Cell-mediated immunity to H-2 antigens. Characteristics of the effector cells as detected in the microcytotoxicity assay. Cell-mediated immune reactivity against murine histocompatibility antigens was compared by using both the microcytotoxicity assay (MCA) and the 51 chromium release assay (CRA). In both assay systems the data obtained showed T cell-mediated reactivity. In the CRA only T lymphocytes were detectable, which were cytotoxic, In contrast, in the MCA reactivity of nonlytic secondary T cells (NLST) was also detected. NLST acquired their MCA-reactivity within the first 24 hr of the 48-hr test period of the MCA. Circumstantial evidence is provided suggesting that MCA reactivity is a product of two different processes, namely, antigen-specific restimulation of immunt T cells and shedding of cytotoxicity inhibiting factors.


Purification and use of the C3d subunit C3. A method is described for the preparation of C3d from fresh-frozen CPD plasma. A redissolved EDTA euglobulin precipitate formed from defibrinated plasma is chromatographed on DEAE cellulose. The C3-rich peak is further chromatographed by stepwise elution from hydroxy-apatite. The highly purified C3 and C3b so obtained are then treated with commercial C3b inactivator. G-200 sephadex filtration of this material produces a low molecular weight peak containing C3d greater than 95 per cent purity. The purified C3d, which contains negligible carbohydrate, has a molecular weight of 28,000 (based on SDS polyacrylamide gel electrophoresis). When added at a final concentration of less than 70 mug per ml, it completely inhibits the anti-C3d hemagglutinin reactivity of a potent anti-C3d antiglobulin serum but does not inhibit sera with reactivities against C3c, C4b, and C5b. Two of three rabbits hyperimmunized with purified C3d produced antisera exhibiting only anti-C3d precipitin activity. After absorption of heterologous antibodies, the antisera strongly agglutinated C3d-coated RBC, failed to agglutinate RBC glutinated C3d-coated RBC, failed to agglutinate RBC coated only with C4, and reacted weakly against strongly anti-Rh coated RBC. The latter reactivity was readily absorbed by whole IgG. Preliminary studies with 125I-labeled C3d indicate its potential value in assessing potency of anti-C3d reagents.


Autologous blood transfusion in coronary artery bypass surgery. Forty-four patients undergoing coronary artery bypass surgery participated in an autologous blood donor program. Blood was collected at weekly intervals up to three days prior to the scheduled date of surgery. Sixteen patients donated a total of two autologous units each, and 28 patients donated one autologous unit each. No donor morbidity or mortality was encountered during or following blood donation. Autologous blood accounted for more than one-third of all blood required by these patients throughout their hospital courses. Autologous transfusion appears to be a safe procedure for patients with severe coronary artery disease.


Functional characterization of a naturally occurring antibody cytotoxic for a subpopulation of splenic T cells. Sera from old (greater than 6 months) New Zealand Black (NZB) mice were shown to contain an IgM antibody which was cytotoxic for thymus-derived (T) lymphocytes in the presence of rabbit complement. This antibody in the presence of complement markedly decreased the response of normal spleen cells to the T cell mitogen concanvalin A (Con A) but not to another T cell mitogen phytohemagglutinin-P (PHA-P). Responses of these treated cells to the polyclonal B cell mitogens, bacterial lipopolysaccharide (LPS), and polyriboinosinic-polyribocytidylic acid (poly[I]-poly[C]) were unimpaired. This naturally occurring NZB antibody was different from conventional anti-theta serum which abolished the response to both PHA-P and Con A. Moreover, the NZB serum affected spleen cells from both theta-C3H and theta-AKR mice. The ability of such serum to influence, differentially, Con A reactive cells as opposed to PHA-P-reactive cells, suggest that the NZB antiserum recognizes a subpopulation of T lymphocytes.


Localization of intracular and intraorbital foreign bodies by means of A-scan ultrasonography. This paper discusses the use of ultrasonography in ophthalmology for foreign body localization and detection. The problems and advantages of using A-scann methods to verify and improve upon x-ray diagnosis are considered.


The impulsive test in man.

The impulsive test in man. The impulsive test is brief and comfortable to the patient. The SVM is the best discriminator of the variables examined. By using percent differences between CW and CCW responses in the same subject at the same stimulus magnitude, we can define a range for the normal population and indicate patients outside that normal range. The impulsive test gives directional information in patients with unilateral lesions. In patients with severe bilateral loss of vestibular function, measurable responses are still obtainable; while in patients with primary cerebellar disease, responses are increased. The test may also be useful in giving anatomic information about posterior fossa lesions.


T cell deficiency in patients with autoimmune hemolytic anemia ('warm type'). 19 patients with chronic 'warm type' autoimmune hemolytic anemia were studied for abnormalities of cellular immune reactions. Evidence was obtained for a reduction of rosette-forming cells (RFC). Lymphocytotoxic antibodies were present in only 8 patients and correlated, with only one exception, with a reduced number of RFC. No significant deviation from normal ranges of the three major immunoglobulin classes in the patients' sera were found. C3 and C4 complement components were also, with one exception, within normal limits. In 18 of 19 patients no apparent association existed between the type or the amount of autoantibodies and/or complement components fixed on red cells and the levels of the respective immunoglobulins or complement in the sera.


[The diagnosis of subtentorial tumours by vertebral angiography (author's transl)]. The diagnosis of space-occupying lesions in the subtentorial space by vertebral angiography is based upon a good knowledge of arteries and veins and topographic points of this region. An imaginary line between the colliculo-central point and the chorioidal point divides the posterior fossa into two imaginary parts. In this way it is possible to localize displacements in the region of the posterior fossa. Of course, the displacement of the veins and arteries is very important in the verification of the tumours. Consequently, vertebral angiography is of vital importance in the investigation of space-occupying lesions in the posterior fossa.


[Function improvement in levography following aortocoronary bypass]. Actively contracting segments, preoperatively akinetic, were found in 8 of 63 patients, evaluated 6-12 months after aortocoronary surgery by coronary angiography. Ejection fraction was increased from 48.1% (S.D. 15.7) to 68.3% (S.D. 11.4). These patients are characterized by two simple clinical parameters: 1.  All patients had angina pectoris at rest or at minimum exercise except for one; 2. preoperatively, there was a discrepancy between severe ventriculographic and discreet Ecg findings. These findings prove that myocardial function in coronary artery disease can be impaired at rest by ischemia, without clinical signs of coronary insufficiency, such as angina pectoris. Even severe impairment of left ventricular function is no contraindication for coronary artery surgery, if caused by reversible myocardial ischemia.


Ciliated glial cells and neurons in the interpeduncular nucleus of the frog. Some neurons and glial cells of the interpeduncular nucleus of the adult frog Rana esculenta contain one cilium. The cilium complex shows two-centriole basal organization. Cross striated structures are seen apposed to the centriolar formations. The centriole and associated basal body are always close to the vesicular elements of the Golgi apparatus in the neurons and are surrounded by quite a number of microtubules in the glial cells. The observations suggest that these ciliated cells represent specialized elements in which the cilium has probably the same functional transport properties postulated for cytoplasmic microtubules.


Aorto-coronary graft for dissected coronary artery. A 46-year-old woman while undergoing selective coronary cine angiogram dissected her coronary artery. She was managed by heparin therapy followed by urgent aorto-coronary artery saphenous vein graft with no consequences.


Valve replacement and coronary revascularization: combined surgical approach. Report is presented of sixteen patients who had coronary bypass procedures performed in combination with valvular surgery. There was a hospital mortality of two patients of 12.5%. Significant improvement occurred in the remaining fourteen patients or 87.5%. Of these fourteen patients, one patient required re-operation for mitral valve replacement following an open mitral commissurotomy two years previously. Coronary arteriosclerosis complicating the outcome of patients undergoing valvular surgery is well recognized (1). Hall and associates (2) reported the results of seventy-two patients undergoing combined procedures with seventeen operative deaths, an operative mortality rate of 23.6%. Merin's group (3) reported on a series of fifty patients from the Mayo Clinic with an operative mortality rate of 14%. Loop and coworkers (4) reported an operative mortality rate of 8% in fifty patients undergoing combined procedures. Crouch and associates (5) reported on thirty-six patients with four hospital deaths, an operative mortality of 11%. At the Heart Institute of Michigan, five hundred fifty-six patients under-went coronary bypass surgery from December, 1969 to September, 1974. This is an all inclusive, consecutive experience. Overall mortality in this group was nine patients or 1.6%. Of five hundred forty patients who did not have associated valvular surgery, the mortality was seven patients or 1.3%. The purpose of this presentation is to elaborate on the sixteen patients who had coronary surgery combined with valvular surgery. Mortality in this group was two patients or 12.5%.


[The relationship between the clinical picture and course of acoustic nerve tumors and the direction of their growth in the cerebellopontine angle]. The data of clinical, surgical and post-mortem studies in 95 patients with neurinomas of the acoustic nerve permitted to eliminate 3 variants in the growth of neoplastical process into the ponto-cerebellar angle: 1) subtentorial (the upper variant) -- 27 cases; 2) the middle line of the brain stem (middle variant) -- 15 cases; 3) the lower parts of the angle (lower variant)--52 cases. Depending upon the direction of the growth into this space and upon the stage of the disease there were differences in the succession, frequency and expressiveness of focal and general brain symptoms. The development of the disease also differed.


[Rhythm disorders occurring after surgical closure of the interatrial communication]. A detailed evaluation is presented about the frequency and the type of arrhythmias following the surgical correction of 147 cases of atrial septal defects not associated with other congenital heart malformations. A total of 131 arrhythmias occurred in 84 patients. The nodal and the coronary sinus rhythms are the most frequently encountered after surgery, attaining 53,8% of all arrhythmias, while atrial fibrillation or flutter represented about 22%. The follow-up of these arrhythmias concerned the 3 month period immediately after surgery. After that time 20% of the arrhythmias occurring in the early postoperative period persisted. The frequency of arrhythmias increased with age, was relatively independent of the importance of the left to right shunt, the level of the mean pulmonary artery pressure and the sex of the patients; but statistically increased in patients in whom the correction was made with a patch. The authors concluded that there must exist at least two mechanisms to explain the occurrence of arrhythmias. A first one must be in relation to the surgical manipulation; the second, which is only an hypothesis, stipulates an alteration of the conduction pathways due to the auricular distention or the existence of a congenital anomaly of the conduction pathways.


