[Current aspects of the Fiessinger-Leroy-Reiter syndrome seen at the initial stage in a military setting]. The authors report a series of 40 recent personal cases of the Fiessinger-Leroy-Reiter syndrome seen at the initial stage in military personnel, in which post-diarrhoeal forms were combined with post-urethritis forms. They emphasize the special features of the articular lesions which alone orient the diagnosis towards this syndrome which is confirmed by the evolution and the paraclinical examinations. They also emphasize the value for diagnosis of the disease of testing for HLA B27 and also its importance with regard to the prognosis, but they show that this antigen is sometimes absent particularly subjected to numerous hostile factors related to poor hygienic conditions. The authors conclude that the presence of the HLA B27 antigen must not lead to a refusal to recognize the relation of this disease to service in patients who have been subjected to the hostile factors that have a role in the genesis of the Fiessinger-Leroy-Reiter syndrome, as this is frequent in military personnel.


[Fatigue fractures of the metatarsal bones]. The authors report 145 cases of fatigue fractures including 125 of the metartarsals. They compare this distribution that reported by others, in particular in German work. After study of the different types of clinical picture the authors emphasize the importance of repeated and high quality radiological examinations. They describe the four stages of radiological evolution. Each of the images taken out of its context is misleading. They may lead to the diagnosis being missed and thus should be well known.


[Diagnostic value of localized hypofixations in the radioisotope scanning of bones]. The scintigraphic appearances of all localized, evolutive bone lesions, whatever their nature, is usually a "hot spot", that is a zone of hyperfixation of the radioactive material. False negatively scintigraphs are, however, noted: the scintigraphic image appears normal, without a zone of hyperfixation, although radiographs of the skeleton are pathological. The 8 cases presented in this article demonstrate that certain bone lesions (aseptic osteonecrosis and malignant destruction of bone) may sometimes be represented as real zones of hypofixation, as veritable "cold spots". These areas of hypofixation result from either a local interruption in the vascularization, which prevents the isotope from reaching the bony structures, or from a quantitative insufficiency of the bony tissue, this being replaced by neoplastic tissue which, in the cases studied, fixed labelled Bleomycin or iodine-131. These areas of hypofixation and any absences of fixation really are the scintigraphic images of areas of osteolysis or of aseptic osteonecrosis but they are generally masked by hyperfixation around the lesion that results in reactional osteogenesis and hypervascularization.


[Tarsal tunnel syndrome. Apropos of 15 "pure" cases and 100 cases "combined" with leprosy or diabetes mellitus]. The authors have observed 15 cases of the tarsal canal syndrome: the 14 cases operated on showed compression of the nerve by bone fragments resulting from trauma by local varices, by a muscular anomaly, or as a result of enclosure by post-trauma fibrosis. Surgery resulted in 10 cures and considerable improvement in 2 other cases. In addition to these 15 "pure" cases the authors report their experience of neurolysis of the posterior tibial nerve and of the plantar nerves of the tarsal canal in the treatment of perforating plantar lesions in leprosy (88 cases) and diabetes (12 cases). The good results in these cases indicate the value of extending this therapy to the treatment of perforating plantar lesions in cases of large nerve neuritis.


Experience of computer-assisted ECG recording in 242 exercise tests. 242 computer-assisted exercise tests were studied. The computer performs simultaneous averaging of a 6- or 12-lead ECG, keeps track of the work load and time and labels all ECG records. Less than 1 per cent of atrial and ventricular extrasystoles were included in the computer average together with ordinary beats, while 80 per cent of all beats were averaged. Averaging reduced the peak-to-nadir QRS amplitude by 3-4 per cent at a sampling rate of 400/s and by 8-9 per cent at 200/s. Q waves with small beat-to-beat variation were usually well preserved after averaging while more variable QRS details often decreased in width or amplitude. The averaging program performed adequately on most kinds of arrhythmia. Averaging should not be used on pacemaker ECGs. Caution must be exercised in the presence of very frequent ventricular extrasystoles.


Computer classification of ST and T in averaged ECGs at rest and exercise. A computer program for ST and T classification at rest and exercise is described. The automatic ST classification was based on the modification of the Minnesota code suggested by Punsar et al. The T wave classification was based on the Minnesota code of 1968. Recordings at rest, during and after exercise from 217 exercise tests were visually classified by two observers, and their result was compared to the computer's. Computer-observer comparisons yielded no more disagreements than between-observer comparisons. There were computer-observer disagreements caused by computer errors in 3% of the records. The repeatability of the computer's ST classification on records taken during exercise was better than that of one visual observer. Within-computer and within-observer repeatability appeared to be negatively affected by remaining noise in the average.


A system for computer-assisted ECG recording at rest and exercise. Great investments have been made in computerized ECG interpretation but little attention has been paid to rationalization of such costly activities as recording, labelling and mounting ECGs, and still less to the presentation of ECGs. A system for such tasks is described. It includes a PDP8/E computer and modified ink jet ECG recorders, which write alphanumeric text and function as analogue input- and output-devices for the computer. On-line computer service is given independently to two laboratories for ECG at rest, VCG or exercise ECG. After averaging the ECG signal, the computer writes out a properly labelled ECG in an easily surveyable form. The visual interpretation of the ECG is entered and is then written on a new sheet together with the averaged 12-lead ECG and a rhythm strip. In exercise testing, the computer records and processes the ECG at predetermined intervals. The processing includes an automatic ST classification. A summarized presentationof the ECG before, during and after exercise allows easy visual identification of ECG changes. Experience of the system has mainly been obtained from 2 years of routine exercise ECG recording and to a limited extent from ECG and VCG recording at rest.


Immunoreactive insulin (IRI) dynamics in GH-deficient patients following intravenous glycine loading. In hypopituitary short-statured patients glycine intravenous injection (250 mg/kg of body weight) provokes a mild and inconstant stimulation of IRI release followed by a significant fall down. Though insiginificant (P 0.064), the prevalence of IRI responsive individuals to glycine in the patients group of idiopathic etiology could be of pathophysiological importance.


Quantitative study of extrathyroid enzymatic conversion of T4 to T3 in man. The authors present a quantitative study of the extrathyroid conversion process of T4 to T3 in 3 athyroid patients, on the basis of an original biochemical model and a rigorous mathematical treatment, utilizing the kinetic isotope method. The values of thor the constant of the reaction rate of conversion of T4 to T3 and of the T4 fraction that undergoes this process--serum concentrations of T4 and T2--were determined in two completely different ways: 1) the radiochromatographic method, and 2) radioimmunoassay of T3 and competitive protein binding of T4. The results thus obtained supported each other and revealed that more than 1/3 of the body total thyroxine is turned into triiodothyronine by the extrathyroid conversion process. The maximum concentration of the triiodothyronine thus formed is reached after 5-6 days, if the reference level of this hormone is zero. However, the higher the T3 reference concentration in the body, up to the normal physiologic level, the shorter the time interval for reaching the T3 maximum  concentration following a single moderate dose of T4.


Glycogen phosphorylase activity in biopsy samples and single muscle fibres of musculus quadriceps femoris of man at rest. Glycogen phosphorylase activity in biopsy samples of the quadriceps muscle of man taken at rest was measured in the direction of glycogen breakdown. The conditions of assay used were pH 6.8 and 35 degrees C. Mean phosphorylase activity per kg fresh muscle in 8 male volunteers was: phosphorylase a - 259 U, and total phosphorylase - 627 U, where 1 U is the production of 1 mumol glucose-1-phosphate/s under the conditions of assay. The mean value of total activity, transposed to the in vivo condition, is sufficient to support a maximum rate of glycogen degradation calculated as glucosyl units utilized per kg fresh muscle, of 627 mumol/s. This is approximately the rate at which glycolysis occurs during a maximum voluntary isometric contraction. The mean ratio of phosphorylase a activity to total activity at rest was 0.40. Estimates of the mean total phosphorylase activity in type I ('slow') muscle fibres isolated from the quadriceps of 9 volunteers ranged from 210-385 U/kg fresh muscle, and in type II ('fast') muscle fibres from 493-934 U/kg fresh muscle. The average ratio of activity in type II fibres compared with that in type I fibres was 2.5.


Parenteral administration of phospholipase C in the rat. Distribution, elimination, and lethal doses. Infusions of tissue thromboplastin induce intravascular coagulation in animals. Phospholipase C (PLC) (EC 3.1.4.3) from Bacillus cereus has a marked protective effect against such infusions and might be of value in the therapy of certain types of intravascular coagulation. We have therefore studied the toxicity, half-life, and effect on lipolysis of purified PLC in rats, using parenteral administration of 14C-labelled enzyme. Following intravenous injection, the plasma half-life was 5.2-5.4 min, and LD50 was approximately 1.6-1.7 mg/kg. The effect of PLC on lipolysis was moderate. The enzyme does not appear to be bound to any plasma macromolecules, and there was no accumulation of labelled enzyme in tissues other than kidney.


Microcalorimetric measurements of heat production in human erythrocytes. IV. Comparison between different calorimetric techniques, suspension media, and preparation methods. Heat production in human erythrocytes from healthy subjects has been measured under different experimental conditions. Simultaneous measurements were made on the same samples using different types of microcalorimeters: a static ampoule calorimeter, an air perfusion calorimeter, and a flow calorimeter. Obtained heat effect values for specified standard conditions, P degrees, were within uncertainty limits the same for the different calorimeters. Cells were suspended either in autologous plasma or in a phosphate buffer. P degrees values for buffer suspensions were significantly higher than those for plasma suspensions. Erythrocyte samples prepared by the column adsorption technique gave higher P degrees values than those obtained by a conventional centrifugation procedure.


Effect of the thymus storage factor (TSF) on the blood sugar and insulin level. The rat thymus extract prepared with physiological NaCl solution causes--by its TSF component--an increase of the blood sugar level. After sugar loading in TSF-treated animals, the blood sugar level becomes gradually higher and the insulin secretion diminishes as compared to the control animals. Thymectomy moderates but does not inhibit the TSF decreasing effect on the insulin level. Consequently, TSF primarily causes a decrease of the blood insulin level which correlates with a rise of the blood sugar level.


