Improved angina threshold and coronary reserve following direct myocardial revascularization. Angina threshold, coronary reserve, and global myocardial lactate metabolism were studied by atrial pacing in 18 patients with obstructive coronary artery disease before and after aortocoronary artery bypass (ACB) surgery. In 3 of these 18 patients, regional (anterior wall) metabolism was also studied. Following ACB, 16 of the 18 patients did not develop angina at the maximum pacing rate (MPR). One patient developed angina postoperatively at a similar rate as before surgery. In the other patient, postoperative angina threshold was much higher. In the group as a whole, postoperative MPR (159 +/- 3.5 beats/min) was much higher than the preoperative angina rate (124.9 +/- 4.9 beats/min; P less than 0.001). Rate-pressure product (RP) at MPR postoperatively (21.5 +/- 0.89 mm Hg/min X 10(-3)) was also higher than RP at angina rate preoperatively (18.8 +/- 0.92 mm Hg/min X 10(-3); P less than 0.01). Although coronary sinus blood flow (CSBF) both at rest (152 +/- 16.2 ml/min) and at MRP (266 +/- 27.5 ml/min) postoperatively was higher than preoperative CSBF at rest (111 +/- 10.7 ml/min; P less than 0.05) and at angina rate (202 +/- 19.9 ml/min; P less than 0.05), arterial-coronary sinus O2 content (Art.-CSO2) difference was significantly lower postoperatively both at rest (8.9 +/- 0.37 ml/min) and at MPR (9.1 +/- 0.44 ml/min) compared with the preoperative Art.-CSO2 at the rest (12.7 +/- 0.40 ml/min; P less than 0.01) and at angina rate (12.4 +/- 3.8 ml/min; P less than 0.01)...


Changes in survival and symptom relief in a longitudinal study of patients after bypass surgery. The first 350 patients having coronary surgery at Stanford Medical Center (excluding patients with aneurysmectomy or valve replacement) have been followed sequentially utilizing a computer-based information system. Our experience spans 72 months (900 patient-years), with an average follow-up of 30 months. Hospital mortality was 4.9%. Actuarial analysis revealed survival of 91% at 1 year and 80% at 6 years. Forty patients (11.5%) had 43 late myocardial infarctions, of which 5 were fatal. Analyses of selected patient subgroups revealed significantly poorer survival in patients with prior myocardial infarction (P less than 0.05), significant congestive heart failure, or mitral regurgitation (P less than 0.01). Survival in multigrafted (and multivessel) patients was not significantly different from survival in single-grafted (predominantly single-vessel) patients. Actuarial studies suggest improved survival in patients with multivessel disease after coronary artery surgery. Between an initial evaluation at 9 months postoperatively (range: 2 to 40 months) and the most recent evaluation after 30 months (range: 6 to 72 months), 13% of patients showed further clinical improvement, 47% were unchanged, while 40% deteriorated with respect to chest pain. We conclude that initial symptomatic benefits may not be maintained in late follow-up studies owing to progression of underlying vascular disease.


Postoperative changes in aortocoronary saphenous vein grafts revisited: angiographic studies at two weeks and at one year in two series of consecutive patients. Comparison of aortocoronary saphenous vein graft status at two weeks and at one year was made in two series of patients. The early postoperative evaluation includes 122 patients of the first 138 operated in our institution (182 grafts) and 83 subjects from a second series of 100 patients operated after modifications of surgical techniques (184 grafts). The one-year follow-up study was obtained in 105 patients of the first series (154 grafts) and in 67 of the second (152 grafts). The patency rate at two weeks was not significantly different between the two groups: 86.3% vx. 91.8%. A marked decrease of steonses noted early at anastomotic sites was observed: 15% to 5.5% (P less than 0.025). The patency rate at one year improved from 67% to 85,5% (P less than 0.0005). Grafts having flows at operation of at least 50 ml/min had patency rates of 90% in both series. The patency in grafts with initial flows below 50 ml/min increased from 28% to 73% (P less than 0.005). The incidence of late localized graft stenoses greater than 40% decreased from 16.5% to 6% (P less than 0.025), and diffuse narrowing greater than 40% was found in only 12% of the patent grafts at one year in the second series as compared to 31% in the first (P less than 0.001). These improved results do not appear to have been influenced by selection favoring better distal run-off in grafted arteries nor by the introduction of sequential grafts to multiple coronary arteries in the second group. Modified surgical techniques may explain the improved results.


Abnormal regional metabolism and mechanical function in patients with ischemic heart diseases: improvement after successful regional revascularization by aortocoronary bypass. Left ventricular anterior wall metabolism was investigated concurrently with global myocardail metabolism by simultaneous preoperation sampling of anterior interventricular venous (AIV) and coronary sinus (CS) as well as arterial bloods in seven patients with severe obstructive lesions of the major coronary arteries, including left anterior descending. Postoperative study was performed two weeks to six months following successful aortocoronary artery bypass surgery. All grafts including the aorto-left anterior descending artery grafts were patent. Preoperatively in three of the seven patients, anterior wall lactate extraction (R%L) was negative at rest. The average R%L at rest (7 +/- 14%) was abnormal and was negative (-49 +/- 26%) at a maximum supraventricular pacing rate (MPR) of 137 +/- 4.6 beats/min. Postoperatively, not only was resting R%L (39 +/- 4;4%) normal but also it remained normal during atrial pacing (32 +/- 8.5%) even though the postoperative MPR (164 +/- 4.4 beats/min) was much higher than the preoperative MPR; Postoperatively AIV pO2 both at rest (21 +/- 1.1 mm Hg) and at MPR (22 +/- 1.3 mm Hg) and directly determined O2 saturations (resting: 34 +/- 3.0%; MPR:35 +/- 2.1%) tended to be higher than the preoperative values (AIV pO2, resting: 18 +/- 1.7; MPR: 19 +/- 1.7 mm Hg; AIV O2 saturation resting: 30 +/- 2.7; MPR: 33 +/- 3.3%), although only differences in pO2 were statistically significant. In five of the seven patients in whom the pre and postoperative left ventricular angiograms could be compared, systolic wall motion of the left ventricular anterior wall improved markedly postoperatively. Average global myocardial lactate extraction (G%L) preoperatively was normal (19 +/- 4.8%) at rest but was negative (-22 +/- 12%) at MPR. Postoperatively however, G%L both at rest (44 +/- 5.5%) and at MPR (34 +/- 7.9%) were normal. Coronary sinus pO2 and O2 saturation were also higher postoperatively compared to the preoperative values. Over-all left ventricular performance indicated by increase in ejection fraction also improved postoperatively. This improvement was not caused by increased coronary blood flow. Postoperative coronary sinus blood flow both at rest (114 +/- 19 ml/min) and at MPR (199 +/- 27 ml/min) however were less than the preoperative values (resting 136 +/- 24, MPR 261 +/- 40 ml/min), There was also no increase in global O2 delivery and O2 consumption despite higher heart rate and rate-pressure product achieved during postoperative pacing stress and the patients did not develop angina. These findings suggest that improved regional and global metabolism and mechanical functions observed postoperatively in these patients may be due to redistribution of blood flow to the ischemic and nonischemic myocardium following successful aortocoronary artery bypass surgery.


Concordance for coronary risk factors among spouses. Values for several coronary risk factors, including systolic and diastolic blood  pressure, serum cholesterol, triglycerides, blood glucose, uric acid, hemoglobin, weight, vitral capacity and cigarette smoking have been found to be similar among spouses in the Framingham Study. However, longitudinal analyses show that this spouse concordance does not increase over a twelve-year observation period, suggesting that it has arisen through the marriage of similar people rather than through the sharing of a common marital environment. Apparent conflicts between cross-sectional and longitudinal findings have been resolved by showing that spouses who were concordant at the begining of the study are more likely to survive to later exams, while discordant spouse pairs tend to be dissolved through the death of one of their members.


The treatment of pulmonary metastasis in osteogenic sarcoma. The survival times in a control series of 145 cases of osteogenic sarcoma without pulmonary resections including records of pulmonary nodules and surgical wedge excisions, suggest that pulmonary resection is a noteworthy adjunct treatment. The 5-year survival of patients subjected to repeated pulmonary surgery is known for 22 patients who were under the age of 21. Where aggressive pulmonary resections were performed, i.e., repeated thoracotomies, and multiple wedge resections of nodules, a 5-year survival rate of 31 per cent (after date of primary amputation) is noted and compared to a previous study of 145 cases, 121 of which had untreated pulmonary metastases, and at 5 years, only 2 per cent of these patients with metastases were still alive. Lung wedge resection survivals are highly significant statistically although survival with residual disease must be considered in part at least, due to aggressive chemotherapy (i.e., high dose methotrexate with citrovorum rescue in combination with other drugs).


Dissection and rupture of the ascending aorta. Unusual complications of aortocoronary bypass surgery. This is a report concerning two cases of unusual complications, dissection and rupture of the ascending aorta, secondary to saphenous vein bypass surgery. We recommend that evaluation of patients undergoing saphenous vein bypass surgery include careful image-intensifier fluoroscopic examination during coronary arteriography. If aneurysmal dilatation of the aorta or calcification is observed, ascending aortography should be performed to better evaluate the aorta, and surgeons should be alerted to use appropriate maneuvers and techniques to minimize the risk of complications in the aortic site of the vein anastomosis. Internal mammary coronary-artery bypass should be the procedure of choice in such conditions.


Saphenous vein graft from aorta to coronary vein with production of continuous murmur. A complication of coronary artery bypass surgery. A saphenous vein graft was inadvertently placed from the aorta to the coronary vein adjacent to the proximal left anterior descending coronary artery in a 53-year-old man with symptomatic coronary artery disease. The post-operative finding of a continuous murmur led to cardiac catheterization and successful surgical correction. The postoperative finding of a continuous murmur must alert the clinician to this possible technical error.


[Complications following colon surgery]. 615 transperitoneal operations on the colon and rectum produced the following results. 377 abdominoperineal resections, anterior resections, partial and subtotal colectomies and proctocolectomies, 87 closures of colostomies and 151 operations with resection. 66% of the operations were required due to tumors. The death rate with 545 preopreratively prepared and scheduled operations was 8.1% whereas with the 70 emergency operations it was 25.7%. In 254 or 41.3% of the cases there were postoperative complications. Severe postoperative complications due to infection were the most frequent, followed by cardiopulmonary, haemorrhagic, urological and complications due to ileus. The quotient of insufficiency with the 356 anastomoses was 16%, the death rate 1.4%.


