Olfactory bulb projections in the bullfrog Rana catesbeiana. The projections of the accessory and main olfactory bulbs of the bullfrog are described as part of a long term analysis of the morphological differences in amphibian and reptilian telancephalons. Unilateral aspiration of the accessory olfactory bulb results in an ipsilateral projection to the pars lateralis of the amygdala via the accessory olfactory tract. Degenerating fibers from the accessory olfactory bulb are tracable into the cell-free zone between the dorsal striatum and the lateral pallium, and projections to these neural populations may also exist. Unilateral lesions of the main olfactory bulb reveal two major secondary pathways: an ipsilateral medial olfactory tract that projects to the rostral ventromedial portion of the medial pallium, the postolfactory eminence and the rostal, lateral and medial septal nuclei; and an ipsilateral lateral olfactory tract that projects to the dorsal striatum, the lateral pallium and the ventral half of the dorsal pallium. Two crossed secondary olfactory pathways to the contralateral telencephalon decussate via the habenular commissure after entering the ipsilateral stria medullaris. A crossed lateral pathway terminates in the dorsal striatum, the caudal, lateral pallium and the ventral portion of the dorsal pallium. A crossed medial pathway terminates in the internal granule layer of the main olfactory bulb.


[Binocular inferior altitudinal hemianopia following occult hemorrhage (author's transl)]. Authors report a case of binocular inferior altitudinal hemianopia caused by occult haemorrhage from the gastrointestinal tract. There was a 36 hours' period between the onset of visual field defects of the two eyes. The ocular signs have thrown light on the grave anaemic condition. The internal state of the patient was rapidly improving but the visual field defects have remained the same.


[The border lines between the 3 forms of trichromaticity in anomaloscopic examinations (author's transl)]. After presentation of the up to date knowledge on transition form between normal and protanomalous trichromates as well as the gap between normal and deuteranomalous trichromates and author reports on 20,000 investigations of his own on colour vision. Registration of all special cases since 1957 are presented. With reference to the large material it is found that, when all important factors of this investigation are condidred, there is a relatively sharp border between normal and the deuteranomalous at an Ag of 1.75, whereas in the transitional zone of Ag 0.4-0.85 there is marked overlapping between protanomalous and normal trichromates especially in the region of Ag 0.6-0.8. Whereas a differentiation between normal and the deuteranomalous is easily made through the Ag further methods, especially observation of the position of the yellow serew of the anomaloscope. Are always required to differentiate between normal and protanomalous trichromates.


Revascularization of the stenotic left main coronary artery and impaired left ventricle. The high mortality rate associated with revascularization for stenosis of the left main coronary artery and impairment of the left ventricle (classes III and IV) has been significantly reduced by a twofold approach: combating hypotension during induction of anesthesia and preventing ischemia resulting from anoxic arrest, often needed to facilitate the insertion of the left coronary anastomoses. These two goals have been successfully achieved by (1) a readiness to institute circulatory assist by means of femoral-to-femoral cardiopulmonary bypass and (2) augmentation of coronary flow through immediate insertion of a vein graft between the aorta and right coronary artery, if the anatomy permits.


Multiple myeloma. A clinical review.

Multiple myeloma. A clinical review. This group of proliferative diseases of the plasma cell line, in which manifestations of abnormal immunoglobulin production are associated with variable degrees of depressed antibody synthesis, pose fascinating problems crossing many clinical and research disciplines. The present state of diagnosis and clinical management is assessed.


In vivo interaction of the Kunitz protease inhibitor and of insulin with subcellular structures from rat renal cortex. Rats were injected with labeled Kunitz protease inhibitor and killed at various times thereafter.  Radioactivity was measured in various fractions of kidney homogenates in order to study the time-dependent fixation to different cell organelles, expecially the transition from the brush border to lysosome fraction.  With short survival periods (up to 5 min), the renal protease inhibitor is recovered nearly completely with the brush border fraction.  With longer periods, a shift towards particles with higher densities and higher beta-glucuronidase activities takes place.  Similar results have been achieved with insulin.  Lysosomes were prepared and subfractionated following i. v. administration of the protease inhibitor or insulin.  The radioactivity of the peptides was found in the lysosomal range of density.  According to our present and previous results, the renal pathway of the protease inhibitor consists of 3 steps: binding to the brush border, reabsorption into micropinocytotic vesicles and phagosomes, and final enrichment in phagolysosomes with subsequent degradation.  We suggest this type of transport to be representative for peptides in general.


Thromboembolism in pregnancy.

Thromboembolism in pregnancy. Eighteen patients were given carefully controlled intravenous heparin for thromboembolic disease of pregnancy. Thirteen were treated in later gestation and postparium, mainly following warfin therapy. One was treated in early pregnancy and 4 in the postpartum period. Heparin was delivered by constant infusion and dosage regulated by maintaining the thrombin time at 2 to/ times normal. Therapy was stopped for a few hours before and after delivery so that the thrombin time was normal or nearly normal at birth. Two minor episodes of thrombosis recurred in 1 patient while on warfarin, and significant postpartum bleeding occurred in one other. Substituting heparin for warfarin in late gestation was of value in preventing neonatal bleeding complications.


Isolation of a polypeptide that has lymphocyte-differentiating properties and is probably represented universally in living cells. A polypeptide of 8500 molecular weight is described that induces the differentiation of T (thymus-derived) cell and B (bone-marrow-derived) cell immunocytes in vitro, apparently via beta-adrenergic receptors and adenylate cyclase activation. This polypeptide shows a high degree of evolutionary conservation, exhibiting close structural, functional, and immunological similarity when isolated from such diverse origins as cells of mammals and higher plants. This polypeptide was detected in animal cells, yeast, bacteria, and higher plants, and so may well be a universal constituent of living cells.


The immunobiology of skin cancer.

The immunobiology of skin cancer. The immunobiology of skin cancer was studied with thymus-dependent lymphocyte (T cell) levels (an in vitro measure of cellular immunity), with lymphocytic infiltration (LI) of the tumor (an in vivo measure of host-tumor relationship), and with HL-A typing (a genetic measure of histocompatibility). The T cell levels in preoperative patients with squamous (SCC) and basal (BCC) cell carcinoma were significantly lower than in the non-cancer control population (normals). The T cell levels were significantly lower in patients with large tumors than in those with small tumors. The T cell levels remained significantly low in patients cured of large tumors, but were normal in those cured of small tumors. Patients with Bowen's disease not only had T cell levels significantly lower than normal (as a group), but there was also a significant increase in the number of patients who had T cell levels less than two standard deviations below the normal mean. This may signify that they have a greater risk of developing a second kind of malignancy elsewhere. There was a direct correlation between the degree of lymphocytic infiltration (LI) of the tumor, the tumor size, and the T cell level. Small, well-localized tumors had a marked LI and high T cell levels--while the large, deeply invasive tumors had a minimal, or absent, LI and low T cell levels. The presence of HL-A antigens 1 and 8 correlated both with a tendency toward large tumors and with low T cell levels. This may represent the association of a human immune response gene with the human histocompatibility locus. Possibilities for the application of these findings in the clinical management of skin cancer are discussed.


Agenesis of the corpus callosum with interhemispheric cyst. The radiographic features of a cerebral malformation are presented. The major findings are absence of the corpus callosum, a large interhemispheric cyst, and ventricular dilatation. This cerebral dysplasia originates in the first trimester of fetal development resulting in gross psychomotor deficiencies and seizure disorders. Diagnosis which depends predominantly on encephalographic or ventriculographic findings enables formulation of a guarded prognosis.


Aneurysms of the small pancreatic arteries: a cause of upper abdominal pain and intestinal bleeding. Aneurysms of the smaller splanchnic arteries, though rare, are of great significance because of the high mortality rate associated with rupture of these vessels. Such aneurysms often occur in patients with pancreatitis or pancreatic pseudocysts. Four cases are presented to demonstrate the preoperative diagnosis of this entity by selective arteriography.


Xerographic applications in neuroradiology. A comparison with conventional film imaging. The capacity of electrostatic imaging for edge enhancement and wide latitude recording can improve visualization in neuroradiologic studies using low differential absorption contrast agents. Gas myelography and pneumoencephalography show the most satisfactory improvement in visualization. Tomography combined with xerography enhances definition further, but with gas myelography, especially in the thoracic region, plain xeroradiographic definition is frequently diagnostic.


Fracture of the first rib as a complication of midline sternotomy. Fracture of the first rib occurred in six patients after cardiac surgery through a midline sternotomy. Two of the fractures could not be seen on the chest films and were demonstrated only on oblique radiographs of the cervical spine. Symptoms simulating myocardial infarction and/or pulmonary embolism were present in three of the six cases. In a review of 50 randomly selected cases of midline sternotomy, first-rib fractures were found in 3(6%).


One hundred consecutive operations for diverticulitis of the colon. This report describes 100 consecutive patients treated surgically for diverticulitis of the colon. The main indications for operation were recurrent attacks (33), rapid progressive symptoms (17), bleeding (16), palpable mass (14), or combinations of the above. Eighty-four patients had primary resection (two deaths), ten had staged procedure (two deaths), and six had Hartmann procedures (one death). The mortality was highest in staged procedures as this group of patients included those with complications resulting in the greatest operative risks. No deaths occurred in the elective cases. In 25 cases, various complications developed. The most common was wound infection and sepsis. The five deaths in the series are reported in detail with an evaluation of possible alternative methods of treatment. Follow-up of the series showed only one recurrence in the two years after operation.


The clinical presentation of mesenteric vascular disease. The clinical presentation of 17 patients with mesenteric vascular disease admitted to Mount Sinai Medical Center was reviewed. The signs and symptoms were similar in most cases. However, the acute onset of the symptom triad of abdominal pain, diarrhea, and bloody stools in an elderly patient should make one suspect the possibility of mesenteric vascular disease. The gross and light microscopic appearance of the intestinal tract was characterized by hemorrhagic infarcts regardless of the cause of the bowel ischemia. Mortality from this disease remains high, with only four of our 17 patients alive four months after operation.


