Pathogenesis of one variant of sea-blue histiocytosis. Hematopoietic cells from three siblings of a family with sea-blue histiocytosis were studied using in vitro cell culture techniques, histochemistry, and electron microscopy. Sphingomyelinase activities in cultured fibroblasts derived from these patients averaged 18 per cent of control levels. Ultrastructural examination of the sea-blue histiocytes showed numerous acid phosphatase-containing inclusions with closely packed, concentrically arranged, membrane-like lamellae with a periodicity of approximately 45 A. The inclusions are thought to result from the spatial orientation of complex lipid molecules and water. These structures are consistent with secondary lysosomes and are similar to those seen in some cases of adult Niemann-Pick disease and other cases of sea-blue histiocytosis. Extraction of lipid did not alter the blue-staining characteristics of the histiocytes. Sea-blue histiocytes were seen in liquid bone marrow cultures but did not proliferate, suggesting that the mature sea-blue macrophage is a terminal cell. We propose that partial sphingomyelinase deficiency may be one cause of sea-blud histiocytosis.


Long-term functional results of surgery for coronary artery disease in patients with poor ventricular function. Thirty-two patients with coronary artery disease and an ejection fraction (EF) below 0.40 had coronary bypass and/or left ventricular aneurysm (LVA) resection. Twenty-four patients had a previous infarction, 12 had congestive heart failure (CHF), and left ventricular end-diastolic pressure averaged 15 mm. Hg. Nineteen patients had three-vessel involvement and there was an  average of 2.4 vessels involved per patient. Bypass was accomplished on 87 per cent of vessels; 11 patients had resection of LVA; 11 had coronary endarterectomy. There were no hospital deaths, 63 per cent of the patients were improved, and 56 per cent were able to return to work or full activity. There were five late deaths (16 per cent). There was good functional improvement in 83 per cent of the survivors, followed 1 to 4 years. We believe that patients with poor ventricular function due to severe coronary artery disease should not categorically be denied surgery, and that operation can be done with a low hospital mortality rate and good functional results.


The superiority of aortic cross-clamping with profound local hypothermia for myocardial protection during aorta-coronary bypass grafting. Two different operative techniques for aorta-coronary bypass grafting were utilized in two comparable groups of patients. In one group (155 patients) distal anastomoses were carried out with the aorta cross-clamped and myocardial protection provided by profound local hypothermia (clamped group). In a second group (149 patients) distal anastomoses were carried out with the aorta unclamped and the left ventricle fibrillating and vented (unclamped group). Mortality rates were similar in the two groups (0.6 per cent in clamped group versus 1.3 per cent in unclamped group). The incidence of perioperative infarction was 15 per cent in the unclamped group and 8 per cent in the clamped group (p less than 0.05). Postoperative serum glutamic oxaloacetic transaminase (SGOT) and lactic dehydrogenase (LDH) levels were significantly higher for the first 4 postoperative days in the unclamped group than in the clamped group. Hemodynamic studies in a subset of each group revealed no important differences in left ventricular function in the immediate postoperative period. The data demonstrate that in patients undergoing aorta coronary bypass grafting, performance of distal anastomoses with aortic cross-clamping and profound local hypothermia results in less intraoperative myocardial injury than performance of distal anastomoses in the perfused, fibrillating, and vented left ventricle.


Recent progress in mycoplasma research.

Recent progress in mycoplasma research. Today, 12 years after the identification of Eaton agent as a mycoplasma, much new information on this infection has accumulated. Better methods have become available, which will be helpful in determining whether other mycoplasmas might be human pathogens, e.g., some ureaplasmas in nongonococcal urethritis. Experimental mycoplasma infections in birds and animals have revealed common features with immune complex diseases in man. They may serve, therefore, as useful models for human mycoplasma disease. However, the most important finding in recent mycoplasma research has been the isolation of mycoplasma viruses. Viruses belonging to three different groups have been discovered. It will be interesting to study whether the virus determines the pathogenicity of mycoplasmas or not.


A quantitative approach to evaluating the effect of stimulating devices on the perception of noxious stimuli. A new type of dolorimeter has been used in determining the nature of the mechanism responsible for the analgesic effect produced by electrostimulating devices. A study in normal subjects, yielding quantitative data on this analgesic effect, is reported.


Neurostimulation of the celiac plexus.

Neurostimulation of the celiac plexus. Effective relief of abdominal pain lasting from 2 hours to 25 days was achieved in eight patients by neurostimulation of the celiac plexus. The procedure is judged to be superior to the nerve block.


The viability of external electrical stimulation as a therapeutic modality. This study indicates that external electrical stimulation is a valuable tool for control of acute pain in about 80 percent of patients but, for significant relief of pain, in only about 25 percent of patients with chronic pain. The author recognizes that in order to increase its use, a system for delivery of this therapy under a doctor's prescription, rather than having to teach each individual practitioner the technique for using the device, must be developed. In chronic-pain patients when external electrical stimulation is inadequate, a more aggressive and comprehensive program of operant conditioning, progressive physical exercise, drug withdrawal, autogenic training, and biofeedback is advised.


Innovations in neurologic implant systems. Physiologic findings and clinical observations with several new implant systems are discussed. One system studied is designed with electrodes implanted over the anterior region of the spinal cord. Another system is designed with an anterior-posterior spinal cord electrode passing current across the spinal cord. Also given are observation and description of cortical and cerebellar implant systems. Current-density plots of the electrode arrays are included.


Experiences with electrical stimulation devices for the control of chronic pain. The results of a study involving the treatment of pain syndromes by electrical stimulation in 98 patients are reported. Advantages and disadvantages of three electrostimulation techniques--transcutaneous stimulation, peripheral nerve stimulation, and dorsal cord stimulation--are discussed. Also included is a brief discussion of the possible mechanism of suppression of pain stimuli.


Implanted devices for electronic augmentation of nervous system function. Electrical stimulation of the dorsal cord is discussed as a mode of therapy for intractable pain, and placed into its proper perspective as a part of a comprehensive rehabilitation program. The author reviews his experience with electrical stimulation and emphasizes features of the patient-selection process.


Electrical stimulation of peripheral nerves for relief of intractable chronic pain. Electrostimulation of peripheral nerves was used in patients to relieve chronic pain due to nerve injury. After follow-up for periods of 6 to 48 months, most of the patients exhibited some degree of pain alleviation. This paper details the circumstances of some of the cases and cites precautions to be taken in the use of this therapeutic mode.


Effects of furosemide on sodium content and transport pool in frog skin (Rana esculenta): comparison with vasopressin and ouabain. The effects of ouabain, vasopressin, and furosemide on intracellular concentrations of total sodium([Na]) and potassium [K]), on exchangeable sodium ([Na]) and the sodium transport pool ([Nap]) were investigated in isolated short circuited skins of rana esculenta. Furosemide was added to the epithelial bathing solution, vasopressin and ouabain to the corial bathing solution. Results were compared with the amount of net sodium transport measured by short circuit current (scc). Ouabain reduces scc and increases [Na] and [Na]; [K] is decreased. The administration of vasopressin leads to a sharp increase of scc, combined with an enhancement of of [Na] and [Na]; [K] shows no significant change. [Nap] is significantly increased, too, and approximately to the same amount as [Na]. Furosemide causes an increase of scc, whereas a significant change of [Na], [Na] and [K] could not be detected. On the other hand, [Nap] was enhanced significantly. The results support the hypothesis that furosemide like vasopressin is acting by increasing the entry of sodium into the transport compartment of the active cell layer. The result is an increased transfer of sodium across the skin.


Air filling of the subarachnoid space over the cerebral convexities at repeat encephalography. In order to check the constancy of convexity block, the airencephalograms (AEG) of seventeen patients who had undergone two separate examinations were reexamined. A satisfactory filling by air of the basal cisterns or Sylvian fissures was a prerequisite for including the AEG in this series. Consistent results related to air filling of the parietal region were obtained at the two examinations except in one patient with clinical signs of a pontine neoplasm. When the AEG was repeated in a very short time and with unchanged clinical conditions, the degree of air filling over the convexity was practically identical. But, with progressive neurological signs, the parietal air blocks showed a slight increase and also extended to the frontal region. It was concluded, firstly, that upper convexity block is a reproducible finding; secondly, that it is related to organic brain disease, the extent of the convexity block being correlated to the degree of clinical deterioration. As judged from other studies using isotope cisternography, the subarachnoid space is usually not complelely obstructed. It is suggested that the organically changed brain and leptomeninges create special physical conditions for the appearance of convexity air block in the AEG.


Experience with Dimer-X 1-ventriculography. Positive contrast ventriculography was carried out in 72 cases, using the water-soluble contrast medium Dimer-X. The examinations were performed 1--3 days after ventricular drainage had been carried out to relieve raised intracranila pressure. After injection of 2--7.5 ml. of the medium into the non-anaesthetised patients -- including 37 children and juveniles -- the ventriculographs were taken under visual control using Mimer III. This method is simple and can be rapidly carried out. Radiographs taken in two planes, supplement by tomography if required, are sufficient for an accurate diagnosis. During the examination only two children suffered from vomiting, while another patient sustained a generalised convulsion because the contrast agent came into contact with the surface of the brain.


[Hiatal hernia during a course of indirect anticoagulant treatment]. A personal case of haematemesis in a patient subjected to indirect management with anticoagulants is reported. The prothrombin values were not within the danger limits. Some concise notes on the points raised by this finding are presented and essential features of the diagnosis and treatment are discussed.


Prevalence of coronary heart disease in samples of New Zealand Maoris and Pakehas. This paper reports the prevalence of coronary heart disease (CHD) and its relationship with several standard risk factors in samples of New Zealand Maoris and Pakehas. The age standardised prevalence rates of CHD are: 16.1 percent, and 7.3 percent in Maori females and males respectively, and 11.5 percent and 6.5 percent in Pakeha females and males respectively. In Maori females only serum uric acid is associated with an increasing prevalence of CHD. The high prevalence of CHD in females as compared with the higher national mortality rates for males suggests that the case fatality rates for CHD are higher in males. The lack of association between CHD and the risk factors in Maori females suggests the possibility of two syndromes of CHD in Maori females.


