid, the cortisol concentration rises as a function of gestational age while that of cortisone falls (P less than 0.001). The ratio of cortisol/cortisone is significantly related to gestational age (r=0.693, P less than 0.001), and shows an even stronger correlation with saturated lecithin concentration (r=0.832, P less than 0.001). When examined independently of gestational age, the correlation of the cortisol/cortisone ratio to saturated lecithin concentration remains highly significant (r=0.641, P less than 0.001). Similar findings were observed in fetal lung liquid, except that in this fluid both the saturated lecithin concentration and the ratio of cortisol/cortisone are significantly higher than simultaneously determined values in amniotic fluid. These observations provide further evidence that the process of fetal lung maturation is closely linked to the fetal hormonal milieu.


Increased RNA polymerase activity in isolated liver nucleoli from thyroidectomized rats treated with triiodothyronine. In isolated liver nucleoli from thyroidectomized rats the activity of the two RNA polymerase I populations, one of which is active and the other inactive towards the endogenous chromatin template, is greatly enhanced 10 and 24h after a single ip injection triiodothyronine (T3). When the nucleolar enzyme is solubilized and assayed with exogenous DNA as template, it retains, after T3 treatment, the same increase in activity as observed in intact nucleoli. On the contrary, the template availability, as judged by the binding capacity of isolated nucleoli for [3H]actinomycin D, does not appear to be modified by the hormone. These observations support the conclusion that the enhanced nucleolar RNA synthesis following T3 administration is due to an increased activity of the RNA polymerase I itself rather than to a greater availability of ribosomal RNA cistrons. The hormonal stimulation of both nucleolar RNA polymerase activities depends on continuous protein synthesis since it is almost completely abolished by the administration of cycloheximide.


Preparation of bio- and immunoactive human prolactin in milligram amounts from amniotic fluid in 60% yield. Bio- and immunoactive human prolactin (hPRL) was isolated from amniotic fluid. The overall yield is a single passage through the procedure was 60%; 5 liters of amniotic fluid (10 mg hPRL) yielded 3 mg (30%) of a mixture of hPRL isohormones A, B (both minor), C and D (both major), and less than 10% contamination with extraneous protein. A further 3 mg hPRL was less highly purified. Two mg hPRL was recycled. The product has been stable for at least 1 year at--70 C, suitable for iodination, and gave rise to RIA dose-response curves indistinguishable from those obtained with pituitary hPRL. The isolated hormone, after stoichiometric iodination, is active in binding to both mammary gland and liver cell membrane receptors and exhibits a biological activity, in the local pigeon crop-sac assay, of 47.3 +/- 6.1 IU/mg. The isolation procedure consisted of 3 steps: 1) hollow-fiber dialysis to concentrate amniotic fluid; 2) gel filtration on Sephadex G-50 to remove bulk contaminants; 3)isoelectric focusing in a density gradient, taking advantage of the elevated isoelectric points, relative to contaminants, of hPRL isohormones (6.0-6.5, corrected). Production of this preparation, carried out on two separate occasions, required each time 3 months of a single investigator's time, inclusive of assay work.


Enhanced thyroxine metabolism and high uptake goiters in rats after a single dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Nine days after treatment of rats with a single dose (25 microgram/kg) of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the 1 h biliary excretion of [125I]-thyroxine (T4) was increased 4-fold and the [125I]T4 bile:plasma ratio and the biliary clearance rate of plasma [125I]T4 were increased 10-fold. The proportion of biliary 125I present as T4-glucuronide was larger in TCDD-treated rats. Unexpectedly, TCDD did not influence the 30 min biliary excretion of [125I]triiodothyronine (T3), the [125I]T3 bile:plasma ratio, and the biliary clearance rate of plasma [125I]T3. TCDD also elevated serum thyrotropin concentrations, produced goiters and increased thyroid 131I uptake. Serum T4 concentrations were reduced to half of normal in TCDD-treated animals, but their serum T3 levels were elevated. Sephadex uptake of serum [125I]T3 was reduced in the TCDD group.


The site of insulin resistance after injury. Intracellular glucose concentrations in skeletal muscle have been measured in normal and injured rats individually infused with 51Cr-EDTA as an extracellular space marker. In normal rats, even when infused with glucose at a high rate, membrane transport appeared to be the rate-limiting step in glucose utilization by muscle. After injury the concentration of intracellular glucose was increased, and positively correlated with that in plasma, showing that the loss of sensitivity to insulin after injury is due to impairment of an intracellular metabolic step.


Effects of peptide anabolic hormones on growth of myoblasts in culture. The roles of growth hormone and somatomedin in stimulating muscle cell proliferation were investigated in a series of experiments on myoblast growth in culture. At levels 100 times normal circulating concentrations, neither growth hormone nor insulin stimulated growth of rat muscle cells in serum-free medium. In contrast, Temin's Multiplication Stimulating Activity (MSA), a close biological and chemical analog which served as a somatomedin surrogate in this study, was active at concentrations corresponding to the reported circulating levels of the somatomedins; MSA gave consistent stimulation of myoblast proliferation, protein accumulation, and [3H]thymidine incorporation by rat myoblasts and by Yaffe's L6 myogenic cell line. (The unreliability of [3H]thymidine in corporation as a quantitative assay for mitogenic activity is illustrated.) Addition of insulin at physiological concentrations and at the very high levels often used to stimulate cell growth did not enhance the effects of MSA on myoblast proliferation; effects were barely additive. We interpret these results to support earlier indications from studies on diaphragm muscle that the somatomedins are physiologically important mediators of the growth-promoting actions of growth hormone in muscle.


