Adenotonsillectomy in a Jehovah's Witness with blood dyscrasia. A case is used to illustrate a method of management of three unusual problems all simultaneously appearing in the same patient. Urgent surgical intervention was necessary for a child with a bleeding disorder, but the parents religious doctrine prohibited the use of whole blood or its products. The combined efforts of the legal, medical, and allied medical professionals led to a successful resolution of the patient's multiple problems.


[The two-phase occurrence of head-shaking nystagmus (author's transl)]. The report deals with 22 cases of two-phase head-shaking nystagmus. The results can be summarised as follows: 1. The two-phase head-shaking nystagmus is only found in connection with peripheral-vestibular disorders and particularly with unilateral disorders. It occurs only temporarily in the course of the vestibule disorder and may be observable for several months. 2. The head-shaking nystagmus, which follows immediately after the head-shaking (first phase), is to be considered a deficiency nystagmus. After a short period of latency after the disappearance of the first phase, a nystagmus in the opposite direction appears (second phase). This is considered to be a recovery nystagmus. 3. In the case of unilateral labyrinth lesions, the direction of nystagmus of the second phase of two-phase head-shaking nystagmus indicates the side of the lesion. The functions of the diseased labyrinth, however, have not been completely destroyed in this case. In the case of bilateral lesions, the direction of nystagmus of the second phase probably points toward the more heavily damaged side. While it is found only rarely, the two-phase head-shaking nystagmus thus permits reliable diagnosis and detection of the probable side where a peripheral vestibule disorder is located.


Predictive validities of several clinical color vision tests for aviation signal light gun performance. Scores on the American Optical Company (AOC) test (1965 edition), Dvorine test, Farnsworth Lantern test, Color Threshold Tester, Farnsworth-Munsell 100-Hue test, Farnsworth Panel D-15 test, and Schmidt-Haensch Anomaloscope were obtained from 137 men with color-defective vision and 128 men with normal color vision. The validity of each of these tests in predicting scores on the aviation signal light gun was assessed by using daytime and nighttime administrations of the light gun as the criteria. Two "best sets" of plates from the AOC and Dvorine tests were selected by calculating a multiple regression equation in a stepwise manner with the nighttime and then the daytime administration of the signal light gun test as the criteria. Based on a graphic presentation of the miss and false alarm rates for each test at various possible cut scores, suggestions were made regarding the use of each test and the selection of optimal pass/fail scores.


A comparison of the effects of ouabain and 2-deoxy-D-glucose on the thermodynamic variables of the frog skin. Previous studies support the validity of a linear thermodynamic formalism relating the rates of active Na-+ transport and oxygen consumption Jr to the electrical potential difference delta-psi and the affinity A (negative free energy) of the metabolic driving reaction. The formulation was further tested in paired control and experimental hemiskins by the use of two inhibitors of Na-+ transport. Ouabain, a specific inhibitor of the Na-+ pump, might be expected to diminish the dependence of Jr on delta-psi without affecting A, whereas 2-deoxy-D-glucose, a competitive inhibitor of glucose metabolism should be expected to diminish A. Both inhibitors were used at concentrations adequate to depress Na-+ transport (i.e. short-circuit current Io) to some 50% of control level. Measurements were made of Io and dJr/d(delat-psi), and the apparent value of the affinity Aapp was calculated according to the thermodynamic formulation. Ouabain depressed minus dJr/d(delta-psi) without affecting Aapp whereas 2-deoxy-D-glucose depressed Aapp without affecting minus dJr/d(delta-psi). The demonstration of these effects indicated the utility of the formalism.


[Lymphocyte in chronic lymphatic leukemia]. In patients with chronic lymphatic leukemia (CLL) the majority of peripheral blood lymphocytes was characterized as B cells by surface membrane markers. Ultrastructural studies revealed a reduction of the cytoplasmic area. Furthermore, the number of lysosomes was diminished corresponding to a decreased activity of lysosomal hydrolases. Increasing blood lymphocytosis was paralleled by an increase of the percentage of lysosome-poor lymphocytes. Response of CLL lymphocytes to in vitro stimulation with PHA and PWM was either lacking or diminished and/or delayed, and the number of transformed cells was reduced. Thus, the majority of CLL lymphocytes appears to represent both morphologically and functionally abnormal neoplastic b cells. During the early and later phase of stimulation the mitogen-reactive CLL lymphocytes exhibited alterations of the lysosomal apparatus similar to those observed in normal cells. The reactive lymphocytes may be derived from residual populations of normally functioning T and/or B cells. However, the neoplastic cells may also be able to respond to the mitogens. In vivo studies showed impaired kinetics of circulation and recirculation of CLL B lymphocytes, whereas the T cells were normal in this respect.


A study of 137 cases of renal trauma.

A study of 137 cases of renal trauma. Renal injuries are rarely a threat to life and all patients should have an intravenous urogram performed at the time of admission. Patients with a normal urogram may be mobilised for early discharge. Patients with minor abnormalities of the urogram, but in whom all the collecting system is visible, rarely caused any difficulties in management. Should the haematuria persist beyond a week, then arteriography should be performed. The arteriogram sometimes shows the presence of major cortical lacerations with minor abnormalities of the intravenous urogram. If the initial urogram fails to opacify the injured kidney, immediate arteriography is required to exclude a vascular injury. We also believe that early arteriography is advisable in those patients where part of the kidney appears to be non-functioning as it is in this group of patients that operation may become necessary. The indications for renal arteriography are summarised in Table II.


Responses of spinal neurons to iontophoretically applied prostaglandin E1 in the frog. Prostaglandin E1 (PGE1) has been tested by microiontophoresis on interneurons and motoneurons in the isolated spinal cord of the frog. PGE1 action was almost exclusively excitatory, regardless of the cell type and the test condition used. In general, the excitatory response had rapid onset and termination, and was susceptible to tachyphylaxis. Responsive interneurons were scattered throughout the tissue, and the incidence of responses showed no obvious relation to the mono- vs. polysynaptic connection of cells to primary afferents and descending fibers of the lateral funiculus. PGE1-sensitive interneurons were encountered more often in preparations from summer than from winter animals. These findings, coupled with the demonstration of prostaglandin biosynthesis and catabolism in the tissue, suggest that PGE1 plays a role in the normal function of spinal neurons. The intimate mechanism of PGE1 action remains to be elucidated.


Treatment of Pneumocystis carinii pneumonitis with trimethoprim-sulfamethoxazole. Pneumocystis carinii pneumonitis (PCP) is fatal in 90 to 100% of the cases if no treatment is given. Trimethoprim-sulfamethoxazole (TMP-SMX) was used at one of two dosage levels in the treatment of 20 children with PCP and cancer. Of 14 patients treated with 20 mg TMP--100 mg SMX/kgd, 12 recovered and 2 died. Treatment of the fatal cases and one of the patients who recovered was supplemented with pentamidine. When six patients were treated with 4 to 7 mg TMP--20 to 35 mg SMX/kgd, four recovered and two died. Both fatal cases and one of the patients who recovered were also treated with pentamidine. There was no significant adverse effects from TMP-SMX.


Immunologic parameters of children with urinary tract infection: effects of trimethoprim-sulfamethoxazole. In order to determine whether a deficiency in immunologic response predisposes certain children to recurrent infections of the urinary tract, four groups of children were investigated: a control group; children with extraurinary infections; children with urinary tract infections; and a group of children treated with trimethoprim-sulfamethoxazole (TMP-SMX). In none of the groups were there changes in humoral immunoglobulins, peripheral neutrophil counts, serum complement concentrations or urinary excretion of IgG, IgA, or IgM that might might predispose to infection. However, children with urinary tract infections were more likely to belong to blood group A (66.6%; expected frequency, 45%) and had a blunted thymidine uptake of their stimulated lymphocytes (RLB) when compared with children with extraurinary infection. As well, their nitroblue tetrazolium reduction (NBT) was significantly lowered and this paralleled their RLB response. We postulated a shared antigenic feature of either their renal-urinary tissue or bacterial antigen with blood group A antigen; this prevents the mounting of an effective immunologic defence. If TMP-SMX further depresses the lymphocyte response, it may be considered contraindicated in urinary tract infection. In 11 children treated with this drug we found no significant difference between their RLB and NBT responses and those of children with infections of the urinary system treated with other drugs. We conclude that TMP-SMX does not alter the immune responses in children.


Quantitation of T- and B-lymphocytes in peripheral blood of patients with solid tumours. I. Relation to other parameters of in vivo and in vitro immune competence. The absolute number of T- and B-lymphocytes in the peripheral blood was measured in 22 patients with disseminated nonlymphoid solid malignant tumours. Patients with normal absolute lymphocyte counts had normal absolute numbers of T- and B-lymphocytes; patients with low counts had low numbers. The percentage of T- and B-lymphocytes was similar, in both groups of patients, to that of healthy control subjects. Patients with a normal absolute lymphocyte count had better in vitro lymphocyte responses to mitogenic agents than did patients with low absolute lymphocyte counts. Improvement of depressed in vitro lymphocyte responses to normal on culture of cells in AB plasma was most likely in patients with normal absolute lymphocyte counts. The absolute lymphocyte count by itself, then, provides useful information about the immune status of patients with solid malignant tumours.


A rapid and specific radioimmunoassay for methotrexate. A sensitive and precise radioimmunoassay for methotrexate has been developed using antibody induced in rabbits, tritium-labeled methotrexate, and a nitrocellulose membrane separation technique. Antibody specificity was characterized by comparing the effectiveness of various related compounds to displace labeled methotrexate from the antibody-binding site. Assay of serum samples from persons receiving the drug was rapid and easy to perform. In a pharmacokinetic study of methotrexate, corresponding results were obtained when measurements were made by either enzymic assay or by radioimmunoassay. Drug concentrations could also be monitored in the cerebrospinal fluid and urine of patients on high-dose methotrexate therapy followed by citrovorum factor rescue. The system measured a little as 0.1 to 1 pmole of methotrexate, depending upon the antiserum used, and naturally occurring folates did not interfere with these determinations.


Adducts between the carcinogen 2-acetamidophenanthrene and adenine and guanine of DNA. The sulfate and acetate esters of the carcinogen N-hydroxy-2-acetamidophenanthrene attack calf thymus DNA in vitro to yield adducts of 2-acetamidophenanthrene with guanine and adenine in the DNA. These adducts were found to be 8-(N-2-phenanthrylacetamido)deoxyguanosine and N6-1-(2-acetamidophenanthryl)deoxyadenosine, respectively. These reactions, and the already known reactions of esters of N-hydroxy-2-acetamidofluorene, together with Hückel molecular orbital calculations, suggest that the relative tendencies of a series of N-aryl-N-acetylnitrenium ions to react with adenine and guanine may be predicted.


