[On-line monitoring of cardiac output with a new pulse contour computer (author's transl)]. A new pulse contour cardiac output computer, operating from the aortic pressure wave form was tested in cardiac surgical patients. Reference cardiac output was measured by thermal dilution technique. Satisfactory agreements were obtained between the thermal dilution and the COC-pulse-contour cardiac outputs when rapid variations of cardiac output occurred as well as slowly developing changes. The results show that the computation of the stroke volume from the aortic pressure wave form offers a simple, clinically useful method for on-line monitoring of cardiac output in critically ill patients. Possible error sources are discussed.


[Diagnosis, frequency and importance of the "low-output-syndrome" in the postoperative period after mitral valve replacement (author's transl)]. From 1970 until 1975 single mitral valve replacement was carried out in 162 patients using Björk-Shiley disc prostheses. The surgical mortality (within 30 days postoperatively) was 9.3% (n=15). Out of these 15 patients 9 died due to myogenic cardiac insufficiency. 21 patients with "Low-output-Syndrome" due to myogenic insufficiency however survived. The improvement of intraoperative myocardial protection since 1972 (using hypothermia and cardioplegic induced cardiac arrest) reduced the frequency of myogenic cardiac insufficiency to 1%. Unrelated to the above mentioned we saw in 18.5% of all patients after ECC-procedures a temporary "Low-output-Syndrome" after the 3rd postoperative day due to pericardial effusion.


[Acute left heart failure following repair of atrial septal defects. Its treatment by reopening]. Among 716 patients operated on for an ASD, 15 of them, following closure of the defect, developed acute left heart failure requiring partial re-opening. The most prominent anatomical finding in these cases was hypoplasia of the left ventricle. Also remarkable in some patients was severe pulmonary hypertension, which may have led to right ventricular hypertrophy. Therefore, a marked difference of the stroke work of the left and right ventricle, respectively, appeared to be the essential underlying hemodynamic mechanism. The prognosis has been found to depend mainly on prompt surgical intervention; so in all poor-risk cases continued monitoring of left atrial pressure is indicated for early detection of impending left heart failure.--The high incidence of left heart failure as cause of death after repair of an ASD indicates the importance of this complication.


[Determination of serum-digitalisglycoside concentrations by radioimmunoassay before, during and after operations with extracorporal circulation (author's transl)]. In 13 adult patients serum-glycoside concentrations, renal glycoside elimination and endogenic creatinine clearance were determined before, during and in the first 4 days following the operation. A postoperative digitalis cumulation has not been seen. But there was a diminished digitalis tolerance in the immediate postoperative phase. Two patients got ventricular bigeminus. The low potassium values at the same time may possibly affect the sensitivity of digitalis.


[Effect of intraaortic-ballon-counterpulsation on the changes of myocardial blood flow following coronary artery stenosis and occlusion (author's transl)]. To prove the effectiveness of the IABP in case of impending myocardial infarction in one series of experiments myocardial blood flow changes due to IABP in dogs with stenosis of the left circumflex coronary artery (LC) were investigated using tracer microspheres. In a control series the left anterior descending artery (LAD) was occluded. In acute LAD occlusion the IABP caused an increase of blood flow in the epicardial layer. In case of LC stenosis there was a far greater increase in blood flow by the IABP most prominent in the endocardial layer. Our experiments indicate that the IABP seems to be effective in impending myocardial infarction.


[Improvement of myocardial blood flow and cardiac hemodynamic by means of intraaortic balloon pumping IABP during experimental heart failure (author's transl)]. The influence of the intraaortic balloon pumping (IABP) on the hemodynamic and coronary blood flow under control conditions and after experimental heart failure induced by coronary artery ligature was proved on eight dogs. By timely use of IABP (systolic pressure over 60-70 mmHg), the cardiac hemodynamics can be improved by means of reducing myocardial oxygen demands, and on the other hand by raising the coronary perfusion and oxygen supply.


[Intra-aortic balloon pumping in cardiogenic shock after cardiac surgery (author's transl)]. The results of intra-aortic balloon pumping in 7 patients with cardiogenic shock after cardiac surgery are reported. 2 patients were unresponsive to IABP, 4 patients showed initial stabilization of the circulation, but became IABP-dependent and died. One patient could be weaned from IABP, but died of uncontrollable cardiac arrhythmias. These results are discussed.


[Diagnostic and therapy of postoperative cardiac low-output-syndrome by means of intraaortic balloon pumping (IABP) or external counterpulsation (ECP)--a comparison (author's transl)]. A beneficial influence on the myocardial energy imbalance of the hypoxaemically damaged heart can be reached with either intraaortic balloon pumping (IABP) or external counterpulsation (ECP). In the realm of our acquired clinical experience with two groups of patients, the technical demands of these cardiac assist devices are discussed and distinguished from one another in relation to different indications.


[Respiratory care in infants following cardiac surgery (author's transl)]. Report on results in postoperative intensive care of 73 infants. 37 underwent corrective surgery on extracorporeal circulation (mortality 24,3%), 36 were operated on without ECC (mortality 16.7%). All infants had been intubated by the nasotracheal route, 39 were treated with CPPV (mean duration 32.5 h), 23 with IPPV (mean duration 28 h). Almost 50% were treated with +7 cm H2O CPAP (mean duration 32 h). Advantages and potential hazards of CPPV and CPAP are discussed.


[Disturbances of ventilatory distribution as a cause of postoperative hypoxemia after cardio-thoracic surgery (author's transl)]. In a group of 21 patients with thoracotomy the lung function was investigated pre-and postoperatively with particular consideration to N2-clearance. From the N2-clearance an Inspiratory Gas Distribution Index (IDI) is derived. This Index allows in combination with blood gas analysis an interpretation of ventilatory disturbances in the lung.


[Postoperative analgetics in patients after thorax surgery (author's transl)]. The amount and sort of analgetics given postoperatively in 1000 patients who had major heart or lung surgery was statistically analysed. A critical review of comparable literature revealed that all about analgetics usually is estimated. New and more objective criteria were found.


[Postoperatives acute renal failure after operations with extracorporeal circulation (author's transl)]. An acute renal failure was observed postoperatively in 3,45% of 929 patients operated with the heart lung machine during the years 1970-1972. Because of the bad results of any therapy in the case of acute postoperative renal failure, the diagnostic procedures of the preoperative renal function were intensified of the preoperative renal function were intensified in order to prevent an acute postoperative renal failure. Therefore additional measurements of the creatinine clearance and in few cases radioisotopic clearance tests were done.


[Drug induced acute renal failure after heart surgery (author's transl)]. The incidence of acute renal failure following cardiac surgery was markedly increased during the last years in our medical center. There was no correlation to known etiologic factors such as preexisting disease, hemolysis, low perfusion rates, post-operative low output syndrome etc. Post-operative renal failure was mainly seen in children between 2 and 10 years and was noted after 3-4 days of normal renal function. Peritoneal dialysis was carried out in 39% of out patients and the overall mortality was 10.7%. Careful analysis of our cases exhibited a correlation of the post operative acute renal failure to the intravenous application of Aescin. After abandoning this drug from our post-operative therapy we did not observe a similar case since almost one year.


[Treatment of postoperative renal insufficiency after cardiovascular surgical procedures by peritoneal dialysis (author's transl)]. In 1972 and 1973 there have been 698 (351 with ECC) cardiovascular surgical procedures. 29 cases of renal insufficiency were seen in this group, 15 requiring peritoneal dialysis. There were only two survivors in the latter group. However none died due to renal insufficiency. The indication, technique, complications, results are discussed in detail.


[Experiences in the treatment of acute renal failure following cardiovascular surgery (author's transl)]. After 9021 cardiovascular operations 210 patients developed acute renal failure. 140 (67%) out of this group died. The mortality rate of acute renal failure could be reduced from 80% (1958-1966) to 50% (1973-1974). Dialysis treatment should begin early and also in special cases, in which the cause of acute renal failure is not under control. Beyond optimal dialysis therapy common intensive care is important for the prognosis of acute renal failure, especially adaption of drugs to renal function (antibiotics and digitalis), high-caloric alimentation, consequent treatment of infections, strict balance of fluid and electrolytes.


[Mortality and preoperative left ventricular function in aortocoronary bypass surgery (author's transl)]. Left ventricular function in 8 patients with coronary heart disease, who died during or immediately after surgery, was compared with the corresponding data of 25 survivors. Both groups were similar in age and had about the same number of myocardial infarctions preoperatively. For LVEDP, EDV, EF and VCF critical values could be defined, which were found in none of the survivors. These values were: LVDEP approximately 20 mm Hg, EDV approximately 150 ml/m2, EF less than 30% and VCF less than 0,4 circ/s. The least prognostic significance was found for LVEDP; EDV and VCF correlated best with the surgical risk.


[Acupuncture analgesia and controlled respiration. A new modified method of anesthesia in open heart surgery (author's transl)]. From October 1973 to February 1975 cardiac surgery with extracorporal circulation using Acupuncture as analgesia was performed in 88 patients in the surgical clinic of the University of Giessen. Acupuncture is performed by electric-stimulation of 8 points at the lower legs, the neck and ears with 90 V and 5-6 Hz. All patients are intubated; controlled respiration is maintained with 50% O2 and 50% N2O. During the whole operation, 20 minutes after intubation the patients are responsible. The main advantage of the new method we see in a good postoperative cooperation of the patients, which are generally extubabed in the operation room.


[Immunglobulin levels and alterations of the lymphocyte function after extracorporal circulation and massive blood transfusion (author's transl)]. Cardiovascular operations are connected with an increased risk of infection. Postoperatively there happened a temporary fall of all immunglobulin levels. Concerning the cellular immunity, we found an impressive decrease of the transformation of the lymphocytes in the presence of polyclonal mitogens which normalises only partially after the eighth day. These results refer to a complex alteration of the immunological apparatus, imposing as a temporary immundeficiency, and could contribute to an elucidation of the increased risk of infections.


