[Demonstration of aqueous outflow patterns of normal and glaucomatous human eyes through the injection of fluorescein solution in the anterior chamber (author's transl)]. After partially injecting the anterior chamber with a 0.2% fluorescein-Ringer solution we examined using a blue filter slitlamp normal eyes, eyes with open-angle glaucoma, and eyes following iridectomy, iridencleisis, Elliot's trephination, and trabeculectomy. In normal eyes at physiological intraocular pressure, 1--9 aqueous veins were found with a mean of 4.6. The distribution of these veins was usually irregular, being more numerous and of largest caliber in the lower nasal quadrant. With only a few exceptions the aqueous veins originated 1--2 1/2 mm peripheral from the limbus and joined the episcleral veins after a short course. The venae recipientes were characterized by a straight and deep course. In eyes with an open-angle glaucoma the average number of aqueous veins was found to be increased compared to the number found in healthy eyes. However, the caliber of these veins was smaller and distribution mor uniform. Eyes having undergone iridectomy do not differ from normal eyes in the mechanism of aqueous humor outflow. After iridencleisis and after trephination the transport of aqueous humor from the anterior chamber is achieved through a filtration bleb: (1) transconjunctival, (2) by bulk-flow through lymphatic vessels, (3) diffusely through lymphatic vessels or veins. In most cases the different transport mechanisms were combined and pure types were seldom found. There was a very definite relationship found between the size of the filtration bleb and the development of draining lymphatic vessels. After trabeculectomy the following drainage mechanisms of the aqueous humor were observed: 1. Subconjunctival outflow of aqueous humor. The further drainage in this case was achieved as in the old types of fistula building operations i.e., primarily through the lymphatic vessels. 2. Direct transport of aqueous humor into the surgical area through newly incorporated veins and lymphatic vessels. 3. Drainage of aqueous humor through still functioning aqueous veins.


[The combination of micro-disk-electrophoresis and electroimmunodiffusion for investigation of aqueous humor proteins (author's transl)]. A combination of micro-disk-electrophoresis and electrophoresis into antibody-containing agarose gel is described which permits both qualitative and quantitative analysis of human aqueous humor proteins. This technique is an enrichment of methods for investigation of aqueous humor.


[Experimental siderosis bulbi: an echographic-histological study (author's transl)]. In 20 eyes of 10 rabbits a siderosis was provoked by intravitreal injection of 0,1 ml of a 1% watery solution of Mohr's salt. The course of the following vitreous retraction was observed during 4 weeks by means of ultrasonography, and each echogram was compared with the corresponding histological finding. The results of these investigations show that by means of ultrasonography vitreous destruction or liquefaction can be ascertained and distinguished from an undulation, taught or funnel-shaped detachment of the posterior hyaloid membrane; in addition, this membrane and retinal detachments are well discernible by this method.


[Experiences in the radiographic contrast medium dimer-X in orbital diagnosis (author's transl)]. Experiments in animals and the employment of the contrast medium in a number of patients showed, that Dimer-X is well tolerated. No negative side effects were observed during the study. Employing only a little quantity of the medium, diluted with distilled water in the ratio of 1:3 or 1:4, good contrast representations are obtainable in the tissue of the orbits. It is completely absorbed within a relatively short period.


[The influence of the retina on the maturation of the testicles: an experimental study in rabbits (author's transl)]. In the present experimental study in rabbits the importance of the non-illuminated retina as a superior regulating centre for the maturation of the testicles is demonstrated. Involvement of the retinal maturation by an experimentally provoked total retinal detachment is followed by a cessation of the development of the testicles. The extent of this influence can be brought in evidence by means of the quotation of the fatty acids C20:4/C22:5 as well as on the hand of the histological findings.


[Comparative intraocular pressure measurements with position independent hand-applanatation tonometers (author's transl)]. A study of comparative intraocular pressure measurements was made using the hand-held applanation tonometers of Perkins and Draeger in the sitting and lying patient. A series of 100 patients was investigated by two observers taking the pressures with both tonometers under blind conditions. The statistical evaluation of the data revealed an average pressure increment when lying down of 2.5 to 3 mm Hg for both observers and both tonometers. This postural response is fully reversible when getting up and an overshoot-phenomenon statistically significant is noted. The pressure increment when lying down is not related to initial pressure level and there is no clear relationship to the age of the patients tested. Interobserver variation as well as variations of both tonometers are evaluated. The effect of repeated tonometry in this study is considered. Some aspects of position influence on the intraocular pressure are discussed.


Glycogen concentration changes in retina, vitreous body and other eye tissues caused by disturbances of blood circulation. The glycogen content in the individual eye tissues is strongly correlated to blood supply. Our investigations on the retina of bovines, which have not been fully evaluated, show that the time interval between interruption of blood supply and preparation of the retina is of special importance. Pressure ischemia affects a decrease in glycogen content in the retina and vitreous of rabbits, which is, however, less distinct in the vitreous. Decrease of glycogen with ischemia also takes place in the cornea and, to a lesser degree, in iris and choroid. In contrast, there is no decrease in the glycogen content of the lens. Changes in glycogen content of the rabbit retina after ligation of the A. carotis communis is less distinct than with pressure ischemia. In the vitreous, changes in glycogen content could not be observed. Values measured in both tissues of the ligated eye decrease with additional pressure ischemia.


[Light and electron microscopic studies on short-term preserved corneae (author's transl)]. Rabbit corneae were stored at a temperature of +4 degrees C in the following media: 1. 5% Dextran T40, 2. McCoy's Medium 5a (modified), 3. Dextran T 40+McCoy's 5a Medium + gentamicin sulphate (250 mug/ml). The endothelia of the corneae were examined by light and electron microscopy after preservation for a varied number of days. The structure of the endothelia, stored for 1, 6, 12, 18 days, was compared to fresh corneal endothelial cells. The results indicate that corneae preserved in Dextran 5% T40 + McCoy's 5a Medium + gentamicin sulphate might be equivalent to fresh corneal tissue in keratoplasties.


Studies on the influence of leucomycine on the carbohydrate metabolism of the lens in vitro. The influence of leucomycine (10(-5) M--5 X 10(-3) M) on enzyme activities, free adenine nucleotides, and some intermediates of glycolysis in bovine lenses has been investigated. After a 48 h incubation in TCM 199, 6 out of 9 enzymes activities tested were decreased. Concentrations of energy rich nucleotifes, glucose, fructose, and fructose-6-phosphate as well as those of fructose-1,6-diphosphate and lactate were also decreased, whereas adenine monophosphate was increased.


[A histological and electron microscopic study of the rabbit retina after application of vincristin (author's transl)]. Temporary electrophysiological damage to the rabbit eye proportional to dosis and application time was observed after application of Vincristin (Lilly). Cell destruction in all retinal layers was observed upon histological and electron microscopic examination of the animals. The outer segments of the receptor cells showed chiefly diffuse damage, and the pigment epithelial cells showed a high incidence of reorganization. Follow-up examination one year later showed this damage to be partially reparable, especially when very high doses had not been applied. Regeneration of the outer segments was observed. Destruction through pyknosis of the nucleus and cytoplasmal destruction was observed in a small number of receptor cells, bipolar ganglion cells, and ganglion cells. This also explained the absence of lasting functional abnormalities in the ERG and EVP.


Uptake of horseradish peroxidase (HRP) by the endothelium of the short-term stored rabbit cornea. In vitro study of the uptake of horseradish peroxidase (HRP) by the corneal endothelium was carried out on rabbit corneae which were stored in a preserving medium for various periods. The stored corneae were incubated in HRP solution with or without adenosine triphosphate (ATP). The number of pinocytotic vesicles decreased as the storage time was prolonged. Addition of ATP to the HRP solution led to an increase in the pinocytotic vesicles in all storage periods. The pinocytosis in the 12-day stored corneal endothelium was only observed when the tissue was incubated in an HRP solution containing ATP. From these results, it was concluded that the viability of the stored corneae can be evaluated with uptake of HRP by the endothelial cell, and that the addition of ATP leads to an enhancement of pinocytotic activity in the endothelial cell.


[Fuchs's heterochromic cyclitis. Electron-microscopic study of nine iris biopsies (author's transl)]. The irises of 9 cases of Fuchs's heterochromic cyclitis, obtained by iridectomy during cataract surgery, were examined pathohistologically and electron microscopically. There is a chronic type of iridocyclitis with infiltration of mainly plasma cells and with a marked degenerative and atrophic component. The main feature of the fine structure is the presence of isolated organelles, mainly mitochondria, with intact structure, a result of a process which seems to destroy first the endoplasmatic reticulum and leads to cytolysis. This phenomenon, however, is present too in cases of types chronic iridocyclitis, but to a lesser extent. Thus, the extent of the atrophic process seems to be the only pathognomonic criteria for Fuchs's heterochromic cyclitis. The electron microscope cannot reveal pathognomonic criteria for Fuchs's heterochromic cyclitis, and, furthermore, we could not demonstrate any findings which could establish or confirm the etiology. The theory of a dysfunction of the sympathetic innervation and the theory of a vascular pathogenesis could not be confirmed. The question is discussed whether Fuchs's heterochromic cyclitis is a autoimmune-disease which attacks the endoplasmatic reticulum first.


Influence of various anesthetic drugs on the intraocular pressure of cats. Cats with one normal eye and one eye with experimental glaucoma were trained to tolerate tonometry while conscious. They were then given the general anesthetic agents pentobarbital, ketamine, and CI-744 in the lowest and twice the lowest dosages which permitted tonometry in untrained cats. Pentobarbital lowered intraocular pressure (IOP) by 20-50%. Ketamine raised IOP by about 10%. CI-744 had essentially no effect on IOP. The two conpoments of CI-744, tiletamine (CI-634) and zolazepam (CI-716) were given individually in the doses in which they had been given as part of CI-744. Tiletamine had no effect on IOP, while zolazepam lowered IOP by about 10%.


[The influence of vitamin A deficiency on the electrooculogram (author's transl)]. Hypovitaminosis A caused by a malabsorption syndrome had led to nearly selective disturbance of rod function in a 30 years old female. No rod dark-adaptation could be recorded. The b-wave in the ERG was lacking and the EOG was flat. The cone function appeared to be unimpaired. This could be documented by normal cone-ERG, colour vision, visual acuity and central visual fields. Following treatment with vitamin A the subjective dark-adaptation, the b-wave in ERG and the EOG recovered. The results show that cones contribute barely to the oscillations of EOG.