Two approaches that increase the activity of analogs of adenine nucleosides in animal cells. Deamination of many analogs of adenine nucleosides results in the loss of their chemotherapeutic efficacy. Two approaches have been used in this study to overcome this problem. First, some adenine nucleotides, which are resistant to mammalian adenosine deaminase, are more toxic to animal cells than are the respective nucleosides. For toxic to animal cells than are the respective nucleosides. For example, 9-beta-D-arabinofuranosyladenine 5'-phosphate, a molecule that penetrates the cell without degradation, has a more sustained toxicity against mouse fibroblasts (L-cells) than does 9-beta-D-arabinofuranosyladenine (ara-A). Furthermore, L-cells treated with 2',3'-dideoxyadenosine 5'-phosphate are extensively killed after 48 hr, whereas 2',3'-dideoxyadenosine is almost nontoxic to L-cells. Specific inhibition of adenosine deaminase by nontoxic concentrations of erythro-9-(2-hydroxy-3-nonyl)adenine greatly potentiates the biological activity of both ara-A and 3'-deoxyadenosine (cordycepin). Simultaneous administration of cytostatic concentrations of ara-A and the inhibitor of adenosine deaminase to L-cells killed greater than 99.9 percent of cells in 36 hr. A similar concentration of ara-A plus the deaminase inhibitor also markedly extended the mean survival of mice bearing Ehrlich ascites carcinoma as compared to ara-A alone. A cytostatic concentration of cordycepin 1 x 10-4 M), administered in the presence of deaminase inhibitor, killed greater than 99.9 percent of cultured L-cells in only 8 hr. During the latter incubation, accumulation of uridine in acid-insoluble material reached a maximum after 30 min, and incorporation of thymidine into acid-insoluble material was almost totally arrested after 2 hr.


Anomalous left coronary artery from pulmonary artery. An eight year angiographic follow-up after saphenous vein bypass graft. We have presented a 7-week and 8-year postoperative angiographic follow-up of a 36-year-old man who had an anomalous left coronary artery arising from the pulmonary artery and who had an aortocornary bypass graft to the left anterior descending artery. The late study showed 1) a large, well functioning patent graft, 2) lack of significant postoperative change in the size of the right coronary artery and 3) new collateral vessels between the distal left anterior descending and left circumflex coronary arteries and persistence of collateral vessels between the distal right and left circulflex coronary arteries. This report is the longest known angiographic follow-up of a patient with this anomaly who has been treated with bypass surgery.


Ventricular function before and after direct revascularization surgery. A proposal for an index of vascularization to correlate angiographic and ventriculographic findings. In order to determine the effect of direct bypass surgery on the total coronary arterial supply to the heart, a numerical construct was devised to incorporate the development of new obstructive lesions and the presence of patent or nonpatent grafts. This construct, termed a vascularization index (VI), was used to evaluate left ventricular function and anginal symptoms after coronary artery bypass surgery in 56 patients. Patients with an increase in local or total arterial blood supply (positive delts VI) often had similar directional changes in segmental wall motion and ventricular ejection fraction. Patients with a decrease in local or total arterial blood supply (negative delta VI), due to either nonpatent grafts or progression of atherosclerotic disease, also usually had similar directional changes in segmental wall motion and ventricular ejection fraction. (Although nearly all patients reported a decrease in anginal symptoms after surgery, delta VI could not identify degree of improvement.) Use of an integrated approach in describing pre and postoperative myocardial blood supply appears to be the most reliable method of explaining changes in left ventricular function.


Myocardial revascularization combined with intracoronary infusion of hyperosmolar solution in the early management of postinfarction ventricular septal defect. Report of a case. A patients is described with postinfarction ventricular septal defect in whom the perforation was successfully closed within 24 hours of septal rupture. This presents the second such case reported in the literature. Adjunctive measures consisting of myocardial revascularization and intracoronary infusion of mannitol were thought to be important in the successful outcome of the operative procedure. The importance of complete preoperative cardiac catheterization with coronary arteriography is stressed. The theoretical role of endothelial and myocardial cellular edema as a cause of depressed myocardial function immediately following an ischemic insult is proposed as a practical consideration in the high mortality associated with this condition. Methods used to prevent or reverse such cell swelling are described. The details of the operation in which viable ventricle myocardium was used to fill the septal defect are presented.


Hypotension accompanying the onset of exertional angina. A sign of severe compromise of left ventricular blood supply. Serious obstructive coronary artery disease was found in all patients who developed hypotension accompanying the onset of angina during multistage exercise testing. Seventeen exercising patients demonstrated a fall in systolic pressure to below resting levels as chest pain and ST-segment depression appeared. Two patients died suddenly six weeks after treadmill testing and prior to arteriography. The remaining fifteen were studied with coronary arteriography and all except one exhibited greater than or equal to 90% stenosis of the left anterior descending artery (LAD). The remaining patient demonstrated two 75% LAD stenoses in series. Five exhibited significant (greater than or equal 75%) narrowing of the main left coronary artery (MLCA) and thirteen of fifteen had significant stenosis of proximal LAD and circumflex arteries. The two patients without significant circumflex disease exhibited greater than or equal to 90% stenosis of the dominant right coronaryartery (RCA) circulation. Six of six patients had restoration of a normal blood pressure response following coronary bypass surgery, which also relieved angina and reversed ST-segment depression. Conditions essential for proper interpretation of this sign are discussed. If these conditions are met, then a fall in systolic pressure during treadmill-induced angina pectoris is a reliable sign of severe compromise of left ventricular blood supply.


Prinzmetal's variant form of angina pectoris. Re-evaluation of mechanisms. Thirty-five patients with typical Prinzmetal's variant angina were studied by coronary cineangiography. There was no demonstrable stenosis of the major coronary arteries in 19 patients. Nine patients with single coronary stenosis underwent aortocoronary bypass and had recurrence of the symptoms postoperatively. Administration of nifedipine effected complete cessation of the symptoms among patients formerly treated medically. Although surgical treatment did not effect permanent relief of pain, all patients initially treated surgically experienced relief of pain when nifedipine was administered. The pathophysiology of variant angina remains obscure. Our results suggest that neurohumoral factors exert more of an effect on the myocardial cell than on the coronary vessels.


Regional myocardial blood flow measurements before and after coronary bypass surgery. A preliminary report. Myocardial blood flow in 16 patients before and after coronary bypass surgery in conjunction with coronary angiography, left ventricular function measurement, and graded exercise test. Radioactive 133-Xe was injected into the coronary artery or bypass graft and the washout was recorded by an Anger camera. Myocardial blood flow increased in 11 out of 14 patients and decreased in three patients. The average flow was 55 (plus or minus 6) preoperatively and 96 (plus or minus 10) ml 100 g/min postoperatively. Increase of blood flow occurred in both the bypassed left anterior descending coronary artery (LAD) region and the nonbypassed left circumflex coronary artery (LCIR) region. The postoperative flow increase and the absolute postoperative flow values are higher with saphenous vein than with mammary artery grafts. Statistically significant correlation is not found between myocardial blood flow changes and exerice tolerance. The volume measurements (end diastolic volume, stroke volume, ejection fraction) remained unchanged.


[Haemodialysis for renal failure in a case of systemic lupus erythematosus (author's transl)]. Severe acute renal failure developed in a patient with systemic lupus erythematosus which was characterized by typical skin rash, polyserositis, haemolytic anaemia and liver damage. Serological examination revealed anti-DNA antibodies in high concentrations, positive Coombs' test, excessive elevation of serum-IgG with markedly depressed serum complement fractions (C3, C4). Acute lupus nephritis led to prolonged oliguria and anuria requiring regular dialysis over almost five months. Immuno-suppressive treatment with cortisone and azathioprine finally reversed the renal failure: BUN returned to 33 mg/  100 ml, with a plasma creatinine of 1.8 mg per 100 ml.


[Immuno-coagulopathies and their dangers in dental-surgical interventions]. It is reported on three patients with an immunocoagulopathy, the diagnosis of which was established on the basis of immunological coagulation studies.  These patients were submitted to oral surgery.  In connection with the case histories, it is reported on pathogenesis, diagnostics, and special therapeutical requirements in cases of hemorrhagic diathesis with a circulating anticoagulant antibody.


[Influence of vestibular and afferent impulses on the spontaneous activity of interneurons in the spinal cord of cats]. Responses of the cat spinal interneurons were studied under electrical stimulation of dorsal roots and adequate stimulation of vestibular apparatus.  The evoked activity of interneurons in response to electrical stimulation of dorsal roots had different forms.  Three types of responses to adequate stimulation of vestibular apparatus were observed.  The patterns of convergence of afferent and vestibular impulses on the interneurons are discussed.


CSF scanning in achondroplastic children with cranial enlargement. This paper reports on an 18-month-old achondroplastic child with dilated lateral ventricles.  Results of a cisternographic investigation were normal.  No shunting procedure was carried out, and subsequent clinical progress was satisfactory.  Some patho-physiological aspects of achondroplastic dysgenesis are discussed.


Paracortical alteration in lymphadenopathic and tumor-draining lymph nodes: histologic study. Histologic studies of 142 enlarged lymph nodes from 124 patients, diagnosed histologically as nonspecific chronic lymphadenitis or reactive hyperplasia, revealed a characteristic nodular alteration in the paracortical area of nodes from the axillary, cervical, and inguinal regions, and rarely in abdominal, mediastinal, and retroperitoneal groups. In 1389 lymph nodes from 100 radical mastectomy specimens similar changes were noted more frequently in the lower than in higher levels of the tumor-draining axillary nodes. The nodule was composed of small lymphocytes associated with postcapillary venules and histiocytes-macrophages. The latter varied in distribution from a scattered pattern resembling a starry-sky appearance in the initial phase of paracortical alteration to the replacement of small lymphocytes in advanced stages. Plasma cells and lymphatic sinuses were characteristically absent from this nodular alteration. An impressive example of such changes was seen in four cases of dermatopathic lymphadenitis. Studies of the paracortical area may provide new insight into the pathogenesis of some lymphadenopathies.