Impaired anticoagulant effect of heparin in the artificial kidney. An experimental study. Dialysis of blood and plasma was performed in vitro, in a 'mini-Kill' dialyser as well as in dialysis bags. A marked shortening of the thrombin-clotting time was observed, indicating fall in heparin anticoagulant effect. The concentration of heparin, however, as measured by polybrene titration, was substantially less reduced. Fibrin formation, as evidenced by the ethanol gelation test, occurred more often in the dialysed than in the control plasma. In conclusion, the discrepancy between concentration and anticoagulant effect of heparin could be partly explained by influx from the dialysate of calcium, magnesium, and acetate ions. The fibrin-polymerizing effect of these ions was confirmed by a shortening of the clotting time with Reptilase, a proteolytic enzyme not influenced by thrombin inhibitors such as heparin. In addition, liberation of platelet factor 4 may be responsible for some reduction in antithrombin activity of heparin. No evidence of heparin being dialysed or adhering to the dialysis membrane was found.


The effect of standing and exercise on plasma catecholamines, serum insulin, and serum gastrin. Glucose-stimulated insulin secretion was measured in six normal subjects in the resting supine position, during standing, and during a period of moderate exercise in the supine position. Plasma noradrenaline averaged 0.26 ng/ml in the supine, resting position and rose to 0.57 and 0.61 ng/ml at the end of the standing experiment and the exercise period, respectively. Plasma adrenaline was unchanged in the standing position but rose threefold during exercise (to 0.09 ng/ml). Serum gastrin tended to decrease in all three experiments after the injection of glucose. Glucose-stimulated insulin secretion was the same during the first 10 min after the injection of glucose in the three experiments. It is concluded that a moderate increase in adrenergic activity has no influence on glucose-stimulated insulin secretion.


Quantitation of active pancreatic endopeptidases in the intestinal contents of germfree and conventional rats. Trypsin, chymotrypsin, and elastase were measured in the intestinal contents of germfree and conventional laboratory rats. Active trypsin was highest in the lower part of the small intestine and fell abruptly in the cecum. Trypsin was present in the feces of germfree rats but not of conventional laboratory rats. Electrophoresis of supernatant fluids from intestinal contents, and functional assays with specific synthetic substrates confirmed these results. The concentrations of active elastase were very high in the upper small intestine but low elsewhere. Active elastase was present in contents from the large intestine of germfree, but not conventional laboratory rats. These results suggest that normal microbiological inhabitants of the intestinal tract of rats play a role in the inactivation of pancreatic enzymes.


Bile acid metabolism and vitamin B12 absorption in ulcerative colitis. Bile acid and vitamin B12 malabsorption were evaluated in 34 cases of ulcerative colitis. Twenty-four patients were non-operated and 10 patients were colectomized. The postprandial duodenal bile acid concentration was abnormally low in 13 of 24 non-operated cases and found to be correlated to the activity of the disease. Two of six patients subjected to colectomy had a reduced bile acid concentration. Bile acid absorption was assessed by the cholyl-glycine-1-14C breath test combined with faecal analysis. The 14C-excretion in breath was abnormally elevated in only one of the patients in the total material. The faecal 14C-output was related to the disease activity in the non-operated group. Patients colectomized for ulcerative colitis had an extremely high excretion of isotope in the ileal effluent, from 15 to 81 per cent of the dose given. The faecal 14C-output was correlated with the duration of the ileostomy and the mass of ileal discharge. Vitamin B12 malabsorption was only present in five patients. It is concluded that patients with ulcerative colitis during the active phase of the disease have bile acid malabsorption, and patients colectomized for ulcerative colitis have an abnormal high bile acid deconjugation in the ileal effluent.


Ileostomy in ulcerative colitis. Results in 149 patients. The operative mortality among 144 patients treated with proctocolectomy and ileostomy for ulcerative colitis was 7.6%. Half the patients had fulminating colitis. Only 4 patients died during the follow-up period. Intestinal obstruction needing laparatomy occurred in 8.6%. Ileostomy revisions have been carried out in 13%, and significantly more often in females than males owing to a higher frequency of stoma retraction. Other ileostomy problems (leakage, skin soreness, excoriation) were experienced by nearly half the patients. These problems were episodic in the majority and could usually be remedied by instruction and new devices. Less than 7% used colostomy bags. In the remainder the changing interval appeared to be a measure of ileostomy success. The average length of the ileostomy spout was significantly longer in males without ileostomy problems (5.8 cm) than in males having leakage (3.7 cm). This difference was not apparent in females. Working and sexual impairment was rare. The success of an ileostomy depends on proper management, i.e., access to expert advice, instruction, training, follow-up, and adequate supplies of appliances. A stoma therapist on the staff is therefore extremely valuable.


Fine needle aspiration biopsy of the pancreas. Fine needle aspiration biopsy from the pancreas was carried out peroperatively in 60 patients. A suspicion of malignancy due to a palpaple mass in the pancreas was raised in 45 cases and confirmed by cytology in 27 cases. Of the remaining 18 cases in which malignancy was suspected, the majority were caused by penetrating gastroduodenal ulcers or pancreatitis. There was only one false negative cytological report among the 37 patients with available histological control. There were no complications due to the aspiration biopsy.


Morphological and functional changes of the liver following small intestinal bypass for obesity. Liver biopsies of 6 patients were obtained at time of jejuno-ileal bypass and compared with liver biopsies obtained at 6, 12, and 18 months after the operation. The extent of fatty changes, cellular infiltration, connective tissue infiltration, and parenchymal cell damage was recorded. In biopsies taken 6 and 12 months postoperatively a considerable increase was observed in steatosis and cell damage, biopsies obtained at 18 months after the operation showing reduction or clearing of fat. Transient increase in periportal cell infiltration was observed, and in one patient a manifest cirrhosis developed, necessitating partial reversal of the shunt. An attempt was made to correlate the histological changes with alterations in standard liver function tests. The tests were of limited value in predicting the histological changes unless the morphological changes were very serious and the liver in a state of insufficiency. The importance of liver biopsies in the follow-up of bypass patients is stressed.


Demonstration of a vitamin B12 binder in pancreatic juice. Effect on the intestinal uptake of vitamin B12. Determination of vitamin-B12-binding capacity and gel filtration of human pancreatic juice (HPJ) and rat pancreatic juice (RPJ) demonstrated a vitamin B12 binder different from gastric intrinsic factor (IF). The results also indicated the presence of the pancreatic B12 binding in human duodenal juice. The binder in RPJ had no significant effect on the uptake of 57CoB12 and 57CoB12 bound to rat IF by perfused rat intestinal segments (p greater than 0.5; p greater than 0.1). The binder in HPJ had no effect on the uptake of unbound 57CoB12 or 57CoB12 bound to human IF by guinea pig intestinal brush borders (p greater than 0.05; p greater than 0.1). The results indicate that the pancreatic vitamin B12 binder does not influence the intestinal uptake of vitamin B12.


Selective loss of parietal cells in the gastric remnant following antral resection. The mucosa of the gastric remnant of 41 subjects who had been operated upon 17-18 years earlier for peptic ulcer was studied histologically. The histological changes were classified as follows: 1) normal mucosa, 1; 2) simple gastritis, superficial or atrophic, 27; and 3) "selective loss of parietal cells", 13 subjects. The latter type was characterized by marked loss of parietal cells without corresponding loss of other epithelial elements and without an inflammatory reaction. These changes were thought to reflect a lack of a trophic action on parietal cells exerted by gastrointestinal hormones, as e.g. gastrins.


Prevalence of antral and fundic gastritis in a randomly selected group of an Estonian rural population. The state of the gastric antral and the fundic mucosa was examined by gastroscopic biopsy in randomly selected 16-69-year-old subjects of a rural medical district. Fundic gastritis was found in 45% of the series, being superficial in 25% and atrophic in 20%. Antral gastritis occurred in 68%, being superficial in 39% and atrophic in 29%. The occurrence of antral gastritis was more frequent (XZ=15.25; df=1; p less than 0.001) than that of fundic gastritis. Antral gastritis and normal fundic mucosa were found in 32% and isolated fundic gastritis in 10% of the series. In the cases in which gastritis had affected both gastric regions, the changes quite often reflected different stages of the disease. The fundic and antral mucosae were normal only in 22% of the subjects examined.


Pressure-responses to cholecystokinin in the fundus and antrum of isolated guinea-pig stomachs. Cholecystokinin produced dose-dependent increases in motor activity in antral and fundal pouches of isolated guinea-pig stomachs. The response was immediate; the motor activity increased to a peak within 2 min, then decreased somewhat, but stabilized within 5 min at a value that was higher than before addition of cholecystokinin. In the antral pouches the response consisted of an increase in the amplitude of the rhythmic contractins; in the fundal pouch it was seen as an increase in basal pressure. The antral response was significantly greater in pouches distended to an initial basal pressure of 15-25 cm H2O than in undistended pouches. The fundal reponse was not enhanced by distension.


Effect of highly selective vagotomy on gastric emptying. Our objective was to study the gastric motility after highly selective vagotomy (HSV) by determining the gastric emptying rates of isotonic saline and glucose. In 15 controls and 15 patients after HSV, 750 ml of saline and glucose respectively were introduced into the stomach with an interval of two hours. Twenty minutes after each infusion had been started the content of the stomach were aspirated. Phenol red was added as a marker in order to obtain information about the amount of gastric secretion plus possible duodenal regurgitation. In the controls the mean volume of gastric contents recovered was 208 ml after saline and 539 ml after glucose. The corresponding mean volume of test meal remaining was 158 ml after saline and 465 ml after glucose. In patients after HSV the figures for gastric contents were 81 ml after saline and 303 ml after glucose and for meals remaining 59 ml after saline and 259 ml after glucose. The data indicate that HSV speeds the gastric emptying of liquids, while liquids of different compositons are still emptied at different rates, indicating the preservation of a control of the gastric emptying.