Role of rate of change of glucose concentration as a signal for insulin release. In the isolated perfused pancreas, the amount of insulin secreted in response to a glucose stimulus was evaluated as a function of the maximum rate of change of the stimulus. Range of glucose concentration, total amount of glucose, total duration of the changing stimulus, the average concentration, and the average rate of change of concentration were the same. Fast changes stimulated more insulin secretion than slow changes, indicating that the rate-sensor property was inherent in the control of insulin release.


Stereoselective inhibition of cholesterol side chain cleavage by enantiomers of aminoglutethimide. Because aminoglutethimide is a potentially important drug in the treatment of certain maligancies as well as fertility control, its stereoisomers were studied for binding to corpus luteum mitochondrial cytochrome P-450 and inhibition of cholesterol side chain cleavage. The binding affinity, determined from induced spectral changes, is 2.6 times greater for the d- than for the l-isomer. In the enzyme assay, the d-isomer is 2.5 times more potent as an inhibitor of cholesterol side chain cleavage than is the l-isomer. The extent of inhibition and the change in the absorptivity of the P-450-inhibitor complex are linearly related for both chiral and racemic forms. Thus, the active center of the enzyme is stereoselective for the enantiomers of aminoglutethimide.


Characteristics of pituitary colloid proteins and their correlation with blood pressure in the rat. Salt resistant rats (R-strain of Dahl) accumulate large amounts of colloid in the pituitary cleft. Such colloid is largely absent in pituitaries of salt susceptible rats (S-strain of Dahl). Polyacrylamide gel electrophoresis of pituitary cleft colloid from R rats shows 4 proteins, designated R1, R2, R3 and R4 in order of decreasing electrophoretic mobility. These proteins have apparent molecular weights of 52,000, 63,000, 130,000 and greater than 235,000, respectively. Their apparent isoelectric points as determined by preparative isoelectric focusing are 4.82, 5.02, 5.54 and 4.35, respectively. Ferguson plots for R1, R2 and rat albumin suggest that R1 and R2 are size isomers of albumin. The molecular weights of R2, R3 and R4 suggest that R2 may polymerize to form a dimer and tetramer. Chronic feeding of 8% NaCl diet for 6 weeks does not influence pituitary accumulation of R1 protein in either R or S rats. Pituitary R1 accumulation does, however, segregate with resistance to salt-induced hypertension in genetic experiments. This strongly suggests that the accumulation of R proteins in the pituitary cleft reflects some genetically controlled change concerned with control of sodium metabolism.


LH concentrations in human maternal and cord serum. Maternal blood and umbilical cord venous blood were collected immediately after delivery in 32 subjects who had completed normal birth during the 38 to 41 weeks of pregnancy, and the concentrations of human chorionic gonadotropin (hCG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were determined by radioimmunoassay (RIA). The specific LH RIA utilized for the measurement of LH is unaffected by hCG at sample levels as high as 500 IU/ml. HCG concentrations were 10,370 +/- 1,480 mIU/ml (mean +/- SE) in mother's serum and 34.5 +/- 5.2 ml in cord serum, while LH concentrations were 0.729 +/- 0.055 and 0.438 +/- 0.033 ng/ml, respectively. The concentration of all 3 gonadotropins in maternal serum was greater than cord serum and the ratio was markedly high with 302:1 for hCG, while the ratio was smaller for LH, being 1.7:1, while that for FSH was 4.2:1. There was no difference in the levels of LH and FSH in relation to the sex of the fetus.


Effect of acute exposure to cold on the levels of corticosterone and pituitary hormones in plasma collected from free conscious cannulated rats. To investigate the initial response of the pituitary and adrenal cortex functionings of rats acutely exposed to cold, we developed a technique for cannulation which allowed sequential blood collection  from conscious and freed rats. Two cannulae were inserted, one into the carotid artery used for collection and the other into the femoral vein for blood transfusion to keep the blood volume constant. Significant increases in plasma corticosterone and thyrotropin were evoked within 15 min after exposure. While plasma growth hormone (GH) slightly decreased, and the prolactin level tended to fall by 1 hr after cold exposure but the difference was not significant as compared with control values.


Alpha-subunit of human chorionic gonadotropin in fluid of molar vesicles. Sera and fluid in molar vesicles from 4 patients with hydatidiform mole were analyzed for hCG and its subunits. These samples were initially chromatographed through a standardized Sephadex G-100 upward column. Starting materials and each fraction on gel filtration were radioimmunoassay in homologous hCG, hCG-alpha and hCG-beta assays. The specimens obtained from 4 patients contained primarily hCG and little hCG-beta. Immunoreactive hCG-alpha was barely detectable in sera but was clearly demonstrated in vesicle fluid from molar patients. This immunoreactive hCG-alpha was combined with [125I]hCG-beta. The combined protein, [125I]hCG and [125I]hCG-beta recombined with urinary hCG-alpha were concentrated in the superovulated rat ovary in vivo. However, [125I]hCG-alpha and [125I]hCG-beta were not taken up by the ovaries. The biosynthesis of hCG-alpha are discussed.


Endocrine control of the intestinal calcium excretion. Calcium excretion from rat intestine was measured by placing distilled water in an intestinal loop in situ and measuring the calcium content after various intervals. More calcium was excreted from the intestine of 18-month-old rats than that of 1-month-old rat. Acute hypocalcemia failed to change the intestinal calcium excretion significantly. Parathyroidectomy decreased intestinal calcium excretion and administration of Parathyroid Extract reversed it. Renal damage produced by injection of Na-sulfacetylthiazole increased the intestinal calcium excreation but dihydrotachysterol reversed it. Gastrin at 200 microng/kg increased the intestinal calcium excretion. Calcium excretion, like calcium absorption, appears to be controled by various endocrine factors and the method of intestinal loop in situ appears to be useful to study the part played by these factors.


