[Contributions to the strain-specific virulence of Cryptococcus neoformans. Animal experiments with two C. neoformans-strains isolated from bird manure. Preliminary report (author's transl)]. The results briefly presented here highlight some of the observations met with during the course of a study aimed at finding out differential pathogenic behavior of the two strains of Cryptococcus neoformans i.e. W71/A117 and W2/A94 with special reference to cryptococcoma formation. Both strains were isolated from bird excreta but differed in their gross and microscopic morphology. Groups of male albino mice NMRI were separately inoculated, intramuscularly, with a comparable dose of the two strains. All the 50 animals challenged with W71/A117 developed macroscopically distinct cryptococcoma of variable size, and fatally progressive disease, involving most of the internal organs, namely, brain, heart, lung, liver, spleen and kidneys. On the contrary, only 34 of the 50 mice infected with the strain W2/A94 showed cryptococcoma formation at the site of inoculation, which were comparatively much smaller in size and gradually diminished. None of the animals, observed over a period of 93 days, died, and showed any sign of metastasis. In another series of experiment, only one instance of mortality was observed in a group of 80 mice inoculated intraperitoneally with about 2 X 10(7) viable cells of this strain. However, the fungus could be recovered, in a majority of cases, only from the brain of animals sacrificed after one month, though most of them showed no sign of sickness. The number of mice yielding positive cultures gradually decreased, and after 87 days the fungus could not be isolated from any organ. The high morbidity and mortality in mice caused by strains W71/A117 was significantly lowered when the animals were infected intramuscularly 3 months ago with the strain W2/A94. After an observation period of 61 days, 91% of the double infected animals were still alive in comparison to 23% survival among the animals challenged with the strain W71/A117 only.


[Studies on the relationship of temperent phages and bacteriocines of streptococcus faecium (author's transl)]. Two bacteriocins (enterocin E1A and E1B) as well as a complete bacteriophage (PE1) were produced by Streptococcus faecium strain E1. Although the phage could be demonstrated by electron microscopy it was not possible to observe phages or phage-like particles in the purified preparation of the large enterocin E1B. Phage PE1 had a much smaller activity spectrum than that of enterocin E1A and E1B, inhibiting only one strain of Streptococcus faecium and one strain of Streptococcus salivarius. The enterocins were not neutralized by antiphage sera, thereby suggesting that the enterocins and the phage are chemically unrelated.


[The endotoxin from S-, R- and M-forms of enteropathogenic E. coli O 149: pyrogenicity, Shwartzman-phenomenon and hypersensitivity (author's transl)]. The authors are interested in elucidation of the role of endotoxin from S, R- and M-forms of E. coli O 149, and of the role of hypersensitivity in pathogenesis of Colibacillosis. It was shown in this experiment that all S, R- and M-form of E. coli O149 possess endotoxin with almost the same pyrogenicity in normal rabbits. The pyrogenicity increases enormously in the hypersensitized rabbit. There were also not observed differences between endotoxins extracted from S, R, M-mutnants. All 3 endotoxins evoke in normal rabbits the skin Shwartzman-Phenomenon, the S-endotoxin was there much stronger. This phenomenon increases in capacity in hypersensitized rabbits. Thus again, the role of hypersensitivity in Colibacillosis was proved to be important.


[Do the severity and duration of rheumatoid arthritis influence pulmonary ventilation?]. Pulmonary ventilation was studied in 100 patients with rheumatoid arthritis of an outpatient clinic, using whole-body plethysmography, spirography, and pneumometry. The patients with more or less severe joint involvement, as well as the patients with shorter or longer duration of their disease, did not show any significant difference in their dynamic and static pulmonary fuction. Patients with serious joint destructions showed a bronchial obstruction in 29%. 36 patients who were treated with thioglucose gold had a significantly better expiration capacity. A causal connection with the underlying disease is discussed. Further examinations should take therapeutic procedures and longitudinal studies into consideration. It is doubtful that significant restriction of ventilation is present in rheumatoid-arthritis. Methodically there was a good argreement between whole body plethysmography and pneumometry.


[Mucous (M) mutants of enteropathogenic, septicemic and saprophytic E. coli (author's transl)]. Mucoid M mutants of enteropathogenic (for suckling pigs), septicemic (for calves), and saprophytic E. Coli were subject of the study. The characteristics of the M colonies have been listed in Table 1. Both spontaneously occurring M mutants which had been isolated by culturing of E. coli strains (S form) in normal horse serum (undiluted) for several weeks were observed. Enzymatic-biochemical tests revealed the existence of M mutants with full enzmatic activity which are identical with the homologous S and R forms. There were also M mutants exhibiting a considerably reduced enzymatic activity. Antigenic-serological analysis (agglutination) exhibited M mutants which were agglutinated by the homologous sera, at low and high titres. In contrast to this, one group of M mutants was found not to be agglutinable, despite autoclaving at 120 degrees C for 2 hours. Some mutants cultured in broth for several weeks were re-exhibiting S colonies of full biochemical activity and full antigen reactivity against homologous agglutinating sera.


[Biochemical aspects of chronic rheumatic inflammation]. Morphological phenomena in rheumatoid arthritis are closely correlated to the biochemical aberrations of connective tissue metabolism. Both, morphological and biochemical analysis of the altered tissue portions demonstrate evidence for uncontrolled proliferation resp. metabolism similar to human and experimental malignoma. The present state of biochemical knowledge in this field permits to describe the metabolic state of the afflicted tissue by means of enzyme activity and substrate pattern and to draw some conclusions in respect to the pathogenesis of inflammatory processes involved in chronic rheumatic diseases.


[Swarming phenomenon of an aeromonas spec (author's transl)]. A genuine swarming phenomenon, such as has previously been known to occur in Proteus, Bacillus and Clostridium species only, was observed in an Aeromonas species. Fig. 1 shows the terraced swarming zones of the Aeromonas species on nutrient agar. The swarming rate, expressed as the growth of the swarming zone per time unit, was measured to be 70-120 mum/min on blood agar at 30 degrees C. The swarming could be inhibited by incubation at 37 degrees C (Table 2), by low saline concentrations (Table 3) as well as by addition of 4-nitro-phenylglycerol to the medium (Table 4). A DIENES-phenomenon between the swarming zones of Proteus strains and that of the Aeromonas species could not be observed (Fig. 2). The manner of swarming as seen in phase contrast microscopy was the same kind as that of Proteus. Furthermore, it could be shown by means of light- and electronmicroscopical investigations that the swarming phenomenon is connected with changes in the cell morphology and the form of flagellation (Figs. 4 and 5). Whereas in broth cultures (Fig. 3) as well as in the centre of colonies on solid media (Fig. 5a) the cells appeared as cocoid rods with polar flagellation, they developed elongated forms at the edge of the swarming zone, which - either in addition to or devoid of the polar flagella - were peritrichously populated with thin, flagella-like filaments (Figs. tb, 6, 7 and 8). The discussion deals with the various forms of bacterial surface translocation and investigates into the role of peritrichous flagella or fimbriae in the swarming phenomenon.


Minimal inhibitory dosage of rifampicin in intermittent treatment of Mycobacterium leprae infection in mice. The total minimal inhibitory dose of rifampicin determined in the experimental mouse model, was found to be 10 mg/kg body weight, administered once a week for 6 weeks or once every 2 weeks for 12 weeks. From these and other results it is suggested that administration of RMP in human treatment can be reduced to a total amount of 7.2 either as a 600 mg dose once a week for 12 weeks or as a 900 mg dose once a week for 8 weeks. At present these regimens can only be used as an introductory treatment for multibacillary cases and are still too expensive for developing countries, but their efficacy should be evaluated in the field as sole treatments in tuberculoid cases, since they could signify a substantial economy for the management of the majority of leprosy infections.


A comparison of tests for nitrate reduction. 504 strains of different bacteria have been tested for nitrate reduction by a conventional method and two microtests. A quick microtest for nitrate reduction is suggested allowing to read results after 1 hr cultivation. Nitrate reduction is a valuable test particularly for the species differentiation of the genera Bacillus, Micrococcus, Pseudomonas, Alcalignes, Moraxella, and other ones.


[Quantitative description of the resistance of microbiological indicators by means of characteristic data (author's transl)]. The ambiguity of the quantitative description of the resistance of microbiological indicators by means of the terms common thus far, namely "resistance" (maximal period of action after which all indicators still exhibit organisms capable of reproduction) and "death time" (minimal period of action after which organisms capable of reproduction cannot be demonstrated any more in any of the indicators) is shown. Among other factors, the probability that all indicators will yield identical findings (sterility or growth of surviving organisms) at a defined time, is dependent upon the number of indicators in each case. The more indicators are tested, the lower "resistance" and the later the "death time" will be. Instead of times when all indicators present an identical reaction, times (or values related to these times in a defined way) should be taken at which indicators show the absence of organisms or the presence of surviving ones with a defined frequency. There is a defined relationship between the frequency of indicators found free from (resp. containing) surviving organisms and the number of surviving organisms per indicator (cf. Figs. 1 and 2). If the regularity of the decrease of organisms with the period of action of the destroying agent is known, 2 values are sufficient for a clear description of the resistance of a preparation of microbiological indicators. As characteristic values those values of action are proposed after which 99% and 1% of indicators will exhibit surviving organisms (t99% and t1%, respectively). The period during which the dependence of the frequency of presence of sterile indicators (po) upon the period of action of the destroying agent may be determined with sufficient precision and at justifiable experimental expenditure, is corresponding to a decrease of surviving organisms to appr. 1/30. From practical experience, it will be justified in the preponderant majority of cases to assume a logarithmic orderof death as given. Under such conditions, there will be a clear relationship between lg(-ln po) and the period of action of the destroying agent, so that test results may be easily evaluated by means of a simple graphical method or regression calculation. Graphical (FIG. 3) and mathematical determination of characteristic values from the frequency of indicators exhibitoring surviving organisms in the destruction test, after different periods of action, is explained by means of an example (Fig. 3; Tables 2 and 3) and a calculation (Table 1). To keep variation of experimental results sufficiently low, at least 30 (if possible 50) indicators per period of action should be studied for surviving organisms (cf. Fig 4). When evaluating results, different weights of the individual values and their asymmetric distribution around a maximum at t80% (Fig 5) should be taken into consideration.