Slow fibers in the frog cruralis muscle. Extrafusal slow fibers have been identified by electron microscopy in a muscle fiber bundle isolated from the anterior head (m. cruralis) of the triceps femoris of Rana pipiens. Light microscopic examination of this muscle revealed two equally numerous fiber types, one Fibrillenstruktur-like (twitch) and the other structureless (slow). A comparison of force developed by tetanic stimulation and by K+ depolarization also suggested approximately equal numbers of twitch and slow fibers.


[Variability of heat resistance of frog muscle tissue in Ringer's solution]. The variability in the initial level of heat resistance of muscles was found to decrease with increase in the duration of keeping the frogs in vivarium. However, the variability in the resistance of isolated muscles kept in Ringer's solution during 90 min. is independent of this factor and lesser than the initial one. The data obtained suggest that the narrowing of the variability in the resistance of muscles kept in Ringer's solution is determined by the dispersion of the initial level of the resistance. This phenomenon is only observed when the individual variability in the resistance of muscles is sufficiently high immediately after their isolation.


Stages of vegatative afferentation in reorganization of bladder control during intravesical electrotherapy. 420 patients were treated with transurethral, intravesical electrotherapy to improve the function of paralyzed urinary bladder. Normal conscious micturition control was obtained by 314 patients. This electrotherapy contrasts sharply in method and goal with all implanted pacemakers or inserted electric plugs. Nor does the therapy have anything in common with various bladder training methods. The aim of therapy is to recreate vegetative afferentation from the bladder to the CNS. Reactivation of the intramural bladder receptors and facilitation processes plays an important part in establishing normal bladder control.


[The presence of scleroderma and chronic lymphadenosis concurrently in a patient (author's transl)]. This report deals with the case of a 50 year-old woman with long-standing scleroderma of the acral-asphyxial type with a relatively slight tendency to progression. Chronic lymphadenosis has been an additional feature of this case over the past few years. The following findings appear of particular interest: autoimmune phenomena in the form of antinuclear antibodies, a virtually monoclonal proliferation of B-lymphocytes and a relative T-lymphocyte deficiency. It is suggested that both conditions may be pathogenetically connected with an immunologically defined insufficiency of the lymphocytic system. Hence, in view of this observation, it may not be correct to consider scleroderma a "paraneoplastic phenomenon".


Coronary artery anatomy before and after direct revascularization surgery: clinical and cinearteriographic studies in 67 selected patients. This report relates the postoperative clinical and cineangiographic status of 67 patients selected from a total of 202 patients who underwent coronary artery surgery at the Peter Bent Brigham Hospital from July, 1970, to July, 1972. The mean interval after operation was 12.6 months. Ninety-one per cent of the 67 patients were improved from their preoperative status. Forty-eight patients (71 per cent) were studied to evaluate recurrence of mild to moderate angina or occurrence of interval myocardial infarction, and 19 patients (29 per cent) were entirely asymptomatic. In the 67 patients studied, 112 coronary arteries received a total of 115 grafts. (There were 89 ungrafted coronary arteries.) Total graft patency rate for the 58 patients in whom angina was totally or significantly relieved was 65 per cent. However, one or more grafts were patent in 52 (90 per cent) of these 58 patients. In grafted arteries, progression was found in segments proximal to the graft in 37 per cent of arteries, at the site of anastomosis in 10 per cent, and distal to the site of anastomosis in 17 per cent. The frequency of obstruction distal to the site of anastomosis was not significantly different from the frequency of progression in nongrafted arteries, in contrast to preliminary data from this laboratory. Overall and regional progression in grafted arteries appeared to occur primarily within the first four months after surgery and was found, thereafter, in a constand percentage of vessels studied. Progression in coronary arteries was independent of patency or occlusion of the graft to the vessel. It is hypothesized that while proximal progression is probably a consequence of altered hydraulic factors, distal lesions seem to represent natural progression of atherosclerotic disease.


Variant angina pectoris: a clinical and coronary arteriographic spectrum. The clinical course and coronary arteriographic findings in eight patients with Prinzmetal's variant angina pectoris are reviewed and contrasted to previously reported cases.  In six patients with S-T-elevation inferiorly, three had normal coronary arteriograms, one had complete right coronary artery occlusion, one had diffuse triple-vessel disease, and one did not undergo coronary arteriography.  In two patients with S-T-elevation anteriorly, severe stenosis of the anterior descending coronary artery was present.  Medical treatment in four patients and surgical revascularization of the anterior descending coronary artery in two patients were both accompanied by marked symptomatic improvement.  Spontaneous loss of angina occurred in two patients.  During 17 months' mean follow-up, seven patients have remained free of angina and one died suddenly.  Variant angina pectoris may be accompanied by a variety of coronary arteriographic findings and the prognosis appears more favorable than previously reported.


Bilateral arteriosclerotic coronary arterial aneurysms successfully treated with saphenous vein bypass grafting. A man with ischemic heart disease was discovered to have bilateral coronary arterial aneurysms that were sucessfully treated with saphenous vein grafting. Preoperative coronary arteriograms revealed a tight luminal stenosis at the proximal end of the large aneurysm in the left anterior descending artery, suggesting poststenotic dilatation as an etiologic or contributing factor. The right coronary artery was totally occluded proximally, but was noted to be aneurysmal at operation. This is the 14th published case of nonfistulous coronary arterial aneurysm diagnosed in vivo, and the first associated with proximal luminal stenosis.


Bilateral nonfistulous congenital coronary arterial aneurysms. A 15 year old boy collapsed and died after participating in a basketball game. Autopsy revealed bilateral congenital coronary arterial aneurysms. The diagnosis was made post mortem but, retrospectively, might have been suspected during life, even before angiography. The clues to the correct diagnosis were chest pain, a systolic and diastolic murmur and a mass on the right heart border in the chest roentgenogram.


Ampicillin in Haemophilus influenzae meningitis. Clinicopharmacologic evaluation of intramuscular vs intravenous administration. Sixty-two children with Haemophilus meningitis were treated with ampicillin sodium, 200 mg/kg/day for ten days. Thirty-one received the drug intravenously (IV) for ten days; the other 31 patients received ampicillin IV for five days (except for one test dose given intramuscularly [IM] on day 2) followed by IM administration of ampicillin the last five days. Ampicillin concentrations in cerebrospinal fluid (SCF) were higher one hour after IV administration, but at two and four hours, concentrations were greater after IM doses. Responses to therapy and rates of complications were similar in the two groups. Fourteen patients had positive CSF cultures on day 2. Ten of these were isolated only on Levinthal medium and would have been overlooked with routine culture methods. All organisms were ampicillin-susceptible and all CSF cultures were negative by 48 hours. More patients with delayed sterilization had neurologic sequelae (78%) than patients with prompt CSF sterilization (13%). The schedule of five days of IV treatment followed by five days of IM therapy was pharmacologically and clinically as effective as ten days of IV therapy and has practical advantages.


Crohn's disease of the colon. II. Controversial aspects of hemorrhage, anemia and rectal involvement in granulomatous disease involving the colon. In 160 cases with granulomatous colitis or ileocolitis, blood was found in the stool in 72 or 45%. Massive bleeding occurred in four patients (25%); overt bleeding in 51 (32%) and occult bleeding, repeated guaiac positive stools, in 17 (11%). Thus, clinically obvious bleeding occurred in about one patient in three. Of the four patients with massive hemorrhage one required subtotal colectomy, one right hemicolectomy and the other two were controlled by medical measures including blood transfusion. In each of the surgical cases, the massive bleeding originated in the region of the cecum. An additional patient, not in the series, required proctectomy as a life-saving measure following subtotal colectomy. Clinically obvious rectal bleeding in Crohn's colitis is approximately ten times as frequent as in regional enteritis but only one-third as frequent as in ulcerative colitis. There was no correlation between rectal bleeding and rectal involvement determined radiologically or by signoidoscopy, in the whole series but there was a strong association in the small group of Crohn's colitis with rectal involvement (86% with bleeding) and a significantly greater proportion of patients with colitis with rectal involvement and hemorrhage (P smaller than 0.02). Anemia is common in both groups but in Crohn's colitis it is almost always, 75%, associated with rectal blood loss, whereas in ileocolitis this association is much less marked, 40%, indicating other important causes of anemia when there is small bowel disease. The bleeding patient with Crohn's colitis should be managed medically initially. Uncontrollable, continuous, or massive hemorrhage may require angiography and early surgical intervention.


Hemorrhagic erosive gastritis.  A clinical study. Four hundred consecutive patients, in a representative Southern California population, hospitalized for upper gastrointestinal hemorrhage, had endoscopic examinations performed within 24 hours of arrival in the emergency room.  Seventy-four (18.5 percent) of these were found to have the typical lesions of acute hemorrhagic erosive gastritis.  The clinical spectrum of this group is examined and a comparison made with a Veterans Hospital population reported previously.


Gastric mucosal lacerations from blunt trauma to the abdomen. A 17-year old, Caucasian male, high school student sustained gastric mucosal lacerations from blunt trauma to the abdomen during a football game with associated severe upper gastrointestinal bleeding.  The lacerations were diagnosed by endoscopy and treated conservatively with uneventful, rapid and complete recovery.


Atypical retinitis pigmentosa masquerading as a nerve fiber bundle lesion. "Sector" or "asymmetric" retinitis pigmentosa was mistaken as bilateral nerve fiber bundle defects in a 56-year-old man for six years, leading to an unnecessary work-up for anterior visual pathway disease and to an incorrect diagnosis of low-tension glaucoma. Confusion arises because this variant may present with  bilateral, superior, half-ring visual field defects that intersect the blindspots. These defects may be misplotted as typical arcuate Bjerrum's scotomas. The ophthalmoscopic changes that correspond to these visual field defects may be so subtle as to be overlooked. Fluorescein angiography helps bring out the retinal lesions, and moderately subnormal electroretinographic and dark adaptation studies are definitive.


Exogenous fungal endophthalmitis caused by Paecilomyces. A 17-year-old white boy developed a fulminating corneal infection and endophthalmitis in his left eye after trauma. He was treated with antibiotics and corticosteroids for one week prior to diagnosis. A saprophytic fungus, Paecilomyces viridis, was cultured from corneal scrapings and was demonstrated in the vitreous cavity by histopathologic examination.