Acute pancreatitis ten years experience in the Waikato district. Seventy patients admitted to Waikato Hospital between 1964-74 with acute pancreatitis have been reviewed. Biliary tract disease and alcohol are the most common aetiological agents. The disease is most common in middle age. Europeans and Polynesians have similar incidence rates. The diagnosis is frequently not made at admission and most admissions are in the afternoon or early evening. Radiology is helpful in the diagnosis although nonspecific. Abnormal biochemistry is discussed and related to mortality. Additional tests, serum catalase/methaemalbumin are promoted to assist in the diagnosis and indicating the severity of the disease. Glucagon and Trasylol are discussed as being beneficial in this disease and combination therapy is suggested. The role of surgery is discussed.


Four channel electronystagmographic (ENG) studies of eye movements induced by linear accelerations. A parallel-swing ENG study in rabbits led to two investigative conclusions: (a) for experimental purposes the parallel swing test must be performed with monocular, both horizontal and vertical leads, and (b) such studies must be performed in a darkened room. Following surgical bilateral "immobilization" of the cupulae of the horizontal semicircular canals, horizontal nystagmus induced in the parallel-swing test is probably generated by the otolithic system.


The circular eye-tracking test. I. Simultaneous recording of the horizontal and vertical component of eye movement in the eye-tracking test. Almost all of the conventional clinical reports on the eye-tracking test are made on the horizontal component of the smooth pursuit function of oculomotor system; few are made on the vertical component. One reason is that during the conventional vertical eye-tracking test the artifacts caused by movement of the upper eyelids often make it difficult to analyze the data. To overcome this problem the authors have developed a method to record simultaneously the horizontal and vertical components of eye movement in the eye-tracking test, and moreover, to reduce artifacts as much as possible. Our method, the circular eye-tracking test, is performed by means of an apparatus that provides a visual stimulus drawing a circle clockwise, at a rate of 120 degrees/sec, with a radius of 25.5 cm, and viewed at a distance of 70 cm.


Conductance fluctuations in Ranvier nodes. Voltage fluctuations associated with the sodium system were measured upon elimination of the potassium current in the nodal membrane by internal application of cesium-ions. The intensity of this noise reaches a maximal value at a membrane potential in the vicinity of --40 mV. Here the power spectrum consists of two additive components: a 1/f component and a Lorentzian. The Lorentzian is associated with h-gate kinetics and is consistent with the binary state conduction model. On the basis of this model the sodium-channel conductance is calculated to be 2 to 5-10(-12) S. The analysis is complicated by the existence of an incomplete slow sodium inactivation process.


Deviating flux ratios for Na+ in ouabain-treated frog skin. Unidirectional Na+ fluxes across ouabain-treated frog skins were measured at different applied voltages. The calculated influx/efflux ratios appear to deviate markedly from Ussing's flux-ratio equation. This means that interactions of Na+ ions with some component in the system occur. Possible mechanisms, responsible for this phenomenon, are indicated.


A study of desensitization using voltage clamp. The onset and offset of desensitization produced by carbachol and hexyl and heptyl TMA at voltage-clamped frog endplates were studied. Desensitization onsets exponentially with a rate constant which is proportional to the agonist concentration. The proportionality constant varies with the agonist used. The plateau current finally attained falls steeply to low values with increasing agonist concentration, and with further increase in concentration varies relatively little. The offset of desensitization is sometimes accompanied by the appearance of a second transient increase in current. It is proposed that desensitization is due to channel blockade by the agonist molecule itself.


1-Pyrene-butyrylcholine: a fluorescent probe for the cholinergic system. The action of 1-pyrene-butyrylcholine, a new cholinergic fluorescent probe, has been studied at the cellular level using electrophysiological and fluorescence techniques. The spectroscopic properties of the probe were found to be similar to those pf pyrene-butyric acid, the excited-state lifetime in air-saturated aqueous solutions being 92 nsec. At micromolar concentrations the probe was found to exert a nondepolarizing, reversible blocking action at the neuromuscular junction of the frog. The same cholinolytic effect was observed in hypersensitive denervated muscles. The synaptic localization of the probe could be observed with fluorescence microscopy using sub- and micromolar concentrations. Treatment of the nerve-muscle preparations with proteolytic enzymes, resulting in the separation of the nerve ending from the muscle end-plate, enabled a distinction to be made between the fluorescence arising from these two parts of the synapse. Intense presynaptic fluorescence was observed, and was not altered by micromolar concentrations of alpha-bungarotoxin, d-tubocurarine, hemicholinium, or cholinesterase inhibitors. Faint reversible staining of the end-plate region was observed in enzymically treated muscles and was inhibited by prior treatment with alpha-bungarotoxin. Fluorescent alpha-toxin revealed similar patterns of fluorescence in the end-plate of enzyme-treated muscles. The postsynaptic localization of the fluorescent probe is therefore tentatively identified as the one producing the cholinolytic effect upon binding to acetylcholine receptor sites.


Binding of autologous erythrocytes to immature T-cells. A small percentage of normal mouse thymus and spleen lymphocytes form rosettes with autologous erythrocytes. The number of these autologous rosettes increases 15- to 20-fold after adult thymectomy and to a lesser degree with aging. Autologous rosette level is also abnormally high in nude (congenitally athymic) mice. The high level of autologous rosette-forming cells found after adult thymectomy is normalized by injecting ng amounts of purified circulating thymic factor. Autologous rosette-forming cells adhere to nylon, belong to the less dense spleen cells, are in majority steroid-resistant in the thymus. All these properties suggest that autologous rosette-forming cells might belong to immature T-cell (thymic-dependent cell) precursors.


Idiotype positive T cells visualized by autoradiography and electron microscopy. Anti-idiotypic antibodies were prepared in (CBA X C57BL/6)F1 hybrid mice by immunization either with CBA anti-C57BL/6 alloantiserum or with purified CBA thymus-processed lymphoid cells (T cells) Iodinated anti-mouse Ig or triple sandwich ferritin-labeling techniques served to visualize the reaction between idiotype and anti-idiotype. From 5 to 10% of purified CBA T cells appeared to carry receptors for C57BL/6 antigens. Heavily labeled cells had the morphology of small lymphocytes.


Acetylcholine receptors at neuromuscular synapses: phylogenetic differences detected by snake alpha-neurotoxins. Phylogenetic differences in acetylcholine receptors from skeletal neuromuscular synapses of various species of snakes and lizards have been investigated, using the snake venom alpha-neurotoxins alpha-atratoxin (cobrotoxin) and alpha-bungarotoxin. The acetylcholine receptors of the phylogenetically primitive lizards, like those from all other vertebrates previously tested, are blocked by these alpha-neurotoxins. In contrast, receptors from snakes and advanced lizards are insensitive to one or both of the toxins. It is suggested that toxin-resistant acetylcholine receptors appeared early in the evolution of Squamata and preceded the appearance of alpha-neurotoxins.


Primary acceptor in bacterial photosynthesis: obligatory role of ubiquinone in photoactive reaction centers of Rhodopseudomonas spheroides. Reaction centers were found to bind two ubiquinones, both of which could be removed by o-phenanthroline and the detergent lauryldimethylamine oxide. One ubiquinone was more easily removed  than the other. The low-temperature light-induced optical and electron paramagnetic resonance (EPR) changes were eliminated and restored upon removal and readdition of ubiquinone and were quantitatively correlated with the amount of tightly bound ubiquinone. We, therefore, conclude that this ubiquinone plays an obligatory role in the primary photochemistry. The easily removed ubiquinone is thought to be the secondary electron acceptor. The low-temperature charge recombination kinetics, as well as the optical and EPR spectra, were the same for untreated reaction centers and for those reconstituted with ubiquinone. This indicates that extraction and reconstitution were accomplished without altering the conformation of the active site. Reaction centers reconstituted with other quinones also showed restored photochemical activity, although they exhibited changes in their low-temperature recombination kinetics and light-induced (g = 1.8) EPR signal is interpreted in terms of a magnetically coupled ubiquinone--Fe2+ acceptor complex. A possible role of iron is to facilitate electron transfer between the primary and secondary ubiquinones.


Isolation and identification of alpha1-antitrypsin as a component of normal and malignant human breast and other tissues. Alpha1-Antitrypsin has been detected using radial immunodiffusion in the 90,000g supernatant fraction of malignant and adjacent normal human breast, colon, and anal tissue, as well as malignant lung, stomach, and ileum. Immobilized chymotrypsin, bound to Sepharose or Affi-Gel 10 has been utilized to separate 11 peaks of antiproteolytic activity by affinity chromatography of normal and malignant human breast tissue extracts. Glycoproteins are associated with eight of the peaks. Peak 1 contains predominantly alpha1-antitrypsin in addition to a minor component. The purification of the inhibitors, as judged by disc gel electrophoresis, is extensive. In some peaks, only one or two protein bands are observed, suggesting that affinity chromatography on Sepharose- or Affi-Gel 10-chymotrypsin might be used for the isolation of alpha1-antitrypsin and other inhibitors in preparative amounts.


Length-dependent optical diffraction pattern changes in frog sartorius muscle. The length dependence of the laser light diffraction pattern produced by R. pipiens whole sartorius muscle has been examined at rest and during tetanic contraction. The muscle diffraction pattern was scanned by a vidicon camera; camera output was digitized and processed by an on-line digital computer to allow a real line display of a section through the diffraction pattern. Analysis of the first order diffraction line profiles yielded values for line amplitude, intensity, center of gravity, line width and percent dispersion. The calculated dispersion provided a measure of the muscle's sarcomere length distribution. First order line amplitudes and intensities were observed to increase, then decrease, with progressive stretch from 1.0 to 1.3 reference length. The percent dispersion among sarcomeres in resting muscle averaged 11% and was approximately proportional (coefficient = .0341) to length. The amplitude and intensity of zero and first order diffraction lines decreased during tetanus, while the line widths and dispersions increased. First order line intesity during tetanus was maximum at about the same length as during rest, i.e., at approximately 2.5 mu sarcomere length. Sarcomere dispersion increased by about 6% during tetanus.


