Hyperacute renal allograft rejection in the primate. Intrarenal effects of heparin and associated net release of factor VIII activity and kallikrein activation. Two groups of specifically presensitized Macaca speciosa monkeys received renal allografts via anastomosis to an indwelling arteriovenous (A-V) shunt. One group was pretreated with heparin (2 mg/kg) intravenously and the other was also treated with constant heparin infusion (1 mg/kg/hr) directly into the renal artery. These studies were performed to evaluate the effects of heparin within the kidney on total and compartmental blood flow, complement (C3) levels, sequestration of formed elements, and activation of the coagulation, fibrinolytic, and kinin-forming systems during the initial 3 hours of hyperacute rejection. The results are compared with those previously reported in unmodified control allografts. Heparin prolonged blood clotting time to infinity, markedly prolonged total renal venous blood flow, and normalized compartmental distribution in both groups despite antibody deposition similar to that in controls. With heparin pretreatment only, initial morphologic injury was much reduced but then progressed rapidly. Marked initial cortical cyanosis with mottling appeared to change constantly and was associated with fluctuations in renal turgor, total blood flow, and sequestration of formed elements, all of which suggested repetitive local cortical arterial spasm and incremental destruction of the grafts. Activation of coagulation Factors II and XII was also revealed and marked net Factor VIII activity was observed in the venous effluent. The latter reflects either formation and release of this factor by the injured kidney, or provides in vivo documentation of the "hyperactivation" of Factor VIII by thrombin known to occur in vitro. The addition of intrarenal artery heparin infusion resulted in greater improvement in early total blood flow rates and more uniformly progressive cyanosis and loss of turgor, but the diffuse initial morphologic injury suggested more uniform perfusion of injured areas. Intrarenal consumption of C3 and sequestration of formed elements was similar to that in controls. Paradoxically, prompt activation and consumption of all coagulation factors, plasminogen, and prekallikrein were observed, but formed fibrin was sparse. The exess amount of Factor XIIa present during heparin blockade may have been diverted to production of plasminogen activator and kallikrein formation. The enormous numbers of neutrophils observed within vessels of grafts which showed the greatest kallikrein activation provide the probable in vivo demonstration of the chemotactic properties of kallikrein noted by others in vitro. Heparin-induced platelet aggregation may have played an important role in the failure of these grafts. These studies elucidate the intrarenal effects of heparin during hyperacute rejection and again suggest that vasoconstriction is the most important early determinant of graft failure, as blood flow appeared unrelated to the degree of vascular injury and apparent obstruction. Also, heparin may exer a beneficial effect on blood flow by other than its known action on coagulation.


A possible autoimmune parathyroiditis following ozone inhalation. II. A histopathologic, ultrastructural, and immunofluorescent study. Histologic, ultrastructural, and immunofluorescent changes in the parathyroid glands of rabbits have been studied after 48 hours of ozone inhalation at a dosage of 0.75 ppm. The frequent changes observed included hyperplastic parathyroiditis followed by capillary proliferation and leukocytic infiltration. The progressive cytologic events consisted of the presence of eosinophilic leukocytes, reticuloendothelial and lymphocytic infiltration, disaggregation of the parenchyma, and interstitial edema. The ultrastructural changes consisted of degeneration of nuclei, atrophy of the mitochondria, dilatation and atrophy of the endoplasmic reticulum of the chief cells of the parathyroid gland, proliferation of the venous limb of the capillary network, and the prominent interstitial elements. The immunofluorescent techniques revealed positive immunologic response. These data suggest that ozone inhalation perhaps triggers an immune reaction which causes inflammatory injury to the parathyroid gland. The possibility that the modified functional chemical groups of the parathyroid gland act as autoantigen is discussed.


Comparative anatomy of the larynx in man and the chimpanzee: implications for language in Neanderthal. Using the larynges of the newborn human and chimpanzee as models, Lieberman and Crelin ('71) and Lieberman, Crelin and Klatt ('72) have reconstructed the larynx of the "classic" Neanderthal La Chapelle aux Saints. The authors used their reconstructed vocal tract to generate linguistic functions which led them to conclude that Neanderthal lacked the ability to produce fully articulate human speech. In this paper, it is shown that their reconstruction of the larynx of Neanderthal is based on a placement of the hyoid bone of La Chapelle which is too high. The reconstructed hyoid bone of La Chalpelle which is too high. The reconstructed hyoid bone has been placed in a position unlike that occupied by hyoid bones of newborn humans, adult humans, stillborn chimpanzees or adult chimpanzees. In any laryngeal reconstruction, the function of swallowing must be taken into account. The ability of the reconstructed Neanderthal to swallow is discussed in light of a comparative analysis of swallowing in man and the chimpanzee. It is concluded that the statement that Neanderthal was less than fully articulate remains unsubstantiated because it rests on a questionable reconstruction of the larynx.


Genetic, acclimatizational and anthropometric factors in hand cooling among North and South Chinese. The left hands of unacclimatized North Chinese (N=16) and South Chinese (N=13) were exposed to 5 degrees C water for 30 minutes followed by a 10 minute recovery period. Significant differences independent of body composition were found between the two samples on mean 30 minute temperature during immersion, time and temperature of the onset of initial CIVD (cold-induced vasodilation) at 0.01, 0.05 and 0.10 levels respectively. The result suggests the presence of a genetic component in the cold responses of Continental Asian populations and the possibility of the presence of a clinal distribution of cold response in Asia.


Arthritis in the prehistoric Southeastern United States: biological and cultural variables. Recent research shows that a bacterial life form, Erysipelothrix insidiosa, can produce rheumatoid arthritis in deer, swine, and dogs, and that a number of animals, including man, birds, and fish, may be infected by the organism. Examination of the archaeological record suggests that both cultural and biological variables may be interrelated in the maintenance of some forms of arthritis over long periods of time in geographically disparate populations. Re-examination of Cherokee folk beliefs concerning arthritis suggests that they had some recognition of this connection, and it also suggests that they had some recognition of this connection, and it also suggests that the term "magical" may relate more to the world view of the observer than to any actual inability of preliterate peoples to draw causal relations on the basis of their own intimate knowledge of their environments.


Cobalt inhibition of insulin secretion and calcium uptake by isolated rat islets. Cobalt (Co'++) inhibited glucose-, leucine-, and K'+-induced immunoreactive insulin (IRI)release by isolated rat islets.  This inhibition of the insulinotropic effect of glucose was dose dependent, affected both phases of secretion, was very rapid, and was well reversible.  It exhibited a kinetics similiar to that of Ca'++ omission, and the metal (2.5 mM) prevented Ca'++ reintroduction from restoring a normal rate of IRI release.  Theophylline (2 mM) partially overcame the inhibitory effect of 0.5 mM Co'++, but not that of 2.5 mM.  Glucose-induced secretion was lessmarkedly reduced by 0.5 mM Co'++ in the absence of Mg'++ or in the presence of 7.5 mM Ca'++.  Even at 12.5 mM, the metal did not alter glucose oxidation by theislets.  By contrast, Ca uptake by islet cells was reversibly diminished (55%) in the presence of 1.25 mM Co'++.  Calcium influx (measured after 2.5 min) was aslo reduced by Co'++ to a degree that did not change after longer incubation periods.  It is concluded that Co'++ inhibits IRI release mainly through an antaognistic action on Ca entry in beta cells.


Secretin effect on gastrin, gastric secretion in dogs with chronic antral stimulation. Antrocolic transposition in four dogs with Heidenhain pouch and gastrojejunostomyresulted in a marked increase in fasting plasma gastrin concentration and sustained highacid secretion, closely related to gastrin levels.  A marked production of pepsin output could not be correlated with plasma gastrin.  Reduction in plasma gastrin concentration was more than twofold less pronounced than the reduction in acid output for 1 and 2 U/kg-h, while the 0.5 U/kg-h no effect was noted.  For both acid output and gastrin concentrations, close correlations were noted between presecretion level and remaining level upon secretin infusion.  Despite the reduction in the secretory volume of the pouch, 0.5 and 1 U/kg-h of secretin induced a 1.5- and 2-fold increase in pepsin output, respectively.  Two untis per kilagram-hour decreased the secretory volume as well as the pepsin output.  If the physiological release of secretin in dogs does not exceed the equivalent of the lowest dose studied, our results would indicate that acid inhibition is a physiological activity of secretin, while the effect on circulating gastrin concentration seems to be phamacological.


Psychiatry and the elderly: an overview. The author notes that the elderly in our society have not been provided with treatment, research, and services commensurate with their needs. These needs are reflected in the increasing incidence of psychopathology, suicide, and poverty with increasing age. The psychiatric profession's therapeutic nihilism toward the elderly may reflect unresolved countertransference issues that result in a form of prejudice called "ageism." Many of the conditions labeled "senility" are actually manifestations of socioeconomic or medical problems that could be resolved with prompt, appropriate treatment. The author makes several recommendations--the creation of a multidisciplinary nongovernmental commission on mental health and illness of the elderly, reexamination by psychiatrists of their attitudes toward the elderly, and proportionate representation of older individuals in psychiatric services, training, and research.