Ba++ on the resting frog stomach: effects on electrical and secretory parameters. Ba++ added to the nutrient solution bathing the resting frog stomach increased resistance, decreased the PD, and stimulated acid secretion. Under short-circuit conditions, the increase in H+-secretory rate was accompanied by a decrease in short-circuit current (I-sc). These changes were reversed by NaSCN (10 mM), suggesting that Ba++ had not impaired the current-generating mechanism per se. Histamine-induced acid secretion was associated with an increase in net Cl- flux, particularly in the N yields S flux (JNS). Ba++ increased acid secretion with no increase in JNS and a decrease in net Cl- flux. The effects of Ba++ were amplified by low-Cl- solutions. Histamine, in the presence of Ba++ and low-Cl- solutions, increased acid secretion and transmucosal resistance, suggesting the operation of a neutral pump in the secretion of HCl. It is concluded that Ba++ limits Cl- entry and also acts as a secretagogue.


Effects of bile salts on amphibian gastric mucosa. The effect of five different bile salts on the mucosal or serosal surface of isolated bullfrog gastric mucosa was investigated. Serosal exposure (30 min) to 15-40 mM taurocholate (TCA) or taurodeoxycholate (TDCA), 10-40 mM deoxycholate (DCA), or 2.5-7.5 mM cholate (CA) typically produced a marked increase in resistance (R) and a decrease in potential difference (PD), short-circuit current (I-sc), and H+ secretion. Flux of 36Cl from serosal to mucosal solution decreased progressively. The flux of [14C]sucrose across the mucosa was slightly decreased. Microscopy showed condensation of the parietal cells. Mucosal exposure (30 min) at concentrations above 2.5 mM DCA or CA and 15 mM TCA and TDCA caused a marked decrease in R, PD, I-sc, and H+ secretion, and the flux of [14C]sucrose across the mucosa was increased. Extreme destruction of the surface mucous cells was the primary histologic finding. The effect of dehydrocholate was identical to that of TCA. Mucosal bile salts cause an increased permeability primarily by injury of the surface epithelium whereas serosal bile salts affected primarily the oxyntic cells.


Angiography of cerebellar hemorrhage secondary to hypertension. In a patient with cerebellar hemorrhage due to hypertension, deterioration may be so rapid there is not sufficient time for radiographic studies prior to craniectomy. In the less critically ill patient, posterior fossa angiography is the procedure of choice and is highly accurate in localizing the mass lesion. Angiography is particularly helpful in the patient with an atypical presentation because an etiology of the hemorrhage other than hypertension may be demonstrated.


Isoproterenol in offsetting adverse effects of vasopressin in cirrhotic patients. Vasopressin administered as a peripheral infusion (40 U/hr) significantly reduced portal vein pressure in ten awake patients with cirrhosis and portal hypertension. A vasopressin-induced reduction in cardiac output occurred in five of the ten patients (50 per cent). Vasopressin-induced changes in systemic arterial pressure, heart rate, and portal venous pressure were independent of alterations in cardiac output. When the five patients with vasopressin-induced reductions in cardiac output were given a combination of vasopressin and isoproterenol, cardiac output was maintained and the reduction in portal vein pressure was equal to that observed with unopposed vasopressin therapy. Thus, the addition of isoproterenol prevented a vasopressin-induced reduction in cardiac output while permitting vasopressin to reduce portal vein pressure.


Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis. Twenty-four patients with massive rectal hemorrhage and known or subsequently proved colonic diverticular disease had the bleeding site localized by mesenteric angiography and received intra-arterial infusion of vasopressin to arrest the bleeding. In twenty-two patients the bleeding was controlled with the vasopressin infusion whereas in the remaining two, hemorrhage did not stop and surgery was performed. Of the twenty-two patients in whom bleeding was arrested by vasopressin infusion, twelve received no further surgical therapy, five had elective prophylactic surgical resection after a period of hemostasis, and the remaining five underwent segmental resection for bleeding that recurred after cessation of the infusion. Of the twelve patients who were not operated on, three had rebleeding two, four, and twelve months after vasopressin infusion and two of these three patients required surgery. The remaining nine have had no recurrent bleeding for periods ranging from seven to thirty-four months. Of ten patients who had segmental resection after precise localization of the bleeding site and initial control with vasopressin, no one has had recurrent hemorrhage for periods ranging from two to eighteen months.


Duodenal hematoma. Critical analysis of recent treatment technics. Analysis of the fifty-six cases of duodenal hematoma reported since 1966 shows a significant rise in incidence, with uncertainty regarding the most appropriate approaches to therapy. The diagnosis can generally be made by recognizing the "coil spring" sign on upper gastrointestinal series. Thirty-four per cent of the patients reviewed were treated successfully with conservative management. Sixty-two per cent were treated surgically. Fifty-one per cent of the surgical patients were treated by simple evacuation of the hematoma, and 12 per cent of these required reoperation for recurrent obstruction. Forty per cent of the surgical patients were treated by evacuation and gastrojejunostomy, and 21 per cent of these required reoperation for marginal ulceration. A previously unreported case is presented and a new surgical approach utilizing gastroduodenostomy is described, which is believed to offer potentially less risk of subsequent marginal ulceration or recurrent duodenal obstruction.


Clinical appearance of optic disc drusen in childhood. In a series of 50 individuals with optic disc drusen diagnosed before the age of 15, the anomaly occurred most often in the form of an elevation of the whole or one part of the optic disc without visible superficial drusen. Superficial drusen were seen only in 15 of the 92 eyes with the anomaly. In those 42 subjects in whom the anomaly was bilateral, it was seldom symmetrical. The reduced visual acuity found in a few cases could be attributed to causes other than the drusen. In 10 eyes the anomaly was observed to be associated with visual field defects. The age distributions of the subjects with visual field defects and with superficial drusen show that they were more common among older children. The superficial position of the drusen and the presence of visual field defects do not, however, have a close cause-and-effect relationship. A cilioretinal artery was observed to co-exist with optic disc drusen with a high frequency, i.e. in more than 40 per cent. Other vascular aberrations were also noted in association with the optic disc anomaly. Neurological symptoms were the most common cause for consultation in the 50 children examined. In more than half of the present cases appearance of the optic disc had contributed to the suspicion of an intracranial expansive process. A fallacious similarity between the elevation of the optic disc caused by buried drusen and optic disc edema caused by increased intracranial pressure presents a problem of differential diagnosis, expressly in younger children.


[Scanning electron microscopy of the zonula apparatus of higher primates. A further approach to a new theory of accommodation (author's transl)]. The architecture of the zonula apparatus of two species of monkeys is studied by scanning electron microscopy. Some specimens were treated with pilocarpine respectively atropine immediately before enucleation. The zonula consists of two functionally different groups of fiber strands, i.e. span and holding bundles (after Rohen and Rentsch), the course and structure of which is described in detail. After application of atropine the "holding bundles" appear to be stretched in the area between the ciliary processes and the lens, whereas after pilocarpine application they appear loose and irregularly arranged. Screw-like, spiral fiber strands were often seen in the scanning electron microscope. It is assumed that the spiral fibers develop in the stage of relaxation of the zonula apparatus.


[Gross anatomy of the vitreous body (author's transl)]. The anatomical arrangement of vitreous structures in human and animal eyes is described on the basis of coinciding findings of histological examinations, biomicroscopy and the "optical dissection" of unfixed vitreous specimens. The "funnel" of the primary vascular vitreous disappears completely during development. The vitreous cavity is filled with secondary vitreous. Its structure in nearly homogeneous, containing "holes" of low density at all sites where the structure of a normal inner retinal surface is altered. During postnatal development the secondary vitreous forms a new funnel system, consisting of zones of different density and of membranelles (vitreous tracts). Before completion of this funnel system, destruction of the vitreous gel begins and confuses the typical arrangement. Postnatal vitreous structures include: zones of different density: preretinal zone, intermediary zone, retrolental zone; holes (of low density): prepapillary hole, prefoveal hole, prevascular fissures, vitreous tracts (of high density): preretinal tract, median tract, coronary tract, retrolental tract ("hyaloid" tract). The pattern of the "holes" strongly suggests that the framework is formed by retinal elements.


[Inhibition of corneal metabolism by glucocorticosteroids. An in vitro study (author's transl)]?14Hemmung des Hornhautstoffwechals durch Glukocorticosteroide. Eine in vitro Studie. Cortisone and its derivates demonstrates influence to the metabolism of connective tissue. In this in vitro-study the action of water soluble Dexamethason (Schering) to corneal tissue is quantitatively determined. Incorporation of radioactive sulfate into the glycosaminoglycanes and the sulfate-hexosamine-quotient of keratansulfate and chondroitinsulfate is pointed out. 1. A 2 times 10-7 M Dexamethason-concentration and 6 hours incubation time causes reducing of sulfate incorporation in the case of keratansulfate (I) about 94 per cent and chondroitinsulfate (II) about 89 percent compared to nontreated control. Increasing concentration of Dexamethason leads the inhibition of sulfate incorporation to 66 per cent (I) and 63 per cent (II) respectively. Removing the epithelium from the stroma before incubation the Dexamethason concentration and 6 h incubation time only 84 percent and 80 per cent radioactive sulfate is found in keratansulfate and chondroitinsulfate. An increasing Dexamethason concentration leads to inhibition of 55 per cent (I) and 46 per cent (II) respectively. 2. A comparable inhibition of sulfate incorporation is demonstrated with constant Dexamethason concentration and variable duration of incubation. A 1 hour incubation reduced incorporation of sulfate to 89 per cent for keratansulfate and 81 per cent for chondroitinsulfate. The 24 hours incubation inhibits incorporation to 69 per cent (I) and 65 per cent (II) respectively.


Electrical injuries to the eye.