Long-term prognosis of idiopathic gastric erosions. The long-term prognosis of multiple gastric erosions (erosive gastritis) is analyzed in 58 cases observed over 10-17 years, showing the disease to recur through decades. Idiopathic erosions occur mainly in the antrum and can be visualized roentgenologically, whereas "stress" erosions are in the body of the stomach and may only be diagnosed endoscopically.


The effect of barium on blood in the gastrointestinal tract. The effect of various commercial barium sulfate preparations on blood coagulation, flocculation, and hemolysis was studied. There was considerable variation not only among different barium products but also among different concentrations of the same product. There is no good experimental evidence that barium enemas do stop bleeding. It is probably best to avoid the use of any enema in attempting to control major colonic bleeding; but if an enema is given for this purpose, a tap-water enema is better, as it contains no anticoagulants and is more effective in producing clot formation than most barium suspensions.


Hemorrhage from the gastroesophageal junction. A cryptic angiographic diagnosis. The angiographic localization of gastroesophageal-junction hemorrage emanating from the left inferior phrenic artery (which originated from the abdominal aorta) is described. The diagnosis was established after conventional selective celiac and left gastric arteriography failed to demonstrate extravasation. The arteriographic evaluation of upper gastrointestinal hemorrhage requires consideration of the variable arterial distribution to the gastroesophageal junction and an awareness of the variable causes of dense opacification (including superimposed adrenal glands) that may mimic extravasation.


Radiological visualization of the vestibular aqueduct. Technique and morphological features. Thin-section tomography in the lateral and off-lateral projections permits radiographic visualization of the vestibular aqueduct, which is seen as an inverted J. The proximal curved portion has a constant configuration, while the distal straight portion varies according to the width of the external aperture and may be tubular, funnel-shaped, or filiform. Nonvisualization of the curved portion does not necessarily mean that it is not present.


Electrohydrolytic fragmentation of retained common duct stones. The fragmentation of biliary tract stones by the electrohydrolytic principle in vivo is presented. Included is a description of the apparatus.


Surgical treatment of coronary artery disease: pure graft operations, with a study of 741 patients followed 3--7 yr. This report reviews the experience with bypass graft surgery in the pure form, without associated cardiac procedures, in 6828 patients operated upon from 1967 through 1974. The hospital mortality rate in this group was 1.4%. The incidence of definite perioperative myocardial infarction was 6.9% prior to 1971, and 4.1% in the past 3 yr. Graft patency in postoperative studies performed an average of over 12 mo after surgery was 83.6%, and 89% of patients had one or more functioning grafts. In a subgroup of 741 consecutive patients operated upon with pure graft techniques from 1967 through 1970, survival seemed to be improved when compared to another group of similar, but nonoperated patients. The average annual mortality rate was 3.3% per yr in the surgical group (including surgical mortality) compared to 8.8% per year in the medical group. Differences in survival were most striking in patients with isolated anterior descending, double and triple vessel involvement. In the 741-patient subgroup the incidence of new occlusions of grafted arteries was related to the severity of the lesion(s) for which the operation was performed, and unrelated to graft patency. Arteriographically demonstrated new occlusions of ungrafted arteries were infrequent, and few patients developed significant new lesions during the period of observation. Symptomatic improvement is related to completeness of revascularization as determined by postoperative arteriography.


Effects of antiarrhythmic drugs on cardiac membrane conductances; a study using the Hodgkin and Huxley mathematical model. A study in voltage clamp conditions of the modifications of the cardiac membrane conductances by quinidine sulfate has been carried out on frog atrial fibers by means of the double sucrose gap technique. The computation of the parameters related to the conductances has been done according to the Hodgkin and Huxley mathematical model proposed in 1952. The computed conductances concern the sodium conductance, the calcium conductance, and the total delayed conductance. A decrease of all of the studied conductances is observed in the presence of quinidine sulfate. This drug also mainly induced a slowing down of several activation, inactivation, and reactivation kinetics. The results obtained allow a more detailed explanation of the mechanism of action of quinidine sulfate in the membrane. Although quinidine is known to possess antiarrhythmic properties, the exact mechanisms of its action are not clear. The present study was therefore undertaken to provide some information on this point.


Effects of ouabain on sodium uptake by frog heart and skeletal muscle. Effects of ouabain (10(-3)-10(-12) M) on frog heart and skeletal muscle net uptake of Na from a K-free Conway-Ringer solution at 0-2 degrees C were investigated. Under these circumstances Na pumps are inactive and fibers are gaining Na even without ouabain. Changes in K, H2O, and solids were also measured. Na gains and K losses were increased by ouabain at greater than 10(-6) and greater than 10(-7) M, respectively, and decreased in heart muscle at less than or equal to 10(-8) M. It is suggested that these effects are due to actions on membrane permeability. Implications for mechanisms of positive inotropic effect of glycosides and for treatment are discussed.


The action of ethanol upon the action potential and contraction of ventricular muscle. Isolated isometric ventricular muscle of frogs and cats was studied. Perfusing solutions were played directly on the muscle to permit rapid exchange of the extracellular space. Developed force and maximal rate of rise of force were measured in all studies and action potentials (AP) were recorded in some. For both species low concentrations of ethanol (75 degrees  mg/l) potentiate contraction. Higher concentrations ( greater than or equal to 750 mg/l) depress contraction progressively with increasing concentration. Concentrations which depress contraction, e.g., 3-4.5 gm/l, usually shorten AP duration. The shortening of AP duration can occur even though contractile force does not fall and, conversely, force may fall while AP duration is unaffected. When 10 mM caffeine is added to the perfusate of either species, AP duration is prolonged and contraction is potentiated. If both ethanol (4.5 gm/l) and 10 mM caffeine are added simultaneously to the perfusate, there is a rapid (within 4 beats) increase in AP duration and an initial depression of contraction, followed by a further increase in AP duration and a significant potentiation of contraction. The steady state contraction is less than with caffeine alone. These preliminary studies suggest that ethanol may depress contraction both by shortening AP duration and by a direct effect upon the contractile apparatus.


Optical studies on contractile structures during activity. The optical properties of myocardial fibers and skeletal fibers were compared at rest and during activity. Scattering by myocardial trabeculae is more important than by skeletal fibers but birefringence of myocardial trabeculae is less important than that of skeletal fibers. The absorbance curves of both isolated myocardial trabeculae and skeletal fibers in vivo reflect their main components; during contraction the absorbance increases mainly at 285 nm and this increase starts earlier than contraction recorded with a mechanotransducer. An absorbance change in the spectral range of 420-440 nm is also reported which could represent very early biochemical change in the contractile fibers. The technique used, combined with electrophysiological data, allows one to study different problems related to the biophysics and biochemistry of contraction.


The influence of calcium and calcium + vitamin D2 treatment on bone mineral after partial gastrectomy. Sixty-three men and 23 women who had undergone partial gastrectomy for ulcer disease were randomized into three groups to study the effect of calcium (2 g per day) and calcium + vitamin D2 (1000 IU calciferol per day) treatment for eight months on bone mineral. The Americium-241 gamma ray attenuation method was used to measure the changes in bone mineral density. Calcium and calcium + vitamin D2 increased the bone mineral density statistically significantly in the males, but not in females. Partial gastrectomy causes bone rarefaction, and consequently these patients reach the risk level of bone mineral density for osteoporotic fractures earlier than healthy subjects. The conclusion drawn was that prophylactic treatment is needed after partial gastrectomy. Further study is required, especially of women, to find the most suitable form of treatment for disturbances in bone mineral metabolism after gastric resection.


Influence of prednisone and cytostatics on human blood B-, T- and O-lymphocytes in diseases. B-, T- and  O-lymphocytes detected as EAC-, E- and non-rosette forming lymphocytes were investigated in venous blood in 49 patients with connective tissue diseases, psoriasis and chronic lymphogenous leukaemia (CLL) during treatment with either prednisone alone, prednisone and cytostatic agents or cytostatic agents alone. Prednisone alone did not change the B-, T- and O-lymphocyte counts. Cytostatics alone or in combination with prednisone reduced the B- and T-lymphocyte counts concomitant with a significant increase in the O-lymphocyte count. The findings could be explained by assuming that cytostatics disturb the immunological functions of the lymphocytes and finally deprive the cells of their B- and T-markers. The optimal immunosuppressive treatment with cytostatic agents may be associated with a certain reduction of B- and T-lymphocytes which may be used as a guideline for dosage.


A study of proteolysis as a possible mechanism for T-cell-mediated target cell lysis. The hypothesis that proteolysis is implicated in T-cell-mediated target cell lysis was tested in two ways: first, various inhibitors of protease activity were used either during or before the cytotoxicity test. Ovomucoid, TPCK, and PMSF proved to be not or only marginally inhibitory, whereas the considerable inhibitory action of TLCK was shown to most likely be a toxic effect of the inhibitor. Second, radioactive substrates for cathepsin activity were used, either free in the medium or fixed on the surface of the target cells, to detect a possible breakdown of these substrates by a release of intracellular cathepsins during the cytotoxicity test. Very little dialysable breakdown products were formed, and there was no difference between their amount in either a homologus or a heterologous system. It is concluded that proteolysis probably is not the mechanism by which target cells are killed. Alternative mechanisms are discussed.


Thymus: central role in the immune system of the frog. In the leopard frog (Rana pipiens), the thymus profoundly influences immunologic development by providing virtually all the progenitor lymphocytic cells for the bone marrow and other peripheral lymphoid organs. The thymus houses a self-perpetuating population of lymphopoietic cells that originally self-differentiated in that gland.