Ring-shaped alkali burns of the rabbit cornea. III. Late phase of the stroma reaction. The present paper deals with late changes of the corneal stroma after alkali burns from the 5th day after the injury up to the 58th day. As has been pointed out in a previous paper, between the 3rd and 5th day the process of healing within the corneal stroma changes and at the end a dense scar ensues.


[Does methylmethacrylate induce cardiovascular complications during alloarthroplastic surgery of the hip joint? (AUTHOR'S TRANSL)]. Cardiovascular experiments in dogs and rabbits under various conditions demonstrated that monomethylacrylate has no direct cardiac depressant activity. The transient decrease in blood pressure and heart rate of patients receiving endoprostheses and experimental animals is elicited by a vagotropic effect of the methacrylates and can be antagonized by prophylactic application of atropine. Severe cardiovascular incidents involving an acute cor pulmonale are induced via the steep rise in pressure within the bone-marrow canal during the forcing in of the endoprosthetic shafts, leading to intravasation of bone marrow and its thromboplastine like compounds, thus resulting in a partial coagulation. A schedule of simple prophylactic procedures proved to be effective in preventing fatal cardiovascular complications.


Protease inhibitors in patients with chronic obstructive pulmonary disease: the alpha-antitrypsin heterozygote controversy. A group of 163 patients with chronic obstructive pulmonary disease, from the pulmonary service of a large urban hospital, were evaluated for their protease inhibitor (Pi) type by starch gel and crossed immunoelectrophoresis, for serum concentrations of alpha1-antitrypsin and alpha1-antichymotrypsin, and for pulmonary function. Of the patients with emphysema, 17.8% were of Pi type Z; 50% of these were less than 45 years of age, compared to 13% of those of Pi type M. Of all patients with chronic obstructive pulmonary disease, 4.9% were of Pi type Z; 4.9% of patients were of Pi type MZ (heterozygotes) compared with 1.9% of the control population. There was an increased incidence of chronic obstructive pulmonary disease in persons of Pi type MZ, but no increase in persons of Pi type MS. Concentrations of both alpha1-antitrypsin and alpha1-antichymotrypsin were increased and were correlated. No patient had a deficiency of alpha1-antichymotrypsin.


Effect of human alpha-antitrypsin in papain-induced emphysema in the hamster. The possibility that human alpha1-antitrypsin could effectively prevent development of emphysematous lesions produced in hamsters 7 days after exposure to aerosolized papain (3% for 3 hours) was investigated. Pretreatment with intratracheal human alpha1-antitrypsin prevented the appearance of these lesions in a dose-dependent manner. On the other hand, systemic administration of large doses of human alpha1-antitrypsin failed to prevent papain-induced pulmonary lesions, despite a significant increase in serum trypsin inhibitory capacity. These results suggest that intra-alveolar rather than serum concentrations of human alpha1-antitrypsin are critical for preventing the development of pulmonary emphysema in this animal model. It is interesting that although the mechanism by which human alpha1-antitrypsin prevented the papain-induced lesions is unknown, intratracheally administered human alpha1-antitrypsin similarly prevented the development of pulmonary emphysematous lesions induced by 0.1 mg of porcine pancreatic elastase given intratracheally.


Etiologic diagnosis of intrapleural empyema by counterimmunoelectrophoresis. Cultural methods failed to identify the infecting organism in 4 patients with intrapleural empyema. Antimicrobial drugs had been administered to 3 of the patients before their admssion to the hospital. In each case, soluble polysaccharides believed to be those of pneumococcus or hemophilus were detected in the empyema fluid by counterimmunoelectrophoresis. These findings provided a rational basis for management of antimicrobial therapy for 3 of the patients and useful information on the origins of the empyema in the fourth patient. Counterimmunoelectrophoresis is a useful additional method for presumptively identifying the infecting organism in patients with intrapleural empyema.


Upper gastrointestinal bleeding associated with biliary diversion. Significant upper gastrointestinal bleeding following operation was noted in 14 of 218 patients undergoing external biliary drainage. None of these patients sustained hepatic injury or needed hepatic resection. Three patients died from causes related to the upper gastrointestinal hemorrhage, and in 12 of the 14 patients the episode of hemorrhage occurred within three days of the biliary tract operation. The majority of the patients were febrile or septic at the time of the biliary operation. Biliary tract infection, when combined with external biliary drainage, may predipose to major upper gastrointestinal hemorrhage.


Primary appendectomy.

Primary appendectomy. A review of 403 patients undergoing appendectomy in a community hospital led to the following conclusions. Appendectomy with the finding of a normal appendix and no other condition requiring operation was accompanied by a higher complication rate and longer hospitalization than appendectomy for nonperforated diseased appendix. A high frequency of removal of normal appendices did not result in a lower incidence of appendiceal perforation. An increased diagnostic accuracy in the surgical treatment of "acute appendicitis" was not associated with increased incidence of appendiceal perforation. These findings support the thesis that a more discriminate diagnosis of acute appendicitis will lower the incidence of unnecessary appendectomy without increasing the morbidity from unrecognized appendiceal disease.


Intussusception following jejunoileal bypass: case report and review of the literature. Jejunoileal bypass carries a number of potential complications, one of which is intussusception of the excluded segment. The incidence of this complication is probably about one to two per cent. The usual symptoms consist of intermittent episodes of colicky abdominal pain. The roentgenographic diagnosis is difficult because the condition occurs at the blind end of the excluded segment and it is not possible to reflux contrast material to this area. If the intussusception is associated with severe gastrointestinal hemorrhage, selective angiography may provide the diagnosis.


Night blindness and the retinal mechanism of visual adaptation. An account is given of investigations into the mechanisms of dark-adaptation in the retina of man and of the skate and other fish. Working hypotheses as to the possible sites of abnormal function in the various disorders of which night blindness is a feature are presented.


The temporal bone in the preauricular pit, cervical fistula, hearing loss syndrome. Histological study of the temporal bones of an infant with the preauricular pit, cervical fistula, hearing loss syndrome revealed abnormalities in the middle ear, the vestibular system, and the cochlea. There is a gross bilateral abnormality in the form and relationship of the middle ear spaces, the middle cranial fossa and the inner ear. The horizontal canal lacks ampulla and crista; the posterior canal terminates a short distance from the ampulla. The cochlear cavity is approximately four fifths of normal size. The modiolus of the cochlea shows minor abnormalities. Spiral ganglion cells and peripheral nerve fibers are present in all coils, but are below normal in population in the basal and apical coils. The stria vascularis is slightly deformed and partly atrophic in the upper apical coil. An occasional concretion is present in the base of the stria vascularis in the middle and apical coils.


Complications in acute pancreatitis.

Complications in acute pancreatitis. In a group of 260 non-selected cases of acute or subacute pancreatitis, severe complications occurred in 60 (23.1%). Long lasting shock and/or massive internal bleeding (5.4%), severe renal problems (anuria, tubular necrosis, nephrosis) (5.4%) and frank hepatic failure due to extensive liver necrosis or other severe destruction (5.0%), invariably lead to death. The clinical group of findings pointing to a fatal course usually manifested themselves during the first three days. Severe renal and hepatic lesions were in many cases secondary to shock in fulminant rapidly deteriorating cases. Prevention and efficient management of shock are thus essential prerequisites for saving the patient. Other important complications included severe intra-abdominal suppuration and abscesses, peritonitis and sepsis (3.9%), pseudocysts of the pancreas (5.4%) and biliary stasis (18.4%). Severe obstruction to bile flow with associated jaundice occurred in only 4.6% of cases; unselected operative biliary decompression does not therefore appear indicated. If an early laparotomy is performed, efficient debridement and drainage are of utmost importance. Fatal pancreatitis was associated with extensive necrosis of the pancreas in about 80% of cases; possibly subtotal pancreatic resection at an early laparotomy would have given better results in these most severe cases, as recently reported in the literature.


Spheroplasts of Haemophilus influenzae induced by cell wall-active antibiotics and their effect upon the interpretation of susceptibility tests. The interpretation of in vitro susceptibility tests of Haemophilus influenzae performed by the agar or broth dilution methods with Levinthal enrichment was found to be markedly influenced by the production of spheroplasts by this species. Using an inoculum of 10(7) organisms/ml, this phenomenon was frequently evident macroscopically as a haziness on agar substrates and in broths containing cell wall-acting agents, such as ampicillin, cephalothin, and penicillin, but was not noted with chloramphenicol. Phase-contrast microscopic examination of the haze from these sources revealed numerous spherical bodies in contrast to the typical cocco-bacillary forms observed in growth controls. With this inoculum size, minimal bactericidal concentrations could not be determined since subculture of 0.1 ml of the hazy broths or the surface haze onto chocolate agar resulted in most instances in the development of a small number of colonies which, upon smear and gram stain, revealed typical Haemophilus morphology. An inoculum of 10(4) organisms/ml abolished the haziness on agar surfaces and in broths and resulted in clear-cut end points. Also, although spherical bodies were still present, they were distinctly less in number as contrasted to tests performed with an inoculum of 10(7) organisms/ml. It is recommended that minimal inhibitory concentration end points in antibiotic susceptibility tests be determined by microscopic, rather than macroscopic, observation of the growth milieu to determine the presence or absence of morphologically typical bacilli which, when observed, is indicative of true in vitro resistance.


Uptake of metronidazole and its effect on viability in trichomonads and Entamoeba invadens under anaerobic and aerobic conditions. [(14)C]metronidazole used at the chemotherapeutic concentration of 10 mug/ml is taken up rapidly by the anaerobic protozoa Tritrichomonas foetus, Trichomonas vaginalis, and Entamoeba invadens kept under anaerobic conditions. It can be calculated that within 30 to 60 min the intracellular concentration of the label is 50 to 100 times higher than in the medium. The presence of air markedly suppresses the uptake in the trichomonads and abolishes it in E. invadens. The suppression disappears after anaerobic conditions are established. The rate of uptake in T. foetus is dependent on the concentration of the drug in the range studied (1 to 200 mug/ml). Analysis of double reciprocal plots suggests that the drug enters the cells predominantly or exclusively by diffusion. The major factor driving the uptake is most likely the intracellular biotransformation of the compound. If less than 3 mug of drug per mg of protein is taken up by T. foetus no decrease in viability is observed. Above this level the cytotoxic activity corresponds roughly to the amount accumulated in the cell, irrespective of whether the conditions are anaerobic or aerobic.