Can pulmonary artery pressure be predicted without right heart catheterization in chronic obstructive lung disease? We have investigated the dependance of observed pulmonary artery mean pressure (PAP) on body surface, age, PaO2, pH, PaCO2, hematocrit, and spirometric data (VC, FEV1/VC, RV/TLC) in 70 patients with chronic obstructive lung disease (COLD). After elimination of all variables that failed to correlate with PAP, multifactorial analysis showed that only two of nine independent variables, namely PaO2 and body surface, correlated significantly with PAP. According to our calculations, 28.9% of total PAP is predictable by PaO2, 1.5% by H+ concentration, 2.8% by RV/TLC, and 2.5% by body surface. Fully 64.2% of total variability was not accounted for by our regression analysis; thus the error of predicted PAP was so great (+/- 17 mm Hg for P = 0.05) as to invalidate the method. We also recalculated our subjects' PAP values by applying Enson's and Grassi's equations to our own lung function and biochemical data, and compared the predicted PAP values thus obtained with those measured directly in our subjects. Both equations proved imprecise and/or inaccurate in the individual case. From this we conclude that whereas available equations may be suitable for predicting the mean PAP value of a large population sample, the same equations cannot give a reliable prediction in individual cases.


[Clinical experimentation with intravenously administered disopyramide]. The intravenous injection of disopyramide (1.5 mg/kg) induces the return to sinus rhythm in about 60% of arrhythmias. When there exist perturbations of the cardiac rhythm, secondary to recent myocardial infarction, the percentage of success reaches 70%. The drug induces the disappearance of the extrasystoles in 80% of the cases, whatever the nature of the underlying cardiopathy. Although the secondary effects of the drug are slight, it is advisable to administer the substance in a slow intravenous injection (5 minutes), while controlling the arterial pressure and the E.C.G.


The prognostic implications of systolic time intervals after acute myocardial infarction. STI were measured on the 7th day after acute myocardial infarction in 144 male patients. These patients were reviewed at 6 weeks and 86 were reinvestigated and reviewed at 6 months. The STI could not predict the patients who would have either angina or a further myocardial infarction. Left ventricular function, as measured by STI, appeared to be a minor factor governing return to work after myocardial infarction. Patients who had developed ventricular aneurysms at 6 months had significantly increased EMI at 6 weeks. STI on day 7 had considerable prognostic significance for left ventricular failure at 6 weeks and death between day 7 and 6 weeks and it is suggested that LVET index could be usefully, and easily, introduced as a parameter after myocardial infarction.


Clinical and circulatory effects of oral isosorbide dinitrate in patients with angina during exercise. Isosorbide dinitrate was given orally to 6 patients with anginal pain on exertion and its effect on exercise capacity, ECG and other hemodynamic parameters was compared with the control values and with the results of a group of 6 patients who received a placebo. The drug seems to affect favourably the working capacity and the ECG on exercise for a longer period than NTG while we do not observe a placebo effect.


Persistent atrial standstill.

Persistent atrial standstill. The authors present a case of permanent atrial standstill with syncopal attacks, in a patient with chronic Chagas' Heart Disease. The recognition of this dysrhythmia was based upon the conventional and intracavity electrocardiographic tracings in addition to phonomecanographic and hemodynamic data. The recording of the His Bundle electrogram demonstrated the absence of atrial activity, with the His potential preceding all ventricular complexes and an advanced conduction defect distal to the bundle of His. A diffuse type of atrial involvement was suggested by the lack of response to pacemaker stimulation. An increase in ventricular rate following intravenous atropine administration, led to the diagnosis of an a-v junctional rhythm with a widened QRS complex due to an associated right bundle branch block. Following the implantation of an epicardial ventricular pacemaker, the patient became completely asymptomatic despite the persistence of electrical and mechanical atrial standstill.


Double-inlet left ventricle with absent sixth aortic arch and multiple cardiac malformations. The first well-documented case of double-inlet left ventricle in association with absence of the derivatives of the sixth aortic arch of foetal life (the right and left branches of the pulmonary artery and the ductus arteriosus), is reported. In addition there were a total anomalous pulmonary venous connection to the portal vein, an ostium secundum type atrial septal defect and dextrocardia.


[Diagnostic significance of phono-mechanographic medication of constrictive endocardial fibrosis (or endomyocardial fibrosis)]. The phonomecanographic investigation of 12 patients with FEC allow us to recognize diagnostics signs of great interest. 1. The ventricular aspect of the jugular veinous pulse involving a positive systolic wave and a diastolic aspect in "dip-plateau" is a chief indication of a right ventricular fibrosis. This indication is more significant of FEC when the nadir of the dip is far above the base line, when the dip-rising time is short, when the telediastolic ratio is high (more important than 0.40) when the electro-mechanical latency time is prolonged and when the isovolumetric relaxation time is normal. 2. The apexogram aspect in diastolic dip-plateau is a capital indication for a fibrosis of the left ventricule. This indication is more significant when the nadir of the dip is above the baseline, when the telediastolic ratio is high (more important than 0.30) when the electromechanical latency time and the isovolumetric relaxation time are normal. 3. The protodiastolic endocardial vibrancy recorded during the dip climbing and showing the features we described, seems to us to be a very important sign. This vibrancy can be preceded or/and followed by a short and early diastolic murmur of low frequency, always finishing at the end of the dip. 4. Recording of pulmonary valves or atrio-ventricular murmur is an important diagnostic feature in an adiastolic syndrome. 5. Recording of a pulmoanry infundibular impulse is an indication for a right ventricular fibrosis. This indication is very significant if the tracing is a dip-plateau.


Thrombotic obstruction of Bjork-Shiley tricuspid valve prosthesis. Report of three cases reoperated with success. Three patients presented subacute right heart failure, 6, 12 and 22 months after replacement of the tricuspid valve with a Björk-Shiley prosthesis. The principal finding encountered on clinical examination was a tricuspid filling murmur with inspiratory accentuation. The mean prosthetic gradient found at cardiac catheterization was 7, 8 and 10 mm Hg. At surgery, the three prostheses were thrombosed on their ventricular aspect and all the three were replaced with new ones of the same model. The patients are alive and in good condition, 21, 17 and 8 months after the operation. Problems which relate to the surgical management of tricuspid valve disease are discussed.


[Epidemiology of the coronary risk in a semi-rural population of 420 patients having presented a myocardial infarct]. Various sociological and biological parameters have been studied in a population of 420 subjects - 335 men and 85 women - living in a semi rural country and having presented a myocardial infarct. Our study shows big differences in epidemiology between men and women: 1. The age of women is on an average seven years older than men (63 years against 56). 2. The women's average rate of cholesterol oversteps men's rate by 21 mg% (291 mg % against 271). 3. The blood pressure, systolic and diastolic, is distinctly higher by women (mean 171/97) tan by men (148/98). Amid women, 63% have a S.B.P. equal to or higher than 160 mm Hg against 23% by men and 56% have a D.B.P. equal to or higher than 100 mm Hg against 21 % by men. 4. Hyperglycemia is more frequent among women; man rate: 103 mg % against 88 mg % by men; 17 % of the women have an equal to or higher rate than 110 mg % (8 % among men). 5. Obesity, expressed by a weight index, equal to or higher than 120, is found in 76 % of the women and 34 % of the men. The mean index is 123 by the women and 115 by the men. 6. Cigarette smoking is far more important by men: 65 % of the men smoke at least 15 cigarettes a day with smoke inhalation. This factor is practically not met by women. The smokers get their myocardial infarct at a significantly lower age than no smoking men and women. The women of our infarct population have thus an age, a cholesterol rate, a blood pressure and a glycemia higher than men of the same population; they are more frequently overweight but they don't smoke. Consequently, metabolic agents seem to play an essential part in coronary risk in women.


[Long-term prognosis of myocardial infarct]. The authors study the long-term prognosis of a population of male subjects having survived 24 to 48 hours to their first myocardial infarction. The mean annual mortality is 6%. The long-term cumulated survival is particualarly influenced by a high blood pressure and by heart failure occurring during the acute episode and in a lesser proportion by age; the prognosis at long-term is not or little influenced by family history, cholesterolemia, cigarette smoking or the presence of angina before infarction. The presence or absence of heart failure and high blood pressure allows to make sub-groups with very different long-term prognosis. In the framework of secondary prevention of ischaemic heart diseases, the authors propose to start a controlled study implying both a programme of physical activity and a long-term energical treatment of arterial hypertension.


Refractory cardiac arrhythmia due to hypomagnesmia. A case of ventricular bigeminy possibly due to magnesium deficiency is reported. Magnesium sulphate was successfully used for its management. Differential diagnosis of idiopathic cardiac arrhythmias should always include hypomagnesemia as one of the causes and magnesium should be replaced for its proper management.


[Epidemiology of cardiovascular disease in the urban population of the town of Pahlavi (North Iran)]. A survey of cardiovascular diseases was carried out in June-August 1973 in the city of Pahlavi, a port in the Caspian area in Iran. A representative sample was taken from persons aged 35 years and older from both sexes. The prevalence of high blood pressure (WHO definition) is 29,7% in men and 31,0% in women of this age group. ECG tracings were prepared and the prevalence of various abnormalities are presented. A considerable proportion of the population have ST segment and T wave abnormalities. Correlation between ECG abnormalities and blood pressure figures has been studied. This study shows that there is a relationship between ECG abnormalities of group 3, 4 and 5 (Minnesota Coding) and the levels of blood pressure.


Postventriculotomy aneurysm and left ventricular dysfunction following closed mitral commissurotomy. A ventricular aneurysm at the site of a previous transventricular commissurotomy for mitral stenosis was diagnosed in a 39 year old female. Catheterization data showed abnormal left ventricular response to exercise and to increased afterload. Death occurred following mitral valve replacement. At autopsy no cause other than left ventricular aneurysm could be established to explain left ventricular dysfunction.


[Calcific constrictive pericarditis of anginal form complicated by hemopericardium and tamponade during anticoagulant treatment]. The case-history of a patient with calcified constrictive epicardopericarditis with rapidely progressive aggravation after digestive hemorrage due to excessive dose or oral anticoagulant therapy is reported. The occurrence of a cardiac tamponade has necessitated pericardectomy which has permitted to detect a partitionned hemopericardium. The surgical act was followed by gross improvement of both constrictive phenomenon and angina pectoris which have grounded the prescription of anticoagulant therapy. Anticoagulant therapy is likely responsible of the hemopericardium. Such facts are exceptionals in the course of constrictive pericarditis; diagnostic and therapeutic problems related to this complication are studied. The question of angina pectoris in the course of acute and chronic pericarditis is briefly studied by the way of this observation. Attention is drawed on the danger of the prescription of anticoagulant therapy in the course of some constrictive pericarditides.