A study of transsexuals seeking gender reassignment. The authors report the results. of a computerized psychodiagnostic assessment of 19 males and 1 female seeking sex-reassignment surgery. The most pervasive finding was hysterical personality trend (13 of 20 cases). Twelve patients exhibited psychotic trends: 6 showed psychotic thinking on test scores, and 6 received computer-preferred diagnoses of paranoid or schizoid personality. However, most of these 12 patients were not considered psychotic on interview, and those who had sex-reassignment surgery had good results


Massive development of amebas in the large intestine. Fedor Aleksandrovich Lesh (Lösch). Fedor Aleksandrovich Lesh (Lösch) 1840-1903. Although Lösch was a distinguished Russian physician, little has been written about him in English. A graduate of the Medico-chirurgical Academy in St. Petersburg (1863), he defended a doctoral thesis on pulmonary embolism and infarction in 1866, and became an assistant professor of medicine in 1871. From 1872 to 1885 he was a lecturer on diagnosis at the Women's Medical College and a consultant to the Nikolayev Military Hospital. In 1885 he became Professor of Diagnostic Medicine at Kiev University where he remained until his retirement in 1897. In 1870, Lösch found Balantidium coli in the stools of two patients and made a detailed study of the clinical aspects of balantidiasis. In the same year he described in detail Giardia lamblia and Blastocystis hominis. Altogether, he published some 20 papers on the diagnostic and clinical aspects of various diseases, with special emphasis on the microscopic aspects of coprology. It was in 1875 (exactly 100 years ago) that Lösch, in this monumental paper, reported the clinical aspects of recurrent intestinal amebiasis, identified and described its cause, Entamoeba histolytica, and produced the disease in an experimental animal. This work on amebiasis was completed while he was assistant professor at St. Petersburg, on the wards of Prof. E. Eichwald. Clinicians will cherish the description of the patient's symptoms; protozoologists must be delighted by the description of the parasite and its motility; experimentalists will be nervous about his luck in infecting one of three dogs; and iconoclasts must derive satisfaction from Lösch's caution in not automatically assigning a direct causal relationship between the presence of the parasite and the disease.


Observations on malaria in Indonesian timor. Malaria parasitemias were found in 35% of 520 individuals from a village in Timor, Indonesia. Plasmodium falciparum accounted for 80% of infections. The existence of P. ovale in Timor is reported for the first time. The WHO Standard Field Test for drug resistance did not reveal significant resistance of P. falciparum or P. vivax to chloroquine.


Application of the indirect fluorescent antibody method in a study of malaria endemicity in Mato Grosso, Brazil. Four surveys of malaria endemicity were conducted in the Cuiabá Sector of Mato Grosso State, Brazil, at 6-month intervals during the period April 1970 to September 1971; during April 1970 a survey was also conducted in the Campo Grande Sector. Over 4,000 dual specimens--blood films for parasite diagnosis and filter paper blood spots for determination of fluorescent antibody (IFA) response--were collected from the general population, including school populations whenever possible. Parasitologic examinations yielded positivity rates ranging from 0.8 to 2.3%. In the Cuiabá Sector, sero-positives (larger than or equal to 1:20) ranged from 9.3 to 13.6%; in the survey in the Campo Grande Sector only 4.3% of the specimens were positive. There was an expected increase in IFA response with age in both the proportion of positives and mean maximum titers. In the Cuiabá surveys 75 to 91% of the maximum positive responses were to the Plasmodium falciparum antigen, while in Campo Grande only 46% of the maximum titers were for P. falciparum. The wide differences in malaria endemicity observed within the Cuiabá Secctor were attributed to differences in climate, geography, and degree of development of the several regions. A study of surveillance reports from 1966 through the survey dates revealed that the high rates of infection seen often resulted from detection activities in the larger cities and probably represented cases imported from endemic areas to the north and west. In order to interpret accurately the endemicity of malaria in an area and, thus, determine the necessity for introduction or continuation of control measures, thorough epidemiologic studies are necessary. The addition of a serologic method to normal surveillance can increase the accuracy of interpretation.


Development of antibodies to Plasmodium vivax as measured by two different serologic techniques. Sera from individuals infected with Plasmodium vivax were tested for the presence of malarial antibodies using the indirect fluorescent antibody (IFA) and the indirect hemagglutination (IGA) tests. The primary infection resulted in the conversion of all sera to a positive response in the IFA test, whereas only 50% gave a positive IGA response. There was a direct relationship between the duration of the primary parasitemia and percentage giving positive IGA response. Relapse resulted in high level positive IFA and IGA responses.


Pathogenesis of acute avian malaria. IV. Immunologic factors in nephritis of acute Plasmodium gallinaceum infections of chickens. Study of urinary waste of chickens with acute Plasmodium gallinaceum malaria indicated that serum proteins of the globulin and albumin classes were passed. Protein extravasation did not begin until globulin-associated serum antigen and its antibody were detected in the blood. Both serum antigen and antibody were found in the wastes for as long as the antigen was present in the blood. Extracts of kidney tissues contained serum proteins that were not present in extracts from normal kidneys, and serum antigen and its antibody were both present. Frozen kidney sections reacted strongly with fluorescein-conjugated antibody to serum antigen, showing diffuse granular immunofluorescence characteristic of immune complex nephritis. Sections from chickens with nephritis induced by injections of malarious plasma also showed deposits of extravasated antigen. The experiments suggested that complexes of serum antigen and antibody served as a permeability factor, or activated other permeability factors and may have caused the glomerulonephritis associated with acute avian malaria. The passing of serum proteins in the urinary wastes after chickens had recovered from acute malaria suggested that persisting damage may have resulted.


Soil survival of toxoplasma oocysts in Kansas and Costa Rica. Toxoplasma oocysts in cat feces were marked with a tracer amount of strontium-85 (85-SR), and were superficially buried simulating the natural disposal of feces by cats. Oocyst infectivity in Costa Rica was followed qualitatively and persisted for 1 year in three shaded sites, two moist, and one relatively dry site. Oocyst infectivity was quantitated in the Kansas deposit over a period of 18 months, including two winters. After initial mixing in soil, the level of infectivity remained fairly stable. Infectivity was recovered, probably from the surface on one Musca, several isopods, and earthworms. These data on persistence of Toxoplasma oocysts in soil support the concept that Toxoplasma infectivity in nature may be increased logarithmically by cats.


Rifampin therapy of lepromatous leprosy. Patients with borderline-lepromatous (BL) or fully lepromatous (LL) leprosy were treated in the sanitarium for approximately 1 year with oral rifampin (600 mg daily) or with oral dapsone (100 mg daily). They were then treated as outpatients with intramuscular acedapsone (225 mg every 12 weeks) or oral dapsone (50 mg daily). They have now been followed for a total of 28 to 34 months. Death of Mycobacterium leprae during the initial 24 weeks was monitored by mouse inoculation with M. leprae from skin punch biopsy specimens. With rifampin therapy, death of M.leprae occurred rapidly, and viable M. leprae were nearly undetectable by the time the first specimen was taken after the start of treatment, at 4 weeks. With dapsone therapy, death of M. leprae was slower, and in some cases the inoculation results were still positive at 12 weeks. The therapeutic response during the period of outpatient treatment has been satisfactory. The number of dead M. leprae, as measured by the bacterial index in skin smears and the number of acid-fast bacteria in skin specimens, has continued to decrease, and clinical progress has been satisfactory. The measured drug-induced death of M. leprae occurred at about the same rate in BL patients as in LL patients. Disappearance of dead M. leprae from the tissues was much more rapid in BL patients than in LL patients.


Acedapsone (DADDS) treatment of leprosy patients in the Karimui of Papua New Guinea: status at six years. Acedapsone (DADDS), a repository sulfone given by injection five times a year, has been used since 1967 for the treatment of all leprosy patients in the Karimui, an area of diffic-lt access. More than 460 patients have been treated, 336 beginning in November 1967 and continuing through the latest assessment 6 years later. The injections have been well received and they have been administered very regularly. Clinical observations were begun before 1967, as a base-line of assessments was available for the patients whose disease appeared before that time. The response to DADDS therapy has been satisfactory except in 5 of the 28 multibacillary patients in whose smears solid-staining Mycobacterium leprae have reappeared. M. leprae was isolated in mice from three of these patients; one strain has been proven to be completely susceptible to dapsone (DDS), and the other two very probably are. DDS levels in the plasma of these five patients were normal and well above the minimal inhibitory concentration. The most probable explanation is that a few viable M. leprae survived in the presence of inhibitory concentrations of DDS for the 4 to 6 years during which dead bacilli were disintegrating and disappearing from the tissues. The other 23 multibacillary patients responded satisfactorily. The decrease in the number of M. leprae in the skin smears has been most prompt in patients with low initial bacterial loads and in those with borderline lepromatous diagnoses. A high initial bacterial load and a fully lepromatous diagnosis were associated with a slow initial loss of M. leprae in the 1st year, followed by a more rapid loss the next year. All of the multibacillary patients have now been treated by the addition of a 90-day course of rifampicin.


Simian hemorrhagic fever: Studies of coagulation and pathology. Simian hemorrhagic fever (SHF) was induced in three species of monkeys (Macaca mulatta, M. radiata and M. fascicularis) using plasma from animals that died with SHF in the 1967 outbreak at the California Primate Research Center. The disease was uniformly fatal in all three species with death occurring by day 5 in M. radiata and M. fascicularis and by day 7 in M. mulatta. Serial studies of hemostasis were consistent with the occurrence of disseminated intravascular coagulation, particularly in the M. mulatta. Studies of pathology were typical of previously reported findings in SHF and support the possibility of intravascular coagulation. The role of intravascular coagulation in the pathogenesis and outcome of SHF remains uncertain but studies of the influence of heparin on the disease are in progress.


Natural infections of Anopheles albimanus with Plasmodium in a small malaria focus. Entomologic surveys conducted in a small village in an area of known high malaria transmission in El Salvador yielded a high rate of infection in Anopheles albimanus collected inside houses in which cases of malaria had occurred. Of 324 specimens dissected, 12 were found to harbor sporozoites or oocysts. This is in contrast to prior reports of extremely low infection rates in collections of this species from malarious areas, and suggests that under some circumstances A. albimanus does meet the criteria of an effective malaria vector.