Heterogeneity of Staphylococcus aureus enterotoxin B as a function of growth stage: implications for surveillance of foods. Staphylococcus aureus was grown in a fermentor under controlled conditions of pH, oxygenation, and temperature, while the higher-molecular-weight products of its growth were continuously removed across ultrafiltration membranes. These products were examined by single and double gel diffusion and immunoelectrophoresis against a variety of available anti-enterotoxin B antisera. All antisera examined were polyvalent for S. aureus antigens. However, two electrophoretically distinct proteins were the major reactants with the antisera. One of these was present in early- to mid-log-phase cultures. After mid-log growth was achieved, both were present but in continuously changing proportions. This observation was repeated with a variety of growth conditions and media. A significant part of the physicochemical heterogeneity of enterotoxin B observed over the past 20 years is thus correlated with the growth phase of the organism. Taken together, these facts are used to argue for a two-step rationale for the detection of food-borne staphylococcal disease: (i) screening for a presumptive hazard by analysis for any antigen, toxin, or enzyme of S. aureus in a foodstuff and (ii) confirmation of the hazard by identifying the presence of an enterotoxin using a combination of physicochemical and serological techniques.


The management of infected abdominal aortic grafts and graft-enteric fistulas. Seven cases of infected aortic grafts or aorto-enteric fistulas following resection of an abdominal aortic aneurysm are reviewed. All cases were treated with axillo-femoral bypass and graft removal. Patients had recurrent fever, chills, and abdominal pain (5 patients), or massive gastrointestinal hemorrhage (2 patients). The two patients with massive gastrointestinal hemorrhage died. Three of the 5 long-term survivors had a recurrence of the retroperitoneal abscess after graft removal; one of these died. One axillo-femoral bypass graft required early thrombectomy. There have been no subsequent problems with any of the grafts in the 2.5 to 4 year followup period. Axillo-femoral bypass immediately before graft removal is the treatment of choice for infected or fistulous aortic grafts. Any delay in graft removal after the onset of symptoms should be avoided.


The management of Hemophilus influenzae, Type B, pericarditis. The incidence of Hemophilus influenzae, type B, infections in children has been increasing recently, so the number of cases of pericarditis is likely to rise also. We describe the clinical manifestations and treatment of H. influenzae, type B, pericarditis based on 4 patients and a review of the literature. The most common complication is cardiac tamponade, which requires drainage. All patients should be treated with antibiotics (chloramphenicol, ampicillin) and a drainage procedure. Because of several recently reported cases of subsequent constrictive pericarditis, we recomment anterior interphrenic pericardiectomy both for drainage and to prevent constrictive pericarditis. With appropriate therapy the survival rate should be very high.


Vein grafts to left-sided coronary arteries: passage through the transverse sinus. Vein grafts to left-sided coronary arteries, unlike those to the right coronary artery, do not course and land naturally on an axis parallel to that of the recipient artery. To run such a course, the graft must take off from the aorta in a direction upward and to the left, then loop back toward the left anterior descending, the diagonal, or the circumflex coronary artery. Because of limited space in this area due to the reflection of the pericardium near the left pulmonary artery and left atrial appendage, the vein loop may bend at that point or, when made shorter, may kink at the site of the coronary anastomosis. To avoid the formation of these sharp angulations, the graft may be made to course posteriorly and superiorly into the transverse sinus, behind the main pulmonary artery and the aorta, and may be sutured on the right anterior aspect of the ascending aorta. Following is the description of this technique and its advantages.


Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention. Sternal osteomyelitis and mediastinitis caused by Pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.


A new approach to left heart decompression. A simple, safe, indirect technique for decompression of the left heart is described. Pulmonary artery venting produces immediate and total decompression of the left heart through spontaneous retrograde pulmonary flow across the open mitral valve in the hypothermic (29 degrees C) electrically fibrillated heart. This allows free retrograde flow of left heart blood across the pulmonary valve into the right ventricle, where it is taken up by the usual caval cannulas. In 25 of 66 consecutive patients undergoing elective ventricular fibrillation and anoxic arrest, left heart venting was necessary as indicated by rising left heart pressures. Total cardiac decompression was immediately and completely achieved by this simple indirect technique. Direct left heart venting, with its associated risks and disadvantages, was never necessary, and we now consider it obsolete.


A simple and effective left ventricular vent tube. We have devised a simple, cheap, left ventricular vent that is relatively free from malfunction. It has further use in that it serves as a means of cooling the endocardium when hypothermic techniques are utilized.


Antibodies to components of extractable nuclear antigen. Clinical characteristics of patients. Forty-four patients with antibodies to ribonuclease-sensitive extractable nuclear antigen (ENA), ribonuclease-resistant ENA, or both, are described. Most patients with antiribonucleoprotein (anti-RNP) antibodies have overlapping features of systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), and polymyositis, and have a low incidence of nephritis. Most patients with antibody solely to ribonuclease-insensitive ENA have SLE; these patients with SLE are typical of the general SLE population, except that they demonstrate an increased incidence of Raynaud phenomenon. Furthermore, it is shown that antibody to ENA may occur in other rheumatic and nonrheumatic diseases, and that not all patients who have a clinical overlap of SLE and PSS that is suggestive of mixed connective tissue disease have anti-RNP antibody.


Subcutaneous electrical stimulation (acupuncture) in the clinical practice of physical medicine. There has been a rapid growth in both interest and concern over the value of acupuncture in this country during the last three years. Initially it was regarded with doubt, then with overwhelming interest, but only recently have any research data appeared as to its true value and applicability to western medicine. An acupuncture research project was initiated in November 1972 by the author to assess the immediate and long-range benefits of acupuncture in a group of 179 patients with various neuromuscular-skeletal pain and mobility problems. A total of 1,112 treatments have been administered. A follow-up survey of these patients was completed in October 1974 with 126 (70%) of the patients responding to a subjective questionnaire. In 49% of the patients the initial response to acupuncture treatments was some reduction of symptoms and in a significant percentage there was persistence of beneficial response for greater than three months.


Acupuncture effect on neurosensory deafness. Bilateral neurosensory deafness offers a unique opportunity to study the effects of acupuncture objectively. By treating only one ear, and using audiometric evaluation techniques instead of subjective evaluations of hearing, an analysis of any achieved improvement seemed feasible. Only patients with well documented bilateral nerve deafness were accepted into the program. A baseline audiogram with speech discrimination and puretone air and bone conduction thresholds was obtained prior to treatment. Thirty-eight patients underwent ten consecutive acupuncture treatments on one ear only, with the other ear serving as a control. After the course of acupuncture, the audiometrics were repeated by the same audiologist. There was no significant increase in hearing after acupuncture therapy.


Chronic consumption coagulopathy accompanying abdominal aortic aneurysm. Each of two patients harboring a stable abdominal aortic aneurysm manifested severe recurrent bleeding consequent to chronic consumption coagulopathy (CCC). Both underwent successful aneurysmectomy, but in only one patient did bleeding cease and depressed clotting factors return to normal activity. In the other patient, subsequent observations suggested that his coagulopathy actually resulted from occult pancreatic carcinoma. We propose here criteria for establishing stable aneurysm as the cause of CCC and demonstrate the efficacy of heparin in reversing the coagulation defect prior to surgical intervention. These cases also illustrate that the discovery of CCC accompanying stable aneurysm may signal the presence of another underlying disorder.


Recurrent variceal hemorrhage following successful Warren shunt. Recurrent variceal hemorrhages are demonstrated following a technically successful Warren shunt. Serial barium esophagrams show the progressive enlargement of distal esophageal varices. Results of celiac arteriograms and direct examination confirmed the patency of the distal splenorenal shunt. Hemorrhage from varices was shown by fiberoptic esophagoscopy; end-to-side portacaval anastomosis reduced portal pressure and stopped the bleeding.


Transhepatic variceal sclerotherapy.

Transhepatic variceal sclerotherapy. We attempted to control variceal hemorrhage, using transhepatic variceal sclerotherapy of a coronary varix. The procedure transiently controlled hemorrhage, but bleeding resumed from short gastric varices hours later.


Coagulation factor VIII. Localization in the aqueous outflow pathways. Antihemophilic factor A-von Willebrand factor (AHF-vWF) is a protein involved in the first phase of blood coagulation and in the mechanism of platelet adhesion. The localization of this protein has been studied in the anterior segment of fetal and adult human eye by a direct immunofluorescence method. It was found that AHF-vWF is present in the wall of aqueous outflow pathways but not in that of Schlemm canal. As it has fibrinolytic activity in the endothelium of Schlemm canal, this structure can be expected to be especially well protected against fibrin deposition and occlusion by platelets and thrombi. The ciliary processes of the adult eye had no AHF-vWF activity. Instead, fluorescein isothiocyanate-fluorescence could be seen in the vessel wall of the ciliary processes of the fetal eye. This difference may be connected with the function of aqueous secretion.


T-cell rosette test in squamous cell carcinoma of the head and neck. The percentage of total T-lymphocytes was measured in 38 patients with histologically diagnosed squamous cell carcinoma of the head and neck. This measure of cellular immunity, which appears to be important in tumor-cell destruction, is demonstrably lowered in advanced stages of this disease. With the use of this test, the effect of a combined chemoimmunotherapeutic regimen consisting of methotrexate sodium, isoniazid, and BCG vaccine was sutdied. In this small series, no decrease of the T-cell count following treatment by methotrexate was demonstrated, except when a high dosage followed by leucovorin calcium was used. The BCG vaccine appeared to enhance T-cell counts, and one patient who was treated with cryosurgery had a dramatic increase in circulating T-lymphocytes. The T-cell test may be of clinical importance in the development of treatment sequences that provide maximum reduction of tumor cell mass while preserving host T cells.


[Postpartum hemorrhage syndrome caused by factor VIII inhibitor in the blood]. The appearance of Factor VIII inhibitor in women after childbirth is a very rare occurence. However the hemorrhagic syndrome which results from such condition can be very serious and difficult to treat. In this paper a case of young women is described who developed after childbirth a severe bleeding disorder. Clinical feature was very similar to those seen in haemophilia. The patient was investigated in the local hospital but the diagnosis was not made. The bleeding disorder lasted with various extension for six months and patient finally developed a severe sublingual and laringeal bleeding. She was transfered to the Clinic "B" of Internal Medicine in a very serious condition. On examination there was marked prolongation of the clotting time and no detectable Factor VIII. On the basis of these findings and the clinical expression of bleeding disorders, the tentative diagnosis of Factor VIII inhibitor was made. The treatment was not possible to institute because the patient expired within hours. Autopsy showed that bleeding into deep laringeal tissue was the sole cause of her death. Additional examination of the of the patient's plasma specimen using the antibody assay (Biggs-Bidwell-1959) showed the presence of the antibody to the Factor Viii which were active in 1:100 dilution.