[Comparative studies of methods of salmonella enrichment (author's transl)]. Eight different methods of salmonella enrichment were compared in two series of experiments involving 100 samples of whole-egg powder and 80 samples of frozen whole liquid egg, respectively. 66 out of a total of 100 samples of whole-egg powder had been artificially infected with varying numbers of S. typhi-murium; 60 out of 80 samples of frozen whole liquid egg were found to be naturally infected with various salmonella species. 3 of the 8 methods (Table 1) were compared within an international collaborative study with 14 laboratories in 11 countries participating. A reduction of the pre-enrichment period from 18 to 6 hours and of volumes used in pre-enrichment and selective enrichment from 10 and 100 ml, respectively to 1 and 10 ml, respectively were found to have adverse influence upon the result of isolations, in particular in the case of weakly infected samples. In contrast, extended incubation over 48 hours as well as preparation of two sub-cultures on solid selective media following incubation of enrichment cultures over 18-24 hours and 42-48 hours, respectively always resulted in a certain increase of salmonella yield which, however, exhibited gradual differences for the individual methods examined. Preparation of a 2nd sub-culture meant, in particular, a decisive improvement of the result of isolations from artificially infected samples if selenite-cystine enrichment volumes were 10 and 100 ml, respectively. The best results could be obtained by means of the following methods of enrichment: Pre-enrichment of material in buffered peptone water at 37 degrees C over 18 hours; pipetting of 10 ml inoculated and incubated pre-enriched material into 100 ml selenite-cystine or tetrathionate enrichment medium according to MULLER-KAUFFMANN; onward incubation of the enrichment culture at 43 degrees C over 48 hours; and preparation of sub-cultures on solid selective media after 24 and 48 hours. The method using tetrathionate enrichment medium was found to be most expensive, results, however, were the most consistent ones.


[Utilization of LIN (lysine-indole-motility) medium for the preliminary identification of enteropathogenic bacteria]. A multiple-test medium for the routine laboratory identification of enteropathogenic bacteria is described. The medium has the following formula: Bacto-peptone (Difco) 5 g; yeast extract (Difco) 3 g; casein tryptic digest peptone (Merek) 15 g; glucose 1 g; L-lysine-monohydrochloride (Merck, No. 5700) 5 g; NaCl 5 g; bromcresol purple 0.016 g; agar 2 g; distilled water 1000 ml; final pH 6.6. The medium is dispensed in amounts of 5 ml into tubes of 14 X 85 mm and autoclaved at 120 degrees C for 10 min. The tubes are tightly closed with rubber stoppers. - The medium is inoculated by stabbing to the bottom of the tube. Readings are made after over-night incubation at 37 degrees C. A scheme for the preliminary identification of enteropathogenic bacteria is given, based on LIM medium in conjunction with Kligler's iron agar, and the oxidase reaction.


[The application of chorioallantois membranes of chicken embryos for the virulence determination of Nocardia asteroides (author's transl)]. The pathogenicity of Nocardia asteroides and other strains of different Nocardia species against chicken embryos was investigated. The strains were inoculated on the chorioallantois membrane of embryonated eggs and the resulting lesions were judged. 55 Nocardia asteroides strains and some strains of the species N. brasiliensis, N. leishmanii, N. caviae, N. (Actinomadura) madurae, N. caprae, N. rubra, N. pellegrini, N. corallina and N. polychromogenes were studied. 47 strains of the species N. asteroides were pathogenic, 2 apathogenic and 6 strains showed doubtful results. All the investigated 5 strains of the species N. brasiliensis, N. leishmanii, N. caviae and N. (Actinomadura) madurae, provoked typical lesions on the chorioallantois membrane. The other investigated strains were apathogenic. With this, described test it is possible to distinguish between pathogenic and apathogenic Nocardia strains, which is indeed important for the diagnosis of Nocardia infection.


[Phagocytosis and intracellular proliferation of Nocardia asteroides (strain Weipheld) in cell structures in vitro. 1. Alveolar macrophages of guinea-pigs (author's transl)]. Phagocytosis and intracellular proliferation of Nocardia asteroides (Weipheld) were studied in alveolar macrophages from normal guinea-pigs that had been immunized in two stages and guinea-pigs that had undergone long-term cortisone treatment (28 mg/kg/day over 30 days). The highest phagocytosis values were found in the guinea-pigs that had been immunized in two stages (3.85-6.82%). In the case of normal macrophages, values of 2.90-4.95% were observed. The lowest values (2.10-3.6%) were found for macrophages from those guinea-pigs that had been treated with hydrocortisone. Differences between the groups were statistically significant. Following phagocytosis, the phagocytosis index was seen rising in all three groups, reaching its highest values for alveolar macrophages from the cortisone-treated guinea-pigs (after 8 hours - 1.15). The cytotoxic effects of Nocardia upon the cells in the lung washing liquid from normal guinea-pigs immunized in two steps and guinea-pigs treated with high cortisone doses over an extended period were exhibiting identical trends. After 8 hours' exposure, 22.6% dead and decayed cells were found, against 5.9% in normal controls. Leucocytes proved to be most susceptible to the cytotoxic effect of Nocardia; alveolar macrophages were less and small lymphocytes least susceptible.


Selective involvement of the brain in experimental murine cryptococcosis. I. Microbiological observations. During the course of infection in intraperitoneally infected white mice with a particular strain of Cryptococcus neoformans, it was possible to observe a time-limited and selective presence of the fungus in the brain. The presence of the fungus in the brain without causing clinical symptoms and the rare mortal exacerbation of the brain involvement offers possibilities for comparative studies of experimental and human cryptococcosis. On the basis of these strain-specific results new aspects of the virulence of C. neoformans and the epidemiology of cryptococcosis are discussed.


[Role of chronic toxoplasmosis infection in pathology of the nervous system and eyes in adults]. The authors conducted a statistical correlation of frequencies of neurological and ophthalmological pathology in a group of patients with different disorders of the nervous system, where 556 had positive and 788 negative seroallergical reactions to toxoplasmosis. It was possible to establish that most of the neurological and ophthalmological symptoms of toxoplasmosis were significantly more frequent in individuals of the first group, except patients with disseminated sclerosis, myopathy and myasthenia.


[Place of the clinic in studying the nature of schizophrenia]. For successful international studies it is necessary to overcome differences in national psychiatry that are conditioned by the existing clinical methods of research. However, this method is necessary for a cognition of the substrate of a disease as it depicts regularities of clinical expressions of a disease. An example of that is given by Jackson who displayed a correlation between the positive and negative symptoms in a psychosis. This concept is considered from the point of view of relations between adaptive reactions of the organism and a breakage (Pavlov, Davidovsky) and in connection with the nozological problems.


[Lithium prophylaxis].

[Lithium prophylaxis]. The author considers some difficulties and discrepancies in the diagnosis of schizophrenia, schizo-affective psychoses on the one hand and manic-depressive psychosis on the other in a group of out-patients receiving treatment with lithium for the prophylaxis of affective disorders. Factors common to both groups and being the basis for the selection of lithium prophylaxis are considered. Special attention in these cases is paid to the course of the disease.


Homolanthionine in fungi: accumulation in the methionine-requiring mutants of Aspergillus nidulans. Homolanthionine, a higher homologue of cystathionine, was found to accumulate in the mutants of Aspergillus nidulan impaired in the synthesis of methionine from homocysteine. The additional introduction of mutation resulting in a block at cystathionine gamma-synthase but not at cystathionine beta-synthase abolishes accumulation of both homolanthionine and cystathionine. This suggests a possible participation of cystathionine gamma-synthase in homolanthionine synthesis.


[Influence of BCG on the production of antibody-forming cells in the primary and secondary immune response against sheep erythrocytes in the mouse]. Adult mice react with an increased production of PFC (plaque-forming cells) against sheep erythrocytes (SE). in the primary immune response after application of BCG. Animals receiving 0,5 mg of BCG 10 days before SE show an increase in direct PFC of more than 50%. No effect was observed after injecting BCG 14 or 5 days before SE or using a dose of 0,1 mg of BCG. The results indicate that the effect of BCG on the humoral immune response is influenced by the interval between application of BCG and the SE as well as the BCG-dose. By contrast, BCG had no significant influence on the secondary humoral immune response. In a few cases the immune response seemed to be suppressed.


Central venous catheterization through the basilic vein or by infraclavicular puncture? A controlled trial. Central venous catheterization through the basilic vein and by infraclavicular puncture of the subclavian vein was compared in a trial with random allocation to 125 candidate patients. The catheters were inserted via the two routes with roughly equal success rates. Subclavian catheters were maintained better for the period required than were basilic catheters. The infraclavicular puncture caused initial, and basilic catheterization, late complications. Consequently, infraclavicular puncture is preferable for long-term, and basilic catheterization for short-term, needs.


Surgical treatment of 102 tendo achillis ruptures-- suture or tenontoplasty? A series of 102 patients with total subcutaneous rupture of the achilles tendon treated surgically from 1944 to 1972 is presneted. All patients were treated early after the acute event, and the diagnosis was made on clinical examination. Group I comprises 54 patients treated over the first part of the period by simple tendon suture, and group II comprises 48 patients from the second part of the period treated by tenontoplasty ad modum Silfverskjöld. The results in the two groups are compared and also contrasted with the results following conservative treatment more recently reported. Operative treatment is recommended rather than conservative bandaging. There were no recurrent ruptures in group II, but 2 patients in group I had rupture recurrence. The functional results were not statistically significantly different in the two groups. There was no operative mortality. Surgical complications were infrequent, and, in general, did not affect the period of treatment, nor the duration of incapacity. Recent studies reported in the literature cast doubt on frequent previous reports of pathological changes in the tendon predisposing to rupture. Some constitutional weakness would appear to be etiological from this study where some familial incidence was noted, and particularly there was an incidence of not simultaneous bilateral rupture. The risk of contralateral rupture if patients returned to sporting activity to the same extent as before the primary injury was 26% (12-45%).