[The influence of increased clotting reactions as shown by thrombosis formation in the immediate postoperative period on aortic valve prothesis (author's transl)]. Massive thrombosis formation on the valve periphery and on the top surface of the valve occurred in three patients (1,5%) in the immediate postoperative period with the Björk-Shiley valve in the aortic position. Between the third and sixth day these patients died of acute heart failure as a result of coronary artery displacement. Upon autopsy operative technical complications and postoperative infections were ruled out as the cause of death. What appears to be clinically important is an increase in clotting time in the immediate postoperative period which can be proven statistically. This increased clotting inclination was only found in these three patients and in one patient with frequent immediate postoperative peripheral embolic episodes. We therefore feel that early anticoagulation therapy is necessary. Heparin administration is preferred as it not only lowers the clotting ability of the blood but also the adhesive quality of the platelets.


[Heart valve surgery in bacterial endocarditis (author's transl)]. Bacterial endocarditis was the cause of heart valve destruction in 23 patients. Additional 5 patients were reoperated because of an infected valve prothesis. 13 were operated upon during the inactive stage. Nevertheless infection recurred after operation at least in one patient. 10 patients underwent operation during the active stage, 6 of these with stable cardiac function, 4 in cardiogenic shock. Hospital mortality was 2/6 and 1/4 respectively. One patient died after three months of persisting infection. Three of five patients with infected valve prosthesis survived reoperation. An attempt is made to define the indication for valve surgery in bacterial endocarditis.


[Reversibility or irreversibility of pulmonary function changes after cardiac surgery on insufficient or stenotic cardiac valves (author's transl)]. In 69 patients with mitral- or aortic valves disease lung function tests were made preoperatively and 2 to 4 years after cardiac surgery. We wanted to demonstrate the extent and the improvement of restriction, obstruction and disturbed diffusing capacity of the separate diseases with different severities. We found correlations between the clinical grade of the disease and the changes in lung function. In particular grade III of the mitral stenosis showed severe restriction, obstruction and disturbed diffusing capacity. Patients with mitral insufficiency III had changes of mild degree, aortic diseases were without disturbed lung function. All detected changes of lung function were irreversible and could not be influenced by postoperative hemodynamic improvements.


[The correlation between pulmonary hypertension and histological findings of the pulmonary vessels in congenital heart disease (author's transl)]. In nearly 100 infants the hämodynamic and histological findings of pulmonary hypertension in congenital heart diseases are correlated when a banding-procedure was done. There were: 45 ventricle septal defects, 10 atrio-ventricular canals, 13 transpositions of the great arteries, 16 patent ductus arteriosus and 7 miscellaneous. A hämodynamic hypertension was more frequent than the histological hypertension; but there was a difference in the different heart diseases: The patients with patent ductus arteriosus and hypertension show only in a few cases histological alterations; in infants with VSD the correlation was much more better. Whether a banding procedure of the pulmonary artery is able to provide the progress of pulmonary sclerosis may be discussed after a second excision of lung-tissue when the correction of the heart disease is done.


[Atypical aortic coarctation (author's transl)]. Special problems in the surgical treatment of aortic coarctation may be caused by unusual morphological findings as a long hypoplastic segment, the combination with pre- or poststenotic aneurysms or by atypical localisation of the stenosis in the aortic arch, the decreasing or abdominal aorta. A bypass procedure is considered as the method of choice for the repair of coarctation in the aortic arch or the "critical zone" of the abdominal aorta (renal- and suprarenal segment). The bypass-principle allows many variations of branching and avoids cross-clamping of the aorta. The involvement of important branches as is the left common carotid, the superior mesenteric or the renal artery, necessitates a vascular reconstruction in the same session. Probably the first report about a very rare combined lesions is presented: the combination of an aortic arch coarctation in association with a complete situs inversus (right descending aorta), a common carotid trunc, an aneurysm of the left subclavian artery (first branch of the arch) and congenital cysts of the right upper lobe of the lung (Case No. 1). Usually concomitant aneurysms are found in the pre- or poststenotic aortic segment. Some of the infrarenal fusiform aneurysms (Case No. 4 and 5) are occasionally of poststenotic origin, secondary to a longstanding infrarenal coarctation. In these cases the procedure of choice is the total exstirpation and the interposition of a Dacrongraft. Important branches (as the subclavian or renal artery) can be some times inserted directly in the vascular protheses. Using the bypass technic or the patch graftplastic of Vosschulte the risk of late operation (beyond the age of 30 years) may be remarkably reduced.


[Congenital incomplete aortic-arch-syndrome as a rare cause of cerebral ischemia in consequence of a steal-syndrome (author's transl)]. A subclavian-steal-syndrome of a congenital origin is a rare observation. The authors report on a 27 years old female patient with characteristic symptoms. The vascular deformity consisted of a right-sided aortic arch, a right descending aorta, separate origins of the anonymous and the right carotid arteries, and an aplasia of the proximal parts of the left carotid and the left subclavian arteries. A combined dacron-venous-bypass was placed from the ascending aorta to the left arm-neck arteries and thus cerebral circulation was improved and the patient got free from symptoms. Special problems of morphology and hemodynamics are discussed on the hand of arteriograms.


[Rupture of the right atrium following blunt trauma of the thorax (author's transl)]. A rupture of the right atrium following blunt trauma of the thorax was operated with success. The effectiveness of different diagnostic procedures is discussed.


[Single staged correction of congenital heart disease with patent ductus arteriosus: ductclosure with metal clip via a median sternotomy incision (author's transl)]. Using the Hemoclips a patent ductus arteriosus can easily be closed at its pulmonary origin via a median sternotomy incision. This enlarges the surgical indication for single staged correction of congenital heart lesions combined with a patent ductus arteriosus.


[Different ultrastructure of the right and left myocardium after preservation for 24 hours (author's transl)]. After a 24 hrs' preservation of rat hearts, in 22% the viability test with allogenic perfusion showed a singular recovery of the right ventricle (57 of 257 experiments). The ultrastructural aspects correlate with the differences of the function. The micrographs of the right myocardium show--except a mild edema--ultrastructural integrity, but the micrographs of the left myocardium show marked alterations of the ultrastructure: edema, swollen mitochondria with destroyed cristal membranes, swelling of the sacrotubular system and alterations of myofibrils.


[Mediastinal chondrosarcoma (author's transl)]. A 41 years old female patient was operated on account of mediastinal tumour. A chondrosarcoma of 10 X 8 X 8 cm was removed. The patient remained symptomfree and had no complaints over 4 years after the operation, but after this relapse and pulmonary metastasis developed. In connection with the demonstrated case the referring literature of mediastinal chondrosarcomas was surveyed and it could be established that this is the twentieth published case about mediastinal chondrosarcoma.


[Pulmonary sequestration combined with Bochdalek's hernia (author's transl)]. Representation on a case of lung sequestration in combination with a hernia of Bochdalek in a nine weeks old infant. A high standing right diaphragm, diagnosed through the X-ray pictures, commanded thoracotomy as choice approach to the diaphragm. On the inspection, we found a Bochdalek hernia and as an incidental finding, on the same side, a partly extralobar, partly intralobar sequestration of the lung.


[Pulmonary rhabdomyosarcoma (author's transl)]. A 55-years old patient is reported who became ill with recurrent attacks of coughing and haemoptysis some 3 weeks before death. An extensive mediastinal tumor was demonstrated radiologically. Pathoanatomical examination showed a pleomorphic rhabdomyosarcoma of the lower left pulmonary lobe with metastases in the right lung and regional lymph nodes.


[Analysis of two different surgical corrections of the coarctation of the aorta (follow up examination of 49 children) (author's transl)]. 36 children operated upon with the diagnosis coarctation of the aorta have been controlled in a follow-up examination. We payed special attention to the surgical technique and brought the results in connection with the method of operation. One group had the stenosis corrected by resection and end-to-end-anastomosis, the second group with plastic operation, either by a longitudinal incision, resection of a diaphragm and transverse closure, or by improving the dilatation using a dacron patch. The results in both groups are satisfactory. Actually we prefer to carry out the resection with end-to-end anastomosis. Plastic correction remains reserved for selected cases. We believe that the high mortality rate in infants can be reduced by operation in hypothermy and by removing the stenosis as completely as possible.


[Nuclear structures at late stages of Rana temporaria oogenesis. II. Autoradiographic data]. Seasonal dynamics of RNA synthesis in the nuclei of 3rd year vitellogenetic oocytes of Rana temporaria has been studied by autoradiography. The nucleoli and chromosomes exhibit the highest level of RNA synthesis in summer, when lampbrush chromosomes are well developed, and multiple nucleoli start moving away from the nuclear membrane. The weakening of RNA synthesis is observed in autumn, when the nuclear structures assemble in the centre of the nucleus to form the karyosphere. The synthesis level is the lowest in winter, and increases in spring. The karyosphere of Rana temporaria is involved in protein metabolism of oocytes. Possible reasons of the seasonal RNA synthesis dynamics by the oocyte nuclei are discussed.


[Effects of Hodgkin cytotoxic serum on electrophoretic mobility of normal and Hodgkin peripheral blood lymphocytes. (author's transl)]. The effect of Hodgkin patient cytotoxic sera on the electrophoretic mobility of normal and Hodgkin peripheral blood allo-lymphocytes has been studied. Contact with cytotoxic serum determined a significant decrease in the electrophoretic mobility of lymphocytes, due to the presence of cytotoxic antibody on the lymphocyte surface. The antibody seems to be directed against T-lymphocytes. The results are discussed in the light of the preceding data by the authors on the role of anti-T-autoantibodies in Hodgkin's disease.


Early acute aseptic iritis after cataract extraction. Severe iritis which occurs within the first five days after cataract extraction may be categorized as (1) bacterial endophthalmitis, (2) toxic iritis, or (3) aseptic iritis. These entities can sometimes be distinguished because of their clinical features. If bacterial endophthalmitis is suspected, anterior chamber paracentesis should be considered and appropriate antibiotic treatment should be initiated. Acute iritis may result from the introduction of toxic agents into the eye, and may follow the use of products sterilized with ethylene oxide. Early acute aseptic iritis probably occurs more often than has previously been recognized. Response to intensive anti-inflammatory treatment is usually prompt and dramatic. The judicious use of cryoextraction and the careful manipulation of intraocular tissues may minimize the incidence and the severity of postoperative inflammation.


[Electric stimulation of intestinal motility in the postoperative period]. The authors performed 208 electric stimulations of the bowel motor activity with the aim of prophylaxis and treatment of its postoperative paresis. The studies  have shown that electric stimulation accelerated considerably the process of rehabilitation of the bowel motor function, but it would not prevent the development of grave functional intestinal obstruction. But nevertheless  electric stimulation is a highly effective method in the complex of measures for treatment of grave functional intestinal obstruction. Electric stimulation of the bowel should be introduced in every day practice of intensive postoperative care departments.