Role of coronary artery surgery in patients surviving unexpected cardiac arrest. During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.


Antibody-dependent and direct lymphocyte-mediated cytotoxicity in patients on hemodialysis. Twenty-two patients on chronic hemodialysis were tested for direct lymphocyte-mediated cytotoxicity (DCML) and antibody-dependent lymphocyte-mediated cytotoxicity (LALI) against selected panels of normal donor lymphocytes. The DCML reaction was only positive in patients who had received blood transfusions within the two or three months prior to testing. Thus this reaction has limited value in practice as a parameter for presensitization. The use of third-party effector cells and of target cells precoated with antibody in the LALI reaction was evaluated, and it is advocated that effector cells from the patient investigated and direct application of patient serum to reaction mixtures should be preferred in order to avoid false negative reactions. In patients who had once manifested lymphocytotoxins, LALI disclosed a much broader reactivity than seen with a conventional complement-dependent cytotoxicity technique (CDC), whereas in this study patients who had never developed cytotoxins were also negative with the LALI technique. It is concluded that a positive LALI cross-match, in spite of a negative CDC cross-match, will be a common finding in donor-recipient combinations where the recipient has preformed cytotoxins. The effect of this on subsequent graft prognosis needs further clarification.


Low serum alpha-1-antitrypsin level as a contributory factor of combined emphysema in silicosis. In order to evaluate low serum alpha-1-antitrypsin level as a contributory factor of combined emphysema in silicotic patients, serum alpha-1-antitrypsin analysis was carried out in 80 patients with silicosis. Low serum alpha-1-antitrypsin level was found in 5 patients. Large opacities were observed roentgenologically in only 1 out of these 5 cases in contrast to 31 of the other 75 cases. Also the suggestive findings for the emphysema were showed in 4 of these 5 cases while such findings were found on their chest X-ray films in only 43 of the other 75 cases. FEV 1.0% below 50 were calculated in 3 of the 5 cases, on the contrary in 22 of the 75 cases. RV above 50% predicted value was showed by all the 5 low antitrypsin patients, in contrast to only 25 of other 74 cases. The silicotic patients with low serum alpha-1-antitrypsin concentration are most likely to have an association with a high incidence of complicated emphysema.


The monoaminergic innervation of the telencephalon of the frog, Rana pipiens. A large number of serotonin (5-hydroxytryptamine, 5-HT)-type axon terminals has been visualized in the so-called 'striatum' (pars ventralis and dorsalis) of Rana pipiens by means of the Falck-Hillarp histochemical method. The frog striatum contains, however, a much smaller number of catecholamine (CA) type axon terminals and differs strikingly in that aspect from the neostriatum of 'higher' vertebrates which is known to receive a massive CA innervation. In the telencephalon of Rana pipiens the highest density of CA axon terminals occurs at the level of the medial wall, which appears highly hypertrophied in comparison to the thin lateral wall. The CA terminals are mainly concentrated within nucleus accumbens septi and in the ventrolateral portion of nucleus lateralis septi where they surround intimately the non-fluorescent neuronal somata of both septal nuclei. The three pallial fields (medial, dorsal and lateral) of Rana pipiens are nearly devoid of CA axon terminals. A moderate amount of 5-HT terminals is present, however, within the caudal half of both the medial and dorsal pallial fields. Finally, a few CA-type neuronal somata are found lying amongst the mitral cells of the olfactory bulb. As a whole, the telecenphalon of Rana pipiens appears more profusely innervated by axons of the 5-HT-type than by those of the CA-type. This finding has been related to the fact that in the frog brain stem the CA neuronal somata are scarce in comparison to the highly developed 5-HT neuronal systems.


Evidence that monoamines influence human evoked potentials. We have measured latency and flash/pattern differentials of the visual evoked potential (VEP) from phenylketonuric humans, while systematically manipulating rates of amine synthesis in the central nervous system using two techniques. We have observed that stimulation of monoaminergic activity in the visual processing system, either by lowering inhibitory levels of phenylalanine through dietary restriction or by a properly balanced administration of indole and catecholamine precursors, shortened VEP latencies and permitted the development of a discriminative brain response to patterned stimuli. The close temporal relationship between these electrophysiological changes and the neurochemical manipulations following treatment initiation of discontinuation argue that monoamines play a significant role in the mediation of human sensory evoked potentials.


[Demonstration of gastrointestinal hemorrhages in the acute radiation syndrome]. Increased radioiron excretion with feces following irradiation is a sure indicator of thrombopenia-induced gastrointestinal hemorrhages which are to be regarded as one of the main causes of the acute radiation syndrome or radiation death respectively. We analyzed the daily 59Fe- excretion of whole-body irradiated mice from the 7th to the 16th day after radiation insult, this period being the critical phase in the course of acute radiopathy with a mortality amounting here to about 50% of the irradiated animals (bone-marrow syndrome). On the eleventh day after radiation exposure, 59Fe-excretion of irradiated animals significantly exceeded by more than fivefold that of the controls. If, before radiation exposure, the mice have been treated with the protective agent AET, they survived without exception and, moreover, a significantly reduced 59Fe-excretion was noted too, the control values almost being reached again. By means of the radionuclide 59Fe therefore, ont only statements are possible concerning the functional state of the erythropoietic system, but also troubles of the hemostatic system can be detected, e.g. the pathological transition of blood into the gastrointestinal tract.


[Liquor-scintigraphic findings with Yb 169-DTPA in cerebro-atrophic processes]. Liquor-scintigraphic examinations were carried out with Yb 169-DTPA in two patients, who were offering - clinically as well as by pneumo-encephalographic findings - the picture of a cerebro-atrophic process. Especially the first case showed the typical course and symptoms of Alzheimer's disease. A "stasis" of the radionuclide, lasting for 48 hours, was manifesting liquor-scintigraphically herein, in the course of which there was - initially - a weak representation of the ventricles. However, the complete clinical picture of a communicating hydrocephalus did not show up. In the second case, an undisturbed liquor circulation and absorption, to a great extent topically and temporally undisturbed, were observed. The question arises whether Alzheimer's disease is manifesting together with such a disturbance of the liquor circulation, already described also by other workers. The second case makes clear that the liquor space scintigraphy cannot be used as only diagnostic method in all cerebro-atrophic processes.


Maternal mortality in Western Nigeria.

Maternal mortality in Western Nigeria. Data on maternal deaths were collected from a randomly selected sample of medical institutions in the Western State of Nigeria for the years 1972 and 1973. An overall maternal mortality rate of 3.8/1000 total births were recorded for 1972 and 1973 respectively. The major causes of maternal mortality were haemorrhage, obstructed labour, eclampsia, anaemia of pregnancy and infection.


[Substitution of T-cell function by poly-4-vinypyridine in the formation of the primary and secondary immune response]. The influence of poly-4-vinylpiridine (P-4-VP) on the production of antibody forming cells (AFC) has been studied. P-4-VP induces helper activity in lymphoid organs of B-mice. P-4-VP injected into mice substitutes T cell function in the development of immunological memory. The possibility of substitution by P-4-VP of various functions or of different subpopulations of T cells in T cell-deprived mice is discussed.


[Bone marrow reaction to surgical intervention in gastroduodenal hemorrhage]. Experimentally and clinically, the authors have studied the effect of massive blood loss and various operative procedures (Billroth I and Hofmeister-Finsterer gastrectomies, pyloroplasty with vagotomy) on the hemopietic system. It has been found that the bone marrow response was mainly dependent on blood loss. A surgical intervention renders but insignificant effect on hemopoiesis, similar to that of a moderate hemorrhage, the character of an operative procedure being of no improtance.


[Characteristics of blood coagulation and rational hemostatic therapy of acute gastroduodenal hemorrhage]. The results of studies on the state of the coagulative and fibrinolytic system of blood in 78 patients with acute gastroduodenal hemorrhages are summarized. The causes of bleeding were as follows: ulcerous gastroduodenal disease -- in 38 cases, cancer of the stomach -- in 20, esophageal venous varices -- in 11 and erosive gastritis -- in 9. Some features of hemorrhage due to erosive gastritis, esophageal varices, ulcerous disease and gastric cancer are described.


[Gastroscopy -- a routine procedure in the investigation of diseases of the stomach (author's transl)]. After a short review of the development of endoscopic investigations, the technique of gastroscopy is described and the indications for this procedure are pointed out. This procedure is of equal importance as radio-diagnostic measures in the routine investigation of stomach diseases and is of particular value when used as an emergency procedure and in the follow-up of patients after gastric operations. It also offers great advantages in the diagnosis of stomach tumours since biopsy material can be obtained from the lesion. Stomach haemorrhage due to gastric erosion, oesophagitis and the Mallory-Weiss syndrome are best diagnosed by gastroscopy. There are practically no contraindications to gastroscopy. The only precluding factor being an uncooperative patient. It is not contraindicated in patients with oesophageal varices or deformity of the spinal column. Complications are very rare. In the case of emergency gastrocscopy, shock must be counteracted and the blood pressure normalized before the investigation can be performed.


[Algesimetric measurement of the effect of cerebral electrotherapy on the pain threshold (author's transl)]. The effect of cerebral electrotherapy (CET) on the pain threshold was investigated in 3 test persons, on 5 points of the neck of these persons. Altogether 1200 algesimetric measurements were performed. The statistical evaluation showed a significant tedency (p less than 0.01) towards an elevation of the pain threshold by CET.


[Unusual generalized granulomatosis. Two case reports (author's transl)]. Report about two cases of unusual generalized granulomatosis in males, with multiple lymphomas and involvement of internal organs and brain, leading soon to death. The diagnosis was malignant histiocytosis and disseminated eosinophilic granulomatosis. The malignant histiocytosis is differentiated from malignant fibroxantoma (malignant histiocytoma). The unusual cerebral features in the second case - diagnosed as disseminated eosinophilic granulomatosis - seem to show some relations to histiocytosis X. The problems in diagnosis of generalized granulomatosis are pointed out.