Acute hemorrhagic gastritis--diagnosis and treatment. Approximately 10-20% of patients admitted with acute gastrointestinal bleeding suffer from hemorrhagic erosive gastritis. A material of 36 patients is presented and the literature reviewed. The moderate bleeders stop bleeding within hours to a few days and the majority may safely be managed conservatively, i.e. with blood transfusions. The severe bleeders continue to bleed for a long time and surgery is often required. Different operative procedures have been suggested. The mortality in this group of patients is high--nearly 30%, and the frequency of postoperative rebleeding is also high. It is concluded that there is no absolute operative procedure of choice but vagotomy combined with subtotal gastrectomy offer the best protection against rebleeding. Treatment with selective application of vasoconstrictors is mentioned.


[T-lymphocyte subpopulation in the blood of patients with chronic lymphocytic leukemia]. In 40 healthy subjects and 80 patients with chronic lymphocytic leukaemia (CLL) rosette formation test with sheep erythrocytes subjected to the action of neuraminidase (nRTB), immunofluorescent investigation of membrane immunoglobulins (BIg) and a combined test (nRTB + BIg) were performed. The relative number of rosette-forming cells (T lymphocytes) was much lower in the group of CLL patients (0.16 +/- 0.08 1/1) than in controls (0.64 +/- 0.12 1/1). The absolute number of T lymphocytes (BLLT) was, however, significantly higher in patients with CLL 5.1 +/- 4.4 G/L) than in controls (0.98 +/- 0.28 G/L). The relative number of bireceptor cells was 0.0045 +/- 0.0093 1/1 in CLL patients and that of null-cells 0.24 +/- 0.17 1/1. Analogous values in the control group were 0.0089 +/- 0.009 1/1 and 0.21 +/- 0.091 1/1. The possible causes of this rise in the absolute number of T lymphocytes in CLL may by: 1) proliferation of both subpopulations of lymphocytes, 2) reaction of T lymphocytes against leukaemic cells, 3) disturbances of equilibrium between B and T lymphocytes.


B, T and null lymphocytes in newborn infants and their mothers. Estimation of B, T and null cells were performed on 29 newborn healthy babies and 16 mothers. The lymphocytes were isolated from peripheral venous blood, which is considered to be more representative of the immune state in the newborn than the cord blood. B lymphocytes were estimated by cytofluorometric measurements, T lymphocytes by sheep red blood cell rosette technique, (SRBC-R). Combined immunofluorescence and SRBC-R technique revealed the null cells. In the newborn babies the amount of B and T cells were found to be diminished. In the mothers the amount of B lymphocytes were low compared with normal adults. The rather high null cell percentage found in the babies might represent immature precursor cells. Mothers seem to be immuno-depressed as reflected in the low amount of B cells.


Response of human lymphocytes to mitogenic stimuli after irradiation in vitro. Human lymphocytes were exposed to varying doses of roentgen irradiation in vitro and thereafter tested for reactivity to different polyclonal mitogens and antigens using DNA synthesis as a marker for viability. The dose response profiles obtained indicate that there are two subpopulations of lymphocytes which are responsive to phytohaemagglutinin, poke weed mitogen, concanavalin A and allogeneic cells. One is relatively sensitive to radiation and the other is relatively resistant. However, no "resistant" PPD-tuberculin responsive cell population could be detected. Irradiated lymphocyte populations enriched for T-cells exhibited both a sensitive and a resistant PHA-responsive population, whereas cell populations enriched for B-cells only exhibited a radiation sensitive one.


Reisolation and characterization of Haemophilus influenzae-murium. Twenty-three Haemophilus influenzae-murium strains were isolated from the nasopharynx of healthy CFLP white mice. Microbiological characterization of the cultures confirmed the taxonomic position of the organisms which had become problematic due to the loss of the original isolates. The type strain proposed, EO1, is available from the Hungarian National Collection of Medical Bacteria, National Institute of Public Health, Budapest as 95001.


Perceptions of the use of drugs--a cross-sectional analysis. Samples of six specific groups were surveyed regarding their differential perceptions of the use of drugs. Current use was discussed in terms of comparisons of different groups' ratings of each group, comparisons of differential use of drugs by each group and comparisons between each groups' perception of its own use and its perception of use by other groups.


Purification of kallikrein from cat submaxillary gland. Cat submaxillary kallikrein was purified from the water extract of the gland by 50-75% acetone fractionation, DEAE-Sephadex A-50 chromatography, Sephadex G-75 gel filtration and Ampholine isoelectric focusing. The final preparation gave the activities of 1260 KU/mg in vasodilator assay, 24.5 and 11.6 units/mg on BAEE and TAME esterolytic assay, respectively. Trasylol gave only weak inhibitory effect on this kallikrein. The isoelectric points of the kallikrein were in the range pH 4.2-5.0, and this kallikrein seemed to consist of several multiple forms with different pI values, like some other glandular kallikreins. It gave a single protein band in disc electrophoresis, while it migrated in retard and formed a broad one. This may be ascribable to the rich carbohydrate content in the kallikrein.


Prekallikein and kallikrein inhibitor in liver cirrhosis and hepatitis. Plasma prekallikrein (kallikreinogen) and kallikrein inhibitor, assayed with the kaolin activable esterase method, have been evaluated in 20 patients with hepatic cirrhosis, in 12 cases with jaundice from acute viral hepatitis, and in 9 normal. A significant reduction of the plasma prekallikrein in cirrhosis has been found. A lowering of plasma prekallikrein has also been observed in viral hepatitis; in this condition, however, the modifications were less important than those obtained in cirrhosis. In three cases of hepatitis, the behaviour of the plasma prekallikrein and kallikrein inhibitor have been controlled during the period of the disease and compared with the behaviour of some conventional parameters, such as serum transaminases and bilirubin. An important increase of the prekallikrein level has been observed during the improvement of hepatitis. These data confirm the implication of the prekallikrein-kallikrein system in severe liver diseases, and indirectly points out the role of the liver in maintaining the physiological balance of the kallikrein system.


Histamine and kallikrein system in man.

Histamine and kallikrein system in man. Histamine infusion modifies the kallikrein system, studied by kaolin contact method, in man. The main modifications are the increase of the spontaneous esterase activity and the prekallikrein lowering. Apparently the histamine administration activates the kallikrein, and consequently a release of kinin can take place.


Plasmatic prekallikrein and kallikrein inhibitor in pregnancy, labor and in newborn. In order to reveal the possible physiological role of the kallikrein during the stress of birth, the prekallikrein and kallikrein inhibitor were evaluated in 15 pregnant women and in 15 newborns from terminated pregnancies. The results show a very low level of prekallikrein in the funiculus blood at the moment of birth and a still lower level in venous blood 24 hours after birth. No important changes resulted in the mother's blood either in pregnancy, nor at the end of the labour.


Monitoring tissue oxygenation of the heart after myocardial revascularization. A polarographic technique capable of simultaneous monitoring of myocardial tissue oxygen tension (MPO2) and intramyocardial electrograms by way of the same electrodes has been developed. Initially, the method was evaluated in dogs to verify the appropriateness of the directional changes of MPO2 in function of selected determinants of myocardial oxygen supply (regional coronary blood flow, arterial blood oxygen tension) and demand (heart rate, force of ventricular contraction). A combined reduction of MPO2 and elevation of the S-T segment in the corresponding electrograms was observed only when a 50 percent or greater reduction of blood flow to the sampled area was effected. Subsequently, in nine patients undergoing aortocoronary bypass surgery, MPO2 was measured from 48 areas for 2 weeks postoperatively. In 11 normal and 31 revascularized areas, MPO2 increased during the postoperative period. In four areas subsequently found to be supplied by occluded grafts MPO2 decreased from 12.7 +/- 3.1 (mean +/- standard error) to 10.1 +/- 3.3 mm Hg (P less than 0.05). In two areas, MPO2 decreased during the 3rd postoperative day from 16 to 3 and from 14 to 4.2 mm Hg, respectively. This reduction was attended by a significant rise in the S-T segment of the corresponding electrograms. This finding preceded by 24 hours standard electrocardiographic evidence of myocardial infarction. This technique appears to be sensitive and reliable, and thereby capable of enhancing the management of patients during the high risk early postoperative period after coronary bypass surgery.


Gastrointestinal bleeding and iron absorption in the experimental blind loop syndrome. Rats with surgically created self-filling jejunal blind loops and the blind loop syndrome manifested gastrointestinal bleeding and hyperabsorption of iron. Although the mean hematocrit and serum iron levels of rats with self-filling blind loops became overtly anemic and manifested low-serum iron levels. It is suggested that the documented gastrointestinal bleeding in these rats with the experimental blind loop syndrome is another manifestation of damage to the intestinal epithelium in conditions of small intestinal bacterial overgrowth.


Immunologic and electronmicroscopic characteristics of a case of immunoblastic lymphadenopathy. A new disease entity of the lymphoid system has recently been reported by Lukes and Tindle as immunoblastic lymphadenopathy and by Frizzera and associates as angioimmunoblastic lymphadenopathy with dysproteinemia. Reported herein are cytologic, histologic, ultrastructural and immunologic studies of several tissues of a patient with this disorder. In addition to confirming the previous observations that the main cellular constituents in the affected tissue consist of immunoblast, plasmacytoid lymphocytes and plasma cells, the authors have demonstrated a profound deficiency of T lymphocytes in this patient. The previously described amorphous interstitial material appears to represent multiple small cytoplasmic fragments. The histiocytic component, which appears in variable amounts in this disease, in the reported case was very active in phagocytizing cellular and nuclear debris, some of which appeared to be lymphocytic in origin. A rubella infection preceded the onset of the disorder by 3 months.


alpha1-Antitrypsin deficiency and liver disease in children. This report describes the clinical, biochemical, and hepatic morphologic findings in ten children with severe serum alpha1-antitrypsin deficiency. Genetic protease inhibitor (Pi) phenotyping, using acid-starch gel and crossed antigen-antibody electrophoresis, demonstrated Pi phenotype ZZ in all our cases. In eight patients, manifestations of liver disease appeared during the first year of life. The case reports show that alpha1-antitrypsin deficiency should be suspected in any child with neonatal hepatitis, unexplained hepatomegaly or splenomegaly, or cirrhosis. In our report, one infant is normal at age 6 months, and one infant had progressive hepatic damage that culminated in liver failure and death at age 6 months. The variable clinical course and prognosis for infants with severe alpha1-antitrypsin deficiency is well illustrated by these two infants.