Tolerance induction in TxXBT and TxXB mice. Adult normal mice and those mice which had been thymectomized, X-irradiated, and reconstituted either with bone marrow cells and thymus cells (TxXBT) or with bone marrow cells along (TxXB), were given varying amounts (0.1-5 mg) of deaggregated soluble bovine serum albumin (sBSA). They were challenged 10 days later with an immunogenic form of BSA. TxXB mice were supplemented with normal thymus cells 3 days before the challenge. With any dose of sBSA, TxXBT and normal mice were made tolerant. Only 5 mg of sBSA, the highest dose in these experiments, was effective in inducing the tolerance in TxXB mice. The simultaneous administration of 5 mg of sBSA and 0.1 mg of alumprecipitated BSA plus 0.01 mg of endotoxin resulted in the priming in TxXBT mice but induced tolerance in TxXB mice. These results indicate that: (a) B-cell tolerance could be induced independently of the influence of T cells; (b) the tolerogen susceptibility of B cells may be lower than that of T cells; (c) such a weakly immunogenic agent as the mixture of tolerogen and immunogen could either activate the antibody response in the presence of T cells or induce B-cell tolerance in the absence of T cells.


Limiting dilution analysis of helper T-cell function. Limiting dilution analysis has been applied to the study of T-cell 'helper' function in vitro. Using the microculture system one can estimate the numbers of (a) 'helper' T cells involved in specific collaboration with B cells and (b) those T cells which are able, on being activated by their specific antigen, to facilitate the response of B cells to another antigen. Such studies have enabled us to demonstrate that: (1) a single 'helper' T cell was able to activate a single B-cell precursor to detectable antibody production; (2) the 'helper' function of primed T cells was radio-resistant; (3) a minimal estimate of 'helper' frequencies could be obtained in defined cell populations; (4) nonspecific facilitation was directed towards virtually all available B cells of a given specificity if these were challenged with their appropriate particulate antigen; (5) the microculture system offers the opportunity to determine whether specific and non-specific T-cell 'helper' effects are a consequence of the activity of one T-cell type or of differenct subpopulations of T cells.


An investigation of the characteristics of a negative pion beam by means of induced chromosome aberration in human peripheral blood lymphocytes. The depth dose profiles of unstable chromosome aberrations were determined by irradiating blood samples at various depths in a plastic phantom exposed to a beam of negative pi mesons (pions). The pions were derived from an experimental beam line from the Nimrod 7 GeV proton synchrotron. With a momentum of 160 MeV/c and a spread of 15 per cent a Bragg profile was produced peaking at 13-9 cm. An ionization peak to plateau ratio of 1-6 was obtained and for cytogenetic damage this was increased to 2-9. Dicentric and acentric dose-response data from peak and plateau positions were fitted to Y=alphaD+betaD-2 models for comparison with data obtained from 60-Co gamma-rays and fission neutrons. With respect to 150 rads gamma-radiation, the r.b.e. values for the pion peak were 2-1 for dicentrics and 2-3 for acentrics. In the plateau the value for both aberrations was 1-5. At pion doses likely to be used as daily radiotherapy fractions, the aberrations predominantly resulted from single-track events, indicating little likelihood of interfraction recovery, particularly in the peak position. It is concluded that the biological damage characteristics of pion beams, as determined from a cytogenetic end-point, offer several features attractive to the radiotherapist.


Inhibitory effect of U.V. -irradiation on the formation of twisted circular lambda DNA. Ultra-violet irradiation of lambda phage results in an inhibition of conversion of lambda DNA in host cells from the initial linear form to twisted circular form. The formation of open circular lambda DNA in vitro (formation of Hershey's circle) was quite resistant to the irradiation. The occurrence of denaturation of ultraviolet irradiation was detected in lambda DNA.


Maximum r.b.e. of fission neutrons for induction of somatic mutations in maize. This investigation was conducted to determine the maximum r.b.e. of fission neutrons for the induction of yellow-green sectors in maize. Seeds heterozygous for the yg2 locus were adjusted to 13 per cent water content, irradiated with varying doses for eitherfission neutrons or 60Co gamma-radiation, and soaked for 2 hours in nitrogen-bubbled water at ambient temperature before planting. Frequency of yg2 sectors, as scored in leaves 4 and 5, increase linearly for both radiations. The r.b.e. values were greater than1100 at 0.40 sectors per leaf 4 and greater than 600 at 0.20 sectors per leaf 5; however, at these low frequencies, the standard errors were  3 times greater than the r.b.e. At 6.0 sectors per leaf 4, the r.b.e. values were 111 plus or minus 9; and at 3.0sectors per leaf 5, 118 plus or minus 21. As measured by sectors per krad, mutagenic efficiency increased with increased dose of gamma-radiation; the opposite was true for fission neutrons. This trend was more evident for leaf 4 than for leaf 5.


Vasopressin and hepatic artery.  Effect of selective celiac infusion of vasopressin on the hepatic artery flow. Electromagnetic flow measurement study was performed in 20 anesthetized dogs to evaluate the effect of selective celiac infusion of vasopressin on the hepatic arterial vasculature.  Teh hepatic arterial flow showed a biphasic response with an initial decrease followed by a substantial increase in spite of a continued infusion.  The left gastric, splenic, and superior mesentric arteries showed a monophasic response with persistent decrease of flow during the whole infusion.  The biphasic response of the hepatic arterial flow is thought to be due to autoregulatory dilative action of the liver to a decrease of the portal flow.  The results and previous clinical experience suggest that the selective infusions of vasopressin into arteries supplying the liver can be used for short-term vasoconstrictive therapy of acute gastrointestinal bleeding in patients without liver damage.  Further experience is necessary to evaluate the safety of prolonged hepatic infusions in patients with liver damage.


Experimental catheter obstruction of the gastric coronary vein.  Possible technique for percutaneous intravascular tamponade of the gastroesophageal varices. Experimental catheter obstruction of the left gastric (coronary) vein was explored in 10 dogs.  Using a transjugular approach, the liver was punctured and the portal vein catheterized.  Coaxially introduced catheters were then used to catheterize selectively and produce an intravascular obstruction (tamponade) of the gastric coronary vein.  Ballon catheters were used for a temporary occlusion.  Injection of a tissue adhesive, isobutyl 2-cyanoacrylate, was used for a definitive obliteration.  The achieved results show the anatomical feasibility of this approach and give good perspective for development of a clinical method for percutaneous intravascular tamponade of the bleeding gastroesophageal varices in cirrhotics.


Comparison of iothalamate meglumine, metrizamide and iodophendylate in cerebral ventriculography.  A clinical, radiological and histopathological study in the rat. Clinical, radiological and histopathological findings following cerebral ventriculography in the rat using the water-soluble contrast media iothalamate meglumine and metrizamide, and the oil-soluble iodophendylate are reported.  Clinically, iothalamate meglumine caused convulsions, while there were no adverse reactions to the other media.  Radiologically there was good visualizaiton of the ventricles with all media.  Iodophendylate was retained in the ventricles for the duration of the experiment (up to 60 days), while the water-soluble media had disappeared within 20 minutes.  Histologically there were no pathological changes attributable to the water-soluble media.  Iodophendyalte led to enlargement of the ventricles, and macrophages containing oil were seen on the ependymal lining.


A symposium on surgery for coronary artery disease. Patient selection and preoperative evaluation. Patient selection based upon preoperative evaluation is a complex problem. In using a procedure with the tremenduous implications and applications seen in aortocoronary bypass grafting, excesses in enthusiasm and criticism are the rule rather than the exception. With patience and careful evaluation,,the correct place for the procedure will be found and, though it is not quite the panacea once claimed for patients with coronary artery disease, aortocoronary bypass surgery will remain an important and valuable therapeutic tool, perhaps the most significant development in cardiovascular treatment of the past decade.


Aortocoronary bypass-classification and results. Technical, physiologic, metabolic, and pathologic factors combine to determine the long-term patency of aortocoronary bypass grafts. Numerous variables are present in each of these categories, and the results of the operation cannot be determined unless comparable groups of patients are studied objectively. The classification proposed in this paper takes into account many of the factors that can effect graft patency. The available results of direct coronary arterial surgery are stated and used as the basis for five-year projections in the context of the proposed classification system.


Low free serum histidine concentration in rheumatoid arthritis. A measure of disease activity. A study of sera from 285 patients with definite or classical rheumatoid arthritis (including 37 patients receiving no anti-inflammatory drugs) and sera from 67 healthy subjects has confirmed 10 published reports of a statistically significant decreased blood histidine concentration in patients with rheumatoid arthritis. Contrastingly, in sera from 231 patients with a variety of acute and chronic illnesses other than rheumatoid arthritis, no statistically significant hypohistidinemia was observed either in the group as a whole or in association with the administration of aspirin, prednisone, indomethacin, phenylbutazone, or dextropropoxyphene. In the patients with rheumatoid arthritis there was a statistically significant correlation between the serum histidine concentration and the following: Westergren sedimentation rate (r=-0.33, P smaller than 10- minus 9), grip strength (r=0.26, P smaller than 10- minus 9), hematocrit (r=0.23, P smaller than 10- minus 9), duration of morning stiffness (r=-0.14, P=10- minus 5), walking time (r=-0.13, P=10- minus 4), latex titer of rheumatoid factor (r=-0.11, P=0.001), and the duration of arthritis (r=-0.06, P=0.05). There was no statistically significant association between the serum histidine concentration and the duration of rheumatoid arthritis in the 151 patients with disease of 0-10-yr duration (r=0.02, P=0.5), the sex of the patient, or the presence of antinuclear antibody (R=0.007, P=0.9). The serum histidine concentration was less in rheumatoid patients receiving steroids (P=0.00001), gold (P=0.009), and aspirin (P=0.15) than in rheumatoid patients not receiving these drugs. This study indicates that histidine determinations on properly preserved casual serum samples can be helpful in the diagnosis of rheumatoid arthritis and in the evaluation of the activity of the disease.