Age-dependent change of serum 5alpha-dihydrotestosterone and its relation to testosterone in man. Serum 5 alpha-dihydrotestosterone (DHT) and testosterone (T) were measured in 78 normal men aged between 12 and 89 years, separating DHT and T by celite micro-column and using reliable radioimmunoassay. In four age groups of young (20-39 years), middle aged (40-59 years) and old (60-79 years and 80-89 years) men, the mean +/- SEM for serum DHT were 98 + 12, 91 +/- 9, 82 +/- 7 and 54 +/- 15 (ng/100 ml), respectively. The corresponding values for T were 696 +/- 27, 698 +/- 18, 624 +/- 20 and 457 +/- 21 (ng/100 ml). DHT and T showed significant correlation in each age group: r = 0.625, p less than 0.05 (young men), r = 0.727, p less than 0.02 (middle aged men), r = 0.673, p less than 0.05 and r = 0.734, p less than 0.02 (old men), respectively. There was a significant decline in DHT and T levels of 80- to 89-year-age group compared those of 30- to 39-year-age group (p less than 0.05 and p less than 0.005 respectively). But there was no significant changes in DHT and T levels between other age groups. After 3 daily in injections of 4,000 IU human chorionic gonadotropin (hCG) the levels of serum DHT of the young group (20-32 years) and old group (72-78 years) increased 2.6 times and 1.9 times more, respectively. T increased 2.7 times and 1.4 times more, respectively.


Recurrent carcinoma of the colon in the anastomosis diagnosed by roentgen examination and colonoscopy. After resection for cancer of the large bowel recurrence at the anastomosis occurs in about 10%. In 30 operated cases roentgenography and colonoscopy were performed. In 18 cases roentgen examination gave rise to suspicion of recurrence at the anastomosis but this was confirmed by colonoscopy and surgery only in 6 cases. In two additional cases with normal roentgenographic findings recurrence at the anastomosis and a second primary cancer were diagnosed by colonoscopy in one case each. The clinical symptoms provided no guidance in the diagnosis of recurrence. Roentgen examination is admittedly less conclusive than colonoscopy for discovery of recurrent and metachronous carcinoma. The methods are, however, complementary and both examinations should be regularly carried out in order to establish an early diagnosis.


Biopsy and cytology in the diagnosis of early gastric cancer: 10-year experience with direct vision techniques at a Japanese institution. The results of direct vision biopsy and cytology for the diagnosis of early gastric cancer during the periods from 1964 to 1969 and from 1970 to 1974 were compared. From 1964 to 1969 the diagnostic accuracy of gastric biopsy was 94.7% at the initial examination and 97.3% in the final diagnosis, while washing cytology under direct vision gave a diagnostic accuracy of 83.0% at the first washing and 93.3% in the final cytologic diagnosis. Because of such a high yield of gastric biopsy, it was the procedure of the first choice from 1970 to 1974, giving a diagnostic accuracy of 96.7% at the initial examination and 99.4% in the final biopsy diagnosis with only one suspicious case. The cytologic examination by brushing has, therefore, become supplementary to biopsy in cases where a stenosis proximal to a tumor obscures the definitive tissue.


An evaluation of endoscopic retrograde pancreatography (ERP) in chronic and relapsing acute pancreatitis. The results of ERP carried out in a series of cases of established and suspected chronic and acute relapsing pancreatitis are presented. Radiological findings are divided into major and minor alterations of the pancreatic secretory system. X-ray findings are easy to interprete in chronic pancreatitis with major alterations. Minor anomalies of the pancreas are difficult to interprete in the absence of supporting evidence. Biliary tract involvement is useful for diagnosis of chronic pancreatitis.


Endoscopic diagnosis of Barrett's esophagus. Four cases of Barrett's esophagus are presented. Diagnosis was confirmed by multiple serial biopsies of the esophagus. There are many features on endoscopic examination which suggest the diagnosis of this anomaly. These features are described in detail along with endoscopic pictures.


Endoscopic results in five patients with Crohn's disease of the esophagus. In our experience with five cases of Crohn's disease of the esophagus, the endoscopic appearance has been demonstrated. Corresponding to the basic pathological changes, the findings are very different, but two stages may be differentiated: Stage I in which inflammatory changes predominate as a mild or more often erosive-ulcerative esophagitis. Stage II is a stenosing form similar to a peptic stenosis or to a stenosing tumor. The morphological changes are predominantly limited to the lower part of the esophagus with a tendency to extend to the proximal regions. The diagnosis may be established endoscopically only in special cases with shallow ulcerations within a normal mucosa or with cobble-stone relief which is usually seen in the colon. In all other cases, a specific macroscopical appearance of Crohn's disease of the esophagus does not exist and no specific differentiation is possible from other forms of esophagitis. Only by a combination of endoscopy, radiology and histology can the diagnosis be suspected. Guided biopsies are not able to confirm the diagnosis histologically. The exact diagnosis of Crohn's disease of the esophagus is only possible by histological examination of the resected esophagus.


New technique for endoscopic treatment of bleeding gastric ulcer. In two patients with bleeding gastric ulcer hemorrhage could be stopped by submucous infiltration around the lesion without any complication. This simple method using a selfconstructed needle seems to guarantee good results especially in bleeding little arteries. Infiltration was performed with a 1.5% solution of Aethoxysklerol (Kreussler, Wiesbaden-Biebrich) using 3-5 ml totally for treatment.


A new procedure for the removal of gastric polyps and foreign bodies. A simple procedure for the removal of multiple gastric polyps and foreign bodies is described. Before endoscopy, the introduction of a catheter bearing a nylon bag at its proximal end in the stomach is necessary. The method is safe and efficient, only 1.4% of the polyps were lost in a series of 69 polypectomies.