Anti-tumour and anti-metastatic activity of 3-(P-Chlorophenyl)-2,3-Dihydro-3-Hydroxythiazolo (3,2-A)-Benzimidazole-2-acetic acid (WY-13,876). Extensive investigation of 3-(p-chlorophenyl)-2,3-dihydro-3-hydroxythiazolo(3,2-alpha)-benzimidazole-2-acetic acid (Wy-13,876) in BDF1 mice implanted with Lewis lung tumour has shown that it is an effective anti-tumour and anti-metastatic agent. In vitro examination using HEp-2 human epidermal tumour cells has indicated that Wy-13,876 is not cytotoxic. When mice implanted with Lewis lung tumour and treated with Wy-13,876 are also injected with anti-thymocyte serum, an increase in lung metastases is observed suggesting that thymocyte activity is involved in the drug's mechanism of action. An increase in peripheral T lymphocytes observed in rats 18 h after a single oral dose of Wy-13,876 further supports this possibility. When Wy-13,876 is given to tumour -bearing mice in combination with low, ineffective doses of 5-fluorouracil or cyclophosphamide, further reduction of primary tumour growth is observed.


Estimation of plasma esterolytic activity and its in vitro inhibition by proteinase inhibitors during acute pancreatitis in the human. The plasma esterolytic activity was measured using benzyol arginine ethyl ester (BAEe) in the peripheral venous blood of patients with acute pancreatitis, normal healthy volunteers and a contrast group of patients with acute intrabdominal inflammations other than acute pancreatitis. The plasma esterolytic activity was significantly elevated in the pancreatitis group. This activity was maximal during the first 48 hours of the illness and remained elevated for a further 8 days thereafter. Aprotinin in a dose of 2000 K.I. u/0-3 ml plasma did not completely inhibit this esterolytic activity, although it resulted in a more substantial inhibition than either ovomucoid or soy bean inhibitor. It is concluded that pancreatic enzymes are released into the circulation during acute pancreatitis and that Aprotinin does not completely inhibit this proteolytic activity. This polyvalent proteinase inhibitor should therefore be administered in much higher dosage than that used hitherto in  acute pancreatitis. The plasma esterolytic activity seems to be of diagnostic value in acute  pancreatitis.


Immunological aspects of psoriasis. I. Immunoglobulins and anti-IgG factors. Sixty patients with psoriasis have been studied for quantitative estimation of serum immunoglobulin A, G and M (60 cases), immunoglobulin E (43 cases), salivary immunoglobulin A (28 cases) and anti-IgG factors in the serum (40 cases). All the data have been statistically compared to a large control group (300 subjects). The results show an increase of the serum IgG and IgA means, an increase of salivary IgA which is correlated with the serum IgA, an increase of IgE levels in some patients and the presence of anti-IgG activity in the serum of 45% of patients with psoriasis. All these findings are statistically significant when compared to controls. These data could be in favour of auto-immune processes in psoriasis.


Identification of subpopulations of lymphocytes and macrophages in the infiltrate of lichen planus lesions of skin and oral mucosa. The mononuclear cells of the infiltrate in lichen planus lesions of skin and oral mucosa have been identified by detection of their membrane receptors in frozen-tissue sections. By this method, the infiltrate would appear to consist of predominantly T lymphocytes, some macrophages and only a few B cells. The pathogenesis of lichen planus is discussed in the light of these findings.


The effect of transfer factor on neutrophil function in chronic mucocutaneous candidiasis. Chronic mucocutaneous candidiasis with hypoparathyroidism in a 6-year-old-boy is described. In addition to defects of in vivo and in vitro correlates of delayed-type hypersensitivity to Candida albicans the child also had abnormalities of neutrophil function in terms of their capacity to respond by chemotaxis to a known attractant and to kill suspensions of C. albicans. Dialysable transfer factor was given on six occasions at intervals of between 26 and 45 days. Neutrophil chemotaxis (optimal conditions) was restored following each of the six injections, neutrophil chemotaxis (sub-optimal conditions) following five of the six injections and candidicidal capacity following four of the six injections. The effects of transfer factor were transient requiring repeated injections. The Candida delayed-type hypersensitivity skin test was restored to normal but lymphocyte transformation to Candida extract was not consistently positive following treatment. There was a slight clinical improvement following therapy. These abnormalities of neutrophil and lymphocyte function point to the complexity of chronic mucocutaneous candidiasis. The improvement in neutrophil chemotaxis and candidicidal capacity following treatment suggests that transfer factor may be a heterogeneous group of molecules, some of which affect granulocytes and restore defects in their function.


Mouse red-cell rosettes in B-lymphoproliferative disorders. A high proportion of peripheral-blood lymphocytes formed spontaneous rosettes with mouse red cells in 22 out of 23 cases of chronic lymphocytic leukaemia (CLL); the proportion was significantly higher than in 19 cases of other B-lymphoproliferative disorders (non-CLL group) and in 19 normal controls. Intermediate findings were obtained in 10 cases of "hairy" cell leukaemia. Blast cells from various types of acute leukaemia did not bind mouse red cells. Pre-treatment of the lymphocytes with neuraminidase led to a significant increase in the proportion of rosettes in CLL only. This test may prove useful in distinguishing CLL from other B-lymphoproliferative disorders, particularly prolymphocytic leukaemia.


Immunoradiometric assay of factor VIII related antigen, with observations in 32 patients with von Willebrand's disease. A solid phase non-competitive immunoradiometric assay (IRMA) has been developed which allows measurement of factor VIII related antigen (VIIIR:AG) levels in normal plasma as low as 2.5 x 10(-4) U/ml. The assay is based on the extraction of VIIIR:AG from test plasma by means of polystrene tubes coated with a specific unlabelled anti-VIIIR:AG rabbit antiserum and subsequent labelling of the extracted antigen with 125I-labelled anti-VIIIR:AG rabbit IgG.


Recurrent erosion of the cornea.

Recurrent erosion of the cornea. Altogether, 80 patients aged between 24 and 73 years with recurrent erosion of the cornea have been studied and compared with a control group of 200. The patients' erosions were divisible into macroform and microform types. The macroform occurred in 10%, the microform in 56%, and both types in the same patients in 31%. The macroform was more commonly related to trauma than the microform. However, many (40%) were spontaneous in origin. The most common cause of the initial trauma was a finger nail. The recurrences occurred at around the time of waking, either just before or just after. Difficulty in opening the eye occurred in 10%. There was little evidence of precipitating factors, but eye rubbing was admitted by 10% and barbiturates were implicated in 3%. The corneae were examined in the healed state, when a high incidence (59%) were found to have superficial corneal dystrophies of the fingerprint lines, bleb, and Bietti's lacunar (map-like) types. These are considered individually, particular attention being paid to the distinction between the various types of line resembling the fingerprint line. Epithelial microcysts were also a common finding (59%) and were sometimes of the Cogan type. In only 11% of patients were there no corneal signs in the healed state. The need for careful examination of the cornea by retroillumination, using both the iris and the fundus, is stressed. The control group, in contrast, showed a very low incidence of dystrophies and cysts. Treatment was given initially with either drops or ointment and no differences in healing were found. Debridement was performed in 12 eyes as an initial treatment and also in four eyes which were not healing on medical treatment. Debridement assisted healing, but did not prevent recurrence. One eye was treated with debridement and scarification and seven with carbolization. These procedures appeared to reduce the recurrence rate. Sodium chloride ointment 5% was found useful as a prophylactic taken at bedtime, and the recurrence rate increased when it was withdrawn.


The inhibition of human leucocyte elastase and chymotrypsin-like protease by elastatinal and chymostatin. The ability of elastatinal and chymostatin, protease inhibitors of microbial origin, to inhibit human leucocyte proteases (EC 3.4.-) was studied. Elastatinal and chymostatin are capable of inhibiting the pancreatic enzymes elastase and chymotrypsin, respectively. It was found in these studies, with synthetic substrates, that elastatinal is a much weaker inhibitor of human leucocyte elastase than it is of porcine pancreatic elastase. Elastatinal caused no inhibition of the activity of human leucocyte chymotrypsin-like protease. Chymostatin was found to be a powerful inhibitor of human leucocyte chymotrypsin-like protease. Its affinity to the leucocyte protease was higher than its affinity to bovine pancreatic alpha-chymotrypsin. Chymsotatin had a weak inhibitory effect on the activity of human leucocyte elastase. Studies were also carried out on the ability of chymostatin to inhibit the release of 35SO2-4 from rabbit articular cartilage by human leucocyte chymotrypsin-like protease. Preincubation of the chymostatin with the protease before the latter was added to the 35SO2-4 -labeled cartilage caused inhibition of proteolysis as measured by 35SO2-4 release. Preincubation of chymostatin with 35SO2-4 -labeled cartilage prior to addition of the human chymotrypsin-like protease to the tissue also inhibited 35SO2-4 release. However, in the case of preincubation of cartilage with alpha1 -antitrypsin there was no such inhibition. It therefore appeared that chymostatin, unlike alpha1 -antitrypsin, was capable of penetrating the cartilage matrix and exerting its inhibitory effect upon the human leucocyte chymotrypsin-like protease that was subsequently added to the tissue.


T-cell qualities of lymphocytes and/or leukemic cells from peripheral blood in acute myeloid and lymphatic leukemia before treatment and at relapse. PHA stimulation of peripheral blood lymphocytes and/or leukemic cells has been studied in 65 patients with acute leukemia before any prior treatment. There were 38 patients with A.L.L. and 27 with A.M.L. In relapsing A.L.L. 15 observations were made before reinduction therapy. In about 40% of all the cultures PHA stimulation was done simultaneously with PWM-stimulation. Before any treatment normal lymphocytes showed a normal response, being however somewhat diminished at relapse. Most of the cases of A.M.L. had so many leukemic cells in peripheral blood that no reliable measure of stimulation of the few lymphocytes left was possible. In A.L.L. this was however possible in about 30% of all the cases studied. In cultures of the predominantly leukemic cells, lymphoblasts showed a positive response in a minority of cases studied. If the peripheral WBC-count was high, a response was usually absent. In some of the cases of A.M.L., the leukemic cells reacted to PHA and PWM. Unexpected but very remarkable is our finding that in the control cultures, without added mitogen, the incorporation of labelled 3H-thymidine was usually very high in A.M.L. contrasting with A.L.L. leukemic cells who incorporated very little of the label. These striking differences were observed both in 72 and 144 hours cultures and were not caused by differences in viability between these two leukemic cell-types. The capacity of A.L.L.-leukemic cells to form E ("T") and EAC ("B") rosettes was studied in 20 cases. The percentages of rosette forming lymphoblasts differed widely from patient to patient. It is concluded that in A.L.L. leukemic cells are in a minority immuno-competent cells and it is suggested that the lymphoblast is an immature cell, arrested in the maturation towards a T-lymphocyte, the degree of maturity differing from patient to patient. Furthermore the striking difference in spontaneous labelling of myeloid versus lymphoblastic leukemic cells seems to be helpful in the differential diagnosis and may in part explain the well known differences in prognosis and behaviour towards cytostatics between these main leukemia types.