Electrical injuries to the eye. The effect of electric current on the eyes of experimental animals was studied. An apparatus was constructed to allow single and multiple shock exposures from 0 to 600 volts at variable exposure times. The current was measured on a Tectronex Storage Oscilloscope. Mature Dutch rabbits were used as experimental animals. When rabbit eyes were subjected to a current of 500 volts for no less than 250 milliseconds and 400 milliamperes or more, a permanent decrease in the amplitude of the b-wave of the Electroretinogram resulted in some animals. No histological or ophthalmological alterations in the retina, optic nerve or vasculature could be observed using conventional techniques. The cataractogenic properties of electric current were also studied. Most previous observations dealing with this subject utilized a multiple shock technique--something which is unlikely to occur in any accidental exposure. This study focussed on the production of lens changes in rabbit eyes following single exposures of measured electric current. The biomicroscopic characteristics of these changes were described. Minimal lens changes were produced by single shock exposures ranging from 6 to 26 watts per second while typical electrical anterior subcapsular cataracts were produced by current of 23 to 80 watts per second. Exposure times were mostly 250 milliseconds or less since the survival rate of animals subjected to longer exposures made such studies unfeasible. Three patients with electrical injuries were presented and some of the pertinent literature was reviewed.


Black hypopyon: report of two cases.

Black hypopyon: report of two cases. Two patients are described in whom black hypopyon and black keratic precipitates occurred as a result of intraocular melanoma. In one instance the hypopyon was due to a clinically unsuspected primary choroidal melanoma in an eye with opaque media; in the second case the tumor was metastatic to the uvea froma cutaneous melanoma. Histological examination showed the hypopyon to be composed of pigment-laden macrophages and neoplastic melanoma cells.


Cholesterolosis of the anterior chamber. The clinicopathologic findings in eight eyes with cholesterolosis of the anterior chamber are presented.  In five patients the cholesterol was present as an anterior chamber deposit or free-floating crystals, or both, and was recognized clinically.  In two patients the anterior chamber cholesterol had incited a granulomatous inflammatory reaction and was mistaken clinically for lipid keratopathy.  Anterior chamber crystals were an incidental laboratory finding in the final patient.  Intraocular cholesterol may be present as free crystals or contained within foreign body granulomatous inflammation, macrophages, or fibrous tissue.  Possible sources of anterior chamber cholesterol crystals are discussed.  In most cases they seem to be derived from the breakdown of intraocular hemorrhage.


Goniotrepanation (gotrep) and further observations on this operation for chronic glaucoma. The conclusions from the current data on the goniotrepanation, which are based upon the systematic observations on 175 eyes operated on with this microsurgical procedure and for a period of 2 to 4 years, can be characterized as follows: a) Intraocular pressure regulation obtained in 91 per cent of the cases.  b) Avoiding excessive hypotony.  Mean intraocular pressure value postoperatively 12 to 14 mm Hg.  c) Achieving a regular level filtration site overlying the trephination hole, limiting polycystic conjunctival degeneration to 8.5 per cent, which is common with the usual filtration procedures.  d) Maintenance of intact visual function in a great percentage of the operated eyes, with a decrease in visual acuity in 5 per cent without any observable visual deterioration.  e) The advantages of goniotrepanation listed above, emanating from observations over a 2-year period, point explicitly to the effectiveness of this operative procedure and explain the survival of goniotrepanation up to the present.


The screening of the central visual field. The Armaly technique, a method of screening for glaucomatous field defects was evaluated in 100 normal eyes and 38 selected central field defects using the Goldmann perimeter and the Auto-Plot tangent screen. The screening results obtained from the Goldmann perimeter and the tangent screen using the selective perimetry of Armaly were compared with the results obtained from the Friedmann central field analyser.  Testing normal eyes we found the highest initial false positive rate with the Friedmann analyser and the lowest initial false positive rate with the Auto-Plot tangent screen.  The specificity of the Friedmann analyser for detecting early central field changes is less than the Goldmann perimeter or the Auto-Plot tangent screen when using Armaly's technique.  On the other hand, the Friedmann analyser turned out to be the easiest instrument to handle and requires least experiences for the observer.  Some problems of mass screening perimetry are discussed.


[Herpes Simplex Keratitis under the Scanning lectron Microscope(author's transl)]. In 12 rabbits a dendritic keratitis could be provoked by applying a suspension of herpes viruses (Herpes virus hominis -- HVH type 1) onto their previously both uviolised and non-uviolised corneae. 4 days later ophthalmectomy was performed and the corneae were examined by the scanning electron microscope. Macroscopically, both in the uviolised eyes and the control eyes punctiform lesions of the corneae were observed. After short ray-treatment (3 min) no differences were present between the uviolised and non-uviolised eyes. At longer time of exposure (7--15 min), however, a more distinct alteration occurred in the uviolised eye. The scanning-electron-microscopical picture showed the dendritic lesions to be composed of numerous circular foci of 100 to 200 mu. There were no differences in the lesions of the uviolised and non-uviolised corneae. The fact that after ultraviolet ray-treatment a great part of the epithelial cells is sloughed off, but, nevertheless, the same dendritic lesions develop, contradicts the assumption of a morphological substrate of the epithelial cells being the inducing factor.


[Ultrastructural studies on the pterygium. I. Epithelium and glands of the conjunctival part (author's transl)]. 13 pterygia from patients aged between 39 and 81 years are studied by electron microscopy. The pterygium is covered by a multilayered, highly differentiated cylindrocellular epithelium. Arrangement and height of the microvilli of the superficial epithelial cells differ from those of the conjunctival epithelium. Morphological signs of secretion and resorption are found. As a characteristic the basal epithelial cells of the pterygium are rich in metaplasmatic filaments. Tubular glands are localised underneath the covering epithelium; they may reach the deep substantia propria. Their walls consist of a single layer of cylindrical cells. A varying number of goblet-cells are embedded between them. The secretion by the epithelial formations of the pterygium is of the merocrine, holocrine and microapocrine type.


[Ultrastructural studies on the pterygium. II. Connective tissue, vessels and nerves of the conjunctival part (author's transl)]. The stromal part of the pterygium is remarkably rich in plasma cells. The connective intercellular substance shows two different pathological modifications: A clotting together of collagen fibres to broad, osmiophilic, elastoid bands and a widening of the spaces containing the granular nonfibrillar ground-substance . The vascular system consists mostly of fenestrated sinusoid capillaries. Their endothelial cells frequently show degenerative changes and the basement membrane of the vessels can be as thick as up to 50--100 fold the normal size. For the first time nervous formations could be found in the pterygium. Axons of the autonomic system join the basal epithelial cells, where they form terminal endings. Encapsulated myelinated and nonmyelinated corpusles probably stem from the sensory nervous system.


[Investigations on the effectiveness of a new antimycotic through experimental keratomycosis in rabbits (author's transl)]. Thirty-two rabbits infected with Fumigatus keratitis were treated for a period of  10 to 20 days with a new antifungal agent known as "BAY b 5097" (Canesten). It was administered to 6 animals (500 mg/kg body weight; 12 eyes) orally; 20 received unilateral topical treatment. In both groups the therapy failed to supress mycosis in the avascular cornea. In topical treatment problems concerning common solvents arise: They are unable to reach the intracorneal infection, and most of them are incompatible for conjunctival use.


[Standard candida mycosis in the rabbit eye (author's transl)]. Whole-body X-irradiation administered to rabbits prior to intracorneal inoculation with Candida albicans is required to produce a verifiable mycotic keratitis. Damage to the corneal tissue, which in rabbits is generally resistant to Candida, can thus be avoided. The mycosis usually lasts for a period of 12 to 14 days. Twenty-four animals (48 eyes) were infected. The fungi were recultivated in 21 animals (24 eyes). All attempts were successful.


[The unilateral emigration of leukocytes from conjunctival vessels (author's transl)]. The phenomenon of unilateral leukodiapedesis is demonstrated in the irritated conjunctiva of rabbits and rhesus-monkeys. The leukocytes will penetrate the vessel walls first in the neighbourhood of the irritation. This can be demonstrated during the first minutes after the onset of an inflammatory reaction only, i.e. prior to a general leukocytosis of the tissue. By fixation with glutaraldehyde or osmium-tetroxyde the dynamic movement can be visualized and the directions of the irritation and of the migration are obvious in the conjunctiva. So this tissue provides an excellent model to demonstrate the unilateral sticking and the directed migration of leukocytes through vessel walls, a fact to which references seem to be missing in the ophthalmopathologic and pathologic literature.


DC recording of the human corneofundal potential. The limitation of an AC technique for the amplification and display of the indirectly recorded human corneofundal potential (CFP)is discussed. A Mingograph M34 with EMT 12 B preamplifiers (Siemens) has  been tested with regard to a DC recording of the CFP. With the same purpose the electrical characteristics of two electrode types--a Kaiser lead alloy electrode and a Beckman silver-silver chloride cupped electrode--were examined and a suitable preparation of the skin contact area indicated. Finally the base line stability was evaluated and a comparative study of AC and DC recordings of the CFP presented and subjected to statistical anaylsis.


Investigations on laser coagulated rat eyes by fluorescence angiography and microscopy. Laser coagulation using 50 and 100 mW of power, a spot of 50 microns and an exposure time of 0, 2 seconds were performed on rat eye fundi. We observed the effects which were produced in the retina and choroid utilizing both fluorescence photomicroscopy with incident excitation light and fluorescence angiography. No distinct differences were noticed between the effects produced by 50 and by 100 mW. Both energies damaged choroid and retina, especially the outer part of the retina. Moreover, fluorescein angiography within 24 hours gave us effective information for estimating the applied laser effect.


Alkali and acid burns of the rabbit eye: measurement of aqueous flow by means of intravenously injected Na-125 I and Na-131I. Rabbit eyes were burned either with 1N NaOH or 1 N HC1. On the fifth day following the injury, aqueous humour flow was determined according to a method originally described by Becker (1962), using intravenous injection of Na-125I and Na-131I in different time intervals. In alkali-burned eyes the main finding was stoppage of the aqueous humour flow, probably due to obstruction of outflow channels. In acid-burned eyes the significantly elevated diffusion out of the eye was probably caused by altered function of the highly irritated and hyperemic iris. Results confirmed the previous findings achieved by the rate of disappearence of 14-C-glucose injected into the anterior chamber of the burned eyes.


[Glucose and lactate concentration in tears of rabbits following mechanical stress and wearing of contact lenses]. The concentration of glucose and lactat in tears is significantly different after slight or strong irritation of the eye. More glucose and lactat can be washed out of alterated tissue compared to normal one, although we estimate that the metabolits are primary more secreted after irritation. Under soft contact-lenses the concentration of both metabolits increase continiously during a certain period. Under hard contact-lenses the single measurements are very different. We have to estimate many disturbing factors.