[Measurement of electric impedance as a screening method for diagnosing haemorrhagic diatheses (author's transl)]. Changes in electrical impedance during blood clotting have been previously described. Personal measurements on blood of 18 healthy donors and 29 patients with various disorders of clotting gave reproducible results with this method. There was a marked difference between normal subjects and those with bleeding diatheses regardless of type. There was good correlation between impedance changes and the thrombelastogram, the former being more sensitive in diagnosing haemorrhagic disorders. Further studies are required to evaluate its place as a screening method in these conditions.


[Early carcinoma of the stomach in Europe (author's transl)]. In a retrospective study of 317 816 gastroscopies between 1968 and 1973, the incidence of early carcinoma of the stomach was assessed. Among 18 887 gastric carcinomas there were 1170 early carcinomas. The most frequent kind was one of mucosal changes with defect (types II c and III according to the Japanese classification). 47% of early carcinomas were located in the lesser curvature. The diagnosis was made by biopsy in 90% of cases. The correctness of biopsy was proportional to the number of biopsies per lesion. Adding cytological examination to biopsy decreased the number of false-negative results by 30%. In most cases the history was non-specific. But in 70 patients (16%) over 40 years gastro-intestinal bleedings were the reason for endoscopic examination and led to the diagnosis of early carcinoma.


Primary immunodeficiency with early encephalopathy in two siblings. An anatomo-clinical study. The authors describe two siblings affected by an immunodeficiency state characterized by low IgA and IgM levels in serum, and an early encephalopathy with infantile spasms and hypsarrhythmia. The nosography of this unusual association and the relationship to ataxia telangiectasia and allied disorders are briefly discussed.


Myasthenia gravis: ALG treatment of seriously ill patients. The authors review the theoretical basis of human antilymphocyte globulin (ALG) and human antihymocyte globulin (ATG) treatment in myasthenia gravis. Ten selected seriously ill myasthenic patients were treated with ALG and/or ATG. Three of the patients improved significantly and a further four moderately, whereas the condition of three patients did not change. ALG therapy is effective in the suppression of cellular immune mechanism, therefore it can be assumed that it exerts its effect in myasthenia gravis by inhibiting thymus hormone stimulation.


Stimulation of granulopoiesis by androgens without concomitant increase in the serum level of colony stimulating factor. The marked enhancing effect of daily injections of 19-nortestosterone decanoate (19-ND) upon granulopoietic recovery of mice made neutropenic by a single dose of BCNU was studeid in regard to the possible regulatory role of CSF. Serum levels of CSF in BCNU-treated mice with or without 19-ND injection were not found to differ significantly from those in normal mice. BCNU treatment with or without 19-ND did not alter the CSF increases in response to endotoxin injection. Increases in dividing marrow granulocytes in the 19-ND mice were preceded by increases in their marrow CFC. The acceleration of granulopoietic regeneration was thus not mediated by the serum colony stimulating factor. It is attributed to a stimulatory effect of 19-ND on proliferation of CFC and/or CFU.


T and B lymphocytes in patients with chronic renal disease on hemodialysis. The T and B lymphocytes in peripheral blood were reduced in patients with glomerulonephritis treated with hemodialysis as compared to normals. Although the absolute number of 'null' cells was also decreased, the percentage of 'null' cells was increased in these patients.


The role of the dentist in the emergency room. Although most of the problems seen by the dentist in the hospital emergency room are not life-endangering, they can still cause considerable difficulty for the patient and anxiety for the doctor when not treated quickly and effectively. To manage an emergency effectively requires a prepared plan of action. Such planning must participation of the physicians, nurses, and auxiliary emergency room personnel. Since oral and maxillofacial emergencies may present unfamiliar problems to them, they must be instructed in advance about their role in proper care of such patients. Likewise, the dentist must familiarize himself with the emergency room- its operation and its facilities. Through such cooperative efforts, effective patient management will be provided no matter what unforeseen situation may suddenly arise.


Ageing and autoimmunity.

Ageing and autoimmunity. A total of 483 healthy persons from Czechoslovakia, divided into three age groups (below 40, 41-60 and above 61 years) were examined for eight types of autoantibodies (antibodies to epithelial cells and to colloid of thyroid gland, parietal cell antibodies, antibody to intersititial duct cells of parotis and to adrenal cells, anti-nuclear and anti-mitochondrial antibodies, intrinsic factor antibodies). A significantly increased occurrence was observed in the oldest age group, the results being more manifest in women. A conspicious increase was seen particularly in the thyroid antibodies. The results correspond to those of other authors from different geographic areas.


Human T-lymphocyte rosette formation: inhibition by cytochalasin B. The effects of cytochalasin B, colchicine and vinblastine on the rosette formation of human T lymphocytes with neuraminidase-treated human erythrocytes (nHRBC) and with sheep red blood cells (SRBC) have been studied. Pretreatment of the lymphocytes with cytochalasin B which affects microfilament action reversibly inhibits both nHRBC and SRBC rosette formation. Colchicine and vinblastine known to interact with microtubules causes no major reduction in rosette-forming cells. The results suggest that normally functioning microfilaments are necessary for nHRBC and SRBC rosetting, whereas microtubules are not essential for the blinding of the erythrocytes to the lymphocytes.


Natural cytotoxic reactivity of mouse lymphoid cells against syngeneic and allogeneic tumors. II. Characterization of effector cells. Studies were performed to characterize the effector cells responsible for natural cytotoxicity of mouse lymphoid cells against a variety of syngeneic and allogeneic tumor lines. Since spleen cells from normal nude mice were found to be highly cytotoxic, they were used for most of these experiments. Only a small proportion of the reactivity was affected by treatment with anti-theta serum plus complement. Macrophages dis not appear to be responsible for the reactivity, since treatment with carbonyl iron/magnet or carrageenan did not affect the levels of cytotoxicity. The effector cells were non-adherent, since passage over nylon columns resulted in a considerable increase in activity. The active cells did not have receptors for immunoglobulin or complement, since removal of cells with these receptors by columns or monolayers containing sheep erythrocyte-antibody (EA) complexes or EA-complement complexes did not remove activity. Antibody-dependent cell-mediated cytotoxicity appeared to be ruled out as the mechanism for natural cytotoxicity, since aggregated gamma globulin and a potent anti-immunoglobulin reagent did not inhibit reactivity, and since no role for humoral factors could be demonstrated. The natural effector cell was found to be quite labile at 37 degrees C, losing much of its activity after 4 h. Since no surface markers could be detected on the effector cells, and the mechanism for cytotoxicity appeared distince from others previously described, it is proposed that the natural cytotoxicity against mouse tumor cells is mediated by a unique subpopulation of lymphoid cells, which are tentatively designated N-cells.


Constitution of the cell envelope of Haemophilus influenzae in relation to competence for genetic transformation. Cell envelopes of Haemophilus influenzae have been prepared by breakage in a French pressure cell followed by differential centrifugation. The envelope fraction may be resolved into an inner-membrane (light) and an outer-membrane (heavy) fraction on density gradients. Envelopes from competent cells possess elevated levels of lipopolysaccharide with a composition different from that of log-phase cell envelopes. Three apparently new polypeptides have been observed in envelopes from competent cells by gel electrophoresis in sodium dodecyl sulfate; additional quantitative alterations in the profiles of membrane polypeptides also company the development of the capacity to transport deoxyribonucleic acid. Most of the polypeptide changes are confined to the outer membrane; one new polypeptide is associated with the inner cytoplasmic membrane of competent cells. Protein synthesis during competence developement is rquired for the change in lipopolysaccharides and in the envelope polypeptides to occur.


Minicell production and bacteriophage superinducibility of thymidine-requiring strains of Haemophilus influenzae. Aminopterin- or trimethoprin-resistant thymidine-requiring strains of Haemophilus influenzae produce minicells, and the ratio of minicells to cells increases during the stationary phase of growth. Strain LB11, isolated after mutagenesis of a thymidine-requiring strain (Rd thd), produces more minicells than the parent strain. The mutations involved in high frequency minicell production have been transferred into the wild type (strain Rd) by transformation. The thymidine requirement in the resulting strain, MCl, is essential for minicell production, since spontaneous revertants of MCl to prototrophy do not produce minicells. The ratio of minicells to cells was increased more than 10(3)-fold by differential centrifugation. The minicells contain little or no deoxyribonucleic acid (DNA). Phage HPlcl apparently cannot attach to minicells. Competent cells of LB11 and its thymidine-requiring parent strain produce defective phage as a result of exposure to transforming DNA, whereas only LB11 produces many defective phage in response to the competence regime alone. Competent HP1c1 and S2 lysogens of MC1 and Rd thd are also superinducible by transforming DNA, but competent LB11 lysogens produced about the same amount of HP1c1 or S2 phage with or without exposure to transforming DNA possibly because of competition between the induced defective phage and Hp1c1 or S2 phage.


Lack of T-cell immune abnormalities in peripheral blood lymphocytes in patients with Graves' disease or hypothyroidism. Lymphocytes capable of forming nonimmune (E) and immune (EAC) rosettes with sheep erythrocytes and lymphocyte reactivity to phytohemagglutinin were determined in normal subjects, in patients with hyperthyroidism due to Graves' disease and in patients with hypothyroidism with and without goiter. Neither patient group differed from the normal subjects either in regard to lymphocyte count, the proportion of thymus dependent (t) lymphocytes forming nonimmune or bone marrow-dependnet (B) lymphocytes forming immune rosettes or lymphocyte reactivity to phytohemagglutinin. These results fail to provide evidence that these disorders are associated with an immune abnormality with increased or abnormal T cells in peripheral blood.