[Intestinal lesions after chemical burns of the digestive tract]. Based on the analysis of 235 patients with chemical burns of the esophagus and stomach and their sequelae, as well as the data of 111 pathoanatomical and medicolegal autopsies in persons, died in different periods after poisoning with corrosive substances, a burn of the duodenum and small intestine was observed in 71 cases. It was found that such factors as an intake of large doses of caustic liquors, poisoning in full stomach, especially in a state of alcohol intoxication, largely contribute to retropyloric penetration of a corrosive substance. A burn of the duodenum and small intestine would considerably aggravate the life prognosis during the first days of poisoning, and the former was observed in every second patient who died. In later period insignificant lesions disappeared completely, while at the site of deep burns an isolated or associated narrowing of the duodenum and small intestine developed. Surgical interventions were performed mainly in later periods in the presence of scarring contractions of the duodenum and small intestine, that impede an intestinal passage, and were aimed at its restoration. In the early period operations were performed only in life risk complications (intestinal hemorrhages, peritonitis), and these were of a palliative character.


[Irradiated cases of cervical and breast cancer II. Comparative investigation of the immune status of irradiated cases with stage III cancer of the cervix and operated, non-irradiated cases (author's transl)]. Eleven patients with stage-III cancer of the cervix were investigated before, during and after radio-therapy in regard to their state of humoral immunity on the basis of determinations of the serum IgG, IgM and IgA concentration, of hetero- and isoagglutinins, of tetanus antitoxin before and after vaccination with toxoid, of measles antibodies and of the percentage of lymphocyte membrane fluorescence. The cellular immunity of the same patients was investigated by determination of the percentage of spontaneously-rosetting lymphocytes, of skin-test reactivity with DNCB before and after sensitization, of skin-test reactivity with candida, trichophyton, varidase, OT and staphylo antigen. The function of polymorpho-nuclear leucocytes was investigated by means of the NVT test and St. aureus, E. coli and latex particles. All investigations were performed both before, and 3, 6, 9 and 12 weeks after the commencement of radiotherapy and the results were compared with those of an operated, non-irradiated group (stages I b and II a). Two types of noteworthy results were observed: 1. A decrease in immunological reactivity, probably in connection with cancer, since this reaction was observed both in irradiated and in non-irradiated cases, characterized by lowered or absent immune answer to tetanus toxoid, lymphopenia, decrease in sensitization to DNCB and less positive skin tests to old tuberculin and varidase. 2. An additional inhibition (although in one investigation stimulation of the immune answer was also seen), probably in connection with radiotherapy, characterized by an additional decrease in immune answer to tetanus toxoid, in skin sensitivity to DNCB sensitization and in tests with old tuberculin, and an augmented lymphopenia, as well as an increase in positive skin tests with varidase. No significant changes were observed with any other method.


[ Histopathological changes in the thymus of the white mouse after infection with Toxoplasma gondii (author's transl)]. Three days after infection of mice with a virulent strain of T. gondii first histopathological destructions of the thymus are visible. The number of lymphocytes decreases step by step till to the animals' day of death on the 7th day p.i. At this time the cortex has lost all its thymocytes. Electronmicroscopical pictures show destruction of most of the reticulum cells and lymphocytes. In those cells which are still alive multiplicaiton of Toxoplasma trophozoites is to be seen. A lot of parasites are lying extracellular in the detritus of the destroyed thymus-cells. After infection of mice with an avirulent strain of T. gondii there is a loss of lymphocytes in the cortex of the thymus too. Starting at day 5th to 7th p.i. it reaches its peak at the time of the 10th to 15th day after infection. After this period restitution of lymphocytes in the cortex is going on. At about the 30th day p.i. replacement of all the lymphocytes is finished. Sometimes the cortex seems to be enlarged, that means now there are more thymocytes in the cortex than in uninfected controls. Neither reticulum cells nor lymphocytes show destruction of their ultrastructure. Only a process of activation of the lymphocytes can be seen by electronmicroscopy. In the lymphocytes the mitochondria are enlarged and there are more than in the controls. At the same time Golgi-apparatus and endoplasmatic reticulum become prominent.


[Simultaneous vaccination with BCG and measles vaccine: results of a controlled trial]. The main purpose of the controled assay on a combination of B.C.G. and measles vaccine was to ascertain whether these two vaccines could be administered on young children in simultaneous injections, in two different parts of the body and on the same day, and whether in that case they led to rates of haemagglutination inhibitory antibodies against measles on the one hand, and induration diameters of Mantoux's intradermoreactions against B.C.G. on the other, not inferior to rates and diameters obtained when using the same vaccines separately. This survey, carried out in Cameroon, involved one thousand individuals. It confirms the suggestion that the two vaccinations may be carried out simultaneously when circumstances require an early and total protection of a child population with minimum sanitary stress.


In vitro effect of metronidazole on the ultrastructure of Trichomonas vaginalis donné. The effect of metronidazole on the growth and fine structure of exponeentially growing cells of Trichomonas vaginalis was examined. Cell division stopped about one hour after the addition of 1-4 mug/ml of metronidazole, and the cells were apparently arrested in the interphase. One to two hours after the addition of metronidazole, the movement of flagella and of the undulating membrane had decreased, but cell death had not occurred until 7-8 hours later. The fine structure of the cytoplasm was changed 30 to 60 minutes after addition of metronidazole. Proportionally, the number of polyribosomes had decreased whereas the number of single ribosomes in the cytoplasm had increased. The electron-density of the cytoplasmic matrix was higher in cells which were treated with metronidazole than in cells from control cultures. The findings of the present study indicate that the initial effect of metronidazole on T. vag. cells in vitro is an inhibition of cell multiplication as well as an impairment of protein synthesis.


The origin of slow potentials in semicircular canals of the frog. Slow potentials generated in the sensory organ of the ampulla were recorded in isolated semicircular canals of the frog by means of fluid electrodes. These potentials, which may be picked up from the intrampullar fluid and those from the ampullar nerve appear to be generated at different stages of the process taking place in crista ampullaris. Slow intra-ampullar potentials apparently reflect receptor potentials of hair cells. They are preserved after degeneration of the nerve fibre endings and are relatively insensitive to DNP poisoning; their amplitude is maximum at high K+ concentrations. Slow nerve potentials appear to be due to electronic spreading of post-synaptic excitatory potentials generated at cytoneural junctions. They disappear after degeneration of the nerve fibres, in low Ca++ and high Mg++ solutions and are extremely sensitive to DNP poisoning. An analysis of the time-course of the slow ampullar and nerve potentials referred to the discharge of impulses in afferent fibres was performed with a view to interpreting the transduction mechanism of semicircular canals.


A reexamination of "neck reflex" eye movements in the rabbit. Horizontal eye movements of rabbits were recorded during sinusoidal oscillation (15-40 degrees, pk-pk; 0.1-8 Hz) and step displacement of the body in yaw about a fixed head. Modulated, slow-phase eye movements followed all frequencies of stimulus with relatively invariant amplitudes (2-4 degrees). Saccadic movements, up to 17 degrees, accompanied all frequencies of oscillation and particularly step displacements. Saccadic amplitude was unrelated to measurable characteristics of the stimuli but was a function of arousal. The latency of any eye movement was a minimum of 80 msec. It is concluded that none of the observed eye movements provide stabilization during head movements but are evidence of the contribution of neck information to general mechanisms of whole body orientation.


Comparison of skin test results obtained with different dust, Dermatophagoides; Acarus siro and spider extracts. The authors describe the comparative analysis of skin tests performed in 87 asthmatic children with extracts of house dust, grain dust and different arthropodes beloging to the Arachidaegenus. Most of these patients were living in traditional agricultural environment. Reactions to the Acarus siro and grain dust (Sevac) extracts gave significant correlation, whereas house dust did not show this agreement. Extracts from spiders (Aranidae) caused often, in 40% of asthmatic children, positive skin reaction; that was the same frequency as with Dermatophagoides, nevertheless the correlation was only partial. The authours conclude that Acarus siro and antigenically related mites are the main allergizing component of grain dust; excretes of spiders display a comparable allergizing factor in house dust as do Pyroglyphid mites in this area.


Use of problem-oriented medical record in psychiatry: a survey of university-based residency training programs. A survey of university-based psychiatric residency training programs revealed that nearly one-half of them use the problem-oriented medical record (POMR) and that conversion to this system appears to be growing rapidly. Experiences with the method have in general been positive. The author identifies factors associated with successful operation of the POMR and suggests that an integrated, hospital-wide adoption of the system may be crucial.


Analysis of tasks and human factors in anesthesia for coronary-artery bypass. A comprehensive task analysis of the anesthetist's activities during coronary-artery bypass procedures was carried out using time-lapse cinematography. This film was analyzed frame by frame to detect types of activities and the proportion of time spent on each. Link analysis was used to reveal recurring sequences of activities. Of the 9 activity categories, the anesthetist spends the greatest portion of time observing the patient and scanning the entire operative and monitoring field. Ten to 15% of the time is spent logging data on the anesthetic record. The challenge for the anesthetist is to optimize his performance, and those under his direction, in the face of the changing workload resulting from variations in patients' conditions. Use of an automated monitoring system that charts patient vital signs would allow the anesthetist to apportion this time among other tasks.


Nitrous oxide encephalography: 5-year experience with 475 pediatric patients. 475 pediatric patients with a variety of neurologic conditions were subjected to encephalography, using N2O as the contrast medium and N2O-halothane as anesthetic agents. This technic is both safe and effective, as reflected by no mortality and satisfactory roentgenograms. By application of the principles of gas physics, postoperative discomfort has been greatly reduced, resulting in a more comfortable convalescence and earlier discharge.


The 9p- syndrome.

The 9p- syndrome. Six patients (4 females and 2 males) with terminal deletion of the short arm of chromosome 9 distal to band p22 are described. The disorder constitutes a clinically identifiable syndrome consisting of mental retardation, sociable personality, trigonocephaly, mongoloid eyes, wide flat nasal bridge, anteverted nostrils, long upper lip, short neck, long digits mostly secondary to long middle phalanges, and predominance of whorls on fingers. The findings suggest that the clinical features are antithetical to the trisomy 9p syndrome. The deleted chromosome segment is relatively small and could be easily overlooked. It is hoped that this delineation of clinical features seen in 9,p- patients may help in focusing attention on the small deletion.