Bile acid metabolism after jejunoileal bypass operation for obesity. Bile acid metabolism and duodenal bacterial flora were studied in 12 obese patients before and 1-2 months after jejunoileal bypass operation, either including 37.5 cm jejunum and 12.5 cm ileum (Type I) or 12.5 cm jejunum and 37.5 cm ileum (Type III). The cholic acid pool size was unchanged after type I, but decreased after type III, bypass. The daily fractional turn-over of cholic acid increased about five times after both types of operation. The synthesis rate of cholic acid increased after both types of bypass, but more after type I than after type III. In duodenal bile the ratios of cholic to taurine conjugates increased after type I, but were unchanged after type III bypass, whereas the ratio of cholic to chenodeoxycholic acid was unchanged after both types of bypass. The bacterial flora and the occurrence of free bile acids in the fasting duodenal contents did not change after either of the two types of bypass operation. It is concluded that jejunoileal bypass results in marked disturbances in the bile acid metabolism. Surprisingly, these are most severe after bypass including the longest ileum, possibly because of insufficient stimulation of the bile acid synthesis in this type of operation.


The incidence and result of radiological examination of the stomach using a barium meal. In 1964 1.6-1.8% of the population in Copenhagen County - with a population of approx. 500,000 - were referred for a radiological examination of the stomach. The incidence, the same in both sexes, increased with increasing age, being 1% at the age of 20 years and 3-4% at the age of 70 years. The probability of demonstrating an ulcer was twice as high in men (32%) as in women (17%), reaching a total of approx. 25%. The incidence of a "negative" result was thus highest in women. In this "non-ulcer" group the sex ratio male:female was correspondingly 0.6:1. Patients with a new ulcer constituted over a certain age a surprisingly constant fraction of those examined -- in men approx. 15%, in women approx. 9%. The total incidence of new and relapse cases of peptic ulcer was 2.6-3.6 per 1000 inhabitants, with a ratio male:female of 1.6:1. The age incidence was constant for women after the age of 50 years and maximal for men in the 70-year age group. The probability of demonstrating changes that within an observational period of 6 years were found to be caused by cancer of the stomach was 1%, corresponding with an incidence of 0.2 per 1000 inhabitants.


Effect of high cholesterol, olive oil diet on the lipids and connective tissue in rat liver. A biochemical study. Rats were fed a high cholesterol, olive oil diet for one or seven weeks. The resulting hypertrophic fatty livers were analyzed for lipids, nucleic acids, and connective tissue components. The cholesterol and neutral glyceride contents of liver increased approximately 30-fold during the first week while phospholipids remained almost unchanged. After seven weeks the accumulation of cholesterol was further increased and the content of phospholipids enhanced. The total amounts of DNA and RNA rose with increasing weight of fatty liver. In seven weeks the diet caused a marked increase in hepatic collagen and glycosaminoglycans. The synthesis of collagen was increased in fatty liver slices after both one and seven weeks of the experiment. Fatty liver produced by this lipid diet is suggested as a suitable model for studying the mechanism by which lipids stimulate hepatic fibroblasts.


Response of uraemic bone marrow cells to erythropoietin in vitro. In vitro culture technique of bone marrow cells has been applied to study the cause of anemia in uraemic patients on maintenance haemodialysis. Incorporation of 59Fe into haem in bone marrow cells of the patients in the presence of erythropoietin, as well as the inhibitory effect of their plasma on the response of normal bone marrow cells to erythropoietin, was examined. Increase in haem synthesis rate by erythropoietin in the bone marrow cells of uraemic patients (n 14; 7.9 +/- 1.4) wasnot significantly different from that in normal bone marrow cells (n 9; 5.9 +/- 1.4,p greater than 0.05), thus indicating the presence of erythroid precursor cells with normal responsiveness to erythropoetin in uraemic patients.  All the plasma from uraemic patients inhibited, in dose-dependent way, the response  of normal bone marrow cells to erythropoietin. Levels of erythropoietin in the plasma samples of uraemic patients were much lower than those of the patients with iron deficiency anaemia with comparable Hb concentrations. On the basis of these results, the humoral inhibitory factor appears to play a significant role in the pathogenesis of renal anaemia, in addition to the low level of circulating erythropoietin.


Deaths from severe megaloblastic anaemia in hospitalised patients. In a series of 128 consecutive patients dying from severe megaloblastic anaemia, over half the deaths occurred within one week of hospitalisation and one third were sudden and unexpected. Congestive cardiac failure was extremely common in these patients and was often associated with pleural effusions. Just over half the patients were examined at autopsy and of these 42% had pleural effusions and 15% had pericardial effusions. The cause of the latter is unclear as is their clinical significance, nevertheless this condition has not previously been reported in the megaloblastic anaemias and may well play a part in the fatal outcome in such patients. Blood transfusion was administered to over half the patients, usually in the form of whole blood. It is recommended that transfusions be used sparingly, and consist of cells or preferably exchange transfusion, the latter being of particular value in the elderly or in those with pre-existing cardiac failure.


Control of the immune response: role of macrophages in regulation of antibody-and cell-mediated immune responses. The ability of peritoneal macrophage subpopulations, separated into different classes according to their size, to reconstitute antibody or cellular immune responses in macrophage-depleted spleen cells has been investigated. Data are presented to show that whether reconstitution is by "normal" or "activated" macrophages, be they syngeneic or allogeneic to the lymphocyte source, different populations reconstitute antibody and cellular immunity. Reconstitution is in general by two classes of macrophages, small and large. The former seem to reconstitute only if syngeneic to the responding lymphocyte pool, whereas large macrophages reconstitute immune responses from allogeneic lymphocytes as well as syngeneic lymphocytes. Evidence is also presented to show that syngeneic large macrophages can determine the type of immune response reconstituted; that is, with greater numbers of large cells only cytotoxic responses (and not T-dependent antibody formation) were reconstituted and vice versa.


The serine protease nature of the C3 and C5 convertases of the classical and alternative complement pathways. Activated Factor B, incorporated into the cobra venom factor (CVF)-dependent C3/C5 convertase, was inactivated by diisopropylfluorophosphate (DFP). Inactivation was time- and dose-dependent and was enhanced by the presence of substrate. Treatment of the zymogen of Factor B with DFP effected significant inactivation. Incorporation of [3H]diisopropylphosphate into the zymogen and into the activated form of Factor B was demonstrated after [3H]DFP treatment and subsequent electrophoresis of the proteins on polyacrylamide gels containing sodium dodecyl sulfate. Inactivation of activated C2 incorporated into the classical C5 convertase was observed on DFP treatment of the enzyme. DFP also reduced the activity of the C2 zymogen. The description of their serine proteinase nature further emphasizes the close structural and functional relationship of C2 and Factor B.


Antigen and unspecific mitogen stimulation of lymphocytes eluted from rheumatoid inflammatory tissue. Lymphocytes were eluted from synovial tissues of 17 patients with classical rheumatoid arthritis, using a procedure previously reported. Stimulation was obtained with the unspecific mitogens phytohemagglutinin (PHA), pokeweed mitogen (PWM), and concanavalin A (Con A) as well as with purified protein derivative of tuberculin (PPD) and mitoycin-C-treated allogeneic lymphocytes, whereas candida antigen usually gave a low response. The pattern of reactivity to unspecific mitogens was similar to that obtained with lymphocytes from peripheral blood of rheumatoid arthritis patients. Two different PPD preparations usually gave transformation of the same magnitude as seen with PHA. This was in contrast to the reactivity of the peripheral blood lymphocytes. It could be demonstrated that the elution procedure initiated some degree of lymphocyte transformation, mainly potentiating the responses to PHA and Con A.


Blocking effect of rheumatoid factor on the in vitro cytotoxicity of lymphoid cells from carcinoma patients. Human cryo-IgM rheumatoid factor (RF) preparations blocked the tumor-specific in vitro cytotoxicity of ovarian or bladder carcinoma patients' lymphoid cells in microcytotoxicity assays. The effect was mediated by pretreatment of the effector cells. Cryo-IgM RF free of detectable IgG blocked in a dilution-dependent manner, and immunosorbent purification of contaminating IgG from another preparation did not abrogate the blocking effect. Control IgM preparations lacking RF activity did not block the cytotoxicity, and normal human serum preincubation of the RF preparations rendered them inactive, indicating that the blocking effect was due to the anti-IgG activity of the RF.


Antibody suppression and antiallotype antibodies. I. Failure of antibody to suppress antibody formation in rabbits possessing antiallotype anantibodies. Antibody formation in rabbits against sheep erythrocytes (SRBC) was suppressed after injection of anti-SRBC IgG. Suppression did not occur, however, if the injected IgG had an allotypic marker to which the rabbits possessed circulating antibody.


e-Antigen in patients with transient and chronic carriership of hepatitis B antigen. Serum samples from 39 patients with hepatitis B antigen (HBSAg) were studied for presence of e-antigen. 21 patients had HBSAg transiently and 18 were carriers of HBSAg for 14 months or more. All serum samples from the 18 carriers reacted in the e-antigen system; 16 individuals had e-antigen and 2 had anti-e. In contrast, only 3 of the 21 patients with transient HBS-antigenemia were found to have e-antigen. The clinical course of 31 of the 39 patients was followed from the acute stage. All of the 18 patients who did not develop e-antigen became free from symptoms within 13 weeks. In the remaining 13 patients e-antigen was found and 10 became chronic HBSAg-carriers; 4 with biopsy-verified chronic hepatitis and 6 with biochemical findings consistent with this diagnosis.


Infections in splenectomized patients. A study of 131 patients. A retrospective study on infections was done on 131 patients (predominately adults) undergoing splenectomy with a median follow-up to 11 months. 43 patients died, and 23 of them were infected. Three succumbed primarily from their infection; in 9 the infection was a contributing factor; and 11 died primarily from their underlying disease with an associated infection. 64 patients had lymphoreticular malignancies, 53 had a nonmalignant condition and 14 had carcinomas. Infection rates were 42%, 42%, and 21% respectively. Bacteremia rates (all in adults) were were 5%, 4%, and 7% respectively. Over four-fifths of the infections were hospital acquired. 12 of 14 community onset infections occurred in patients with lymphoreticular malignancies.


A comparison of angiography and scintigraphy as diagnostic methods for amebic liver abscess. A comparison has been made between scintigraphy with radioactive gold and selective angiography as methods of diagnosing amebic liver abscess in a small series begun in 1965. In 5 cases with a positive scintigraphy, the diagnosis of a liver abscess was supported by angiography in 3.