[Histiocytosis X of the hypothalamus (author's transl)]. A case report on histiocytosis X in the hypothalamic region in a 47 years old woman is presented. There was a 10 years history of diabetes insipidus, but only immediately before the death vegetative and psychical disturbances occurred. Difficulties of the diagnosis and of the estimation of histological findings are discussed.


[Orgainc tricuspid pathology in rheumatic valvulopathies]. Surgical observations show that organic tricuspid lesions are not uncommon: 3.2% among cases of valvular surgery, 9.5% among patients with combined mitral and aortic replacements. Pure stenosis is relatively rare (7 cases) but easy to diagnose: this lesion plays a protective role on pulmonary parenchyma. There is no symptom due to congestive lungs and few pulmonary post-operative complications among these patients. Organic tricuspid insufficiency, isolated or associated to stenosis is more frequent (18 cases) but more difficult to diagnose before surgery. There seems to be no protection of the pulmonary circulation. Pulmonary arterial hypertension, clinical and radiological features of congestive lungs and post-operative pulmonary complications are usual.


A direct comparison between internally and externally measured left ventricular systolic time intervals. In 38 cardiac patients a direct comparison was made of systolic time intervals derived from the external carotid pulse tracing and from the central aortic pressure curve, simultaneously recorded by means of a catheter-tip micromanometer. In addition the transmission time of the upstroke and the incisura of the central pulse wave to the carotid artery was studied. In spite of close linear correlations, significant differences in absolute values were observed between internally and externally measured systolic time intervals. The transmission times of upstroke and incisura of the pulse wave also differed significantly. Both findings were directly related and dependent upon the heart rate.


A modified technique for transseptal angiocardiography: review of 186 cases. Perforations of the left atrial or ventricular wall and extravasations of contrast medium during transseptal left heart catheterisation or angiocardiography can be eliminated by replacing the normally used transseptal catheters by Pigtail-catheters. With only 2.8% minor complications without sequelae in 181 successful studies, transseptal angiocardiography of the left heart through Pigtail-catheters is not only less hazardous than injections through the transseptal catheters used up to now, but possibly bears even less risk than direct retrograde injection into the left ventricle. The best method of showing the left atrial cavity and the mitral valve is transseptal left atrial injection. According to our findings in the evaluation of the ventricular function by means of quantitative angiocardiography, transseptal angiocardiography with injection into the left atrium is preferable to retrograde direct ventriculography, as ventricular ectopic beats were absent and supraventricular ectopic beats were as rare as 5% of cases. With this method, local disturbances of wall motion during injection could also be avoided and one or two more cycles could be evaluated before the depressant effect of contrast medium started.


Aortic septal defect and coronary-systemic micro-fistulae. This report concerns a 32-year-old man, who at the age of 11, had an aortic septal defect with severe pulmonary hypertension. The defect was partially closed and the patient was left with a continuous murmur, an a-v shunt and marked diminution of pulmonary hypertension. Five years later he was asymptomatic, auscultation was normal and no shunt was found at cardiac catheterization. At 32 years of age, although asymptomatic he had abnormal "T" waves, and a selective coronary angiography demonstrated micro-fistulae involving the anterior descending coronary artery. It is suggested that these fistulae may be responsible for the abnormality of ventricular repolarization.


Varicella followed by glomerulonephritis. Treatment with corticosteroids and azathioprine resulting in recurrence of varicella. The present report outlines the clinical features of a 2-year-old boy who following varicella developed purpura of the lower extremities, transient gastrointestinal bleeding and glomerulonephritis. The triad of symptoms suggests Schonlein-Henoch Syndrome, but coagulation studies and renal biopsy did not confirm this, and varicella is thought to be the cause of the complications. Therapy with corticosteroids and azathioprine had only a minor effect on the nephritis but caused depression of serum IgG and specific antibody resulting in reinfection or reactivation of varicella.


Immunodeficiency and prognosis in Hodgkin's disease. Blood lymphocytes from the majority of 33 unselected and untreated patients with Hodgkin's disease were deficient in T-lymphocytes and their DNA synthesis induced by concanvallin A mitogen and PPD antigen was impaired. The spontaneous DNA synthesis during the first 24 hours of culture was often raised. The prognostic role of the lymphocyte deficiency was evaluated in a follow-up 10-22 months after institution of therapy. The lymphocyte functions were more commonly abnormal in patients responding poorly to treatment (incomplete remission, relapse after treatment, or death) than in patients entering complete remission. The lymphocyte deficiency seems to give information about prognosis in Hodgkin's disease in addition to histopathology, clinical stage, B-symptoms and age.


Host specificity of DNA in haemophilus influenzae: The physiological and genetical bases of instability of restriction and modification of DNA in strain Rd. Further investigations of the instability of restriction and modification properties of H. influenzae Rd strain were carried out. It has been shown that the instable properties of hsd Hind1 system are maintained even after transfer of this system to another H. influenzae strain. The expression of hsd Hind1 system is very sensitive to various physiological changes which do not influence the other hsd systems present in the same Rd strain. The instability of hsd Hind1 system is postulated to be connected with some regulator gene(s).


Intracranial neurinomas of the nerves of the jugular foramen. Report of 12 personal cases. 12 patients, 10 women and 2 men, were operated on for removal of a jugular foramen neurinoma. Removal was total in 11 cases and operative mortality was 16.6%. As there are no clinical or instrumental signs that permit sure distinction between these tumours and those of the cerebellopontine angle, only a thorough radiological study of the jugular foramen allows correct diagnosis. Often, however, the diagnosis is made during the operation.


[Diagnostic possibilities of positive contrast ventriculography (author's transl)]. A comparison has been made of the relative merits of air, Conray 60, and Dimer X ventriculography in 100 cases. The great virtue of positive contrast ventriculography is its superior ability to demonstrate abnormalities in the midline and in the posterior cranial fossa. Tomoventriculography using a multiple layer cassette permits exact localization of intraventricular lesions without causing additional discomfort to the patient. The subtraction technique confers additional benefits. Positive contrast ventriculography has its limitations when there are large extraventricular masses.


Coronary artery disease in an 18 year old with pseudoxanthoma elasticum: successful surgical therapy. An 18 year old girl with pseudoxanthoma elasticum, a 7 year history of angina pectoris and evidence of an old anteroseptal myocardial infarction was found on coronary angiography to have three vessel coronary artery disease. A triple coronary artery-saphenous vein bypass graft was performed, and she has been asymptomatic for 1 year. Histologic examination of a segment of the right coronary artery revealed changes consistent with the vascular lesion of pseudoxanthoma elasticum.


Zeta sedimentation ratio in rheumatic disease. Comparison of the zeta sedimentation ratio with the Wintrobe and Westergren sedimentation rates. The zeta sedimentation ratios (ZSR) of 104 normal subjects and 106 rheumatology clinic patients were compared with their Westergren and Wintrobe erythrocyte sedimentation rates (ESR). The mean ZSR for normal subjects was 49.42 +/- 3.75%. The rheumatology clinic patients were separated into noninflammatory and inflammatory disease groups. The mean ZSR values for these groups were: noninflammatory, 51.60 +/- 5.33%; inflammatory, 59.43 +/- 7.32% (t = 5.5, p less than 0.001). The correlation between ZSR and ESR values was excellent. The ZSR determination has several advantages over the standard ESR in that it can be performed on blood anticoagulated with EDTA and need not be corrected for age, sex or packed cell volume. The ZSR is a rapid, reproducible test correlating well with rheumatic disease activity.


Relationships between neurological findings and classroom behavior. Five hundred seventy-five children from low-income urban neighborhoods who were between 10 and 12 years of age were examined by pediatricians for certain neurological signs. Classroom teachers ranked each child according to types of behavior. Data on neurological signs found in more than 15 children and on types of classroom behavior clinically expected to be related to central nervous system defects were studied statistically. Significant positive associations were found between nystagmus and hyperactivity, mixed dominance and hyperactivity, and mixed dominance and variable day-to-day performance. Errors in moving parts of the body on verbal command were associated with distractibility and underachievement. Head circumference greater than the 90th percentile for age was associated with unvarying behavior and clumsiness; tactile agnosia with unvarying behavior; asymmetry of the eyes with hyperactivity; and asymmetrical position of the child's head with underachievement. A negative association was found between nystagmus and musical ability.


Crohn's disease of the colon. IV. Clinical features of Crohn's (ileo) colitis. Using accepted diagnostic criteria we have selected, for study, 160 patients with Crohn's disease involving the colon. There is a remarkable discrepancy between the clinical diagnosis prior to or at the time of initial admission to this hospital and the diagnosis following definitive investigation and observation of the progression of disease. The peak age incidence occurred in the second decade. The colitis group showed a greater percentage of patients over 30 years of age. Although histopathology was not obtained in all patients, there appeared to be sparing of the ascending colon in a small percentage (9 percent) of patients with ileocolitis. Comparison of the clinical features of granulomatous disease limited to the colon and granulomatous ileocolitis shows a significantly greater incidence of extraintestinal symptoms and overt bleeding in the former. Nausea, vomiting, subacute obstruction, abdominal mass and internal fistulas were substantially more common in ileocolitis but the difference was not statistically significant. In this series retroperitoneal abscess did not occur in patients with disease localized to the colon. In the 10 patients with ileocolitis who developed an abscess, however, the site of fistula was the colon in four patients. In one of these, the abscess was left-sided.


Endogenous Candida endophthalmitis leading to bilateral corneal perforation. A premature neonate developed advanced bilateral endophthalmitis before the significance of underlying Candida sepsis was appreciated. Severe endophthalmitis resulted in corneal thinning, descemetocele formation, and perforation. The infection occurred in the clinical setting of broad-spectrum antibiotic therapy and indwelling intravenous catheters. Cultures of blood and catheter tips had been positive for Candida but were not considered significant until advanced ocular infection was noted. The septic process resulted in the infant's death after systemic amphotericin B therapy was discontinued because of renal toxicity.