Gas endarterectomy with distal bypass of the coronary arteries. Carbon dioxide gas endarterectomy was first applied in cases of total occlusion of the right coronary artery. The early technique involved removal of the disease core along the entire length of the vessel. At follow-up, progressive changes were observed to cause segmental stenosis within the proximal and middle portions of the vessel which led to complete reocclusion of the artery at 36 months. In every case, however, the distal branches of the endarterectomized arteries appeared unaffected. On the basis of these results, we have modified our technique. The present treatment involves distal endarterectomy with aortocoronary bypass to the endarterectomized segment. This surgical approach is appropriated only in cases of diffuse atherosclerotic involvement of the distal arterial branches. It can be applied to any one of the three main coronary artery branches and has therefore broadened the range of patient selection for direct myocardial revascularization. The operative mortality in our series of 58 patients was 6.9 per cent (4 patients), but all deaths were associated with such aggravating factors as anerurysm formation, valve disease, and the preoperative evolution of myocardial infarction. The associated morbidity rate was 6.8 per cent; two patients had disruption of the sternal wound, and one suffered uncomplicated myocardial infarction. The fourth patient had a myocardial infarction followed by development of conduction defect and required operation for the insertion of a permanent transvenous pacemaker. To date, follow-up indicates a high patency rate among the surviving 54 patients.


Mouse embryo development in vitro: effects of inhibitors of RNA and protein synthesis on blastocyst and post-blastocyst embryos. The effect of inhibitors of RNA synthesis (Cordycepin, Actinomycin D) and protein synthesis (Cycloheximide) on the development and growth of mouse blastocysts in vitro was explored. Blastocysts exposed in vitro for 24 hours to 50 mu-g/ml Cordycepin, 0.005 mu-g/ml Actinomycin D, or 0.1 mu-g/ml Cycloheximde grew and began to attach to the dish in the similar manner as did the controls. Cell number, 3-H-thymidine-labeling index and mitotic index in treated blastocysts were also similar to controls. Cell number, 3-H-thymidine-labeling index and mitotic index in treated blastocysts were also similar to controls. Control blastocysts grown in vitro for six days attached to the dish, trophoblastic layer was spread and inner cell mass continued to grow and formed an egg-cylinder like structure. Blastocysts grown in constant presence of 50 mu-g/ml of Cordycepin in themedium or those exposed to inhibitor only for the first 24 hours failed to develop inner cell mass derivatives in culture, although the growth of trophoblastic cells was as in controls. The same results were obtained if blastocysts were exposed to 0.005 mu-g/ml of Actinomycin D or to 0.1 mu-g/ml of Cycloheximide either continuously or for the first 24 hours. Higher concentrations of Actinomycin D (0.05 mu-g/ml) or Cycloheximde (1 mu-g/ml) were toxic for the blastocysts causing their degeneration within 24-48 hours. Our results suggested that appropriate concentrations of RNA or protein synthesis inhibitors could prevent the development of inner cell mass derivatives with essentially no effect on the development of primary trophoblast. This would indicate that the process of differentiation of inner cell mass cells is much more sensitive to metabolic inhibitors than the differentiation of giant trophoblastic cells.


Azulene analogs of pharmacological agents III: acute toxicity and local anesthetic activity of azulylamides and azulenecarboxamides. This paper describes the acute toxicity of two azulylamides and six azulenecarboxamides and the nerve conduction-inhibiting properties of some of these compounds. The azulene derivatives are compared to their benzenoid prototypes, lidocaine and procainamide, as part of a continuing investigation of the biological properties of nonbenzenoid aromatic compounds.


Mechanical deactivation induced by active shortening in isolated muscle fibres of the frog. 1. The effect of active shortening on the time course and magnitude of isometric tension development during a single twitch and during an incompletely fused tetanus was studied at 0-2-1-2 degres C in isolated semitendinosus muscle fibres of the frog. 2. Active shortening caused a depression of the contractile force without markedly affecting the total duration of the twitch. The depressant effect increased with increasing amounts of sarcomere shortening. Sarcomere shortenings of 0-05 mum and 0-3 mum reduced the twitch force by approximately 5 and 20 percent of the maximal tetanic tension, respectively. 3. A given sarcomere shortening induced the same absolute amount of depression of the contractile strength when the movement was carried out at different times during the initial 200-250 msec after the stimulus. 4. The influence of load and velocity of shortening during the movement phase was studied. Differences in load ranging between zero and 1/3 of the maximal tetanic tension (with concomitant changes in speed of shortening from Vmax to approximately 1/5 of Vmax) did not affect the degree of depression markedly. Underthe conditions studied, the extent of movement appeared to be the only significant determinant of the depressant effect. 5. The reduction in force induced by active shortening persisted for 800-900 msec during an incompletely fused tetanus. 6. It is suggested that the depressant effect is based on a structural change in the myofilament system that is produced as the A and I filaments slide along each other during muscle activity.


Receptive field organization of ganglion cells in the frog retina: contributions from cones, green rods and red rods. 1. The impulse discharge of ganglion cells was recorded with extracellular micro-electrodes in the excised and opened eye of the common frog, Rana temporaria. 2. When a single unit was isolated, the cell type was first determined according to the Maturana, Lettvin, McCulloch & Pitts (1960) classification with the aid of varying moving and stationary stimuli. 3. Class 4 cells respond only to a decrease of light when cones are stimulated but respond to an increase of light when green rods are stimulated. A distinct class of deviating class 4 cells was found that give a brief high frequency burst at 'off' from their small excitatory receptive fields (ERF); unlike typical class 4 cells they possess a purely inhibitory surrounding field (IRF).4. The contributions from the cones and the green and red rods were isolated by measuring the thresholds of the discharges with on-off stimuli of varying wave-lengths against strong yellow backgrounds, or against a very weak background or no background at all. The spatial distribution of the contributions to the ERF was determined by mapping threshold profiles, and additional information about ERF and IRF was obtained from area-threshold curves. 5. The cone-mediated ERFs were found to be 0-06-0-50 mm wide (1-5-12 degrees of visual field), which agrees well with the sizes of the dendritic trees of the ganglion cells. The green rod-mediated ERFs can be 0-5-1-5 mm wide and have less distinct boundaries than the cone-mediated. The green rod-mediated ERF of an individual ganglion cell is always larger than the cone-mediated ERF of the same cell. The red rod-mediated ERFs seem to be somewhat larger than the cone-mediated but smaller than the green rod-mediated. 6. The green rods contribute only to the on thresholds of class 1, 2 and 4 cells, but both to on and off in typical class 3 cells, while the cones contribute to on and off in classes 1-3 and only to off in class 4.7. When the red rods begin to contribute during dark adaptation they seem to enter the cone but not the green rod channels. 8. All three receptor types contribute to the IRF surrounding the ERF of classes 1, 2, 3 and deviating class 4 cells. Normal class 4 cells have no IRF. 9. The organization of the receptive fields is discussed in relation to the anatomy and electrophysiology of the cell types transmitting the signals from the receptors to the ganglion cells.


Fluorescence intensity changes associated with contractile activation in frog muscle stained with Nile Blue A. 1. Extrinsic fluorescence intensity changes were studied in frog semitendinosus muscles stained with Nile Blue A in response to electrical stimulation. Muscles were stretched and put into hypertonic solutions to prevent movement. The muscles were illuminated at 90 degrees to their long axis with a narrow beam of light at a central wave-length of 6250 . Fluorescence emission was measured at 90 degrees to the exciting light using a filter which absorbed light of wave-lengths shorter than 6400 . 2. In response to a single stimulus the fluorescence intensity increases briefly. The fluorescence response is propagated at a constant velocity of about 1.5 m/sec. The average ratio of the maximum fluorescence intensity change to the resting fluorescence is 4.5 times 10-3 for supramaximal shocks. The fluorescence intensity change starts early in the falling phase of the action potential. 3. The fluorescence intensity change increases when nitrate replaces chloride and decreases when D2O replaces H2O. The rates of rise and fall of the fluorescence change was unaffected by nitrate replacement of chloride but are slowed where D2O replaces H2O. The rates of rise and fall of the fluorescence change increase with increasing temperature for all solutions used. The peak fluorescence intensity change, however, goes through a maximum at about 17 degrees C for aqueous chloride and nitrate solutions in the range of 10-25 degrees C. With D2O solutions, the peak fluorescence intensity increases monotonically in this range of temperatures. 4. The fluorescence intensity change in response to trains of action potentials are not additive. 5. Depolarization of muscles treated with tetrodotoxin using triangular-shaped fluid electrodes produces an increase in fluorescence at about the same threshold values required to elicit tension in preparations that are not fully stretched. The fluorescence intensity change precedes in time tension development. Near threshold depolarizations, the delay in onset of the fluorescence response can be 80 msec or longer. Byond threshold, delays become shorter and peak responses larger. During maintained depolarization, after the peak response, fluorescence declines to a plateau value. 6. The results suggest that the fluorescence intensity changes are associated with excitation-contraction coupling, possibly with changes in the transmembrane potential of the sarcoplasmic reticulum.


Energy balance in DNFB-treated and untreated frog muscle. 1. Heat production and chemical changes were measured in untreated and dinitrofluorobenzene (DNFB)-treated muscles during isometric tetani. Levels of total creatine (Ct), free creatine, ATP, ADP, AMP, inorganic phosphate, glucose-1-phosphate, glucose-6-phosphate, fructose-6-phosphate, fructose-1,6-diphosphate, pyruvate, phosphoenolpyruvate, and lactate were measured. Changes in inosinic acid (IMP) were also measured. 2. DNFB effectively inhibited the creatine kinase reaction (Lohmann reaction). 3. Our major finding is that even after effective treatment with DNFB the observed heat plus work after 2 sec and 5 sec of stimulation is significantly greater than the enthalpy change produced by the measured chemical changes. This confirms that an unidentified exothermic process occurs during muscle contraction; this conclusion was reached previously from studies of untreated muscle. 4. The unexplained heat plus work is unlikely to be derived from glycolytic reactions since under anaerobic conditions no formation of lactate, pyruvate, phosphoenolpyruvate or fructose-1,6-diphosphate could be detected in either untreated or DNFB-treated muscles even 34 sec after a series of three 5 sec isometric tetani. 5. In the first 2 sec of stimulation the unexplained heat plus work is less in DNFB-treated muscles than in untreated muscles. However from 2 to 5 sec of stimulation the unexplained heat plus work is the same in treated and untreated muscles.