The radiology corner: metastasis to the colon. This case serves to illustrate the multiple routes which may occur in the dissemination of carcinoma of the stomach of the large bowel. Spread along the gastrocolic ligament involves the superior aspect of the transverse colon with limitation laterally by the phrenicocolic ligament. Once ascites has developed there is spread along the superior border of the sigmoid and lateral margin of the right side of the colon.


Comparison of longitudinal and cross-sectional analysis: maternal age and stillbirth ratio. Previous studies have reported a U or J shaped association between stillbirth ratio and maternal age and have led to attempts to determine the causes behind the association. These analyses have generally been based on cross-sectional data. This study contrasts the descriptions of the association resulting from cross-sectional and the more appropriate longitudinal analysis of the same body of data. It is concluded that cross-sectional analysis substantially underestimates the maternal age of which stillbirth ratio reaches a minimum for each birth order examined. Additionally, the basic shape of the relationship is sometimes altered. Weighted logistic polynomial regression is used to describe the associations. Traditional interpretations of the results of a cross-sectional analysis have been that women who postpone childbearing until the late twenties thereby increase their risk of stillbirth. A consequence of the present findings is the rejection of the claim that women who choose employment during the period of their early twenties automatically incur elevated risk of stillbirth in their postponed pregnancies.


Marked cyclic leukocytosis-leukopenia in chronic myelogenous leukemia. A spontaneous oscillation of the white blood cell count was observed in a 58 year old man with chronic myelogenous leukemia (CML). Similar cyclic variations were noted in the platelet and reticulocyte counts with no apparent alterations in marrow cellularity to account for such changes. Since direct correlation was noted between white blood cells, platelets, and reticulocyte counts versus spleen size, it suggests that splenic hemopoiesis may be responsible for these cyclic changes. A possible inverse relationship between colony-stimulating factor (CSF) activity and the white blood cell count was noted, suggesting that CSF may be the humoral agent controlling granulocyte production. A direct correlation between the white blood cell count and serum unsaturated vitamin B12 binding capacity (UBBC) and lysozyme was also noted and further supports the concept that the latter two are measures of the granulocyte pool and metabolism. An inverse relationship between CSF activity and the UBBC suggests that these may be two different entities. Finally a modified form of standard chemotherapy may be effective in inducing remission in cases of CML with marked cyclic leukocytosis-leukopenia.


Massive colonic bleeding and oral contraceptive "pills". Two patients on oral contraceptives who developed massive colonic bleeding have been presented. The clinical course and various studies suggest the mesenteric insufficiency syndrome as being a possible result of oral contraceptive effect on mesenteric vasculature. Although no definite histologic confirmation is available, the onset, course, and follow-up of these patients suggest contraceptive-induced massive colonic bleeding. The spectrum of oral contraceptive-induced colonic bleeding may vary from mucosal injury with massive colonic bleeding to transmural infarction. Only the clinical follow-up would determine the severity of the involvement and that would determine whether surgical intervention  will be necessary.


Miotic drugs: a review of ocular, visual, and systemic complications. Cholinergic drugs and anticholinesterases have caused ocular complications including cataracts, iris cysts, retinal detachment, iritis, increased intraocular tension, allergic and toxic reactions, and hypermia. The visual complications include accommodative spasm; myopia and reduced visual acuity; changes in vision sensitivity, dark adaptation, and visual fields; and discomfort. The systemic complications are those common to cholinergic drugs and anticholinesterases. This review is intended as a ready reference to the drugs that cause such effects and source material.


The development of the Generation II as an aid for patients with retinitis pigmentosa and night blindness. The Generation II is a modification of the Army's night photography/observation instrumentaton. Low levels of light are intensified approximately 700 times to stimulate cone function. The individual with no rod function is able to see at night under these intensified amounts of illumination. The device can be used for night "spotting and mobility" purposes, much like a telescope is used during the day by the partially-sighted with intact rod function and poor cone function. This paper is presented to inform the optometrist of the availability and usefullness of this device for his patients.


Clinical observation of posterior polymorphous dystrophy. The clinical picture of this dominant corneal endothelial dystrophy is illustrated with a series of case histories. Differential diagnosis is considered both from the clinical manifestations and from the histopathological evaluation of degenerate corneal tissue.


Genetic control of the immune response to poly(Glu52Lys33Tyr15) in neonatally thymectomized high and low responder rats. The immune response to poly (Glu52Lys33Tyr15) is under polygenic control and linked to the major histocompatibility complex of the rat. Aggregation of this antigen with methylated bovine serum albumin (MeBSA) eliminates the expression of genetic control by increasing the response of low responders and decreasing that of high responders. Humoral and cellular aspects of the immune response to both unaggregated and aggregated poly (Glu52Lys33Tyr15) were investigated in neonatally thymectomized high-responder ACI and low-responder F344 rats. T cells are necessary for responses to unaggregated poly (Glu52Lys33Tyr15) since thymectomy significantly decreased numbers of antibody-forming cells and serum antibody levels, and delayed hypersensitivity responses and antigen-induced in vitro proliferation. However, thymectomy had no significant effect on these parameters of immune responsiveness in either ACI or F344 rats immunized with poly (Glu52Lys33Tyr15)/MeBSA. Aggregation also increased IgG production and delayed hypersensitivity and antibody affinity in low responders.


alpha- and beta-adrenergic receptors in regulation of ionic transport in frog cornea. The effect of catecholamines and adrenergic blocking agents on the transport of Cl- and Na+ of the isolated frog cornea was studied. Cl- transport was stimulated by the three catecholamines tested at 10(-6) to 10(-5) M concentration. The stimulation produced by 10(-6) M epinephrine was partially inhibited by both the alpha-blocker phentolamine and the beta blocker propranolol. The stimulation produced by 10(-6) M isoproterenol was not affected by 10(-5) M phentolamine but was completely prevented by 10(-5) M propranolol. The stimulation produced by 10(-5) M norepinephrine was completely blocked by the 10(-5) M propranolol and partially by 10(-5) M phentolamine. Catecholamines had no effect on the normally small Na+ transport. When the Na+ transport was previously increased by amphotericin B, epinephrine and isoproterenol produced a small and inconsistent stimulatory effect. Norepinephrine was without effect. It is concluded that both alpha- and beta-adrenergic receptors are present in the frog cornea and that the Cl- transport is increased by the stimulation of either receptor. The minimal effect on the Na+ transport further suggests the separation of pathways of the Cl- and Na+ transport in the frog cornea.


Inhibition of H+ secretion in the frog gastric mucosa by ATP and related compounds. Addition of adenosine triphosphate (ATP) to the nutrient (submucosal-facing) solution of the histamine-stimulated in vitro frog (Rana pipiens) gastric mucosa produces a marked reduction in the H+ secretory rate and an increase in transmucosal potential difference (PD) and resistance in both Cl- and Cl-free media. The effects are reversible upon removal of ATP. The threshold concentration is between 1 and 2 mM, and 5 mM produce maximal inhibition. It is shown that the effects of ATP are not due to a change in pH or osmolarity of the nutrient fluid, or to a decrease in the Ca2+ and/or Mg2+ activities of the nutrient fluid. It is also shown that the inhibitory action of ATP is not dependent on a chelation complex between Ca2+ or Mg2+. Adenosine diphosphate also produces effects essentially the same as ATP whereas 5'-adenosine monophosphate and adenosine produce relatively little or no change.


Snake venom ophthalmia and blindness caused by the spitting cobra (Naja nigricollis) in Nigeria. Venom entered the eyes of 9 patients spat at by the spitting cobra, Naja nigricollis. In 5 the only effect was a simple conjunctivitis but 4 had corneal ulceration, 1 developed anterior uveitis indicating absorption of venom in the anterior chamber, and 2 were permanently blinded. Treatment of this rare emergency is discussed: immediate irrigation of the eye with water, careful examination for corneal abrasion, and prevention of secondary infection are recommended. The value of local specific antivenom is unproven.


Bleeding from stapler anastomosis.

Bleeding from stapler anastomosis. Three patients with massive bleeding after stapler-performed intestinal anastomosis are reported on. Two patients required secondary operation for control. The cause was mechanical instrument failure. Periodic in vitro testing is recommended as a preventive measure.


Age-related changes in the proteolytic enzymes of mammalian lens. A longitudinal study has been conducted on three exopeptidases which include an esterase, leucine aminopeptidase, and a triglycinopeptidase and two endopeptidases, a neutral protease and a proteinase or catheptic activity in bovine lenses. The esterase and leucine aminopeptidase behave similarily showing increased activities with aging. Triglycinopeptidase has a somewhat lower order of magnitude when compared to the other exopeptidases. The neutral protease shows initially high activity early in the developmental life period, whereas, the proteinase or catheptic activity indicates a continuous increase with aging. Data whereas, the proteinase or catheptic activity indicates a continuous increase with aging. Data is also provided on enzymic activity in the different sections of the lens which include the combined anterior cortex and epithelium, lens nucleus, posterior cortex, and equatorial ring.


EOG: light test and dark test.

EOG: light test and dark test. The EOG test is divided into two parts: a light and a dark test. The adaptation period is extended to 30 min. During this adaptation period the luminance in the cabin decreases (or increases) slowly to the starting value of the light or dark step. In a model, we studied the influence of this ramplike luminance course on the results. Standard values for the test were calculated with 30 test persons. Our test results show a lower relative standard deviation (V = 10%) compared with earlier published results.


Experimental Fibroplasia in the rabbit vitreous. Retinal detachment induced by autologous fibroblasts. Fibroblasts were cultured from autologous dermal connective tissue of albino rabbits and implanted (1 X 10(6)-3 X 10(6) cells) into the vitreous space of 18 rabbit eyes under sterile surgical conditions. In 13 eyes a distinct growth of the cells occurred, and vitreous strands were formed. In 9 eyes a retinal detachment followed, and in some it was associated with traction of optic nerve tissue into the vitreous. The proliferating fibroblasts produced collagen fibrils showing a band period of 45-55 nm. Intravitreal collagen formation is considered to be a pathologic phenomenon capable of inducing the development of vitreous retraction and retinal detachment.