Evaluation of a new fibre colonoscope the Olympus TCF-2L. Experience with the new Olympus twin channel TCF-2L colonoscope is presented. Based on 60 examinations including 25 polypectomies it is concluded that the instrument when compared with other colonoscopes is easier to handle and its advancement within the colon is faster, smoother and therefore less disagreeable to the patient. The proximal colon is easier to reach than previously experienced. Polypectomy and retrieving of polyps can efficiently be undertaken. This instrument will undoubtedly further enhance the usefulness and therapeutic value of fibre colonoscopy.


Gastroscopic cytology in intestinal metaplasia. Based on the findings of goblet cells the authors established cytologic criteria for the diagnosis of intestinal metaplasia. With this technique they made the diagnosis of intestinal metaplasia in 79.4% of the cases surgically confirmed, this contrast to endoscopic biopsy with only 35.2%. on the other hand, the cytologic diagnosis of malignancy is obtained in the same series in 92% of 25 gastric cancers against 80% of endoscopic biopsy. Among the controls surgically verified there was no cytologic false positive neither for malignancy nor for the diagnosis of intestinal metaplasia. The authors believe that any case with signs of malignancy and intestinal metaplasia may have a better preoperative prognosis.


Guided dilatation and transurethral resection in one session for the treatment of the postprostatectomy obstructive complications above the verumontanum. 53 patients presenting with post-prostatectomy obstructive complications above the verumontanum were treated in a single session by means of guided dilatation of the stricture followed by transurethral resection of the stenosing fibrotic tissue. The results obtained in cases of vesical neck stenosis were very encouraging. Unsatisfactory results were observed in cases of cervicoprostatic fibrosclerosis where resection was insufficient for resolution of the obstruction. No failures or complications with the guided dilatation technique have been observed.


A new technuque of ERC(P) using a straight-view  fiberscope. A new technuque of ERC(P) using a forward-veiwing fiberscope is described in details. By this procedure the position of the maximal bended tip of the instrument provides a more selective cannulation of the common bile duct, preventing the risk of pancreatic duct filling. The method was performed in 15 cases and succeeded in 12. ERCP, using this technique, can be performed after normal esophago-gastro-duodenoscopy. However, at present time it is not a routine procedure. Technical improvements on the instrument are necessary to facilitate the method.


Peroral direct cholangioscopy (PDCS) using routine straight-view endoscope: first report. A new endoscopic method, the peroral direct cholangioscopy (PDCS) is described. A prograde fiberscope of 8.8 mm diameter can be directly inserted, without using a second scope as a guide, into the biliary system after EPT (endoscopic papillotomy). The lumen of the common bile duct is observed entirely and exactly. The image is excellent. Also acessories may be inserted into the duct via the biopsy channel under direct control.


A new catheter for endoscopic manometry of Oddi's sphincter. With a newly designed manometry catheter and a modified pull-through maneuver a high presure zone can reproducibly be recorded between the duodenum and the pancreato-biliary tree corresponding to Oddi's sphincter. Catheter marking allows in addition calculation of the length of this zone. Since the sealed end of the catheter remains during pressure recording within the ductal system repeated push-and-pull maneuvres can be performed through the sphincter area.


Clinical evaluation of a sonde-type small intestinal fiberscope. Endoscopic examination using a specially designed sonde-type small intestinal fiberscope (SSIF, Olympus) was performed in 37 patients of our clinic. The improvement of the scope has enabled us to observe the greater parts of the small intestine within a short time and without hazard to the patient. Therefore, with further improvement of this instrument and the insertion technique, we will be able to inspect all parts of the small intestinal mucosa and diagnose the lesions more easily.


A new technique for insertion of the colonoscope through the ileocaecal valve. At colonoscopy it is important to examine the distal part of ileum in inflammatory diseases particularly. Different techniques for insertion of the colonoscope into the ileum have been described. In our experience these methods require considerable skill and practice. We have therefore worked out a technique for easier access to the ileum with a colonoscope. A closed biopsy forceps is used for identification of the ileocaecal valve by dislodging the upper lip. The forceps is manoeuvred through the ostium and then the colonoscope can be inserted into the ileum with the forceps as a guide.


Coloscopic inversion.

Coloscopic inversion. Direct visualization of the inner anal orifice by means of coloscopic inversion in the ampulla recti eliminates one of the last "blind zones" in digestive endoscopy.


Early gastric carcinoma in patients with a Billroth II partial gastrectomy. In a consecutive series of 830 routine gastroscopies a total of 43 patients was found with gastric carcinomas, Thirteen of these were patients with a previous Billroth-II operation for ulcer disease. Early cancers were found in ten patients (23%), and four of these ten (3 men, 1 woman, aged 49 to 76 years), had been operated on 20-33 years previosuly with a Billroth II partial gastrectomy. All patients had symptoms indicating gastro-intestinal disease. We conclude that a high number of gastric stump carcinomas may be detected at an early stage, and that endoscopy of the whole gastric stump, with multiple biopsies and brush cytology from the entire gastro-jejunal anastomosis, is of crucial importance in detecting such carcinomas.


Electrohydraulic impulse lithotripsy of bladder stones with URAT-I. The electrohydraulic method of crushing bladder stones due to many aforesaid advantages can fully replace mechanical lithotripsy as being both more effective and having little danger of traumas. In rare cases when the stone cannot be crushed with Urat-I its removal should be performed by way of cystomy.