The effects of prolonged repetitive stimulation in hemicholinium on the frog neuromuscular junction. 1. Cutaneous pectoris nerve-muscle preparations from the frog were stimulated for prolonged periods in solutions with curare alone, curare and hemicholinium no. 3 (HC-3), or curare and glucose plus choline. End-plate potentials (e.p.p.s) and miniature end-plate potentials (m.e.p.p.s) were recorded intracellularly. Black widow spider venom (BWSV) was applied to determine the degree of depletion of the transmitter stores. 2. The ultrastructure of the neuromuscular junctions was studied in the electron microscope. Some of the preparations were fixed immediately at the end of the period of stimulation and others were fixed about an hour after BWSV had been applied. In some experiments horseradish peroxidase (HRP) was present during the period of stimulation and the fixed tissue was treated to reveal the distribution of the tracer. 3. The amplitude of the e.p.p. fell rapidly to almost zero during 2 hr of stimulation at 2/sec in 100 muM HC-3 and little recovery occurred during a subsequent hour of rest. About 2-7 times 10-5 quanta were secreted. The e.p.p.s usually persisted throughout the period of stimulation in the other solutions and 2-2-6 times as much transmitter was secreted. 4. When BWSV was applied immediately at the end of the period of stimulation in HC-3, almost no m.e.p.p.s were discharged and only small m.e.p.p.s were discharged when the venom was applied after an hour of rest. 5. When BWSV was applied to unstimulated terminals that had been bathed in HC-3, or to terminals that had been stimulated and rested for an hour in glucose plus choline, m.e.p.p.s of nearly normal amplitude were discharged. 6. Terminals stimulated for 2 hr at 2/sec in 100 muM HC-3 contained a normal complement of synaptic vesicles and a large proportion of vesicles were labelled with HRP when the tracer was present during the period of stimulation. 7. BWSV induced the almost complete depletion of vesicles from terminals that had been stimulated in HC-3. 8. Depletion of vesicles also occurred when terminals were stimulated for 20 min at 10/sec after they had been previously stimulated for 2 hr at 2/sec in HC-3. These terminals showed extensive infolding of the axolemma and they contained swollen mitochondria. 9. These results indicate that stimulation in HC-3 depletes terminals of their store of transmitter but not of their population of vesicles and that vesicles empty of transmitter can fuse with and reform from the axolemma of the nerve terminal.


B and T cells in a cat with thymic lymphosarcoma. The mixed antiglobulin reaction and the formation of nonimmune rosettes with guinea-pig red blood cells (RBC) distinguished feline B and T cells, respectively. In a cat with thymic lymphosarcoma, the cells reacting in these tests formed separate, nonoverlapping populations. The malignant cells were large lymphoblasts replacing the normal thymus and infiltrating local lymph nodes, where they localized only in the paracortical, i.e., thymus-dependent areas. Cells from the nodes could therefore be identified as malignant or normal by their size. The mixed antiglobulin reaction showed that the malignant cells did not carry the surface Ig characteristic of B cells, whereas these malignant cells formed nonimmune rosettes with guinea-pig RBC. Among lymph node cells, most surviving normal and small lymphocytes, from outside the thymus-dependent areas, reacted as B  cells. The morphologic evidence therefore corroborated the test results, which indicated that the formation of rosettes with guinea-pig RBC seems a reliable means for the demonstration of T cells in the cat.


Aorta-coronary artery saphenous vein bypass grafts. Isolated and combined with other procedures. The results in 578 patients who underwent a saphenous vein bypass graft operation (isolated SVBG) or a SVBG combined with other procedures (combined SVBG) from 1969 through 1972 were analyzed. The operative mortality rate was low (3 percent) for isolated SVBG but increased considerably for combined SVBG. The late mortality rate was also low (4 percent) for isolated SVBG and also increased markedly for combined SVBG. The operative mortality rate did not change in the group undergoing left ventricular aneurysmectomy or mitral valve surgery for postinfarction mitral insufficiency, whether or not SVBG was used; however, late results were better in both groups when SVBG was performed. Among all groups, patients with postinfarction mitral insufficiency or rheumatic mitral incompetence associated with coronary artery disease had the poorest outcome. Despite the operative and late deaths, patients undergoing SVBG with aortic valve replacement showed excellent results in the group of survivors.


Serum enzyme data in diagnosis of myocardial infarction during or early after aorta-coronary saphenous vein bypass graft operations. In 397 cases, serum glutamic oxaloacetic transaminase (GOT) and creatine phosphokinase (CPK) values were determined on the first, second, and third days after aorta-coronary artery saphenous vein bypass graft operations. Electrocardiographic (ECG) or vectorcardiographic (VCG) evidence of postoperative transmural infarction was found in 48 cases. Multivariate analysis indicated that GOT and CPK concentrations on day 1 had substantial discriminatory value regarding infarction. Discrimination by GOT values was not significantly improved by addition of CPK. Of the 61 cases positive by GOT values measured 1 day postoperatively (greater than 100 U. per liter; normal smaller than 24), 32 (52 percent) were negative by ECG or VCG; of the 336 cases negative by GOT, 19 (6 percent) were positive by ECG or VCG. GOT and CPK values increased with the number of vessels grafted and with the use of ventricular rather than atrial vents. Total serum enzyme values lack specificty in diagnosis of transmural infarction after the saphenous vein bypass operation.


Delayed coronary artery dissection after angiography. A case description with successful operative treatment. A patient is described in whom right coronary artery dissection occurred 48 hours after coronary angiography. Successful operative treatment consisted of immediate saphenous vein bypass grafting and ligation of the proximal coronary artery. Several aspects of the case are characteristic of this pathological entity as reported in the literature and suggest principles of surgical management.


A study of B and T cells in multiple sclerosis. Peripheral blood T and B lymphocytes were enumerated using E and EAC red blood cell rosetting techniques. The percentage of EAC-binding cells in peripheral blood of multiple sclerosis patients is elevated (31.7 plus or minus 2.4S.E.M.) when compared with the percentage in healthy controls (18.5 plus or minus 1.1 S.E.M.). The total T cell percentage is not significantly lower in multiple sclerosis than in controls, but fewer T cells in patients with multiple sclerosis are able to bind 10 or more red blood cells.


In vitro resistance of haemophilus influenzae to co-trimoxazole and trimethoprim. Over a period of five months Haemophilus influenzae isolated from 123 patients were tested for resistance to co-trimoxazole and trimethoprim by the disc method of sensitivity testing and isolates from four patients were found to be resistant. However, the minimum inhibitory concentrations of trimethoprim lactate were estimated for the isolates from these four patients only one was found to be resistant. This H. influenzae strain was from one of the two patients in the survey who had a history of repeated courses of co-trimoxazole therapy. The discrepancy between the results of the disc sensitivity tests and the minimum inhibitory concentration estimations of the resistance of H. influenzae to co-trimoxazole and trimethoprim. The appearance of co-trimoxazole and trimethoprim resistance in H. influenzae isolated from a patient who has had prolonged treatment with co-trimoxazole is in agreement with the findings of other authors.


Exogenous Moraxella liquefaciens endophthalmitis. Moraxella species have been generally associated with diseases of the external eye. In this report we present a case of exogenous Moraxella liquefaciens endothalmitis which developed 14 years after an intracapsular cataract extraction.


Acupuncture and transdermal electrostimulation in the treatment of deafness. A review and critique of the research on acupuncture and transdermal electrostimulation therapy in treating sensorineural hearing loss is presented. Of 111 subjects in these studies were noted to exhibit a decrease in hearing sensitivity. Additional data collected at our clinics on four preschool hearing-impaired children failed to provide evidence of improvement following acupuncture. Similar results are reported with transdermal therapy, suggesting that both procedures are inappropriate for the treatment of sensorineural hearing loss.


Displacement currents in the node of Ranvier. Voltage and time dependence. The time course of the membrane currents in the node of Ranvier in which the sodium and potassium conductances have been blocked reveals asymmetries during and after the application of depolarizing and hyperpolarizing voltage-clamp pulses of identical size. Since 1. the integrals of the "on" and "off" current transients were found to be equal and opposite, 2. the change displaced reached saturation (about 140-10-minus 15 C/node) when the internal potential was taken to a sufficiently positive value during the depolarizing pulses and, 3. the size of the charge transferred was unaffected by temperature although its time constant had a large temperature coefficient (Q10 = 2.4), these currents to our opinion must result form charge movements confined to the membrane and, therefore, can be considered as non-liner displacement currents. The steady-state rearrangement of the charges is consistent with a Boltzmann distribution of charges (effective valence z = 1.65) between two configurations characterized by different energy levels. The midpoint potential of the distribution curve is -33.7mV and its maximum slope, kT/ZE, is 14.9 mV. Following changes in membrane potential the charges undergo a first order transition between these states. We propose that these displacement currents arise from a redistribution of the charges involved in the sodium gating system.


Voltage-dependence of drug-induced conductance in frog neuromuscular junction. Membrane currents from voltage-clamped frog muscle fibers were recorded during iontophoretic application of steady doses of carbachol, acetylcholine, and suberyldicholine to the endplate region. In the presence of these drugs, an exponentially relaxing current was observed after step changes of membrane potential. The time constant of relaxation was found to be voltage-dependent. It was equal to the time constant obtained from the autocorrelation function of drug-induced conductance fluctuations measured under similar conditions. Analysis of instantaneous current at the on- and offsets of voltageclamp pulses showed that there is no shift in equilibrium potential during the pulses.


Picosecond detection of an intermediate in the photochemical reaction of bacterial photosynthesis. Preparations of photosynthetic reaction centers from Rhodopseudomonas sphaeroides were excited with flashes lasting approximately 8 psec. Immediately after the excitation, there appeared a transient state which was characterized by new absorption bands near 500 and 680 nm, by a bleaching of bands near 540, 600, 760, and 870 nm, and by a blue shift of a band near 800 nm. The transient state decayed with an exponential decay time,t, of 246 plus or minus 16 psec after the flash. As the transient state decayed, the radical cation of the reaction center bacteriochlorophyll complex appeared. This indicates that the transient state is an intermediate in the photooxidation of the bacteriochlorophyll. The absorpiton spectrum of the transient state shows the state to be identical with a state (P-F) which has been detected previously in reaction centers that are prevented from completing the photooxidation, because of chemical reduction of the electron acceptor. Analysis of the spectrum suggests that the formation of P-F involves electron transfer from one bacteriochlorophyll molecule to another within the reaction center, or possibly from bacteriochlorophyll to the bacteriopheophytin of the complex. The initial absorbance changes after flash excitation also include a bleaching of an absorption band at 800 nm. The bleaching decays with tau approximately equal to 30 pse. The bleaching appers not to be a secondary effect, but rather to revael another early step in the primary photochemical reaction.


Aneurysm of the gastroduodenal artery.

Aneurysm of the gastroduodenal artery. Report on the case of a woman having a history of duodenal ulcer, who underwent six unsuccessful operations for several hemorrhages of the digestive tract. When angiography was finally carried out, this revealed an aneurysm of the gastroduodenal artery, probably located at the base of the ulcer. The diagnosis was verified at the subsequent operation which made it possible to arrest the haemorrhage by ligating the aneurysm.