[Ultrasonic biometry and oculopression]. The changes of the intraocular distances provoked by oculopression (10 min, 40 mm HG) were explored by ultrasonic biometry. Immediately after removing the oculopressor, a flattening of the anterior chamber and a deepening of the vitreous cavity occurred. The maximal deepening of the anterior chamber together with the shortening of the vitreous axis appeared 9 min after oculopression on an average. The causes of the predominance of the initial lengthening (0.24 mm on an average) and of the following shortening (0.16 mm on an average) of the vitreous cavity compared with contrary changes of the anterior chamber are discussed.


Tumors of the small intestine.

Tumors of the small intestine. An analysis of 80 cases of malignant and benign tumors of the small intestine is presented, and major clinical features of various histologic lesions are discussed. Tumors of the small intestine are rare, and the small bowel may have intrinsic protective systems against the development of neoplasms. Gastrointestinal bleeding and symptoms of intermittent obstruction are prominent findings in patients with symptomatic benign tumors, although many benign tumors are incidental findings at operation for an unrelated disease. Benign lesions should be removed by local excision. Virtually all malignant tumors are symptomatic with abdominal pain, nausea and vomiting, anorexia and weight loss, and gastrointestinal bleeding being common findings. Earlier diagnosis is essential if the prognosis for patients with small intestinal malignancies is to be improved. A high degree of suspicion must be aroused with any vague, nonspecific gastrointestinal complaints in patients over 40 years of age. Exploratory celiotomy should be performed in symptomatic patients even though no abnormality may be detected on roentgenographic examination.


Suppression of T-lymphocyte rosettes by rifampin. Studies in normals and patients with tuberculosis. Studies of circulating T- and B-lymphocyte rosettes were done in 20 healthy controls and 29 patients with pulmonary tuberculosis, including 18 receiving rifampin chemotherapy. Eight of the 18 patients in the rifampin group (44%) had significant suppression of their T-cell rosettes as compared with patients with tuberculosis not receiving rifampin (P less than 0.005). Seven of the eight patients with suppressed T-cell rosettes had received the drug for longer than 6 weeks. No significant difference was observed in circulating T- and B-lymphocyte rosettes between healthy controls and patients not receiving rifampin. Administration of this drug to two healthy subjects in a dosage of 600 mg daily for 28 days was associated with suppression of T-lymphocyte rosettes. The maximum decreases of 40% and 37% were observed at 14 and 21 days respectively, with return to base-line values within 2 weeks of discontinuation of drug therapy; this indicates complete reversibility. Long-term sequential studies will be required to determine whether T-cell suppression after prolonged therapy with rifampin is also reversible or associated with any harmful sequels.


Clinicopathologic case report: ultrastructure of the epithelial dystrophy of Meesmann. As in previous studies of Meesmann dystrophy, intense vacuolation of the epithelium was observed. However, neither histochemical nor electron microscopical examination of the specimens showed any evidence of abnormal quantities of glycogen or the electron dense peculiar substance of Kuwabara and Ciccarelli. Electron microscopy indicated that the basic alteration leading to the manifestations of the dystrophy was electron dense bodies in the cytoplasm of the basal epithelial cells. These electron dense bodies appeared similar to lysosomes. In the more superficial cell layers, the electron dense bodies were engulfed by vacuoles that gradually increased in number and size to fill the cytoplasm and, finally, destroyed the most superficial cells.


Hearing loss after head injury.

Hearing loss after head injury. This work reports on the hearing loss of 395 patients who were hospitalized after brain concussion. The percentage of hearing loss and vestibular disturbances appearing after fracture of the temporal bone is higher than in cases with skull fractures without fracture of the temporal bone or with brain concussion alone. Conductive deafness caused by head injury usually disappears in two months time. If conductive deafness remains, the suspicion of dislocation of the ossicular bones arises and such patients must undergo an operation. As the cases where sensorineural deafness disappeared within six months after head injury were rare, final evaluation of the hearing loss can be made one year after the head injury. In the majority of cases, vestibular disturbances and positional nystagmus disappear within six months after the head injury.


Acute severe cardiac failure complicating myocardial infarction. Experience with 100 patients referred for consideration of mechanical left ventricular assistance. One hundred patients were referred with suspected acute cardiac failure following acute myocardial infarction. The diagnosis was confirmed in 72: 31 of these patients underwent elective medical treatment, with 2 survivors (6%); 41 were accepted for counter pulsation, but 9 died before this could be initiated and another 2 died shortly after vain attempts to pass the balloon catheter were abandoned; 30 patients underwent counterpulsation with 14 hospital survivors (47%). Survivor status was usually good. Results of counter pulsation were better in patients who were not shocked (with 5/5 survivors) than in those who were in shock (with 9 of 25 survivors). Results support the view that counterpulsation (alone or combined with corrective surgery) may play an important role in the complications of myocardial infarction provided intervention is early.


Isolation and identification of 1,25-dihydroxyvitamin D2. The chemical synthesis of [3alpha-3H]vitamin D2 of high specific activity has been described. With the use of this radioactive material, the existence of a polar metabolite believed to be the active form of vitamin D2 in the rat and chick has been demonstrated. It has been isolated in pure form from an in vitro chick kidney mitochondrial system and identified as 1,25-dihydroxyvitamin D2 by means of mass spectrometry, ultraviolet absorption spectrophotometry, and specific derivative synthesis. Its antirachitic activity equals that of 1,25-dihydroxyvitamin D3 in the rat.


Net Clminus flux in short-circuited skin of Rana pipiens: ouabain sensitivity and Na+ +K+ dependence. Skin of Rama pipiens, like many other species, is considered to actively transport only Na+ when bathed in Ringer's solution on both sides. However, net Clminus influx was previously described by us in short-circuited skin of Rana pipiens, in the summer season. The skins were of low PD (5-30 mV) and high Clminus conductance. Comparison of these findings with other series indicated inverse seasonal variation between PD and Clminus conductance. It was postulated that active Clminus transport exists at all Clminus -conductance levels but at higher PD is too small to be easily detected. This report evaluates Clminus transport across skins of higher PD (and lower conductance) in winter and further characterizes the system. Net Clminus influx was demonstrated over a wide PD range under short-circuit conditions and was inversely related to the magnitude of the open-circuit PD. It was inhibited by ouabain and dependent upon Na+ in the outside medium and K+ in the inside medium. It is concluded that this is the same system present in skin of Leptodactylus ocellatus and may not he unique to these two species. It appears to be distinctly different from the acetazolamide-sensitive influx system seen in "low-Clminus" solutions in skins of numerous species. The findings are discussed in terms of (1) parallel Na+ and Clminus active transport mechanisms and (2) a neutral NaCl-pump model, recently proposed by Rehm.


Dipole moment, enthalpy, and entropy changes of Hodgkin-Huxley type kinetic units. Dipole moment, enthalpy, and entropy changes were calculated for hypothetical structural units which control the opening and closing of ionic channels in axon membranes. The changes of these thermodynamic functions were calculated both for activation (transition to intermediate complex) and for the structural transformation as a whole. The calculations are based on the experimentally determined Q10 values and the empirical formulae for the rate constants (alpha's and beta's) as functions of membrane potentials in Hodgkin-Huxley type models. From the calculated thermodynamic functions we suggest that the specific structural units of the axon membranes are probably of macromolecular (possible protein-like) dimensions with large dipole moments (hundreds of debyes). The calculated dipole moment changes of a single structural unit indicate that in many cases these dipole moments saturate at strong depolarizations or hyperpolarizations. The transitions in structural units show substantial activation enthalpies and entropies but the net enthalpy and entropy changes are practically negligible for the transition as a whole, i.e. the structural units presumably undergo displacements. While the calculated dipole moment changes associated with structural transformations in Loligo and Myxicola show similar potential dependencies, those for Rana usually show a different behavior. The relevance of the dipole moment changes to gating currents is discussed.


Further studies of canine von Willebrand's disease. Additional characterization of von Willebrand's disease (VWD) in a family of German shepherd dogs is presented. Genetic studies of three generations of affected dogs indicate that about 50% of the progeny are affected if one parent has VWD and about 60% if both parents have the defect. Some of these progeny manifested an incomplete form of VWD, suggesting autosomal dominant inheritance with variable expressivity. The disease become progressively less severe with advancing age and repeated pregnancies. Ristocetin-induced platelet aggregation was significantly reduced in VWD dogs as compared with normal, thrombopathic, and hemophilic carrier dogs. Immunodiffusion and electroimmunodiffusion studies with rabbit anticanine factor VII showed the level of factor VII-related antigen to be low in VWD dogs but present in increased amounts in hemophilic dogs. VWD affected dogs had markedly delayed hemostatic plug formation, but their plugs appeared normal by light and electron microscopy. Their platelet nucleotides, ATP/ADP ration, and platelet protein content were normal. Platelet and fibrinogen survival times with [75Se] selenomethionine were also normal, although platelets from VWD dogs incorporated more radioactivity than did those from normal dogs or from dogs with incomplete VWD.


Pure red cell aplasia (PRCA): Response of three patients of cyclophosphamide and/or antilymphocyte globulin (ALG) and demonstration of two types of serum IgG inhibitors to erythropoiesis. Three cases of adult pure red cell aplasia (PRCA) ARE REPORTED. All patients proved refractory to various combinations of androgens and corticosteroids. The first case, harboring a thymoma, showed a complete clinical remission following cyclophosphamide therapy. The second and third responded similarly to either a combined cyclophosphamide + antilymphocyte globulin (ALG) treatment or to ALG administration preceded by a small dosage of cyclophosphamide, which had proved ineffective when administered alone. Serum IgG inhibitors to erythropoiesis were demonstrated in all cases by  means of in vivo and/or in vitro techniques. The inhibitor(s), although directed against the erythroid marrow in both the first and third patients (PRCA type A), apparently functioned as an antibody to circulating erythropoientin (Ep) in the second case (PRCA type B). The inhibitor(s) was always absent in postremission samples. Additionally, experimental models for both types of human PRCA were established in normal rodents. The present studies support the contention that adult PRCA is an autoimmune disease. The therapeutic role of cytotoxic-immunodepressive agents in PRCA patients is confirmed. It is emphasized that ALG may represent an additional therapeutic tool in cases resistant to cyclophosphamide and/or steroids. In addition, cyclophosphamide proved effective in a patient harboring a thymoma not amenable to surgery. Finally, it is postulated that IgG serum autoantibodies, directed against either an early erythroid precursor (PRCA type A) or, more rarely, circulating Ep (PRCA type B), play a major role in the pathogenesis of the disease.