Purification and characterisation of two porcine hypothalamic fractions with LH-releasing activity: evidence for a single LH and FSH-releasing hormone. Two fractions with LH releasing activity were obtained from porcine hypothalami by Enzmann et al. (1972). These fractions were designated E 57 and E 203. By comparison with pure natural LH-RH and synthetic LH-RH, E 203 was identified as purified natural LH-RH. E 57, which has only 25% of the activity of E 203, was further evaluated for its biological and immunological activity. E 57 has the same ratio of LH/FSH-releasing activity as natural LH-RH. The binding to a specific LH-RH antiserum is identical with that of natural LH-RH and E 203. It is concluded, that E 57 is an artifact of isolation derived from natural LH-RH. These findings can be considered as additional evidence for the identity of the hypothalamic LH and FSH releasing hormone, since both gonadotrophins are stimulated by the two hypothalamic fractions.


Studies on the duct-ligated pancreas as allograft for islet cell function. Twenty previously pancreatectomized dogs were heterotopically transplanted with duct-ligated allografts. Sixteen of the grafts were preserved for 24 hours, nine with continuous hypothermic albumin perfusion, seven with hypothermic storage. Five dogs died from early postoperative bleedings. Fifteen surviving dogs had a satisfying endocrine function assessed by blood glucose and serum insulin during fasting and after glucose load. In six dogs the glucagon release from the graft was investigated and significant release was evident in all dogs. A high release was found after L-arginine stimulation. The endocrine function was satisfying after 24 hour preservation both with hypothermic storage and continuous hypothermic albumin perfusion. During such perfusion the pancreas became very oedematous. This did not influence on the outcome of the transplantation. The grafts were enlarged four to eight days after transplantation. Oedema, fibrotic changes and collagen depositions in the interstitial tissue were observed in light microscopy. These changes seemed to come earlier in glands preserved for 24 hours. Islet cells were identified in all functioning grafts and seemed histopathologically and ultrastructurally unchanged. A duct-ligated pancreatic segment was allografted to one diabetic patient in a pilot experiment. There was a satisfying endocrine function for 40 days. After that the graft became necrotic due to thrombus formation.


Acute effects of exogenous growth hormone in man: time- and dose-bound modification of glucose tolerance and glucose-induced insulin release. The time and dose dependency of the effects of a 30-min long iv infusion of human growth hormone (GH) on glucose tolerance and glucose-stimulated insulin release was investigated in 19 healthy subjects. Glucose tolerance deteriorated immediately following GH, and the k-value continued to decrease up to 300 min later. A small but significant reduction of glucose tolerance persisted 24 h after GH administration. Significant deterioration of glucose tolerance was observed with the smallest GH dose used (5 mug per kg body weight), increasing the amount of the hormone having no further major influence. Glucose-stimulated insulin release was significantly inhibited 1 h after administration of a relatively high GH dose (40 mug per kg), both if expressed as mean plasma insulin levels, or as insulin release per magnitude of glucose stimulation (insulinogenic index). In the majority of subjects, insulin release was inhibited also by lower GH doses (5-20 mug GH per kg). However, the mean change with these doses was not statistically significant. The inhibitory effect of GH on insulin secretion seemed to have a duration of several hours. Five hours, but not 24 h, after GH administration (10 mug GH per kg) insulin release was still significantly suppressed. It is suggested that the initial effect of GH on pancreatic beta cells may be inhibition of insulin release, in contrast with the enhancement of insulin secretion observed during chronic administration of GH.


Radioimmunoassay of human prolactin (PRL). A simple and rapid homologous radioimmunoassay of human prolactin (hPRL), by the use of 66% ethanol containing 6.6% ammonium acetate for the separation of free and bound hormones, has been established. PRL levels showed marked individual and daily variations as well as a circadian periodicity in both men and women. Levels of plasma PRL rose with puberty and decreased during post-menopause and in elderly men (ages 60-73 years). There was no marked change in plasma PRL levels at midcycle; however, in some subjects, luteal levels were slightly higher than follicular levels. Administration of oestradiol-17beta caused marked increase in plasma PRL levels during menstrual cycle. During pregnancy, the plasma PRL levels rose as high as 200 ng/ml and decreased within a week or two post-partum. During lactation, the levels were higher and increased with suckling. In a patient with habitual abortion, the plasma PRL level showed a sudden drop prior to abortion. Administration of LH-RH had no effect on the secretion of PRL in human subjects.


Response to pentagastrin in man. III. Comparison of two formulations. Gastric secretion has been studied in response to the standard preparation of pentagastrin and a new, more stable preparation (pentagastrin meglumine). The sensitivity to, and maximal outputs of acid and pepsin elicited by, the two preparations of pentagastrin did not differ. However, the pentagastrin meglumine evoked a better sustained acid secretion with all dose rates than did the standard pentagastrin.


Evaluation of impedance cardiography as a non-invasive means of measuring systolic time intervals and cardiac output. Impedance cardiography was used for non-invasive determinations of systolic time intervals (STI) and cardiac output. The results were compared with simultaneously obtained invasive measurements of STI from central aortic pressure curves and of cardiac output using the dye-dilution technique. The study was performed on eight dogs during increasing halothane concentration. A close correlation was found between non-invasively and invasively measured left ventricular ejection time = LVET (r = 0.986) and pre-ejection period - PEP (r - 0.948). Measurements of cardiac output derived from changes in thoracic impedance were determined 1) using a fixed value of p (p - the resistivity of blood) and 2) using an individual value of p based on the actual hematocrits. When compared to cardiac outputs obtained by dye-dilution the correlation coefficients were r = 0.806 and r = 0.816, respectively. Impedance cardiography is a useful method of evaluating changes in cardiac output. The method permits simultaneous observations of changes in STI and cardiac output as an index of cardiac function.


Paracervical block with etidocaine for out-patient abortion. Paracervical block using etidocaine 0.5 % and 1.0 % without adrenaline proved to be an effective anaesthetic procedure for first trimester abortion performed by surgical dilatation of the cervix and subsequent vacuum suction. Three blocks out of 24 were inadequate, probably due to inaccurate deposition of the local anaesthetic. There were two adverse reactions, possibly as a result of inadvertant intravascular injection. The need for long-acting agents for the present indication is questioned.


Acute intravenous tolerance of etidocaine. Etidocaine can be said to be midway between lidocaine and bupivacaine in respect to its toxicity. Its therapeutic ratio will depend on a more exact comparison of the clinical efficacy of the three agents.


A comparative study between etidocaine and bupivacaine in ulnar nerve block. The long-acting local anaesthetics bupivacaine and etidocaine were compared in a double-blind study using ulnar nerve block. Eleven volunteers took part in the study. Solutions used were: bupivacaine 0.25% and 0.5% and etidocaine 0.5% and 1 %. All solutions contained adrenaline 5 mug/ml. The time of onset and duration of analgesia and motor block, degree of motor block, and changes in skin temperature were investigated. The results did not show any differences in the duration of sensory of motor block. Differences were seen in the degree of motor block in favour of etidocaine. The sympathetic block seemed to be more intense and of longer duration with bupivacaine. Etidocaine had a shorter time of onset in all nerve fibres.


Axillary plexus block with etidocaine.

Axillary plexus block with etidocaine. Axillary plexus block has been used to compare 0.5% and 1.0% etidocaine (with adrenaline 5 mug/ml) in 32 patients in an open label study. The injected volume was 30 ml. The time to total analgesia and motor block was around 10-12 minutes. Complete block was achieved in more than 97% of cases. The duration of total analgesia and motor block was 6-7 hours. The time from injection to return of total sensation and motility was 8.5-10 hours. Adequate analgesia was achieved in all patients but two (one in each group). No noteworthy differences were found between the two solutions.


Supraclavicular brachial plexus block with etidocaine without vasoconstrictor. Preliminary report. When used for supraclavicular brachial plexus blocks, etidocaine 1% gave a quick and sufficient onset. Its duration was longer than that of mepivacaine 2%, and equal to that of bupivacaine 0.5%. Onset times for etidocaine 0.5% and bupivacaine 0.5% were about equal, but the former seemed to give a more profound motor block. The duration of etidocaine 0.5% was shorter than that of bupivacaine 0.5%. The long-acting agents showed great variations in duration, and they all had longer regression times than mepivacaine. No serious pharmacological side-effects were observed during this study, and so far there are no reports on neurological sequelae.


Intercostal blocks with etidocaine. Preliminary report. Although the results are few and should be considered as preliminary, the following conclusions may be drawn: 1. Etidocaine 0.5% and bupivacaine 0.5%, both with adrenaline (5 mug/ml), are comparable with regard to duration of sensory block. 2. Etidocaine 0.5% without adrenaline did not give the same duration of complete sensory block as when adrenaline was present. 3. Etidocaine 0.5% acts as a vasodilator at the site of injection. Adrenaline added to the solution counteracts the dilating effect. 4. Blood level studies of etidocaine do not at present show differences when 0.5% solution with or without adrenaline is used.


Comparative study with etidocaine and bupivacaine in epidural block. Etidocaine 1% and bupivacaine 0.5% (both with adrenaline 5 mug/ml) have been compared in a double blind study in epidural analgesia. Time of onset, duration, recession of analgesia and intensity as well as frequency of motor blockade were recorded in a selected group of patients undergoing varicose vein stripping. The onset of action of etidocaine was more rapid. Duration, recession and intensity of analgesia were similar for the two drugs. The main difference between them was that etidocaine produced a higher frequency and greater intensity of motor blockade.


Comparison between bupivacaine and etidocaine in lumbar epidural block for urological surgery. Lumbar epidural blocks produced by 17 ml of etidocaine 1% or bupivacaine 0.5%, both with adrenaline (5 mug/ml), have been compared in a double-blind trial in 40 patients, all scheduled for elective urological surgery. The onset time and segmental spread of analgesia, tested by pinprick and thermal pain, seemed to be slightly shorter with etidocaine (not statistically significant). The duration of analgesia and the blood-pressure changes were comparable with both drugs. The incidence and intensity of motor block were higher with etidocaine.