Amodiaquine resistant falciparum malaria in Thailand. Amodiaquine cured 38% (13/34) of patients with falciparum malaria in Southeast Thailand. Chloroquine cured 0% (0/13). The cure rates with amodiaquine were the same whether a 1.5 g or 2.0 g course was used. Most patients were resistant to amodiaquine at the RI level and to chloroquine at the RII level. In hospital, amodiaquine cleared parasitemia more frequently than did chloroquine. With the 2.0 g course of amodiaquine, the parasite clearance time was 77 hours; the fever clearance time of 36 hours was low and suggests that amodiaquine does not cause a drug fever. Because of resistance, chloroquine should not be used for falciparum malaria in Thailand. Routine use of amodiaquine is not indicated because more effective drugs are available.


Emergence of La Crosse virus from endemic foci. Fluorescent antibody studies of overwintered Aedes triseriatus. The frequency and distribution of La Crosse (LAC) virus overwintering in Aedes triseriatus diapause eggs were studied during 1974 by following 64 tree-hole oviposition sites in four enzootic hardwood forest areas. A direct fluorescent antibody technique, adapted for detection of LAC virus in individual mosquitoes, proved to be a rapid, reliable and economical tool for ascertaining true field infection rates. Virus was found in larvae from each of the four study areas before the seasonal emergence of adults and detected in 10 (0.6%) of 1,698 individually processed adults reared from collected larvae. In one of these study areas, all 12 located tree-holes were enclosed with screen before the seasonal emergence of adults, to ensure that all collected from these sites originated from overwintered eggs. Of 1,280 Aedes triseriatus processed from this area throughout the season, 16 (1.2%) contained virus. Isolates were found in overwintered Aedes triseriatus throughout the summer months, demonstrating the role of these tree-hole sites as foci for both overwintering and continuing summer season source of LAC virus in these forested areas.


Simplified technic for orthotopic liver transplantation in the rat. A new surgical procedure has been developed to simplify the difficult, complex technic of orthotopic liver transplantation in the rat that we previously described. This procedure eliminates the hepatic artery anastomosis and specifically changes the sequence of anastomoses of the vena cava and portal vein to minimize splanchnic congestion and hepatic ischemia. This has simplified and shortened the operation and has eliminated the need for an extracorporeal portosystemic shunt. Seventy-two per cent operative survival was achieved in fifty-seven orthotopic liver transplantations. This simplified technic of orthotopic liver transplantation in the rat can be applied widely to studies of liver physiology, immunologic rejection, and liver preservation.


Prolongation of pancreatic allograft survival by 5-fluorouracil. Recipient survival in canine pancreatic allotransplantation was significantly prolonged when animals were treated with 5-fluorouracil in combination with low-dose azathioprine. Untreated dogs and those receiving only azathioprine survived for only short periods of time, and pancreatitis was frequently encountered. In contrast, animals treated with 5-fluorouracil were protected from pancreatitis and survived an average of almost three weeks.


Biology of infections of split thickness skin grafts. The purpose of this study was to identify determinants of split thickness skin graft infection. The bacterial count of the experimental wounds was proportional to the incidence of infection in split thickness skin grafts. When the wound was heavily contaminated with 107 organisms, infection developed under most grafts. Graft take frequently occurred in wounds subjected to a lower level of inoculum. The importance of bacterial counts as a determinant of potential skin graft infection was also suggested by a clinical study. We now routinely use quantitative bacterial counts to identify the granulating wounds that are ready for grafting. The type of organism played no significant role in the development of infection.


Early detection of acute rejection in renal allografts using radioiodinated autologous fibrinogen. 131I-labeled autologous fibrinogen was used to detect acute renal allograft rejection in the early postoperative period. Ratios of radioactive counts over transplanted kidneys to those over the heart increased with deposition of radioactive fibrinogen in kidneys undergoing rejection. The test was positive in all instances of acute rejection twelve to twenty-four hours prior to clinical ro biochemical changes. False-positive test results were noted in instances of perinephric hematoma, seroma, and wound abscess and in one patient with urinary tract infection. The test was negative in cases of renal failure secondary to acute tubular necrosis, uric acid nephropathy (in the absence of acute rejection), and chronic rejection. This test is simple, rapid, and practical. It can be performed at the bedside and is free from complications, particularly serum hepatitis.


Spectrum of cholangitis.

Spectrum of cholangitis. Of 402 patients admitted with biliary disease over the last three years, cholangitis has been diagnosed in 36. This represents an 8.8 per cent overal incidence and a 33.8 per cent incidence among patients who have undergone operation or manipulation involving the common duct. Based on this experience, a program of prophylaxis and treatment of cholangitis has been devised with special emphasis on the management of elderly patients in the initial postoperative period.


Enzymatic dissolution of phytobezoars.

Enzymatic dissolution of phytobezoars. A review of phytobezoars is presented, emphasizing medical treatment using enzymatic dissolution for bezoar located in the gastric pouch. Clinical and in vitro studies show the efficacy of both papain and cellulase, and it is suggested that, since each acts on a different component of the bezoar, they be administered in combination. There were no complications with this treatment in the patients reported in this series.


[Experimental candida keratitis. Histological, immunological and electron microscopical studies (author's transl)]. Using histological, immunohistological and electron microscopical methods, it could be demonstrated that the course of experimental Candida albicans keratitis in mice invlves three phases: a traumatically caused alternative phase is followed by a granulocytic exsudative phase and finally by a proliferative phase. The experiments were followed over 41 days. Fungal elements could be detected only during the first 4 days after infection. When topically treated with hydrocortisone, the exsudation of leucocytes was diminished and delayed and the cellular proliferation was reduced considerably in the challenged corneal stroma. A lower number of Candida organisms was found in the cornea when treatment with hydrocortisone was combined with the antifungal drug pimaricin. When treated with pimaricin only however, fungal growth and inflammation were least apparent.


Rapid freezing of deep cerebral structures for electron microscopy. A method is described for the investigation of deep cerebral structures by freeze-substitution. The head of a mouse is sectioned in a guillotine-like apparatus. The exposed surface is subjected to freeze-substitution. Electron micrographs prepared from this material exhibit under a layer of sheared tissue, a layer of tissue comparable with that observed previously in micrographs of the cerebral and cerebellar cortices subjected to freeze-substitution of their natural surfaces. By varying the plane in which the head is sectioned any structure in the brain can be made accessible to freeze-substitution.


The influence of function on chondrogenesis at the epiphyseal cartilage of a growing long bone. In order to study the behaviour of epiphyseal cartilage in a nonfunctional environment, the third metacarpal bone was transplanted intracerebrally as an isograft between 7-day-old litter-mate rats. Host animals were killed 1, 2, 3, 4, 5, 6 weeks post-operatively, and the cellular kinetics evaluated by means of tritiated thymidine autoradiography. The study was also used to compare the effects of function on chondrogenesis at the epiphyseal cartilage with that previously demonstrated for the condylar cartilage of the mandible (Meikle, '73a). Transplantation resulted in three major changes in the cartilage; there was a decreased rate of proliferative activity in the cell columns; the cartilage failed to maintain a satisfactory increase in transverse diameter; the cells of the perichondrium differentiated into osteoblasts instead of chondroblasts. Autoradiographic and histological findings suggested that the inability of the cartilage to increase in transverse diameter was related to the decreased rate of proliferative activity in the cell columns and not to the cessation of perichondrial chondrogenesis. On the basis of these findings two conclusions can be made. 1. Extrinsic mechanical stresses associated with function appear to be necessary for the normal interstitial growth of epiphyseal cartilage during postnatal development, suggesting that functional activity can influence the rate of cell proliferation. 2. Functional activity provides the stimulus for the differentiation of perichondrial cells into chondroblasts.


A Double-blind crossover trial of pseudoephedrine and triprolidine, alone and in combination, for the treatment of allergenic rhinitis. In a double-blind crossover trial of pseudoephedrine 60 mg and triprolidine 2.5 mg, alone and in combination, on 40 volunteers suffering from allergic rhinitis, both drugs were found superior to placebo in reducing the effects of allergic rhinitis and were of equal efficacy. The combination tablet was consistently better than either drug in several of the assessments and was the treatment which the subjects, as a whole, preferred. Side effects were not a problem with any of the medications.


Exercise-induced bronchospasm: evaluation of albuterol aerosol. Albuterol aerosol was compared with isoproterenol and placebo in a double-blind, cross-over study in 12 asthmatic children. A significant increase in mean peak expiratory flow rate 15 minutes after albuterol inhalation persisted for at least five hours after treatment. Inhalation of albuterol one hour before treadmill exercise inhibited exercise-induced bronchospasm.


Specificity of an immunofluorescent test for identification of type specific ragweed antibodies. An immunofluorescent test using ragweed pollen grains for identification of immunolglobulin type-specific rag weed antibodies is described.  The test measured effectively antibody specificity produced by immunotherapy with Allpyral.  Repeating the test after ragweed inhibition and the use of an unrelated pollen grain verified the specificity of the test.


Development of specific lymphocyte immunostimulation and tuberculin skin reactivity in swine infected with Mycobacterium bovis and Mycobacterium avium. Swine infected with Mycobacterium bovis and Mycobacterium avium were studied for development and specificity of lymphocyte immunostimulation and tuberculin skin reactivity to purified protein derivatives (PPD) of tuberculins. Lymphocytes from infected animals had maximal blastogenic responses to PPD prepared from the homologous organisms. The time of appearance of specifically sensitized lymphocytes was studied, as was the specificity of skin reactivity. In vitro lymphocyte responses of M avium serotype 1-infected swine to M avium serotype 1 PPD were greater than were the responses of M avium serotype 2-infected swine to the same antigen. Results indicate that the specific stimulation of sensitized lymphocytes might prove useful in the diagnosis of tuberculosis in swine and in differentiating infections due to different serotypes of M avium.