[Diagnosis and differential diagnosis of hairy cell leukemia]. On account of 2 own observations, main clinical and diagnostic features of Hairy cell leukemia (HCL) will be discussed. HCL is a rare, unusual type of chronic leukemia and is predominantly particular of middle-aged men. The occurrence of middle-sized lymphoid cells having a hairy cytoplasmic edge, and a tartrate-resistant acid PHOsphatase isoenzyme are the characteristic criteria of the HCL. The diffuse infiltration by hairy cells affecting primarily the spleen and bone marrow results in anaemia, granulocytopenia, thrombocytopenia and splenomegaly. Differential diagnosis have to be made in relation to other lymphatic leukemias, leukemic malignant lymphomas and monoclonal gammopathies as well as lymphotropic viral infections. Immunologic behaviour of hairy cells is like that of B-lymphocytes. Therefore, the term "leukemic reticuloendotheliosis" should no longer be applied.


Comparative study between endoscopy and radiology in acute upper gastrointestinal haemorrhage. A total of 158 patients with acute upper gastrointestinal haemorrhage were studied, and the 53 patients on whom emergency endoscopies were performed were compared with the remaining 105. The cause of the bleeding was found in 51 of the endoscopy group and 39 of the control group. Three patients in the endoscopy group and 16 controls died. In the endoscopy group the correct preoperative diagnosis was made in all cases and there was less delay before operation. In the control group five patients had no diagnosis before operation, the preoperative diagnosis was wrong in nine, and five had laparotomies during which no cause of bleeding was found. The patients in the endoscopy group who did not have operations had a shorter stay in hospital than the controls.


Glutamic acid, GABA and their metabolising enzymes in the frog central nervous system. The regional distribution of 9 amino acids, including glutamate and GABA and their metabolising enzymes, has been determined in 5 regions of the frog CNS. Glycine was relatively concentrated in the spinal cord whereas the highest concentration of each of the other amino acids was found in the midbrain. There was a good correlation between the activity of l-glutamate-1-carboxylase (GAD) and the level of GABA in all regions examined and both were concentrated in the midbrain. There was little regional variation in the distribution of 4-aminobutyrate-2-oxoglutarate transaminase (GABA-T).


Penetration and survival of mesocercariae (Alaria spp.) in the mammalian eye. A Canadian woman presented with a motile, intra-retinal worm, which by appearance and movement was strikingly similar to the mesocercaria of Alaria sp., a trematode from frogs. Using these mesocercariae and rabbits this study set out to establish 1) whether these mesocercariae can penetrate the cornea, 2) how long they might survive within the eye, and 3) what reaction is produced. It was found that some penetrated the cornea readily and, after injection, were capable of prolonged survival within the eye. Little overt reaction was produced though histologically the expected chronic inflammatory reaction with eosinophils occurred.


Analysis and reversal of the inhibition of cytophilic antibody receptors produced by antibody. Administration of hyperimmune antibody to leukemia L1210 to allogeneic mice inhibited the development of macrophage-mediated immunity to L1210 in those hosts. In contrast to immunized mice, animals pretreated with antibody showed rapid activation of their peritoneal macrophages, followed by their disappearance and the inability of the residual peritoneal monocytic cells to attach L1210 cells even in the presence of proved cytophilic antibody to L1210. The inhibitory activity of the antibody, which resided entirely in its IgG2 fraction, was manifested only when the specific antigen (L1210 cells) was also injected within 2 days. Pretreatment with antibody to a different leukemia, EL4, failed to inhibit the monocytic uptake of L1210, but it did inhibit uptake of EL4 by monocytes if injected with its homologous antigen. Restoration of the functional capacity of macrophages was accomplished by injecting 1 X 10-7 bone marrow cells i.v. into "suppressed" mice, but 1.5 X 10-7 thymocytes failed to correct the defect. Significantly, thymocytes antagonized the restorative capability of bone marrow cells when they were injected concomitantly. These results indicate that specific inhibition of cytophilic antibody receptors on monocytes could be accomplished through a direct mechanism involving activation and exhaustion of macrophages and an indirect mechanism, perhaps mediated through "suppressor" thymus-derived cells. Although enhancement of the growth of leukemia cells did not occur, several parallels exist in mice with enhanced growth of different tumors. This inhibiotry phenomenon may thus represent another instance of "blocking" in tumor immunity, where the target of suppressive antibody-antigen is the macrophage as well as the lymphocyte.


Ventricular performance and energy of compression, power, and rate of change of power during isovolumic contraction. During isovolumic contraction, there is a calculabe compression of the blood within the ventricle. Energy is expended by the ventricle during isovolumic contraction, and some of it is transferred to the blood in the form of elastic compression. The rate of energy transfer (power) and acceleration of energy transfer (rate of change of power) during isovolumic contraction were calculated based upon considerations of the energy of compression. In anaesthetized dogs, the isovolumic energy of compression was 42 plus or minus 6 (mean plus or minus SE) dyn cm; peak isovolumic power was 1,400 plus or minus 300 dyn cm sec-1; and peak rate of change of power was 56,000 plus or minus 15,000 dyn cm sec-2. During states of augmented contractility induced by isoproterenol, the peak acceleration of energy expeniditure (peak rate of change of power) increased to 126,000 plus or minus 33,000 dyn cm sec-2 (p smaller than 0.001). Conversely, with a reduction of contractility induced by propranolol, the peak isovolumic rate of change of power decreased to 30,000 plus or minus 5,700 dyn cm sec-2 (p smaller than 0.001). The peak rate of change of power was unaffected by changes of the afterload. A trend, however, suggests that it may be affected by preload. The derivations of the isovolumic energy of compression, power, and rate of change of power are based upon firm principles of fluid dynamics. No assumptions related to ventricular geometry, synergy of contraction, or characteristics of muscle fibers are implied. Because of its physiological meaning and the theoretical validity of its derivation, an expression such as the isovolumic peak rate of change of power, when utilized as an index of ventricular performance, would appear to be of value.


Influence of ambient temperature on growth rate of Reissner's fibre in Rana esculenta. The influences of different environmental temperatures on the growth rate of Reissner's fibre (RF) in Rana esculenta were studied in October. At 24 degrees C about 70% and at 18 degrees C about 45% of the length of RF was renewed in 24 hours. This means that the growth rate of RF at 24 degrees C was about 50% faster than that at 18 degrees C. It strongly indicates that increase in ambient temperature from 18 degrees C to 24 degrees C stimulates the secretory activity of the SCO considerably at least as far as the production of RF is concerned. These results are discussed in view of the hypothesis that RF contributes to the regulation of the composition of the cerebrospinal fluid. In this connection some introductory observations on the capacity of RF to bind certain biogenic amines from the cerebrospinal fluid in Rana esculenta are presented.


White pulp compartments in the spleen of rats and mice. A light and electron microscopic study of lymphoid and non-lymphoid celltypes in T- and B-areas. The spleen of rats and mice was studied with the light and electron microscope. Special attention was paid to the delineation and composition of the white pulp compartments: periarteriolar lymphatic sheath (PALS), follicles and marginal zone. These three compartments each have their specific lymphoid and non-lymphoid cells. Reticulum cells and reticulin fibres, although occurring in all three compartments, from a characteristic pattern in each compartment. In the PALS two areas can be distinguished: a central area, largely devoid of reticulum cells, and a peripheral area where reticulum cells are arranged in cylindrical shells. The central PALS FORMS THE THYMUS DEPENDENT AREA OF THE SPLEEN, THE PERIPHERAL PALS contains both T- and B-lymphocytes. T-B-interactions requiring cell contact could take place in the latter area. Lymph vessels originate from the shells of reticulum cells around the smaller arterioles; these vessels follow the central arteriole to the hilus of the spleen. Circumstantial evidence suggests that the lymph vessels form a recirculation pathway for T-cells and possibly also for B-cells. In two areas of the splenic white pulp characteristic non-lymphoid cells are present. The central PALS contains interdigitating cells (IDC), which show a close contact with surrounding T-lymphocytes. The light zone of the follicle centre exhibits dendritic cells (DC). B-cells are found between the ramifications of the DC. It is conceivable that these cells play a role in the homing of T-cells and B-cells respectively. In addition they might create a microenvironment supporting differentiation and proliferation of T- and B-cells. The marginal zone does not contain a characteristic non-lymphoid cell type. However, in this compartment B-cells are directly exposed to the circulating blood. It is suggested that this factor constitutes one of the essentials of the microenvironment in the marginal zone.


Alpha-1-antitrypsin in duodenal fluid and gallbladder bile. Using the immunoelectrophoretic method alpha-1-antitrypsin was detected in all but 6 of 26 samples of duodenal fluid obtained from 16 patients with various gastroenterological problems. The concentrations (mg/100 ml) of alpha-1-antitrypsin in duodenal aspirates from children with liver disease (7.32 plus or minus 6.1) were less than those from children with cystic fibrosis, Shwachman Diamond syndrome, or Hirschsprung's disease (16.7 plus or minus 11.9; p smaller than 0.02). Alpha-1-antitrypsin was detected in all but one of 6 samples of gallbladder bile, the exception being that from a patient with extrahepatic biliary atresia. No significant correlation was found between the alpha-1-antitrypsin concentration in the samples studied and the corresponding total antitrypsin activity.


Tapeworm cyst infestations of the brain. Tapeworm cyst infestations of the brain often present as diagnostic problems. The radiological appearances in proven cases are discussed with a brief review of the life cycle and clinical presentations.


[Ulcerating duplication of the ileum as rare cause of massive intestinal hemorrhage in the adult]. In this paper is presented the case of a 27 year old woman in whom a congenital duplication of the distal ileum led to a massive hemorrhage. Heterotopic gastric mucosa was found in the ileal lesion and ulcer formation histologically proven. This case shows that congenital lesions of this sort may not come to the attention of the pediatrician or pediatric surgeon but become the concern of the surgeon in adult life.