Specific concentration of polynucleotide immune complexes in the cryoprecipitates of patients with systemic lupus erythematosus. Although the association of cryoglobulinemia with hypocomplementemia and tissue injury in systemic lupus erythematosus is well recognized, composition of cryoprecipitates in terms of circulating antigens and antibodies in this disease is less clear. To clarify this question, cryoprecipitates from patients with SLE were examined with sensitive assay techniques for certain antipolynucleotide antibodies and DNA antigen. DNA antibodies were highly enriched relative to serum levels in the majority of cryoprecipitates. DNA antigen was also demonstrable. Antibody to ribonucleoprotein, although less frequently present, was similarly enriched in certain cryoprecipitates. In contrast, anti-double strand RNA, which was commonly detectable in relatively high titer in serum, was only minimally concentrated in a minority of cryoprecipitates. Absorption experiments using red blood cells heavily coated with polynucleotide antigen indicated that a major proportion of the IgG in certain cryoprecipitates was specific antibody. The data strongly suggest that the cryoprecipitates in systemic lupus erythematosus represent circulating immune complexes that are soluble at 37 degrees C and come out of solution in the cold. The marked concentration of immune complexes in the cryoglobulin offers a simple and direct method for determination of the nature of the complexes. The accumulated evidence obtained in the present study indicates that these complexes closely reflect, in their composition, the circulating immune complexes which are most significant pathogenetically in renal tissue injury.


Effects of thrombin treatment of preparations of factor VIII and the Ca2+-dissociated small active fragment. When human, canine, or bovine factor VIII preparations are chromatographed on 4% agarose at ionic strength 0.2, the factor VIII activity elutes as a single peak in the void volume with slight tailing. Incubation of such preparations with dilute (0.01 U/ml) highly purified thrombin results in some activation of factor VIII. Chromatography of such incubation mixtures, under the same conditions as before, results in elution of two peaks of factor VIII activity one in the void volume and one much later with marked tailing. The void volume peak has most of the protein and some factor VIII activity. These void volume fractions also contain all the von Willebrand factor activity of thrombin-treated bovine preparations. Longer treatment with thrombin, or treatment with stronger thrombin, appears to shift much more of the procoagulant activity to the later eluting peak. Also, when the peak of factor VIII activity, found in the void volume after thrombin treatment, was again incubated with dilute thrombin, an increase in factor VIII activity occurred. Chromatography of this incubation mixture demonstrated only a small amount of activity in the void volume, while the bulk of the activity was present in the second peak. On the other hand, thrombin treatment of factor VIII activity from peak 2 caused a rapid decline of activity instead of a further increase. It is proposed that the residual factor VIII activity found in the void volume represents unreacted factor VIII, while the late eluting peak represents thrombin-activated material that is of smaller apparent size. The late eluting peak differs from the small active factor VIII fragment obtained by Ca2+ dissociation, as the latter can be activated by thrombin. A similar set of experiments was performed using ultracentifugation of bovine factor VIII preparations on sucrose density gradients. Results of these experiments agreed completely with those obtained with get chromatography. Preparations made from human hemophilic plasma, by the procudure employed in the purification of human factor VIII, were also incubated with thrombin and chromatographed. von Willebrand factor was again found only in the void volume fractions, but there was no factor VIII activity in any fractions eluted. In other control experiments, activated and unactivated factor VIII fractions did not clot fibrinogen and contained no assayable factor IX or X. The thrombin-modified factor VIII of small size was inactivated by both a naturally occurring human inhibitor to factor VIII and the gamma globulin fraction of a rabbit antisera produced against the calcium-dissociated small active factor VIII fragment.


Studies of the human factor VIII/von Willebrand factor protein. III. Qualitative defects in von Willebrand's disease. The Factor VIII/von Willebrand factor protein was characterized in two unrelated patients with von Willebrand's disease in whom procoagulant and Factor VIII/von Willebrand factor antigen levels were normal. In both patients evidence of an abnormal protein was observed on crossed antigen-antibody electrophoresis. In one patient the Factor VIII/von Willebrand factor protein eluted from Sepharose 4B in a position and distribution identical to normal with normal levels of procoagulant activity and antigen. However, the partially purified Factor VIII/von Willebrand factor protein had markedly reduced von Willebrand factor activity in a ristocetin assay. In the second patient the peak of Factor VIII/von Willebrand factor protein, antigen, and procoagulant activity eluted from a Sepharose 4B column with an estimated molecular weight of approximately half that of normal. This protein had no von Willebrand factor activity. In both patients the reduced Factor VIII/von Willebrand factor protein subunit was indistinguishable from normal on polyacrylamide gel electrophoresis. These studies indicate that in some patients with von Willebrand's disease there is a qualitative defect of the Factor VII/von Willebrand factor protein; the total amount of protein, antigen, and procoagulant activity are normal while the von Willebrand factor activity is deficient.


Treatment goals in geropsychiatry.

Treatment goals in geropsychiatry. Each geriatric patient has observable problems which can generate treatment goals implemented by a treatment plan. Extensive record keeping would be required to document this tripartite scheme. In practice, either problem-oriented or goal-oriented records are used. Problem records tend to drift toward a goal concept, since problems are usually stated in only sufficient detail to serve as a guide to treatment. The results of a problem-oriented format are described for 143 state hospital patients whose mean age was 74 years. The most common number of problems was 5 per patient. Physical problems were the most frequent (N equals 456), followed by behavioral (N equals 203), thought-related (N equals 156), administrative (N equals 99), affective (N equals 69), and attitudinal (N equals 10). The author's experience with both systems leaves them with preference for the problem-oriented system with geriatric patients since physical problems are so numerous.


Immunocompetent cells from the lower respiratory tract of normal human lungs. Subpopulations of lymphocytes in the broncho-alveolar air spaces of normal human lungs were compared with those in peripheral blood. Bone marrow-derived (bursal-equivalent) cells (B cells) were identified by complement receptors (EAC rosettes) and by surface immunoglobulin. Thymus-derived lymphocytes (T cells) were identified by their proliferative response to mitogens and the E rosette technique. Cells in lung air spaces were recovered from eight healthy nonsmoking volunteers by segmental lavage with the flexible bronchofiberscope. On the average, macrophages constituted 78% and lymphocytes 17% of the cells in the aspirates. B cells detected by surface immunoglobulin and complement receptors equaled 22% and 15% of lung lymphocytes, respectively. The distribution of lung B cells into heavy chain immunoglobulin classes revealed IgM and IgG to be the predominant classes, with mean values of 14.5% and 9.3%, respectively; the corresponding value for IgA was 5%. A comparable order of frequency (IgM greater than IgG greater than IgA) was observed for purified peripheral blood lymphocytes in the same and other control subjects. T cells comprised the majority (47%) of identifiable lung lymphocytes by the E rosette method. The presence of lung T cells was also corroborated by their proliferative response to mitogens (phytohemagglutinin and concanavallin A), but the response was less than that of equal numbers of peripheral blood lymphocytes from the same subjects. The B/T cell ratio for lung lymphocytes was comparable to results with peripheral blood lymphocytes in the same subjects, but a higher proportion of lung lymphocytes could not be identified as either T or B cells. It is postulated that lung lymphocytes participate in the local immune defenses of the lung.


Transfer of ampicillin resistance between strains of Haemophilus influenzae type B. Haemophilus influenzae type B, strain W-2, is highly resistant to ampicillin (MIC, 12.5 mug/ml). The ampicillin resistance of strain W-2 was transferred to an antibiotic-sensitive strain TF-2 (RifR, SmR) during mixed incubation on membrane filters at 36 C(transfeer frequency, 4.6 times 10(-5) per donor). Resistance was also transferred from the primary recipient to a secondary one (TF-3, EryR, NovR). The transfer frequency between these derivative strains was 10(-4) after incubation for 30 min. Resistance in strain W-2 remained even after growth in the presence of ethidium bromide or at an elevated temperature, although ampicillin resistance was lost from 13%-25% of transcipient cells after growth in broth. Strain W-2 and transcipients of ampicillin resistance had equivalent levels of beta-lactamase activity, while sensitive segregants and recipient strains demonstrated little or no enzyme activity. Transfer of ampicillin resistance between strains of H. influenzae is probably mediated by conjugation since transfer (1) requires cell-to-cell contact, (2) remains unchanged in the presence of DNase I, and (3) occurs in the absence of demonstrable bacteriophage.


Determination of the von Willebrand's disease antigen (factor VIII-related antigen) in plasma by quantitative immunoelectrophoresis. Measurement of the von Willebrand's disease antigen (factor viii-related antigen) has become an increasingly useful tool in the differential diagnosis of those disorders of hemostasis characterized by an abnormality of factor viii procoagulant activity.  Optimal conditions for assay of the von Willebrand's disease antigen in plasma by the quantitive immunoelectrophoretic technique are described.  Potential sources ofsystematic error have been evaluated and a dilution effect has been identified.


Clinical results with metrizamide ventriculography. Seventeen ventriculograms with the non-ionic water-soluble contrast medium, metrizamide, were performed in 15 patients, with neglibible adverse effects. Visualization of the ventricular system was good in most of the patients. A combined technique, using both metrizamide and gas, increased the diagnostic value of the procedure in some cases.


Percutaneous trial of stimulation for patient selection for implantable stimulating devices. The author describes a flexible electrode which can be inserted percutaneously for a period of several days in candidates for an implantable electrical stimulating device for pain relief. This allows the patient a trial of stimulation which closely mimics that of the intended implantable system. If this trial does not give adequate pain relief in a variety of situations, the patient is not considered to be a suitable candidate for an implantable device. The trial of stimulation in no way obviates the need for careful scrutiny of the social and psychological factors accompanying chronic pain problems.


Familial variable immunodeficiency: autosomal dominant pattern of inheritance with variable expression of the defect(s). In 1963, Rosen and Bougas reported the case of a woman with recurrent infection, marked elevation of 19S, and virtual absence of 7S gamma globulin. Recently, members of her family were found to have similar abnormalities: Ten of the 37 family members tested had elevated levels of serum IgM accompanied by a combined deficiency of IgG and IgA in three, and by a deficiency of either IgG or IgA in two. In five, an increase in IgM was the sole abnormality. Two children had deficiencies of IgG and IgA with normal serum levels of IgM. Ten of the 12 affected individuals had no IgD detectable by radial immunodiffusion and six had a low percentage of IgG-bearing B lymphocytes. A lack of correlation between the immunochemical abnormalities and either the presence or severity of clinical illness was observed. The presence of immunodeficiency in three generations and in both sexes of this family suggests an autosomal dominant mode of inheritance with variable penetrance of the defect.


Teaching problem-oriented recording: a systematic approach. Medical students and practitioners usually learn how to use problem-oriented medical records (POMR) by haphazard means. In attempting to put system into the teaching of POMR, the authors devised teaching case material and two instructional formats: self-instruction and workshop. The results of a controlled study with second-year medical students to determine the relative effectiveness of instructional formats and case materials are presented. At the end of instruction POMR performance was measured by assessing the student's ability to convert a case to POMR format. The results suggest that all student groups attained an acceptable performance level no matter which format they experienced.