[Partial trisomy 15q due to maternal translocation t(7;15)(q35;14)]. Partial trisomy for the long arm of chromosome 15 was detected in a 21-year-old girl with severe growth and mental retardation. A balanced reciprocal translocation - t(7;15)(q35;q14) - is present in the mother.


Trisomy 19 q.

Trisomy 19 q. Two sibs with trisomy for the long arm of chromosome 19 are reported. The common features included flat facial profile with microcephaly, hypertelorism, ptosis, prominence of the glabella, small nose with anteverted nostrils and a characteristic fish-shaped mouth. In addition congenital heart disease, physical retardation and seizures were seen in both sibs. That tristomy 19q can be suspected clinically is emphasized.


[Attempt at antenatal diagnosis of argininosuccinic aciduria]. Antenatal diagnosis in a woman previously delivered of a child with arginino-succinic aciduria, due to deficiency of arginino-succinase (EC 4.3.2.1.), showed the fetus to be unaffected. This was confirmed at birth.


[Distribution of chromosome breakage point induced by arabinosylcytosine on in-vitro human lymphocytes]. The cytogenetic effects of arabinosyl cytosine on human leukocytes in vitro has been studied using continuous and discontinuous treatments. Optimum activity occurs at the end of the S period. Interchromosomal distribution of breaks is non-random. The hypothesis of a very late replication for some chromatid segments is discussed. The relations between banding and the position of breaks are discussed.


[Partial 7 q trisomy. One or 2 syndromes? Apropos of a new case]. Partial trisomy 7qter due to malsegregation of a familial balanced translocation t(7;8)(q33;p113) is reported in a 2-year-old boy with the following features: psychomotor retardation (IQ = 46); hypotonia; normal; facial asymetry with palpebral fissures slanted downwards and outwards, deeply set eyes, and divergent strabismus.


De novo appearance of a translocation t(5p; 2Iq), and its transmission in both balanced and unbalanced forms to the next generation. A family is described in which a reciprocal translocation involving 5p and 21q appeared de novo in the chromosome complement of a woman who then transmitted it in both balanced and unbalanced form to her progeny. The proposita, a child with the cri du chat syndrome, had a deficiency for most of 5p, all of 21p, 21 centromere, and a small proximal segment of 21q. The reported cases of the cri du chat syndrome associated with translocations are reviewed and discussed in relation to this family.


Chromosome breakage in low birth weight newborns. The frequency of chromosome aberrations in cells cultured from umbilical cord blood was determined for 50 low birth weight (LBW) and 50 normal birth weight (NBW) euploid newborns matched for sex, race, and maternal age. The metaphase spreads had been prepared in the course of an earlier study of frequency of aneuploidy and results are from 72-h cultures, i.e., presumably, at the second division in vitro. There were no significant differences between the two groups in the frequency of cells with chromosome breakage, chromosome gaps, or hyperdiploid cells. There was, however, a significantly higher frequency of hypodiploid cells in the LBW group. The present findings differ from those of others who have reported an increase in chromosome breakage in premature newborns.


Deletion - translocation del (12) (p11) leads to (t10;12) (p13;pII). Renewed examinatinon with improved banding techniques of a boy previously reported to have the karyotype 46, XY,del(12)(p11) revealed a translocation 46, XY,t(10;12)(p13;p11), and reexamination of a boy previously reported to have the karyotype 46,XY/46,XY,del(5)(p13) showed the same mosaicism, but with a significantly lower frequency of cells with del(5)(p13), 8% compared with 23% at the time of birth. The decrease of the frequency of cells with chromosome abnormality in mixoploids during the first years of life as found in the present case as well as in prevously reported cases is discussed.


Trisomy iop.

Trisomy iop. A stillborn male fetus having a trisomy of the short arm of chromosome No 10 is described. The father is a carrier of the reciprocal translocation 46XY,t(10;21) (10pter leads to 10p11::21p11 leads to 21qter). The clinical picture included growth retardation, bilateral cleft lip and palate, micrognathia, short neck, microphalus and bilateral clubbed feet. The long bones were markedly thinned with spontaneous fractures. Autopsy findings included pulmonary hypoplasia and renal dysplasia. Previous reports of trisomy 10 and trisomy of the short arm of chromosome 10 are discussed.


[Trisomy 10 p. A previously reported case explained by binding]. A previously reported male infant having died at 4 months, was considered trisomic Cp, his mother being carrier of balanced translocation t(Cp-;Bq +). Reexamination of the chromosome complement after R-banding showed the translocation to be t(4;10)(q35;p11). The propositus was therefore trisomic 10p. The essential clinical features were: a small birth weight and a short birth length; hypotonia; psychomotor retardation; dolichocephalia; a high and bulky forehead; narrow lips; large, lowset ears with a posterior rotation; a small chin; bone and joint anomalies; dextrocardia.


[Trisomy 11 q (q23.1 - qter) through maternal translocation t(11;22) (q23.1;q11.1). A new case]. A 4-year-old boy with partial trisomy 11q resulting from malsegregation of a maternal translocation, t(11;22)(q23.1;q11.1), exhibits the following malformations: severe mental deficiency; growth retardation and hypotonia; brachycephaly with flattened occiput and forehead; facial dysmorphia; pre-auricular fistula. These features are in good agreement with the syndrome recently described for partial trisomy 11q. The translocation appears to be identical in that in three other families already reported.


[Investigations of the T and B cells and the hemopexin-carrying lymphocytes in cases of porphyria cutanea tarda (author's transl)]. The immunoglobulins and hemopexin carrying cells have been determined in 14 patients having Porphyria cutanea tarda and in 15 healthy volunteers. At the same time, the stimulating effect of phytohemaglutinine and the leucocytesmigration inhibition by purified tuberculine proteins, were measured. In the 14 cases of Porphyria cutanea tarda, the IgG content and the number of hemopexin carrying lymphocytes was significantly increased, while the amounts of the other immunoglobuline carrying cells, and of T lymphocytes, was unchanged. Phytohemaglutinine stimulation and inhibition of leukocytes migration by purified tuberculine proteins were found to be identical in both patients and control groups.


Immunoglobulin binding factor (IBF) produced by T cells: selective interaction with slow migrating rabbit IgC. Antigen-stimulated T lymphocytes release a variety of soluble factors among which an Immunoglobulin Binding Factor (IBF). We report a method of titration of IBF making use of its capacity to inhibit complement-dependent hemolysis of sheep erythrocytes sensitized with rabbit IgG antibodies. Using this technique we have investigated the specificity of IBG for rabbit immunoglobulins fractionated by DEAE-cellulose chromatography. The interaction of IBF with IgG is found to be restricted to the slowest migrating fractions of rabbit IgG.


Transformation of human lymphocytes in vitro by autologous and allogeneic rheumatoid synovial fluids. To assess the possible participation of cellular immune mechanisms in the pathogenesis of rheumatoid arthritis (RA) in vitro studies of the blastogenicity of rheumatoid and non-rheumatoid synovial fluids for human peripheral blood lymphocytes were conducted. In autologous cultures it was found that 13 of 19 rheumatoid fluids induced significant lymphocyte blastogenesis, whereas only 1 of 13 nonrheumatoid fluids induced such a response. In allogeneic cultures rheumatoid fluids induce significant blastogenesis of RA lymphocytes in 18 of 23 experiments, and of non-RA lymphocytes in 8 of 18 experiments. By contrast, nonrheumatoid fluids induced significant blastogenesis of RA lymphocytes in 2 of 13 experiments, and of non-RA lymphocytes in 1 of 14 experiments. The blastogenicity of fluids was found to correlate significantly with the presence therein of immunofluorescent intracellular inclusions of immunoglobulin and complement. These studies support the concept that the presence of immune complexes in the majority of rheumatoid synovial fluids might render the latter blastogenic for human lymphocytes in vivo, thereby perpetuating rheumatoid synovitis.


[Cold lymphocytotoxins: their relationship with various physiological and pathological conditions]. The significance of cold lymphocytotoxins, observed at 15 degreesC, is not clearly understood at the present time. The frequency of their appearance has been studied in normal subjects (blood donors, aged people, vaccinated subjects, post-traumatic splenectomy) and in patients with a neurologic disease (multiple sclerosis), a neoplasic disease (breast cancer)and hematologic diseases (thrombocytopenia, acute leukemia, chronic lymphatic leukemia, Hodgkin disease and systemic lupus erythematosus). There are no antibodies found in the geriatric group; they are found only in 3,9 % of blood donors and in 18 % of the subjects after vaccinations. A range of 17 to 30 % is found in subjects with breast cancer or multiple sclerosis. More than 50 % of the individuals with Hodgkin disease or lupus erythematosus produce these antibodies (52 % and 73 % respectively). In acute leukemias and chronic lymphatic leukemias, lymphocytotoxic antibodies sometimes appear at 37 degrees, reacting with autologous cells and having no HL-A specificity.


Early and late results after surgical treatment of preinfarction angina. Among 3,707 patients who underwent aortocoronary bypass, 302 had preinfarction angina. Coronary angiography revealed single-vessel disease in 43 patients, double-vessel disease in 81, and triple in 178 patients. Plane ventriculography showed contractility to be normal in 178 patients, fair in 88, and poor in 36 patients. Left ventricular end-diastolic pressure was normal in 203 patients, 13 to 23 mm Hg in 73, and larger than or equal to 24 mm Hg in 26 patients. Using cardiopulmonary bypass and moderate hypothermia, single coronary bypass was performed in 45 patients, double bypass in 120 patients, triple in 118 patients, quadruple in 15, and quintuple in 4 patients. Right coronary artery endarterectomy was necessary in 22 patients. The early mortality was 6.6% (20 patients) and was strongly related to poor contractility and congestive heart failure. One- to four-year follow-up data were obtained in 126 patients. Late myocardial infarction occurred in 11 patients and caused 4 late deaths; 3 unrelated deaths occurred. Ten patients experienced no benefit from their operations, 56 are completely asymptomatic, and 53 are significantly improved. Our results show that surgical intervention can improve the poor prognosis of preinfarction angina and appears to be superior to medical treatment.


Intraaortic balloon assistance.