[Intraocular pressure measurements on soft contact lenses (author's transl)]. The pneumotonograph was evaluated for its capability to record and measure intraocular pressure through soft contact lenses. In a series of patients with chronic corneal diseases treated with soft contact lenses, good pressure and intraocular pulsations were recorded both with and without the soft lenses. Areas of scarred cornea give incorrect values, whereas areas of corneal edema give values similar to those obtained in the presence of a soft lens and are believed to reflect accurate and reliable pressure readings. In normal eyes, it has been found that the presence of a plain soft lens does not modify the accuracy of pressure measurement. High values do occur, however, when the refraction of the lens exceeds eight diopters.


[Problems in the determination of color coordinates after the visual comparison method on the fundus of the eye (author's transl)]. A short description of color measurements on the fundus according to the method of visual comparison. The Zeiss Fundus camera equipped with an attachment served as the basic instrument. The method will not have clinical value until exact statistical values for the range of error of the different methods of measurement are available. A large number of color measurements in a short period of time on one patient's eye for gauging purposes is not possible. Therefore series of measurements are carried out on a phantom eye in order to determine the range of error in the color measurements under different conditions. Description of the results. The accuracy of the measurements which can be reached under ideal conditions with the phantom eye cannot always be reached with the patient's eye. Description of a model case for further series of measurements. The same errors of measurement appeared for reddish, yellow-orangeish, and almost white color areas. The fact that the adjustable lamp had to be replaced had practically no consequences. A series of measurements conducted according to the highest and lowest luminary densities allowed by the German Industrial Norms justifies the decision to limit the luminary density for the color measurements on the ocular fundus to 40 to 70 asb. Under the described conditions the error of measurement is smaller than is necessary clinically.


Concomitant Subdural and Preretinal hemorrhage. A case report is presented of a patient with a chronic subdural hematoma, who only once had a short episode of central nervous signs. The outstanding symptom was a seemingly spontaneous introcular hemorrhage, ipsilateral to the subdural hematoma. The mechanism of the ocular manifestation is discussed.


Indentification and radioimmunologic estimation of sexual steroid hormones in aqueous humor and vitreous of rabbit eye. The occurrence of testosterone, estrone, and estradiol-17 alpha in aqueous humor and vitreous body of the rabbit eye was demonstrated. The identity of the steroid hormones was confirmed by their chromatographic properties, microreactions, and radiochemically by crystallization to constant specific activity of their labeled acetates. The levels of testosterone and estrogens in rabbit male and female plasma, aqueous, and vitreous were determined by radioimmunologic assay. The concentrations of the steroid hormones in plasma are higher than in aqueous and vitreous. However, testosterone in aqueous circulates in free form and lacks the binding to sexual hormone-binding globulin as in plasma.


[Experimental ultrasonography of the rabbit eye (author's transl)]. In 20 adult rabbits of the Gelbsilber-strain the axial depth of the anterior chamber, the axial thickness of the lens, and 7 different diameters of the vitreous chamber were measured by means of bioechometry for standardization of the to date neglected experimental ultrasonography of animal eyes. For proper interpretation of echograms of the rabbit eye the particular anatomy and topography of the lens must be considered. Penetration of the large and almost spherical lens by the beam can only be avoided if the probe is placed behind the limbus or behind the equator of the globe. In the axial ultrasonogram the high single peaked echo of the posterior lens capsule appears between the third and fourth fifth of the entire axial length. In all other types of echogram the beam passes through peripheral sections of the lens oblique, and produces several small echoes, thus eventually simulating a pathologic echogram of the vitreous body.


Antibiotic prophylaxis in penetrating injuries of the eye. In a specially developed experimental model of an infected penetrating eye injury the importance of time and mode of antibiotic administration in the prophylaxis of post-traumatic eye infection was evaluated. It was concluded that the early administration of an antibiotic to which infecting organisms are sensitive can prevent the development of an inflammatory reaction in the majority of injured eyes. The late administration of the same antibiotic (6 h after injury) has no effect at all. Subconjunctival injection was found to be superior to intramuscular if the antibiotic was given at a similar time after injury. The results of this experiment stress the importance of very early antibiotic administration in the prophylaxis of an infection in penetrating eye injuries.


[Contribution on the infraocular optics (author's transl)]. Experience indicates that a person will have a comfortable vision only if the sizes of the image in both eyes are approximately equal; a tolerance of approximately 5% is acceptable for this. In other words both optical systems, consisting of a spectacle lens, a contact lens, and the eye must have approximately the same focal length. Patients who have one phacic and one aphacic eye will usually possess quite different focal lengths with conventional contact lens correction. However, with the addition of spectacles and of appropriate contact lenses on one or both eyes, the ophthalmologist has at his disposal a new variable. The given formulas and rules of thumb enable him to choose the strength of spectacles-contact lens combinations so that the patient will also have sharp vision in both eyes and regain a comfortable binocular sight. The method is illustrated by examples.


[On the ultrastructure of proliferative changes (cell metaplasia) in the retinal pigment epithelium over malignant melanomas of the choroid (author's transl)]. Proliferations of the retinal pigment epithelium over malignant melanomas of the choroid from three human eyes were examined at various locations: 1. at the posterior pole, 2. in the equator region, 3. at the ora serrata. The observation was made that in each proliferation one cell type dominates which could be distinguished by its shape and cytoplasm from those of the other proliferations. Only the cells of the proliferation at the posterior pole correspond with the normal pigment epithelium. Most of the cells in the equator region show several properties of glia cells whereas these of the ora resemble fibroblasts. Our findings suggest that the proliferated pigment epithelium over malignant melanomas of the choroid is capable of undergoing metaplastic changes.


Glucocorticoids and intraocular pressure: an experimental study. The state of intraocular pressure and aqueous humor dynamics as well as histomorphologic and histochemical change of the eye tissues as a result of administration of glucocorticoids were studied in 62 rabbits. After administration of glucocorticoids by instillations and subconjunctival injections there was a trend toward increased intraocular pressure but no statistically significant change in the intraocular pressure was demonstrated. When glucocorticoids were administered for 1 month, a significant increase in production and outflow of aqueous humor was established. Continuation of the experiments for 2 months or longer was accompanied by a significant decrease of the outflow facility coefficient and inhibition of aqueous humor formation. Histologic and histochemical examinations of the eyes of the rabbits studied for 2 months revealed marked dystrophic changes in the trabecular meshwork tissues.


T and B lymphocyte rosettes in bronchial asthma. In this study the percentage of T and B lymphocytes was not significantly different between asthmatics and normal subjects. However, the absolute number of T and B lymphocytes was lower in asthmatics, which supports the hypothesis that atopy may be associated with immunodeficiency state.


Increase in E-rosettes after transfer factor (TF) treatment: fractionation of TF. The effect of transfer factor (TF) on E-rosettes (ER) was studied in vivo in a patient with Hodgkin's disease. Transfer factor was given in doses of 10 units/sq m intramuscularly. The ER forming cells and the ER scores were determined. The ER score method took into account the number of erythrocytes in each rosette. The increase in ER score was maximum at 24 hours and it declined during the following one to two weeks. It was suggested that TF may have to be given more frequently than indicated by the persistence of skin reactivity. TF was fractionated with high pressure liquid chromatography. Fraction 2 increased ER in a patient with Schwannoma. Non-specificity of TF was also discussed.


Follow-up of patients with saphenous vein bypass grafts for angina pectoris. These studies are in agreement with others that aortocoronary vein grafts done for severe angina pectoris are associated with a low operative and late mortality rate. Most patients were significantly improved in regard to pain and exercise tolerance. "Optimal" graft site is associated with a graft patency rate of about 90 per cent. There is clear evidence that left ventricular function, particularly with exercise, is improved in some patients. When a graft is placed in an obstructed coronary artery supplying a segment of abnormally contracting myocardium, there frequently is significant improvement of contraction when the graft remains patent.


Ruptured submucosal gastric artery microaneurysm. A patient with massive upper gastrointestinal hemorrhage from a ruptured submucosal gastric artery microaneurysm is described. Intraoperative diagnosis was made and wedge resection of the lesion resulted in survival of the patient. Forty-two cases in this entity have been reported in the literature, with nonoperative therapy being uniformly fatal; there were only four cases of successful surgical management. An increased awareness of this entity in cases of unexplained gastrointestinal hemorrhage is the key to diagnosis and successful management.


Alpha1-antitrypsin deficiency and pancreatic fibrosis. A 39-year-old woman with homozygous ZZ alpha1-antitrypsin deficiency was found to have pancreatic fibrosis in addition to the recognized pulmonary and hepatic abnormalities. Pancreatic exocrine function was normal but endocrine studies showed glucose intolerance. Pancreatic fibrosis may be another manifestation of alpha1-antitrypsin deficiency.


Coronary artery surgery: the use of decision analysis. The choice between coronary by-pass surgery and medical therapy in patients with angiographically documented coronary artery disease was examined. This decision analysis included consideration of patient preferences, severity of disease, prognosis with medical therapy, surgical mortality rate, graft patency rate, the probability that surgery will provide both short-term and long-term pain relief, and the probability that surgery will alter long-term survival. Coronary surgery was found to be the preferred therapy in many patients with disabling angina; it was rarely found to be the preferred therapy in asymptomatic patients, even those with proximal obstruction of the left anterior descending coronary artery. The therapeutic decision was strongly affected by differences in patient attitudes and differences in the past results of the prospective surgeon. This paper presents both a data base and a methodology that allow the physician to apply decision analysis to individual patients with coronary artery disease.


Intestinal bypass operation as a treatment for obesity. The intestinal bypass operation has come into wide use as a method for treating the grossly obese patient. Because it carries risks of morbidity and mortality, it is only suitable for those who meet certain minimal criteria. During the first year after surgery, weight loss varies from 9.1 to 68.0 kg [20 to 150 lb]. These patients have shown improved self-esteem and a reduction in the amount of depression. Mortality for this operation is approximately 4%; many serious complications (liver failure, pulmonary embolus, improper wound healing, severe loss of minerals, and vitamin deficiencies) occur. Hyperoxaluria may result from increased intestinal absorption. A dilated colon (pseudocolonic obstruction) may develop from bacterial overgrowth in the distal segment of the bypassed intestine. Since these serious complications affect 40% of the patients, the operation should be done by trained and skilled physicians who will also be able to manage the long-term postoperative period.