The nonhistone chromosomal proteins of vertebrate liver and kidney: a comparative study by gel electrophoresis. The nonhistone chromosomal proteins (NHC proteins) probably include enzymes of chromosomal metabolism, general structural proteins, and possibly control elements. In theory, these proteins may have been strongly conserved during evolution, as the histones have. We have used sodium dodecyl sulfate (SDS) disc gel electrophoresis to analyze and compare the NHC proteins of two tissues, liver and kidney, from rat, cat, cow, chicken, turtle, and frog. The gel patterns indicate that the NHC proteins have changed much more during evolution than have the histones; the total pattern of NHC proteins has not been conserved. However, there does appear to be a conservation of a subset of bands for each tissue investigated. Further chemical analysis will be required to establish the significance of the results.


Local adoptive transfer of the antitumor cellular immune response in syngeneic and allogeneic mice studied with a rapid radioisotopic footpad assay. The immunologic nature of the cellular immune response against tumor cells inoculated in the footpad of mice was studied with a rapid, quantitative, and specific assay. The results indicate: a) The antitumor cellular immune response could be transferred adoptively in syngeneic and allogeneic mice with specific immune thymus (T) lymphocytes isolated on nylon columns; b) T-independent cells of host origin were necessary for the manifestation of the antitumor footpad reaction; and c) there was a close correlation between immune responses detected by the footpad assay and those detected by transplantation techniques. The footpad reaction consisted of several nonspecific and specific components. Nonspecific factors disturbing the specific footpad reaction in syngeneic and allogeneic recipients were discussed.


Daily intravenous infusions of Corynebacterium parvum in twenty patients with disseminated cancer: a preliminary report of clinical and biologic findings. Twenty terminally ill patients with various disseminated tumors were treated with daily iv infusions of Corynebacterium parvum given alone at doses of 4 mg/day, 5 days/week, for 4-16 weeks. In 8 patients (40%), the lesions partially regressed to less than 50% of their original size. Another patient who did not improve with C. parvum therapy had a complete remission after the first course of chemotherapy. Skin tests, total leukocyte counts, and T- and B-cell counts revealed variable and unpredictable changes. Phytohemagglutinin- and concanavalin A-induced blastogenesis tended to increase. Of 10 patients, 8 had a significant decrease in serum C3 levels after completion of C. parvum therapy, possibly due to an increased C3 consumption by macrophages activated by the immunostimulant. That nonspecific immune stimulation after repeated iv infusions of an immunostimulant can by itself induce regression in disseminated disease does not agree with the current concept that immunotherapy can be effective only against minimal residual disease. The therapeutic procedure proposed here, though frequently associated with moderate short-lasting side effects, is devoid of serious toxicity.


Transplantation of human cancers to nude mice and effects of thymus grafts. Human cancers were transplanted to nude mice; a cell line originating in the foregut (distal stomach or first portion of the duodenum) produced exponential nonmetastasizing growth, preventable by prior thymus implantation. Implantation of thymuses into mice with established tumors resulted in increased animal survival and in four instances in complete regression of the neoplasm. Cell lines of pancreatic carcinoma and melanoma and surgical specimens of melanoma and of neoplasms from the pancreas and colon showed variable growth patterns in this system. Repeated attempts to transplant gastric adenocarcinoma were unsuccessful.


Synthesis of reovirus-specific polypeptides in cells pretreated with cycloheximide. When L cells are infected with reovirus in the presence of cycloheximide neither virus-specific polypeptides nor viral double-stranded RNA are synthesized. There is some synthesis of viral single-stranded RNA, transcribed mainly from segments L1, M3, S3, and S4 of the 10 viral genomic segments, and in previous work this has been termed the early mRNA pattern. In an attempt to determine whether these early transcripts are functional mRNA's, the transcripts were allowed to accumulate for a period of 17.5 h at 31 C in cycloheximide-treated cells. The cycloheximide was removed and the cells were exposed for various periods to radioactive amino acids to label any virus-specific polypeptides that might be synthesized. An immunoprecipitation technique was used to separate the viral polypeptides from cellular extracts and this precipitate was then analyzed on sodium dodecyl sulfate-polyacrylamide gels. Within 30 min of cycloheximide removal, four major polypeptides (lambda2, mu0, sigma2a, and sigma3) and two minor polypeptides (lambda1 and mu2) were found. In infected cells without cycloheximide eight viral polypeptides (lambda1, lambda2, mu0, mu2, sigma1, sigma2, sigma2a, sigma3) were found at 17.5 h after infection and the same pattern was found between 3 to 4 h after removal of cycloheximide which had been present for 17.5 h after infection. The latter result shows that the cycloheximide inhibition is reversible and that the cells readily recovered and synthesized the normal complement of viral polypeptides. In one set of experiments cordycepin was added to infected cells immediately after the removal of cycloheximide at 17.5 h to inhibit the synthesis of new viral transcripts. During the succeeding 4 h in the presence of cordycepin, the pattern of protein synthesis was the same as that obtained during the 30 min after cycloheximide removal. It is concluded that the polypeptides formed right after removal of cycloheximide are the translation products of transcripts accumulated during cycloheximide treatment and, therefore, that these transcripts are functional viral mRNA's.


Lymphocytotoxins in vasectomized men.

Lymphocytotoxins in vasectomized men. Serum samples before and after vasectomy were examined for cold and allogeneic lymphocytotoxic antibodies. The techniques used did not demonstrate a significant increase in the incidence of these antibodies following vasectomy.


Jamestown Medical Clinic System.

Jamestown Medical Clinic System. Comprehensive health care can be provided in rural and poor areas despite a decreasing number of physicians in those areas. A single physician increased his productivity by 300% to 400% by combining already available resources: specially trained and supervised nurse-practitioners, problem-oriented charting, and multiphasic screening. With emphasis on the nurse-practitioner as the main "person of contact" for the patient, the physician is able to shift from 50% to 75% of his usual tasks to these specially trained personnel. Patients have come to regard the physician as a "consultant" to the nurse-practitioner.


Selective deficiency of thymus-derived lymphocytes in experimental pyelonephritis. Pyelonephritis was induced in experimental animals derived of thymus-derived (T) lymphocytes by adult thymectomy and serial sublethal irradiation. In this model T lymphocytes were reduced to less than 1% of normal adjudged by the in vitro Phytohemagglutinin (PHA) responsiveness of lymphoid cells from deprived animals compared with control animals. Pathologic, bacteriologic and immunologic aspects of renal infection were studied in the T cell-deprived animals during the acute, resolving and chronic stages of pyelonephritis. The experiments have shown that the ablation of lymphocytes did not appreciably alter the course of the disease.


Bovine venereal vibriosis. Ultrastructure of endometrial inflammatory lesions. The inflammatory lesions in bovine venereal vibriosis have been examined by light and transmission electron microscopy in order to provide a better understanding of host defense of the uterus against bacterial invasion. Neutrophils and eosinophils were found mainly at the endometrial surface and in glandular lumina. Mononuclear cells within the endometrial tissue were identified ultrastructurally. Lymphocytes were most abundant, plasma cells were next in frequency, and mononuclear phagocytes were least often observed. An attempt was made to classify lymphocytes on the basis of presence or absence of a cytoplasmic network of filaments and other ultrastructural characteristics.


Effects of halothane and nitrous oxide anaesthesia on 5-HT turn-over in the rat brain. The effects of anaesthesia with halothane and nitrous oxide on the turn-over of 5-HT in the rat brain were analysed. The rate of 5-HT synthesis was estimated on the basis of 5-HTP accumulation following 5-HTP decarboxylase inhibition. Inhalation anaesthetics reduced the rate of 5-HT synthesis in the whole brain, this effect being particularly marked in the forebrain. In addition, the reduction of the rate of 5-HT synthesis was still detected after a large tryptophan loading indicating that halothane and nitrous oxide anaesthesia reduced the activity of tryptophan hydroxylase in vivo. The utilization of 5-HT was also delayed during anaesthesia since the rate of 5-HT disappearance following the inhibition of its synthesis at the decarboxylation step was decreased in the whole brain. In spite of this reduced turnover of 5-HT in the brain of rats exposed to inhalation anaesthetics, the 5-HIAA levels were permanently elevated. This was the result of a partial inhibition of the active elimination of the acidic metabolite from the brain during this kind of anaesthesia.


Quantal release parameters during fade of endplate potentials. An analog of hemicholinium-3 caused the fade of endplate potentials during repetitive stimulation at low rates. The quantal parameters of release were estimated during steady-state conditions before and in the presence of the drug. The fade of EPP's was associated with a decrease in quantal content (m). The decrease in m was, in turn, associated with a decrease in the binomial parameter n and an increase in the binomial parameter p. The changes in n and p are discussed in relation to available stores of transmitter and the probability of transmitter release.


Is there any transtubular reabsorption of filtered proteins in rat kidney? The bovine protease inhibitor aprotinin (Trasylol) has a high affinity to the kidney and is preferentially pinocytized in the proximal tubule. After i.v. injection of 1mug 124 I aprotinin the blood content decreases to 2.8% of the primary injected amount within 3 hrs, while simultaneously each kidney contains 29%. This substance was used to test whether or not a peptide which is pinocytized, is released in the intact form into the peritubular blood. By a cross circulation technique with two unilaterally nephrectomized rats we were unable to detect any transport of pinocytized, intact peptide through the proximal tubule cell over the observed cross circulation period of 1-8 hrs even when using 5000 times the above dosage. Since the total amount of aprotinin in the kidney is immunologically reactive (ca. 97%), and 65% of the radioactivity in the blood is not reactive after 6 hrs, we believe that the last step in the absorption process consists in digestion inside the lysosomes and instantaneous release of the split products into the blood.


Aspects of the biochemical pharmacology of cytembena. Cytembena, at low concentrations, caused an inhibition of the in vitro growth of L1210 mouse leukaemia cells which could not be reversed by reduced folates, purines, amino acids or deoxyribonucleosides. Invitro experiments with a number of enzymes of folate metabolism produced no evidence that this drug acts as an anti-folate in mammalian tumor colls. However, Cytembena, in therapeutic doses, caused a rapid and extensive inhibition of DNA biosynthesis. There was no inhibition of RNA biosynthesis, but at high doses some inhibition of protein biosynthesis was observed. Deoxyribonucleoside triphosphates accumulated in the presence of Cytembena, suggesting that the inhibition of DNA biosynthesis was at the polymerization stage. However, in vitro experiments failed to demonstrate any direct interaction of Cytmebena with either DNA or DNA polymerase.