Intraaortic balloon assistance. Intraaortic balloon (IAB) assistance in 64 patients over 2 1/2 years has resulted in a survival rate of 11% (1 patient) when used alone but 47% when utilized in patients treated surgically (long-term survival, 38% [21 patients]). Patients undergoing coronary artery bypass grafting or aortic valve replacement have a long-term survival of 50% (8 and 9 patients, respectively). The required duration of IAB support has a bearing on the clinical result. Complications have been minimal. Though it was originally developed to assist in the nonoperative management of complications of ischemic heart disease, IAB assistance offers significant promise as an adjuvant to operative therapy for both ischemic and valvular heart disease.


Local deep hypothermia for combined valvular and coronary heart disease. Local deep hypothermia was utilized as the sole method of myocardial protection in 113 consecutive aortic valve replacements. Thirty-six patients had simultaneous revascularization, mitral valve replacement, tricuspid valve replacement, or a combination of these. In follow-up for as long as 36 months there have been 3 hospital deaths (2.6%), all occurring in the group having isolated aortic valve replacement. No hospital deaths occurred among patients undergoing a combined procedure.


Experience with the radial artery graft for coronary artery bypass. Forty-eight radial artery grafts and 22 saphenous vein grafts in 37 patients undergoing coronary bypass procedures were studied early postoperatively. Most of the saphenous vein grafts were patent, but one-half of the radial artery grafts were occluded. Failure of the radial artery grafts could not be attributed to unfavorable runoff in the recipient vessels. Radial arteries carrying higher flows and those to vessels having more severe degrees of proximal stenosis occluded with a higher frequency. The radial artery should not be used for coronary bypass.


In favor of the Y-graft for aortocoronary bypass. The technique of multiple coronary artery bypass grafting has included separate conduits, snake grafts, and Y-grafts. Against the Y-graft have been reports of lesser patency and several theoretical objections. The theory is discussed and a laboratory model presented which demonstrates a flow difference of 2 ml/5 sec or less between Y-grafts and single grafts. In conjunction with this, 171 patients having aortocoronary bypass were analyzed and showed a combined one-year graft patency of 77% with no significant difference between single grafts and Y-grafts. It is concluded that the technical simplicity of Y-grafts is advantageous and that, if the operation is performed within the guidelines set forth, revascularization with Y-grafts is an acceptable method.


Pathological changes in surgically removed aortocoronary vein grafts. Pathological changes in aortocoronary vein grafts were investigated in 17 patients who had a second revascularization procedure 1 to 53 1/2 months after their initial operation. Subendothelial proliferation was present in all grafts and had resulted in total occlusion of 7. With increasing duration of implantation the proliferative lesions tended to show hyalinization and to affect the media. Advanced atherosclerosis had developed in 2 grafts.


Unexpected death following aortocoronary bypass. Since 1968, 1,800 aortocoronary bypass procedures have been performed with 37 operative or early postoperative deaths (2.1%). Twenty-one deaths (57%) occurred in patients with one or more of the following predetermined risk factors: ventricular aneurysm, decreased left ventricular contractility, left main coronary artery stenosis, valve replacement, recent infarction, or cardiogenic shock. The remaining 16 deaths (43%) were unexpected and occurred in patients with none of these risk factors.


Transthoracic intraaortic balloon cannulation to avoid repeat sternotomy for removal. Cannulation of the ascending aorta for intraaortic balloon assistance is a practical alternative to the standard transfemoral cannulation in patients with significant aortoiliac occlusive disease. One disadvantage of ascending aortic cannulation has been the requirement for a repeat sternotomy to remove the balloon. This report describes the successful implementation in 2 patients of a technique of ascending aortic balloon insertion and removal that avoids a second sternotomy.


[Legal abortion and hemostasis. Histological examinations and comparison to post partum hemostasis (author's transl)]. 30 women were examined to determine the hemostasis during the legally induced abortion. The blood coagulated in the intervillous spaces while the fetus is removed. Immediately after the termination of the curettment the nidation area is covered by filaments of fibrin and incorporated erythrocytes. More frequent as post partum platelet thrombi occur especially in the area of decidua parietalis. The intravascular findings are similar to post partum changes after the removal of the placenta. Obstruction clots of the spiral arterioles contain fibrin deposits, pletelet thrombi and erythrocytes (mixed form of thrombi). Residual decidua and trophoblast cells are seldom involved in the obturation of the vessels. The traumatic damages of the uterine wall are described (extravascular fibrin deposits, interstitial bleeding, succulent tissue a.s.o.).


The influence of protease inhibitor on hydroproteolytic activity and serotonin content in the intestine of rats after fractionated irradiation. Hydroproteolytic activity and content of serotonin in the small intestine and colon were studied in rats X-irradiated on the whole body with fractionated doses of 5 X 150 R. Twenty-four hours after exposure to X-rays, lipase, acid phosphatase activities and cathepsin activity as well as serotonin content were assayed in the intestinal tissues. Irradiation altered the hydroproteolytic activity of the tissues, in a majority of cases by increasing hydrolytic activity and lowering proteolytic (catheptic) activity in all parts of the small intestine and decreased serotonin content in the first and third segments of the small intestine. Trasylol injected s.c. in doses of 10,000 units/kg before and after irradiation modified hydrolytic tissue activity of the studied segments of the intestine and lessened the fall in serotonin content of the intestines after irradiation.


[Secretory granules in cardiomyocytes].

[Secretory granules in cardiomyocytes]. The specific granules having the appearance of spherical formations of 2000-4000 A in diameter are described in the cardiocytes of the atria and ventricles of mature frogs (R. temporaria). Each granule consists of electron dense granular matrix and a membrane up to 60 A trick. The amount of these granules in the cardiomyocytes of the atria is greater and they occasionally form accumulations, connected as a rule with the elements of the lamellar complex. The rough reticulum is better developed in the cells containing clusters of granules. The granules described are considered to be secretory ones.


[Morphologic changes in the lymph microcirculation of serous membranes in rheumatism and systemic lupus erythematosus]. Microcirculation consists of two elements--hemomicrocirculation and lymphomicrocirculation, the both being closely interrelated with each other. Lymphomicrocirculation was studied on the serous membranes taken from dead people who had died of rheumatism and systemic lupus erythematosus (SLE). The microcirculatory bed in the serous membranes was identified by V. V. Kupriyanov's method. The results of the studies showed that in serous membranes in rheumatism there occurred gradual emptying of lymphomicrocirculation and at the same time--compensatory-adaptive and regeneratory processes, the latter being manifested in formation of blind projections of capillaries, in broadening of the lumen. In SLE the lymphatic link actively participated in elimination of metabolism products and underwent a continuous rearrangement with formation of closed and communicant cysterns. Moreover, there was noted a new formation of lymphatic capillaries, which should be considered as a compensatory-adaptive process. Hemo- and lymphomicrocirculation elements are intimately connected due to close contacts between capillaries of the two elements of microcirculation, however, without formation of connecting fistulas. Hemo- and lymphomicrocirculation is an integrate, and under conditions of pathology there developed therein compensatory-adaptive and regenerative processes aimed at the maintenance of tissue metabolic and hemodynamic homeostasis.


[Lymphoid tissue and the body's non-specific resistance]. In experiments on rats and mice the author and his pupils showed that nonspecific effect of stimulators brought about in the first hours following the exposure migration of cells from the lymphoid organs, increase in the number of lymphoid cells in the bone marrow by 40-60%, appearance in the bone marrow of T-cells, and increase in the number of hemopoietic cells (CFU). This contributed to the activation of hemopoiesis and to development of transient hyperplasia of the bone marrow to the stage of elevated resistance of the organism. It was shown that transplantation of T-cells performed in the first hours after the sublethal irradiation hastened regeneration of hemopoiesis. All the data indicated above testify to the role of the lymphoid tissue in nonspecific resistance of the organism.


[Meningo-encephalic tuberculosis in childhood. Anatomo pathological study of 10 cases]. The anatomo-pathological study of ten cases of tuberculosis of the central nervous system (CNS) in children under 10 years old is reported. The emphasis is given to the macroscopic and microscopic changes produced by the tuberculosis in the meninges, in the nervous parenchyma  and in the vessels. The clinical and pathological findings are discussed and correlated with the literature. The authors concluded that: 1) the lesion in children with tuberculosis of the CNS is generally a proliferative meningoencephalitis; 2) the nervous parenchyma may be affected by the contiguous propagation of the tuberculous process or by the circulatory changes secondary to the arterial lesions; 3) because of the localization of the endocranial vessels in the sub-arachnoidal space they are generally injured by the inflammatory process, which can determine an obliterating endarteritis, which can be observed by a carotid angiography.


The transcochlear approach to the skull base. A new approach to tumors of the skull base is described. This approach is accomplished by forward extension of the translabyrinthine opening into the cerebellopontine angle. The facial nerve is mobilized in the temporal bone from the stylomastoid foramen to its entrance into the internal auditory canal. Having removed the barrier of the facial nerve, additional bone removal can be carried forward to the internal carotid artery, which now becomes the forward limit for temporal bone resection. The access attained through this exposure allows removal of tumors arising from the petrous tip, as well as tumors arising directly from the clivus. We provide the case histories of four patients in whom this approach was successfully used in removal of skull base tumors.


Alpha 1-antitrypsin activity of perilymph. Occurrence during progression of otospongiosis. Previous studies by the Adams method demonstrated a strong correlation between hydrolytic enzyme activity of perilymph and progression of bone conduction loss two years preceding stapedectomy. Alpha 1-Antitrypsin was chosen since its activity can be very precisely measured by a radical immunodiffusion technique and since it is one of the enzymes identified in perilymph of patients with active otospongiosis. Samples of 3 mul to 5 mul of perilymph removed during 103 stapedectomies and samples of known alpha 1-trypsin activity were placed on slides coated with alpha 1-antitrypsin serum. The zone of diffusion was stained and measured after 38 hours of incubation. Antitrypsin values were lowest in 24 cases, two with no preoperative bone conduction progression, three with moderate progression of 10 to 15 dB, and 19 with rapid progression of more than 20 dB. They were highest in 36 cases with no progression, and in one case with moderate progression. This study confirms previous reports on the enzymatic activity in otospongiotic disease.


alpha-1-Anti-trypsin, an inhibitor of renin. A naturally occurring competitive inhibitor of pig kidney renin has been identified in human plasma. The inhibitor was shown to be alpha-1 anti-trypsin and the effect in vitro on the renin activity was examined. The slope in the Hill plot is compatible with the assumption of one-site competitive inhibition. Other proteinase inhibitors, such as alpha-2-macroglobulin and C1 inactivator, however, have no inhibitory effect on the renin-angiotensinogen reaction.