Characterization of an ampicillin-resistant Haemophilus influenzae type B. A 28-year-old female in Denver was found in early 1974 to have frontal sinusitis, osteomyelitis, and bacteremia due to Haemophilus influenzae, type B. The minimal inhibitory concentration of ampicillin for this organism was 100 mug/ml and the minimal bactericidal concentration was >100 mug/ml. It was inhibited by chloramphenicol at 0.4 mug/ml. Further studies demonstrated that ampicillin and methicillin were synergistic against this organism. It was shown to produce a diffusible beta-lactamase. Transferase of resistance from this organism to a susceptible Haemophilus parainfluenzae and a reciprocal transfer were accomplished. A test for transformation was negative as was a test for reversal of resistance by ethylenediaminetetraacetic acid.


[Aortocoronary bypass].

[Aortocoronary bypass]. Surgical revascularisation of the myocardium by aorto-coronary by-pass, has become in recent years, the operation of choice for the treatment of lesions of coronary arteriosclerosis. The quality of the results observed in our series, of 200 operated patients, and those reported by other authors, is emphasized. The problems raised by extension of this surgery, especially in the precise pre-operative assessment of ventricular function, the optimum material to use for realisatin of the graft and the course of coronary lesions after by-pass operations are then discussed.


[Influence of injection of cortisone acetate on blast transformation and antibody-dependent cell-mediated cytotoxicity in rabbit (author's transl)]. Inhibition of circulating antibody production by steroids has been repeatedly shown in steroid-sensitive animals such as mice or rabbits. It is well known that after a single injection of 5 mg of cortisone acetate, mouse spleen cells loose their ability to be transformed by B cell mitogens such as lipopolysaccharides or Nocardia water soluble mitogen. Therefore it was of interest to study in the rabbit the influence of cortisone on the reactivity of spleen cells to a B cell mitogen (blast transformation and polyclonal strimulation) and their ability to be cytotoxic in the antibody-dependent cell-mediated cytotoxicity assay. Our data demonstrate that the cells which mediate such a cytotoxicity are cortisone-resistant whereas the B lymphocytes--which can be transformed and polyclonally activated by these mitogens--are sensitive to cortisone treatment.


Aortocoronary saphenous vein autograft accidentally attached to a coronary vein: follow-up angiography and surgical correction of the resultant arteriovenous fistula. The fate of aortocoronary saphenous vein bypass graft to the left anterior descending (LAD) coronary vein is reported. The vein graft communicated with the coronary sinus through the proximal LAD vein, producing a functional coronary arteriovenous fistula. The LAD vein was totally occluded distally at follow-up four months after operation. The natural history of congenital fistulas between coronary arteries and the coronary sinus suggested that bacterial endocarditis, pulmonary hypertension, and cardiac failure were all possible future complications in this patient. Operation was performed to revascularize the LAD artery to relieve persistent angina, and to close the fistula. Postoperative angiography showed a patent graft to the LAD artery with complete obliteration of the fistula. The patient is asymptomatic ten months after operation.


Gait analysis in stroke patients to assess treatments of foot-drop. By using the combined, computerized analysis of stroboscopic photography, pattern recognition devices, electromyography and foot switch outputs, gait patterns were studied in 15 stroke patients with foot-drop. Three patients were treated with a peroneal nerve stimulator for five weeks; six received intensive physical therapy; and six received both physical therapy and biofeedback training three times a week for five weeks. Each patient was examined at initial visit and after five weeks. Based upon case evaluations, both the patients with the stimulator treatment and those with biofeedback training showed and maintained improvement of gait pattern following the treatment period. This result suggests that the biofeedback and peroneal-stimulator technique may have a common mechanism that should be exploited in the rehabilitation of stroke patients.


Electrically induced flexion reflex in gait training of hemiplegic patients: induction of the reflex. Since the introduction of the concept of functional electrical stimulation, the use of multiple stimulation sites to activate several paretic muscles in a coordinated fashion during ambulation has been suggested. Rather than stimulating multiple muscles, we have applied a train of electrical pulses to a single skin area to activate several muscles simultaneously through the induction of a flexion reflex, and evaluated the effectiveness of this reflex in producing or assisting the swing phase of the gait cycle in the hemiplegic patient. Two considerations in selecting the best stimulus site were (1) the magnitude of the reflex as measured by the length of time the foot was off the floor following a stimulus and (2) the patient's tolerance to the stimulus. The magnitude of the reflex was proportional to the strength of the stimulus current in all skin areas tested; namely the sole, dorsum of the foot, and lower posterior thigh. Of the six patients tested a flexion reflex was not elicitable by sole stimulation in one and by posterior thigh stimulation in another. In every case, compared to the two other areas, stimulation of the sole was best tolerated and produced responses of equal or greater magnitude with the same intensity of current, even though larger voltages were required owing to greater tissue impedances. With a fixed frequency of 30 Hz, a pulse duration of 3 msec, and a stimulus current sufficient to produce the reflex, the duration of the reflex could be adjusted for each patient by varying the train duration from 100 to 700 msec. This technique offers a means of providing or assisting the swing phase in the gait training of the hemiplegic patient.


[Research on V. cholerae anti-antibodies (agglutinating and vibriocidal) in patients affected by cholera-like gastroenteritis. Studies performed during the cholera epidemic occurred in Apulia in August-September 1973]. Agglutinating and vibriocidal antibody titers anti-V. cholerae of the serotypes Ogawa and Inaba, were determined in sera from 189 patients with cholera-like diarrheas during the epidemic of cholera occurred in August-September 1973, in Bari. Antibodies were determined in 74,2% of 70 patients, whose in the faeces and vomiting were isolated strains identified as V. cholerae, biotype El Tor, serotype Ogawa. This frequency was higher against the serotype Ogawa. The antibodies could be proved very early, 4-6 days from the beginning of symptomatology, but they disappeared as rapidly; really, at 2.3 months antibodies were determined in 7,7% only of the above mentioned subjects. As regards the other 119 patients with non-vibrio, cholera-like diarrheas, antibodies were determined in 28 subjects only; 27 of these has received cholera-vaccine some weeks before. One single case remained which was bacteriological negative, but showed signifcant agglutinating and vibriocidal antibody titers against the serotypes Ogawa and Inaba.


Endoscopic argon-ion laser phototherapy of bleeding gastric lesions. An argon-ion laser, coupled to a flexible fiberoptic endoscope, was used to photocoagulate experimentally produced bleeding gastric ulcers in dogs. Argon-ion laser phototherapy rapidly and effectively achieved hemostasis in all bleeding ulcers. Bleeding arteries up to 2 mm in diameter were photocoagulated. Intact normal gastric mucosa was exposed to laser energy for varying periods of time to determine if transmural photothermal injury occurred. Exposure for greater than 15 seconds at 1.0 w of throughput power caused microscopical evidence of transmural injury. Healed, laser-treated ulcers could not be differentiated from nontreated control ulcers or normal stomach one month after injury. The Beer law and the heattransfer factors relating to soft tissues are discussed. The coupled argon-ion laser-endoscope may be a safe tool to treat self-limited superficial bleeding gastric lesions.


Subjective multivariable analysis bu computer for evaluation of coronary artery bypass. Subjective multivariable analysis by computer was utilized to evaluate the results in a series of 659 patients undergoing coronary artery saphenous vein bypass surgery. A video terminal gave access to a remote computer. The postoperative subjective response was evaluated by questionnaires sent to patients at 6- to 12-month intervals, and was augmented by treadmill testing and postoperative coronary arteriography. Operative risk and subjective response are related only to the degree of ventricular function lost prior to surgery. Long-term  results were best in patients in whom complete revascularization was possible. Current operative risk is less than 1%; a five-year survival rate of 90% to 95% is predicted. More than 90% of patients were asymptomatic or "greatly improved." Postoperative treadmill tests were negative in 88% of patients in these groups. In patients who were only "slightly improved" or "not improved," repeat catherization showed a graft patency rate of 84%, suggesting that recurrent symptoms were related to the extent of preoperative disease or to the progression of disease in nongrafted vessels, rather than to graft occlusion.


Operative risk in patients with previous coronary artery bypass. The records of 141 patients who had had coronary artery bypass and myocardial revascularization were reviewed. Fifteen percent (20) of the patients in this series required a surgical procedure from three months to five years following coronary artery bypass. Twelve percent (16) of these patients had elective operations, and 3% had emergency operations. In the elective group there were no deaths. One patient had a proved myocardial infarction, and three patients had transient arrhythmias with no changes in myocardial enzymes. In the emergency group there was one death, from sepsis following splenectomy for splenic abscess. Although the series is small, the data suggest that patients with coronary artery disease who have had myocardial revascularization are acceptable risks for elective and emergency operations. Whether the risk is lower in this group as compared to that in other patients with coronary disease who have not had bypass surgery has not been demonstrated.


[Some biological aspects of cancer. Approach to a general theory of cancerogenesis]. Cancer is considered to be the consequence of internal evolutionary drives typical of species with open evolution (e.g. vertebrates) deficient in the primary teleonomic mechanisms underlying the maintenance of reproductive invariability. With this in mind, a biological test is hypothesized which would make it possible to identify and isolate substances from definitely non-variant species with the purpose of studying their influence on the morphogenetic processes that, at cytoplasmatic level, bring about the transformation of normal into neoplastic cells. On this basis it might be possible to establish an inhibition therapy to back up immunitary therapy as a complement to surgery and radiation.


Cerebellar-pontine angle tumors. Results of quantitative vestibulo-ocular testing. A new quantitative vestibulo-ocular test battery was evaluated in 12 patients with surgically confirmed cerebellar-pontine angle tumors. The battery consisted of precise vestibular and visual stimuli and digital computer analyses of responses. Eleven of 12 patients, including all patients with acoustic neurolemmomas, had significant vestibular deficits on the tumor side (P less than .01). Contrary to previous reports, rotatory tests (impulse and sinusoidal acceleration) reliably identified the side and magnitude of vestibular deficit. Eight of nine patients with surgically confirmed brain stem compression had significantly impaired smooth pursuit (P less than .05). Optokinetic nystagmus was impaired in five of nine patients with brain stem compression (P less than .05). By combining the results of the entire test battery with standard clinical evaluation, a good prediction of tumor size, location, and type was possible.