The use of transfer factor in a patient with agammaglobulinemia. We have studied a 9-year-old boy with agammaglobulinemia treated for the past 6 years with exogenous gamma-globulin who was noted to have an immunoglobulin (Ig)M level of 35 mg/100 ml and circulating B cells as determined by immunofluorescence. Of the circulating lymphocytes, 41% had alpha-immunoglobulin heavy chains, 3% gamma chains, and 3% mu chains. Synthesis of gamma heavy chain classes showing wide heterogeneity and alpha and mu chains of restricted mobility was demonstrated by radioimmunoelectrophoresis. Because of the patient's poor clinical response to exogenous gamma-globulin administration and the paradoxic presence of circulating B cells, with the capacity to synthesize immunoglobulins in vitro, we elected to begin a course of therapy with transfer factor. After the initial four doses of transfer factor (2 x 10(8) lymphocytes/dose) his serum IgG rose from 50 to 130 mg/100 ml, the same level which he had previously attained during continuous exogenous gamma-globulin therapy. His serum IgG has remained at this level for the past 12 months with trimonthly booster doses of transfer factor. The patient has not required any additional gamma-globulin therapy and he has remained clinically asymptomatic. Our studies in a patient with agammaglobulinemia have shown that transfer factor therapy may affect immunoglobulin synthesis. The concurrent discontinuation of exogenous gamma-globulin administration makes it difficult to attribute the changes to only one or another aspect of therapy. We await further reports of the effects of transfer factor in the therapy of patients with B cell disorders.


The sodium pertechnetate Tc 99m scan: an aid in the evaluation of gastrointestinal bleeding. Twenty pediatric patients presenting primarily with unexplained gastrointestinal bleeding were evaluated with sodium pertechnetate Tc 99m imaging. Three patients had normal barium enemas and scans consistent with Meckel's diverticulum. These three patients and three additional patients with normal scans underwent surgical exploration. Meckel's diverticula containing gastric mucosa were found in all three patients with positive scans. No diverticula were found in the three patients with normal scans. Four other patients had scans that were considered abnormal but not felt to represent Meckel's diverticula. In one of these patients a radiographic gastrointestinent, a nonspecific terminal ilial ulcer without gastric mucosa was found at surgery. The two other patients had normal radiographic gastrointestinal studies and no further evaluation was carried out. The etiology of gastrointestinal bleeding in pediatric patients is frequently unexplained even after thorough evaluation including celiotomy. The sodium pertechnetate Tc 99m scan is a safe, simple, non-invasive procedure that can demonstrate Meckel's diverticula with greater certainty than the barium enema and can suggest suspicious areas that can then be evaluated by more definitive procedures.


The relationship between head circumference and the development of communicating hydrocephalus in infants following intraventricular hemmorrhage. Rapidly enlarging head circumference is a standard clinical sign of progressive hydrocephalus in an infant. Six neonates 29 to 36 weeks gestational age, with intraventricular hemorrhage, confirmed by ventricular tap, had head circumferences measured at intervals from birth. The sudden appearance of rapidly expanding head size, not associated with changing clinical status, occurred 9 to 20 days after the estimated time of hemorrhage in all of the infants. Air ventriculography within three days of abnormal acceleration of head circumference growth demonstrated moderately to severely dilated ventricles. The ventricles were probably enlarging slowing from the time of hemorrhage because there was no associated clinical deterioration in the infants coincident with the rapid increase in head circumference. After intraventricular hemorrhage, enlarging head circumference appears to be an insensitive sign of hydrocephalus in premature infants.


Effects of waterbed flotation on premature infants: A pilot study. Two types of waterbeds were developed to impart compensatory vestibular-proprioceptive stimulation to premature infants. Twenty-one infants ranging in gestational age from 27 to 34 weeks and birthweights from 1,050 to 1,920 gm were included in this pilot study. Assignment to experimental and control groups was made by random design. The experimental group consisted of ten infants who were placed on a gently oscillating waterbed before the sixth postnatal day, where they remained for seven days. Their clinical progress was compared with that of a control group of 11 similar babies. Waterbed flotation was found to be a safe procedure; there was no significant effects on the infants' vital signs, weight, or frequency of emesis. Highly significant differences were found in the incidence of apnea between the two groups, with infants on the oscillating waterbed having significantly fewer apneic spells. Infants placed on the waterbed during the first four postnatal days benefited more than those placed later. A non-oscillating waterbed was found clinically useful for very small prematures with severe skin problems, for infants recovering from abdominal surgery, and for infants receiving parenteral nutrition.


Influence of receptor-receptor fibres on the spontaneous afferent activity from semicircular canals in the frog (Rana esculenta). The influence of the efferent vestibular system having been eliminated, the spontaneous activity of afferent fibres of the ampullary nerves of the horizontal and vertical anterior semicircular canals was recorded in the frog. By stimulating the ampullary nerve of one of these two canals while recording on the other, as well as by sectioning branches of the vestibular nerve and then using statistical methods, it is shown that receptor-receptor fibres have an inhibitory action on afferent activity from the horizontal and vertical anterior semicircular canals.


Production of antibodies of identical idiotype but diverse immunoglobulin classes by cells derived from a single stimulated B cell. The availability of anti-phosphocholine antibody of the TEPC 15 idiotype from the clonal progeny of a single precursor cell, stimulated in vitro, permitted the demonstration of monoclonal antibodies with as many as three immunoglobulin classes with identical variable regions. This demonstration was dependent on sensitive radioimmunoassays which showed a one to one relationship between the total anti-phosphocholine antibody produced by a clone and the sum of anti-phosphocholine antibody of the different classes as well as the amount of antibody of the TEPC 15 idiotype. The class distribution was confirmed by isoelectric focusing identification of IgM, Igta, and IgGl antibodies of the TEPC 15 idiotype produced by single clones which showed characteristic pI values for each immunoglobulin class. Thus, within the generative phase of a single antibody-producing cell clone, various heavy chain constant regions can be linked to the same variable region, and single precursor cells have the capacity to generate progeny expressing at least three distinct immunoglobulin classes.


Aspects of the psychology and epidemiology of rheumatoid disease. In a prospective study of rheumatoid disease (RD) clinical, serological, radiological, and biochemical factors were assessed on 102 patients and scores obtained on the Middlesex Hospital Questionnaire (MHQ). Patients with early RD had MHQ scores closely resembling those in the normal population. Using a new clinical prognostic index, patients who develop severe RD tended to have low scores at initial testing on the MHQ. Patients whose serum was positive for rheumatoid factor also tended to have low scores on the MHQ. Together these findings suggest a possible subclassification of RD into a less severe form in which psychosocial factors may be important, and a more severe form in which heredity or some other constitutional factor (or factors) may be important, rheumatoid factor acting as a 'marker'.


Dietary tryptophan and the selection of ethyl alcohol in different strains of rats. Rats of three different strains were tested systematically for their selection of water or ethanol offered in a two-choice situation. In order that preference-aversion curves could be derived, the concentrations of ethanol were increased in strength from 3 to 30% over an 11 or 12 day test sequence. L-tryptophan was added to the rat's diet in 1% or 3% mixtures for a predetermined interval beginning before or during a test for ethanol preference. Given to female hooded rats of the Royal Victoria strain, excess tryptophan elevated the ethanol preference threshold and significantly increased ethanol intake according to the dose administered. However, in male hooded rats of the Long-Evans strain, tryptophan augmented only slightly the selection of ethanol. Male Sprague-Dawley rats, an albino strain, were unaffected by the addition of this essential amino acid to their diet. Although tryptophan may exert its effect on ethanol intake through an alteration in the metabolism of cerebral serotonin, such an effect seems to be dependent upon the strain of rat tested.


Screening hallucinogenic drugs: systematic study of three behavioral tests. The effects of several hallucinogenic and non-hallucinogenic drugs have been studied on three behavioral tests proposed as useful indexes of hallucinogenic activity: "head-twitching" in mice, defecation in an open-field, and suppression of responding on a differential reinforcement of low rates (DRL) schedule of reinforcement. According to the original propositions, after administration of hallucinogenic agents the frequency of head-twitches would increase in mice, the defecation of rats in an open field would decrease without consistent change in ambulation, rearing and grooming, and the responding of rats on a DRL schedule would yield a typical cumulative record pattern. It was found that the head-twitch test was sensitive to mescaline and LSD-25, but not to delta9-THC or to myristicin and elemicin. Besides, the data on interobserver agreement suggested there is a high degree of subjectivity involved in assessing this response. In the open-field test, non-hallucinogenic drugs such as chlorpromazine and apomorphine fell into the hallucinogenic pattern proposed. In addition, the post-injection interval selected seemed to critically affect defecation scores. The DRL "hallucinogenic" pattern occurred nonspecifically after administration of hallucinogenic and non-hallucinogenic drugs. It was concluded that the three tests have limited value for screening purposes.


Combined radiosensitizer infusion and irradiation of osteogenic sarcomas. Three children with osteogenic sarcomas which were either unresectable or whose parents refused permission to amputate were treated with combined intra-arterial 5'bromodeoxyuridine (BUdR) infusion and high-dose-per-fraction megavoltage irradiation to the primary site. Pulsed, 48-hour BUdR infusions were performed prior to each 600-rad radiation therapy fraction, with a total radiation dose to the primary site of 4,200-4,800 rads in five weeks. Local control was obtained in all 3 children. One child is alive two years after treatment, another died with metastatic disease and the third patient who received radiotherapy to the lungs for pulmonary metastases is without evidence of disease one year later.


Neuroradiology of basal anterior fossa (transethmoidal) encephaloceles. Encephaloceles of the basal anterior fossa, though primarily congenital in origin, may be insidious in presentation and remain undetected until adulthood. Conventional plain films and hypocycloidal tomograms show a basal osseous defect with its margins bevelled toward the nasopharynx. Magnification angiography is the diagnostic study of choice and reveals herniation of the anterior inferior frontal artery through the osseous defect. Pneumoencephalography, the classical technique of investigation, was found to be unrewarding in demonstrating the herniated sac or in determining the presence or absence of brain tissue within the sac; however, it is of value in demonstrating a ventricular communication with the encephalocele and evaluating ventricular dilatation.