Evaluation of chlorine compounds for surface disinfection by laboratory and in-use testing. The disinfecting properties of chloramine and compounds containing chlorinated trisodium phosphate and potassium bromide or sodium dichlorisocyanurate and detergents were studied by laboratory and in-use tests and compared with a phenolic disinfectant containing detergents. In a modified Kelsey test all the preparations were effective in the recommended dilutions in clean conditions. The effectiveness of the chlorine-bromine disinfectant substantially decreased in the presence of organic material. The in-use testing was performed in infectious disease and intensive care wards. Chloramine was so disliked that the in-use test could not be carried out. In the infectious disease ward the total bacterial colony counts of the floors (disinfected once a day) were twice as high as those of the intensive care ward (disinfected 3 times a day) during the use of the phenolic and chlorine-bromine disinfectants. The frequent cleaning routine seemed thus to have an effect on the microbial contamination of the floors. The same difference was found in the contamination of the other non-vertical surfaces although they were disinfected only once a day in both wards. In both wards the total bacterial colony counts of all non-vertical surfaces were lower during the use of halogen compounds than during the use of the phenolic disinfectant. The staff, however, complained of the irritation of the skin and the mucous membranes when using chlorine disinfectants.


Endocarditis caused by Actinomyces viscosus. A case of severe endocarditis caused by Actinomyces viscosus is described in a previously healthy 70-year-old man. The isolated strain has been characterized by biochemical tests, gas-liquid chromatography and serology. The pathogenic significance of the organism is discussed and the difficulty in reaching a correct diagnosis due to the similarity to species of Corynebacterium is pointed out.


Recurrent toxoplasmosis.

Recurrent toxoplasmosis. A case of recurrent toxoplasmosis in a previously healthy 34-year-old woman is reported. Although she was treated 3 times with co-trimoxazole, which in our experience has been efficient in the treatment of toxoplasmosis, and responded to treatment clinically and serologically, she relapsed with clinical symptoms and rise of anti-toxoplasma titres. Hypothetically, toxoplasmosis is a latent infection which can be activated by other diseases and by immunodepression.


Survival of bacteria in four different transportation systems. The survival of various bacteria in pure cultures and in mixed suspensions in two Stuart (SBL and Bifok) and one Amies (Securline) transportation systems were compared with the conventional agar slope. Considerable differences were found. Stuart Bifok and Stuart SBL were superior to the other two.


The adrenergic innervation and adrenergic receptor activity of the feline urinary bladder and urethra in the normal state and after hypogastric and/or parasympathetic denervation. After long-term parasymphatetic denervation, detrusor muscle hypertrophy was found regardless of whether the hypogastric nerves had been sectioned simultaneously or not. After hypogastric denervation only, there was no difference in gross appearance from normal bladders. Adrenergic innervation was studied by means of a histochemical fluorescence technique. After hypogastric denervation, there was usually a slight increase in the detrusor innervation, and a clear decrease in the trigone and urethral adrenergic innervation. After parasympathetic denervation, the detrusor showed an increase in adrenergic innervation, while the innervation of the trigone and the urethra was unchanged. After simultaneous parasympathetic and hypogastric denervation, the adrenergic innervation of the detrusor was similar to that of the bladders subjected to parasympathetic denervation only. The adrenergic innervation of the trigone and urethra was similar to that found after hypogastric denervation only. Adrenergic receptor functions were studied by a method in which changes in the isometric tension of muscle strips were recorded following different pharmacological treatments. In the normal state, noradrenalin and phenylephrine caused contraction and isoprenaline relaxation of the trigone-urethra. In the detrusor, noradrenalin caused relaxation of strips contracted by carbacholine. Relaxed detrusor muscle strips were usually not contracted by noradenalin. In 2 out of 8 normal cats, however, a contraction was observed after very large doses of noradrenalin. After hypogastric denervation, the adrenoreceptor functions were consistent with those of the normal state. After parasympathetic denervation, the trigone-urethral receptor functions were unchanged compared with the normal receptor functions. In the detrusor, isoprenaline caused relaxation and noradrenalin and phenylephrine contraction. After simultaneous parasympathetic and hypogastric denervation, the results were consistent with those obtained after parasympathetic denervation only. Thus, the present study showed an increased adrenergic detrusor innervation and alpha-receptor activity after parasympathetic denervation regardless of whether the hypogastric nerves had been sectioned simultaneously or not. Although alpha-receptors might exist in the normal detrusor, beta-receptors dominate strongly. After parasympathetic denervation, there seems to be a change in the relation between alpha- and beta-receptors in favour of alpha-receptors.


The urethral electromyographic and gas pressure profile. Technique and patterns. A new technique for recording of the urethral pressure profile is described. The technique consists of a combined electromyographic and gas urethral pressure profile recording. Normal and pathological patterns are described. The method provides information of the correlation between intra-urethral pressure and activity in the periurethral striated musculature, and has proved useful in the assessment of neurological dysfunction of the urethra.


An urodynamic study of emepronium bromide in bladder dysfunction. The effect of emepronium bromide in 13 patients, most of whom had uninhibited bladders, has been studied urodynamically. Under the influence of this drug, the detrusor pressure and the urinary flow was reduced, and abdominal straining during during micturition was commonly recorded. The bladder capacity increased considerably, but all subjects developed residual urine. The effect of emepronium bromide on the bladder capacity seemed to last for a longer period than the effect on the detrusor pressure.


Selection of patients for surgical correction of urinary incontinence after prostatic surgery. It has been suggested that patients with urinary incontinence after prostatic surgery should be accepted for operative correction only if there is no urethral stricture, no urinary infection, and a normal cystometrogram. To study the frequency of these contra-indications, 37 patients suffering from incontinence after suprapubic enucleation of benign prostatic adenomas were examined. Urethral strictures were found in 16 patients, recurrent urinary infection in 16, and an abnormal cystometrogram in 9. Only 13 patients were found to fulfill all three criteria for operative correction. The validity of the criteria is discussed on the basis of our experience from 13 patients operated upon with a free fascial sling. Ten of them were cured or improved. Three patients remained incontinent; these 3 patients were the only ones in the operated series who did not fulfull the suggested criteria for correction. Thus, so far, the criteria seem to be justifiable.


Hydrostatic pressure treatment for carcinoma of the bladder. A clinical and urodynamic evaluation of the effect on bladder hemorrhage and fibrosis in irradiated patients. Hydrostatic pressure treatment as described by Helmstein was given to 12 patients with hematuria secondary at irradiation for carcinoma of the bladder. The bladder function was evaluated on the basis of urodynamic examinations before and after the treatment. The study includes examination of the effect on the renal function. In 6 patients, hemostasis was obtained for a period averaging 10 months. No serious complications occurred. Following irradiation, the patients showed a characteristic micturition pattern with a small bladder capacity and a marked increase in pressure during the filling phase. The micturition took place partly by use of the abdominal musculature; the detrusor pressure was falling during the whole voiding time. The voiding was almost complete, and the flow values were slightly reduced. The hydrostatic pressure treatment resulted in no demonstrable changes in this micturition pattern. Evaluated from the creatinine clearance, the renal function was unchanged after the treatment, and neither polyuria nor an increased excretion of sodium was demonstrated during the first hours after the treatment. We conclude that before major surgery is decided on, hydrostatic pressure treatment should be given to patients with hemorrhage following irradiation for carcinoma of the bladder. No improvement can be expected in patients where the often pronounced pollakiuria is due to fibrosis of the bladder secondary to irradiation.


Renal revascularization after splenic artery implantation into the kidney of dogs. Studies on renal function and blood flow. Renal vascularization by splenic artery implantation into the kidney was studied in 11 dogs. Renal function and blood flow were evaluated after creation of stenosis of the ipsilateral renal artery. It was concluded that the method can be used to revascularize an ischemic kidney resulting in a sufficient renal blood flow with an adequate distribution of blood and maintenance of a reasonably good renal function after contralateral nephrectomy and division of the ipsilateral renal artery.


effect of kidney resection on blood pressure and plasma renin activity. Case report and clinical study. Acute transient hypertension following kidney trauma occurred in a 17-year-old youth due to increased activity of the renin/angiotensin system. The systemic blood pressure and plasma renin activity was also studied following elective kidney resection. In one group of patients the operation was performed with clamping of the renal vessels; in the other no clamping was performed. Only minimal changes in blood pressure and plasma renin activity was found in both groups.


Roentgenologic aspects of haematuria.

Roentgenologic aspects of haematuria. In the roentgenologic investigation of haematuria, urography is the main diagnostic tool, other examinations being only of supplementary value. The main importance of other roentgen examinations is the possibility of excluding certain types of suspected disease as the cause of haematuria, and to demonstrate certain vascular malformations in the kidneys with renal angiography. Urography and cystoscopy should be performed in all patients with haematuria, and the possibility of pathologic conditions in both upper and lower urinary tract must be kept in mind. A large number of overlooked calculi and the finding of unsuspected malignant renal tumors in cases where the urography was performed on an emergency basis, underlines the important fact that "emergency"  in these cases only indicates that the patient is an acute distress, not that the examination should be hasty and incomplete, or if so, should be supplemented by a repeat examination under normal conditions.


Hydronephrosis. Assessment of late results after treatment of pelvi-ureteric junction obstruction. Hydronephrosis is probably caused by a muscular anomaly at the pelvi-ureteric junction. A pyeloplasty technique involving the resection of this anomalous portion has been generally recommended. However, this study shows that procedures which preserve the anatomical continuity might also lead to excellent late results. The immediate postoperative complications were few and minor, and the low incidence of complications was partly the result of the splinting technique, which is therefore recommended. A scheme for evaluation of late results is suggested.


Uroliathiasis with primary hyperparathyroidism. A one-year screening. A one-year material of 290 patients with clinically verified urolithiasis was screened for primary hyperparthyroidism, by X-ray examination, analysis of calculi, plasma calcium and phosphate, plasma parathyroid hormone and a clinical history examination. Primary hyperparathyroidism was found in 10 patients, 8 with adenomas and 2 with hyperplasia. The results suggest that with the present policy of investigation, there is a considerable underdiagnosis of parathyroid changes in patients with urolithiasis. An interesting finding was the distribution of plasma calcium concentrations in this material, which indicates that patients with urolithiasis have a generally higher lever of plasma calcium than others.