Localization of contractile-dependent Ca: comparison of Mn and verapamil in cardiac and skeletal muslce. The effects of two excitation-contraction uncoupling agents, manganese (Mn) and verapamil, are compared in heart and fast-twitch skeletal muscle. Particular attention is given to the effect of the agents on the first contraction following a period of quiescence when the agents are administered during the quiescent period. Mn significantly diminishes dP/dt of the first beat in heart muscle, whereas verapamil has no significant effect. Neither Mn nor verapamil has a significant effect on the first postquiescent contraction in skeletal muscle, though verapamil produces a diminution of dP/dt in subsequent contractions in both tissues. A comparison of the effect of the agents on 45Ca exchange in heart cells in tissue culture indicates that Mn induces a rapid displacement of a rapidly exchangeable component of heart-cell calcium with subsequent inhibiton of influx. Verapamil, by contrast, produces no rapid displacement but only an inhibiton of influx. The functional and Ca-exchange effect of the two agents are compatible with a model which places most of the contractile-dependent Ca at the cellular surface in heart muscle and at deeper, intracellular sites in fast-twitch skeletal muscle.


Hemodynamic consequences of delayed ventriculoconal conduction in the frog Rana catesbeiana. We investigated the function of the conus arteriosus in the bullfrog Rana catesbeiana using a combination of anatomical and physiological techniques. Although there is a normal delay in ventriculoconal conduction and we could induce a spectrum of ventriculoconal conduction disturbances by manipulating the region of the ventriculoconal junction, we found no histological evidence of specialized conducting myocardial tissue in this region. The performance of the conus arteriosus was explored during various disturbances of ventriculoconal conduction and also during hemodynamic disturbances produced by hemorrhage and afterloading. The conus was found to contribute little to forward flow under ordinary circumstances, but its contribution increased greatly during bleeding or partial occlusion of the truncus. In contrast to the conclusion of others, no evidence could be adduced to support the idea that the conus serves as a depulsating chamber. Disparities in previous reports concerning the operation of the conus as a booster pump are attributed to special experimental circumstances.


Determination of the ENa of from skin from studies of its current-voltage relationship. Studies were done to test the idea that the emf of the sodium pump (ENa) of isolated frog skin could be estimated directly from studies of its current-voltage relationship. ENa was estimated in two ways: a) from the bidirectional sodium flux ratio according to Ussing and Zerahn, and b) from the values of open-circuit voltage, short-circuit current, and the shunt resistance estimated when the [Na] of the outer solution was reduced to zero. When the values of ENa were compared with the values of E1 obtained from the current-voltage relationships, they were found to be the same despite considerable variability in the values of ENa between skins (77-168 mV). In general, the values of ENa were considerably higher when the skins were bathed with sulfate-Ringer as compared with chloride-Ringer solution. These data are compatible with the idea that in nonedge-damaged frog skin, the unidirectional sodium fluxes were confined primarily to active transport pathways alone, and, accordingly, they may be excluded from parallel-shunt pathways.


Trichomonas vaginalis in a perinephric abscess. A case report. A patient with chronic vulvo-vaginitis due to Trichomonas vaginalis, and obstructive uropathy associated with renal calculi, developed a perinephric abscess following trauma incurred in a motorcycle accident. T. vaginalis was seen on smear and cultured from the purulent drainage from the perinephric abscess. Although T. vaginalis is commonly pathogenic only to the lower genito-urinary system, the upper urinary tract may very rarely be involved by ascending infection. If this protozoan spreads to extraluminal sites the inflammatory potential is marked, as has been found in animals with experimental infection. Examination of a fresh smear of pus may be critically important in the diagnosis of closed-space infections of unknown etiology.


Gastro-intestinal haemorrhage from peptic ulcer. An evaluation of bloodless transfusion and early surgery. Over a 3-year-period 72 patients with upper digestive tract haemorrhage due to peptic ulcer were transfused exclusively with isotonic sodium chloride and glucose solutions in equal quantities. The results are compared with 69 patients treated previously in whom conventional blood transfusion regimes had been used. Transfusion therapy was combined with emergency surgery involving vagotomy and draininage, with surgical haemostasis in situ. There were no significant differences between the two groups with regard to anaesthesia, surgery and post-operative managemement. Apart from anemia, there were less early and late complications in the group not receiving blood. The amount of crystalloid solutions administered varied between 7000 ml and 19,000 ml causing a diuresis of 1000 ml to 5300 ml within the first 24 hours. The use of this transfusion regime for haemodynamic re-equilibration in upper gastro-intestinal haemorrhage due to ulcer, in cases in which haemostasis can be obtained with certainty by emergency surgery, allows transfusion of stored blood and colloid solutions to be avoided and emergency surgery to be safely undertaken at the earliest moment. The severe acute anaemia which is caused appears to create no special problems.


Electrostimulation in the management of chronic pain. A new form of electrostimulation was investigated in a series of 768 patients with chronic pain. The method is based on the insertion of needle-electrodes in symmetrically selected points of the body and the passage of an electrical current of specified parameters. Treatment sessions last about 15-20 min and are repeated at intervals of 1 to 7 days. The procedure is simple and free from undesirable side effects. The investigation was based on 12000 sessions. The results of the treatment are discussed. No hypothesis of the mechanism of the beneficial effects obtained by electrostimulation is given, though the gate control theory of pain is cited.


A micro-rosette test for newborns.

A micro-rosette test for newborns. It is known that human T-cells can be identified by rosette formation with sheep red blood cells. The authors have developed a micro adaptation of the rosette-forming cell test with which they compared the lymphocyte distribution of 38 newborns to that of 42 older children. The percentage of lymphocytes spontaneously forming rosettes was similar in the two groups. Absolute lymphocyte counts were also similar. They suggest that this micro-rosette test could offer the clinician a rapid and inexpensive laboratory method of assessing cell-mediate immunity in the neonate.


A preliminary report on regenerative healing in the equine tendon. The concept of regenerative healing has been used to manipulate the healing process in experimental animals and clinically to augment bone healing in people after orthopedic operation. An implanted electrical device was used in an attempt to produce regenerative healing in experimentally created equine tendon injury. The bimetallic electrical implant did not produce regenerative healing under the conditions of this experiment. The mechanism of implantation and discussion of the results are included.


Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience. A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.


Different lymphocyte populations in rheumatoid arthritis and their relationship to anti-Ig activities. The anti-immunoglobulin activities of rheumatoid arthritis appear to be related not only to plasma cells and their precursors, the B-lymphocytes. Evidence for interaction of IgG with T-lymphocytes and with Fc-bearing lymphocyte-like cells has now appeared. Both these cell types can mediate cytotoxicity which may also induce inflammation in addition to that provoked by rheumatoid factors and immune complexes. Rheumatoid factors and immune complexes may act primarily through the complement system. However, active inflammation in rheumatoid patients can occur without abundant immune complexes, e.g. in B-cell-deficient patients (31). In some cases this may be due to activation of the alternate complement pathway. However, the T-cell system with its series of lymphokines may also play an active part-in the inflammatory process. And both T-lymphocytes and Fc-bearing lymphocyte-like cells, the K-cells, can mediate cytotoxicity. Also in such patients further studies are needed to work out the complex interactions between these cell types and to discover the underlying cause or agent in the chronic destructive rheumatoid inflammation.


[Localization of the genes of 28S and 18S RNA in human somatic chromosomes by in situ hybridization]. In situ hybridization of human somatic cell chromosomes suggests that the genes coding for the 28S and 18S RNA's are located in the satellite of acrocentric chromosomes rather than in the secondary constriction, and that two minor sites exist in the centromeric region of chromosomes 1 and 2.


New approach to caloric stimulation of the vestibular receptor. A new caloric testing method is described. During continuous aural irrigation, fluid is switched between hot and cold values at times computed according to a mathematical model of heat conduction in the labyrinth area. As a result, the induced temperature difference across the lateral semicircular canal describes an approximately sinusoidal time course, reaching peak values of equal magnitude but opposite sign. The magnitude of the caloric stimulus may be selected by choosing appropriate irrigation durations from a graph or table. Application of the test to clinical subjects demonstrated that the heat conduction model and analysis used in timing the sequence of thermal pulses was accurate. The new procedure causes less patient discomfort and requires less time to complete than does the conventional Fitzgerald-Hallpike test.


De novo occurrence of 46,XX,t(4;13) (q31;q14) in a mentally retarded girl. A 12 year-old mentally retarded girl with multiple congenital malformations presented with an apparently new chromosome abnormality involving a de novo balanced reciprocal translocation between part of the long arms of chromosomes 4 and 13. This was observed in 291 metaphase spreads derived from short-term leucocyte and skin fibroblast cultures.


[Pure trisomy 9p 47,XX,+ del(9) (q11). Discovery of one cell 46,XX, del(9) (q11) in the father]. A case is reported of "pure" trisomy 9p: 47,XX,+del(9) (q11). The affected 6-year-old girl has moderate psychomotor retardation (IQ near 70), with speech retardation. She is mildly dysmorphic, with the characteristic features of trisomy 9p: a "worried look", a unilateral grin, slant of the palpebral fissures, a globulous nose, brachymesophalangia and the characteristic dermatoglyphic features. The parents karyotypes are normal, except for one cell from the father which had the karyotype 46,XY,del(9)(q11), the implications of which are discussed.


[Proceedings: Measurement of the secretory activity of the interrenal glands in Rana esculenta L (author's transl)]. In the green frog, the total corticosterone concentration measured by radiocompetitive binding assay, is 4,00 +/- 0,5 mug/ml. In captivity, this level is stable; in the natural environment, it changes with the hour and the date of the sampling. The percentage of bound corticosterone is about 30%.


Brachydactyly type B and symphalangism in different members of a Mexican family. A patient with typical brachydactyly type B is described. By history, 4 generations had some affected members and it was possible to examine a sister and 2 children of the proposita. These individuals in addition to the brachydactyly had symphalangism, an abnormality not previously described in association with brachydactyly type B.