Effects of the ultimobranchial and parathyroid glands and vitamins D2, D3 and dihydrotachysterol2 on blood calcium and intestinal calcium transport in the frog. Administration of 500 mug vitamin D2 or D3 with ingestion of calcium to ultimobranchialectomized (UBX) or UBX-parathyroidectomized (PTX) frogs (Rana pipiens) induced hyerpcalcemia and hypercalciuria not apparent in control or PTX frogs. Calcium transport in isolated everted gut sacs was significantly elevated in UBX and UBX-PTX frogs but not in controls or PTX animals. Further, with Vitamin D3 in UBX frogs the duodenal segment had a greater capacity to transport calcium than the jejunal-ileal segment when compared to control, PTX or UBX-PTX frogs. Dihydrotachysterol2 and calcium ingestion also induced hypercalcemia, hypercalciuria and increased calcium transport in gut of UBX and UBX-PTX frogs, with no change seen in PTX or controls after 5 days. The inhibitory influence of the ultimobranchial glands on intestinal calcium transport apparently does not require the presence of the parathyroids and exhibits an inhibitory influence against a high calcium gradient across the duodenal segment.


Calcium transients in amphibian muscle.

Calcium transients in amphibian muscle. The calcium-sensitive bioluminescent protein aequorin has been microinjected into isolated amphibian twitch muscle fibers in order to detect the intracellular calcium transients associated with excitation-contraction coupling. While it is not yet possible to make quantitative estimates of the changes in calcium concentration involved, it is possible to detect substantial changes in intracellular calcium transients resulting from changes in temperature, stimulation frequency, fiberlength, and the osmotic strength of the bathing medium.


Membrane particles and transmission at the triad. The structure of the membranes limiting the sarcoplasmic reticulum (SR) and transverse (T) tubules in frog and fish muscle fibers has been studied by freeze fracture. Emphasis is placed on the structure of the membranes at the triad, where thin sections have previously shown that rows of regularly disposed "feet" join SR and T exposed fracture faces allows the following conclusions. 1) The SR membrane is continuous and identical in appearance along the whole sarcomere. Thus the SR is a single uninterrupted compartment and it is likely that the major function of the reticulum, calcium accumulation is performed by the membrane limiting the lateral sacs of the triad, as well as the longitudinal tubules. 2) At the level of the junction with the T tublue, the SR presents a strikingly different number, size and arrangement of particles and pits. This distinct portion of the SR membrane extends father than the area covered by the junctional "feet" and no correlation can be found between the disposition of particles within the membrane and that of the feet on the membrane surface. 3) The T system membrane presents few prominent particles on its junctional face, but these are far less numerous than the feet. 4) Thus, no visible preformed channels exist between SR and T system lumina and it is suggested that direct electrical coupling between the two membranes during excitation is unlikely.


In vitro responsiveness of lymphocytes of different mouse strains to phytohaemagglutinin. Responsiveness of spleen and lymph node lymphocytes to in vitro stimulation by phytohaemagglutinin was investigated in several mouse strains. Considerable interstain differences in RNA and DNA synthesis were found both for PHA-stimulated and unstimulated cells; the latter component thus tends to contribute to the observed over-all differences in lymphocyte responsiveness to "specific" stimulation. Of the tested strains and F-1 HYBRIDS, THE HIGHEST RESPONDERS WERE A/Ph, its F-1 hybrids with a few other strains and BALB/C. The possibility that the interstrain differences in the rate of nucleic acid synthesis and hence in lymphocyte responsiveness could be due to different sensitivity of the lymphocytes to experimental treatment was not confirmed experimentally. Relatively high rate of synthesis of nucleic acids in PHA unstimulated cells and its great interstrain variation is interpreted in terms of variation in "spontaneous" transformability.


Teratogenesis and the movement of ions.

Teratogenesis and the movement of ions. There is evidence that in early embryos, mechanisms exist for the control of the movement of monovalent ions; that sodium is extruded during gastrulation and neurulation, and that in two- to three-day-old chick embryos with head abnormalities, ratios of sodium to potassium may be abnormally high. It is suggested that the origin of neural tube defects in early development may be associated with failure of control of ionic movements.


Lymphoid cell dependence of eosinophil response to antigen. VI. The effect of selective removal of T or B lymphocytes on the capacity of primed spleen cells to adoptively transferred immunity to tetanus toxoid. Spleens from mice primed with tetanus toxoid 30 days earlier contain memory cells capable of adoptively transferring secondary type cell-mediated (eosinophil) and humoral (antitoxin) responses to irradiated, reconstituted recipients. Spleen cells derived from 10-day-primed donors, on the other hand, possess the capacity after transfer to elicit secondary type eosinophil responses, but not anamnestic antitoxin responses. Treatment of 30-day-primed cells with anti-theta serum and C' prevented transfer of memory for both responses, whereas similar treatment with rabbit anti-mouse IgG (RAM-IgG) serum and C' only inhibited transfer of memory for the antitoxin response. Addition of non-primed spleen cells to antisera-treated primed cells failed to restore secondary type responses. Recombination of 30-day-primed anti-theta and RAM-IgG-treated cells re-established the capacity to transfer these responses. To determine whether the same T cells which mediate the eosiniphil response also act as helper cells in antitoxin production, antisera treated 10- and 30-day-primed cells were combined prior to transfer. Ten-day-primed T cells induced eisoniphil responses and also co-operated with 30-day-primed B cells to produce antitoxin. In contrast, 30-day-primed T cells elicited eisinophil responses, but were unable to induce antitoxin production when combined with anti-theta-treated 10-day-primed cells. These results indicate that B memory cells are not present in the spleens of the donor mice 10 days after priming, but T memory cells are present. It is concluded that primed T cells mediated both eosinophil and antitoxin responses, while B memory cells are involved only with antitoxin production. Following subcutaneous priming T memory cells are present in the spleen prior to B memory cells, and T memory cells which mediate the eosinophil response at 10 days after priming also augment the production of antitoxin by B memory cells.


The mechanism of interaction between T and B lymphocytes in the in vitro response to sheep erythrocytes. Non-specific collaboration across a dialysis membrane. Purified T lymphocytes from normal mouse spleen restored the antibody-forming cell response to sheep erythrocytes of various B lymphocyte populations when separated from them by a cell-impermeable dialysis or nucleopore membrane. A 2-5-fold increase occurred when spleen cells from neonatally thymectomized mice or congenitally athymic mice, and an adherent spleen cell population were used as sources of B cells. Antigen was required in both T- and B-cell compartments, but a nonspecific reconstitution occurred when the antigens present in the two compartments were different. It is concluded that during the first 20 hours of culture, T lymphocytes produce a non-specific factor in response to antigen. Although the factor acts at a distance, it does not have a non-specific mitogenic effect upon all B lymphocytes. Some of its properties are similar to those of other reported T-cell factors and of the 'sheep erythrocyte reconstitution factor', found naturally in some batches of foetal calf serum.


Growth of Mycobacterium marinum in the footpads of T-cell-depleted mice. Mycobacterium marinum strains 1218 and 1219 were inoculated into the hind footpads of T-cell-depleted specific pathogen-free C57B1/6 mice, and the growth and survival of the organisms at the site of injection, the draining popliteal lymph node, and the spleen and lung were quantitated for up to 70 days. T-cell depletion largely ablated the normal cell-mediated antituberculous response to the M. marinum population. The mice were able to control the further growth of the inoculum within the footpad only after it had reached 5 to 10 times that present in the normal controls. The high temperature-adapted strain (37 C; strain no. 1218) induced an increasing infection in the liver, spleen, and lungs of the THXB mice, and the infection eventually spread to the opposite footpad and to the tail skin. Strain 1219 gave rise to considerable systemic involvement in the THXB host despite its inability to survive at 37 C, but the size of the splenic and lung populations was considerably lower than in the 1218-infected animals. Both M. marinum infections persisted in the tissues of the T-cell-depleted mice with no indication of a cell-mediated immune response. Footpad swelling in the M. marinum-infected mice was not greatly reduced by T-cell depletion, and, if anything, tended to persist at high levels long after the swelling of the control feet had gone into a decline. On the other hand, incorporation of tritiated thymidine by cells within the infected footpads, the draining lymph node, and the spleen was considerably reduced in the T-cell-depleted host compared with control values. Late in the infection, there was a significant increase in the amount of label taken up by the cells in the footpads of the T-cell-depleted host.


Survival of synchronized Chinese hamster cells exposed to radiation of different linear-energy transfer. Chinese hamster V79 cells were exposed to ionizing radiations of a wide range of linear-energy transfer (LET), including 145kV x-rays and six different heavy ions accelerated in the Berkeley heavy-ion linear accelerator. The LET of the ions ranged from 19 keV/um to 2000 keV/um. Survival curves were determined for both synchronized and asynchronous cells, using survival of colony-forming capacity as the end-point. Results with asynchronous cultures were similar to results reported previously for mammalian cells. There was increased effectiveness of killing per dose with increased LET until a change in shape of the single-cell survival curves resulted, from sigmoidal to exponential, with carbon ions (LET of 190 keV/um). With heavier ions, exponential curves were obtained, but with decreased effectiveness per unit dose. Synchronized cultures were obtained by mitotic selection. The expected Chinese hamster cell-cycle survival curve variation was found for X-rays, mainly reflecting the variation in the single-cell extrapolation number, with late S-phase cells the most resistant to radiation. When synchronized cultures were irradiated with the heavy ions that produce exponential survival curves; the survival curves were independent of the cell-cycle time of irradiation. With radiations of LET values between the low and high extremes, a reduced cell-cycle survival curve variation was found, indicating a gradual reduction in the cell-cycle survival curve variation as a function of increased LET.


Chromosomal aberrations in rats fed irradiated wheat. The effects on chromosomal aberrations in bone-marrow cells of feeding irradiated wheat to well-fed and malnourished rats were investigated. Rats maintained on low levels of dietary protein (5 per cent) had a higher incidence of breaks and deletions in their bone-marrow chromosomes compared with rats maintained on  adequate levels of protein  (18 per cient), showing that the level of dietary protein per se can produce structural abnormalities. Feeding of irradiated wheat to rats was associated with increase in the number of polyploid cells in the bone-marrow. The level of protein in the diet did not appear to influence polyploidy.