[Choleragenic intoxication in hydrobionts]. Experiments were conducted on Rana temporaria in which cholerigenic intoxication was induced. Administration of high doses of choleragen caused in the epithelial cells of the small intestine of frogs structural-functional changes analogous to those observed in suckling rabbits used as a classic model for studying the mechanisms of cholerigenic intoxication.


[T-lymphocyte migration into the bone marrow in the initial period of the stress reaction]. Six to nine hours after the beginning of stress-reaction caused by a 6-hour immobilization there appeared, in the bone marrow of CBA mice, cells with the antigenic (theta-antigen) and functional (cells-helpers) characteristics of T-lymphocytes. Migration of T-lymphocytes into the bone marrow was regarded as the mechanism of increase in nonspecific resistance of the organism.


[Temperature dependence of the kinetics of dark reduction of bacteriochlorophyll P870, oxidized by impulse laser and continuous light in photosynthetic reaction center preparations from Rhodosuedomonas spheroides strain 1760-1]. A comparative study was carried out of temperature dependence of kinetics of dark reduction of bacteriochlorophyll P870 oxidized both by pulsed laser and continuous actinic light in preparations of photosynthetic reaction centres-bacteriochlorophyll-protein complexes from Rhodopseudomonas spheroides, strain 1760-1. Half-time of the recombination of primary products--P870+ and reduced primary electron acceptor A1, which decreases with temperature lowering from 180-240 ms at 120K, is determined. Values of the rate constant of electron transfer from A1 to secondary acceptors at 29,K (2.7.10-1s-1) and the activation energy of this reaction in the range of 298-255K which is 11.8 kcal/mole are calculated.


Emergency arteriography in acute gastrointestinal bleeding. Emergency arteriography was carried out on 35 patients with acute gastrointestinal bleeding, in 31 of them within two hours of active bleeding (a haematemisis; a diagnostic change in central venous pressure, pulse rate, or blood pressure; or gastric aspiration of fresh blood). A definite site of bleeding was identified in 27 patients (77%)-this being a small-intestinal vascular abnormality in three--and a probable site in three. Confirmation of the bleeding site was obtained in 20 out of 23 patients treated surgically. An intra-arterial vasoconstrictor infusion was given as a temporary measure before surgery in seven patients, only one of whom showed active bleeding at operation. An intra-arterial vasoconstrictor infusion was tried as definitive treatment in an additional 10 patients, but in four out of seven with a chronic ulcer bleeding recurred after 5-68 hours and was therefore treated surgically. We recommend the diagnostic use of arteriography in patients with reliable evidence of active bleeding if its site cannot be determined by endoscopy. We do not recommend its therapeutic use in those with a chronic ulcer, except to facilitate resuscitation before surgery; further studies are needed to define its role in those with an acute lesion.


Factor-VIII-related antigen: measurement by enzyme immunoassay. Factor-VIII-related antigen was measured, both by an enzyme immunoassay using a microplate method and by the Laurell technique, in normal people, patients with von Willebrand's disease, haemophiliacs, and obligatory haemophilia carriers. The enzyme immunoassay was simpler to perform and gave equally reliable and reproducible results. Many more assays could be carried out at any one time.


Extra-articular features in early rheumatoid disease. One hundred and two patients who presented with rheumatoid disease within the first year of onset were studied prospectively every four months for a mean 4.5 years to assess the incidence of extra-articular features. The features that seemed to be common in the early stages included hand-muscle wasting, carpal tunnel syndrome, lymphadenopathy, non-specific ankle swelling, and rheumatoid nodules, and to a lesser extent hepatomegaly, being underweight, conjunctivitis, skin transparency, and a palpable thyroid gland. Those features which seldom occurred early included scleromalacia, temporal artery inolvement, salivary gland enlargement, distal-motor neuropathy, splenomegaly, digital vasculitis, and pulmonary and cardiac complications. Being underweight indicated a significantly more severe outcome.


Prognostic value of early features in rheumatoid disease. Extensive data on 102 patients who presented with rheumatoid disease within a year of onset were gathered by a prospective study to assess the prognostic value of early features. Outcome was evaluated at a mean 4-5 years from onset on the basis of functional grade, extent of joint disease, early morning stiffness, and grip strength. Twenty-six patients improved, 14 pursued a mild steady course, and 62 had a persistently severe or deteriorating condition. The features recorded at the first visit were correlated with outcome. Those indicating a poor prognosis were: older age at onset, being underweight, poor grip strength, many affected joints, involvement of wrist or metatarsophalangeal joints, poor functional status, fulfilment of many of the American Rheumatism Association criteria for rheumatoid disease, raised erythrocyte sedimentation rate, seropositivity on sheep cell agglutination or latex tests, low haemoglobin level, raised blood urea level, and early erosions on x-ray films.


The effects of 5-hydroxytryptophan and L-tryptophan on wakefulness and sleep patterns in the cat. Sleep in cats was studied for 24 h after i.p. injections of D,L-5-hydroxytryptophan (5-HTP, 40 mg/kg) or L-tryptophan (200 mg/kg and 300 mg/kg) in two separate experiments. Total sleep, total slow wave sleep or deep slow wave sleep was not changed in any experiment. There was an increase of the awake, drowsy pattern over the whole recording period after both 5-HTP and tryptophan injections. An accentuated drowsy pattern, with high voltage 4 c/sec synchronous waves, but with no sleep spindles, was seen during the first hours after 5-HTP injection. REM sleep was completely absent during the first 6 h after 5-HTP and significantly reduced during the first 3 h after tryptophan. The similarity of the effects of 5-HTP and tryptophan suggests that they both act as serotonin precursors. It is also suggested that the serotonin precursors have a general deactivating effect on the waking state, and that they do not necessarily subserve a specific sleep-inducing or sleep-maintaining function.


Audiogenic seizures: relation to age and mechanisms of monoamine neurotransmission. Mice with a genetically determined susceptibility to audiogenic seizures were utilized to analyze the ontogeny of central monoamine neurotransmission in relation to a behavior with age-specific properties. Levels of noradrenaline (NA), dopamine (DA), and 5-hydroxytryptamine (5-HT) were measured in forebrain and hindbrain regions at 14, 21, 28, and 42 days postnatal age in genetically sensitive or resistant strains of mice. An in vivo estimate of tyrosine and tryptophan hydroxylase activity was obtained at the same ages by following the accumulation of 3,4-dihydroxyphenylalanine (DOPA) and 5-hydroxytryptophan (5-HTP) respectively, after the administration of a centrally effective L-amino acid decarboxylase inhibitor (R04-4602, 800 mg/kg). At 14 days, there was a faster rate of accumulation of DOPA in both the forebrain and hindbrain of the sensitive mice compared to mice of the nonsensitive strain. At 21 days, the age of maximal sensitivity in the sensitive mice, the levels of NA were significantly lower in both regions of the sensitive mice, but the accumulation of DOPA was similar between strains at this age. There was also a slightly lower level of 5-HT in the forebrain of sensitive mice at 21 days accompanied by a slower rate of accumulation of 5-HTP in this region. In the hindbrain of the sensitive animals however, the rate of accumulation of 5-HTP was faster than in the sensitive strain. At 28 days, some impairment in mechanisms within NA-containing neurons in the sensitive mice was still apparent (including lower NA levels). At 42 days, there were no differences in amine levels, however, the levels of accumulated DOPA and 5-HTP were significantly lower in the sensitive strain. The results suggest that in the sensitive mice, developmental differences in mechanisms of monoamine storage and/or synthesis may exist which could contribute to deficient amounts of physiologically releaseable transmitter.


Deoxynucleotide-polymerizing enzyme activities in T- and B-cells of acute lymphoblastic leukemia origin. All 5 thymus-dependent cell (T-cell) lines (Molt-3; Molt-4; RPMI-8402; CCRF-CEM; CCRF-HSB-2) and 7 thymus-independent cell (B-cell) lines (RPMI-8382, RPMI-8392, RPMI-8412, RPMI-8422, RPMI-8432, RPMI-8442, CCRF-SB) established so far from acute lymphoblastic leukemia patients were examined for deoxynucleotide polymerizing enzymes. All T- and B-cells had DNA polymerase gamma, DNA polymerase beta, and terminal deoxynucleotidyl transferase both in the soluble (the latter 2 enzymes only in small amounts) and chromatin fraction, whereas DNA polymerase alpha was found only in the soluble fraction. With respect to their sedimentation and chromatographic behavior, template-primer requirements, Km for deoxythymidine triphosphate or deoxyguanosine triphosphate divalent cation preference, effect of NaCI and inhibitors, the enzymes from T- and B-cells resembled each other and those from other mammalian cells. DNA polymerase alpha, beta, and gamma from T-cells like those from "fresh" acute lymphoblastic leukemia cells, were more thermolabile than those from B-cells or phytohemagglutinin-stimulated normal lymphocytes. In addition, the terminal deoxynucleotidyl transferase from the above cells was completely inactivated in 5 to 6 min at 50 degrees, whereas the DNA polymerase alpha, beta, and gamma retained considerable activity even after heating for 25 min at 50 degrees. DNA polymerase activity of the soluble fraction from T-cells was of the same magnitude as in B-cells when expressed on a DNA basis but twice that of B-cells when expressed on a protein basis. High terminal deoxynucleotidyl transferase activity, equivalent to that observed in acute lymphoblastic leukemia cells, was found in all T-cell lines that, when expressed on a DNA basis, was 30 to 100 times higher than the B-cell lines tested. These results support the suggestion of earlier investigators that T-cell lines examined here may have originated from leukemic cells.