A case of ring 18 chromosome in a sibship with multiple spontaneous abortions. We report the study of a female infant with physical stigmata suggestive of 18 chromosomes deletion, in whom cytogenetic studies revealed a 446,XX,r(18) complement. She was the last born of a sibship of seven composed otherwise by three spontaneous abortions, two perinatal deaths and one living female. The chromosome studies of the parents were normal. The cytogenetic finding and the phenotype are discussed in relation to the 18 chromosome deletion syndromes. The phenotype of the propositus would indicate that her ring 18 is significantly deficient of long arm segment. The apparent sporadic occurrence of this chromosomal anomaly in this family is discussed.


[Increase of the LDH-B activity in a boy with 12p trisomy by malsegregation of a maternal translocation t(12;14) (q12;p11)]. A newborn male trisomic for 12p is compared with three other 12p trisomics already reported in the literature, as well as with three patients monosomic for 12p. A "type and countertype" opposition is observed for five characters: in the trisomy, turricephaly, shortness of the nose, protruding anthelix, wide palms, and increased LDH-B activity; in the monosomy, protruding occiput, large nose, hypoplasia of the anthelix, narrow palms, and decreased LDH-B activity.


The 12p trisomy syndrome.

The 12p trisomy syndrome. Trisomy for the short arm of chromosome number 12 was diagnosed (by a G-banding method) in a girl with multiple congenital defects. Her mother and two sisters showed a balanced translocation 46,XX,rcp(12;21)(p11;p11), so, the affected girl was the result of a maternal adjacen t-1 meiotic segregation with a karyotype 46,XX,der21,rcp(12;12)(p11;q11)mat. Another sister decreased at 3 yr of age showed similar phenotypical features and was considered also affected although no karyotype studies were performed. Both affected cases were compared with a previous one and the concordant characteristics allowed the individualization of the following syndrome: severe mental retardation, peculiar flat facies with prominent checks, epicanthic folds, broad and irregular implantation of the eyebrows, broad and flat nasal bridge with short and narrow nose, anteverted nostrils and large philtrum, broad and prominent lower lip, low set ears with folded helix, prominent anthelix and deep concha, "spade" shape fingers (sharp-pointed distal phalanges) with shortness of the fifth, bilateral genu valgum, slightly increased space between first and second toes, secral dimple, generalized hypotonia and hyporeflexia of knees and ankles, nistagmus, retarded and dysrythmic bone age, simian creases or equivalent and distal axial triradii.


Partial deletion of the short arm of chromosome 12(p11; p13). Report of a case. Chromosome analysis of a 15-day old boy with multiple malformations revealed a partial deletion 12(p11;p13).


An inherited translocation t(4;15) (p16;q22) leading to two cases of partial trisomy 15. A four year old girl with severe mental retardation and multiple congenital abnormalities manifested "partial trisomy 15". Her mother, pregnant at the time of examination, possessed a balanced translocation which, after banding techniques, was identified as t(4;15)(p16;q22). Amnio-centesis revealed the karyotype of the fetus to be identical to that of the proposita and a therapeutic abortion was performed. Prenatal investigation of a subsequent pregnancy revealed a normal male karyotype. Comparison of the proposita and aborted fetus of this family with the 5 reported other cases of "partial trisomy 15" does not allow for a precise recognizable clinical syndrome.


Vestibular reactions associated with minocycline. Several recent reports have indicated that minocycline, a drug effective for meningococcal disease prophylaxis, is associated with a high incidence of vestibular side effects. In January 1975, a questionnaire on adverse reactions was completed by all 29 staff members of a North Georgia hospital who had taken minocycline at the recommended dosage after exposure to a suspected meningococcal meningitis case and by 25 age-, sex-, and occupation-matched non-treated controls. In the treated group 86% experienced moderate to severe vestibular symptoms; 84% of the symptomatic persons experienced their onset after one or two doses of 100 mg. Fifty-two percent of the treated staff members stopped taking the medication because of these effects. The symptoms resolved within 48 h after affected persons discontinued the medication. Until the safety of minocycline can be reestablished, rifampin is recommended for meningococcal disease prophylaxis, and alternative drugs are encouraged for other indications.


Double-antibody radioimmunoassay for staphylococcal enterotoxin C2. A sensitive double-antibody radioimmunoassay for staphylococcal enterotoxin C2 is described. The assay procedure employs anti-rabbit gamma globulin, prepared in goats, to precipitate the antigen-antibody complex of enterotoxin C2 and anti-enterotoxin C2. The test is sensitive to 100 pg of enterotoxin.


Eosinophil-specific and other granulocyte-specific antinuclear antibodies in juvenile chronic polyarthritis and adult rheumatoid arthritis. Sera from 151 children of whom 112 had juvenile chronic polyarthritis (JCP), and from adults with rheumatoid arthritis (RA), and from healthy pregnant females were tested for the presence of granulocyte-specific antinuclear antibodies (GS-ANA). These were detected in 20% of sera from cases of JCP, in 68% of adult RA, but in none of the controls. Eosinophil-specific ANA were the only ANA present in 18% of positive children and 54% of the positive adults. GS-ANA in children were predominantly IgG and of low titre. Heat-stable GS-ANA were detected in sera from eight children but none bound complement. The presence of GS-ANA was not significantly associated with sex, age of onset, duration of disease, mean active joint count, mean ESR, nor with the presence of fever, rash, splenomegaly, amyloidosis, pericarditis, or rheumatoid factor.


Rubella antibody levels in juvenile rheumatoid arthritis. Increased rubella antibody titres have been reported in patients with juvenile rheumatoid arthritis (JRA) and it has been suggested that rubella virus may be of importance in the aetiology or pathogenesis of the disease. In the present study, rubella and rubeola antibody titres in 85 patients with JRA were compared to age- and sex-matched controls. 41% of the patients did not have rubella antibody, but the geometric mean titre of those with JRA who had antibody was slightly higher than that of the controls with antibody (58-9 against 42-7; P less than 0-05). The level of rubella antibody titre correlated with serum IgG levels. There was no difference in rubeola antibody titres between patients and controls, and rubeola antibody did not correlate with serum IgG. Fifteen JRA patients developed rubella antibody after rubella vaccine or natural disease. This did not result in unusually high antibody titres and was associated with a mild exacerbation of symptoms in only two patients. This study suggests that the slight increase in rubella antibody in JRA is a nonspecific manifestation of increased immunoglobulins.


Antinative DNA antibodies as a reaction to pyrazole drugs. A case history is presented of the occurrence of a high binding capacity for native DNA in the serum of a patient on phenylbutazone. This reverted to normal on stopping the drug. The patient also had a reversible neutropenia and leucopenia, and it is suggested that the high anti-DNA binding capacity was a feature of a drug-induced lupus-like phenomenon.


Erosive hemorrhagic gastroduodenitis with fibrinolysis and low factor XIII. Four patients with erosive hemorrhagic gastroduodenitis were found to have high fibrinolytic activity of the gastric juice. No increase in the fibrinolytic activity could be demonstrated in the circulating blood, but the values found for fibrinogen, plasminogen and alpha2-macroglobulin were low. A high content of FDP was found in the serum. All patients had a markedly decreased content of factor XIII. Platelet count and other coagulation components were normal. These findings were interpreted as signs of local fibrinolysis in the diseased parts of the gastrointestinal canal. The bleeding stopped after oral and intravenous administration of a fibrinolytic inhibitor (AMCA Cyclokapron) and of factor XIII-containing concentrate. In bleeding from gastroduodenal ulcer and esophageal varices, no increase in gastric fibrinolytic activity was found. It is suggested that the high local fibrinolytic activity in the stomach in erosive gastritis together with the low content of factor XIII contributes substantially to the hemorrhage in this condition. These observations may lead to a revision of the treatment of such cases.


Results of direct coronary artery graft reconstruction. A five-year clinical and arteriographic appraisal. Three hundred thirty-six patients with severe coronary artery disease were operated upon between June, 1969, and December, 1974. All were followed from 1 to 66 months (average, 37 months) with respect to survival and late myocardial infarction. The patients operated upon were compared statistically with a group of unoperated patients, and this evaluation demonstrated significantly better late survival in the surgically treated patients who had double- and triple-vessel disease. Two hundred thirty-six consecutive patients had clinical and late arteriographic reevaluation more than 6 months postoperatively; 78% were asymptomatic. Factors affecting graft patency are reviewed in detail. Late graft patency is determined by preoperative selection of vessels for grafting. Patency is not an index of success for this procedure. Surgical therapy appears to be the treatment of choice for patients with two- three-vessel coronary occlusive disease.


Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases. The feasibility of utilizing the coronary venous system for myocardial revascularization was explored in 18 dog experiments and 3 clinical patients at St. Mary Medical Center. Experimental models were developed using mammary artery-to-coronary vein anastomoses, free vein grafts from the aorta to the coronary veins, and saphenous vein bypass grafts from the aorta to the cardiac veins in the patients. Evaluation of myocardial revascularization was done by one or more of the following methods: (1) electromagnetic flowmeter measurements of graft blood flow; (2) myocardial scanning after injection of radioactive materials; (3) hydrogen electrode evaluation of arteriovenous shunting; (4) coronary cineangiograms; (5) methylene blue injections with visual observation of myocardial staining and collateral venous pathways; (6) pulse-flow tracings; (7) electrocardiographic changes; and (8) myocardial venous capillary response to papaverine and isoproterenol. The experimental studies consistently demonstrated evidence of myocardial revascularization through the coronary venous system. Three patients with intractable angina pectoris and previous unsuccessful revascularization procedures underwent saphenous vein bypass grafting from the aorta to the coronary vein. Postoperative coronary cineangiograms showed patency in 2 of 4 grafts. Myocardial scanning demonstrated radioactivity in the regions served by the patent grafts. All patients survived and were partially or completely relieved of their symptoms.