Cochleo-vestibular disturbances in diving. Insidious development of high-tone sensorineural hearing loss may be associated with diving, but the evidence is not certain and further research is needed. 'Internal ear barotrauma' can cause an acute or relatively acute onset of hearing loss and/or vertigo, and it may be that 'alternobaric vertigo' provides a link between the insidious and acute forms of labyrinthine injury in diving. With deep diving, decompression sickness and other syndromes can also affect the cochleo-vestibular system. These aetiologies and effects will be discussed, together with evidence from an audiometric survey of naval divers and of 5 experimental deep divers.


Effect of aprotinin on immunological resistance in tumour-bearing animals. Previous studies suggested that aprotinin might enhance the host's immunological resistance to tumours. This possibility has now been further investigated by studying the behaviour of tumours in both hamsters and mice. A second tumour graft in tumour-bearing hamsters appeared more rapidly than the first. Prior administration of aprotinin abolished this effect. Pretreatment of non-cancerous mice with cortisone nullified the effectiveness of aprotinin in inhibiting the growth of a subsequent tumour graft. These results are interpreted as additional evidence that aprotinin enhances the immunological system against tumour cells.


Immunological classification of acute lymphoblastic leukaemias: evaluation of its clinical significance in a hundred patients. The use of T and B lymphocyte markers and of different antisera raised against malignant B cells and fetal thymocytes allowed the classification of 100 patients with acute lymphoblastic leukemia (ALL) into three groups. (I) Patients with non-T non-B ALL whose cells were devoid of conventional B and T markers but characterized by a leukaemia associated antigen (69 cases). (2) Patients with T-derived ALL (28 cases). (3) Patients with ALL of B cell origin (three cases). The search for haematological and clinical correlations showed that those patients with T-derived ALL tended to have a higher leucocyte count (P=0.05) and acid phosphatase positivity of blast cells (P= 0.01), a higher incidence of tumour presentation (P=0.05) and a thymic mass. Survival curves for the two main groups of patients are similar at 36 months but meningeal relapses were more frequent in patients with T-derived ALL (P=0.02).


Quantitative determination of factor-VIII protein by two-stage gel electrophoresis. A new method for the quantification of factor-VIII protein in plasma is described which utilizes only commercially available equipment and material. The procedure involves separation of factor VII from other plasma proteins by a two-stage sodium dodecyl sulphate gel electrophoretic technique and quantification of the protein by scanning densitometry. The plasma from normal individuals, haemophiliacs, obligate carriers of haemophilia and patients with von Willebrand's disease have been examined by this technique. In general, the data support the earlier findings obtained by quantitative immunoelectrophoresis. In addition, some abnormalities not detected by immunoelectrophoresis are observed by the gel electrophoresis technique.


Droplet degeneration of the cornea in North Cameroon. Prevalence and clinical appearances. The prevalence of droplet degeneration of the cornea in a defined population of 517 persons in north Cameroon was similar in males and females, but severe changes were commoner in elderly men. Most cases showed only mild changes of granularity and droplet formation in Bowman's zone, but they were sometimes widespread. More severe changes were seen in only nine patients. The clinical appearances are compared with those described from other parts of the world. In support of the aetiological role of direct sunlight, droplet degeneration was much more prevalent in the savanna than in the rain-forest in Cameroon. The condition ranges in severity from very mild to very severe, but difficulties in differential diagnosis, particularly in advanced cases, make it doubtful whether the same basic condition is being described in all cases. These doubts will be resolved only by properly conducted epidemiological studies in different parts of the world.


A 4-vinylprotochlorophyllide complex accumulated by "phofil" mutant of Rhodopseudomonas spheroides. An authentic intermediate in the development of the photosynthetic apparatus. A photosynthetically competent mutant strain of Rhodopseudomonas spheroides was isolated. In addition to bacteriochlorophyll, this organism produced particle-bound precursor 4-vinylprotochlorophyllide. The spectral characteristics of the pigment complexes(es) accumulated in the culture medium were very variable. The spectral form occurring within the bacteria was characterized from fluorescence data. Its particle weight, 130 000, was determined by Sephadex G200 filtration. The main components of the complex were protein, lipid and pigment (6.8:61, w/w). As indicated by qualitative analysis, the lipid components were characteristic constituents of the photosynthetic membrane. Kinetics of pigments synthesis showed that the total pigment synthesis was not affected by the mutation; bacteriochlorophyll content was always lower in the mutant than in the parent strain. The repigmentation process was followed by fluorescence emission. The results indicated that the mutation affected membrane component synthesis required for the bacteriochlorophyll(ide) incorporation. The pigment complex was concluded to be an authentic intermediate in photosynthetic apparatus morphogenesis. The reasons for its excretion are discussed.


Separation of human lymphoid cells by preparative cell electrophoresis. III. Studies on cells of lymphoid organs in hematological normal persons. Blood and bone marrow lymphocytes and cells of lymphoid organs in hematologically normal persons have been studied using free-flow electrophoresis by which a preparative separation of cells according to their electrophoretic mobility is achieved. The results are demonstrated as electrophoretic distributions. Blood lymphocytes have a peak corresponding to relative high electrophoretic mobility, whereas the majority of marrow lymphocytes is found in fractions corresponding to low electrophoretic mobility. The distributions of small lymphocytes from tonsil, spleen and lymphnode either resemble the distribution of blood lymphocytes or have a bimodal fashion with peaks corresponding to blood lymphocytes or marrow lymphocytes. Large lymphoid cells capable of DNA synthesis are concentrated in fractions of intermediate mobility. The results confirm the concept that peripheral T cells have a high electrophoretic mobility whereas most B cells are of low mobility. In contrast to peripheral T cells, cells of the thymus have an intermediate or low electrophoretic mobility. Thus, it appears that in the lymphoid cell system differences in the electrophoretic mobility not only reflect different functional properties but also differences in maturation stages.


Local anesthetic alteration of miniature endplate currents and endplate current fluctuations. The effect of the local anesthetic QX222 on the kinetics of miniature endplate currents and acetylcholine induced endplate current fluctuations was studied in voltage clamped cutaneous pectoris muscle of Rana pipiens. Both the endplate current fluctuation spectra and the miniature endplate current decay consisted of two or three components depending upon the holding potential and local anesthetic concentration. The cutoff frequency of each spectral component was equal to the decay rate of its corresponding constituent of the miniature endplate current. Comparison of the relative amplitudes of the spectral and miniature endplate components indicated that QX222 did not act by creating two kinetically distinct populations of acetylcholine receptors. QX222 action could be explained by alteration of the acetylcholine receptors such that they sequentially change conformation form one open state to another. A specific case in which QX222 binds to the open state of the acetyl-choline receptor creating a blocked state, was found to account for the observed relationship between the relative amplitudes of the miniature endplate current and spectral components, as well as the previously observed voltage and concentration sensitivity of the decay rates of endplate current components.


Myelin x-ray patterns reconciled.

Myelin x-ray patterns reconciled. Two different X-ray diffraction patterns have been published for frog sciatic myelin. Here the apparent discrepancy is attributed to different spacings between the myelin membranes in the two experiments. Assuming the single membrane has the same structure in the two cases, some restrictions on the phasing are indicated. Several possible profiles for the single membrane are then considered. A profile derived by assuming a lecithin cholesterol-like bilayer within the membrane accounts for all the published data. Three published profiles also are considered. These are not quite in as good agreement with observation, but they cannot be excluded at present.


Pulsed nuclear magnetic resonance study of 17O from H217O in rat lymphocytes. Lymphocytes obtained from thymus glands of normal rats and culture lines of malignant rat thymocytes were enriched with H217O. The longitudinal and transverse relaxations of the 17O were determined separately in samples of packed cells and supernatant solutions. The longitudinal relaxation of intracellular 17O of fresh viable lymphocytes was nonexponential, becoming simply exponential with eventual necrosis. The rate of spin-lattice relaxation (1/T1) was fitted by a sum of two exponentials. The average mole fraction of the molecules subject to the slower relaxation rate (1/T1s) was two-thirds of the total water. Lowering the Larmor frequency (omega) from 7.72 to 4.36 MHZ increased the faster component (1/T1f) by 12% without altering (1/T1s). The value of the single exponential decay of the nonviable cells was not appreciably different from the initial rate of relaxation of the fresh cells. Similar results were obtained in studies of the transverse relaxation rates. The simplest interpretation is that two-thirds of the cell water is located within the nucelus and is characterized by a slower rate of relaxation than the one-third of the cell water in the cytoplasm because of the different macromolecular compositions of the two-subcellular compartments. The malignant lymphocytes were characterized by prolonged values for the slow and fast components of both the longitudinal and transverse relaxations of 17O.


[The role of catecholamines in the centrifugal regulation of taste receptors]. An electrophysiological method was used to study the centrifugal inhibition of the impulse activity of taste receptors of the frog tongue. A deficiency of catecholamines in the organism (reserpinization) or perfusion of the adrenaline-blocking agents through the lingual vessel (propranololi hydrochloridum, dibenamine) were found to prevent the centrifugal inhibition, while perfusion with an adrenomimetic agent (epinephrine) enhanced this effect. Such effects of the adrenergic agents were also observed in the animals which were subjected to desympathization by bilateral extirpation of the first ganglion of the sympathetic chain. A conclusion was drawn that catecholamines in the papilli were necessary to obtain the central inhibition influences on the function of the taste receptor apparatus.


[The effect of the polyvalent proteinase inhibitor, trasylol, on antibody formation under normal conditions and in experimental atherosclerosis]. Antibodies to erythrocytes of sheep and human serum albumin were formed in rabbits with alimentary atherosclerosis as intensively as in control. Trasilol failed to affect the antibody formation in normal animals, but sharply decreased the production of specific immunoglobulins (especially the 7S) in rabbits with experimental atherosclerosis. Thus, the action of the preparation is realized not by way of direct inhibition of functional activity of the lymphoid tissue cells, but by inhibiting the immunostimulating factor circulating in the blood in experimental atherosclerosis.