Accuracy of brain scanning in pediatric craniocerebral neoplasms. A total of 2,563 children were studied by cerebral radionclide angiography, immediate postinjection blood-pool imaging, and delayed 2- to 4-hr. brain scanning. Of 110 new neoplasms of the brain or skull examined, 90% were detected by these means. The scan did not appear to be as accurate in craniopharyngiomas (6/10) and brainstem tumors (5/6). Thirty-nine recurrent tumors not studied previously all produced positive brain scans. Meticulous positioning of the pediatric patient is necessary at all times for accurate results.


The diagnosis and management of accidental haemorrhage with associated coagulopathy. An approach to the diagnosis and management of accidental haemorrhage with associated coagulation failure is discussed and outlined. It is stressed that special investigations play a minor role in planning management. The main aim should be to achieve rapid delivery, preferably via the vaginal route. About 50% of these cases are associated with uterine atony and inertia. This is probably due to raised local and circulating levels of fibrin/fibrinogen degradation products (FDP). In such cases uterine activity can be restored by the administration of large intravenous doses of Trasylol (Bayer). Life-endangering complications such as acute respiratory and renal failure should be prevented by prophylactic management and by treatment aimed at rapid delivery. The indications for Caesarean section are outlined. The need for careful assessment prior to discharge of these patients and for re-assessment throughout the puerperium is stressed.


[Plastic enlargement of the left ventricular outflow tract. A new operative method (author's  transl)]. A new operative technic for widening the stenotic left ventricular outflow ("left ventricular tunnel") is described and a clinical case is reported. A vertical incision along the anterior aspect of the aorta descends with a slight angle across the outflow tract of the right ventricle. After aortic valvectomy the ventricular septum is cut between the left and right coronary commissure through its full thickness and the incision extended inferiorly across the stenotic area. A dacron patch is sewn into the gap of the septum and aortotomy in order to widen the area of previous stenosis and prosthetic replacement of the aortic valve is performed. Finally another dacron patch is used to close the defect in the right ventricular outflow tract.


[Interruption of the aortic arch with tetralogy of Fallot. Report of a successful one-stage correction of both anomalies, and review of the literature (author's transl)]. In a ten year old girl, a combination of interruption of the aortic arch (IAA) and tetralogy of Fallot was corrected simultaneously using cardiopulmonary bypass. The interruption was bypassed by implantation of the proximal end of the left subclavian artery into the ascending aorta. The simultaneous correction of both malformations was possible by a left anterolateral transsternal thoracotomy. The success of this operation was confirmed by cardiac cathetherization and angiography. As far as we know this the first report of a successful simultaneous correction of this unusual combination of cardiac malformations.


[Surgical treatment of acute dissection of the ascending aorta (author's transl)]. Since 1959, 51 patients underwent open heart surgery for correction of acute dissection of the ascending aorta. Upon admission 33 patients were severely hypotensive or in porgressive heart failure. Acute aortic insufficiency was found in 24 patients, and hemiplegia or hemiparesis in 4. In 45 patients the ascending aorta was reconstructed with a woven graft. After excision of the dissected part of the aorta primary anastomosis or patch aortoplasty was performed in 6 patients. The aortic valve remained intact in 26 cases, and resuspension of the commissures restored competence of the aortic valve in another 9 patients. Sixteen patients required aortic valve replacement because of disrupture of the commissures. Dissection extended into the coronary ostia in 5 cases. Reconstruction of the coronary system was accomplished by reimplantation of the ostia, interposition of a vein graft or aorto-coronary bypass. Nine patients died within the early postoperative course from uncontrollable hemorrhage (4), further dissection (3) and myocardial infarction (2). Within the first year after surgery another 5 patients died from acute aortic dissection (2), pseudomonas-infection causing rupture of the proximal graft anastomosis (1), and myocardial infarction (2). The contraindications of antihypertensive treatment of actue dissection of the ascending aorta are discussed. We recommend prompt surgical intervention in acute dissecting aneurysm of the ascending aorta.


[Surgery of emphysematous bullae and pulmonary cysts (author's transl)]. Following a survey of operations performed at the Ruhrland clinic, particular reference is made to the surgical treatment of emphysematous bullae and pulmonary cysts. In these cases, the frequent occurrence of a pneumothorax must here be mentioned. These large bullae are however frequently and incorrectly diagnosed as a pneumothorax. The treatment of these emphysematous bullae, which often occur on both sides of the thorax, is by means of a bilateral axillary thoracotomy. This operation can be carried out in one session, provided a distinct improvement of the pulmonal functions is expected.


[Surgical therapy of bronchiectasy and its results (author's transl)]. 69 patients suffering from bronchiectasies underwent surgery at the II. Surgical Clinic of the University of Vienna from 1958 to 1972. Analysis of results revealed three groups: 1. 67% of the patients cured completely, 2. 23% significantly improved, 3. 10% no improvement. The evaluation of spirometric measurements of not improved patients showed extensive preoperative obstructive ventilation disturbance.


[Tracheal-stenosis in neonates, infants and small children (author's transl)]. By modern technics of investigation and treatment cases of stenosis of the trachea even in neonates and infants are found. These are to be treated with all modern possibilities including resection for tumors. New types of tracheal-stenosis are detected.


[Diagnosis and therapy of pulmonary sequestration (author's transl)]. Pulmonary sequestration is a rare malformation which is characterised by lacking connection to the bronchial system and by atypical arterial blood supply. Unidentifiable tumorous, cystic or infiltrative lung diseases, especially of the lower lobes, should always lead to aortography to exclude pulmonary sequestration.


[Operative treatment of intralobar pulmonary sequestration (author's transl)]. Among 2700 thoracotomies at the Ruhrlandklinik Essen we have operated eight cases of intralobar pulmonary sequestration. The malformation was found to be situated four times in the left lower lobe, three times in the right lower lobe, and one time in the middle lobe. The only way of curing the suffering consists of surgical interference. At six of eight cases we had to performe a lobectomy, two patients with obviously demarcated alterations have been treated by an exstirpation.


[Surgical treatment of hyperplastic inborn failures of the lung (author's transl)]. A very rare hyperplastic inborn failure regarding construction of the lung is the accessory lung. It will be reported of an accessory lung in the left mediastinum (without connection to the bronchial system) and of a trachea-accessory lung (with connection to the bronchial system). Both cases had caused symptoms which required a surgical elimination of the accessory tissue. In the first case the left lung had been displaced due to the production of secretion - formation cyst. In the second case the unsufficient secretion flow off had caused repeated pneumonia and formation of bronchiectasis.


[Pulmonary varices (author's transl)].

[Pulmonary varices (author's transl)]. In world literature up to now 41 cases of pulmonary varices have been described. Two own cases showed particulars in so far as one patient had an internal fistula between a varix in the base of the upper lobe of the lung and another varix in the apex of the lower lobe. Besides a varix the second patient had an AV-fistula in the right middle lobe. Already pre-operatively either case was diagnosed as vascular anomaly by angiography. By injecting the contrast medium into the vessels of the resection specimen a clear representation of the varices could be obtained.


[Diangosis and treatment of pulmonary arteriovenous fistula in infancy (author's transl)]. Pulmonary arteriovenous fistulas are seldom diagnosed in infancy because of few signs and symptoms in early life. The clinical picture is due to the right-to-left shunt and includes dyspnea, cyanosis, polycythemia, clubbing, and murmur over the fistula. The diagnosis can be suspected by demonstration of a typical density on chest X-ray. It can be established by angiocardiography. Because of the life-threatening complications resectional treatment is recommended already in infancy. A case is reported, diagnosed on the second day of life by angiocardiography and treated 3 months later by lobectomy.


[Solitary pulmonary arteriovenous fistula in infancy and childhood (author's transl)]. Pulmonary arteriovenous fistula is not a rare congenital malformation, but obviously most often it is a very late diagnosis. Moreover the disease is associated with a high risk of serious complications, namely cerebrovascular accidents. Two patients, an one month old infant and an 8 years old boy with typical symptoms and signs are presented. Both of them were operated upon successfully. It is concluded, that the diagnosis of solitary pulmonary arteriovenous fistula should lead to immediate operation, which is technically easy and of low risk only, even in infancy. Conservative surgery is recommended without sacrifice of healthy lung tissue, i.e. local excision or segmental resection in subpleural lesions and lobectomy for deep-seated fistulas.


[The congenital lobar emphysema--a case of emergency for the thoracical surgery during the early infancy (author's transl)]. The congenital lobar emphysema is a not very often found malformation. It causes during the first respirations a excessive, almost unilateral, segmental or lobar expansion. This ensues quickly a unilateral, intrathoracic high pressure with atelectasis, displacement of the mediastinum to the otherside and following extensive respiratory and circulatory derangements. The fully developed syndrom may lead to death very quickly. If diagnosis is assured, therapy of choice is to resect the involved parts of the lung.


[Lobar emphysema: differential diagnosis and treatment (author's transl)]. Lobar emphysema with acute severe respiratory distress is predominately seen in early infancy while the few cases after one year of age usually show signs of recurrent respiratory infection. Several conditions causing increased transparency on one side of the chest x-ray must be be differentiated. In case of emergency the simple chest x-ray must be sufficient for diagnosis. In this situation even the performance of a diagnostic thoracotomy can become necessary. The removal of the affected lobe is the treatment of choice. 6 cases of lobar emphysema are reported.


[Differentiated surgical therapy in congenital lobar emphysema (author's transl)]. Congenital lobar emphysema (CLE) is a clinical and radiological entity with a multiplicity of etiological factors. Six patients are presented with CLE of the left upper lobe. In three of them CLE was associated with cardiovascular malformation i.e. persisting ductus arteriosus and in one case additionally with double aortic arch. These infants were treated by division of the compressing vascular structure without lobectomy. Only one required secondary resection. Left sided CLE presumably caused by vascular compression should be considered a special group in which surgical correction without lung resection is justified.


Congenital lobar emphysema.

Congenital lobar emphysema. 43 patients with congenital lobar emphysema were treated surgically at the Thoracic Unit, Hospital for Sick Children, Great Ormond Street, London, between 1954 and 1974. Nearly half of the infants had additional congenital anomalies. 7 children died after operation.


[The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy (author's transl)]. The management of bronchopleural fistula after lung resection is discussed. The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy is described. In 4 cases of 2000 lung resections occurred a bronchopleural fistula after right pneumonectomy. In all cases the fistula was closed definitive. In one case developed a fistula between the pleural space and the oesophagus after operation.