Age at maternal separation and gastric erosion susceptibility in the rat. The development of susceptibility to immobilization-induced gastric erosions was studied in laboratory rats previously separated from their mothers at 15, 21 or 25 days of age. Early separation (day 15) produced animals whose maximum susceptibility occurred at a much younger age, generated a susceptibility curve over life that was the inverse of the curve for animals separated later and led to severe gastrointestinal hemorrhage as a common and distinguishing complication in younger rats. The pathogenesis of erosion formation in early separated rats may be unique in that, for that group only, the food deprivation component of the immobilization paradigm, when presented alone, also produced erosion of the glandular stomach, with hemorrhage.


Comparison of ventricular enlargement and radiopharmaceutical retention: a cisternographic-pneumoencephalographic comparison. The cisternograms and pneumoencephalograms of 58 patients with suspected "normal pressure" hydrocephalus were correlated and the relationship of ventricular radiopharmaceutical entry and stasis to ventricular size was analyzed. It was found that radiopharmaceutical entry relates directly to ventricular size, stasis occurring only in markedly enlarged ventricles. Cerebrospinal fluid imaging alone is a highly reliable diagnostic study only if patients exhibit the characteristic cisternographic patterns of normal pressure hydrocephalus. In those who do not, pneumoencephalography and cisternography are valuable complementary studies which can also be used to identify primary cortical atrophy.


The efficacy of the brain scan in diagnosis of brainstem gliomas. Nineteen cases of brainstem glioma were reviewed to evaluate lesion detection by brain imaging and other radiological methods. 99m-Tc-pertechnetate brain imaging was definitely abnormal in only one patient. Other techniques proved to be more sensitive and specific. Angiograms were abnormal in 10 of 18 cases while pneumoencephalography demonstrated the lesion in 16 of 19 cases. Brain imaging is not a sensitive diagnostic study in patients with suspected brainstem glioma. A normal brain scan is not useful in excluding this diagnosis and further radiological evaluation is necessary.


The validity of criteria for the evaluation of cerebral atrophy by computed tomography. Computed tomography of the brain was used in evaluating demented and nondemented elderly people. The incidence of convulutional atrophy and ventricular enlargement correlated well with pathologic and pneumoencephalographic examination of a similar population. Computed tomography also showed certain instances of dementia without atrophy and evidence of atrophy without dementia. The absence of brain atrophy in a demented patient should prompt a search for a potentially treatable cause of the dementia. The authors discuss criteria for diagnosing atrophy by computed tomography and conclude that, because of its noninvasive nature, it is a valuable aid in screening demented patients for treatable diseases.


Concurrence of ulcerative colitis and chronic acitve hepatitis, Clinical courses and results of colectomy. Seven patients with coexisting chronic active hepatitis and ulcerative colitis are reviewed. The activity of the two diseases varied independently. Proctocolectomy was necessitated in 6 patients and was followed by disappearance or decreased in titres of smooth muscle and antinuclear autoantibodies and immunoglobulins and, in one patient, by a rapid normalization of markedly elevated transaminases. Although the series are small, we feel that our data suggest that proctocolectomy for severe ulcerative colitis may have some beneficial effect on a coexisting chronic active hepatitis.


Structural requirements in the Fc region of rabbit IgG antibodies necessary to induce cytotoxicity by human lymphocytes. Rabbit IgG anti-chicken erythrocyte antibodies were compared with the Fab/c or Facb fragments of IgG and with partially reduced and alkylated IgG for the capacity to induce cytotoxicity by normal human lymphocytes. The Fab/c antibody fragment, which lacks one Fab region, was still able to induce cytotoxicity. In contrast, the Facb antibody fragment, which lacks the C-gamma3 domains, was nearly ineffective in activating the effector cells, whereas intact antibody activity was demonstrated by its ability to inhibit the cytotoxicity induced by unsplit IgG. Similarly, partial reduction and alkylation of the IgG antibodies, under conditions affecting the interchain disulphide bonds only, greatly diminished their ability to induce cytotoxicity, although they effectively inhibited the cytotoxicity induced by untreated IgG. On the basis of these results and previous data, we suggest that the reaction of the Fc region of IgG with the effector cell depends on the integrity of the C-gamma2 domain in the native, divalent state or on the interaction between the C-gamma2 and C-gamma3 domains.


Teeth loss and the inflammation of teeth-supporting tissues in rheumatoid disease. To compare the state of dentition between rheumatoid and control patients, ortopanthomograms were taken of 126 rheumatoid and 119 control patients. This roenthenologic examination revealed a signficantly higher incidence of teeth loss among the rheumatoid patients than among the control patients. To determine whether the dental periapical lesions of patients with rheumatoid disease differ histologically from corresponding lesions in control patients, the dental periapical lesions of 43 rheumatoid and 23 control patients were examined with a routine histochemical technique. No differences were detected however between these two patient groups either as regards the histologic features of their periapical lesions or as regards the incidence of these lesions, whether granulomas or radicular cysts. Furthermore, examination of the gingival tissues from 21 rheumatoid patients did not either reveal any distinguishing histologic feature. Amyloid was sought in the teeth-supporting tissues of both rheumatoid and control groups with techniques involving light, polarization and fluorescence microscopy. In neither group was amyloid detected with certainty with any of these techniques. The higher incidence of teeth loss among rheumatoid patients invited further investigation into the relationship between dental health and rheumatoid disease.


Treatment of vaginal discharge with yoghurt. A preliminary trial was  conducted, using yoghurt to assess its potential for the management of vaginal discharge. The results were encouraging in non-specific vaginal discharge and warrant further investigation. The treatment was ineffective in reducing Trichomonas vaginalis infestation, and in this condition no further investigation is warranted.


[Recurrent haemoptysis for a period of five years following aspiration of a gall stone]. The article deals with a case report of a 71-years-old female who suffered from hemoptysis over a period of five years. The first hemoptysis occurred postoperatively after a cholecystectomy in December 1966 and was thought to be caused by pulmonary embolism. Persisting episodes of more or less slight hemoptysis in the following years lead to repeated different diagnostic procedures. Radiologically there was an infiltration of the right lower lobe rather constant in size. Endoscopically no bronchial obstruction was visible. In July 1972 the patient suffered from a more severe hemoptoe. X-ray findings were nearly unchanged. With bronchoscopy the hemorrhage could be localized to the segmental bronchi 8 and 9. Right lower lobectomy was done in September 1972 without an exact preoperative diagnosis. The patient had an uneventful postoperative course despite of her age. Pathological examination of the specimen showed a foreign body looking like a gallstone. This diagnosis was confirmed by chemical analysis. To get an explanation we inquired into the circumstances of the cholecystectomy performed 5 years ago. These lead to the conclusion that the concrement must have been vomited and aspirated by the evidently not intubated patient. These suggestions were supported by the fact, that the former operation has been done because of a gangrenous gallbladder with a highly delated common duct and the duodenum, stomach and transverse colon being involved in an inflammatory infiltration. Dangers of asymptomic foreign body aspiration and diagnostic problems in non-opaque peripheral foreign bodies are discussed.


[Intrapulmonary thymoma].

[Intrapulmonary thymoma]. A primary intrapulmonary left-sided thymoma is described in a 23-year old man. Eight similar observations can be found in the world literature. The histology is quite uniform. The tissue shows characteristic epithelial and lymphatic cellular elements but organoid differentiation into medullar and cortex is lacking. Hassall's granules are only rudimentary. Giant cells in all stages of development, tissue mast cells, varied supporting tissue, epithelial border layer and connective tissue capsule are all present. There is no blastomatous degeneration. Theoretical indications to explain the sudden onset of tendency to proliferation of the ectopic thymus independant of age and sex are discussed.


[Complications in mediastinoscopy - a possibility of direct therapy]. Complications in diagnostic mediastinoscopy are between 0, 7 percent and 1,8 per cent. Lesions of the great vessels end letal in most cases. A possibility is reported how to treat lesions of the tracheobronchial system in emergency cases with lyophilised dura and a histoacryl-adhesive for tissue.


[Phleborgaphic studies of subclavian vein compression at the shoulder girdle]. 60 healthy persons without clinical signs of neurovascular compression at the shoulder girdle were investigated with phlebograms of the arm under various arm-positions. Venous obstruction could be demonstrated under hyperabduction and shoulder-retraction in 70 per cent of the phlebograms. A compression of the subclavian vein in extreme positions of the arm can therefore be demonstrated in a significant number of healthy individuals. A narrowing of  the costoclavicular space and an impression by the head of the humerus seem tobe the most frequent mechanisms of compression. Repeated compression between clavicula and first rib leads to thickening of the vein wall, forced expiration (Valsalva) to temporary stasis. These mechanisms could be the reason for primary subclavian vein thrombosis in otherwise healthy individuals.


[Surgical problems in the treatment of aneurysm of femoral artery bifurcation]. The different types and causes of aneurysm in the region of the femoral artery bifurication as well as the possibilities of surgical treatment are discussed on the basis of 4 patients, each with a differnt type of aneurysm. The examples show clearly that the basic of 4 patients, each with a different type of aneurysm. The examples show clearly that the  basic disease can prevent successful surgical reconstruction of the arterial blood circulation. The use of synthetic prostheses is not possible in case of infection in this area  because of the deleterious subsequences unless the entire infected area can be avoided with a bypass. (Fig. 2a). Trials with autologous veins and arteries, are , therefore, justified. The technical procedure for the use of the greater saphenous vein or deep femoral artery is described. In the authors' patients as well as those reported in the literature, it is clear than aneurysms in the region of the femoral artery bifurcation are sometimes difficult to treat. Hwerver, their localisation near the surface should allow early diagnosis and prompt treatment.


[The development of intramyocardial haemorrhages or fluidaccumulation in the extracellular space]. Isolated rat hearts according to Langendorff and rabbit hearts after orthostatic collapse were studied under the  light and electron microscope. The light-micrographs were also quantitatively analysed. Changes in the vessels are noticeable, especially those in the sinusoid's. Vessel ruptures occur,  also isolated endothelial ruptures with intact basement membranes and perfusion fluid enters the extracellular space. Numerous 0.06-01 mu large vesicles appear in the cytoplasma of the endothelial cells. A large number of vesiculation processes can be demonstrated along the cell membrane. The extracellular space is strongly-dilated. Changes in the colloid osmotic pressure and a rise in perfusion pressure have no clearly demonstrable influence on the extent of extravasation under the experimental conditions. The mechanism possible inducing such vessel changes is discussed.