[Electrotonic potentials of spinal cord dorsal roots in frogs with experimental tetanus]. Tetanus toxin administered to frogs in doses which produced general tetanus depressed the reciprocal inhibition of spinal reflexes. This depression was not associated with the block of the processes which led to depolarization fo the central terminals of the primary afferent fibers.


[Quantitative characteristics of the phenomenon of acceleration of hematopoiesis regeneration in thymocyte transplantation]. Experiments were conducted on hybrid mice (CBA X C57BL) F1. The quantitative characteristics of the phenomenon of acceleration of postirradiation bone marrow regeneration in transplantation of syngenous thymocytes was given. It was revealed that in the range of 10(6)--10(8) cells the effect was independent of the number of transplanted thymocytes. The transplantation during the first 12 hours after the irradiation was equally effective from the aspect of stimulation of the bone marrow restoration. This phenomenon was not expressed under the following conditions: a) transplantation of thymocytes 24 hours after irradiation; b) irradiation of recipients in a dose of 600--700 R; c) irradiation of a thymocyte suspension in vitro in a dose of 10 kR with a subsequent incubation at 37 degrees C for 6--7 hours; d) irradiation of thymocytes in vitro in a dose of 200 kR.


[The influence of 1-DOPA on emotional responses and serotonin metabolism in the rat brain]. Experiments were conducted on male Wistar rats. Intraperitoneal injection of 1-DOPA (.100 - 200 mg/kg increased the brain concentration of dopamine and homovanilinic acid and lowered the level of brain serotonin, with simultaneous elevation of its metabolite 5-HIAA. A decrease in serotonin level was accompanied by increased emotional reactivity and agressiveness in rats. L-DOPA (100 mg/kg) decreased the binding of serotonin formed from tryptophane (100 mg/kg), accelerating its catabolism in the brain; at the same time 1-DOPA eliminated the depressive action of tryptophane on the emotional reactivity and aggressiveness. It is supposed that increased emotional excitation elicited by 1-DOPA was partially mediated through the block of the serotoninergic system.


[Dilatation of arterioles in the frog submaxillary muscle under the influence of visible light]. Frog denervated submaxillar muscle arterioles dilates under the influence of visible light. In darkness the vessel returns to tis initial condition. The degree of dilatation is in the main inversely proportional to the initial diameter of the vessel. Besides, the vessel reactivity also depends on the thickness of its wall. Thick-walled arterioles are the most reactive ones. Their diameter becomes 2 -3 times greater under the influence of visible light. This light-evoked vasodilatation should be taken into account during intravital microscopy, as such a considerable dilatation of arterioles caused by light changes their reactivity considerably.


[The effect of tryptophan, 5-hydroxytryptophan, serotonin, histidine and histamine on the peroxidation of lipids in hepatic mitochondrial membranes]. The method of recording the superweak chemifluorescence was applied to the study of the effect of tryptophan, 5-oxytryptophan, sertonin, histidine and histamine on the peroxication of lipids in the membranes of mitochondria of rat liver in the presence of Fe++ ions inducing this process. 5-oxytryptophan and serotonin inhibited this process in a concentration of 10(-5)-10(-4) M (protein content -1.8 mg per 1 ml of mitochondrial suspension). On the basis of studying the kinetics of the initial portion of the ascending branch of the "slow flare up" constants of the antioxidatinve activity (constituting 2.2-10(3) and 9.8-10(3) M-1 for 5-oxytryptophan and serotonin, respectively) was calculated. The antioxidative action is associated with the presence of the phenol group in the molecule of the compound under study. It is supposed that the action of 5-oxytryptophan and serotonin on peroxidation of lipids in the membranes was of significance for the regulation of permeability of the biological membranes, along with their effect on the other membrane processes.


[Assessment of the quantity of T-lymphocytes and other rosette-forming cells in the blood of patients and healthy subjects]. In using the reaction of spontaneous rosette formation to assess the immunity T-system one should not limit one-self to determination of the percentage content of the rosette-forming cells alone. Immune status can be properly judged by determination of the content of immunocompetent cells per one cubic mm of the blood of the given donor. When the reaction is staged on the leukocyte suspension not only lymphocytes, but also other cell forms with the capacity of binding sheep erythrocytes can be determined.


[The effect of 5-hydroxytryptophan on shivering thermogenesis]. Studies carried out on ground squirrels showed active warming of these animals during arousal from  hibernation to be closely connected with intensification of the shivering thermogenesis. The intraabdominal administration of 5-oxytryptophane, a precursor of serotonin clearly suppressed the shivering thermogenesis in arising ground squirrels and slowed down their warming.


[Immunologic competence of T- and B-lymphocytes in tolerance induced by cyclophosphamide]. A study was made of immunological competence of T- and B-lymphocytes of mice subjected to tolerogenic treatment (administration of a massive dose of sheep erythrocytes and cyclophosphamide 7 days before the experiment). The capacity of lymphocytes of tolerant mice to influence the interaction of normal T- and B-lymphocytes was also investigated. This form of tolerance was caused not by T-suppressors, but by a true deficiency of T-cells-helpers (both in the thymus and in the spleen), and partially of B-cells (in the spleen). Some lack of B-cells in the bone marrow was connected with a nonspecific action of cyclophosphamide. Cyclophosphamide is supposed to selectively eliminate cells proliferating in response to the antigen.


[Kidney ultrastructure in experimental lithiasis and nephrocalcinosis]. An experimental electron-microscopic study of the kidneys was carried out in experimental oxamide nephrolithiasis in rabbits and hypervitaminosis D in rats. The most pronounced changes were revealed in the proximal and the distal convoluted tubules. It is suggested that cytosomes and lysosome-like bodies possibly participated in stone formation and nephrocalcinosis. It is supposed that they played an important role in the morphogenesis of nephrolithiasis man.


Immune function at diagnosis in relation to responses to therapy in acute lymphocytic leukemia of childhood. Tests of immune capacity were performed on blood from 49 children with newly diagnosed, untreated acute lymphocytic leukemia, and relation to prognosis was determined. Patients were treated with multiple-drug therapy and prophylactic cranial irradiation. Median follow-up time was 16 mo (range 10--37 mo). Principal unfavorable findings at diagnosis were absolute numbers of T lymphoid cells outside the range 850--2500/mul blood, absence of whole blood responses to phytohemagglutinin in vitro, a low titer of complexed antibody, and the presence in serum of free leukemic blast cell membrane antigen. Fourteen patients showed two or more unfavorable findings at diagnosis. Eleven of these have died. Four of the remaining 35 patients have died. A shorter duration of first remission was found among patients with abnormal numbers of T cells at diagnosis. The findings suggest that the immunologic capacity of the patient at diagnosis is an important determinant in responses to therapy.


Periodic oscillation of blood leukocytes, platelets, and reticulocytes in a patient with chronic myelocytic leukemia. A patient with chronic myelocytic leukemia had a cyclic oscillation of blood neutrophils, eosinophils, monocytes, platelets, normoblasts, and reticulocytes but not of lymphocytes. The cycle interval was 53--69 days. Except for reticulocytes all other cells cycled with neutrophils. Plasma colony-stimulating factor (CSF) oscillated out of phase with neutrophils, suggesting that granulocytopoiesis is regulated through CSF by a feed-back mechanism. Plasma erythropoiesis-stimulating factor (ESF) also oscillated. ESF crests preceded or coincided with reticulocyte crests, indicating that the ESF elevation may have been responsible for the reticulocyte peaks. The relationship between neutrophils and reticulocytes and their oscillations with plasma CSF and ESF suggests that there is a common stem cell which differentiates along one cell line or the other depending upon the balance of regulatory stimuli. The fraction of blood neutrophilic precursors (myeloblasts, promyelocytes, and myelocytes) in DNA synthesis fluctuated with neutrophil level. The calculated generation time was shorter at the crests than at the troughs of the neutrophil cycles. This finding suggested that the rate of proliferation of the neutrophils changed periodically. This observation, along with a periodic increase in differentiation of the stem cell toward the neutrophilic cells, is the probable explanation of oscillation of the neutrophil count in the blood.


A comparison of the time course of excitation and inhibition by iontophoretic decamethonium in frog endplate. 1 The depolarization of frog endplate by a brief iontophoretic application of decamethonium was slower in time course than the inhibition of a long carbachol response produced by the same decamethonium pulse, or than the excitation produced by a brief equipotent carbachol pulse. 2 The delay between the peak inhibition and peak excitation produced by decamethonium, about 50 ms, is too great to be explained by slow receptor activation kinetics, since Katz & Miledi (1973) have shown that the lifetime of decamethonium-activated receptors is only 0.25 milliseconds. 3 If doses of carbachol and decamethonium are adjusted to give response amplitudes in the ratio corresponding to the ratio of their presumed maximum responses, then there is little difference in the time courses of the responses. 4 This observation, together with the finding that increasing the dose applied slows the decamethonium response much more than the carbachol response, suggests that a decamethonium response contains contributions from a much wider area of receptive membrane than does a carbachol response of equal amplitude. 5 Simulation shows that these geometrical effects are sufficient to account for the rapidity of inhibition compared to excitation without postulating slow receptor kinetics. 6 It is pointed out that similar effects may account for certain results obtained in iontophoretic studies of desensitization.


The efficacy of Alcoholics Anonymous: the elusiveness of hard data. The paper is concerned with methodological problems relating to the scientific study of the effectiveness of Alcoholics Anonymous (AA). Studies of the effectiveness of AA fall into two categories--longitudinal and cross-sectional, and may be criticized on the basis of over-simple criteria of success. The particular problems of the requirement for control groups in studies of effectiveness are pointed out. The problems arising out of the whole process of affiliation and disaffiliation and their implications for scientific study are discussed. The requirement for sound statistical analysis is stressed, and inadequacies in the techniques of follow-up are indicated. The studies which have some bearing on AA as a treatment facility are reviewed. These include multivariate studies involving AA attendance as one factor, studies in which AA was the main variable in a hospital programme, and longitudinal studies of AA from within the organization. Particular difficulties in using cross-sectional surveys for the purpose of estimating efficacy are pointed out. The conclusion reached is that because of the methodological difficulties the totality of these studies dose not add significantly to the knowledge concerning AA which we possess from clinical experience. Moreover, without a change in the unusual characteristics of AA when considered as a treatment facility it seems unlikely to be possible to assess its effectiveness in a scientific manner.