Opiate drug receptors on excitable cell membranes. In drug interaction studies on intact mice it was found that naloxone (3mumoles/kg) antagonized the general central nervous system depressant effects of morphine or meperidine. Higher naloxone doses (0.3 and 0.4 mmoles/kg), like the fullagonists, potentiated the loss of the righting reflex produced by phenobarbital. Naloxone (0.3 to 14 muM) antagonized the depressant effects of morphine or meperidine on the compound action potential of frog's sartorius muscles in vitro. Higher naloxone concentration (ED20=0.3 mM, ED100=3.0mM), like the full agonists, depressed action potential production. These results show that high doses of naloxone can duplicate some effects of morphine or meperidine but at low doses it antagonizes the effects of the full agonists. This would suggest that naloxone is a partial agonist with a very low intrinsic activity. These results also indicate that there are opiate drug receptors on excitable cell membranes and that drug activation of these receptors inhibits action potential production.


Effect of helium on membrane resistance. Resistance measurements were made of bimolecular lipid membranes (BLM) according to Mueller and Rudin (10). With the addition of excitability inducing material (EIM), a bacterial protein, the electrical resistance of the BLM was reduced to within biological limits. Frog pericardium was used in the same system as a natural membrane comparison. Exposure of these membranes to air, oxygen and nitrogen resulted in no significant change in the resistance of the bilayers or the pericardium. Exposure to helium and helium 79%-oxygen 21% mixutre resulted in a significant increase in the membrane resistance.


Cytoplasmic and outer membranes separation in Rhodopseudomonas sphaeroides. A cell envelope fraction had been prepared after mechanical disruption of lysozyme-EDTA spheroplasts from depigmented Rhodopseudomonas sphaeroides (aerobically grown in the light). On linear sucrose gradients this fraction can be separated in a cytoplasmic membrane fraction and an outer membrane fraction. The cytoplasmic fraction (buoyant density: 1.18 g/cm3) has been characterized by its succinic dehydrogenase activity and by its composition. The outer membrane fraction (buoyant density: 1.21 g/cm3) does not contain any respiratory activity nor hemoproteins. The same fractionation has been done on cells repigmented in the dark by lowering the O2 pressure. In that case the same two fractions have been detected in addition to the chromatophore fraction (buoyant density: 1.14 g/cm3). However both, and specially the outer membrane fraction, were contaminated by chromatophore material.


Postinfarction ventricular aneurysm. Successful surgical treatment. Over a two-year period, 18 patients with postinfarction ventricular aneurysms were treated surgically. There were no operative or early deaths, and only one (5.5%) late (20 months) death. The indications for surgery included angina, congestive heart failure, and serious arrhythmias. Electrocardiograms and plain chest roentgenograms were unreliable in making the diagnosis. All patients had cardiac catheterization and, at operation, a definite localized aneurysm was demonstrable. In 15 patients (83%), coronary artery bypass grafts were performed at the time the aneurysm was excised. Good results should be expected from surgical treatment of symptomatic ventricular aneurysms. Simultaneous bypass grafting should be performed when indicated.


Retroperitoneal approach for portasystemic decompression. A left retroperitoneal approach has been developed and used to perform a renal-splenic shunt for portal decompression in seven patients with massive variceal hemorrhage. In each patient, at least one intra-abdominal finding contraindicated a conventional transperitoneal portasystemic shunt. Retroperitoneal approach avoided possible complications and permitted successful portal decompression with cessation of bleeding in each instance. These results support the use of this technique when it is necessary to avoid the peritoneal cavity in a patient requiring portasystemic decompression.


Long-term survival following coronary artery bypass. Analysis of 4,522 consecutive patients. A consecutive series of 4,522 patients who received aortocoronary bypass (ACB) from October 1969 through December 1974 has been analyzed with respect to cumulative (actuarial) survival, cause of late death, and late postoperative complications. Through December 1973, 2,676 patients received ACB alone. Cumulative survival was 85.9% for five years. Late cumulative mortality averaged 2.7% per year. Causes of death were myocardial in origin in only 60.4% of the patients. Late complications of nonfatal myocardial infarction occurred in 4.1% of the patients, and congestive heart failure occurred in 10.2%. However, preoperative congestive heart failure was present in 25% of these subjects. Mortality in 1974 was 3.4% in patients who underwent ACB only, and 4.2% for all patients who received ACB procedures (1,478 patients). Comparison to previous medical data makes it appear that this surgery increased the actuarial survival over long-term follow-up.


[The acute vestibular paralysis (author's transl)]. Acute vestibular paralysis may not be considered as a nosologic entity but as a syndrome. Symptomatology (vertigo, spontaneous and provoked vestibular nystagmus, absence of cochlear signs) shows an uniform picture. The results of the caloric test as well as the nystagmic responses induced by galvanic stimulation and the development of central vestibular compensation however indicate that the site of the lesion is not only confined to the labyrinth but may also occur at the level of the peripheral neuron or even the vestibular nuclei. Etiology and pathology are still vague. Our own clinical observations as well as the scarce data in literature about morphological and experimental studies suggest in a way that vascular and infectious disorders are of importance as primary releasing factors. Hypothetically, vestibular loss of function may either be caused by a disturbance of labyrinthine microcirculation, initiated in a great majority of cases by infection, or by a direct lesion of the peripheral neuron as well as the vestibular nuclei. Retrolabyrinthine lesions may be due to menigoencephalitis, caused by a neurotropic virus or other infectious agents such as Toxoplasma gondii. Acute vestibular paralysis should be strictly distinguished from vestibular neuronitis. While vestibular paralysis is a syndrome, vestibular neuronitis must be considered as a nosologic entity, including a lesion of the peripheral neuron as well as evidence of an infectious event.


The management of septic arthritis in childhood. A prospective study of one hundred children with septic arthritis showed that the knee and hip were the joints most affected and that Staphylococcus aureus and Haemophilus influenzae Type B were the commonest bacteria grown. Our treatment, consisting of early arthrotomy and intravenous methicillin and ampicillin, followed by six weeks of joint immobilization and oral administration of cloxacillin and ampicillin, effectively reversed the inflammatory process and compared very favourably with other methods of treatment. Significant residual joint abnormalities, present in 7% of the children, resulted from severe joint damage occurring before treatment. To achieve the best results, this regime must be instituted before permanent joint damage has occurred. This will only be achieved if an early clinical diagnosis of septic arthritis is made.


Percutaneous radiofrequency gangliotomy in the treatment of trigeminal neuralgia and other facial pain. Thirty-eight patients with facial pain in the trigeminal distribution have been treated by percutaneous coagulation of the trigeminal ganglion. Although use has been made of radiological criteria, it has been found from the physiological data obtained from stimulation that motor and sensory phenomena provide more information of electrode placement and that good pain relief results when these criteria are met. The advantages of the method are: (i) minimal operative risk; (ii) control of the extent of the lesion created; (iii) small sensibility deficit; (iv) minimal complication rate; (v) short hospitalization; (vi) satisfactory result in more than 90% of patients; (vii) no recurrence of pain to date.


Acute coronary insufficiency. An urgent surgical condition. In 41 of 220 consecutive patients who had a coronary artery bypass operation between July 1973 and March 1974 the operation was for acute coronary insufficiency (recurrent chest pain with transient electrocardiographic changes persisting after admission to hospital). Their mean age was 54 (range 33-70 years). Eleven patients had had angina before, 14 had had at least one myocardial infarction, and 16 presented de novo. Eight of the latter 16 patients required only a single graft, usually to the left anterior descending artery, a significantly greater number than the two of the other 25 patients (P less than 0.01). Fourteen of these 16 patients had normal ventricular contraction, a significantly higher proportion than the 13 of the remaining 25 (p less than 0.05). No collaterals were seen in any of the 10 with single-vessel disease, which was significantly fewer than five out of 18 with double- and nine out of 13 with triple-vessel disease (P less than 0.005). Patients with rapidly developing obstruction, especially in the proximal left anterior descending artery, may not have time to develop collaterals,  present acutely with good ventricular function, and may be particularly at risk. There was no operative mortality. The patients had a perioperative myocardial infarction, and there was one late death. At follow-up averaging 9-7 months (range 5-14 months) 32 (80%) patients were angina-free, no myocardial infarctions had occurred, and 85% were fully employed. Urgent coronary artery bypass grafting is a safe and effective treatment for acute coronary insufficiency.


Pseudoxanthomatous mastocytosis.

Pseudoxanthomatous mastocytosis. A case of xanthelasmoidea (pseudoxanthomatous mastocytosis) occurring in a 50-year-old Iranian man is described. The patient had a large upper gastrointestinal haemorrhage.


Immunohistological studies, with anti-connective tissue and anti-immunoglobulin antisera, of the skin in lupus erythematosus and scleroderma. Skin lesions from six patients with systemic lupus erythematosus, five patients with discoid lupus erythematosus, twelve patients with systemic sclerosis, five patients with localized morphoea and twenty controls were examined by immunohistological techniques using fluorescein-labelled anti-human IgG, anti-human C3 and anti-human renal glomerulus antisera. The major immunohistological changes in systemic sclerosis and in localized morphoea consisted of foci of intercollagenous staining for connective tissue antigens in the reticular layer of the dermis. It is suggested that these findings indicate collagen neogenesis. In lupus erythematosus the major changes occur in the dermo-epidermal junction and consist of deposits of IgG and C3 and thickening and disruption of the membrane as demonstrated by the use of heterologous sera containing antibasement membrane antibodies. Immunohistological techniques are useful in the diagnostic differentiation between scleroderma and lupus erythematosus.


Heterogeneity in biological activity of human factor VIII antibodies. Antibodies against factor VIII collected from six patients were studied for their effect on factor-VIII coagulant activity, Willebrand factor activity (WF) and factor-VIII-related antigen. The results demonstrate differences between individual antibodies; some acting primarily as anti factor VIII, others inhibiting both after VIII and WF. Differences in effect between plasma and serum indicate that the process of coagulation alters the interaction of these antibodies.