[Transbronchial brush biopsy under TV-fluoroscopy control (author's transl)]. Transbronchial brush biopsy is indicated when routine methods fail to establish the diagnosis of a pulmonary lesion. More than 50 biopsies have been performed without complications. The diagnostic accuracy of about 50% positive reports will definitively improve with the better selection of cases and with greater experience with this technique.


[Histological and histochemical evaluation of the cellular infiltration of s.c. implanted sparks prothesis. Experiments on rats (authors transl)]. Sparks-prothesis of 3 mm diameter were implanted into inbred rats and withdrawn after one to ten weeks. They were then fixed in Formalin and embedded in Paraffin and Metachrylat. After cutting (2.5 mu), the histological and histochemical parameters were examined. Cellular infiltration was studied after a certain period of time. The basic results of the genesis of that infiltration are given as follows: during the first two weeks following the s.c. implantation, derivates of monocytes (cells which play an imminent and important role during arterial replacement) were found. After the third and fourth week collagenous and elastic fibers could be seen, the connective tissue became stronger. The most favorable time for grafting can be evaluated by these experiments.


[Radiographic in vivo visualization of parts of the ventricular conduction system of the heart (author's transl)]. The in vivo tolerability of an in vitro in cow, calf and sheep hearts developed method for radiographic visualization of parts of the ventricular conduction system is tested in animal experiments.


[Instantaneous blood flow velocity profiles before and after aortic valve replacement (author's transl)]. In 17 patients the instantaneous velocity profile was recorded before and after aortic valve replacement (Starr-Edwards, Björk-Shiley, Lillehei-Kaster). A single gated pulsed Doppler Ultrasonic flownmeter was used for analysis. Distal of these valves a flat flow profile was recorded showing high velocity gradients near the walls. As a main cause of this, numerous eddies and turbulent flow have been suggested. Downstream of a Starr valve a flat profile appears with a slowing down of forward flow just behind the ball. The disk valves Lillehei-Kaster and Björk-Shiley demonstrated a higher flow velocity in direction to the larger opening. The "in vivo" studies have been supported by "in vitro" measurements. The highest flow velocities were above 100 cm/sec and thus, according to Reynolds definition, in the turbulent range. The turbulent flow produces a washing effect, which is emphasized during the cardiac cycle. The importance of these data can be discussed by clinical results only.


[Ultrasound transit-time method for evaluation of regional myocardial function (author's transl)]. The validity of an ultrasound transit-time method for defining local function was evaluated under experimental conditions in the anaesthetized open chest dog. Miniaturized piezoelectric crystals (1,5-2 mm phi) functioning as emitters and receivers were inserted into different depths of the myocardium to study the contraction patterns of defined muscle segments in different muscle layers and the dynamic changes of left ventricular wall thickness during the heart cycle. Changes in myocardial function were induced by coronary stenosis or occlusion and by the application of drugs. This method was shown to be a sensible and reliable tool for the evaluation of local myocardial function.


[The effects of left ventricular distention on coronary blood flow and myocardial metabolism during cardiopulmonary bypass (author's transl)]. These studies show that distention of the fibrillating left ventricle during cardiopulmonary bypass impedes subendocardial flow and causes myocardial ischemia. While myocardial oxygen requirements increase when the heart becomes distended (La Place relationship) the elevated intracavitary pressure acts as a counterforce to subendocardial flow and prevents it from increasing sufficiently to meet these increased metabolic demands. The resultant ischemia is accentuated when the fibrillation is maintained electrically, since the fibrillating stimulus itself impedes subendocardial flow and causes ischemia.


[Regional myocardial blood flow and left ventricular function in critical coronary stenosis and after coronary artery bypass grafting in the dog (author's transl)]. In 7 mongrel dogs myocardial ischemia is produced by means of an ameroid constrictor placed on the left circumflex coronary artery (CCA). Myocardial blood flow (MBF) is diminished by 56% in an area of 25% of the anterior wall of the left ventricle. A decrease in dp/dtmax suggests a small depression of left ventricular function. After bypass operation the slight changes in EDP, dp/dtmax and Vmax indicate no significant improvement of total ventricular function. MBF increases from 42 +/- 10 ml/100 g/min to 67 +/- 21 ml/100 g/min (p smaller than 0.02) in the area supplied by the bypass. In this region intramyocardial pressure rises significantly suggesting improvement of regional myocardial function.


[Coronary circulation and myocardial oxygen cosumption after cardioplegic arrest (author's transl)]. Coronary blood flow, myocardial oxygen consumption, and cardiac hemodynamics was measured before and after cardiopulmonary bypass in two group of patients (7 and 4) with minor congenital heart disease where cardiac arrest was induced by means of "cardioplegin" or "external surface cooling" (Shumway). Only myocardial oxygen consumption was reduced 20% after bypass in the "cardioplegin" group; all other measured parameters remained essentially constant.


[Metabolism and ultrastructure of magnesium aspartate-procaine arrested hearts of rabbit and man (author's transl)]. In normothermia, mild, and deep hypothermia the metabolism and the electron microscopic structure were investigated in human and rabbit heart muscle after magnesium aspartate-procaine cardioplegia. In comparison to plain ischaemic arrest splitting of adenine nucleotides and glycogen was significantly reduced in all experiments with the induced cardioplegic arrest. For 40 min at 32 degrees C almost no changes in ultrastructure were seen in heart muscle after induced arrest, while severe and/or irreversible damages were seen in the cell structure of the heart muscle due to plain ischaemic arrest.


[The effect of ischemic and cardioplegic heart standstill on the myocard metabolism in normal and less perfused heart (author's transl)]. The tolerance of ischemia in normal and less perfused myocard during an ischemic and cardioplegic heart standstill was investigated. A decrease of ATP and ADP and an increase of the lactate, pyruvate and AMP was established during an ischemia of 20 minutes. The less perfused hearts gave considerably worse results regarding the energy transformation than normal hearts. In less perfused hearts the energy reserve of myocardial metabolism showed a considerably better behaviour during a cardioplegic heart standstill of 45 minutes than an ischemic one of 20 minutes. During the recuperation period this trend was emphasised.


Complement-activating properties of some rat alloantibodies. The complement-activating property of immune sera, and of separated 19S and 7S antibody fractions, was examined with a number of rat histocompatibility antigen-alloantibody systems. It was confirmed that xenogeneic sera are very efficient sources of complement in the in vitro immune cytolysis of rat lymphocytes and erythrocytes by the alloantibodies of 19S and 7S classes. However, with allogeneic complement only 7S alloantibodies were able to lyse rat lymphocytes, and none of several alloimmune sera, nor any fractions derived from them, lysed allogeneic erythrocytes. The evidence suggests that the popular notion that IgM antibodies, as a class, are more efficient than IgG molecules in complement-mediated cell lysis may need qualification as to the source of complement and the type of target cell used in a given-experimental system.


Functional characterization of membrane components of cytotoxic peritoneal exudate T lymphocytes. II. Trypsin sensitivity of the killer cell receptor. Studies were carried out to investigate the nature of the lymphocyte membrane receptor involved in the specific lysis of [51Cr]EL4 target cells by BALB/c cytotoxic peritoneal exudate lymphocytes (PEL) in vitro. In confirmation of earlier related studies, the cytolytic reaction is markedly inhibited by trypsin treatment (1 mg of trypsin/10(6) PEL/ml; 37 C for 30 min) of the PEL. Trypsinized PEL recover their cytolytic activity after 6 hr of incubation in trypsin-free medium at 37 C; recovery is suppressed at 4 C. Significantly, trypsinization of PEL inhibits their ability to adsorb to EL4 target monolayers, indicating that lymphocyte-target cell binding is a trypsinsensitive step of the cytolytic interaction. Specificity of binding for EL4 is restored upon recovery from trypsin treatment. In addition, trypsin treatment, under conditions sufficient to inhibit cytolysis, causes a drastic nonspecific deletion of iodinatable membrane species from the surface of PEL. Thus, a direct correlation between altered cytolytic function and membrane structure cannot be made. Interestingly, trypsinized PEL retain the capacity to kill EL4 to which they are agglutinated by concanavalin-A, suggesting that the lytic mechanism, as distinguished from the binding receptor, is still intact. Papain and pronase also have an inhibitory effect on cytolysis, while neuraminidase causes a significant augmentation of lymphocyte-mediated cytolysis.


Porcine intestinal adenomatosis: a possible relationship with necrotic enteritis, regional ileitis and proliferative haemorrhagic enteropathy. Necrotic enteritis and regional ileitis are recognised causes of sporadic death in pigs. In both conditions, the intestinal mucosa harbours the bacterium, Campylobacter sputorum subsp mucosalis, which was first associated with procine intestinal adenomatosis.


Serum trypsin inhibitory capacity and pi phenotypes. II. Prevalence of alpha1-antitrypsin deficiency in an allergy population. A series of 138 patients seen consecutively in an adult allergy clinic were studied to determine serum alpha1-antitrypsin (alpha1-AT) levels and protease inhibitor (Pi) phenotypes. These were compared with a control group of 700 healthy young adult blood donors. Both total serum trypsin inhibitory capacity (STIC) and alpha1-AT levels as determined by immunoelectrophoresis (IEP) were measured. Phenotypes were determined by antigen-antibody-crossed IEP. Alpha1-AT levels in the allergy group were not significantly different from control values. STIC in the allergy group was 1.34 +/- 0.28 mg. trypsin inhibited per ml. serum and in the controls, 1.32 +/- 0.28 mg. IEP values were 205 +/- vs. 200 +/- 36 mg. per dl. Similarly, no increase in Pi phenotypes known to be related to any disease state was observed. Since Pi phenotypes other than the most common MM are rare in Negro populations, phenotype data were corrected to include only Caucasian subjects. In the allergy group adjusted for racial composition we found 2.86% MZ, 5.72% MS; no SZ, SS or ZZ was detected. A comparable control  group contained 3.68% MZ, 6.23% MS, 0.71% SZ-SS, but no ZZ Pi phenotype.