Glycosaminoglycan metabolism in pregnancy. An unselected group of pregnant patients was followed during pregnancy. Serial assays were made of maternal serum levels of hyaluronidase activity, free amino sugar and uronic acid. It was found that there was a highly significant correlation between the serum levels of hyaluronidase activity and uronic acid, both of which rose during pregnancy. In normal pregnancy the maternal serum amino sugar level showed a moderately significant correlation with length of gestation, which was not shown in abnormal pregnancies. Conversely the rise in uronic acid level with length of gestation was most signigicant in patients with complicated pregnancies.


Origin of esterases in human whole saliva. Whole saliva of 59 healthy persons was used for determination of esterase activity. The pattern of esterase was studied by means of isoelectrofocusing on thin-layer acrylamide gels. The esterases found in whole saliva are suggested to be derived from the cells of the tissue in the oral cavity. This origin is indicated (e.g.) by comparison between isolectrophoretic esterase patterns of whole saliva, submandibular saliva, gingival biopsy and fibroblast culture. Antisera against partially purified saliva esterases were produced in rabbits. These sera, used in immunoelectro-osmophoresis, gave esterase-active immunoprecipitate against whole saliva, the water-soluble materials of disrupted gingival biopsy and fibroblast culture, but not against the material of the bacteria, Streptococcus sanguis, Strptococcus mutans, Streptococcus mitis, Actinomyces viscosus and Lactobacillus fermentum.


Leucocyte energy metabolism. VII. Respiratory chain enzymes, oxygen consumption and oxidative phosphorylation of mitochondria isolated from leucocytes. A new method for the destruction of cell membrane with heparin and for the subsequent isolation of mitochondria from different types of leucocytes (polymorphonuclear leucocytes (PMN) and lymphocytes of human blood, PMN and macrophages of guinea pig peritoneal exudates) is presented. This method is less traumatic to the mitochondria than the usual mechanical procedures. The activites of several enzymes of the respiratory chain were estimated. Oxygen consumption was measured with oxyhaemoglobin as oxygen donor and reaction rate indicator. The integrity of the mitochodria can be demonstrated by the determination of the acceptor control index; the existence of a coupled phosphorylation of ADP to the respiration is clearly demonstrated in all type of cells studied; the ADP/O ratios with several substrates, near to the theoretical values, could be estimated in mitochondria preparation of lymphocytes (normal and leukaemic) and of macrophages. The highest oxidative ratios were found in leukaemic cells.


Studies on serum oestrogen and progesterone levels during the oestrous cycle and early pregnancy in mares. Concentrations of progesterone and oestrogens were determined by radioimmunoassay in the peripheral blood of 22 Percheron and Breton breed mares from the 6th day of oestrus to the 150th day of pregnancy. Periodical variation patterns for the mean values of oestrone, oestradiol 17beta and total oestrogens in the cycling mares were found, with two peaks on the third day before and the 15th day after ovulation, and one depression on the 6th day of oestrus. In pregnant mares, the concentrations of oestrone and oestradiol 17beta increased rapidly (P less than 0.05) after Day 105 of gestation. Progesterone levels declined after Day 18 of the cycle in cycling mares, whereas they increased in the pregnant mares. Marked changes in the ratio of total oestrogen to progesterone concentrations were found in cycling mares, especially at oestrus, but in pregnant mares the ratio always remained below 1.00.


A post mortem study of equine digital flexor tendons. The results of a survey are presented in which 589 limbs from 206 horses were dissected. In174 of the limbs lesions were found in either the superficial (131) or deep (43) digital flexor tendons. Changes occurring with age were also recorded. The sites of the abnormalities and their macroscopical appearance are described and the value of the results is considered in relation to the diagnosis and the treatment of clinical lesions.


Treatment of atrial fibrillation in three racehorses. Three young Standardbred pacers with atrial fibrillation were treated with quinidine sulphate (QS) by stomach tube. They were given 10g QS every 2 hours until cardioversion was achieved. Total doses varied between 20 and 30 g. No premedication was given nor any follow up treatment after return to sinus rhythm. All horses were given 3 months rest after the treatment, and when electrocardiographed then, and at 6 months, showed normal sinus rhythm. As all 3 horses won races after cardioversion and showed subsequent normal electrocardiograms it seems likely that atrial fibrillation can occur without detectable pathological changes in the heart.


Exercise studies in horses: 1. A simple telemetry system for recording excercise ECGs in horses. A robust low cost portable radiotelemetry system is described for the horse and its method of operation and advantages briefly discussed. The equipment consisted of 2 electrodes forming a bipolar lead, a transmitter, a receiver and a writing device. The sitting, application and immobilising of the electrodes was a most important factor in obtaining good quality recordings. ECGs were recorded at all paces and also while jumping and the results proved satisfactory.


Exercise studies in horses: 2. The cardiac response to exercise in normal horses and in horses with chronic obstructive pulmonary disease. The relationship of velocity (v) to heart rate (HR)and of kinetic energy (KE) to heart rate, were investigated in 6 normal horses and in 6 horses with chronic obstructive pulmonary, disease (COPD). Radiotelemetry was used to determine the heart rate while subjects were ridden on a 400m track. Velocity was measured by stop-watch between 2 markers 50 m apart at the end of the track. Kinetic energy was calculated from the formula KE =1/2 Mv2, where M = mass of horse, rider, saddle and bridle (KG) and V = velocity (metres per second). In all subjects, the relationship of velocity to heart rate was a linear one at each individual pace (i.e. walk, trot and gallop). There were however significant differences between the v/HR regression curves of each pace. These differences indicated that the increase in velocity per unit increase in heart rate was greater at the trot than at the walk, and greater at the gallop than at the trot. When data for all paces were combined, the relationship log v/log HR was a linear one. The above findings were also true of the relationship of kinetic energy to the heart rate. In horses, which reached maximal heart rate at a relatively low velocity, the v/HR curve became asymptotic. At comparable submaximal velocities, the heart rate of COPD subjects was approximately 20 beats per minute higher than that of normal subjects. This was also true when the term "kinetic energy per units mass" was substituted for velocity.