Kidney function during hydropenia nad water diuresis in patients with idiopathic recurring nephrolithiasis. The kidney function of 41 patients with idiopathic recurring kidney stones was investigated by inulin- and PAH-clearances and by measuring the excretion of electrolytes during hydropenia and water diuresis. All patients had normal inulin- and PAH-clearances and normal concentrating capacity as indicated by free water reabsorption (Tc H2O). Seven patients, all of whom had previously been found to have low excretion of magnesium in urine, were unable to dilute their urine. During water diuresis these patients also had lower osmolar clearance and lower excretion of sodium than the other patients. A defective dilution capacity may be of pathogenetic significance for stone formation; the causes of the defect, however, are not clear.


131I-hippuran renography for control of patients with ureterolithiasis. The value of the 131I-Hippuran renography for control of patients with ureteroliathiasis was investigated in a consecutive series of 58 patients with radiologically verified unilateral ureteroliathiasis. Intravenous pyelography (IVP) and renography (RNG) were performed on admittance and 4-5 weeks later, the interval between the IVP and the RNG being 0-4 days. From 80 comparisons of the results of IVP and RNG (prevalence of abnormal IVP 73%), the predictive value of an abnormal RNG in the control situation was found to be 88% with a 95% confidence interval of 75-93%. The predictive value of a normal RNG was 88% (62-98%). If renography was combined with an X-ray of the abdomen at the control examination, the predictive value of an abnormal RNG was unchanged and the predictive value of a normal RNG increased to 100% (77-100%). On the basis of these high predictive values, a new examination protocol for control of patients with unilateral ureterolithiasis is put forward.


Percutaneous pyelolithotomy. A new extraction technique. Recurrent renal calculous disease is often troublesome to treat because of technical difficulties associated with reoperation. Attempts to dissolve the stones by irrigation with various solutions has not had much success. A new extraction technique has therefore been devised whereby the stones can be removed through a percutaneous nephrostomy umder radiological control. Three cases are described.


Fine needle biopsy of metastases at retrograde pyelography, directed by fluoroscopy. Report of a case with malignant teratoma of the testis. Percutaneous fine needle aspiration biopsy was performed at retrograde pyelography in order to differentiate between metastatic and scarry involvement of a strictured ureter in a patient earlier operated upon because of malignant teratoma. The method is recommended in patients with malignant diseases where the differential diagnosis is impossible to establish at retrograde pyelography or urography.


[Education in psychiatry].

[Education in psychiatry]. In order to give young doctors a specialist training in psychiatry and psychotherapy and to have the necessary number of available posts, the concept of training presently practised should urgently be revided. To justify this demand, the author points to new developments within psychiatry itself as well as to external circumstances. He mentions firstly the extension of the knowledge itself, the pluralism in therapy, the growing specialization within the specialty, the diffusion of the roles as well as the identity crisis and secondly the disproportion to be expected between the number of young graduated doctors and the number of available posts. So that the readermay for his own opinion, the author refers to the relevant literature. The author's personal opinion and his proposals are discussed.


[Open letter to a student in the training for child and adolescent psychiatry]. Summary of an imaginary letter to a junior doctor who would like to get a training child and adolescent psychiatry. The author tries to give his young colleague particulars about the official aspect his training regulated by the FMH in paedopsychiatry, as well as on the cultural and personal aspects of a training course in psychotherapy.


[Choice in psychiatry].

[Choice in psychiatry]. After a general review of the subject discussed, the author deals with it in detail, from the point of view of the various motivations involved, the roles and purposes envisaged, and this in traditional psychiatry as well as in the so-called anti-psychiatry, and he concludes that in each case it is the patient himself, with his own special problems, who should determine the orientations in psychiatry.


[Residual dimension and defect].

[Residual dimension and defect]. We approached the current problem of the residual dimension of psychoses, a problem of significance from both the psychopathological and social-psychiatric viewpoint by studying two well-matched groups of patients suffering from cycloid (schizo-affective) psychosis and hebephrenia. On the basis of the short-term course of the psychosis, we reached the following conclusions: 1. The residual dimension is not uniform, not homogenous and is not nosologically neutral, but is complex, multifold and nosospecific to a significant extent. 2. Assessment of the residual syndrome on "vorgestalt" level is indispensable for analysis of the residual dimension in cycloid psychotics and is also value in the case of heberphrenics (within the group of systematic schizophrenics). 3. We speak of a clinical defect in the case of a stable link between manifest symptoms which point more towards a disorder in the life functions and symptoms of resocialization more related to the life history; detectable defect is used in referring to a stable link between symptoms which are detectable (by test psychology methods) and disorders in resocialization. It must be stressed that the assessment of the psychiatric defect is a doubly resignated way of knowledge as compared to defects which can be evaluated on the anthropological level; however the empirical value derives precisely from the consciously accepted limitation. 4. We found clinical defects only in the heberphrenics. A cognitive defect was detected in the cycloids and a personally defect in the heberphrenics.


[Significance of cranial hyperostoses for the neurologic-psychiatric practice]. The present paper attempts to comment on the relation between diffuse concentric hyperostoses of the cranial vault and neurologic and psychiatric symptoms in a male aged 42 and a woman aged 23 when death occurred. In the past, similar discussions mainly concerned the hyperostosis frontalis interna (Hfi), although the demonstration of a true relation is difficult in the Hfi because of its late occurrence at an advanced age (60-70 years), in which mental disturbances due to other pathological circumstances are frequent as well. The diffuse concentric hyperostosis in young individuals has comparatively seldom been regarded, although in young individuals the age factor in the consideration of mental disturbances can be excluded. The 42 year old male had an 18 years history of mental disturbances such as a mental change and severe episodic psychiatric symptoms, which repeatedly required clinical treatment. Since 18 years he had also suffered from headaches which caused an abusus of phenacetinum. A diffuse concentric hyperostosis of the neurocranium with a long developmental course, as could be derived from microscopical examination, was considered likely to be the reason for the longstanding headaches and the mental change. The 23 year old female was a prostitute suffering from serious headaches and neurodystonia until she died suddenly and unexpectedly, without sufficient autopsy findings. The cranial vault displayed a severe concentric hyperostosis besides other striking changes.


Supratentorial dissemination of medulloblastomas. The present paper reports on 13 cases of medulloblastoma with supratentorial dissemination. With reference of these cases the authors discuss the pathogenetic probabilities of the dissemination of brain tumors, their evidence and treatment, emphasizing the importance of cerebral scintigraphy formed periodically in all patients previously operated of medulloblastoma. When dissemination is detected radiotherapy may give good results. If the symptomatology is very accentuated the secondary supratentorial tumour has to be removed.


[Voice discrimination in patients with cerebral cortical lesions]. A study of voice discrimination by unilateral brain-damaged patients is presented. Performance of this task is a very sensitive index of the presence of a cerebral lesion. The worst results are observed when there is a lesion of the right hemisphere and particularly when the right temporal lobe is involved.


[Intracerebral measurement of electric tensions following peripheral electric injury]. The present research has originated from observing a 25-year-old man who - after an electrotrauma-- showed a hydrocephalus internus in the pneumoencephalogram. The review of the literature available at that time resulted in obtaining only one information concerning this nexus of related problems; thus the search of patients suffering from this trauma began, but as well experiments on animals. Most of the cats being injured by A.C. actually showed a dilatation of the lateral ventricles. Further experiments on dogs have shown that not only in case of transcerebral but also of peripheral injuries by electric currents of certain strength, distinct states of paling on the brain surface could be observed occurring in consequences of the extreme vasosoconstriction of the meningeal vessels. By a further series of experiments on dogs, there was finally demonstrated that also after peripheral electric irritations resp. injuries of different variations, electric tensions in the brain can be measured by intracerebrally installed electrodes at varying irritatnt voltages; up to now, this possibility has been in contest. Neuropathological investigations showed intracerebral and subarachnoid haemorrhages of different size in all injured animals.


[Ruptures and thromboses of the vertebral artery following closed mechanical injuries]. Five cases of occlusion of the vertebral artery in context with mechanical stress - from endogene reasons in one case - and lesions of the vessel walls (in three cases) are recorded. The inferior posterior cerebellar artery was involved in all cases. Variable ischemic lesions resulted in the medulla oblongata and in the cerebellum, which were survived up to four weeks in one case. In the others death occurred within few hours or suddenly and unexpectedly. Related neurological symptoms were absent in one case only. A chiropractic manipulation of the neck was the reason for the arterial insult in two cases.


The inhibitory effect of IgM RF on the release of lysosomal substances. Isolated IgM RF inhibited the IgG-induced release of lysosomal substances, measured as 'large molecular size vitamin B12-binding protein' (LBP) and beta-glucronidase, from separated human granulocytes. The effect was most marked when cytochalasin B was added to the experimental system. The results indicate that the RFs interact with the granulocyte binding region of IgG.


Liver involvement in polymyalgia rheumatica. The incidence of abnormal results in liver function tests was determined in 37 of 51 patients with polymyalgia rheumatica (PMR) or temporal arteritis. Fine-needle biopsies fo the liver were performed on 6 of these patients and the bile canalicular network and liver cytology were studied in the aspirate by enzyme-cytochemical methods. Of the 37 patients in whom it was measured, 23 (62%) had elevated concentrations of serum alkaline phosphatases (AP), mainly of hepatic origin. The concentrations of other serum enzymes associated with hepatic function were normal in all 37 patients. BSP retention was studied in 13 patients and was abnormal in 6 (46%). Three of the 4 patients for whom smears were stained for AP activity had an increase in this activity in their bile canaliculi that corresponded to a rise in the serum concentration of AP. In one of these 3 patients, smears stained for naphthylamidase showed that bile canaliculi had a calibre wider than normal and had granular walls. A second biopsy performed 10 days showed a partial reversal of these changes. Mild fatty infiltration of the liver cells was seen in 2 patients; one patient whose serum concentration of AP was normal also had normal liver cells and bile canaliculi. The structural changes in the bile canaliculi detected in one patient may be evidence of a subclinical hepatic disease associated with PMR. The cholestatic hepatic dysfunction, common in PMR and manifested in over half of our patients by elevated serum AP levels, can easily be confirmed with special staining methods for visualizing the bile canaliculi in cytological liver specimens.