Parenteral aspirin produces and enhances gastric mucosal lesions and bleeding in rats. The effect of parenteral sodium acetylsalicylate (Na ASA) on the development of gastric mucosal lesions and bleeding was studied in control rats and in rats subjected to cold-restraint stress. Although both doses of Na ASA studied, 15 and 60 mg/kg intraperitoneally, alone resulted in lesion formation, only with the larger dose did this reach the level of statistical significance. However both doses of Na ASA alone significantly increased blood loss as measured by a decrease in hematocrit value. The administration of Na ASA 15 MG/kg intraperitoneally to animals subjected to cold-restraint significantly increased blood loss, but not lesion formation, while the larger dose of Na ASA significantly increased both parameters. Thus parenteral aspirin not only can cause gastric mucosal damage and bleeding, but it can enhance lesion formation and blood loss produced by cold-restraint. Two mechanisms may be involved: a smaller dose of Na ASA significantly affecting hemostasis but a larger dose being required for gastric mucosal damage.


Morphology of chronic lymphocytic leukemia and its relationship to survival. The morphology of lymphocytes in blood and bone marrow from patients with chronic lymphocytic leukemia was studied; blood lymphocyte morphology was related to survival. Three primary morphologic groups emerged. Group 1 was characterized by small to medium-sized lymphocytes with narrow rims of cytoplasm and coarsely clumped nuclear chromatin. In group II the predominant lymphocytes were large with abundant cytoplasm. Group III was characterized by a heterogeneous population of lymphocytes with characteristics of both groups I and II. Clinical features of the patients were studied, and B and T typing of the lymphocytes was done. The median survival in group I was 26+ months; in group II 46+ months; and in group III 50+ months. Our data are at variance with previous reports and suggest that survival in patients with large lymphocytes is longer than in those with small lymphocytes.


New diagnostic pseudoisochromatic plates for dichromats based on subtractive color matches. Further subtractive color matches obtained with the Lovibond Tintometer have confirmed the convergence data for dichromats obtained in a previous study. The characteristic color confusions obtained for 15 protanopes and 15 deuteranopes have been used in the selection of pairs of inks for use in the production of new screen-printed pseudoisochromatic plates incorporating geometric symbols and minimum form parameters. The success of these diagnostic plates is found to depend both on the careful selection of the inks to lie upon appropriate pseudoisochromatic lines but also on the reflected luminance contrast between the symbol and the background matrix of dots.


Alteratons in RNA synthesis in lymphotoxin-treated target cells. Lymphotoxin, a cellular mediator produced in vitro by antigen- or mitogen-stimulated lymphocytes, is capable of lysing various types of cells. We have shown that highly purified lymphotoxin preparations both mediate cytolysis and stimulate RNA synthesis in target cells. When RNA extracts from lymphotoxin-treated cells were examined by means of sucrose density gradient centrifugation, we observed a general increase in RNA synthesis, accentuated in species larger than 28S. Analysis on oligo(dT)-cellulose columns revealed a relatively larger increase in adenine-rich m-RNA. In concordance with this finding, we observed a moderate increase in RNA polymerase I (nucleolar) activity and a striking increase in RNA polymerase II (nucleoplasmic) activity in isolated nuclei of lymphotoxin-treated target cells.


Optically induced eye torsion. II. Optostatic and optokinetic cycloversion. Using a synoptophore and an objective photographic method, it was demonstrated that the eyes undergo a tonic cycloversion under the influence of a pattern with slanting stripes. A slight tilt with respect to the vertical had a greater effect than a tilt with respect to the horizontal. The maximum amplitude was of the order of 1 degree. This optostatic eye torsion is considered to be the optomotor analogue of the "ophthalmostatic" otolithic reflex. Optokinetic torsion was also investigated. To this end, rotating discs that were divided into sectors were presented in a synoptophore. The maximum amplitude observed in the 4 subjects was 6 degrees. Optokinetic torsion may be viewed as the optical superstructure above the semicircular canal reflex. Non-fusional cyclovergence, for which purpose counter-inclined or counter rotating contours were presented to both eyes, could not be demonstrated with certainty.


The influence of topically applied bethanidine on intraocular pressure and pupil in the rabbit. Bethanidine sulphate was administered topically to the eyes of conscious rabbits using a 0.5%, 1%, 2% and 5% solution of the drug. The intraocular pressures and pupil sizes were measured in the right treated and left control eyes at 0,1,2,3, 6 and 24 hrs. With all concentrations a pressure decrease with a maximum between 3 and 6 hrs after topical treatment occured. The 5% solution of bethanidine sulphate showed a delayed effect which was submaximal when compared to the 2% bethanidine solution. Using the 1% and 2% solution a ppressure decrease probably due to systemic action of the drug happened in the untreated control eyes. In all experiments the pressure responses had disappeared after 24 hrs in the treated and untreated eyes respectively. By means of the experimental conditions in this study no significant pupillary reactions were found after bethanidine application. The tension effect of 0.5% adrenaline borate remained essentially unchanged when repeated with additional 1% topical bethanidine. Some aspects of sympatholytic drug action on the intraocular pressure in the rabbit are discussed.


Neonatal herpes simplex retinitis.

Neonatal herpes simplex retinitis. Pathologic material from an acute case of neonatal herpes simplex retinitis is presented. There was marked necrosis of all retinal layers including the pigment epithelium. Choroid and vitreous appeared only secondarily involved. The retinal necrosis was sharply delineated stopping at the ora serrata. We interpret this as being more compatible with an immunologically determined process than with direct infection. Indirect evidence for this viewpoint is the failure to find any evidence of virus in the retina, such as inclusion bodies, by electron microscopy or by fluorescent antibody staining.


Activated human retinal microglia under pathological conditions. Six pathological human retinas were studied in order to establish changes, migration, and other reactions of retinal microglia. The different morphological features of other retinal macrophages are also described. Hortega silver carbonate stain was used for this study. This investigation aided in answering some questions on the active movements of microglia elements and other details under discussion.


[The proof of different types of collagen in the bovine eye (author's transl)]. Characteristically stained polyacrylamide gels can be obtained by disk-electrophoresis in acid medium of several tissues of the bovine eye. The technique permits to prove different types of collagen in the eye, and allows the differentiation and identification of the tissues. By these results the different tissues of the eye can be divided into three groups. 1. Tissues showing two alpha collagen components in polyacrylamide gel (cornea, sclera, iris, ciliary body, anterior lens capsule, and the pigmented epithelium of the retina). 2. Tissues possessing one alpha component only (zonula fiber and vitreous body). 3. Tissues which show neither the alpha nor the beta and gamma component of collagen (lens nucleous and retina without pigmented epithelium).


Subconjunctival injection of antilymphocyte serum during corneal hypersensitivity to heterologous alubmin. Thirty-two rabbits were immunized by subcutaneous human serum albumin in Freund's adjuvant and challenged after four weeks by intracorneal injection in both eyes. On a random and blind basis, one of the eyes in each animal received three consecutive injections of antilymphocyte serum obtained from rats and the other eye the same dose of normal rat serum. Statistical analysis of results showed no significant difference between both treatments. Two eyes treated with antilymphocyte serum had limbal necrosis with uveal prolapse.


Penetration of amikacin into the aphakic eye. An experiment was designed to see if an aminoglycoside antibiotic, amikacin, would penetrate the vitreous of rabbits in greater concentrations in the postoperative aphakic eye than in the normal eye. Phakic and aphakic eyes were treated with amikacin by topical, subconjunctival, and intramuscular methods separately and combined. Bioassays of aqueous, anterior vitreous, and posterior vitreous revealed that concentrations of amikacin in ocular fluids after intramuscular administration were greater in the aphakic eye as compared to the normal eye; however, concentrations in the vitreous did not reach reliably bactericidal concentrations even when all three methods of administration were combined.


Photocoagulation of angioma of the eyelid. An infant with a large hemangioma (strawberry mark with a cavernous component) of the eyelid was successfully treated with photocoagulation. The method resulted in rapid involution of the lesion and the visual function of the involved eye could be preserved. A similar treatment in a case with strawberry mark and another with pigmented nevus in the eyelid brought about excellent cosmetic results.


Ultrastructural features of posterior vitreous detachment. The ultrastructural features of vitreoretinal relations in the posterior fundus of enucleated eyes were studied. Vitreous detachment occurs at the anatomical vitreoretinal juncture, between the inner limiting lamina of the retina and the vitreous cortex, the surface of the lamina becoming smooth and without vitreous residues.


Histopathology after vitrectomy with the vitrophage. A 72-year-old adult-onset diabetic woman underwent vitrectomy with the vitrophage because of persistent vitreous hemorrhage. Postoperatively a hyphema developed and elevation of intraocular pressure was refractory to medical management. Intraocular pressure was controllable within normal limits after vitreous lavage. Eleven days after vitreous lavage the patient died from pulmonary embolization. Histologic sections demonstrated a flat pars plana over the sclerotomy site with vitreous condensation along the internal aspect of the wound. Rubeosis iridis was postulated as the source of the hyphema. A hemolytic mechanism may have caused the elevated intraocular pressure.


[Signs, therapy and follow-up of cases with pure blow-out fractures of the orbit (author's transl)]. 30 patients with blow-out fractures were referred to our clinic because of serious "eye troubles", most frequently diplopia and haematoma of the eye lids (Table 1). The signs of the characteristic oculomotor imbalance are described. In 10 out of 29 patients motility was normalised spontaneously within 2 weeks. 19 patients underwent surgery because one of the following criteria was fulfilled: 1. Diplopia and positive traction-test not resolving within 10 days. 2. Large hermiation into the antrum. We believe, that posttraumatic diplopia is not only a result of the incarceration, but also of a direct laesion of muscles and connective tissue. Surgery was done by orbital approach. After reposition of antral prolaps and the bony fragment we used Lyodura or, when nessessary, silicon implants. In all patients treated in this way ocular motility was improved, but normalisation was achieved only in 8 cases (Fig. 8).


[The sources of ophthalmodynamography. Determination of tissue volumes of human lids and orbital contents (author's transl)]. The volumetric determination of all those tissues relevant for Opthalmodynamography (ODG) showed the lids to contribute about a quarter to the total volume; another quarter each was due to the optic bulb including optic fascicel, external bulbar musculature and orbital fat. Bulb and fascicel show no pulsations that could be detected oscillographically, fat tissue is poorly vascularized and therefore is of minor importance in respect to the origin of pulsation. The main causes of ODG-oscillations therefore are external eye muscels and eye lids, each contributing a minimum of one third to the heights of the pulse. Assuming all tissues of possible importance for the origin of ODG to be equally well vascularized the part of ODG pulse height due to influence of eye lids is minimally 25% or 32% in the average.