Influence of immunosuppression on antinuclear antibody and survival of wehi mice. The effect of immunosuppression with cyclophosphamide was assessed in 200 male and female Walter and Eliza Hall Institute outbred mice which are known to develop antinuclear antibody (ANA). Their longevity and the incidence of ANA were studied in comparison with controls. In females, life-span was longer despite a higher age-related incidence of ANA. Cyclophosphamide significantly delayed the development of ANA in both sexes; despite this, life-span was decreased. This is in contrast to what occurs in the highly autoimmune NZB/NZW F1 hybrid mouse. Thus, in weakly autoimmune mice the toxic effects of cyclophosphamide outweighed any benefit resulting from suppression of antinuclear autoantibodies.


Characterization of the normal lymphocyte population cytolytic to Burkitt's lymphoma cells of the EB2 cell line. The normal human lymphocyte population which exhibits "spontaneous" cytolysis of EB2 Burkitt's lymphoma cells has been characterized. The effector cell has EA and EAC' receptors but lacks E receptors and probably surface Ig. "Spontaneous" anti-EB2 cytotoxicity was not reduced by preincubation of the effector cells with plastic or iron carbonyl or by passage through cotton wool or agarose columns but was reduced by passage through nylon wool columns. Thymocytes were not cytotoxic to EB2 cells, and chronic lymphocytic leukaemia cells (of B cell characteristics) had reduced cytotoxicity compared with normal lymphocytes. Cells from various lymphoid organs of rats and guinea-pigs were also cytotoxic to EB2 cells with reactivity in spleen greater than or equal to blood greater than lymph nodes. Spleen cells from neonatally thymectomized rats had increased cytotoxicity compared with normal rat spleen cells, suggesting that T lymphocytes are not essential. The effector cell in rat spleen did not adhere to cotton wool or agarose columns, indicating some resemblance to its counterpart in human peripheral blood.


Altered lymphocyte reactivity in rheumatoid arthritis. Blastogenic transformation of peripheral lymphocytes with phytohemagglutinin (PHA), conconavalin A (Con A), and pokeweed mitogen (PWM) was studied in 29 patients with rheumatoid arthritis (RA). The PHA response was depressed in a subgroup of RA patients with erosive disease. The Con A response was also depressed and paralleled the PHA response. The PWM response was not depressed. These results lend support to the hypothesis of a functional defect of cellular immunity in RA. It was shown that lymphocyte responsiveness to a single mitogen concentration is not an adequate assessment of the overall responsiveness of the lymphocytes tested.


Identification of antibodies to nuclear acidic antigens by counterimmunoelectrophoresis. Saline extracts of rabbit thymus were found to contain many nuclear antigens that reacted with antibodies in the sera of patients with systemic rheumatic diseases. Counterimmunoelectrophoresis (CIE) was used to detect antibodies to nuclear acidic protein (Sm), nuclear ribonucleoprotein (RNP), and antibody to nuclear antigen B, which was reported previously in Sjögren's syndrome. All these nuclear antigens behaved as anions with different mobilities in CIE and could be distinguished from one another by the locations of the precipitin lines. They could also be distinguished by the facts that the nuclear RNP precipitin lines were abolished by digestion with ribonuclease whereas others were unaffected, and that Sm precipitin lines developed later than other precipitin lines. With this technique antibody to nuclear RNP was detected in 46% of patients with systemic lupus erythematosus (SLE) compared to 26% detected by the hemagglutination technique. Similarly the increased sensitivity of the CIE technique was able to show that antibody to B antigen was present in 12% of SLE patients, whereas this antibody was not detectable in the same group of patients by immunodiffusion. This study shows that CIE is a rapid and sensitive technique for detecting precipitating antibodies to a number of nuclear acidic antigens. Methods are described to identify the immunochemical specificities of the precipitin lines by the use of standard reference sera.


Obstructive pulmonary disease in rheumatoid arthritis. Twenty-six of 43 patients (60.5%) with classic rheumatoid arthritis (RA) participating in a controlled, prospective study were found to have maximal midexpiratory flow rates (MMEFs) suggestive of obstructive pulmonary disease. Cigarette smokers with RA had significantly lower MMEFs than either nonsmokers with RA or smokers with degenerative joint disease. There was an increased prevalence of the Pi phenotype MS among the RA patients. Interstitial fibrosis, tobacco smoking, and protease inhibitor deficiencies were all significant factors in producing airway obstruction in patients with RA.


Isolation and identification of the major concanavalin A binding glycoproteins from murine-lymphocytes. The major glycoproteins which bind concanavalin A have been isolated and identified from murine spleen cells, thymocytes,and purified thymus-derived (T) lymphocytes, and from the spleen cells of congenitally athymic (nude) mice. The cells were radiolabeled by lactoperoxidase catalyzed 125I iodination or by culturing the cells in media containing [3H]leucine or [3H]fucose. The cell membrane was solubilized with Nonidet P-40 and the concanavalin A binding proteins were isolated by affinity chromatography and analyzed according to their mobility on polyacrylamide gel electrophoresis in sodium dodecyl sulfate. The major proteins from various lymphocyte preparations were identified by immunoprecipitation with specific antisera. The molecules coded by the histocompatibility-2 complex acted as concanavalin A binding proteins H-2K and H-2D were isolated from T lymphocytes, thymocytes, and bone marrow derived (B) lymphocytes. The Ia antigens were identified from B lymphocytes and tentatively identified from T lymphocytes. In addition to these H-2 complex proteins, immunoglobulin M and D on B lymphocytes also bound concanavalin A binding. All these glycoproteins have previously been identified as cell surface molecules. The presence of certain minor unidentified concanavalin A binding proteins on lymphoid cells is indicated.


Human plasma kallikreins and their inhibition by amidino compounds. Human plasma kallikreins (EC 3.4.21.8) were purified as three distinct enzyme entities which hydrolyzed arginine esters and were active in releasing kinin from heated human plasma as measured by guinea pig ileum contraction bio-assay. The three enzymatically active fractions were termed as 19 S, 7 S-I and 7 S-II kallikreins. They represented purifications of 262- 2200- and 110-fold, respectively. These enzyme activities showed differences in physicochemical and biochemical properties as it appears from their elution profile on Sephadex G-200 and DEAE-cellulose columns, affinity for substrates and susceptibility of inhibition by various protease inhibitors such as trasylol and soya bean trypsin inhibitor. The data suggest that all these three enzyme preparations were most likely kallikreins. All these three enzymes (19 S, 7 S-I and 7 S-II) were inhibited by a series of amidino compounds competitively. Diamidines consisting of two amidinophenyl residues linked in para position by molecular bridge were comparatively stronger inhibitors of all of three enzymes than those linked in meta position and those having single ring structure. The possibility that some of these amidino compounds might prove to be useful for treatment of disease states where the kallikrein-kinin system plays a role, is discussed.


Delayed fluorescence from Rhodopseudomonas sphaeroides following single flashes. Delayed fluorescence from Rhodopseudomonas sphaeroides chromatophores was studied with the use of short flashes for excitation. Although the delayed fluorescence probably arises from a back-reaction between the oxidized reaction center bacteriochlorophyll complex (P+) and the reduced electron acceptor (X-), the decay of delayed fluorescence after a flash is much faster (tau1/2 approximately 120 mus) than the decay of P+X-. The rapid decay of delayed fluorescence is not due to the uptake of a proton from the solution, nor to a change in membrane potential. It correlates with small optical absorbance changes at 450 and 770 nm which could reflect a change in the state of X-. The intensity of the delayed fluorescence is 11-18-fold greater if the excitation flashes are spaced 2 s apart than it is if they are 30 s apart. The enhancement of delayed fluorescence at high flash repetition rates occurs only at redox potentials which are low enough (less than +240 mV) so that electron donors are available to reduce P+X- to PX- in part of the reaction center population. The enhancement decays between flashes as PX- is reoxidized to PX, as measured by the recovery of photochemical activity. Evidently, the reduction of P+X- to PX- leads to the storage of free energy that can be used on a subsequent flash to promote delayed fluorescence. The reduction of P+X- also is associated with a carotenoid spectral shift which decays as PX- is reoxidized to PX. Although this suggests that the free energy which supports the delayed fluorescence might be stored as a membrane potential, the ionophore gramicidin D only partially inhibits the enhancement of delayed fluorescence. With widely separated flashes, gramicidin has no effect on delayed fluorescence. At redox potentials low enough to keep X fully reduced, delayed fluorescence of the type described above does not occur, but one can detect weak luminescence which probably is due to phosphorescence of a protoporphyrin.


Cordycepin and early effects of estradiol on the immature rat uterus. Estradiol induces the synthesis of a specific protein fraction (IP) in the uterus of the immature rat. The injection of cordycepin (3' deoxyadenosine), an inhibitor of poly A synthesis, inhibits the synthesis of IP. This fact suggests that one of the earliest effects of estrogen is the production of Hn-RNA poly-A relative to IP. Moreover, using electron microscopy, the stimulation by estradiol of the nucleolus of the immature rat uterine epithelium has been shown. Cordycepin does not affect this stimulation to any appreciable extent. Biochemical studies (incorporation of radioactive stracers into NRA, affinity chromatography on poly U-Sepharose) carried out in parallel with and under conditions comparable to those used in electron microscopy show that cordycepin does not greatly affect the increase in ribosomal RNA observed under the effect of estradiol. The blocking of IP by cordycepin and the lack of inhibition at the nucleolus level under the same conditions, show that the two early effects of the action of estrogen on the immature rat uterus are not directly correlated.