[Role of DNA-membrane attachment in repair of radiation damage in Micrococcus radiodurans]. The unirradiated bacterial DNA assciated with the membrane is liberated into the cytoplasm after breakage of either a single or a double strand, resulting from X-ray action. During the reincubation period in growth-medium, the DNA is reassociated with the membrane. This phenomenon is very rapid and occurs without increasing the molecular weight of DNA. The study of DNA-membrane complexes shows that the size of the DNA-associated membranous fragment differs according to the lysing technique employed, appearing as a change in the density of the complex. Chloramphenicol decreases reassociation, and iodoacetamide, a radiosensititzing agent, inhibits it completely.


Effect of ethanol on the radiolysis of ribonuclease. The dependence of D 37 on the ribonuclease concentration was measured for depolymerase and hydrolase activity. Ethanol gives different radiation protection to the two functions by OH-scavenging. Evidence for the reaction of ethanol radicals was obtained by simultaneously scavening hydrated electrons, OH-and most of the H-radicals without increase in the radiation protection. The efficiency of the individual primary radicals and the ethanol radicals in inactiviating ribonuclease is calculated from the measured inactivation yield.


Mechanisms of radio-protection by catecholamines in the hamster (Mesocricetus auratus). Whole-body exposure to 1000 or 2000 rads in a 60Co source was used to study radio-protection by norepinephrine, isoproterenol, and phenylephrine in normal and splenectomized hamsters. After exposure, the animals were caged individually,  and percent survivals were recorded daily. The aortic blood pressure of permanently cannulated, unanaesthetized hamsters was measured to test the vasoconstriction-hypoxia mechanism of radio-protection, and plasma calcium levels were measured to test the hypothesis that isoproterenol protects through a mechanism of hypercalcaemia-stimualted cell proliferation. The data support the vasoconstriction-hypoxia mechanism for agents stimulating the alpha receptors, while beta agonists seem to protect through a hypotensive-hypoxia mechanism similar to that of histamine. All the catecholamines protect against the haematopoietic syndrome, but show no evidence of protection against the gastrointestinal syndrome.


Multiple cartilaginous exostoses in the dog. The clinicopathologic aspects of multiple cartilaginous exostoses (MCE) in 2 dogs were compared with those in 9 previously reported cases of MCE in dogs. Although a familial tendency is probable, there is apparently no sex or breed predilection. Only bones that developed by endochondral ossification were affected. The vertebrae, ribs, and long bones were the most frequent location of exostoses. Bones of the carpal and tarsal joints and the skull were not affected in the cases evaluated. Physical examination and radiography may provide strong supportive evidence for a diagnosis of MCE, but a definitive diagnosis must be based on microscopic evaluation of osseous lesions. Treatment is unnecessary unless growth of exostoses results in clinical sequelae. Surgical extirpation of lesions should be considered if dysfunction of the skeletal, muscular, or neurologic systems develops. The prognosis is variable, being dependent on the location and number of lesions, the age of the patient at the time of diagnosis, and the presence or absence of clinical complications.


Studies on the mechanism of action of calciferol. VIII. The effects of dietary vitamin D and the polyene antibiotic, filipin, in vitro, on the intestinal cellular uptake of calcium. Intestinal transport and cellular uptake of calcium were studied in vitro in ileal segments obtained from calciferol (vitamin D)-deficient (minus D3) chicks or in calciferol-treated chicks (+ D3). When calcium flux (J) was measured in both the mucosal yields serosal (J-ms) and serosal yields mucosal (J-sm) directions it was found that calcium transport in the +D3 system was an active process. Calcium was not actively transported in the minus D3 system or by either the +D3 or minus D3 serosal tissues which underlie the intestinal mucosa tissue. It was also found that the serosal tissue was not the rate-limiting step in calcium translocation. When calcium uptake was measured at the mucosal or brush border surface it was found to be a cation-oriented, saturable process in both the +D3 and minus D3 systems and was enhanced by calciferol supplementation. The rate of uptake was found to exhibit a two component transport phenomenon, one a saturable process at low Ca2+ concentrations and the other a linear of diffusion process at higher Ca2+ concentrations (greater than 5 mM). The polyene antibiotic, filipin, was used to study the transport and uptake of calcium in both the +D and minusD chick ileum in vitro. Filipin (10 mug/ml), when added in vitro to solutions bathing the mucosal surface of the ileum, stimulated the calcium flux, J-ms, of minus D ileal tissue by 150 to 200%, but had little or no stimulatory effect on J-ms of +D3 ileal tissue. However, in contrast it stimulated calcium uptake across the mucosal membrane in both the +D3 and minus D3 ileal tissue (50 to 100%). The effect of filipin is specific for calcium uptake as compared to Rb+, P-i, SO4(2-), glycerol, thiourea, and urea uptake. Isolated brush borders from +D3 chicks were found to bind calcium to a greater extent than the minus D3 brush borders, but both membrane fractions had the same cholesterol content. The sum of this and other evidence suggests that of uptake of calcium is a calciferol-mediated event which is not the rate-limiting step in the total transport of this ion across the intestinal epithelial cell. The filipin effect appears to affect a structural reorganization of the brush border membrane in both the +D3 and minus D3 membranes in a manner specific for calcium translocation. It now appears that filipin treatment somehow makes both transport systems more efficient in the uptake of calcium, but in a manner independent of the mode of action of calciferol. However, these data suggest that other components associated with calcium uptake are calciferol-dependent in an as yet unknown fashion.


Complications of Austin Moore arthroplasty. Their incidence and relationship to potential predisposing factors. In a retrospective computerized study of 451 Austin Moore arthroplasties (211 for acute hip fractures and 240 for hip reconstruction), the operative and general complications were correlated with the historical, preoperative, operative, and early and late postoperative factors usually thought to influence the results. Wound complications were significantly associated with diabetes and fracture, obesity and fracture, and procedures lasting two hours or more. General complications showing significant associations were: death or pneumonia with fractures, phlebitis with obesity, and myocardial infarction with fracture. Factors not significantly associated with complications included age, previous hip surgery, time of day of the operation, surgical approach, wound irrigation, use of drains, postoperative anticoagulation, and reaming of the acetabulum.


Direct-current stimulation of non-union and congenital pseudarthrosis. Exploration of its clinical application. Based on the response of bone to electrical current in previous studies, an exploratory clinical study of the effect of electrical current on non-union and congenital pseudarthrosis was performed. Constant direct current of ten to twenty microamperes was applied to twenty-four non-unions and five congenital pseudarthroses. Complete union occurred in fifteen non-unions and in one congenital pseudarthrosis. A single cathode delivering ten microamperes seemed sufficient to heal non-union in small bones, but multiple cathodes each delivering twenty microamperes appeared to be required to heal non-union in the tibia and femur. As the technique was refined, the percentage of successes increased. While these preliminary results appear promising, further laboratory and clinical experiments are required to define the true role of electrical stimulation in clinical practice.


Extractable nuclear antigen effect on the DNA anti-DNA reaction and NZB/NZW mouse nephritis. Extractable nuclear antigen (ENA) is composed of at least two components, one a ribonucleo-protein sensitive to ribonuclease or heat and the other a protein. Antibodies to ENA are associated with a relatively benign clinical course in patients with systemic lupus erythematosus (SLE) in which DNA anti DNA complexes are thought pathogenic. The effect of ENA and anti-ENA on DNA anti-DNA reactions in vitro was studied. ENA effectively inhibited an anti-DNA hemagglutination reaction but no effect was found on binding of radioactive DNA or on the anti-hemocyanin hemagglutination reaction. The inhibitory effect was not abolished by yeast ribonuclease (RNase), heating, or DNase. Anti-ENA HAD NO EFFECT ON ANTI-DNA hemagglutination. In vivo, ENA altered the NZB/NZW mouse nephritis thought to be a model for human SLE nephritis. These results suggest the possiblity of a role for ENA in alteration of diseases due to pathogenic DNA anti-DNA complexes.


Cell-mediated immunity in acute and chronic hepatitis. Peripheral lymphocytes from patients with hepatitis-B surface antigen (HBsAg)-positive and -negative acute hepatitis (AH), chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and normal controls were tested for in vitro cytotoxicity and blast transformation. Cytotoxicity was measured by chrominum (21Cr) release into the medium from 51Cr-labeled Chang liver cells after incubation for 6 h with peripheral lymphocytes at a lymphocyte target cell ratio of 200:1. Concomitant 72-h incubation studies were performed to assess thymus cell-dependent (T) lymphocyte function as measured by conccanavalin A (Con A)- stimulated incorporation of tritiated thymidine (blast transformation) and by cytotoxicity. It was found that (a) lymphocytes from patients with AH are cytotoxic to Chang liver cells compared to controls (P less than 0.001); (b) lymphocytes from patients with acute and chronic hepatitis are less cytotoxic when incubated with autologous and homologous HB2Ag-positive and -negative AH, CAH, and CPH are as cytotoxic as normal controls when stimulated with a nonspecific mitogen such as Con A; and (d) lymphocytes from patients with CAH while on prednisone therapy showed marked depression of cytotoxicity when stimulated with Con A. Thus these studies show that patients with AH have circulating T lymphocytes which are capable of causing the destruction of Chang liver cells. There is no defect in T-cell function as measured by Con A-stimulated cytotoxicity. There is a serum factor (s) in patients with acute and chronic hepatitis which inhibits spontaneous and induced lymphocyte cytotoxicity and blast transformation. Finally, prednisone treatment appears to inhibit lymphocyte cytotoxicity in patients with CAH.


Preliminary evidence for cell-mediated immunity in cross-protection among group A arboviruses. Unfractionated and T cell-enriched populations from spleens of mice immunized with Sinbdis virus confer cross-protection against Semliki forest virus challenge in recipient mice. Both Group A viruses are serologically related, but not by tests for cross-neutralizing antibody. The protection in mice persisted for three consecutive cell passages in uninfected mice. The results suggest that cell-mediated immunity accounts for cross-protection.