Thoracic epidural analgesia -- a double blind study between etidocaine and bupivacaine. In a double-blind study on 40 patients for elective upper abdominal surgery, measurements was made of onset time, duration and segmental spread of analgesia, systolic blood pressure, heart rate and peak expiratory flow during thoracic epidural analgesia with etidocaine 1% and bupivacaine 0.5%, both containing adrenaline 5 mug/ml. No major differences were found between the two agents. The results differ in many aspects from those obtained with these agents in lumbar epidural analgesia.


Relief of pain following upper abdominal operations by thoracic epidural block with etidocaine. Bupivacaine and etidocaine were compared in 0.375% and 0.5% solutions (without adrenaline) in a double-blind study in thoracic epidural analgesia following upper abdominal surgery. Special regard was taken to duration and adequacy of analgesia and changes in motor function. Duration of analgesia was roughly comparable for all four solutions. Bupivacaine 0.375% and etidocaine 0.5% seemed to be appropriate concentrations for adequate pain relief. Motor function, as assessed by changes in FVC, FEV1 and PEFR was not influenced to any greater extent. A progressive fall in FVC with successive injections, indicating increasing motor weakness, did not occur.


A double-blind trial of bupivacaine and etidocaine in epidural block for surgical induction of labour. Compared to bupivacaine, etidocaine has a quicker onset of action both in terms of initial analgesia and time taken to reach maximal extent of analgesia. ;owever, its duration of action is significantly shorter and it produces a striking degree of motor loss. These last two properties make etidocaine relatively unsuitable for obstetric practice, where a long duration of action and a reasonable mobility are desirable. However, it has been found useful for forceps delivery, because of the good muscle relaxation obtained and, because of its greater penetration, in abolishing the missed segments sometimes seen with bupivacaine.


A double-blind comparison of single doses of etidocaine 1 % and bupivacaine 0.5 % during continuous lumbar epidural block in obstetrics. A double-blind investigation of some of the effects of etidocaine 1 % and bupivacaine 0.5 % was undertaken in patients in established labour. The results showed that the duration of bupivacaine was significantly longer than that of etidocaine, while the number of patients with good analgesia was equal in both groups. Motor blockade was less obvious in those patients receiving bupivacaine, but in neither group was this a finding of importance. At 5 minutes the Apgar scores of neonates from both groups were similar and any differences seen at 1 minute may be attributable to factors other than the drugs on trial.


Virus-like particles in Creutzfeldt-Jakob biopsy material. In an electron microscopic study of brain biopsy material from 6 patients with Creutzfeldt-Jacob disease, virus-like particles resembling herpes have been seen. These particles were found only in reactive astrocytes. In 2 out of 6 Creutzfeldt-Jacob brain biopsies some profiles were filled with tubular structures resembling the nucleocapsid of paramyxovirus. The findings are compared with other neurological conditions.


Tissue culture study of a sacrococcygeal chordoma with further ultrastructural study. This report concerns an electron microscopic study of a sacrococcygeal chordoma and its in vitro cultured cells. In vitro, the cells that proliferated in the early phase were predominantly non-vacuolated stellate cells, which were later transformed into vacuolated cells. This suggests that various cell types seen in vivo represent variants of the same cell type at different stages of differentiation and cellular activity. The in vitro tumor cells also show the origin of their vacuoles from both rough endoplasmic reticulum and Golgi membranes. The finding of amorphous and granular material and collagen fibrils in the extracellular spaces of cultured cells seems to suggest that chordoma cells have certain synthetic and secretory activity.


Intravitreal injection of vancomycin in experimental staphylococcal endophthalmitis. Toxicity, clearance, and therapeutic effectiveness of intravitreal vancomycin hydrochloride injection in experimentally induced staphylococcal endophthalmitis were evaluated. Vancomycin was found to be nontoxic in a single, 1 mg/0.1 ml intravitreal dose. Therapeutic levels of vancomycin were present in the vitreous for over 72 hours and in the aqueous during a period from 6 to 48 hours after injection. Injection of a methicillin-resistant Staphylococcus aureus produced a panophthalmitis in our systemically treated controls, whereas in the rabbits treated by intraocular injection, the course of the infection was significantly altered.


Histocompatibility matching in poor-prognosis penetrating keratoplasty. Rabbits were haplotyped for the major rabbit leukocyte-locus A (RL-A locus), which is analogous to the human leukocyte-locus A (HL-A locus). The rabbits were divided into five groups, and the groups were arranged to provide a controlled experimental setting. Standardized alkali burns were induced in selected groups to produce heavy vascularization of the corneal bed. Groups with completely histocompatible corneal donors for the RL-A locus had a 9 out of 10 success rate when keratoplasty was performed on a vascularized bed. Another group of rabbits mismatched at the RL-A locus with histoincompatible corneal donors were prepared in the same manner and had a success rate of 1 out 9. A probable significant difference (P less than 0.005) using Fischer's exact test was found between the two groups.


Conjunctival sensitivity in pathological cases, with simultaneous measurement of corneal and lid margin sensitivity. A total of 209 pathological eyes each had 17 localities tested for sensitivity (cornea, caruncle, upper and lower lid margins (centrally, medially and laterally), and corresponding localities on the palpebral conjunctiva, and upper and lower halves of the bulbar conjunctiva). Reduced conjunctival sensitivity is seen in pemphigoid (excluding the lid margin) in contact lens wearers, at sites of nerves transected during operation and in rare cases of infectious conjunctivitis. Isolated corneal hypaesthesia is seen in bacterial or fungal keratitis. In herpes, the hypaesthesia extends over the bulbar conjunctiva, in zoster, over wider areas (including the lid margin). The sensitivity is normal in keratoconjunctivitis sicca and chronic conjunctivitis. In neurological diseases the hyposensitivity could include the cornea, conjunctiva and lid margin. The conclusion is drawn that a study of the conjunctivo-corneal sensitivity can give differential diagnostic information, provided the normal sensitivity range is known. This has been set out in a Table in 10-year age groups.


The pattern of new bone formation in isografts of bone. The pattern of new bone formation has been studied in isografts of fresh iliac bone and also in isografts of dead or irradiated iliac bone. Two phases of osteogenesis have been found in some fresh grafts. An early phase occurs during the first 3 weeks after transplantation, whilst the second phase is found after 8 weeks. The first phase is absent from non-viable grafts and it is therefore concluded that cells of the grafts are largely responsible for this early osteogenesis. The second phase, it is suggested, has a major host component, and may be due to induction of osteogenic potential in host mesenchymal cells. There may be some dependence of the second phase on the first but the extent is not clear. Removal of the bone marrow from the graft has little effect upon the first phase of new bone formation and it is suggested that surviving endosteal cells are the main participants in early osteogenesis.


Strontium-85 profile counting in fractures of the tibial shaft. A total of 203 profile countings were performed on 68 fractures of the tibial shaft, which included 25 normally healing cases, 37 cases of delayed union, and six cases of non-union. The measurements were performed on the 1st and the 7th day after the injection of strontium. In 27 cases the fracture received 2-3 strontium injections with associated profile counting at different stages of the healing process. The cases of normally healing fractures and delayed union showed differences in the average strontium uptake. However, these differences were not distinct enough to enable classification of individual fractures into groups. In cases requiring bone grafting, the transplant was found to accelerate metabolism and increase the accretion of strontium at the site of the fracture. The investigation shows that the real value of strontium profile counting lies in its ability to give information about the osteogenetic activity of the bone, which is a necessary prerequisite for the healing of the fracture.


A novel titanium rabbit ear chamber for vital microscopy of bone tissue. Seventy-eight small titanium-glass culture chambers of own design for vital microscopy of bone tissue were inserted in the ears in 41 rabbits. After insertion without removing the cartilage on the inner side of ears not previously operated upon, 44 out of 56 chambers (79 per cent) became vascularized. It proved satisfactory for bright field, fluorescence and polarized light microscopical observations of living bone tissue for half a year or longer.


Osteogenesis in rabbit ear chambers.

Osteogenesis in rabbit ear chambers. Heterotopic osteogenesis was studied in vivo by grafting 246 bone tissue grafts onto 39 cultures chambers inserted in the ears of 27 rabbits. Bone formation was obtained from 23 out of 24 autografts placed inside the optical part (greater than 0.1 mm deep) of 8 ear chambers. No bone tissue formation was observed in the optical part (less than 0.1 mm deep) of 23 chambers in which a total of 129 autografts had been placed in a communicating deeper non-optical part. Bone formation was always obtained after autografting bone tissue to the non-optical part of a titanium-glass ear chamber of own design, and bone tissue entered the optical part of these chambers when this was deeper than 0.1 mm. The possible source of bone formation in rabbit ear chambers is mentioned. Resorption of bone tissue autografts was regularly obtained.


Bone remodelling in rabbit ear chambers. A vital microscopical and histological study. Heterotopic autologous bone tissue was studied by vital microscopy in rabbit ear chambers and correlated with the findings from histological sections prepared from the same tissue. The in vivo morphology and remodelling of different bone types were thereby characterized. Autografts were resorbed in a disordered fashion by osteoclasts and woven-fibred bone tissue formed on such grafts. Later parallel-fibred bone, bounded by a seam of osteoid tissue, formed on this scaffold. Bone flakes growing underneath the cover glass were remodelled into shallow hemi-ossicles containing fat marrow, which were always oriented towards the cover glass. Following en bloc removal of the central part of the bone culture, woven-fibred bone rapidly formed within the new connective tissue, filling in the empty space. Such bone was remodelled into cancellous bone containing fat marrow. A balance between resorption and formation was regularly established in the chambers. The bone cultures were thus useful for vital microscopical studies for half a year or longer. In the present study bone remodelling in rabbit ear chambers closely resembled that of orthotopics bone. Ear chamber bone cultures are therefore a versatile in vivo biological model for dynamic bone tissue studies at both tissue and cellular levels.