Pathogenesis of in utero infection: experimental infection of five-week-old porcine fetuses with porcine parvovirus. Injection of porcine parvovirus (PPV) into the allantoic fluid of 3 or 4 fetuses of each of 4 litters of PPV-immune gilts early in gestation (34 to 36 days) resulted in fetal maceration and mummification. A high concentration of virus demonstrated in many tissues of fetuses collected 1 week after initial intraallantoic exposure indicated extensive viral replication. Progressively lesser amounts of virus were isolated from tissues of macerated and mummified fetuses collected after longer intervals; however, direct examination of many of the same tissues by immunofluorescence microscopy revealed masses of viral antigen throughout. Abortion was not a sequela of infection of fetuses of immune gilts nor was either virus or viral antigen ever demonstrated in maternal tissues, including those contiguous with infected fetuses. Intrauterine transmission of PPV from fetuses exposed by intraallantoic injection of virus was only confirmed for 2 of the 18 littermate controls that were tested.


Experimentally induced infection of neonatal swine with porcine parvovirus. One-day-old pigs were exposed to porcine parvovirus (PPV) and killed at postinoculation day (PID) 3 or 7. Signs of illness and lesions were not seen. Hemagglutination-inhibition (HI) antibodies for PPV were present in the serums of pigs killed on PID 7. As detected by viral isolation and immunofluorescence, PPV was mainly located in rapidly proliferating tissues. Heaviest concentration of viral antigen was in the germinal centers of lymph nodes and lightest concentration of antigen was in the central nervous system.


Factors involved in bactericidal activity of sheep serum. The bactericidal activity of blood, plasma, and serum from sheep was measured with 3 strains of Escherichia coli. Plasma showed greater bactericidal activity than blood or serum for strains O78:K80(B) and Lilly. The antibody-complement system of normal serum killed the rough strain, Lilly, but neither antibody nor complement alone were bactericidal. Antibody, complement, and an additional heat-stable cofactor were necessary for killing strain O78:K80(B). Strain 3662 was not susceptible to the lethal action of the antibody-complement system. Capsular and flagellar antibodies did not appear to play any part in the bactericidal activity of serum. There was no relationship between the titer of antibodies to the somatic antigen and the bactericidal titer in the immune serums. The antibodies necessary for killing the smooth strain of E coli, O78:K80(B), were absorbed with the rough strain, Lilly, but not by the other smooth strain, 3662. It is suggested that the target antigen of the bactericidal antibody is not the somatic antigen, but a rough antigen internal to the O polysaccharide.


Bactericidal and opsonic activities of normal sheep serum against gram-negative bacteria. The bactericidal and opsonic activities of normal sheep serum against 9 smooth and 4 rough strains of gram-negative bacteria were measured. Three smooth strains-Escherichia coli 3662, Salmonella typhimurium, and Salmonella gallinarum-were resistant to the bactericidal action of normal sheep serum with or without complement. Six smooth strains-E coli O78:K80(B), Salmonella arizonae, Proteus inconstans, Klebsiella pneumoniae, Salmonella stanley, and Salmonella abortus-equi-were moderately sensitive to bactericidal activity of fresh sheep serum. After complement was added, serum heated at 56 C for 30 minutes did not regain its bactericidal activity against E coli O78:K80(B), P inconstans, nor S abortus-equi. Four rough strains-E coli Lilly, Salmonella cholerae-suis, Shigella sonnei, and Hafnia alvei-were very sensitive to the bactericidal activity of normal sheep serum. Somatic agglutinins were demonstrated in all of the sheep serums against all of the bacteria, but this antibody activity was partially destroyed by heating at 56 C for 30 minutes. The opsonic activity of normal sheep serum was demonstrated in normal mice. In the mouse peritoneal cavity, normal sheep serum enhanced opsonic activity against all smooth strains and 1 rough strain of the bacteria. The other 3 rough strains were extremely sensitive to the opsonic system of normal mice.


Point source epidemic of Mycoplasma pneumoniae infection in a prosthodontics laboratory. A cluster of 10 cases of Mycoplasma pneumoniae infection involving persons working in a prosthodontics laboratory is descrbied.  The pattern indicates a point source epidemic.  The suspected mode of spread was a fine-particle aerosol generated from abrasive drilling of contaminated false teeth.


[Surgery of vesicoureteral reflux (author's transl)]. The objective of surgery of vesicureteral reflux is to block the way of urine from urinary bladder to the ureter without upsetting normal flux of urine in descending sense. Most important techniques used are described from the beginning of this surgery until nowadays and specially the Leadbetter-Politano technique, which accomplished most essential requirements for the obtention of favourable results. Finally special considerations are enumerated to keep in mind in treatment of reflux when is associated to other malformations of urinary tract like the ureteral diverticule of double ureter.


[Urinary tract infections presenting with jaundice (author's transl)]. Ten two to ten weeks old children are presented with urinary tract infection and jaundice. In six cases "E. coli" was the causative organism. Laboratory data seemed to indicate that hemolisis was an important factor in the pathogenesis of jaundice. Treatment with appropriate antibiotics was favorable in all cases. Urinary tract infection with bacteriemia and jaundice is probably the most frequent cause of jaundice among children of two to ten weeks of age.


[Intestinal recirculation in the management of experimental short bowel syndrome (author's transl)]. A short bowel syndrome was produced in 33 mongrel puppies less than one month of age, by resecting 80% of the small bowel. An end-to-end anastomosis was performed in 14 dogs (Group A). Sixteen dogs were reanastomosed by performing an isoperistaltic circular intestinal loop, modified from Tanner and Mackby (Group B). Three dogs had a circular loop performed using Mackby method, but this technique was abandoned because of intraluminal stasis. Long term survival on 18 dogs was 12,5% for Group A and 57% for Group B. Weight gain on the survivors was over 25% higher in Group B. Intestinal transit time was abnormally short only in Group A. The loop procedure seems worthy of further clinical trial.


[Rickets and tetany in the Spanish bibliography of the ninetenth century (author's transl)]. An historical study of the relationship between rickets and tetany through publications edited in Spain from 1800 to 1914 is presented. Twelve collections of journals, both pediatric and general medical, and likewise Medical Treatises, were used. In spite of the recognition of nervous phenomena accompanying rickets towards the beginning of the century, the clear relationship between rickets and tetany was not recognised until the beginning of this century. The causes of this delay are discussed, the main one being the limitations of an anatomoclinic mentality. The limited contribution and the low level of information of the Spanish author is emphasized.


[Antigenic relationships between "Levinea amalonatica" and "Shigella dysenteriae" and "boydii" (author's transl)]. Twenty-eight strains among thirty-five Levinea amalonatica show O antigenic relationships with Shigella as follows: with S. dysenteriae 3 (5 strains), S. dysenteriae 4 (1 strain), S. dysenteriae 5 (3 strains), S. dysenteriae 7 (11 strains), S. boydii 6 (7 strains), and with both S. boydii 15 and S. dysenteriae 8 (1 strain). These strains do not induce purulent keratogenous conjunctivitis in Guinea pigs as Shigella do.


[A comparison of the serological effects of classical cholera vaccine and of purified fraction vaccine, with or without simultaneous yellow fever vaccine (author's transl)]. In order to test whether simultaneously administered cholera vaccine has a depressive effect on yellow fever vaccine, a controlled trial was undertaken on school-age children in the South-Central Province of Cameroun. In addition to this principle objective, the study also permitted a comparison of the serological response in subjects vaccinated with classical cholera vaccine and in those vaccinated with a purified fraction vaccine, either with or without simultaneous yellow fever vaccine. The evaluation was measured by changes in vibriocidal antibodies and cholera agglutinins 30 days after vaccination. Only subjects without cholera antibodies prior to the study, were included. 1) Results obtained by assay of vibriocidal antibodies. It was confirmed that, no matter which cholera vaccine was used, the simultaneous administration of yellow fever vaccine had no influence on the percentage of subjects showing a significant rise in vibriocidal antibodies (4-fold increase in titre) following vaccination. In addition, in this study the purified fraction vaccine resulted in a significantly higher rate of seroconversion than did the classical vaccine. However, in comparison to other studies using classical cholera vaccine, our figures for seroconversion after purified fraction vaccine show very little, if any, differences. 2) Results obtained by assay of agglutinating antibodies. When measured by this method, there was a high frequency of non-reactors to the vaccines. This may be attributed to the date of the post vaccination blood speciment (30th day after vaccination). It has been shown that agglutinins decay rapidly after the 15th day following clinical cholera. Thus, the late date of the second speciment after vaccination could explain why we were unable to show any difference in the level of agglutinin after either classical or purified cholera vaccination. The simultaneous administration of the yellow fever vaccine did not influence the titre of agglutinins induced by the classic cholera vaccine. On the other hand, using the association, the seroconversion rate as observed on the 30th day post vaccination was significantly higher than that observed when the fraction was administered alone. If one accepts the generally admitted specificity of the agglutination reaction after clinical disease, two hypotheses can be considered: a) the yellow fever vaccine has an adjuvant effect for the production of antibodies induced by the purified fraction vaccine, or b) the addition of yellow fever vaccine has a retarding effect on the elimination of the agglutinins which, in the natural disease, are rapidly eliminated. Further studies to verify these hypothesis should be undertaken.


EGG analysis: a history and a prospectus. Progress in EGGy has been largely limited to those clinical situations in which there are pragmatic associations between observed electrical activity and disease processes. Lack of understanding of the functional significances of EEG patterns continues to present the major challenge to those who would use computational methods to increase our understanding of mental processes.


Experimental aural cholesteatoma causing bone resorption. A series of experiments were carried out on 55 guinea pigs in four groups to study the conditions fostering bone resorbin epidermal cysts. The first group had free grafts of canal wall skin applied to the cochlea with and without talc application. The second group had canal skin flaps applied to the cochlea with and without subsequent talc application. The third group had talc applied either to the tympanic membrane or on the cochlea. The fourth group had a canal skin flap inserted into a mucosal pocket in the bulla. The animals were killed three to four months after surgery and the temporal bones were prepared for histology. Epidermal cysts were found at the cochlea in 8 of 55 animals. Cochlear fistulas were found in 6 of 55 animals. The fistulas were associated with epidermal cysts in three cases, otitis media in two cases, and talc granuloma in one case. These experiments show that migrating skin attached to a source of epithelium is capable of inducing bone resorption. Chronic foreign body granulomas and chronic sepsis are also capable of resorbing bone. These three conditions all produce a layer of undifferentiated connective tissue containing chronic inflammatory cells lying against the resorbing bone.