Cytodynamics in the thymus of young adult mice: a quantitative study on the loss of thymic blast cells and non-proliferative small thymocytes. Cell proliferation and cell loss in the thymic blast cell population were studied in young adult mice by (1) stathmokinetic methods combined with an analysis of the PLMe-curve after a pulse 3H-TdR, and (2) nigrosin-dye exclusion combined with 3H-TdR-autoradiography. It was calculated that about 17 percent of the blast cells do not progress into mitosis within the period of an average cell cycle. The dye exclusion studies indicated a rate of blast cell death of about 2-5 percent/hr. The two methods of assessing blast cell loss (death) support each other very well. In spite of these findings scintillation countings on thymuses removed from 1 to 17 hr after 3H-TdR injection showed fairly constant levels of thymic radioactivity. This suggests a very extensive reutilization of 3H-labelled break-down products from dying blast cells. The very sparse labelling of pyknotic thymocytes strongly suggests that thymic blast cells do not become pyknotic. The rate of small thymocyte production and disappearance was studied by pulse and repeated 3H-TdR labelling techniques combined with dye exclusion studies and pyknotic counts. The data from the repeated labelling experiment were analysed by use of a model based on the assumption of first order kinetics of small viable, dead, and pyknotic thymocytes. The rate of cell production was estimated to 1-6 percent/hr whereas the rates of cell loss due to disintegration, i.e. supravital stainability and nuclear pyknosis, were calculated to 0-02 percent/hr and 0-0006 percent/hr respectively. Cell loss due to disintegration was less than 2 percent of the total loss of small thymocytes. It was concluded that pyknotic counts are a useless method of assessing the cell death in the population of thymic blast cells and small thymocytes. On the basis of a model for thymocyte proliferation, production and loss it is suggested that about 45 percent of the small viable thymocytes re-enter the generative cell pool, whereas about 55 percent disappear by emigration.


The size, density, and relative area of chromatic granules ("hydrogenosomes") in Trichomonas vaginalis Donne from cultures in logarithmic and stationary growth. Electron micrographs of Trichomonas vaginalis cells were examined morphometrically by means of an electronic image analyser. Cells from cultures in logarithmic growth contained smaller chromatic granules ("hydrogenosomes") and a higher proportion of sausage- or dumb-bell-shaped granules than did cells in stationary growth. These findings support the view that chromatic granules replicate by division of pre-existing granules and that this involves elongation and attenuation of their mid-region. The total area of cross sectioned granules occupied the same percentage of the cytoplasm of cells from cultures in logarithmic and stationary growth. The density of chromatic granules in the cytoplasm was identical for the two groups of cells.


Fenestrated blood capillaries in rat cranio-spinal sensory ganglia. Several fenestrated capillaries were seen in the endoneurium of trigeminal and dorsal root ganglia from two young adult albino rats treated with tetraethylthiuram disulfide. The finding is regarded as normal, although the possibility exists that intoxication with tetraethylthiuram disulfide may have enhanced the intensity and/or rate of this cytologic specialization of some isolated endothelial cells.


Aortocoronary bypass grafting in a child with coronary artery obstruction due to mucocutaneous lymphnode syndrome: report of a case. A four-year-old boy with a myocardial infarct and total occlusion of the right coronary and the left anterior descending coronary arteries due to mucocoutaneous lymphnode syndrome (MCLS). confirmed by selective coronary arteriography, underwent successful double aortocoronary bypass grafting. Patency of the grafts was demonstrated by graft angiography and the improvement of the contractile pattern of the left ventricle was reflected by the increase in ejection fraction from 0.45 to 0.61. This is the first patient successfully treated by aortocoronary bypass grafting for coronary artery obstructive lesions due to MCLS. This experience has demonstrated the feasibility of surgical management in a child with coronary artery obstruction due to MCLS. However, there are unanswered questions regarding the fate of the saphenous vein graft in relation to the growth of a child. Long-term clinical and angiographic follow-ups are mandatory to determine the significance of this mode of surgical treatment for the sequela of MCLS.


Secondary immunodeficiency in miliary tuberculosis. Cell-mediated immune response was investigated in fifteen patients with miliary tuberculosis. Delayed hypersensitivity skin test with "recall" antigens PPD and SKSD was positive in two and one patients respectively. An irritant dose of DNCB failed to induce non-specific inflammatory response in the skin of thirteen patients and the same patients also did not develop contact sensitivity to DNCB. Leucocyte migration test in the presence of Mycobacterium tuberculosis was also negative in eight of eleven patients studied. The proportion of E rosette-forming cells was found to be significantly depressed, though the proportion of EAC rosette-forming cells did not show any abnormality. On repeat skin tests in five patients after 3 months of chemotherapy and clinical improvement four showed a positive PPD and DNCB response. It was concluded that there is a marked degree of secondary immunodeficiency in miliary tuberculosis.


Antibodies binding polyriboadenylic acid in systemic lupus erythematosus. Immunochemical characterization and isolation by affinity chromatography. Antibodies specific for polyriboadenylic acid (poly rA) are present in sera from patients with systemic lupus erythematosus and from  NZB/NZW F1 mice. The specificity of these antibodies was established by inhibition of [3H]poly rA binding and by affinity chromatography. Poly rA binding was associated with the 19S and 7S regions when serum was fractionated by sucrose density gradient untracentrifugation. Young NZB/NZW F1 mice (1-5 months) had only 19S anti-poly rA, whereas old NZB/NZW F1 mice (2 years) had activity in both 19S and 7S regions, suggesting a possible age-dependent switching mechanism in the spontaneous development of antibodies to nucleic acids. The gamma-globulin fraction from an SLE patient was subjected to affinity chromatography on a column of poly rA covalently linked to Sepharose. An enriched population of IgG antibodies binding only poly rA, but not native or denatured DNA, was isolated in this manner. This procedure may have broad biological applicability for the preparation of isolated immunospecific anti-nucleic acid antibodies.


Lymphocyte subpopulations, serum IgE and total eosinophil counts in patients with bronchial asthma. Absolute T and B lymphocytes, total eosinophil counts (TEC), and serum IgE levels were studied in twenty-three asthmatic subjects. Compared to a mean peripheral T-lymphocyte count of 1620+/-486/mm3 in twenty control subjects, the mean value in the asthmatic patients was depressed significantly at 1192+/-4 12 (P less than 0-005). T lymphopenia was observed in ten of twenty-three patients (43%). The serum IgE was elevated above the upper limits of 507 mug/ml in six of seventeen patients. TEC above 250/mm3 was observed in twelve of seventeen subjects. T lymphopenia and hyper-immunoglobulinaemia E were each associated with hypereosinophilia. No correlation was observed between T lymphopenia and hyperimmunoglobulinaemia E.


Cell-mediated immunity in the rheumatoid diseases. I. Skin testing and mitogenic responses in sero-negative arthritides. Cellular immunity has been investigated in patients with various kinds of sero-negative arthritis. The incidence of cutaneous response to recall antigen streptokinase-streptodornase (SK-SD), and the ability to mount a primary cutaneous response to dinitrochlorobenzene (DNCB) have been examined in patients with ankylosing spondylitis and psoriatic arthritis. The results were not significantly different from normal. In vitro lymphocyte transformation in the presence of phytohaemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM) has been measured using peripheral blood lymphocytes from patients with ankylosing spondylitis, psoriatic arthritis and Reiter's disease. In comparison with a control group, significantly reduced responses were found to a low dose of PHA in the ankylosing spondylitis and Reiter disease patients. Significant increase in response occurred to a high dose of PHA, in patients with psoriatic arthritis and Reiter's disease, and to PWM in Reiter's disease patients. The in vitro results in the ankylosing spondylitis, psoriatic arthritis and Reiter's disease patients suggest some abnormality in the T-cell population in sero-negative arthritis.


In vitro stimulation of murine lymphoid cell cultures by levamisole. Levamisole has been reported to act as an immunological adjuvant. Experiments reported here on the effect of this agent on a variety of murine lymphoid culture systems were designed to gain an insight into its mechanism of action. We have found levamisole to be a weak mitogen for mouse spleen cells producing a dose related response which peaks at 48 hr in culture. The drug acted to augment the response of spleen cells to sub-optimal concentrations of concanavalin A, but had no unusual effect on the lipopolysaccharide stimulation of B-cell DNA synthesis in vitro. Levamisole was directly stimulatory on enriched T-cell populations and was found to have two actions: (1) to stimulate a subpopulation of T cells and (2) to augment the response of suboptimal mitogen concentrations of concanavalin A. In addition, we have found that murine thymocytes stimulated by concanavalin A were greatly potentiated in the presence of levamisole, but this population of cells could not be stimulated directly by the drug.


Formation of auto-rosettes by peripheral blood lymphocytes. A mean of 3-4% (0-5-19-5%) of the peripheral blood lymphocytes of normal adults were shown to bind three or more autologous erythrocytes in vitro to form auto-rosettes. Marked individual fluctuations were observed. Increased percentages were observed in patients with cancer, but not in other selected groups, including a group who had undergone thymectomy for myasthenia gravis. Auto-rosette formation was shown to be a property of T cells by the demonstration of (a) simultaneous binding of autologous and sheep erythrocytes, (b) non-inhibition of auto-rosette formation by anti-immunoglobulin, and (c) formation of auto-rosettes by mitogen-stimulated T blasts. Auto rosette formation is a property of high percentages of human thymocytes, and of lymphocytes treated with neuraminidase or stimulated to blast-cell trans-formation by phytomitogens. It is suggested that auto-rosette formation by these cells is related to their relatively low content of cell-coat sialic acid, as compared with untreated T lymphocytes. The possible influence of the cell coat on lymphocyte function is discussed briefly.


Coronary artery aneurysm. A review of the literature with a report of 11 new cases. In a prospective study, 11 (1.5 percent) of 742 patients had angiographically proven coronary artery aneurysms. The clinical picture was similar to that of patients with severe coronary artery disease. The coronary artery aneurysms were multiple and were associated with extensive coronary atherosclerosis in ten of the 11 patients. Left ventricular function was impaired when measured by end-diastolic pressure, end-diastolic volume, and ejection fraction. Segmental left ventricular contraction was severely abnormal. The abnormality of segmental contraction, distribution of coronary artery obstructions, an presence of collateral circulation were not different from other patients with severe occlusive coronary atherosclerosis. These 11 cases plus the 23 previously reported ante mortem form the total reported in world literature. The etiology of cornonary artery aneurysms is most commonly atherosclerosis (17/34, or 50 percent). The natural history of this condition is not known. Because of the severe atherosclerosis and poor distal-vessel run-off, most patients are not considered good surgical condidates; however, 15 patients have had coronary arterial surgery, and 13 have survived the immediate postoperative period with some improvement of symptoms.