Invagination of the caecum into the colon in a Welsh pony. A chronic wasting disease in a 16 month old Welsh pony filly is described. The animal died 26 days after the onset of illness which commenced with a sub-acute colic and was characterised by progressive loss of appetite and weight. Post-mortem examination revealed a total invagination of the caecum into the colon and it seemed logical to assume this invagination occurred at the start of the illness. A review of the literature showed that total caecal invagination produces 2 distinct clincal syndromes. It can occur either as an acute illness characterised by severe colic and death after about 10 days, or as a chronic wasting disease, such as the case presented here, which may not result in death for several weeks or even months.


Effect of prostaglandin analogue on progesterone-treated pony mares during early pregnancy. Seven Welsh pony mares (9 pregnancies) received either 50 mg, 100 mg or 150 mg progesterone on alternate days, starting on day 21 of gestation. All but 2 pregnancies failed following prostaglandin administration on day 27. Although both mares were receiving the 150 mg progesterone dose rate, this treatment was not consistently successful in preventing pregnancy failure after prostaglandin administration.


Some haematological and biochemical parameters in race horses in Hong Kong. Haematological and biochemical values were determined in 2 groups of flat-race horses, which were trained on the same track in Hong Kong. The first group comprised 217 horses (435 blood samples) from various training strings. The second group, 66 horses (309 blood samples) were from one string kept under similar managemental conditions, but given salts by stomach tube 8 hours before blood sampling. Both groups were sub-divided to show the efs, thus confirming work by other authors. The lower haematological values in the group of horses given salts were discussed and the effect of water retention as a possible explanation was considered.


Demonstration of binding sites for divalent and trivalent ions on the outer surface of chromaffin-granule membranes. 1. Trivalent ions Tb3+, Eu3+ and La3+ aggregate chromaffin granules and produce structural changes in the core material. These ions also stain the outer (cytoplasmic) surface of the granule membrane in the presence of PO43+ ions and inhibit OSO4 staining. The electron-dense patches of TbPO4 complex are distributed in a non-random fashion. 2. Tb3+ also functions as a fluorescent membrane probe for divalent ion binding sites on the granule membrane. Using the enhancement of Tb3+ fluorescence upon binding, a Kd for Tb3+ of approximately 15 micronM was measured. Ca2+ and Mg2+ are competitive inhibitors of this binding while Na+ and K+ had no effect. Results suggest that the fluorescent Tb3+ -binding site is a protein. 3. Tb3+ also binds to mitochondria and other contaminants as judged by electron microscopy. However purified mitochondria show qualitatively different binding of Tb3+ by fluorescence. 4. A model for the location of divalent ion binding sites on the granule membrane and the results are discussed in terms of requirements for the participation of these sites in granule exocytosis in vivo.


The amino-acid sequence of the major parvalbumin from thornback-ray muscle. The primary structure of the major parvalbumin (pI = 4.45) from the cargilagenous fish Raja clavata has been determined. The amino acid sequence was deduced by the analysis of peptides derived from tryptic digestion of the oxidized protein. These peptides were aligned by comparison with (a) overlapping peptides produced by limited tryptic and chymotryptic digestion, and (b) by comparison with the known structures of other fish parvalbumins. The molecular evolution of thornback ray parvalbumin is briefly discussed.


Interaction of glycolysis and respiration in perfused rat liver. Changes in oxygen uptake following the addition of ethanol. The effect of ethanol on hepatic respiration and glycolysis was studied in perfused rat livers. 1. Ethanol increased the rate of oxygen uptake in livers from fed rats, but decreased the rate in livers from fasted animals perfused in the absence of added substrates. 2. Addition of ethanol decreased the rate of lactate + pyruvate production reflecting an inhibition of glycolysis irrespective of whether glycogen or added glucose was the substrate. 3. Half-maximal stimulation of respiration and inhibition of glycolysis were observed at ethanol concentrations between 0.2 and 0.4 mM. 4. A stoichiometric relationship of one mole of stimulated oxygen uptake to 3.6 mol of decreased lactate + pyruvate production was observed under a variety of experimental conditions. 5. The effects of ethanol on oxygen uptake and lactate + pyruvate production were abolished by the addition of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, but were unaffected by aminooxyacetate, an inhibitor of hydrogen transport across the mitochondrial membrane. 6. Carboxyatractyloside, an inhibitor of adenine nucleotide translocase, largely abolished the increase in oxygen uptake due to ethnol, but had little effect on the inhibitory action of ethanol on glycolysis. These data indicate that the ethanol-stimulated oxygen uptake is due to an increased flux through the mitochondrial respiratory chain and that it involves the NAD+-dependent oxidation of ethanol by alcohol dehydrogenase. The data are consistent with the hypothesis that the ethanol-stimulated respiration results from an increased demand for mitochondrial oxidative phosphorylation as a consequence of the decreased extramitochondrial ATP generation following inhibition of glycolysis by ethanol.