Grafting materials and methods in reconstructive ear surgery. The evolution of tympanic membrane grafting over the past 20 years has been based on biologic tissues of mesodermal origin which contain a collagen matrix. The dominant theme of this evolution has been the modification of these collagen membranes by physical and chemical agents to achieve a more ideal graft. The graft material and the operation should be suited to specific problems. Current operative techniques and graft materials are discussed. It is believed that there will be continued modification and manipulation of collagen in the future to achieve a more ideal graft for tympanic membrane restoration.


Reconstruction of the open mastoidectomy ear: a six year progress report. This report deals with 61 mastoid cavities which were revised or reconstructed using homograft techniques over a six-year period. Discussed are the variety of homograft procurement techniques and surgical homograft techniques which have been abandoned and included in a review of 16 consecutive mastoid revisions performed from 1973-1974 utilizing a standard surgical technique.


Chemotaxis in bacteria.

Chemotaxis in bacteria. Bacteria swim by rotating their flagella. They alter course by abruptly changing the direction of this rotation. The probability of the occurrence of this event is biased by chemoreception. The bias depends on the way in which the concentration of the attractant or repellent changes with time. Sugars are detected as they bind to specific proteins which also play a role in transport. The way in which the receptors are coupled to the flagella is not known. The coupling may involve changes in membrane potential.


On the evolution of the physiological model. Most of us who have concerned ourselves with models can perceive outlines like those above to catalog the future evolution of the expository function of models. In the context of a single class of computerized mathematical models of respiratory physiology, we can observe at once the burgeoning interest among scientists, and the similarities between model activity and the general organization of scientific information for use. Although physiological models have become quite advanced in their subject control, there is relatively little coordinated activity in the mechanization of the purposes and philosophical potential of automata. The outlines, however, are visible. An assiduous pursuit of the notion of "explanation" by machine is a major evolutionary step next to occur. It appears to us that various diagrams similar to Figures 5 or 6 can be created and investigated in terms of their relation to the human mind and in terms of formalizing rules for traversing from one plane to the next. The evolution of models will require program-making programs which can decide when and how to aggregate for deductive inference, and how far to penetrate top-down for explanation. The rules for identifying "second order" effects must be established. The decision to ignore or use these rules will be crucial. These are the means whereby the systems are traversed from plane to plane. In a word, models need to synthesize the means to ignore, "forget," and gloss over; only then will we have useful tools for taking informed action in physiology, diagnosis in medicine, or the writing of "scholarly" reviews.


Interrelation between guanosine tetraphosphate accumulation, ribonucleic acid synthesis, and streptomycin lethality in Escherichia coli CP78. The effects of streptomycin on the synthesis of ribonucleic acid (RNA) and guanosine-3'-diphosphate-5'-diphosphate have been examined in the isogenic strains CP78 (rel(+)) and CP79 (rel-). In the absence of the required amino acids arginine, leucine, or threonine, streptomycin stimulates RNA synthesis in CP78 and this stimulation coincides with cell death. However, in the absence of histidine, also a required amino acid, streptomycin kills the cells without stimulation of RNA synthesis above that which occurs in the absence of streptomycin. In all of these instances, guanosine-3'-diphosphate-5'-diphosphate levels vary inversely with RNA synthesis, decreasing when a stimulation of RNA synthesis occurs. Streptomycin has little effect on guanosine-3'-diphosphate-5'-diphosphate levels in CP78 in the absence of histidine. Another histidine auxotroph, 15 T(-)H(-)U(-) (rel(+)), does show streptomycin-stimulated synthesis of RNA which is coincident with cell death. CP79 (rel(-)) is 10 times more susceptible to streptomycin than CP78 and streptomycin causes an inhibition of the relaxed synthesis of RNA. The greater susceptibility of CP79 may be due to a greater initial uptake of streptomycin by CP79.


Killing and lysis of Echerichia coli in the presence of choloramphenicol: relation to cellular magensim. Treatment of Escherichia coli K-10 with 100 mug of chloramphenicol per ml for periods greater than 30 min leads to progressive lysis and killing of cells. The bactericidal action of the antibiotic is dependent on cell growth and physiology; only rapidly dividing cells are susceptible to killing; resting or slowly growing cells are not. The presence of excess Mg(2+) in the growth medium specifically and competitively prevents excretion of macromolecules and cell lysis. However, inhibition of protein synthesis and killing of cells still occur even in the presence of added Mg(2+). The possible relation of these effects to the mode of action of chloramphenicol is discussed.


Comparison of tetracycline and minocyclie transport in Escherichia Coli. Differences between minocycline and tetracycline transport were demonstrated in an Escherichia coli strain with and without an R factor (R46) which confers moderate Tc resistance. Minocycline uptake was similar in R(+) and R(-) organisms, whereas tetracycline uptake was decreased in the R(+) as compared to the R(-) organism. Sodium azide had little effect on tetracycline uptake by either strain but minocycline uptake was completely inhibited by azide. p-Chloromercuribenzoate greatly decreased tetracycline uptake in both strains while minocycline uptake was markedly augmented. Both minocycline and tetracycline were effective inducers of decreased tetracycline transport, but only tetracycline had an effect on minocycline uptake. Mutual inhibition of uptake of one antibiotic by the other could not be demonstrated. These studies indicate different mechanisms of transport of minocycline and tetracycline in E. coli.


Effects of cis-Dichlorudiammineplatinum (II) and related transition metal complexes on Escherichia Coli. A number of transition metal complexes, including the cis and trans isomers of dichlorodiammineplatinum (II), six complexes of rhodium (I), two of iridium (I), and one of ruthenium (II) have been tested for their ability to induce lambda prophage, to produce filamentous growth of Escherichia coli, and to be selectively toxic for strains with defects in the deoxyribonucleic acid repair system. Dichlorotetrakis(dimethylsulfoxide)ruthenium II [RuCl(2) (DMSO)(4)] was strictly similar to cis-dichlorodiammineplatinum II [cis PtCl(2) (NH(3))(2)] in the test for lambda induction, filamentous growth production, and selective toxicity for a recA(-) strain. [Rh COD 1,10-phenanthroline](+) Cl(-), though more toxic for recA(-) than for rec(+)E. coli, was scarcely effective in the test for filamentous growth and did not induce prophage. None of the other tested compounds showed any similarity with cis-PtCl(2)(NH(3))(2). Due to the interesting results obtained with cis-PtCl(2)(NH(3))(2) as an antitumor agent, it seems reasonable to propose RuCl(2)(DMSO)(4) as a potential antitumor substance.


Salmonella survival on pecans as influenced by processing and storage conditions. Survival of Salmonella senftenberg 775W, S. anatum, and S. typhimurium during exposure to currently practiced, as well as abusive, pecan processing and storage conditions was studied. Thermal treatments normally carried out during the processing of pecans are inadequate to consistently destroy salmonellae in highly contaminated inshell nuts. Pecan nut packing tissue was toxic to salmonellae, thus affording some protection against high initial contamination and subsequent survival of the organisms. Examinations of inoculated inshell pecans stored at -18, -7, 5, and 21 C for up to 32 weeks revealed that the extent of survival was inversely correlated to the storage temperature. S. senftenberg 775W and S. anatum were not detectable on inshell nuts after 16 weeks of storage at 21 C. Little decrease in viable population of the three species was noted on inoculated pecan halves stored at -18, -7, and 5 C for 32 weeks. Due to organoleptic quality deterioration in pecan nutmeats at elevated temperatures, sterilization methods other than thermal treatment appear to be required for the elimination of viable salmonellae from pecan nuts.


Potential pathogens in the environment: cultural reactions and nucleic acid studies on Klebsiella pneumoniae from clinical and environmental sources. The phenotypic and nucleic acid properties of Klebsiella pneumoniae have been studied on cultures obtained from six different habitats (humans, vegetables, seeds, trees, rivers, and pulp mills). The 19 cultural reactions of 107 isolates varied significantly only in tryptophanase activity and dulcitol fermentation. The percentage of guanine plus cytosine base composition of 41 isolates varied from 53.9 to 59.2%. The range of percentage of guanine plus cytosine base composition for environmental klebsiellas was broader than that for the cultures of human origin. The range of deoxyribonucleic acid relative reassociation (homology) to the human K. pneumoniae reference strain extended from 5% to 100% and the chromosome molecular weights ranged from 2,200 x 10(6) to 3,000 x 10(6). The species of K. pneumoniae is thus molecularly more heterogeneous than previously thought and most isolates of human, pulp mill, and river origin are genetically indistinguishable. The presence of K. pneumoniae therefore represents a deterioration of the microbiological quality of the environment and should be considered of public health significance. At the present time the health significance of the molecularly more divergent strains, primarily of vegetable and seed origin, their relationship to klebsiellas of human origin, or to other genera of the Enterobacteriaceae is unclear.


Membrane filter procedure for enumerating the component genera of the coliform group in seawater. A facile, quantitative, membrane filter procedure (mC) for defining the distribution of coliform populations in seawater according to the component genera was developed. The procedure, which utilizes a series of in situ substrate tests to obviate the picking of colonies for identification, also provides an estimate of the total coliform density. When pure cultures of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were suspended in seawater and held at 4 C for 24 h, between 56 and 100% of the cells which grew on nutrient agar spread plates at 35 C could be recovered by the mC procedure. Confirmation as coliforms of typical colonies from natural samples was about 95%. Assay variability was found to be insignificant. The recovery of coliforms from marine waters by the mC procedure was comparable to those obtainable by current methods. Klebsiella was differentiated by the urease reaction and E. coli by its ability to form indole. The confirmation frequencies for colonies designated as Klebsiella and E. coli by the in situ tests approached 95% for the former and 98% for the latter.