A comparison of the content of iron in normal and rheumatoid striated muscle. An investigation has been carried out on the presence of iron in striated muscle from normal individuals and from patients with rheumatoid disease. The methods used for the estimation of iron required a neutron activation analysis of total iron and extraction of hemoglobin in cyanide buffer. The results disclosed that there was a higher deposition of iron in rheumatoid muscle as compared with normals. Iron has a destructive effect on lysosomes and mast cells, the effect of which is an inflammatory reaction which may in part cause "metabolic myopathy" in rheumatoid disease. It is tentatively suggested that this "metabolic myopathy" may cause muscular pain and weakness in rheumatoid disease.


Effect of enzyme treatment of Chrithidia luciliae on the reactivity of its kinetoplast with anti-DNA sera. The reactions of sera from patients with connective tissue disease with Chrithidia lucillae kinetoplasts were examined with the indirect immunofluorescence technique on untreated smears and smears pretreated with DNAse, RNAse or trypsin. Of 28 completely examined reacting sera, 20 had their reactions inactivated by DNAse alone, two by DNAse and trypsin, and 6 by DNAse and RNAse. This suggests that although the Chrithidia test is probably at present the method of choice for the diagnostic demonstration of DNA antibodies, its results are not completely unambigous. The kinetoplast DNA is probably conjugated to a non-histone protein and antibodies to the conjugate may occur in some instances. In other instances, antibodies may be directed against DNA-RNA complexes. If the Chrithidia kinetoplasts contain a protein moiety, the latter is apparently not identical with the protein contained in the Chrithidian cell nuclei.


Changes in muscle fibre size and physical performance in patients with rheumatoid arthritis after 7 months physical training. Ten patients with rheumatoid arthritis of moderate severity were given 7 months' physical training. During the investigation period the patiens improved their physical performance capacity as well as they lowered their rate of perceived exertion during submaximum exercise. There was a small increase in muscle fibre size and a correlation was found between muscle strength and type II fibre size. Clinical examination and X-ray studies did not reveal any further joint destruction during the investigation period.


Causes of death in autopsied RA patients. Among 3115 autopsied patients, rheumatoid arthritis was registered in 41 patients (1.3%). The causes of death of these were correlated with the causes of death of 310 non-rheumatoid autopsied patients. Of the RA patients, 32% died from cardiovascular disease, 24% from infection, 27% from renal failure and 7% from malignant disease. Of the control patients, 42% died from cardiovascular disease, 9% from infection, 3% from renal failure, and 23% from malignant disease. The low frequency of malignant disease as a cause of death in RA patients may be due to a continuous immunological stimulation or due to a missed diagnosis of RA in patients who died from malignant disease.


Combined mitral and aortic valve replacement with the Börk-Shiley prosthesis. Combined mitral and aortic valve replacement with the BJORK-Shiley tilting-disc valve prosthesis was performed in 42 patients. Hospital and late mortality rates were both at the 9.5% level. No correlation was seen between mortality and combination of concomitant valve lesions. Morbidity was elevated. No episodes of embolism were observed after surgery, although one patient died of severe haemorrhage. Only one patient showed valvular dysfunction (grade 2/4 leakage), but did not require reoperation. Postoperatively, 75.7% of the patients were asymptomatic for a mean follow-up period of 21.1 months. The Björk-Shiley prosthesis offers a small gradient associated with a low profile, which constitute important advantages in multiple valve replacement.


Computer visualization of flow patterns for prosthetic heart valves. Flow patterns for commonly used aortic valve prostheses were formed with the aid of fluid dynamics equations, numerical analysis techniques and computer graphics. Simulations of velocities, vorticity, pressure and certain stress values were developed by a computer and displayed for man-machine interaction. The ball, disc and tilting-disc occluders were of interest. The displays comprised both contour and perspective patterns; the latter permitting semi-quantitative evaluation of particular parameters. Comparisons between the computer simulations and those flow visualizations formed by Björk and co-workers were assessed. Although the methodology was of prime concern for presentation, the capability of the tilting-disc prosthesis for presenting a more natural flow regime was shown. Thoughts of future studies were entertained.


Haemopericardium as a late complication in anticoagulant therapy following mitral valve replacement. Two patients, who suffered from pericardial tamponade in the course of prophylactic anticoagulant treatment, are reported. The mitral valve had been replaced by a prosthesis in both cases. The diagnosis was suspected clinically and radiologically and proven by pericardiocentesis. One of the patients was treated by a percutaneously inserted small polyethylene tube for continous drainage and the other by thoracotomy and partial pericardiectomy. Both patients recovered and are at present asymptomatic. Th mechanism of bleeding patients receiving anticoagulant therapy is briefly discussed.


Successful correction of double-outlet right ventricle with a ventricular D-l-malposition of the great arteries, bilateral conus, pulmonary stenosis and subaortic ventricular septal defect. The authors present the case of a fifteen-year old girl with double outlet right ventricle with ventricular d-loop and l-malposition of the great arteries, bilateral conus, pulmonary stenosis and subaortic ventricular septal defect, who was operated on successfully. This is the fourth case of double outlet right ventricle with l-position of the aorta that has been surgically corrected. The subaortic position of the interventricular defect favours the creation of the tunnel connecting the left ventricle with the aorta without obstructing the right ventricular outflow tract. The patient was doing well 11 months postoperatively.


Changes in mental functions after open-heart operations. Methodolgical aspects. The authors present an attempt to develop methodological points of view on studies of changes in mental functions after various forms of anaesthesia and operation, e.g. open-heart operations. The value of results from unoperated control patients examined with the same methods and at the same intervals, is pointed out. Intraindividual changes in scores from pretest to post-tests seem to be the best measure of postoperative mental functions. For a more accurate appraisal of the results in a material of this kind, it is also recommended to make only a limited number of basic tests of specified hypotheses. For many investigations in this field para metric methods are unsuitable and nonparametric statics should therefore be preferred.


Anticoagulation with defibrase during prolonged extracorporeal circulation in the dog. Defĩbrase was used for anticoagulation in dogs during extracorporeal perfusion up to 6 hours with a Travenol membrane oxygenator or a Pall filter. The anticoagulation effect was adequate. The already low fibrinogen concentration became unmeasurable, the platelet count decreased, and the fibrin(ogen) degradation products increased during the perfusion. Histological examination showed platelets and white blood cells on the membranes. Perfusion pressure and blood flow were stable during the experiments, and no bleeding, thromboembolism or other adverse side-effects were noted. Defibrase might be an alternative to heparin for anticoagulation during extra-corporeal circulation.


Intra-aortic balloon pumping in the treatment of cardiogenic shock following open-heart surgery. Intra-aortic balloon pumping (IABP) was used in  the treatment of 29 patients in cardiogenic shock refractory to pressor drugs subsequent to open-heart surgery. Nineteen patients recovered from the shock primarily, but four died later in hospital. The remaining 15 were discharged alive. Peroperative electromagnetic flow measurements in one patient showed a 23% increase in aortic flow and a 26% increase in aortocoronary bypass flow when pumping was started.


Electrical induction of ventricular fibrillation in the human heart. A study of excitability levels with alternating current of different frequencies. An experimental study was made on induction thresholds for ventricular fibrillation with alternating currents at frequencies ranging between 6 and 1 600 c/s. The tests were performed on experimental dogs and on patients in association with open-heart surgery. The most vulnerable range was found to be between 12 and 60 c/s. A close similarity was demonstrated between canine and human hearts. The induction of ventricular fibrillation during open-heart surgery is discussed. Ventricular fibrillation, caused by electricity, is either accidental or deliberately induced for medical purposes. The myocardial threshold of excitability towards alternating currents is dependent on two parameters, current and frequency. The vulnerability of the heart towards current has been thoroughly investigated by several authors (Walter, 1969; Dalziel & Lee, 1969; Nickel & Spang, 1965; Kugelberg, 1975). A frequency of 50-60 c/s was utilized in all these determinations, as this is the one of choice in networks for distribution of electric power all over the world. Thus, accidental ventricular fibrillation is most likely to occur with currents of this frequency, and inductions for medical purposes, i.e. during open-heart operations, are achieved in the easiest way with simple transformers delivering the same frequency.


Emergency resection of distal tracheal stenosis. A case report. A case of tracheal stenosis secondary to tracheostomy and respirator treatment is presented. The stenosis caused acute respiratory failure, which made immediate surgical intervention mandatory. It is stressed that usually the tracheal lumen is severely reduced when the stenosis causes alarming symptoms. Rational treatment, which must be instituted immediately, consists of resection of the stenotic area and end-to-end anastomosis.


Parenchymal gas tensions in canine lung. Lung parenchymal oxygen and carbon dioxide tensions were measured in dogs by using chronically implanted Silastic tubes. The effects of pulmonary arterial ligation and bronchial occlusion on lung tissue gases were recorded. Prevention of venous return to the lung increased parenchymal oxygen tension markedly. Obstruction of airways and bronchial arteries resulted in a profound decrease in parenchymal oxygenation.


Working capacity and cardiopulmonary function after extensive lung resections. Twelve patients were investigated 7-168 months after pneumonectomy. Two of them had also undergone resection of a segment of the remaining lung. The follow-up included studies of working capacity, static and dynamic lung volumes, alveolar gas exchange, diffusing capacity, blood gases and central haemodynamics with right heart catheterization. The working capacity was markedly reduced, limited by dyspnoea in 10/12 patients. The dyspnoea was related to reduced static and dynamic lung volumes (50% of normal). The diffusing capacity of the remaining lung was half of that predicted for two lungs from total haemoglobin and age and the transfer capacity of the lungs for oxygen was loaded to its maximum even at submaximal loads, resulting in a decrease in arterial oxygen tension and saturation and an increase in  the alveolo-arterial oxygen tension difference. The central circulation was hypokinetic at submaximal loads and the stroke volume was small. The reduction in working capacity was caused by a number of coacting factors, inactivity, reduced lung function and small stroke volume. It was not possible from the present investigation to single out any of these factors as the main cause of dyspnoea during exercise and thereby the reduced working capacity.