Kartagener's syndrome with corrected transposition. Conducting system studies and coronary arterial occlusion complicating valvular replacement. An 18-year-old man whose sister has classic Kartagener's syndrome was found to have sinusitis, bronchiectasis, and corrected transposition with normal visceral situs. Congenital complete heart block was secondary to absence of conducting-system pathways between a small posterior atrioventricular node and the transposed His bundle and bundle branches. No anterior atrioventricular node was present. Prosthetic valvular replacement of the left-sided (morphologic right) atrioventricular valve was complicated by coronary arterial occlusion by suture, with subsequent myocardial infarction. The case appears to represent an unusual variant of Kartagener's syndrome with the abnormality of laterality being expressed as corrected transposition.


The relative efficacy of vestibular-proprioceptive stimulation and the upright position in enhancing visual pursuit in neonates. 48 healthy neonates born to multiparae were randomly assigned to view a moving stimulus either in the horizontal or the upright position, with or without added vestibular stimulation and with or without pacifier sucking. The infant was shown a moving black line inside a strictly controlled visual environment provided by an apparatus which permitted horizontal and upright positioning and displacement of the infant. Visual tracking was recorded by a concealed TV camera positioned at a constant distance and angle from the infants' eyes in both positions. Quality of tracking during each of 4 trials was scored on a 7-point scale. Results indicate that vestibularproprioceptive stimulation provided to the infant either horizontally or semivertically significantly enhanced his visual tracking, whereas the upright position did not. Pacifier sucking also improved his performace.


[Collagenous fibrillogenesis in the damaged arterial intima]. Development of fibromuscular hyperplasia of the intima (intimal thickening) as a characteristic reparative reaction of the intimal tissue was found in the carotid artery and abdominal aorta after an increased mechanical loading during experimental stenosis by means of optical and electronic microscopic examinations of the arterial wall. In children, whose death was caused by rheumatism at various phases of the disease in the coronary artery there was also focal diffuse intimal hyperplasia. Both in the experimental and in the rheumatic injuries of the arteries in the thickened intima there was more scarce infiltration with plasmatic proteins and lipids were discovered. An inference was made for interferention of serum insudation with collagenous synthesis in the damaged and reparative thickening of the arterial intima.


Increase of serum free thyroxine after propylthiouracil in vitro or its peroral administration to rats. After the addition of 6-propyl-2-thiouracil (PTU) (2.4 mg/ml) in vitro to the normal human serum a two fold increase of dialyzable free thyroxine fraction (%FT4) was found. The addition of the same PTU dose to the serum of intact Wistar rats caused up to 4 fold increase of this fraction. After the addition of increasing doses of PTU (40--400 ng/ml) a linear increase of FT4 was found in human serum, while in rat serum a nonlinear dose-response relationship was observed. After a single peroral administration of PTU to rats (42 mg PTU per animal) the serum PTU level reached the maximum (55 ng PTU/ml) after one hour and then decreased very slowly. The free thyroxine fraction also increased up to 150% of control value, but this maximum increase was observed one hour to later then the maximum PTU level. Then the values of %FT4 rapidly decreased to the initial value. Such effect of PTU in vivo was about twofold greater than that obtained in the rat serum in vitro under the same actual PTU level. The results were compared with similar effect of thiocyanate reported previously and it was shown that the effect of PTU both in vitro and in vivo is greater than that of equimolar levels of thiocyanate.


Further studies on response of blood thyroid hormone level to its acute depletion by isovolemic exchange transfusion. Groups of rats weighing about 400 g and fed low iodine diet for 16 days were injected with 125I- daily from day 8 to 14. Two days later their blood thyroid hormone was acutely depleted with an isovolemic exchange transfusion of hormone-free blood cell suspension. Relative changes of total plasma radioactivity and iodinated compounds were measured at frequent intervals, maintaining isovolemia of the recipient animal. In normal animals a post-transfusion decrease of total plasma radioactivity was related to the degree of exchange of total blood volume as was the post-transfusion increase to the initial level. No post-transfusion increase of total plasma radioactivity or labeled thyroxine was found in thyreidectomized animals. On the other hand, in normal animals a post-transfusion increase of plasma labelled thyroxine was observed. A linear increase of labeled iodide in plasma was found in both normal and thyroidectomized rats, the mechanism of which in thyroidectomized animals may be explained by a reflux of iodide from peripheral tissues to the blood. In normal animals a TSH-induced release of iodide from thyroid due to TSH action may participate in this phenomenon.


Effect of gamma irradiation on biological activity of thyrotropin. The biological activity of thyrotropin (TSH) was tested after sterilization by 0.5 and 12.5 Mrad of gamma irradiation. It was found that the biological activity (McKenzie's assay) of TSH irradiated in dry state was not affected during the first month after sterilization by doses of 0.5 and 2.5 Mrad. However, substantial decrease of TSH biological activity was observed 3--5 months after the irradiation, the lower activity being after the former dose. The irradiation of TSH by 12.5 Mrad in dry state and by 0.5 and 2.5 Mrad in solution resulted in a decrease of biological activity already during first month. The structural changes in the molecule of TSH were apparently not very extensive, since a decrease of disulfide bonds from 0.96 to 0.77 M per 1M of TSH was found immediately after the irradiation, while UV absorbancy and electrophoretic mobility on polyacrylamide gel electrophoresis were unaffected. These changes were followed by the decrease of TSH stability during storage in dry state. It is hypothesized that TSH molecule may be affected in beta subunit or in its connection with alpha.


Effect of vasotocin on plasma GH, free fatty acids and glucose in coho salmon (Oncorhynchus kisutch). Coho salmon fry were injected intraperitoneally with 50 mul of saline containing either 15 or 150 mU arginine vasotocin. Blood was collected 30 min and 120 min post-injection for estimations of hematocrit, plasma glucose, free fatty acids and growth hormone. Vasotocin injections of 150 mU, unlike those of 15 mU, caused a lowering of the blood hematocrit. Plasma levels of glucose, free fatty acids and growth hormone increased following injections of 15 mU vasotocin. The higher concentration of vasotocin (150 mU) decreased plasma levels of glucose (at 120 min post-injection), free fatty acids (at 30 min post-injection) and growth hormone (at 120 min post-injection). It thus appears that vasotocin is an antidiuretic hormone in coho salmon and it is suggested that glucogenic and lipolytic effect of vasotocin are mediated via growth hormone.


18-hydroxylated steroids in human hypertension - clinical study. The detection of two unknown urinary steroids called x and y in various patients was previously reported. Compound x was tentatively characterized as a derivative of dihydro-18-hydroxy-DOC with two additional polar groups. In this communication clinical observations of a set of 25 hypertensive patients are presented. Compound x alone was found in 4 cases, compound y alone 4 cases and both compound x and y in 5 cases. In several other cases, hypokalemia and/or a decreased urinary Na+/K+ ratio were found.


Mineralocorticoid like effect of new 18-hydroxy-steroid isolated from urine of hypertensive patients. The affinity of new urinary 18-hydroxy-steroid (Cp x) for mineralocorticoid receptors was estimated. When rat kidney slices were incubated with 2 x 10(-9) M 3H-aldosterone, Cp x (2 x 10(-5) M) was able to compete with aldosterone for the mineralocorticoid cytosol receptors. Cp x had low but significant affinity for mineralocorticoid receptor sites. This affinity was less than that obtained with 18-OH-progesterone. Moreover, in the adrenalectomized rats, the injection of Cp x induced a decrease of urinary Na+/K+ ratio which seems comparable to that obtained with 18-OH-progesterone.


Protracted milk-ejecting effect of some oxytocin analogues in rats. Protracted effect of [2-0-methyltyrosine]-deamino-1-carba-oxytocin, [2-0-methyltyrosine]-oxytocin and its dimeric form was studied on the mammary gland of lactating rat in vivo. Biphasic course of biological response found for monomers and slow onset of response observed for dimer led to the assumption that the substances behaved like hormonogens.


Effect of calcitonin on fracture healing in rats. The influence of calcitonin on the healing of a fracture of tibial diaphysis in young rats has been studied with the aid of 85Sr investigations. The animals were subdivided into four groups (with facture + calcitonin, with fracture and no calcitonin, without fracture but with calcitonin treatment and intact controls). During the experimental period up to the day 38, repeated applications of calcitonin and 85Sr along with measurements of different parameters followed. These parameters consisted of: total body weights, 85Sr contents in the fractured and opposite tibiae, total body radioactivity of 85Sr, the weights of dried bones dissected after the day 38, the weights of bone ashes and the specific activity of 85Sr in the ashes. Increased 85Sr-uptake was seen as a sign of increased mineralisation of the callus. Calcitonin suppressed the resorption of bone during the callus formation and enhanced the mineralisation of callus to some extent. The main influence of calcitonin was seen to reduce the whole-body metabolic response to a localized skeletal injury--the fracture. The possible importance of this finding for the clinical practice is discussed briefly.


Immunological investigations in two brothers with ataxia telangiectasia Louis-Bar. Two of three brothers with the classical signs of ataxia telangiectasia were investigated for their immunological disorders at the ages of 13 and 16 years, respectively. The elder brother also suffers from autoimmune hemolytic anemia, a complication which has not yet been described in the course of ataxia telangiectasia. Immunological investigations made in both brothers showed a reduction in the number and function of T lymphocytes. The number of B lymphocytes was normal, among which there were cells staining for IgA, although serum IgA was absent. It seems possible that this phenomenon is caused by a disturbance in the process of maturation of lymphoid cells with a lack of differentiation into IgA-synthesizing plasma cells.


Normal colony stimulating factor (CSF) production by bone marrow stromal cells and abnormal granulopoiesis with decreased CFUc in S1/S1d mice. The concentration of CFUC and the production of stromal-derived CSF in the femora of S1/S1d mice were determined. There was a lower concentration CFUC and a smaller total number of nucleated cells in the femoral marrow of WCB6. S1/S1d (S1/S1d) mice than in WCB6. +/+/(+/+) mice or in C57B1/6. +/+ (C57Bl) mice. On the other hand stromal-derived CSF production by femora from S1/S1d mice did not differ significantly from that of +/+'s. These observations indicate that the microenvironmental defect of S1/S1d mice results in decreased growth of granulocytic precursors as well as those of erythroid and megakaryocytic cells. This is consistent with the reported decrease in multipotential stem cell proliferation. Stromal cell derived CSF production was normal and could not be implicated in the decreased production of granulocytic precursors.