Ambroise Paré (1510-1590) and the evolution of the surgical instrumentarium. Ambroise Paré (1510-1590) has done pioneer work not only in surgery but also in the teaching of surgery. For hemostasis, he reintroduced vascular ligation instead of cautery. Moreover, he has improved the surgical instrumentarium. He devised the grooved sound for the operation of incarcerated hernias. He also developed a method for the treatment of the urinary fistulas which frequently occurred as the consequence of the surgical removal of bladder calculi. He raised the level of fracture treatment. It was he who introduced the word 'bistoury' for the surgical knife.


Experience with the use of polyglycolic acid suture material (Dexon) in 500 surgical patients. A highly concise review is presented of the experimental and clinical literature concerning polyglycolic acid suture material, marketed for clinical use for the first time in 1970. It is a synthetic, completely absorbable, non-toxic product, which not only offers a number of advantages over catgut, but may also be used where non-absorbable materials were formerly applied exclusively. Our favorable experiences in 500 patients, who were subjected to many different kinds of general surgical operations, are in agreement with those published in the literature. We have gained the impression that suture fistulization, which may lead to protracted morbidity after use of non-absorbable material, has decreased in incidence and severity after the use of PGA suture material. This is a definite advantage.


Effect of low-dose heparin on incidence of postoperative thrombosis in orthopaedic patients. In a double-blind study, using matched controls, thrombo-embolic prophylaxis with subcutaneous low-dose heparin was studied in 25 patients admitted for orthopaedic surgery. Deep vein thrombosis (DVT) was detected by clinical assessment and by the 125I-fibrinogen leg-scanning technique. As a control the T-1/2 of the 125I-fibrinogen was measured. Six of the 13 patients in the control group and one in the heparin-treated group developed deep vein thrombosis within the first eight postoperative days.


Preliminary studies on the prolongation of the survival of mouse skin allografts cultured on a solid medium. Skin allografts were transferred between individuals of white Swiss mice. No first set reaction was observed, but a second set reaction which resulted in accelerated rejection of the graft, could be induced by a second graft transplanted 2 weeks after the first. However, the histoincompatibility of the graft which causes the rejection, could be temporarily weakened when a graft had been cultured "in vitro" for at least 6 weeks prior to grafting. Nevertheless, histocompatibility differences between two different species e.g. man and mouse, could not be weakened at all by the tissue culture method.


Single daily dose of allopurinol.

Single daily dose of allopurinol. Allopurinol was administered to seven patients with gout to compare the effects of three different methods of administration. Allopurinol 100 mg given three times daily. Allopurinol given once daily as three 100 mg tablets. Allopurinol given once daily as a single 300 mg tablet. Allopurinol as a single dose in the morning gave as sustained control of plasma levels as did divided administration.


The chemotherapy of rodent malaria, XXI. Action of quinine and WR 122 (a 9-phenanthrenemethanol) on the fine structure of Plasmodium berghei in mouse blood. The effects of quinine and a 9-phenanthrenemethanol, WR 122,455 on the fine structure of Plasmodium berghei have been investigated. Changes consequent upon quinine treatment were noted in the outer membranes (including those that surround the "food vacuole") and the digestive vacuoles. These changes were followed by cytoplasmic degeneration and vacuolization. WR 122,455 caused morphological changes in at least three areas of the parasite, (1) the outer membranes, (2) the digestive vacuole and (3) the nucleus. The relationship of these changes to the mode of action of these compounds is discussed. It seems possible that they interfere primarily with limiting membrane-mitochondrial functions. The modifications of pigment formation are characteristic of these compounds and differ from those seen with chloroquine or primaquine.


The chemotherapy of rodent malaria, XXII. The value of drug-resistant strains of P. berghei in screening for blood schizontocidal activity. Data are provided on the activity of a variety of antimalarial drugs against drug-sensitive and drug-resistant lines of Plasmodium berghei in albino mice. Parallel data for the response of the drug-sensitive parasites to these compounds in vitro indicate whether the drugs have a chloroquine-like or quinine-like type of action, or neither. The value of this test system for drug evaluation is debated. It is concluded that the in vivo tests do provide a valuable indication of the potential use of a compound against drug-resistant malaria parasites of man. The tests may also provide a good indication of the future value of new compounds against strains of parasites that are already resistant to chloroquine. Where necessary, steps should be taken to protect promising new compounds.


Sudden increase in virulence in a strain of Plasmodium berghei yoelii. The mild and chronic 17X strain of Plasmodium berghei yoelii showed a sudden increase in virulence following a period of 110 days in the deep freeze. The enhanced virulence was seen in a very high and early parasite peak in the blood and a 100% mortality of all infected mice. The exalted virulence remained unaltered following a number of blood transfers of the strain and after four cyclical transmissions through Anopheles stephensi. Enzyme pattern studies revealed that the virulent strain possessed the enzyme types GPI-1 and 6 PGD-4,-both characteristic for strain 17X of P.b. yoelii. Studies carried out to investigate the possibility of a concomitant viral infection transferred by blood passage, which could have been responsible for the enhanced virulence and mortality in the infected mice, showed no presence of any detectable virus in the blood of the P.b. yoelii infected mice. It is suggested that virulence may provide a marker in genetic work of rodent plasmodia and be included in association with enzyme and drug resistance markers.


Role of complement components in the susceptibility to Plasmodium berghei infection among inbred strains of mice. Inbred strains of mice, sensitive and resistant to Plasmodium berghei infections, including a complement deficient strain were infected with P. berghei. Daily levels of parasitaemia were determined and serum levels of complement components (C3 and C5) measured by standard haemolytic assay. Serum levels of C3 and C5 were depressed in all strains of mice infected with P. berghei. There was no difference in the infectivity and course of P. berghei infection in the co-isogenic C5 deficient and non-deficient strains. The significance of these observations is discussed.


Chloroquine resistance of Plasmodium falciparum in West Irian and East Kalimantan. Evidence is presented of the chloroquine-resistance in Plasmodium falciparum in West Irian and East Kalimantan as shown by clinical observation and quantitative parasite counts in two patients hospitalized in Tokyo where no natural transmission of malaria occurs. The evidence is supported by the determination of plasma chloroquine levels, and in vitro sensitivity tests. The highest plasma level of chloroquine in the patient infected in West Irian was 197 ng/ml (fourth treatment) and 435 ng/ml (fifth treatment), and that in the patient infected in East Kalimantan was 312 ng/ml. Fifty percent inhibition of maturation was obtained in vitro at 0-6 and 0-62 nM/ml of chloroquine, respectively. Both patients were readically cured by 2 g of sulphadoxine and 100 mg of pyrimethamine given in a single dose.


Purification and some properties of malarial pigment. Malarial pigment from erythrocytes infected with Plasmodium berghei was purified by treatment with sodium dodecyl sulphate solution, followed by incubation with Pancreatin. The purified pigment retained the apparently crystalline form of pigment within the parasite, rotated polarised light and had the same solubility characterisation as crude malarial pigment. It contained about 1% iron, all of which could be accounted for in terms of haemin. The iron of the pigment molecule is oxidised by the parasite to the ferric state.


Immunological studies in rodent malaria. I: Protective immunity induced in mice by mild strains of Plasmodium berghei yoelii against a virulent and fatal line of this plasmodium. Mild and virulent lines of Plasmodium berghei yoelii are readily distinguished both by their course of infection and by the preference of the virulent line for mature red blood cells. Mice given either mild line were fully protected against the virulent P.b. yoelii one week after they had become negative. Mice given the mild line of P.b. yoelii 17X were fully protected against a challenge by the virulent line on the third day of infection (D+3). Mice given the mild and virulent lines of P.b. yoelii 17X concomitantly showed only slight protection, all eventually succumbing. Mice given the virulent P.b. yoelii 17X and challenged with P.b. yoelii 17X mild on D+1 showed 2/6 with virulent-like infections and 4/6 infections which resembled the mild controls. Five out of eleven animals challenged with P.b. berghei after immunization with mild P.b. yoelii had infections which resembled the P.b. berghei control group and were dead by D+23. The other six mice became negative, but all of them relapsed and three of them subsequently died. In mice challenged four weeks after their mild P.b. yoelii 17X infections had become negative, 5/6 succumbed to a P.b. berghei infection. Mice immunized with P.b. yoelii 17X mild and challenged with P.v. vinckei one week after becoming negative had a survival rate of 2/10.


The chemotherapy of rodent malaria, XXIII Causal prophylaxis, part II: Practical experience with Plasmodium yoelii nigeriensis in drug screening. Data are presented on the causal prophylactic action of about 100 compounds of various types against Plasmodium yoelii nigeriensis N67 in mice. Examples are given to show how action against pre-erythrocytic schizonts may be differentiated from action on emerging erythrocytic stages. In a series of 35 8-aminoquinolines, all but 10 showed definite causal prophylactic activity at tolerated doses. The data permit the compounds to be ranked in order of activity, and many are shown to be more active in this test system than primaquine. Marked causal prophylactic activity is displayed by a variety of quinone structures, several of which show a significant residual action on blood stages. A high level of activity is found in dihydrofolate reductase inhibitors within several chemical classes. Rorguanil is more effective as a causal prophylactic than a blood schizontocide in the mouse as in man. Sulphonamides and sulphones are also effective in this system. The active levels are influenced by the content of PABA in the diet of the hosts. Causal prophylactic action has been detected in a number of experimental compounds including some antibiotics (such as tetracycline and clindamycin). The pyrocatechol RC 12 shows only slight activity at the maximum tolerated dose. Chloroquine, mepacrine, quinine, quinolinemethanols and phenanthrenemethanols are inactive as causal prophylactics. It is concluded that a rodent malaria-mouse model does provide a relatively simple model for the screening of drugs for causal prophylaxis, and the data so obtained are of relevance to the detection of causal prophylactics against human malaria.