Effect of indomethacin on bone remodelling in rabbit ear chambers. The effect of indomethacin medication on bone tissue resorption and formation was assessed by qualitative and quantitative microscopy in vivo in 18 rabbit ear chambers in 12 rabbits. Five bone tissue experiments were carried out during half a year using the rabbits as their own controls. One daily oral indomethacin dosage of 10 mg/kg body weight given for 3 weeks inhibited resorption of bone autografts in this type of vital chamber and thus inhibited disordered osteoclastic activity. The effect of indomethacin on ordered osteoclastic activity was not quantitated, nor was its effect on parallel-fibred bone tissue formation assessed. The same dosage of indomethacin clearly retarded woven-fibred bone tissue formation (by 1 week) as compared to control experiments, in which the chambers were used as their own controls. It is concluded that indomethacin treatment of patients liable to develop para-articular ossifications therefore seems rational. Indomethacin and drug-induced arthropathy of the hip-joint is discussed in relation to the presented results. A final appraisal of the role of indomethacin in this complex process must await additional material.


An interactive program for the analysis of ENG tracings. An interactive program for clinical and research evaluation of vestibular nystagmus has been developed. Because of the interactive structure of the program, the clinician can make immediate decisions on the interpretation of controversial aspects of the nystagmogram; therefore even the more irregular and noisy ENG tracings, frequently obtained from pathological subjects, can be easily processed. In this way, speed and accuracy of computer processing are coupled with intelligent activity and critical judgement of the clinical evaluation. The program can be implemented on a general purpose minicomputer and no specific technical training is required for its use. The structure of the program and the operations performed by main subsystems are discussed in detail. Examples of ENG tracings processed with the program are reported.


III. Evaluation of the forward triangle area in dye curves from infants and children studied by earpiece densitometry. Onehundred and six dye curves recorded by earpiece densitometry in shunt-free children were analysed with respect to the spatial relationships between the forward triangle and the area under the total primary dye curve. It is suggested that the relationship between these two areas, the forward triangle factor, should be 0.32 for studies in children with the use of dichromatic earpiece densitometry.


Experimental studies on the treatment of unilateral vocal cord paralysis. After the injection of Teflon and Silicon behind the vocal cords of sheeps we noticed that these materials are quite well supported. The little particles of Teflon are surrounded by conjective tissue wheras the Silicon is enclosed in an unic membrane. We could not see a migration of the materials in the depth.


IV. Evaluation of dichromatic earpiece densitometry in children with left-to-right shunts. Earpiece densitometry was performed in 60 infants and children with left-to-right cardiovascular shunts. The method was found to possess a high diagnostic sensitivity with respect to identification of the left-to-right shunt. Earpiece densitometry was in this respect clearly superior to conventional method using oxygen saturation figures. Quantitation of pulmonary blood flow by both densitiometric and oxygen content technique in a small number of patients indicates that the dye dilution technique gives values somewhat in excess of the Fick method. It is concluded that quantitation of the magnitude of the left-to-right shunt and pulmonary blood flow is disturbed by the fact that indicator material is recirculated before the ascending limb of the primary curve is fully inscribed.


Planar relationships of the semicircular canals in man. Principal-component analyses were determined on a series of points measured from the dissected bony labyrinth of ten human skulls, resulting in planar equations for each of the six semicircular canals. Following this, angles were calculated between the ipsilateral canal planes, between opposite synergistically acting canal planes and between each canal and the Reid stereotaxic planes. Results indicated that pairs of ipsilateral canals were nearly perpendicular, with the excpetion of the angle formed between the anterior and horizontal canal (mean = 111 degrees). Pairs of contralateral synergistic canal planes formed angles of 19 degrees between right and left horizontal canal planes and 23-24 degrees between vertical canal pairs. The horizontal canals formed an angle of 25 degrees with the Reid horizontal plane. Mathematical equations of the semicircular canals were used to predict the optimal head position for rotational and caloric stimulation.


The orientation of the semicircular canals in the guinea pig. In 10 adult guinea pigs the stereotaxic coordinates of a series of points along each osseous semicircular canal were analysed to yield an equation of that canal plane in stereotaxic space. Angular relationships among the canal planes and between the canal planes and the major stereotaxic planes are presented together with the optimal positions of the head for physiological stimulation of each canal or pair of synergistic canals. The planes of the semicircular canals in each labyrinth are not perpendicular to one another and the planes of contralateral synergistic canals depart from parallelism by about 30 degrees.


Reticulosarcomatosis originating from skin--A clinicopathological study. The case is that of a 65 year-old male with reticulosarcomatosis originating from the skin. There were multiple tumors composed of reticulum cells located only in the skin, particularly around the large joints. The entire course of illness was three years and five months, during which period regression by irradiation, recurrence, or new formation of tumors were repeatedly seen. At the end systemic tumor spread not only of the skin but also in various visceral organs including lymph nodes occurred. From histological and electron microscopic examinations repeatedly performed with biopsy materials, and finally with autopsy materials it was ascertained that the tumor cells had become smaller in size with less lymphoid cell infiltration at the terminal stage.


Survival after haemorrhage from the brachiocephalic truncus following tracheostomy. A patient with two massive haemorrhages from the brachiocephalic truncus after tracheostomy is reported. An analysis of 6 previously reported long-term survivors following this complication shows that the initial care in controlling the haemorrhage is of major importance. The operation method of choice is permanent division of the brachiocephalic truncus. Transitory or no neurological postoperative complications were found.


The effect of cyclophosphamide, methotrexate and X-irradiation on the ultrastructure and endocytic capacity of murine peritoneal macrophages. 100 mg/kg cyclophosphamide given subcutaneously daily for 5 days and whole-body X-irradiation (500 r) had an appreciable effect on the phagocytosis of E. coli by mouse peritoneal macrophages. Less bacteria were ingested by cells from the treated mice as compared with control cells. In contrast, whole-body X-irradiation had a stimulatory effect on pinocytosis as compared with cells from cyclophosphamide treated mice or control mice. Morphological changes in the cells from animals treated with cyclophosphamide or X-rays were evident. The cells were larger than normal macrophages and contained large amounts of lipid and phagolysosomes and had more vacuoles as compared with control cells. Many giant cells were present in the treated mice. Treatment of mice with methotrexate for 5 days, although affecting the cells morphologically in that they were larger than normal cells and had many vacuoles did not appear to have any effect on either phagocytosis or pinocytosis. Cells from methotrexate treated animals did not contain the large quantities of lipid seen in cells from the cyclophosphamide treated and X-irradiated mice.


Experimental evaluation of the velvet pad rinse technique as a microbiological sampling method. The use of velvet pads glued to aluminium foil has been evaluated as a microbiological sampling method in quantitative bacterial recovery experiments, and the efficiency and precision have been determined. The velvet pads uptake of Staphylococcus epidermidis was 0.93 (or 93 per cent) after sampling from a test surface on blood agar, while the release by subsequent imprinting on blood agar was 0.02, the median effective transfer being 0.02. A mechanical rinse and shake procedure of the velvet pad in 0.9 per cent saline followed by centrifugation and surface plating significantly increased the median release to 0.66, the median effective transfer being 0.61. There was no difference in uptake, release and effective transfer between a pure culture of S. epidermidis and a mixed culture of S. epiderimidis and Escherichia coli. Storage of the velvet pad in 0.9 per cent saline for 2 h at room temperature did not influence bacterial recovery significantly, in contrast to a significant decrease after storage in saline for 24 h or storage in a dry Petri dish for 2 h. The high and fairly constant efficiency of bacterial recovery of the velvet pad rinse technique suggests that it could be employed clinically.


Arterial pressure, cardiac output and systemic resistance before and after pithing in normotensive and spontaneously hypertensive rats. After complete cardiovascular denervation mean arterial pressure (MAP) falls to almost equally low levels in spontaneously hypertensive rats (SHR) and normotensive control rats (NCR). This has earlier been suggested to indicate a dominance of neurogenic mechanisms in established SHR hypertension. -- In the present study, total peripheral resistance (TPR) remains, however, some 35 per cent higher in adult SHR than in NCR after pithing while cardiac output (CO), and stroke volume, is 35 per cent lower in SHR. These opposite differences in TPR and CO after denervation, resulting in equal MAP levels in SHR and NCR, seem rather to be a consequence of the rapidly established structural adaptation that affects all SHR high-pressure cardiovascular sections. Thus, the SHR precapillary resistance vessels display thickened walls and luminal narrowing, which keeps TPR higher than in NCR even during maximal vasodilatation. Due to hypertrophy, the SHR left ventricle exhibits a reduced myocardial stretch for a given filling pressure and stroke volume is consequently reduced more than in NCR after complete denervation. -- Paradoxically, therefore, rather than reflecting any dominance of neurogenic mechanisms in established SHR hypertension the MAP equalization in SHR and NCR after cardiovascular denervation emphasizes the hemodynamic importance of cardiovascular structural changes present in hypertension.


Synaptosomes containing large agranular vesicles isolated from developing rat brain. Using the subcellular fractionation technique the fine structure of the isolated nerve endings (synaptosomes) from the hemispheres and brain stem of the 1-day old and adult rat was examined. In the synaptosomal fractions of the brain of 1-day old rats we observed a new type of nerve endings containing predominantly large agranular vesicles about 1,000 A in diameter. After incubation with alpha-methylnoradrenaline or 5-hydroxydopamine these vesicles remained agranular. It is assumed that the new type of large vesicles represent developing synaptic vesicles.


Stereotactic exploration of brain tumours by ultrasound. A report upon a new technique for investigation of brain tumour anatomy by means of stereotactically directed ultrasound is presented with some illustrative cases. Information obtained with this technique has been found useful when deciding the treatment program for the tumour.


Computer assisted axial tomography in cerebrovascular lesions. Computer assisted axial tomography was performed in 32 patients with clinically possible cerebrovascular lesions. Decreased absorption as a sign of infarction was found in 15, increased absorption as a sign of hemorrhage in 7 cases. In another 7 cases, diagnosed as hemorrhagic infarction, a simultaneous occurrence of increased and decreased absorption appeared. Increased absorption might also depend on compression effect of edema. In three cases no abnormal attenuation could be demonstrated. Infarctions could be observed years after the onset of the symptoms; intracerebral hemorrhages regressed slowly.