[Clinical  use of membrane oxygenators for extended extracroporal circulation]. Extended perfusion with extracorporal circulation membrane oxygenators of the Lande-Edwards type was performed in 43 patients. Two groups of patients were studied in detail: 1. Patients undergoing aortic valve replacement primarily because of calcified aortic defects (n equals 20; average perfusion time 96 min.1 2. Young children in whom the operation of Mustard was mainly performed (n equals 10; average perfusion time 92 min.) There were no deaths or complications due to the use of the membrane oxygenator. Particular emphasis is laid on the careful preparation of the apparatus. Although venous drainage is only by gravity, high flow perfusion was possible in all age groups. Haemodynamics and metabolism were good even after 1 1/2 hours perfusion. Haemodialysis was slight.


[Surgical  problems of the transvenous implantation of cardiac pancemakers]. 489 operation were performed at 323 patients with transvenous implantation of cardiac pacemarkers in 1968-1973. The average of the complications is coming to 25 p.c. of all operations. 41 (34 p.c.) operations of correction are caused by a dislocation of the electrode, 39 (33 p.c.) by a break of the electrode, 18 (14 p.c.) by infectious complications. The operative and technical possibilities to prevent the complications are described. The method of transvenous implantation of cardiac pacemakers is preferred.


[Experimental studies on the circulation of the vascular area of the subdiaphragm using a newly developed pulse-wave pump]. A new developed partial artificial heart system is presented, which allows pulsatile perfusion of vital organs. The results presented reveal the possibility to duplicate pressure curves and peak systolic pressure in the perfused area-similar to physiological preoperative measurements. The kidney function remains intact. Angiographically there is no damage of the kidney vessels evident. The results are compared with datas of other investigators. Especially there opinion about the disturbance of renal flow and function under nonpulsatile conditions are critically evaluated. A possible connnection between the postoperative renal failure after cardio-pulmonary bypass and non-pulsatile perfusion and other pathophysiological mechanisms are discussed.


[Total electrode retraction (Twiddler syndrome) in infection of the pacemaker system]. We report upon a case of total retraction of an electrode (Twiddler syndrom) in an infected pacemaker battery. The silk-thread fixation was still  fastened at the right place on the electrode; the tissue owing to the inflammation was no longer sufficient as a fixation point. The casues of this total retraction of the electrode are the following factors: the battery hat sufficient freedom of movement for rotation following exudation into the pacemaker cavity, the electrode was elastic and above all the pacemaker system was infected which could no longer guarantee a sufficient fixation of the electrode in the infected tissue. Attention is drawn to the necessity to remove an infected pacemaker system.


Perinatal mortality and maternal mortality at the Provincial Hospital, Quang Ngai, South Vietnam, 1967-1970. The perinatal mortality, maternal mortality, infant mortality rates, and the complications of delivery at the Provincial Hospital of Quang Ngai, South Vietnam are described. The perinatal mortality is the only valid statistic available as the infant usually leaves the hospital within three days of delivery. Knowledge pertaining to the 4th to 28th day after birth is scanty and there is insufficient knowledge about the first year of life. Infant mortality is estimated at 277 per 1,000 live births. The perinatal mortality 64.6 per 1,000 live births, and maternal mortality, 106 per 10,000 live births are extremely high in contrast to Western countries. The high perinatal mortality is attributable to deaths during birth, the neonatal and immediate postnatal period. The high maternal mortality is primarily due to caesarean section, anemia, uterine rupture, toxemia, post-partum hemorrhage and puerperal infection.


[Enhancement of the cooperation of T- and B-lymphocytes in the immune response and the induction of antibody production in B-mice]. The effect of poly-4-vinylpyridine and polyacrilic acid on production of antibodyforming cells to the sheep red blood cells in in vivo mixed cultures of T- and B-lymphocytes involved an obvious increase of the immune response. To a lesser extent theimmune response was increased in B-lymphocyte cultures, and no such effect was observed in T-lymphocyte cultures. The poly-4-vinlpyridine and polyacrilic acid were concluded to enhance cooperation between T- and B-lymphocytes and, probably, to replacethe T-lymphocytes function in B-mice.


Phytohemagglutinin lymphocyte stimulation in children with recurrent urinary tract infections. The delayed hypersensitivity (T cell) response of children with recurrent urinary tract infections, normal children, and children with other bacterial infections was measured by the ability of their lymphocytes to react to vitro to phytohemagglutinin. A comparison among these three groups demonstrated no differences in response. We conclude that the delayed hypersensitivity response is grossly normal in most children with recurrent urinary tract infections.


[Spinal cord compression in multiple cartilagineous exostoses (case report)]. A 53-year-old patient with multiple cartilagineous exostoses developed narrowing of the thoracic spinal canal with compression of the cord and spastic paraplegia. The importance of radiologic examination of the whole spine as well as of the extremities is emphasized. When there is an exostosis in the spine neurologic examination disclosing cord compression should be carried out at regular intervals. If there are signs of cord compression, early decompressive laminectomy is the treatment of choice.


[Multiple pseudoxanthomatour rheumatoid nodules]. 2 cases of Rheumatoid arthritis associated with multiple subcutaneous nodules were presented, which resembled "pseudoxanthomatour rheumatoid nodules" as before reported. In the first case, the asymmetrical joint involvement has been preceded by the formation of subcutaneous nodules since 5 years; In the second case, arthritis appeared long before the nodules were formed. In both cases, circumscript vasculitis and high titer of rheumatoid factor were noticed and cystic activities were found in several nodules.


[Factors influencing the results of aortocoronary bypass in a homogeneous series of 125 surgical patients]. A group of 125 patients having undergone aortocoronary bypass by saphenous graft was studied from the point of view of short and medium term results. The following emerged as factors likely to influence these results: --the technique used in the anastamoses and the quality of peroperative myocardial protection; --the presence of hyperlipidaemia; --the restrictive choice of indications in relation to the results of coronary arteriography; --the presence of cardiac insufficiency or an associated valvular lesion. Overall operative mortality was 8 p. cent. Routine ECG's and enzyme studies were carried out to detect postoperative myocardial necrosis. 4 postoperative infarctions without clinical symptoms or signs were detected (2.4 p. cent). 26 patients underwent surgery as an emergency with simultaneous coronary arteriography and surgery in 24. The mortality in this group was not greater (7.6 p. cent) than in the group as a whole. By contrast, mortality was greater in the presence of cardiac insufficiency (25 p. cent) or an associated valvular lesion (16.5 p. cent).


The influence of optokinetic training upon vestibular habituation. Ok-induced modification of vestibular responses elicited by sinusoidal stimuli. Unidirectional optokinetic training modifies the response pattern of bidirectional sinusoidal vestibular stimuli (pendular rotation), resulting in an initial response decline. The latter affects only slow phase velocity, whereas the former shows a frequency increase. Optokinetic training obviously has a facilitating effect upon vestibular habituation which cannot be induced by repeated sinusoidal vestibular stimuli alone. Peak frequency increase as well as slow phase velocity decrease of vestibular nystagmus, induced by optokinetic stimuli, are interpreted as a typical transfer mechanism across two sensory systems.


Severe Haemophilus influenzae infections. From May 1973 thorugh April 1974, a total of 83 children with severe Haemophilus influenzae infections were treated in three Denver pediatric hospitals. Although meningitis was the most common clinical manifestation (45 cases), other foci of infection were also noted (pneumonia, 12 cases; cheek cellulitis, eight cases; epiglottitis, eight cases; empyema, seven cases; pericarditis, three cases; arthritis, one case; periorbital cellulitis, one case; and abscess, one case). Nine children had positive blood cultures with H influenzae without an initial detectable focus of infection. Two patients developed clinically apparent sites of infection (osteomyelitis and scalp abscesses).


Pneumocystis carinii pneumonia. Diagnosis by lung biopsy. Pneumocystis carinii pneumonia was suspected in 52 patients who underwent lung biopsy for diagnosis of diffuse pulmonary infiltrates. All but five of the procedures were limited thoracotomies. There were no instances of significant postoperative hemorrage or of pneumothorax compromising ventilation. The diagnosis of P. carinii pneumonia was made rapidly from imprints of the lung stained by the Gram-Weigert method in the 18 patients who had P. carinii pneumonia. Over-all, the rate of recovery from Pneumocystis pneumonia after treatment with pentamidine isethionate was 41 percent. However, among patients with no other pulmonary lesion (group A), the survival rate was 58 per cent; none of the patients with coexisting pulmonary disease (group B) recovered. The pulmonary infiltrates in the other 32 patients represented a variety of processes, of which 5 were fungal infections and 5 were due to lymphoma. Fifteen patients had an organizing interstitial and intraalveolar pneumonia of undertermined origin.


Ocular manifestations of juvenile rheumatoid arthritis. We followed 210 cases of juvenile rheumatoid arthritis closely for eleven years. Thirty-six of the 210 patients (17.2%) developed iridocyclitis. Iridocyclitis was seen most frequently in young female patients (0 to 4 years) with the monoarticular or pauciatricular form of the arthritis. However, 30% of the patients developed uveitis after 16 years of age. Although 61% of patients had a noncontributory ocular history on entry, 42% had active uveitis on entry. Our approach was effective in detecting uveitis in new cases and exacerbations of uveitis in established cases. Forty-four percent of patients with uveitis had one or more identifiable signs or symptoms, such as red eye, ocular pain, decreased visual acuity, or photophobia, in order of decreasing frequency. Even after early detection and prompt treatment, 41% of cases of uveitis did not respond to more than six months of intensive topical treatment with corticosteroids and mydriatics. Despite this, there was a dramatic decrease in the 50% incidence of blinding complications of uveitis cited in earlier studies. Cataract and band keratopathy occurred in only 22 and 13% of our group, respectively. We used chloroquine or hydroxychloroquine in 173 of 210 cases and found only one case of chorioretinopathy attributable to these drugs. Systemically administered corticosteroids were used in 75 of 210 cases; a significant number of posterior subcapsular cataracts was found. Typical keratoconjunctivitis sicca developed in three of the uveitis cases. This association with uveitis and JRA was not noted previously. Surgical treatment of cataracts, band keratopathy, and glaucoma achieved uniformly discouraging results.