A comparison of pigment from Schistosoma mansoni and Plasmodium berghei. The structures of malarial and schistosomal pigment within the parasites are distinct. The two pigments are distinguishable both before and after extraction from host liver.


Serodiagnosis by fluorescent antibody staining of an outbreak of trichinosis in Lebanon. The opportunity offered by a recent outbreak of trichinosis in Lebannon was utilized to evaluate the applicability of an indirect fluorescent antibody (IFA) test for early diagnosis. Freeze-dried T. spiralis sonicated larval antigen fragments were used, together with human test serum and monospecific anti-human IgG, IgM and IgA fluorescein conjugates. Diagnostic IgG levels of 1/100 and above were observed in serum obtained some time during the acute phase of illness from nine out of ten patients. Diagnosis was made in seven cases within 30 days after the onset of symptoms. IgM antibodies were demonstrated in occasional samples. No IgA antibodies were detected. IgG levels of 1/100 were present in only four out of ten samples obtained 150 days after the clinical onset. These observations suggest that freeze-dried larval antigens make the IFA test an easy and useful procedure in the diagnosis of acute trichinosis. In chronic cases the efficacy of the method appears to be poor.


Food and water intake in gold thioglucose-induced obese Charles River mice. Food and water intake have been measured during the dynamic phase of gold thioglucose-induced obesity in Charles River mice. Regressions of gain in weight with food and water consumption were calculated in young growing animals and in adults fed ad libitum. The influence of fat content in the diet (2.5 and 8% fat) and environmental temperature (68degrees or 79degrees F) was estimated on the regressions. Excessive gain in weight without hyperphagia was observed in growing animals, in adults fed on a fat-enriched diet or maintained within a thermoneutral environment (79degrees F). But a significant hyperphagia was observed in adults fed with a conventional diet and maintained at 68degrees F or in growing animals as a sequela of food deprivation.


Further evaluation of quinestrol in the inhibition of lactation: a double-blind comparison of two dose levels against placebo. One hundred and ninetysix post-partum women, in whom lactation was to be prevented, were given under double-blind conditions either placebo or quinestrol 2 mg or 4 mg as a single oral dose within twentyfour hours of delivery. Early assessment of the results gave a failure rate of 58 per cent, 15 per cent and 5 per cent respectively, with statistically significant differences among the three groups of patients. At the follow-up evaluation, which could be made in only about one third of the women, breast troubles were recorded in 20 to 30 per cent, without significant differences among the groups. Post-partum amenorrhea showed a progressive prolongation from an average of 47.9 days in the controls to 64.6 and 72.6 days respectively in the 2 and 4 mg quinestrol groups. Adverse reactions, represented by delayed uterine involution during hospital stay and abnormal uterine bleeding in the late puerperium, were somewhat more frequent in the higher dose group than in the lower dose and control groups. On the basis of the prsent findings and of similar, though rare, experiences reported in the relevant literature, the question is therefore raised whether the 2 mg quinestrol dose would not be preferable to the 4 mg one for routine use in post-partum nonusing women.


Recurrence of idiopathic membranous nephropathy in a renal allograft. A middle-aged man with idiopathic membranous nephropathy, who developed chronic renal failure, received a cadaver renal allograft. Two months later, massive, persistent proteinuria developed. A biopsy specimen of the allograft showed changes characteristic of membranous nephropathy and identical to those present in the patient's own kidney. The criteria for recurrence of glomerulonephritis in renal allografts are met in this case.


Treatment of tachyarrhythmias by pacing. The present status of the use of electrical pacing to treat tachyarrythmias is reviewed. The pathogenesis of arrythmia formation, methods of pacing, response of specific tachyarrhythmias to pacing and the clinical application of pacing to terminate and suppress tachyarrhythmias are delineated.


Composition of cellulin, the unique chitin-glucan granules of the fungus, Apodachlya sp. Cellulin granules, the polysaccharide inclusions found uniquely in oomycetous fungi of the order Leptomitales, were isolated from Apodachyla sp. The granules were prepared free of cell wall and cytoplasmic contaminants. Biochemical analyses and X-ray diffraction studies demonstrated that the granules were composed of 60% chitin and 39% glucan consisting of beta-1,3- and beta-1,6-linked glucose units. A protein content of only 0.1% was attributed to an insignificant amount of cytoplasmic contamination. Isolated granules and those in situ showed no apparent differences in their microscopic form.


Biosynthesis of sulphur amoni acids in Saccharomyces cerevisiae. I. Genetic analysis of leaky mutants of sulphite reductase. The hypothesis of an alternative pathway of sulphur amino acid synthesis as the basis of the prototrophy of sulphite reductase negative (Sr--) strains of Saccharomyces cerevisiae has been rejected. Met- mutants obtained after phenylmercuric nitrate treatment of Sr- strains accumulate H2S as the consequence of a metabolic block which leads to methionine auxotrophy. This mutation has been shown to be independent of the Sr locus. We assume that the molecular basis of the prototrophy of Sr- mutant resides in a leaky missense induced in the Sr gene.


The fine structure of Herpetosiphon, and a note on the taxonomy of the genus. The fine structure of the Gram-negative filamentous gliding bacterium, Herpetosiphon is described. The outer membrane of the cell envelope could not be resolved as a separate structure, probably because it is fused with the underlying dense (peptidoglycan) layer. There was an additional wall layer outside this membrane-peptidoglycan complex, but a sheath in the classical sense, as postulated in the definition of the genus, was lacking. On the cell surface a loose network of fibrils could be seen. Inside the cells 3 types of intracytoplasmic membranes were discernible: a) true mesosomes near cross walls; b) a system of coarser membranes which was not connected with the septa and formed networks or tubular complexes; c) degenerated septa within bulbs. The bulbs are swollen sections of filaments, occurred mainly in ageing cultures, and are probably a degeneration phenomenon. The filaments contained necridia, i.e. dead and empty cells, across which breaks may occur so that empty cell wall cylinders remain attached to the ends of the daughter filaments, falsely suggesting the presence of a sheath. The taxonomy of Herpetosiphon is discussed in detail: The organism has been described before as Flexibacter giganteus. It is proposed to abandon the species H. aurantiacus in favor of H. giganteus, but to retain the genus Herpetosiphon. An improved definition of the genus is given.


Cytochemical detection of polysaccharides on the surface of the cell membrane complex in fungi. Cytochemical staining in toto (periodic acid, thiosemicarbazide, OSO4) revealed the presence of polysaccharide lamellae on the surface of the cell membrane complex of fungi. The membraneous clusters in the vacuolar bodies of Claviceps purpurea were covered with these lamellae at both surfaces, as it was also the case with the endoplasmic reticulum membranes, the tonoplast and the cytoplasmic membrane. In Saccharomyces cerevisiae, the polysaccharide lamellae were visible on the surface of the endoplasmic reticulum membranes and the plasmalemma; the strain revealed polysaccharide deposits also on the tonoplasts of small vacuoles and in glucanase vesicles. We assume that these observations give precision to the localization of the enzymes synthetizing the glycoprotein components of the fungal cell wall.


The control by respiration of the uptake of alpha-methyl glucoside in Escherichia coli K12. The uptake of methyl alpha-D-glucopyranoside (alpha-MG) by Escherichia coli K12 was decreased by the addition of substrates which stimulated the rate of oxygen consumption by the cells. The inhibition, which occurred only at non-saturating concentrations of alpha-MG, was not the result of a stimulation of the rate of exit of intracellular alpha-MG, and was abolished by the presence of carbonyl cyanide m-chlorophenylhydrazone or sodium azide. Since those drugs inhibit energy conservation at the respiratory chain and did not alter significantly the rate of oxygen consumption under the conditions for the assay of alpha-MG uptake, it appears that the inhibition of the transport system by respirable substrates is mediated by some form of energy derived from respiration.


Dependence of the maximum temperature for growth of Saccharomyces cerevisiae on nutrient concentration. Saccharomyces cerevisae was grown in a chemostat under glucose limitation at three superoptimal temperatures.  In each steady state the specific growth rate was the sum of the dilution rate and the specific death rate, exponential death occurring with exponential growth.  The specific death rate was a function of both the temperature and the concentration of the limiting nutrient.  Each superoptimal temperature was characterized by a critical glucose concentration below which net growth was not possible.  The critical glucose concentration increased with the temperature.  Consequently the maximum temperature for growth was a function of the concentration of the limiting nutrient and approached the optimum temperature for growth with decreasing glucose concentrations.


[The development and the reversion of spheroplasts of a diaminopimelic acid-auxotrophic mutant of Escherichia coli]. 1. The formation and reversion of spheroplasts of the diaminopimelic acid-auxotrophic mutant Escherichia coli K 12, 335, DAP-, R+TEM in a medium lacking diaminopimelic acid have been investigated by microphotography: During their development from rod form cells to spheroplasts cells on slide-surface-agar preparations underwent two successive cell divisions in the course of which the cells retained their rod form. The cells formed by these divisions partitioned into a varying number of spheroplasts of different size. The reversion of spheroplasts to rod form cells, started by the addition of diaminopimelic acid showed two characteristic steps: Each spheroplast partitioned again into several spheroplast-like cell bodies; most of them reverted directly to rod form cells. 2. The release of the R-factor mediated periplasmic TEM-beta-lactamase, E. C. 3.4.2.6., into the growth medium during the development of spheroplasts attained more than 50% of the entire TEM-beta=lactamase activity. The spheroplasts showed a multiple enhancement of TEM-beta-lactamase activity per mg cell protein compared with rod form cells.


Defining synchrony of cell cultures.