Cross-sectional anatomic images by gamma ray transmission scanning. 60Co gamma-ray transmission data were measured along linear scan paths at a number of angular orientations with respect to the patient and submitted to a computer software program. Reconstructed images are displayed as digital density printouts and as isodensity contours on an x-y plotter or oscilloscope screen. Image resolution is limited primarily by factors such as collimation and the amount of transmission data collected; with the rather rudimentary apparatus at disposal, a spatial resolution better than 5 mm has been achieved.


Some problems concerning the determination of different corrinoids by the plate method with Escherichia coli 113-3. Biological activity of some vitamin B12 forms for Escherichia coli 113-3 and the effect of methionine on the assay of these compounds by E. coli 113-3 were studied. It was found that the coenzymatic form had the highest biological activity and that under experimental conditions methionine was an interfering factor in determination of the coenzymatic form and the methyl derivative of B12 only. Otherwise, metionine did not affect the determination of cyanocobalamin an hydroxycobalamin even when the methionine and vitamin B12 ratio was 32 000 : 1.


Mechanism of assembly of tobacco mosaic virus in vitro. We previously proposed that the assembly reaction of TMV in vitro is initiated by 20S protein aggregate specifically interacting to the 5'-end of TMV-RNA, after which the helical rod grows by the addition of protein subunits. Other workers have reported that the source of protein for the growing helix is also the 20S protein aggregate, but not protein subunits. We now summarize the experimental results that confirm our previous hypothesis. 1) TMV-particle, as gauged by infectivity assay and sucrose gradient analysis, could be formed from PRR under conditions where the formation of 20S protein aggregate could not occur. 2) TMV-particle could be formed from PRR by stepwise addition of NBS-modified protein which is lacking the ability to form 20S protein aggregate. 3) The stable disk aggregate of CGMMV-protein are unable to grow the helical rod. 4) The process of rod elongation by protein subunits was observed directly in electron micrography.


DNA repair and evolutionary considerations. A search for a general principle in nuclear biology with use of radiation as a probe. Three types of DNA repair are known: photoenzymatic repair, excision repair, and tolerance repair (the ability to generate damage-free copies of DNA, which could be not exact copies, from damaged DNA templates). Photoenzymatic repair involves the most simple molecular mechanisms and is the most specific (effective only for pyrimidine dimers) and the most widely distributed among present living organisms, followed by excision repair and then by tolerance repair in order of increasing complexity. It is proposed that these repair systems also evolved in this order after the primordial life was created by solar UV light. Current but fragmentary evidence concerning the molecular and genetic bases of the three types of repair tends to support the idea that the increase in DNA-content needed for the evolution of higher forms from the prokaryotes may have been accompanied by the inherent threat of fragility of the giant DNA molecules, so that the higher forms now possess a greatly increased tolerance capacity. Probably the increase is approximately proportional to their DNA content compared with that of prokaryotes. It is shown theoretically that photoenzymatic and excision repair alone cannot deal with the inherent fragility of giant DNA. The development of tolerance-repair capacity, however, inevitably enhances probability of errors in the repair of DNA damage, leading to the accumulation of misrepair events such as mutation, chromosomal aberration and cancer. It is proposed that DNA repair and misreplication repair are responsible for preventing living organisms from regressing to the randomness-dominated world of the non-living. Living organisms would have evolved slowly along zigzag lines between error and repair of DNA.


Pituitary function in chronic alcoholism. Elevated basal LH levels and an exaggerated response to LHRH were found in a high proportion of male chronic alcoholics. This was not associated with reduced plasma testosterone values. In addition, previous reports of an absent cortisol response to hypoglycaemia in a proportion of chronic alcoholics are confirmed.


Disposition of catecholamine-derived alkaloids in mammalian systems. Tetrahydropapaveroline, the tetrahydroisoquinoline alkaloid derived from dopamine, is converted in vivo by rats and by rat liver and brain preparations to tetrahydroprotoberberine alkaloids. The latter alkaloids have also been identified for the first time in the urine of parkinsonian patients receiving L-dopa therapy. These findings suggest that man, like plants, may have the ability to elaborate several classes of alkaloids with potentially important pharmacological consequences. Thus, this newly demonstrated ability of mammalian systems to evoke the biosynthesis of benzyl-tetrahydroisoquinoline-derived alkaloids - a capability previously considered unique to plants - elects the tetrahydroprotoberberine alkaloids as representative of the first class of a possible constellation of complex mammalian alkaloids elaborated from the neuroamines.


[Morphology of the corneal endothelium under normal conditions and during regeneration after mechanical injury]. On a preparation of the corneal endothelium membrane from a rabbit, the morphological structure of the endothelium is examined under normal physiological conditions and during regeneration after abrasion by mechanical means.  Thematerial which is submitted here is outlined in two chapters: (1) The morphology of the normal corneal endothelium; (a) in the contest of the literature on the subject, (b) in comparison with different methods of preparation. (2) The morphology of endothelium regeneration; (a) in the literature as physiological regeneration and, after experimental abrasion, as a model for human endothelium pathology, (b)as a systematic examination at different points of time after mechanical abrasion and in single phases of indirect and direct cell multiplication. After a survey of the comprehensive literature on the subject, several histological fixations and methodds of endothelium preparation as a membrane are given. In a comparison of the findings of the presentation of the normal endothelium, these methods are described in virw of a specific presentation of pathological endothelium rocesses. On the basis of the dyeing characteristics of the cells after intraocular pre-fixation; the evidence of the viscous mucopolysaccharoid membrane on the cell surface (the membrane having been dissected from the endothelium) is discussed...


New observations on the effects of atropine on the sinoatrial and atrioventricular nodes in man. Previous observations of slowing of the heart rate after administration of atropine in doses smaller than 0.4 mg and recent reports of development of rhythm disorders in patients with acute myocardial infarction given atropine prompted us to evaluate systematically the effects of various doses of atropine (0.1 to 0.8 mg) on the response of the sinoatrial (S-A) and atrioventricular (A-V) nodes in healthy volunteers. The response of the S-A node to atropine was characteristically bimodal, slowing at smaller doses and accelerating at larger doses. In contrast, the A-V node showed acceleration of conduction in response to all doses of atropine used. A hypothesis based on current understanding of the electrophysiologic parameters governing impulse formation and impulse conduction is advanced to explain the apparent paradox in the S-A and A-V nodal responses to small doses of atropine. The results suggest the need for caution and continuous rhythm monitoring when giving atropine to patients with acute myocardial infarction.


Spontaneous abortion as a screening device. The effect of fetal survival on the incidence of birth defects. To make sound inferences about the distribution, causes and risks of congenital anomalies requires an understanding of selective survival among fetuses. Studies of spontaneous abortions are therefore advocated. A simple model is proposed of the distribution, among spontaneous abortions and births, of conceptuses with and without anomalies. The resulting equation accomodates both maternal and fetal factors. Interaction between maternal and fetal factors is hypothesized, in the form of a maternal device for screening out anomalous conceptuses. A number of the known facts about congenital anomalies are shown to be plausibly interpreted in terms of the proposed model. Finally, some clinical and epidemiologic implications of the model for the study of spontaneous abortions are pointed out.


Leprosy in Louisiana, 1855-1970. An epidemiologic study of long-term trends. Study of a well known focus of leprosy in Louisiana in 1855-1970 showed a decrease in incidence which began before the use of chemotherapy. Many of the cases had onset in a limited area of Louisiana, French Louisiana, where there was a high incidence of multiple family cases. Overall incidence rates were found to be decreasing for each cohort of birth, and within cohorts after 1920, the highest incidence rates were in the age group 10-19. A high incidence rate was found for cases with onset in the years 1900-1929; rather than an epidemic, this was probably related to bias in the recording of year of onset. Although persistent for a long period, the focus remained limited in geographic extent and seems to be disappearing.


Studies of twins with systemic lupus erythematosus. A review of the literature and presentation of 12 additional sets. To assess the role of genetic factors in systemic lupus erythematosus (SLE), 12 twon pairs (seven definitely monozygotic, three definitely dizygotic) of which one or both twins had SLE, were studied and compared to 17 twin pairs (12 definitely monozygotic) previously described. In the present series, four of seven (57 per cent) definitely monozygotic pairs were clinically concordant for SLE, satisfying the preliminary criteria of the American Rheumatism Association (ARA). Concordance for the presence of antinuclear factor (ANF) and hypergammaglobulinemia was 71 and tinuclear factor (ANF) and hypergammaglobulinemia was 71 and 87 per cent, respiectively. These data closely agree with those on the 12 definitely monozygotic sets previously described. All three of the dizygotic sets in the present series were discordant for clinical SLE, although one clinically well twin had marked serologic abnormalities. Comparison of these data with thos from other first degree relatives of out twins clearly suggests a strong genetic component in the pathogenesis of SLE. The relative contribution of nongenetic and environmental factors to the expression of the disease is discussed.


Serial complement studies in a patient with Goodpasture's syndrome treated with bilateral nephrectomy and renal transplantation. A young male patient with Goodpasture's syndrome was treated with bilateral nephrectomy and when antiglomerular basement membrane antibodies could no longer be detected he received a cadaveric renal homograft. Fifteen months later he is in good health and without signs of pulmonary disease. Renal function is satisfactory, and there are no findings indicating recurrence of the nephritis. Serial complement studies during the entire course revealed varying degrees of activity in the sequence in the different phases: a high degree of in vivo activation of complement was found in the period before the nephrectomy, there was a moderate degree of activation in the period between the nephrectomy and transplantation and, finally, there were no signs of activity in the system after transplantation. This investigation strongly suggests that the complement system is of definite pathogenetic significance in this human equivalent to experimental nephrotoxic nephritis.