The chemical structure of the lipid A component of lipopolysaccharides from Chromobacterium violaceum NCTC 9694. The chemical structure of the lipid A component of lipopolysaccharides from Chromobacterium violaceum NCTC9694 was studied. Sequential treatment of lipopolysaccharide with alkali, acid, sodium borohydride and hydrazine allowed the isolation of a reduced glucosamine disaccharide. According to methylation studies and enzymic analysis with beta-N-acetylglucosaminidase the D-glucosamine residues are beta(1 leads to 6) linked. The disaccharide carries two phosphate groups, one being linked glycosidically, the other being linked as an ester to the non-reducing glucosamine. Application of a different degradation pathway shows that the ester-bound phosphate group is substituted by a 4-aminoarabinosyl residue and that the glycosidically linked phosphate group is substituted by a glucosaminyl residue. Neither the amino nor the hydroxyl groups of both these substituents are acylated. This backbone structure is shown in the following formula: (formula: see text). The amino groups of the central glucosamine disaccharide are substituted by D-3-hydroxy-dodecanoic acid, the hydroxyl groups by dodecanoic, L-2-hydroxydodecanoic and D-3-hydroxy-decanoic acid.


Control of density and microredistribution of concanavalin-A receptors in rat thymocytes at 4 degrees C. In a previous paper, we reported that at 4 degrees C, a cooperative binding of concanavalin A to rat thymocytes is observed which corresponds to a modification of the membrane leading to the recruitment of receptors and their immobilization. In this paper, we report that both phenomena are modulated at 4 degrees C by drugs such as colchicine and cytochalasin B; cooperative binding of concanavalin A, which reflects receptor recruitment is only slightly modified by each drug alone. when the two drugs are used simultaneously, the binding of concanavalin A to rat thymocytes at low concentrations of the lectin is decreased, while at high concentrations it remains unchanged. The binding of succinyl-concanavalin A to drug-treated cells is lowered at all concentrations of lectin. Also, we have studied the effects of colchicine and cytochalacine B on the binding of horseradish peroxidase to cell-bound concanavalin A, or succinyl-concanavalin A. We have found a decreased amount of horseradish peroxidase binding to concanavalin A bound to cells treated with colchicine or cytochalasine B. In the presence of the two drugs the decrease of peroxidase binding suggested a synergistic action of colchicine and cytochalasin B.


The phosphoenolpyruvate-dependent phosphotransferase system of Staphylococcus aureus. 1. Amino-acid sequence of the phosphocarrier protein HPr. The primary structure of the histidine-containing phosphocarrier protein HPr of the phosphoenolpyruvate-dependent phosphotransferase system from Staphylococcus aureus was determined by automated Edman degradation. The complete sequence was deduced from the direct analysis of the protein by automated Edman degradation in a liquid-phase sequencer of Edman and from the sequence of tryptic, thermolytic and cyanogen bromide peptides as obtained by automated Edman degradation in a solid-phase sequencer of Laursen. The amino-acid sequence was found to be Met-Glu-Gln-Asn-Ser-Tyr-Val-Ile-Ile-Asp-Glu-Thr-Gly-Ile-His-Ala-Arg-Pro-Ala-Thr-Met-Leu-Val-Gln-Thr-Ala-Ser-Lys-Phe-Asp-Ser-Ile-Asp-Gln-Gly-Gly-Tyr-Asp-Ser-Met-Gln-Leu-Lys-Ser-Leu-Gly-Val-Gly-Lys-Asp-Glu-Glu-Ile-Thr-Ile-Tm-Ser-Ala-Asp-Lys-Lys-Glu-Gly-Leu-Thr-Lys-Met-Ser-Ile-Val. The 70 residues correspond to a molecular weight of 7685. The one histidine involved in the phosphotransfer reaction of this protein was found at position 15 as part of a region of the sequence which has no predictable secondary structure. It is suggested that this protein belongs to the group of male proteins with the active center located on a protrusion rather than a cleft.


Interrelationship in the regulation of pyruvate dehydrogenase and adenine-nucleotide translocase by palmitoyl-CoA in isolated mitochondria. Full activation of rat liver pyruvate dehydrogenase in vitro by ADP was prevented by palmitoyl-CoA at a concentration sufficiently low to preclude substrate effects secondary to its oxidation by mitochondria. Activation of pyruvate dehydrogenase by ADP in livers of fat-fed rats was less than in the control animal. The results are consistent with the experiments demonstrating an inhibition of adenine nucleotide translocase and on increased intramitochondrial ATP/ADP ratio by palmitoyl-CoA which could account for the effect on pyruvate dehydrogenase. Inactivation of brain pyruvate dehydrogenase by ATP was also diminished by palmitoyl-CoA indicating that the effect was at the level of the adenine nucleotides rather than at either the pyruvate dehydrogenase kinase or phosphatase enzymes.


Guinea-pig pancreatic ribonucleases. Isolation, properties, primary structure and glycosidation. Two ribonucleases were isolated from guinea-pig pancreas by extraction with 0.125 M sulfuric acid, precipitation with acetone and chromatography on carboxymethyl-cellulose. The amino acid sequences were determined from tryptic digests of the aminoethylated proteins. The tryptic peptides were positioned in the sequence by homology with other pancreatic ribonucleases. Both ribonucleases not only differ in the presence (ribonuclease B) or absence of carbohydrate (ribonuclease A), but also at 31 positions of the amino acid sequence. In guinea-pig ribonuclease B a leucine/proline heterogeneity was found at position 64. The carbohydrate in guinea-pig ribonuclease B is attached to asparagine residues at positions 21 and 34. The carbohydrate-free guinea-pig ribonuclease A possesses a recognition site for sugar attachment in the sequence Asn-Val-Ser (62-64).


Bioassay and radioimmunoassay of gastrin and significance of gastrin degradation products. Inactivation of gastrin was studied (a) in vitro by incubation with a high-speed supernatant fraction of rat small bowel mucosa and (b) in vivo by perfusing gastrin through the small bowel vascular bed in anaesthetized dogs. In both types of experiment there was a highly significant loss in the bioactivity of gastrin, but no significant change in its immunoreactivity. This showed that gastrin was inactivated by a subtle chemical change which rendered the molecule biologically inactive, yet left its immunoreactivity unimpaired.