Sarcomere length dispersion in single skeletal muscle fibers and fiber bundles. Light diffraction patterns produced by single skeletal muscle fibers and small fiber bundles of Rana pipiens semitendinosus have been examined at rest and during tetanic contraction. The muscle diffraction patterns were recorded with a vidicon camera interfaced to a minicomputer. Digitized video output was analyzed on-line to determine mean sarcomere length, line intensity, and the distribution of sarcomere lengths. The occurrence of first-order line intensity and peak amplitude maxima at approximately 3.0 mum is interpreted in terms of simple scattering theory. Measurements made along the length of a singel fiber reveal small variations in calculated mean sarcomere length (SD about 1.2%) and its percent dispersion (2.1% +/- 0.8%). Dispersion in small multifiber preparations increases approximately linearly with fiber number (about 0.2% per fiber) to a maximum of 8-10% in large bundles. Dispersion measurements based upon diffraction line analysis are comparable to SDs calculated from length distribution histograms obtained by light micrography of the fiber. First-order line intensity decreases by about 40% during tetanus; larger multifibered bundles exhibit substantial increases in sarcomere dispersion during contraction, but single fibers show no appreciable dispersion change. These results suggest the occurrence of asynchronous static or dynamic axial disordering of thick filaments, with a persistence in long range order of sarcomere spacing during contraction in single fibers.


Insulin binding of acute lymphocytic leukemia cells. Because of differences in insulin binding of cultured lymphoic cell lines, T- and B-cell surface receptor and 125I-insulin binding studies were performed on the bone marrow and peripheral blood leukocytes of 13 children with active acute lymphocytec leukemia. Based on surface receptors, nine patients had null-cell disease and four had T-cell disease. The mean per cent insulin binding of the bone marrow cells from the null-cell patients was 10.0% +/- 8.1 and from the T-cell patients was 0.18% +/- 0.13. The mean insulin binding of the cell suspensions of the peripheral blood from the null-cell patients was 7.3% +/- 7.5 and 0.07% +/- 0.06 from the T-cell patients. Displacement studies with nonradioactive insulin indicated that null leukemic cells bore specific binding sites. These results indicated that there may be metabolic as well as surface membrane heterogeneity among the acute lymphocytic leukemias of childhood.


A comparison of granulopoiesis in culture from blood and marrow cells of nonleukemic individuals and patients with acute leukemia. The objective of this study was to compare the concentration of committed granulopoietic progenitor cells (CFU-C) in marrow and blood. For individuals without leukemia, a highly significant correlation was observed between the concentration of CFU-C obtained from the two sites. However, CFU-C in blood had a slower sedimentation velocity than that reported for marrow and were found not to be in the DNA synthetic phase of the cycle using the tritiated thymidine suicide tehcnique. In patients with acute leukemia, no correlation was observed between concentrations of CFU-C in marrow and peripheral blood, regardless of whether the patients were newly diagnosed, in remission, or in relapse. We concluded that studies of the peripheral blood do not yield the same information in respect to granulopoietic progenitor cells as do studies of the marrow.


Fetal hemopoiesis in diffusion chamber cultures. III. The effect of neutropenia. Proliferation and differentiation of granulocytes, macrophages, and both myeloid committed (CFC) and pluripotent (CFU) stem cells in diffusion chamber (DC) cultures of fetal liver were studied in order to evaluate the role of circulating humoral factors in the control of fetal myelopoiesis. When DC with fetal liver cells were implanted into mice rendered neutropenic by pretreatment with cyclophosphamide, more granulocytes and CFC were produced through day 10 as compared to DC implanted into saline pretreated control hosts. A difference in CFU recovery from fetal liver suspensions grown in DC implanted into neutropenic and control hosts was not seen until day 10. Serum CSF concentrations were increased in neutropenic as compared to control host mice 2 and 3 days after implantation of DC. Levels of serum inhibitors of colony growth showed marked variability but, in general, were similar in both groups. These data provide evidence that fetal CFC and fetal myelopoiesis are influenced by a circulating humoral factor present in neutropenic serum. CSF may be the factor, although the data presented in this paper do not establish this with any certainty.


New data on the vision of South American Indians. A total of 466 males and 437 females from four Brazilian Indian tribes were tested for color blindness with Ishihara's plates. Defective persons were found in three of the four tribes, but when these and other groups are considered the evidence suggests that the frequency of this trait is lower among Amerindians than among Caucasian populations. Visual acuity tests were performed on 296 Yanomama Indians. Their visual acuity was apparently not as sharp as that of the Cayapo or Xavante. But the scarcity among the Yanomama of persons with serious visual impairment of subcutaneous nodules suggests that the focus of onchocerciasis discovered among them is of recent origin.


The effect of quinidine on membrane electrical activity in frog auricular fibres studied by current and voltage clamp. 1 The action of quinidine sulphate 50 muM has been investigated on frog auricular trabeculae transmembrane currents recorded with a double sucrose gap apparatus. Results were obtained either in current or in voltage clamp conditions. 2 Quinidine modified the time course of repetitive activity elicited by long lasting depolarizing currents and reduced the range of current over which repetitive activity could be triggered, eventually abolishing repetitive responses altogether. 3 Several authors have emphasized the limitations of the voltage clamp method. Taking into account these limitations, the numerical values of the parameters obtained in the present work must not be considered as exact values but may be interpreted as indicators of the variations of the parameters. 4 The results are in agreement with previous findings that the main features of the action of quinidine are to produce (a) a reduced maximum rate of depolarization (MRD), (b) a reduced total amplitude of action potential, (c) a flattening of the plateau of the action potential, (d) a slight prolongation of the tail of the action potential, (e) an increased effective refractory period without greatly prolonging action potential duration, (f) no change of resting potential and of 50% repolarization time. 5 The analysis of ionic conductances has provided explanations for the above effects. 6 Quinidine reduced the reactivation kinetics of the sodium inward current, and decreased sodium conductance and the steady state of activation. These effects account for (a) and (b). 7 Quinidine increased the activation and inactivation time constants of sodium conductances, which account in part for (e). 8 Quinidine delayed reactivation of slow inward current, reduced calcium conductance, and decreased the steady state of activation of calcium conductance. These effects could account for (c). 9 The amplitudes of the two components of the delayed conductances responsible for repolarization were decreased by quinidine, and the time constant of activation for the faster of the two was slowed. These effects could account for (d) and in part for (e).


125Iodinated fibrinogen uptake in inflammatory joint disease as a complicating factor in the detection of deep vein thrombosis. An enhanced uptake of 125I-fibrinogen observed in the arthritic knee joint of a patient suspected of deep vein thrombosis was confirmed in a number of patients with inflammatory joint disease in the absence of thrombosis. Whilst this is a potentially serious source of false positive diagnoses, the possibility also exists that this phenomenon could be used to evaluate the degree to which active disease is present in the joints of patients suffering from inflammatory disease.


Interdigitating reticulum cells in the popliteal lymph node of the rat. An ultrastructural and cytochemical study. Electronmicroscopic and cytochemical studies were performed to localize interdigitating reticulum cells (IDC) in the popliteal lymph node of the rat. The morphological features of the IDC of the rat correspond to those described for other species, but also show similarities to normal macrophages in the rat. This is considered to be an argument in favour of the common origin of IDC's and macrophages. Ultrahistochemical studies with horseradish peroxidase (HRP) reveal no phagocytotic capacity of IDC's. After perfusion fixation containing ruthenium red (RR) the surface coat stains heavily: RR is also found deep in the membrane invaginations of the IDC, indicating the presence of polyanionic sialoglycoproteins. The post-capillary-venules (PVC) are very  permeable to both HRP and RR. The phosphotungstic acid-chromic acid stain (PTA-CrA) also reveals glycoproteins in the surface coat; these glycoproteins are susceptible to alpha-neuraminidase, whereas glycoproteins in the Golgi complexes, lysosomes and in the vesicular complexes of IDC are not. The glycoproteins of the latter are susceptible to 0.1 N NaOH. These findings indicate that IDC produce different kinds of glycoprotein, one of which may be secreted and act as a factor for stimulating peripheral T-lymphocytes. Intimate contact between IDC's and PCV's could be observed. It is therefore conceivable that IDC's play an important role in the homing of T-lymphocytes.


Autoradiographic localization of 3H-5-HTP and 3H-5-HT in the pineal organ and circumventricular areas in the rainbow trout, Salmo gairdneri Richardson. The time course of incorporation and cellular localization of 3H-5-hydroxytryptophan (3H-5-HTP) and 3H-5-hydroxytryptamine (3H-5-HT) in the pineal and some brain regions in rainbow trout, Salmo gairdneri, were studied by quantitative and qualitative autoradiography. Among the tissues examined, the pineal shows the highest and most rapid uptake of the two isotopes. Maximum incorporation of 3H-5-HTP is achieved by 2 h and that of 3H-5-HT by 20 minutes post injection. At the end of the six-hour experimental period, a significantly high amount of radioactivity is still detectable in the pineal. The results indicate a much slower turnover of the two indoles, especially 5-HTP, in the trout than is known for mammalian tissues. Both the ependymal supporting cells and the receptor cells of the pineal localize these isotopes. In constant, the intrapienal neurons remain unlabeled. This is taken to suggest lack of capacity of these cells to metabolize 5-HTP and 5-HT. In the circumventricular regions, the two indoles occur in the ependyma of the recessus lateralis and the recessus praeopticus. The label is also localized in the neuropil and the neurons of the nuclei recessus lateralis and praeopticus. Semiquantitative estimates reveal a significant labeling of these areas only 20 minutes after injection, although a weak but inconsistent labeling of the ependyma is evident at 5 minutes. The significance of these results is discussed in regard to (a) normal capacity of circumventricular areas to metabolize indoles and (b) a possible chemical interaction between the pineal and the brain involving a direct pineal-cerebrospinal fluid pathway.


Parasite antigens.

Parasite antigens. The currently available preparations used as antigen in the serological investigation of parasitic diseases are ill-defined heterogeneous mixtures, and there is an evident need for better characterized reagents. Antigens of different parasite species (schistosomes, filariae, trypanosomes, and plasmodia) are discussed and parasite sources enumerated. Modern methods for the preparation of antigenic extracts and their fractionation are described, together with certain guidelines as to their biochemical characterization and their immunological activity. In order to implement this endeavour and to make better use of serological techniques in parasitic diseases, proposals are made concerning collaborative research and field application among a number of laboratories on schistosome, onchocercal, trypanosome, and plasmodial antigens.


Epidemiology of chronic non-specific respiratory diseases. The current state of research into the epidemiology of chronic non-specific respiratory diseases (CNSRD) is reviewed. Recommendations are made on the definitions of CNSRD for use in epidemiological studies, and various aspects of the etiology and natural history of CNSRD are identified as requiring further investigation. The need for standardization of investigative methods is emphasized. Since smoking is such an important factor in the etiology of CNSRD, it is recommended that efforts be made to discourage children from taking up the habit.