Acid phosphatase production as an aid in rapid characterization of Candida species. Yeast isolates were tested for phosphatase activity, using p-nitrophenyl phosphate substrate. Several Candida species displayed characteristic patterns. The enzyme activity was absent in all except one of the 78 isolates of Candida albicans tested. C. tropicalis, C. pseudotropicalis, and C. krusei were the most consistent and active enzyme producers. Enzyme production by these yeasts was not influenced by the amount of growth or a decrease in the pH of the culture media. The characteristic enzyme activity of these three yeasts was demonstrated in the presence of concentrations of inorganic phosphate which inhibited the enzyme activity of other Candida species. The activity of isolates of C. gullermondii, C. parapsilosis, and C. stellatoidea was variable, although none of these were strong enzyme producers. It seems feasible to use phosphatase activity as a simple and rapid additional method for the separation of C. albicans from closely related species of the genus.


Inadequate cell washing as a source of error in fetal hemoglobin determination. Washing the red cells before preparation of the hemolysate is important in avoiding serious clinical errors in fetal hemoglobin determinations. This has been demonstrated using both the alkali denaturation technique and a commercial hemolyzing reagent. Hemolysates prepared from unwashed cells were always above the normal range in samples known to be normal.


Pregnancy following renal transplantation. From 1968 through 1974 at the University of Minnesota there were 17 pregnancies in 12 patients who were renal transplant recipients. Three were cadaver transplants and nine were transplants from living related donors. In eight patients there were two first-trimester pregnancy termination, three mid-trimester abortions by hysterotomy, and one spontaneous abortion. Two of the induced abortions were in patients with ileal conduits. There were no unusual major obstetric complications but toxemia of pregnancy and concurrent bacterial and viral infections were common medical problems. Of the liveborn infants, only three of the 12 were small for their gestational age, seven were of appropriate size, and two were large. There were no neonatal problems and no congenital anomalies. Renal function during pregnancy was carefully monitored and was compromised in three of the patients studied. One patient had three pregnancies, including the delivery of a set of twins. Several months following her third delivery she developed fatal hepatitis. Two patients developed carcinoma in situ of the cervix. Pregnancy following renal transplantation is not without risk. Sexually active female transplant recipients should be counseled regarding pregnancy and sterilization should be offered as an option at the time of transplantation.


Endothelial survival in corneal tissue stored in M-K medium. Cat corneas were stored at refrigerator temperatures in M-K medium (TC-199, 5% dextran), modified M-K medium (TC-199, 1% chondroitin sulfate), or on the intact globe in moist chambers for intervals of one to nine days. Less than 5% of the endothelial cells stained with trypan blue in corneas stored one to four days, regardless of the method of storage. In contrast, after five days, 20% or more of the cells took up the stain in 17 to 21 corneas stored in M-K medium. Although stain uptake indicated nonviability of cells, most of the endothelial cells remained structurally intact when observed by scanning and transmission electron microscopy unless the corneas were incubated in fresh TC-199 for two hours at 35 degrees C before trypan blue staining. In that case, the percentages of disrupted cells observed at each time interval correlated with the percentages of cells that had stained in each cornea. These results indicated that storage in M-K medium did not extend the time donor coreas can be stored before transplantation beyond four days.


Comparative pharmacologic effects of pilocarpine administered to normal subjects by eyedrops or by ocular therapeutic systems. Normal volunteers used 1, 2, and 4% pilocarpine eyedrops, three times daily, or ocular therapeutic systems placed in the conjunctival cul-de-sac to control intraocular pressure. The systems  continuously release 20 and 40 mug/hour of pilocarpine for one week. Although the amount of drug delivered to the eye from the ocular therapeutic system was one fifth that obtained from the eyedrops, the decrease of intraocular pressure was comparable. The ocular therapeutic systems produced small, constant effects on visual acuity, refractive error, and miosis that did not cause visual handicaps or require correction. The effects of eyedrops on these visual factors were large and varied and produced marked visual handicaps that were not correctable with spectacles. Despite its comparable hypotensive effect in normal subjects, continuous delivery of pilocarpine by means of an ocular therapeutic system elicits less severe side effects than pilocarpine eyedrops.


A erimetric technique believed to test receptive field properties: sequential evaluation glaucoma and other conditions. We used a technique to simplify and speed up a perimetric test (Westheimer function). Through sequential testing, the technique was successfully used to evaluate pathologic findings and partially to evaluate treatment regimens in three subjects. One patient had an onset of kinetic field changes and Westheimer function alteration with primary open-angle glaucoma. Temporary remissions of alterations in the Westheimer function and kinetic visual field loss occurred in patients with glaucoma and tobacco-alcohol (complicated) amblyopia. Using these techniques it is possible to localize an anomaly in the outer retinal layer, the inner retinal layer, and central to the optic nerve head. We divided the inner and outer retinal layers on a vascular support basis.


The use of previously administered examinations for computer-assisted instruction. Five-part multiple choice questions use the same procedure as many programmed texts developed for teaching purposes. However, the latter provide immediate feedback, reinforcing a correct answer and correcting a wrong response. Previously-used quizzes, entered into a computer, can provide a learning experience for new students. The computer responds immediately to each student answer, stating whether it is correct or not. If correct, the reason is presented. If incorrect, the reason is stated, and the correct answer is provided along with an explanation.


Orthodontics and dentistry for the hemophilic patient. In this presentation we have contrasted the normal blood-clotting mechanism with the failure to form blood clots in hemophiliacs due to the absence of protein factors necessary for conversion of prothrombin to thrombin. The statistics, hereditary basis, and long-term disabling consequences of hemophilia to the severely ffected patient are described. The systemic means of minimizing severe joint disabilities and serious internal bleeding hazards by employing concentrates of antihemophilic factors to reverse the bleeding defects are discussed. Availability and advantages of the types of concentrates are explained. The fatalistic attitude of hemophiliacs toward hepatitis is discussed, along with admonitions to avoid the use of aspirin, alcohol, and buttock injections. Alternative medications for pain are recommended; and injection sites for pediatric patients are suggested. The details of simplified oral surgical management of hemophilic patients without hospitalization are described, including local anesthetic injection technique, method of performing extractions, general anesthesia techniques when indicated, materials for packing of extraction sockets, regimen and precautions in use of Amicar administration for clot maintenance, postoperative diet, and postsurgical activity guidelines. Also noted is the self-administration of intravenous concentrate infusions at home in the event of hemorrhagin, so that bleeding is on the way to bein controlled even before the patient reaches the hospital. We avoided orthodontic treatment of hemophilic patients in the past; however, recently developed bracket-fixation techniques and auxiliary aids; along with an enlightened understanding that gingival bleeding is ot to be feared, have changed our attitude, and we now treat hemophilic patients in much the same manner as otherwise normal orthodontic patients...


Microvascular changes in lymph nodes draining skin allografts. Histological, histochemical, ultrastructural, and radiolabeling characteristics of the microvasculature in regional nodes draining skin allograft sites are described. From 12 to 48 hours after grafting, these nodes show increased vascular permeability and altered lymphocyte traffic pattern. The rapid rise in lymphocyte migration indices and the apparent plugging of intermediate sinuses by lymphocytes suggest that both increased entry and decreased egress of recirculating cells contribute in "lymphocyte trapping." This is followed by redistribution of cortical capillary arcades as existing germinal centers dissolve and proliferating lymphocytes infiltrate the cortex. Normal microvascular patterns reappeared at 7 to 14 days as primary and secondary nodules form in the enlarged nodes. Increased length and arborization of high endothelial venules resulted from focal proliferation of endothelial cells in transition zones from high to low endothelium. In stimulated nodes, high endothelial cells exhibit increased cytoplasmic basophilia and acid hydrolase activities which correlate with the appearance of numerous polyribosomes, RER cisternae, and lysosomes in their cytoplasm. These "activated" endothelial cells phagocytose microthrombi within venular lumens.


Glomerular microcapillary thrombosis demonstrated by the new technique of immunocathodoluminescence. Fluorescein-labeled antigen-antibody complexes could be made visible by scanning electron microscopy using an intensifying device. This new method of immunocathodoluminescence was demonstrated on cryostat sections of rat kidneys containing glomerular fibrin as the result of endotoxin infusion. The resulting photographs correspond with those obtained by immunofluorescent microscopy. The advantage of this technique is, however, the larger depth of focus. By using thinner cyostat sections it is expected that the higher resolution of scanning microscopy will provide even better details in three dimensions.


The human mandible: lever or link?

The human mandible: lever or link? The mammalian mandible, and in particular the human mandible, is generally thought to function as a lever during biting. This notion, however, has not gone unchallenged. Various workers have suggested that the mandible does not function as a lever, and they base this proposition on essentially two assertions: (1) the resultant of the forces produced by the masticatory muscles always passes through the bite point; (2) the condylar neck and/or the temporomandibular joint is unsuited to withstand reaction forces during biting. A review of the electromyographic data and of the properties of the tissues of the temporomandibular joint do not support the non-lever hypothesis of mandibular function. In addition, an analysis of the strength of the condylar neck demonstrates that this structure is strong enough to withstand the expected reaction force during lever action. Ordinarily the human mandible and the forces that act upon it are analyzed solely in the lateral projection. Moments are then usually analyzed about the mandibular condyle; however, some workers have advocated taking moments about other points, e.g., the instantaneous center of rotation. Obviously it makes no difference as to what point is chosen since the moments about any point during equilibrium conditions are equal to zero. It is also useful to analyze the forces acting on the mandible in the frontal projection, particularly during unilateral biting. The electromyographic data suggest that during powerful unilateral molar biting the resultant adductor muscle force is passing between the bite point and the balancing (non-biting side) condyle. Therefore, in order for this system to be in equilibrium there must be a reaction force acting on the balancing condyle. This suggests that reaction forces are larger on the balancing side than on the working side, and possibly explains why individuals with a painful temporomandibular joint usually prefer to bite on the side of the diseased joint.


The immediate effects of chlorpromazine in newly admitted schizophrenic patients. To evaluate the clinical effectiveness of chlorpromazine in comparison with placebo over a brief period of hospitalization, the authors conducted a double-blind study of the drug in 44 acutely ill schizophrenic patients. These patients had been newly admitted to a brief treatment unit where the average length of stay was 7 to 10 days. The results of this study indicate that chlorpromazine had no more calming or antipsychotic effect than placebo during the first 5 days of treatment. The authors suggest that 5 days is too short a time for a clinical trial to gauge patient response to chlorpromazine.