Osteomalacia and carcinoma of prostate with major redistribution of skeletal calcium. A case of hypophosphataemic osteomalacia occurring in association with a carcinoma of prostate is described. Although only palliative treatment to the primary tumour was possible, worthwhile remission of bone symptoms, due to osteomalacia, was achieved with pharmacological doses of vitamin D. The presence of extensive skeletal metastases modified the radiological features of osteomalacia. Major alterations in the distribution of calcium within the skeleton were observed during a period when total body calcium remained unaltered. This observation may be of relevance to other cases in which osteosclerotic metastases develop.


The ventricular-brain ratio using planimetric measurement of EMI scans. A correlation has been shown between the cross-sectional area of the cerebral ventricular system and the cross-sectional area of the brain in 62 patients, using the EMI Scanner. The percentage ratio has been abbreviated to VBR. The patients were divided into normal, equivocal, cerebral atrophy and hydrocephalus, according to their PEG's. The measurements were obtained by the use of a plaimeter and by outlining the ventricular and cerebral perimeters from the EMI Polaroid pictures. The VBR was found to be approximately five in those patients without detectable pathology, about seven in equivocal cases, and above ten in abnormal cases (atrophy, hydrocephalus). The hydrocephalic readings were generally higher than those for cerebral atrophy.


Emergency portasystemic shunt for bleeding varices. Sixty-eight patients with bleeding oesophageal varices due to cirrhosis of the liver who have had an emergency portasystemic shunt are reviewed. The reasons for the emergency shunt surgery and the results are described and discussed. The low postoperative mortality is attributed to careful case selection. Apart from clinical and serological factors, the importance of the bromsulphthalein excretion test is stressed. Emergency shunts are now undertaken by the author in patients whose serum bilirubin is less than 2-5/100 ml and bromsulphthalein retention less than 10 per cent in 30 minutes. This is in marked contrast to the author's previous series in which there was a 30 per cent mortality. The poor results in patients treated conservatively and the disparity between the author's results and those of other reported series are reviewed and discussed.


Complications of Meckel's diverticulum.

Complications of Meckel's diverticulum. This paper reviews the presentation and surgical pathology of 50 Meckel's diverticula encountered in one hospital in a 20-year period. It is concluded that in children with intestinal bleeding or a "raspberry tumour" of the umbilicus a Meckel's diverticulum is usually suspected. In adults with an acute surgical emergency Meckel's diverticulum is unlikely to be considered. However, a Meckel's diverticulum can give rise to surgical problems in many ways and at any age. In particular, the possiblity of an attached mesodiverticular band leading to obstruction must be stressed.


The bleeding caecal angioma: a diagnostic problem. Three cases are reported of bleeding angioma of the caecum. The wider use and improved technique of selective arteriography have led to an increase in frequency of diagnosis of this condition, and facilitate the management.


Surgical treatment of bronchiectasis in Kartagener's syndrome. A case of Kartagener's syndrome in which bilateral partial pulmonary resection was performed is reported. The literature concerning the surgical treatment of severe bronchiectasis is reviewed.


Dual localization of histamine in an ascending neuronal pathway and in non-neuronal cells evidenced by lesions in the lateral hypothalamic area. The effects of lesions placed in the lateral hypothalamic area, i.e., interrupting the MFB (as evidenced by a 65% decrease in cortical noradrenaline and serotonin) suggest a pluricompartmentation of brain histamine (HA). The existence of an ascending histaminergic system is indicated by the reductions in l-histidine decarboxylase (H.D.) activity, in [3H]histamine synthesis and in HA content, in the cortex of lesioned rats. Moreover, the decrease in H.D. activity was restricted to the regions rostral to the lesion, without modification caudally. The time-course of the alterations in H.D. activity and in HA content is compatible with a process of anterograde degeneration. In subcellular fractionation studies, the reduction in cortical HA content was found to be mainly confined to the P2 fraction, which contains the synaptosomes. Although the widespread ipsilateral distribution of HA synthesizing terminals resembles that of monoaminergic ones, the absence of reduction in H.D. activity after selective destruction of catecholaminergic and serotoninergic neurons, by 6-hydroxydopamine or 5,6-dihydroxytryptamine respectively, renders likely the existence of specific HA-containing neurons. That the release of the amine from these neurons might be related to the nerve impulse flow is suggested by the transient effects of the lesions which preceded the degenerative process (elevated endogenous HA level and slowed rate of [3H]HA synthesis). In addition, the discrepancy between the reduction in H.D. activity and in HA level after the lesions could be explained by the presence of the amine in another neuronal system and/or in non-neuronal cells, not affected by the lesion. This additional compartment is characterized by a high HA content and a low H.D. activity and could therefore be localized in mast-cells. The respective sizes of these two compartments, estimated by several methods, appear to be approximately the same.


Protein metabolism in transected peripheral nerves of the crayfish. The significance of the protein metabolism in crayfish peripheral nerve was studied in relation the ability of crayfish motor axons to survive for over 200 days following axotomy. In contrast to frog peripheral nerves, the crayfish nerves appear to more closely resemble ganglia in their profiles of synthesis expressed on sodium dodecyl sulfate (SDS) gels, and have higher incorporation rates of [3H]leucine into protein than ganglia. Since anisomycin inhibits over 95% of protein synthesis in crayfish peripheral nerve, it was concluded that this local protein synthesis was dependent upon a eukaryotic ribosomal mechanism. Radioautography of isolated nerves reveals newly synthesized proteins in glial sheaths, and also within the axoplasm of large motor fibers. Based upon the data available at present, a hypothesis that the glia surrounding the axons are responsible for the local protein synthesis, and that some of these newly synthesized proteins are transported into the axon, is presented. Transection of crayfish peripheral nerves proximal to the neuron cell bodies produced a more than two-fold increase in [3H]leucine incorporation, but no significant changes in labeling profiles of the proteins on SDS gels. The data suggest that while an active local protein synthesis may be necessary for the maintenance of several crayfish motor axons, it is not a sufficient condition.


Muscle fiber capacity in low conductivity solution. A method is described for computing the effective capacity of muscle fibers, C = Q/V where Q is the charge stored, and V is the membrane potential, using a standard two-microelectrode, constant current injection technique. The method is used to compare physical (or effective) capacity of frog muscle fibers bathed in a low conductivity, 2.5 mMK+ solution, with circuittheory derived quantities in the same cells and in control fibers. No differences can be discerned and it is concluded that low conductivity of physiological solutions, per se, does not significantly reduce the length constant of frog muscle transverse tubules.


Myocardial glycogen in prevention of perioperative ischemic injury of the heart: a preliminary report. The incidence of arrhythmias, low output and acute myocardial infarction in the perioperative period was analyzed for 119 patients who underwent aortocoronary bypass surgery. The incidence for three groups of patients was as follows: 44% for 72 patients who did not receive glucose-insulin-potassium (GIK) before operation (no-GIK group), 32% for 25 patients who received preoperative GIK alone before operation (GIK group) and zero in 22 patients who received GIK before operation plus a bolus of 50% glucose (0.5 ml/kg body weight) at the beginning of operation (GIK-G group) (the difference between the GIK-G group and the other two groups is significant; P less than 0.001). Determination of myocardial glycogen content of 63 ventricular biopsies revealed a 2+ to 4+ content in 48% of the no-GIK group, 83% of the GIK group and 100% of the GIK-G group (P less than 0.05). The incidence of complications in patients with myocardial glycogen content of 2+ to 4+ was significantly lower (P less than 0.005) than in those with myocardial glycogen content of 1+. Experimentally, myocardial tolerance to ischemic injury parallels myocardial glycogen content. Our preliminary observation that prior administration of GIK-G increases myocardial glycogen content with a concomitant reduction in complications is consistent with these experimental observations.


Thrombotic thrombocytopenic purpura: a syndrome of intravascular platelet consumption. In four of five patients with thrombotic thrombocytopenic purpura (TTP) in whom serial tests of hemostatic function were performed, severe thrombocytopenia, normal plasma fibrinogen concentrations and mildly increased concentrations of fibrinogen/fibrin degradation products were observed. Widespread platelet thrombi were found in arterioles and capillaries. Fibrin could be seen around some of the platelet clumps and was the main component in a small number of the thrombi in two patients. The observations show that TTP is a disorder in which intravascular platelet consumption results in disseminated platelet thrombosis. The coagulation system is apparently activated secondarily to platelet aggregation and variable quantities of fibrin are incorporated into the thrombi. Clinical improvement resulted from combined therapy with corticosteroids, heparin and drugs that suppress platelet function.


Erythrocyte receptors and thymus-associated antigens on human thymocytes, mitogen-induced blasts, and acute leukemia blasts. Human thymus cells and blasts from some patients with acute lymphoblastic leukemia (ALL) express similar cell surface properties. This suggests that this type of ALL originates in the thymus or alternatively that these properties of ALL blasts reflect changes occurring during blastogenesis. To test these possibilities, we determined whether mitogen-thymus antigens found on blasts from E+ALL  and on normal human thymocytes. E-rosettes of blood T-lymphocytes dissociated at 37 degrees; in contrast, rosettes formed by E+ALL blasts, human thymocytes, and pokeweed mitogen-stimulated blasts were stable at this temperature. Blasts that formed stable rosettes did not have cytoplasmic Ig, indicating that they were T-lymphoblasts. By immunofluorescence and a radiolabeled antibody assay we demonstrated a thymus antigen(s) that was present on the membrane of E+ALL blasts and on normal thymocytes, but not on normal blood T-lymphocytes [TL-like antigen(s)]. This antigen was not expressed on blasts induced by mitogens. The finding that that mitogen-induced blasts form temperature-stable rosettes, but lack TL-like antigen(s), indicates that this antigen is not required for the expression of E-receptors stable at 37 degrees. The results support the concept that E+ALL results from the malignant transformation of thymus cells.


Microtubules associated with nuclear pore complexes and coated pits in the CNS. Using a new albumin prefixation technique, microtubules have been observed in close association with the nuclear pores of neurons and glia. Thus, microtubules may be involved in such phenomena as anchoring, migration or rotation of the nucleus or in chemical messenger transport between nucleus and cytoplasm. Microtubules are also seen running close to the coated pits of dendrites. The implications are discussed.