Postoperative evaluation after correction of oesophageal hiatus hernia. This is mainly a postoperative study of 33 male and female patients operated on for oesophageal hiatus hernia with the same technique, at the same hospital, by four different surgeons over a 5-year period. All the patients were followed up for a mean period of 2.8 years (range 11 months to 4 years 11 months). The patients were personally interviewed about the clinical (subjective) results of the operation and the outcome is compared with pre-operative symptoms. All underwent postoperative radiological examination with barium meal and the results are given. Further investigations on all available patients, who still had symptoms postoperatively, were carried out by oesophagogastroscopy, pH oesophageal reflux and acid perfusion tests. The result of these investigations are presented, evaluated and compared with clinical symptoms.


Oesophageal clamp anastomosis and stricture formation. An experimental study in the piglet. End-to-end oesophageal anastomoses were performed with a metal clamp in 8 piglets. A transanastomotic catheter was kept in position for 5 weeks following release of the clamp. The results were evaluated by contrast radiography after a further 2 weeks. All the animals survived the operation and the pre-determined observation period. All the anastomoses healed without signs of leakage. They showed strictures of varying degrees, as assessed by radiography of the specimens. The dissected specimens showed scarred changes in the anastomoses where the thin mucosa was regenerated. The results are explained by the fact that the method of clamp anastomosis per se leads to a mucosal defect at the site of anastomosis with ensuing secondary wound healing. The intraluminal tube therby prevents wound contraction with luminal obliteration by giving the mucosa time to regenerate.


[Local treatment of chronic arthritis with radionuclides]. Radiosynoviorthesis plays an important role in local treatment of rheumatoid arthritis. Depending on the size of the joint, radionuclides are used at different depths of penetration. Data from the literature and our own results with 396 treated joints indicate that in 2/3 of cases good therapeutic effects are achieved, e.g. the effect on the local inflammatory process is comparable with surgical synovectomy. This is in agreement with the results of our longterm follow-up of 141 joints after radiosynoviorthesis. As with surgical synovectomy, early synoviorthesis was most successful; however, longterm observations revealed a slight increase in local recurrences. These and primary non-responder cases show a good response to secondary injection of radionuclides. The effect of intraarticular injection of isotopes is possibly due to irradiative action on the inflamed cells, with subsequent fibrosis of the synovium. Side effects of radiosynoviorthesis are rare and generally avoidable. Since late complications cannot be excluded, careful consideration should be given to the indication for radiosynoviorthesis. Radiosynoviorthesis represents an alternative treatment to surgical synovectomy in patients over 40 years of age.


[Abstinence behavior and plasma concentration of disulfiram in alcoholics after esperal implantation]. Abstinence behaviour after disulfiram implantation has been investigated in 21 chronic alcoholics. The blood levels of disulfiram and its metabolites, carbon disulfide (CS2) and reduced disulfiram (diethyldithiocarbamate) were determined and the blood levels of patients with implants were compared with those of patients receiving disulfiram orally. The blood levels in the implanted patients were significantly lower than those of the group taking disulfiram orally. No metabolites were detectable after 3 months, despite the sensitive method employed. Nevertheless, 14 of the 21 chronic alcoholics remained abstinent for 6 months after implantation. This result is probably due in the main to psychotherapeutic guidance.


[The prognostic value of continuously measured pulmonary artery pressure in recent myocardial infarct]. Enddiastolic pulmonary artery pressure (PAEDP) was measured continuously in 100 patients with acute transmural myocardial infarction, beginning on admission to the CCU and lasting till the 3rd, 4th or 5th day. The PAEDPs of the first day were averaged and on this basis the patients were divided into three groups. Mortality in Group I (41 patients with PAEDP below 12 mm Hg) was 4.9%, in Group II (43 patients with PAEDP of 12-20 mm Hg) 16.3%, and in Group III (16 patients with PAEDP above 20 mm Hg) 43.8%. Use of additional hemodynamic parameters such as cardiac output, cardiac index, and cardiac work index increased prognostic precision for patients in the acute stage. However, they did not improve prognostic precision on fatal outcome in the post-acute stage. Bicycle exercise stress tests carried out several months later with simultaneous evaluation of hemodynamics (PAEDP) showed a good suitability for rehabilitation in Group I and in 58% of the patients in Group II. The other 42% had a significant rise in pulmonary artery pressure, could not undergo stress, and, in our view, are suitable for rehabilitation only in exceptional cases.


[Chorea and the use of contraceptives].

[Chorea and the use of contraceptives]. A 20-year-old nullipara without previous history of chorea or rheumatic fever developed unilateral chorea 11 months after first taking oral contraceptives. All laboratory findings were normal except for considerable elevation of the triglycerides. Complete remission of the extrapyramidal disorder occurred within 4 months of discontinuing the contraceptive preparation. It is suggested that the contraceptive steroids may influence some metabolic events which produce vascular changes.


[Cortinarius orellanus: a poisonous mushroom causing late acute renal insufficiency]. Three cases of intoxication due to ingestion of Cortinarius orellanus are presented. The hallmark of the clinical picture is acute tubulo-interstitial nephritis appearing about 10 days after ingestion of the mushrooms. This time lag is specific for intoxication by Cortinarius orellanus. In all the three cases, acute gastroenteritic disorders and hepatocellular damage were observed initially and disappeared spontaneously. Histological examination reveals acute tubulointerstitial nephritis. Experimental data are discussed in regard to the clinical observations.


[Peritoneal dialysis, ultrafiltration and hyperosmolarity]. Observation of a patient who developed serious hypernatremia during peritoneal dialysis with a dialysis fluid containing 135 mval Na+/1 prompted investigation of net water, sodium, potassium and chloride transport during 45 peritoneal fluid exchanges with standard dialysis solutions containing 1.5 and 4.5 g% glucose. With both solutions and an equilibration time of 0 min, net ultrafiltration was observed (89 ml and 230 ml per exchange respectively). In both groups the calculated sodium concentration of the ultrafiltrate was considerably lower than plasma sodium concentrations (27.0 mval/1 and 36.9 mval/1 respectively, resulting in a new sieving coefficient of 0.20 and 0.27 respectively. Therefore, the free water deficit resulting from peritoneal ultrafiltration is directly responsible for the hypernatremia observed during peritoneal dislysis. While the potassium and chloride transport observed in these studies can be explained by diffusion processes along a given concentration gradient, sodium transport and sodium concentrations raise the question of more complex mechanisms. The data are discussed with reference to the relative significance of diffusion processes versus bulk flow and solvent drag.


[Correlations between metric, cyto and histomorphological factors and thermographic findings in breast neoplasms]. Correlations between metric, cyto- and histomorphological characteristics and thermographical results of 119 carcinomas of the breast have been studied by statistical methods. For the purpose of semi-quantitative evaluation the chi2 of 14 characteristics were calculated from foursquare tables and summarized in a correlation matrix. The study revealed a significant increase of thermographically suspect pictures with increasing size, but this was independent of the depth (i.e. the distance from skin surface) of the tumors. The proportion of uncertain but not clearly suspect results was 35% with the infrared telethermovision method, in contrast to 8% with liquid crystal plate thermography. Thermographically non-suspect carcinomas (especially the negative cases with liquid crystal plate thermography) were rich in connective tissue or stroma in most cases. On the other hand, carcinomas with numerous mitoses, large cell nuclei, increased N/C-ratio and large and strongly stained nucleoli predominantly exhibited definitely suspect pictures. The significant correlation between number of mitoses, size and staining of nucleoli and the thermographic results emphasizes that, besides vascularization and altered thermo-regulatory functions, the metabolism of the tumor itself contributes to the temperature differences. The type of growth and histological grading indicate that tumors with unfavourable prognosis preferentially exhibit thermographically suspect results. The use of thermography as a screening method is restricted because of possible false negative results. On the other hand, its additional use is justified in view of the gain in information about the biological situation of suspect alterations of the breast.


[Endocrinology and arterial hypertension]. A close relationship exists between the endocrine system and hypertension. A brief survey is conducted of the endocrine diseases most frequently associated with high blood pressure. The available means for preoperative differentiation of an aldosterone-producing adenoma from idiopathic aldosteronism with bilateral hyperplasia are considered. For cases where high blood pressure is the principal presenting sign in a patient without overt endocrinopathy, the diagnostic resources for the detection of a hormonal cause--particularly renin--are critically examined.


[Amenorrhea].

[Amenorrhea]. Some aspects of the pathogenesis, diagnosis and treatment of amenorrhea are presented. Careful clinical examination is still of great importance. Hormone analysis and sophisticated functional tests, although they permit precise localization of the dysfunction, are usually dispensable for practical purposes. Major progress has been achieved in therapy, though induction of ovulation, particularly by human menopausal gonadotropins, still requires experience and frequent hormonal monitoring.


[Lung neoplasms in the Berne region. Epidemiology and smoking habit, compared to histology]. 223 lung cancer patients were observed from June 1974 to April 1976. The diagnosis was by histology (after biopsy, operation or autopsy). There were 125 (56%) squamous cell carcinomas (sqcc), 42 (19%) small cell carcinomas (smcc), 27 (12%) large cell carcinomas (lacc) and 29 (13%) adenocarcinomas (adec). There were only 6 women (2.7%) in the series (3adec, 2 smcc and 1 lacc). Heavy and very heavy smokers were common in each group; smoking habits--even of patients with adec - differed markedly (p less than 0.0005) from those of an age and sex matched control group of 90 asthmatic patients with atopy. Sqcc patients were evenly distributed over the rural and urban zones of our region. But smcc, lacc and adec were more often seen coming from urban zones (p less than 0.0025). The whole lung cancer group was divided into a small group of 6 non-smokers (2.7%), into a 6.7% group of 15 pipe smokers, into a large group of 69 cigar smokers (30.9%) and into a final group of 133 (59.6%) cigarette smokers. The cigar smokers usually had sqcc (p less than 0.0005). The cancer of cigar smokers is more often a central lesion than a peripheral one (p less than 0.025). A history of repeated airway infections on the one hand, and severe airway infection at the beginning of lung cancer history on the other, are a more frequent association in cigar smokers than in cigarette smokers (p less than 0.01). Therefore, the lung cancer of cigar smokers is especially difficult to recognize. Cigar smoking appears to be just as important a link in the chain of causative factors leading to lung cancer as cigarette smoking.