Identification of women at risk for unwanted pregnancy. Concern about increasing rates of unwanted pregnancy, particularly among adolescents, has led to consideration of steps necessary to develop effective intervention programs. In order to reach a young woman for counseling and contraceptive assistance before she places herself at risk for unintended pregnancy, it seems necessary to develop the capability for identifying high-risk individuals without reference to sexual history. The authors describe a preliminary attempt to predict contraceptively unprotected coitus from responses to projective test stimuli, noting that the problem is so urgent that even early and necessarily incomplete work in this area may have merit in stimulating further research in identification of women at risk for unwanted pregnancy.


A computer-assisted psychiatric assessment unit. The authors discuss the rationale and functional design for an innovative approach to psychiatric intake decision making, stressing the crucial role of an on-line computer support system. The description of the prototype computer-assisted psychiatric assessment process includes an outline of computer and staffing requirements. The authors discuss the initial impact of this psychiatric assessment unit on the hospital's mental health care delivery system.


Psychiatry in Spain: past and present.

Psychiatry in Spain: past and present. The authors discuss the contributions and history of psychiatry in Spain on the basis of extensive literature review and on-site observations. The history of Spanish psychiatry is a rich one, including pioneering efforts in the establishment of mental institutions and a strong traditional alliance between psychiatry and literature. However, the authors note that Spanish psychiatrists today are less innovative than their counterparts in other countries. They emphasize the historical and cultural context of the discipline, with illustrations of the importance of the church, attitudes toward the family, and other sociocultural factors.


Minimal brain Dysfunction.

Minimal brain Dysfunction. Because of the prevalence in our society of children labeled with the term minimal brain dysfunction; physicians who treat children must develop a point of view toward the syndrome and a working procedure for assisting affected children. An approach to this problem can be divided into two parts: detection of somatic disorders and comprehensive management of school problems. The detection of somatic disorders that may have produced or substantially contributed to the school problem requires conventional medical skills for recognition and treatment. Comprehensive management of school problems requires a broader approach by the physician; including counseling of the parents regarding adverse family interactions, advice about educational resources and consideration of the question of drug therapy for behavioral disorders. In all instances parents should be able to rely on the physician to act as a scientific source of guidance on the merits of the plethora of therapies directed toward the child with learning disorders. The ability to function competently in all of these areas will enable the physician to provide a service for children and their families that may profoundly affect their lives.


Increasing acid response to a meal in the chronic Heidenhain pouch. Heidenhain pouches were established in four mongrel dogs. Acid secretory values were studied in response to a meal, both after operation and six to eight months later. Large increases in the acid responses of the Heidenhain pouch to a meal were noted over a period of time. Mechanisms accountable for this acid increase were studied, including serum gastrin response, pepsin activity, and morphologic changes in the pouch. Regeneration or reinnervation of vagal fibers may occur at a subthreshold level but is not well documented. The necessity of repeated control studies in long-term evaluation using the Heidenhain pouch is emphasized.


Kidney transplantation in patients with end stage congenital renal disease. Report of eighteen cases and review of the Organ Transplant Registry. Eighteen patients with end stage congenital renal disease requiring kidney transplantation constituted 12 per cent of the transplantation recipients at this institution over the past six years. The post-transplantation course in this group was remarkably satisfactory, with a 94 per cent graft survival at three years. In addition, we analyzed survival data from over 9,900 patients in the Organ Transplant Registry and demonstrated that transplant recipients with end stage congenital renal disease have equal or better five year patient survival compared with those with acquired end stage renal disease. Only those patients with adult polycystic disease had a less satisfactory prognosis, probably because of age-related factors. In contrast, there were few statistical correlations between renal allograft survival, age, and original disease.


Transcutaneous electrical stimulation in treatment of postoperative pain. Transcutaneous electrical stimulation as a means of relieving acute pain was evaluated in 100 patients who underwent abdominal or thoracic operative procedures. Transcutaneous electrical stimulation proveded pain relief in 77 per cent of test patients as opposed to 17 per cent of control patients. Transcutaneous electrical stimulation is an effective method of treatment that has many advantages over analgesic drugs.


Successful management of miliary tuberculosis after renal transplantation. Miliary tuberculosis is the most lethal form of tubercular disease. If dissemination of tubercle bacilli occurs without therapy, death is almost certain. The importance of establishing an etiologic diagnosis as promptly as possible in patients receiving immunosuppressive therapy is self-explanatory. The presence of a life-threatening infection in these patients requires aggressive antimicrobial therapy and discontinuation of the immunosuppressive drugs until the infectious process is under control; the presence of an impaired immunologic response is responsible for the life-threatening infection and the lack of an acute rejection reaction.


The "parachute" stent.

The "parachute" stent. A method of stabilizing intraoral skin grafts from outside the mouth is described. It provides excellent immobilization ot the graft and superior oral hygiene as compared with conventional intraoral stents.


Late sequelae of radiation therapy in cancer of the head and neck with particular reference to the nasopharynx. Sequlae of radiation therapy may be late in occurring and varied in their manifestations. Although some are untreatable and progressive, the risk of development of some other sequelae can be minimized by careful application of radiotherapy or by ancillary measures, such as dental decay prophylaxis. Some of the serious sequelae secondary to radiation therapy of the nasopharynx have been summarized. These include radiation myelitis, paralysis of the cranial nerves, stricture of the pharynx, radiation-induced cancer, and necrosis with fatal hemorrhage.


T-cell deficiency in patients with squamous cell cancer of the head and neck. Cellular immunity was assessed in patients with operable squamous cell cancer of the head and neck using in vivo skin tests and in vitro lymphocyte stimulation tests. An expansion of a previous study continued to show that 30 per cent of patients with T1N0M0 lesions were DNCB-negative and that with more advanced lesions there was further impairment. A similar finding was observed in the blastogenic response to phytohemagglutinin and concanavalin A but not pokeweed mitogen. Overall, 40 per cent of patients with resectable cancer had a significant depression of the blastogenic responses to conconavalin A and phytohemagglutinin. This depression ranged from 15 per cent in patients with T1N0M0 lesions to 71 per cent in those with T3N0M0 lesions. Although this depression was more severe in patients with palpable cervical node metastases, it was related more to the size of the primary tumor than to the nodes per se. An exception occurred in patients with large fixed nodes in whom the depression of lymphocyte stimulation was most severe. The absolute T-cell count was also depressed in patients with head and neck cancer. This depression parallelled the lymphocyte stimulation results with phytohemagglutinin and conconavalin A and was progressive with increasing stage of disease. A correlation exists between DNCB negativity and early recurrence and shortened survival. Clinical follow-up study is too short to assess the correlation of in vitro immune function with these clinical prognostic factors.


Carcinoma of the lip.

Carcinoma of the lip. A retrospective analysis of 206 patients with lip cancer is presented. Poorly differentiated primary lesions have a high rate of metastases. The metastatic potential of well differentiated lesions, when classified by size in the TNM staging system, is the same as that of intraoral carcinoma. A therapeutic approach is proposed.


Nasolabial flap reconstruction of the floor of the mouth after extirpation of oral cancer. The transbuccal nasolabial flap is an extremely valuable method for primary or secondary reconstruction of the floor of the mouth. We urge its frequent use.


[Corneal lesions in ichthyosis (author's transl)]. The authors report about observations they made in two sisters. One sister showed a fibroid degeneration of the cornea, the other a band-shaped keratopathy respectively, together with an ichthyosis and an alopecia as a result of capillary fractures due to pili torti. An autosomal recessive hereditary transmission could be determined. The cutaneous lesion is either an ichthyosis vulgaris, the hereditary transmission of which could not yet be confirmed, or it is a transition form of ichthyosis vulgaris and congenita.


New Zealand's first general anaesthetic. The administration of New Zealand's first general anaesthetic took place at the Colonial Gaol, Wellington, on the morning of Monday, September 27th, 1847. The agent used was sulphuric ether which was administered by Mr. Marriot, the manufacturer of the Herapath-type inhaler used on this occasion. The operation, a dental extraction, was performed by the Colonial Surgeon, Dr. J. P. Fitzgerald.


Anaesthetic considerations in chronic renal failure. This paper discusses the anaesthetic problems presented by patients in chronic renal failure. The anaesthetic agents and techniques used in 181 patients who underwent 941 operations (including 218 renal transplants) are described.


Chest physiotherapy during mechanical ventilation. The effects of three different physiotherapy techniques on arterial oxygen tensions and A-aO2 gradients were evaluated in 17 patients subjected to mechanical ventilation. No significant changes were detected and the clinical significance of these findings, which contrast with those of other investigators, is discussed.


A simple clinical method of quantitating the effects of chest physiotherapy in mechanically ventilated patients. A simple clinical method, allowing quantitive assessment of the effects of chest physiotherapy on patients subjected to I.P.P.V., is presented. The method involves measuring of the "alveolar" pressure using the end-expiratory retard mechanism available on the Bennet MA 1 (volume cycled) ventilator. Using this simple technique three different methods of physiotherapy were shown to significantly lower alveolar pressure, indicating an increase in pulmonary compliance. The inhalation of acetyl cysteine however, appeared to render treatment less effective in this regard.


The origin and fate of osteoclasts.

The origin and fate of osteoclasts. Despite intensive and ingenious investigation, the origins and ultimate fate of the osteoclast remain shrouded in mystery. This brief review evaluates some of the recent experimental approaches used in the study of the osteoclast, especially whether they form from intra- or extra-skeletal progenitor cells, whether from the same osteoprogenitor cell as the osteoblast, and whether, once formed, they may modulate to osteoblasts. That osteoprogenitor cells can, and do, become osteoclasts is well founded, as is the conclusion that such progenitor cells originate as blood-borne, extra-skeletal cells. Evidence that sessile, intra-skeletal, progenitor cells can form osteoclasts is less direct. There is good evidence that osteoclasts both shed and take-up nuclei, but no direct evidence that nuclear shedding is accompanied by death of the osteoclast, and no direct evidence for the fate of the shed nuclei. Whether the same osteoprogenitor cell can produce either an osteoblast or an osteoclast also remains an open question.