Metabolism in the hypothermically perfused dog kidney. Utilization and production of amino acids. The uptake and utilization of amino acids in dog kidneys during hypothermic perfusion were studied. 21 kidneys were perfused in a Gambro perfusion machine for 6 days with perfusates based on human albumin with and without addition of 17 L-amino acids. Net glucose uptake by the kidney was lower during perfusion with amino acids in the perfusate than during perfusion without amino acids. A decrease in specific activity of labelled glucose was found during perfusion with amino acids in the perfusate indicating a considerable gluconeogenesis which could explain the difference in net glucose uptake. A higher uptake of fatty acids by the kidney was found during perfusion with amino acids in the perfusate than during perfusion without amino acids. In perfusion without amino acids the concentration in the perfusate of almost all amino acids and ammonia increased and thus a net release of nitrogen was found indicating degradation of protein. In perfusion with amino acids in the perfusate a considerable uptake and release of amino acids by the kidney were found. The most pronounced uptake was registered for glutamine, proline and glycine. The most pronounced release was registered for glutamate, alanine and ammonia. During perfusion with amino acids in the medium, the uptake and release of nitrogen were balanced as distinguished from perfusion without amino acids in the perfusate.


Metabolism in the hypothermically perfused dog kidney. Incorporation rate of leucine and threonine into proteins. The incorporation of [14C]leucine and [14C]threonine into kidney cortex proteins was studied during 6 days' hypothermic perfusion of dog kidneys at 8-10 degrees C and during in vitro incubation of dog kidney cortex slices at 37 degrees C. Leucine carbon was incorporated into proteins at a higher rate than threonine carbon both during in vitro incubation of kidney cortex slices and during hypothermic kidney perfusion. The incorporation of leucine and threonine during hypothermic perfusion was linear for 6 days but 50-100 times lower than the incorporation of leucine and threonine in kidney cortex slices at 37 degrees C. During hypothermic perfusion there was a decrease in specific activity of leucine and threonine in the perfusate corresponding to a degradation of proteins which was greater than protein synthesis as calculated from the incorporation of label into proteins. Leucine carbon was recovered in CO2 during hypothermic perfusion and in vitro incubation of kidney cortex slices at 37 degrees C. The incorporation of threonine carbon into CO2 was about 10% of the corresponding value for leucine both during hypothermic kidney perfusion and during in vitro incubation of kidney cortex slices at 37 degrees C. It is concluded that there is a turnover of kidney proteins during hypothermic perfusion with a perfusate containing amino acids.


Factor XIII and fracture healing. An experimental study. The effect of exogenous factor XIII on fracture healing has been tested. It could be shown that after administration of the fibrin stabilizing factor, the concentration of fibrin fibres in the fracture haematoma increases. The resistance against breaking is thus enhanced in treated animals as compared to untreated controls, mainly during the early phases of fracture healing. X-ray diagnosis demonstrated an enhanced healing process of the treated fractures. The accelerated fracture healing by factor XIII adminstration could also be substantiated through histological examinations.


Autograft suture in peripheral nerves.

Autograft suture in peripheral nerves. Fresh collagen fibers prepared from rabbit tendons or aponeurosis were inserted in either median or sciatic nerves of the same animal. The tissue reactions induced by the autologous fibers were compared histologically with those caused by similarly inserted silk, catgut and homograft sutures in contralateral nerves. Sham operations, passing empty needles, were performed on control nerves. The treated nerves were removed on the 5th to the 30th postoperative day, and histological sections were prepared. The insertion of the different sutures in peripheral nerves resulted in tissue reactions of varying types and degrees, depending on the material used. Catgut and silk thread induced extensive degenerative and inflammatory reactions which persisted for more than 4 weeks. Homograft sutures underwent rapid organization with a minor degree of degeneration and inflammation, which persisted for only a short time. Autograft fibers resulted in minimal myelin degeneration and mild inflammatory processes for 5-10 days, which was only slightly different from the regular course of healing seen in sham-operated control nerves. These intial observations suggest that sutures of autograft fibers may prove advantageous in nerv repair.


Beckwitt-Wiedemann's syndrome with medullary sponge kidneys, agonadism and persistent testosterone production. A patient with Beckwitt-Wiedemann's syndrome is described in which associated malformations were hemihypertrophy of the body, medullary sponge kidneys and absence of testes and internal ducts. On the other hand, we demonstrated biochemically the existence of testosterone secretion, with active response to a 3-day HCG stimulation as well as prepuberty levels LH and FSH. This demonstrated the existence of functioning Leydig's cells. The diagnosis of agonadism and anorchia could not be entirely true since they lead to an erroneous conclusion that there always are some disseminated Leydig's cells.


Vena cava resection with renal cell carcinoma. Resection of an involved inferior vena cava along with a kidney tumor is quite feasible and can be curative. This situation is illustrated by a case which has survived for 30 months since such resection and the patient is still free of tumor. Although there is tendency to take venous involvement a sign of poor prognosis, a review of the literature has shown encouraging results with this aggressive approach. Other reasons are given for adopting the radical approach towards advanced or metastatic renal cell carcinoma.


An osteotomy technique in the treatment of staghorn calculus. A technique was devised for dividing the staghorn calculus with an osteotome after obtaining access to the stone by means of a partial nephrectomy aided by renal hypothermia. The advantages of the procedure are a better control of haemorrhage and a clean cut in the stone with removal of predetermined fragments and a diminished splinter formation. In 17 operations there were no complications of haemorrhage nor urinary fistula and, as yet, no recurrence of stone.