[Diagnosis and pathophysiology of renal concentration disorders]. Basic physiology and pathophysiological mechanisms of renal concentrating ability and its defects are discussed. Normal urinary concentration depends on the concerted action of a variety of factors. Consequently, many different causes may underly the symptom of polyuria. Clinical tests of concentrating ability (water deprivation, pitressin test) are of diagnostic importance in diabetes insipidus and polydipsia, but have little practical value in the work-up for chronic renal disease. A critical analysis of maximal concentrating capacity (TcH2O) during induced osmotic diuresis is conducted. It is inferred that the height and shape of the normal TcH2O curve results basically from two physiological processes: It is raised by increasing NaCL transport out of the medullary parts of the ascending limbs of Henle's loops and lowered by influx of hypotonic tubular urine into the collecting ducts. Preponderance of hypotonic influx may result in hypotonic final urine in the absence of tubular functional abnormalitiy. It is not appropriate, therefore, to classify renal concentrating defects according to the shape and height of the TcH2O curve. A synopsis and short description of the known renal concentrating defects is given. They are classified into hereditary, metabolic, diuretic-induced, and toxic disturbances, as well as those seen in renal disease of various etiology. Each defect is discussed in terms of the underlying pathophysiological mechanism as far as currently understood. The most important mechanisms are either disturbed NaCL transport in the ascending limb of Henle's loop, or antidiuretic hormone (ADH) dependent or ADH independent decrease in water permeability of the enddistal convolutions and collecting ducts, or osmotic diuresis.


[Colonic stenosis after pancreatitis].

[Colonic stenosis after pancreatitis]. In 5 out of 35 patients with acute, acute relapsing and chronic pancreatitis, barium enema revealed partial colonic stenosis at the splenic flexure. In 3 patients laparotomy disclosed colonic perforation with abscess, adhesions between colon and pancreas or a marked pancreatic edema. In two patients barium enema follow-up 3-6 months later showed spontaneous resolution of the stenosis. Comparison with 35 cases in the literature shows that colonic stenosis after pancreatitis is usually incomplete, located at the splenic flexure and due to adhesions between the colon and the pancreas. Spasmodic pains in the upper abdomen, increasing constipation and often rectal bleeding or positive guaiac test of the stool may indicate colonic stenosis. Spontaneous resolution is possible, but if operation is indicated the adhesions should be carefully dissected in order to obviate resections of the colon or the pancreas.


[Differential diagnosis of juvenile torticollis]. Torticollis in childhood may be a presenting symptom of many different disorders. The various etiologies of head tilt are briefly reviewed. Further investigations will depend on the patient's history as well as the local and neurological findings. Therapeutic problems are not discussed.


[Value of intermittent pneumatic compression of the calves for the prevention of postoperative thrombosis of the deep veins]. Six prospective, randomized studies using intermittent pneumatic compression of the calf for prevention of postoperative deep vein thrombosis are available and have been analyzed. In 4 studies a significant reduction in the incidence of deep vein thrombosis could be demonstrated. Compared to controls, the reduction in the deep vein thrombosis rate by intermittent compression is about 60%. The frequency of deep vein thrombosis is lower if the patients are treated not only intraoperatively but also for 24-28 h postoperatively. The difference in deep vein thrombosis rate between these two schedules is statistically probable significant. No definite statement can be made regarding the efficacy of deep vein thrombosis prevention in patients with malignant disease, since here the results are controversial. No studies are available on the effect of intermittent pneumatic compression of the leg on the incidence of fatal postoperative pulmonary emboli. This method must therefore be regarded as an interesting alternative in clinical investigation.


[Normogram study: representative data on the state of health of male industrial workers in northern Switzerland. 1. Report: anamnesis and health behavior]. To obtain representative data about the health of industrial workers in nothern Switzerland, 1260 men from 44 plants have been examined. At the time of our study, 21% were under treatemnt by a doctor and 52% had so been 1-3 times during the previous year. 44% hat at some time in the past been patients in a surgical department, 13% in a department for internal medicine and 29% in a department for special diseases. During the previous year 39% reported loss of working days through illness. In 13%, working days had been lost through accidents. 48% were smokers, 38% had never smoked, and 14% had stopped smoking. Alcohol was consumed daily by 37%, three times a week by 30% and once a week by 18%; 11% drank rarely and 4% never, 16% took medicines often, 40% rarely and 44% never. The results of the study are classified by 5-year-age groups and compared.


[Studies on the heredity and pathogenesis of familial combined hyperlipidemia ("multiple lipoprotein type" hyperlipidemia)]. A family with familial combined hyperlipidemia (multiple-lipoprotein type hyperlipidemia) was investigated with regard to mode of inheritance, phenotypic expression, presence of genetic markers, and biochemical parameters related to lipid metabolism. The family of 22 subjects (13 males, 9 females) was composed of 5 type IIa, 8 type IIb, 1 type IV hyperlipoproteinemias and 5 normolipidemics. The distribution of serum cholesterol and serum triglyceride concentration was bimodal. No relationship was observed between hyperlipidemia and blood groups or histocompatibility antigens. Subjects with high HLA 8 or W 15 had, on the average, higher lipid levels than others. However, these antigens were observed in normolipidemics too. The response to therapy with alufibrate (2g/day) was not uniform. Subjects with marked triglyceride lowering exhibited only moderate cholesterol lowering, and marked cholesterol lowering was associated with poor triglyceride lowering. The reduction in serum lipids was observed in unaffected family members as well. It is therefore concluded that alufibrate does not exert an effect on the defect in familial combined hyperlipidemia but on some unspecific sites probably on lipoprotein lipase. The familial combined hyperlipidemia appears to be transmitted in an autosomal dominant mode and very probably determined by more than one gene.


[Experiences with the ISOP (bubble or integral confinement) in surgery of the motor apparatus in Lausanne]. Use of the Celster ISOP integral enclosure method in over 200 bone and joint operations prompts the following conclusions: With ISOP contamination of the surgical field is significantly reduced and the number of discharging wounds after surgery is lower. Delicate operations such as internal fixation of the fractured acetabulum or reinsertion of the cruciate ligament pose few problems under ISOP. The use of ISOP during bone and joint surgery is an advance in the prevention of postsurgical infection.


[Immunological damage to erythrocytes].

[Immunological damage to erythrocytes]. The mechanisms by which red cells are destroyed under the influence of antibodies with different immunochemical and biological characteristics are described. It is shown that the interaction of antibody with the red cell per se does not lead to a disturbance of red cell function. Activation of the whole complement system leads to direct lysis of the erythrocyte (complement hemolysis). The fixation of red cells coated with activated C3:C3 receptors on phagocytic cells is another mechanism which leads to red cell destruction. The hypothesis that adherence to the Fc-receptors of phagocytic cells is essential for the destruction of red cells under the influence of noncomplement-binding antibodies is discussed. Arguments in favour of this theory are correlation between the subclass of IgG red cell autoantibodies and the absence or presence of increased hemolysis in the patient and a correlation between the degree to which red cells of patients with this kind of antibody adhere to monocytes in vitro and the degree of hemolysis in the patient. It is shown by in vitro experiments how this adherence process can take place in vivo in the presence of normal plasma IgG although the latter completely inhibits the adherence phenomenon in vitro.


Macrophages and tumours.

Macrophages and tumours. The interplay between the reticuloendothelial system and the growth of tumours is complex. Tumours stimulate the output of monocytes from the bone-marrow leading in some instances to a marked monocytosis. While tumours contain varying numbers of normal macrophages, and in some rat sarcomata they may constitute up to 60% of the total cells of the tumour, the monocytes in tumour bearers are abnormal in so far as they fail to enter sites of inflammation probably because they have bound immune complexes. There is an inverse correlation between the macrophage content of animal tumours and their capacity to metastasize and this may be related to the capacity of macrophages to kill tumour cells as a result of cell-to-cell contact. Macrophage cytotoxicity can be immunologically specific and this, co-operation with T-lymphocytes is required. In addition, macrophages can also be induced to express an immunologically non-specific anti-tumour cell activity.


[Quantitative Coombs' test in autoimmune hemolytic anemia]. The detection of iso- and autoantibodies to red cells and complement on the surface of erythrocytes has been studied in a continuous flow system using a single channel autoanalyzer. A macromolecule, polyvinyl pyrrolidone, is added to the washed cells in order to increase their aggregability. With this system it is possible to establish a direct relationship between the quantity of antibodies present on the surface of the cells and the red cells agglutinated by an antiglobulin serum. By this method it is possible to evaluate the degree of autoantibody coating of erythrocytes in autoimmune hemolytic anemia, and to adjust therapy accordingly.


[Substitution ofpolysensitized patients with platelets from HL-A typed single donors]. 80 platelet transfusions from 38 different "full-house" HLA-typed single donors (10 siblings, 28 unrelated persons) were given to 14 thrombocytopenic patients refractory to platelets from random donors. The transfusions resulted in increased platelet increments, provided that the donor had no additional HLA-specificities whatsoever. In 14 out of 19 situations of not-identity between donor and recipient and with poor posttransfusion platelet increments, lymphocytotoxicity tests (incubation of 180 min at room temperature) were positive. This test therefore appears to be a useful tool in predicting the outcome of the transfusions. Granulocytotoxicity tests were positive in 4 HLA-identical donor-recipient pairs. Although severe transfusion reactions were observed, no detrimental influence on platelet increments could be found.


[The immunologic status during pulmonry tubercuolsis]. The cellular and humoral immunity of patients with pulmonary tuberculosis has been evaluated prospectively in 22 PPD-positive and 10 PPD-negative patients by intradermoreaction (IDR), blast transformation (SL) and MIF production in response to PPD, Candida and varidase, peripheral lymphocyte count, and quantitative evaluation of immunoglobulins. There is a very good correlation between the different tests, and anergy is frequently found in elderly patients. Negative results (IDR, SL, MIF) are significantly observed in the presence of a negative PPD-IDR, lymphopenia (less than 1,000/mm3), impaired blast transformation in response to PHA (less than 21,000 cpm), and a cavitary form of tuberculosis. These findings suggest a defect of cellular immunity in these patients.