The avian pineal organ. Distribution of exogenous indoleamines: a qualitative study of the rudimentary photoreceptor cells by electron microscopic radioautography. The uptake of 5-hydroxytryptophan (3H-5-HTP) and serotonin (3H-5-HT) and their distribution have been demonstrated, at the ultrastructural level, in the secretory rudimentary photoreceptor cells (SRP cells), in the pineal organ of the parakeet and the duck. In vivo experiments. When the parakeets were injected with 3H-5-HTP alone or pretreated with drugs interfering with monoamine metabolism (e.g. R04-4602, nialamide) prior to injection of the label, the SRP cells always exhibited specific radioautographic reactions, in the regions of the dense secretory granules of the cell body and asynaptic pedicles. The labeling concentration avried quantitatively with time (interval between injection of the label and sacrifice) and drugs used. In vitro experiments. The uptake of 3H-5-HTP and 3H-5-HT in the pineal organ of the duck has also been studied, using an incubation procedure. The results with the two precursors confirmed those obtained "in vivo" with the parakeet. From these results it is suggested that the uptake of precursors in some compartments of SRP cells is qualitatively independent of: a) the experimental period (experiments performed in winter, spring, and summer; uptake of precursors between 11.00 a.m. and 12.00) b) the precursor (3H-5-HTP or 3H-5-HT) c) the observation times. It is concluded that the SRP cell, an important step in the cytological and functional evolution of the pineal organ (Collin, 1969, 1971), is responsible for the synthesis of 5-HT. The metabolism of 5-HT seems also possible in such cells.


Splanchnic hemodynamics in cirrhotic patients with esophageal varices and gastrointestinal bleeding. Twenty cirrhotic patients with esophageal varices and an episode of gastrointestinal bleeding within the previous week underwent hemodynamic studies which used an indicator dilution technique based on selective catheterization of the splanchnic arteries and hepatic vein. Portasystemic shunting of splenic arterial flow averaged 95% (range 80 to 100%) in 17 patients with proved variceal bleeding, but only 8% in 3 who bled from another site. Superior mesenteric shunting averaged 70% (range 27 to 100%) in those who bled from varices, and no shunting was detectable in the nonvariceal bleeders. In at least 4 patients shunting was essentially complete from both beds. In 11 others, however, more than one-third of mesenteric flow still perfused the liver. The pressure gradient from the wedge to free position in the hepatic vein and the hepatic blood flow bore no relationship to the degree of shunting. These data indicated the variability of the splanchnic hemodynamic pattern that may exist in alcoholic patients with esophageal varices. If hemodynamic factors are important in determining the response to surgery, indicator dilution studies to quantitate portasystemic shunting may be a vital part of preoperative evaluation.


Effect of prostaglandin 15(R) 15 methyl-E2 methyl ester on aspirin and taurocholic acid-induced gastric mucosal haemorrhage in rats. The effect of orally administered prostaglandin 15(R)15 methyl-E2 methyl ester on aspirin and taurocholic acid-induced gastric mucosal haemorrhage has been studied in rats. The incidence of haemorrhage induced by aspirin (26-7 mM), 64 mg/kg, together with taurocholic acid (2-5 mM), was significantly reduced from 53-6% to 19-5% by the addition of the prostaglandin (9-9 muM), P less than 0.01. The incidence of haemorrhage induced by aspirin alone (53-3 mM), 128 mg/kg, was significantly reduced from 80% to 20% by the addition of prostaglandin (9-9 muM), P less than 0.002. These results indicate the possible use of synthetic prostaglandins in the prevention of aspirin-induced gastric pathology.


Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations. The clinical data of 180 episodes of upper gastrointestinal bleeding in 168 patients with cirrhosis of the liver are examined. The source of bleeding had been determined by early endoscopy in all cases. In men under the age of 50 years, and without symptoms of liver failure, bleeding was due to ruptured gastro-oesophageal varices in 84% of cases. Severe liver failure was associated with acute lesions of gastric mucosa in many cases. No presumptive diagnosis of the source of haemorrhage could be based on the examination of other clinical data (presence of ascites, mode of presentation and pattern of bleeding, history of ulcer disease, alcoholism, and previous medication.


Comparison of emergent endoscopy and upper gastrointestinal series radiography in acute upper gastrointestinal haemorrhage. A prospective study of early diagnostic procedures in acute upper gastrointestinal haemorrhage was conducted in a series of 76 patients. The diagnostic procedures included upper gastrointestinal series radiography (UGIS) and endoscopy (ENDO). The clinicians' diagnosis and management improved in a statistically significant way as a result of the findings of endoscopy. The findings of UGIS did not significantly improve diagnostic accuracy and resulted in a statistically significant adverse effect on patient management. The results suggest that endoscopy is more effective in promoting early accurate diagnosis and management in patients with acute upper gastrointestinal haemorrhage.


Polymorphism of alpha1-antitrypsin in a Portuguese population. Serum Pi phenotypes were studied in 219 samples. The MM phenotype was the most common as in all other populations. The frequencies of PiS and PiZ were high considering other populations. PiF was not detected.


[Evidence for reduced colour vision in carriers of congenital colour vision deficiencies (author's transl)]. The ability to recognize small spots of coloured light in parafoveal regions of the retina was investigated in women heterozygous for protanopia (2 subjects), deuteranopia (2 subjects), or deuteranomaly (1 subject) and in 3 normal subjects. The homozygous colour normals had excellent discrimination up to 8 degrees excentricity, whereas in heterozygous carriers of congenital colour vision deficiencies the ability to differentiate colours varied from point to point within the retina. The results may be explained by assuming the existence of alternating patches of trichromatic and dichromatic cell populations with the retina of the heterozygous carriers.


Changes in thymocyte reactivity to lectins induced by B-cell mitogens of the type of sulphated polyanions. Dextran sulphate, polyvinyl sulphate and carrageenan (but not the other polyanions tested, such as poly I:poly C, poly-L-glutamic acid or E. coli lipopolysaccharide) act synergisticaly with PHA on mouse thymocyte stimulation, as measured by thymidine uptake and blast cell transformation. Furthermore the active compounds shift the dose response of thymocytes to Con A. The effect could be observed in four different strains of mice tested by using normal or cortisone-resistant thymocytes. Two possibilities are envisaged for explanation of these effects: (a) attachment of polyanions by their anionic groups to cell surface constituents and interaction of the sulphate groups of the polymers with plant lectins; and (b) modification of the cell membrane induced by sulphated polymers changing either the binding capacity or the effectiveness of the membrane-associated events leading to thymocyte stimulation by the lectins.


Rabbit lymphoid cells. I. T-cell mitogens, cell volume and adherence properties as probes for cellular heterogeneity. Thymus-derived cell populations were characterized by sedimentation velocity in the Earth's gravitational field, by adherence properties, and in terms of the thymus-specific antigen RTLA. T cells, responding to mitogens, could be shown to be a subpopulation of RTLA-bearing cells and to have a relatively large volume. The size distribution of mitogen-responsive cells from different individuals showed some variation, but in general large spleen cells took up less thymidine per 10(6) cells than did large cells from other lymphoid organs. Upon stimulation with concanavalin A (con A) small popliteal lymph node cells took up more thymidine per 10(6) cells than did small thymus cells. The corresponding small cells of mesenteric lymph node and spleen took up intermediate quantities of thymidine. Thymus-derived cells that were resistant to complement-mediated cell kill with RTLA antiserum showed greater responsiveness to con A than did the original cell preparations. Non-adherent cells incorporated more thymidine when stimulated with phytohaemagglutinin (PHA) than when they were stimulated with con A. Lightly adherent cells were relatively more responsive to con A stimulation and firmly adherent cells were less responsive to both. The findings were discussed in terms of the density of RTLA on the membranes of T cells. In adherence and in sedimentation velocity fractionation, the relative yield of nucleated cells always exceeded the yield of PHA-  and con A-responsive cells. The differential separation of mitogen responsive and of co-operating cells were considered as a possible cause of this deficit.


Role of membrane structures in B-lymphocyte activation. The effect of binding anti-immunoglobulin, aggregated IgG and immune complexes. It is shown that the binding of bivalent anti-immunoglobulin preparations to the surface immunoglobulin of murine B lymphocytes as well as the binding of aggregates of IgG or immune complexes does not lead to detectable increase in cell division in microcultures. Treating lymphocytes with immune complexes and aggregated IgG does not abolish the subsequent mitogenic response induced by LPS. The background mitosis observed in culture is inhibited with anti-immunoglobulin antibodies.


Central and peripheral action of suppressor cells in contact sensitivity in the guinea-pig. Suppressor cells were demonstrated in the spleen of guinea-pigs made specifically unresponsive to dinitrofluorobenzene (DNFB) with dinitrobenzene sulphonic acid (DNBSO3). Transfusion of these cells at the same time as sensitization with DNFB, produced a significant reduction in the immunoblasts proliferating in the draining lymph node 4 days later. Transfusion on the day of skin testing produced no greater suppression of skin reactivity than cells taken from animals made hypo-reactive to DNFB by contact with dinitrothiocyanate benzene (DNTB). It is concluded that there are at least two sites that suppressor cells can act. In the case of total unresponsiveness induced by DNBSO3, action is both central and in the periphery. In the case of hyporeactivity induced by DNTB, in which there is no defect in proliferation of T cells in response to antigen, the action of these cells is confined to the periphery. results of spleen weight studies suggest that suppressor cells homing in the spleen respond by proliferation to epicutaneously applied DNFB.


Selective effect on T and B cell subpopulations in rat lymphoid organs after urethan treatment. In vitro phytohemagglutinin (PHA) and concanavalin A (Con A) responsiveness of thymus and bone marrow cells, and E, EA, and EAC rosette-forming cells (E, EA, EAC) of these organs and spleen were studied in Fisher rats at various time intervals following a carcinogenic treatment with urethan (UR). Immediately after treatment, organ cellularities were drastically reduced with a progressive recovery as time passed. 1 day after treatment, the response of thymocytes to PHA showed a fourfold increase while organ cellularity dropped to 1%. This response fell below normal values after 7 days with an overshoot after days 14 and 21. UR-treated bone marrow cells showed a response to PHA below normal values after 1 and 7 days, a twofold increase after 3 days and an overshoot after 14 and 21 days. The responsiveness to Con A of both organs was affected by UR treatment to a much lesser extent, although following a pattern similar to that of PHA. E were never found, whether in normal nor in UR-treated animals. As far as the B-cell compartment is concerned, UR causes a progressive diminution of EAC, while the number of EA remains unaffected. The data are discussed in terms of selective effect on T- and B-cell subpopulations.