Pathologic anatomy of the thalamoperforating arteries in lesions of the third ventricle: Part II. A review of vertebral and carotid angiograms in 59 cases of third ventricular pathology demonstrated that the anterior thalamoperforating arteries are affected primarily by obstructive dilatation of the third ventricle, dilatation of the third ventricle secondary to atrophy, intra third ventricular tumors, anterior and para third ventricular tumors, and hypothalamic and thalamic tumors. The posterior thalamoperforating arteries are affected primarily by midbrain atrophy, midbrain tumors, and thalamic tumors. The primary and secondary effects have been outlined. Understanding of the anatomy of the thalamoperforating arteries facilitates localization of the site of obstruction in hydrocephalus, helps differentiate obstructive hydrocephalus from ventricular dilatation secondary to atrophy, permits differentiation between tumoral and non-tumoral dilatation of the third ventricle, aids in the diagnosis and differential diagnosis of intra third and para third ventricular masses including their posterior extent, and facilitates the diagnosis of thalamic, hypothalamic, and midbrain tumors.


Filling defects and nonfilling of the internal auditory canal in posterior fossa myelography. A review of posterior fossa myelography at St. Joseph Hospital within the past 5 years is presented. Three false positive diagnoses have been found. Two of the cases were proved to have arachnoiditis, while one demonstrated a knuckle of artery in the canal. One case with large acoustic neuromas causing nonfilling of the contralateral canal is presented. One case with Type I intracanalicular tumor out of 40 acoustic neuromas in the series was diagnosed prior to surgery. The indication for posterior fossa myelography are discussed with a review of the literature.


Angiographic diagnosis of intra- and extraaxial tumors in the cerebellopontine angle. Angiography is an effective diagnostic modality in the evaluation of patients with suspected cerebellopontine angle tumor, particularly when there is not a clear clinical differentiation between an intraaxial and an extraaxial mass, or when the patient presents with increased intracranial pressure. In a series of 17 extraaxial masses in the cerebellopontine angle and 2 cerebellar tumors which presented into the angle, the most common angiographic findings were: 1. elevation and/or medial displacement of the proximal portions of the superior cerebellar artery; this finding was seen only in the extraaxial tumors and has not been demonstrated with intraaxial masses; 2. downward, medial, and posterior displacement of the proximal portions of the posterior inferior cerebellar artery; 3. lateral displacement and stretching of the hemispheric branches of both the superior cerebellar and posterior inferior cerebellar arteries; and 4. displacement of the vein of the lateral recess and of the petrosal vein either downward and medially or upward and laterally.


Acute proliferative retrolental fibroplasia: evolution of the lesion. Infants with retrolental fibroplasia have been followed at the Bascom Palmer Eye Institute from August 1969 through December 1974. Changes occurring acute proliferative RLF were documented with fundus photography and fluorescein angiography. These are presented and especially those that have prognostic significance are emphasized.


Cicatricial retrolental fibroplasia: its occurrence without oxygen administration and in full term infants. Six patients demonstrating typical signs of the cicatricial phase of retrolental fibroplasia are presented. None of the patients had received supplemental oxygen treatment after birth, and three patients were full term with birth weights ever 6 1/2 pounds. Two of the three premature patients had been born prior to 1901, before the advent of oxygen therapy for premature infants. It is apparent from these observations that retrolental fibroplasia does occur without oxygen administration and also in full term infants.


Retinal detachment in retrolental fibroplasia. Retrolental fibroplasia is a continuing problem in ophthalmology and may lead to retinal detachment. In this study, two groups of patients with retrolental fibroplasia and retinal detachment are described. The first group consists of youngsters who develop retinal detachment during their teenage years and frequently have not been diagnosed as having the disease until the retina detaches. Usually definite retinal breaks can be found near the equator and these are round or oval in appearance and without opercula. A second group of patients was noted to develop retinal detachment at an earlier age. The configuration of these detachments suggested a rhegmatogenous etiology, but retinal breaks were hard to detect because the peripheral retina was frequently obscured by a membrane or cataract. Additional evidence to support this opinion was provided when a small retinal hole was identified in one youngster whose ora could be easily seen. Because of the progressive nature of vitreoretinal adhesion in retrolental fibroplasia, it is advocated that youngsters with any evidence of retrolental fibroplasia at the time of discharge from the premature nursery be followed at one month, three months, and six months of age and at four-month intervals thereafter until the age of four years. If no difficulty develops by the time, yearly examinations suffice. Follow-up examinations are important because when prompt diagnosis of retinal detachment is made, the involved eye can often be salvaged with surgery.


Oxygen toxicity in premature infants.

Oxygen toxicity in premature infants. With the current state of our knowledge regarding uses, hazards, and dangers, the cavalier offhanded attitude which in the past has all too frequently characterized oxygen use in the premature is no longer acceptable. Sufficient knowledge and technical expertise now exist in spezialized centers which will allow maximal benefit at minimum risk from oxygen usage. Where such centers are readily accessible, the need for oxygen therapy should be considered as a major criterion for transfer from a lesser to a more sophisticated newborn care unit.


The role of oxygen in retrolental fibroplasia. The effects of oxygen in the immature or incompletely vascularized retina are conveniently divided into an initial vasoconstrictive and obliterative stage and a secondary vasoproliferative response that occurs after removal of the subject from an enriched oxygen environment. Vasoproliferation starts at the zone of perfused and nonperfused retina. The incompletely vascularized retina is uniquely responsive to these oxygen-induced changes. After vascularization is complete and the retinal vessels reach the ora, the susceptibility to hyperoxia disappears. The vessels in the temporal periphery of the retina have a peculiar susceptibility to the primary and secondary effects of hyperoxia on the immature retina. Ophthalmoscopic examination of the temporal periphery therefore should always be done carefully in the premature infant or in older individuals giving a history of prematurity. The indirect ophthalmoscope provides the most satisfactory instrument for examination. The incidence of retrolental fibroplasia has been greatly reduced following the incrimination of oxygen as its principal cause. Further studies are still required to determine precise blood oxygen levels that are safe for the premature retina and to discover other factors that may play a role in the pathogenesis or RLF.


Alpha1 antitrypsin phenotypes in Northern Ireland. Serum alpha1 antitrypsin levels and phenotypes were examined in 1000 healthy adults in Northern Ireland. The Pi phenotype M accounted for 87-8% Pi MS for 7-3% and Pi MZ for 3-5%. The percentages of the rarer phenotypes were Pi FM 0-3, Pi IM 0-6, Pi SZ 0-4 and Pi Z--0-1. The range of alpha1 antitrypsin levels in different phenotypes showed considerable overlap. Pi MS, Pi MZ and Pi SZ sera gave mean levels of 81%, 61% and 40% respectively of the mean level obtained in Pi M sera and that of the Pi Z--minus serum, 5%. Two distinct types of anomalous pattern were encountered in sera from ten subjects.


Simplified medium for ampicillin susceptibility testing of Haemophilus influenzae. Recent reports of bona fide ampicillin resistance among strains of Haemophilus influenzae have emphasized the need for improved methods of susceptibility testing of clinical isolates. A simplified medium composed of only Mueller-Hinton medium plus supplement C (yeast autolysate and hematin) was used successfully for ampicillin susceptibility testing of 20 recent clinical isolates of H. influenzae, including six strains with confirmed ampicillin resistance. With this medium, susceptible strains were inhibited by less than 1 mug of ampicillin per ml, whereas resistant strains had minimal inhibitory concentrations of 8 mug or greater per ml. This medium can be used for either disk diffusion, tube dilution, or agar plate dilution methods of susceptibility testing. It has the practical advantage of simplicity of preparation and retains the light color and transparency of Mueller-Hinton medium. This medium can also be used for preparation of an inoculum suspension that can be adjusted to a standardized turbidity.


Iodometric detection of Haemophilus influenzae beta-lactamase: rapid presumptive test for ampicillin resistance. Strains of Haemophilus influenzae type b sporadically isolated from clinical specimens are ampicillin resistant due to production of a beta-lactamase. This enzyme which inactivates ampicillin and penicillin G is not produced by ampicillin-susceptible strains. Various characteristics of beta-lactamase production and ampicillin resistance of three H. influenzae type b isolates were investigated. A sensitive iodometric test was employed to detect beta-lactamase; positive results were obtained in 5 min with 10(9) bacteria taken from cultures on a nutritionally adequate agar medium. This simple chemical test will enable the hospital laboratory to obtain presumptive evidence of ampicillin resistance on the same day that H. influenzae is isolated.


Use of the activated coagulation time in intraoperative heparin reversal for cardiopulmonary operations. Activated clotting time (ACT) was used in 300 consecutive patients undergoing cardiac operations to determine the adequacy of heparin reversal. Mean ACT prior to protamine sulfate administration was 9 minutes 40 seconds. A return to normal value (less than 2 min 10 sec) occurred in three-fourths of our patients following administration of 1.5 mg of protamine sulfate for each 100 units of heparin. Additional protamine sulfate was administered in 50 mg doses to those having abnormal ACT until normal clotting was obtained. Normal values for ACT usually coincided with clotting in the operative field. ACT proved to be a reliable guide to protamine sulfate administration.


Beneficial effect of human growth hormone on stress ulcers. Human growth hormone was effective in healing erosions and controlling hemorrhage in six of eight patients with stress ulcers. This approach was based on known beneficial effects of growth hormone on nucleic acid and protein synthesis, demonstration of deleterious effects of stress on nucleic acid and protein synthesis, and demonstrated protective effects of growth hormone on animals subjected to stress. Bleeding cessation within 24 hours of its administration in two patients suggests the possible role of additional mechanisms involved in hemostasis. In a comparable group of eight patients with stress ulcer hemorrhage not treated with this agent, six died with continued bleeding. This high mortality represented the usual outcome in our patients with stress ulcer hemorrhage. These observations need to be extended to additional patients with stress ulcers in a larger randomized study.


Peroneal nerve stimulator in rehabilitation of hemiplegic patients. Of nine hemiplegic patients having foot-drop who were test-treated with the Philips functional electronic peroneal stimulator, only three who tolerated continued use of the stimulator for five weeks had improvement in function. Findings in these cases indicate that to be selected for trial use of a stimulator a hemiplegic patient should fulfill the following criteria: (1) be in the hospital, (2) be ambulant with or without a cane and/or short leg brace, (3) have no severe contracture of the ankle joint, (4) have no severe spasticity, (5) have no obvious lower motor neuron lesions, (6) be cooperative and intelligent, (7) have no severe manual difficulty (he should be able to put on the stimulator without assistance), and (8) be able to tolerate the discomfort from the stimulation.