Defining synchrony of cell cultures. A method was developed for the statistical analysis of growth data from synchronized growth experiments. The analysis provided a firm basis for the recognition of synchrony and the objective graphical presentation of the growth pattern of a synchronized culture. The latter could then supply reliably the parameters required for the calculation of a synchronization index, i.e. for the synchrony evaluation.


Computers and psychiatry. Promises to keep. The potential of computer-based psychiatric information systems is still largely undeveloped. Conceptual, technical, cost, and procedural problems have limited the impact of computers, but there are programs that have been successful or that show promise. While changes in the philosophy of psychiatric computer applications are on-going, a cost-effective, widely available clinical computer system has been developed.


Computer-assisted derivation of a screening interview for alcoholism. A short screening interview for the diagnosis of alcoholism has been developed with the assistance of the automatic interaction detector (AID) program (a multivariate sequential analysis strategy) that is part of the OSIRIS statistical package. Retrospective and prospective tests of the effectiveness of the interview have shown that it permits a diagnosis of alcoholism with less effort than a larger, more comprehansive research interview. The performance of the screening and research interviews have been compared to assess the effects of severity of illness and reliability of individual replies on the diagnoses made by each interview.


Gonadotropin response to LH-RH in anorexia nervosa. The gonadotropin-ovary axis of patients with anorexia nervosa was assessed with the aim of distinguishing between an intrinsically hypophysial deficiency and pituitary malfunction secondary to hypothalamic impairment. The most consistent endocrine abnormality was low serum luteinizing and follicle stimulating hormone (LH and FSH) levels associated with depressed serum estradiol levels. Gonadotropin levels responded to luteinizing hormone-releasing hormone (LH-RH), thus indicating a primarily hypothalamic dysfunction. The increase in serum FSH was at least as great as that of LH. The LH levels were additionally depressed and their increase after LH-RH injection somewhat blunted by three-day treatment with ethinyl estradiol.


[A simple method for breeding major spore quantities of Clostridium butyricum to be used in experiments for tumour diagnostics and therapy (author's transl)]. A simple method is described for breeding major spore quantities of Clostridium butyricum using a modification of Berger's iron bouillon. The method allows the breeding of cultures with comparatively high spore-forming rates which is essential for the use of such spores in experiments in the field of early tumour diagnostics and tumour therapy.


Organ preservation in success of cadaver transplants. The long-term function of 110 cadaver kidney transplants preserved by hypothermic perfusion was compared with that of 79 fresh cadaver kidneys. The one-month failure rate was 4 percent in the perfused kidneys in contrast to a 32 percent one-month failure rate reported by one cooperative group. These data were again confirmed in a prospective, paired study comparing perfused and fresh cadaver kidneys from the same donor. Thus, perfusion of kidneys was not harmful for cadaver transplantation. In fact, of 83 first cadaver transplants, less than 30 percent of perfused kidneys failed in the first year. There appears to be no evidence supporting the idea that bloodless hypothermic perfusion permanently damages human kidneys or increases the chances of rejection.


Renal trauma during laparotomy for intra-abdominal injury. The advantages of nonsurgical or surgical management of renal injuries are important when the renal trauma is found during a laparotomy for intra-abdominal injury. Blunt external trauma caused 85.5 percent of the renal injuries found during laparotomy in 194 patients. A large dose or infusion intravenous pyelogram on a modified operating table has allowed immediate evaluation of the renal injury during a laparotomy. When the degree of renal injury was more severe, renal tissue and function were saved by early surgical management. In this group, lowered morbidity and a sharp reduction in delayed renal operations followed the introduction of immediate surgical management. The nephrectomy rate was 11 percent, which compares favorably with that of nonsurgical management. Clamping of the renal vessels prior to opening Gerota fascia prevented reactivation of hemorrhage and allowed for a deliberate operation with conservation of undamaged renal tissue.


Clinical use of the membrane oxygenator. Since April 1973 we have treated nine patients with extracorporeal membrane oxygenation (ECMO), utilizing the spiral coil membrane lung. One patient is a long-term survivor. All patients except one showed substantial improvement in peripheral arterial oxygen tension. Four adults and two neonates were treated for critical hypoxia. Two patients were treated for cardiac failure but failed to show improved myocardial function. Complications involving perfusion circuitry, cannulation, chronic systemic heparinization, thrombocytopenia, and renal failure have been managed with minimal difficulty. However, irreversible pulmonary, neurologic, hepatic, or gastrointestinal damage due to hypoxia present before the institution of ECMO was associated with lethal complications. The ECMO has supplied adequate oxygenation to this group of nine critically hypoxic patients. Institution of ECMO at an earlier date in patients with critical hypoxia would provide a higher likelihood of survival.


Alterations in kinins of coronary blood from rat heart homografts. Forty-eight heterotopic heart transplants (33 homografts and 15 isografts) were performed in inbred rats. Levels of kallikrein, prekallikrein, and kallikrein inhibitor were determined in coronary sinus venous blood of grafted hearts at various intervals postgrafting. Homograft observations were assessed against those in nonrejecting isografts. Significant increases in homograft prekallikrein level on day 4 were followed by significant increases in homograft kallikrein activity on day 6. Kallikrein inhibitor levels in homografts were consistently increased in relation to isograft levels. Kallikrein and inhibitor activity showed an inverse relationship in their respective changes. High levels of kallikrein and prekallikrein occurred in homografts ten days posttransplantation. Immunological rejecting homografts showed meaningful changes in the activity of kinin-forming substances known to participate in inflammation.


Use of a mechanical suturing apparatus in low colorectal anastomosis. A circular stapling apparatus was especially designed for use in low colorectal anastomoses. In shape and size it resembles a slightly oversized proctosigmoidoscope. After the tumor-bearing segment is resected in the standard manner, the instrument is introduced via the anus through the distal segment into the abdomen. The proximal and distal segments are apposed and mechanically anastomosed. A secure anastomosis is thus performed more quickly and more reliably than by standard suture methods. The method has been used successfully in 20 dogs, without evidence of leakage or stenosis. In 165 human operations for low rectal carcinoma performed in Russia from 1967 to 1972, the mortality was 2.4% and the leakage rate was 3.6%. No stenosis or late stricture occurred.


Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure. For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 +/- 4.7 days) was significantly less than that of the patients treated with CMV (18.8 +/- 14.4 days) (P less than .001).


Renal transplantation in the older age group. Previously reported results of renal transplantation in the older age group have been discouraging; thus this form of therapy has generally been denied to patients over 50 years of age, unless a living related donor was available. A review of our transplant patients aged 51 or older who received cadaver donor kidneys was performed, and comparison was made to the survival being achieved for this group through hemodialysis or transplantation from living related donors. Functional survival of the homograft in the older age group in the Massachusetts General Hospital series compared favorably to that reported by the National Transplant Registry for recipients of all ages. We conclude that cadaver donor transplantation should be offered to increasing numbers of end-stage renal failure patients older than 50 years of age.


Urologic problems in renal transplantation. Of 206 patients who underwent 221 consecutive renal homografts, two patients had major urologic complications. One patient had a partial ureteric obstruction requiring surgical intervention and ureterostomy. Another patient had a fistula at the ureteropelvic junction secondary to vigorous diuresis in the presence of acute retention; eventually nephrectomy was required, but the patient survived. In one other instance, urinary extravasation was suspected without substantiation and with uneventful recovery of the patient. The total incidence of major urologic complications was less than 1%, with no related deaths.


Successful management of caliceal fistulas following renal transplantation. Caliceal fistulas are unusual complications of renal transplantation. Segmental renal infarction and distal ureteral obstruction may be contributing factors in their formation. Two cases are reported, the first probably a result of segmental renal infarction from failure to recognize and anastomose an accessory renal artery, the second possibly related to blunt trauma to the area of the graft in an automobile accident and ureteral obstruction resulting from blood clots. Nephrostomy drainage through a healthy area of renal parenchyma was instrumental in the salvage of both kidneys.


Survival of cardiac xenografts. Effect of antithymocyte serum and enhancing heteroantiserum. Rat hearts were transplanted to the abdomens of mice by primary vascular union, and sinus rhythm occurred a few minutes after perfusion of the rat coronary vessels with mouse arterial blood. Five groups of mice with rat heart transplants were studied to evaluate the effect of mouse antirat serum (MARS) and antithymocyte serum (ATS) on the survival of the xenografted hearts. When high-dose MARS was administered, hyperacute rejection occurred, while the administration of low-dose MARS doubled the survival time of the xenotransplant. Antithymocyte serum greatly prolonged the function and survival of the hearts, while the addition of "enhancing serum" to the ATS regimen did not procure longer survival over that achieved by ATS alone.


[Age characteristics of the structure of the human retina]. Cytological, histochemical and neurohistological methods were used to study the human retina (27 corpses of people from 60 to 80 years of age). Two retinas from people of 32 and 27 years served as controls. The activity of alkaline phosphatase in neurons was established to increases with age. There were also enlargement of cysts and an increase of the square surface of their distribution in the retina, numerous aneurysmatic swelling along the course of the retinal capillaries. The nerve elements of the retina degenerated more often with age and partly died. Varicosities and excessively growing enlarged terminals were found along the course of dendritic and axonic processes. In the macular zone there were hypertrophicsynapses and circularly running sinuous fine fibres. Solitary ganglionic cells in this region had dendrites directed toward on side-they ere asymmetrical. The astrocytigglia was not changed. The fovea bottom contained may Muller's cells. Possible interpretation of the mechanism of appearance of vaicosities and excrescences in the nerve fibres with age age is presented.


[Analysis of certain nodal features of regenerative reactions]. The increased degree of death of cells due to increased functional stresses may serve as a starting factor responsible for the compensatory growth. This fact allows considering reparative regeneration and compensatory growth as phenomena of the same class. Different forms of reparative growth (intracellular regeneration and proliferation of cells, endomorphosis and epimorphosis) serve to concrete tasks of reparation at different levels of organization of the morphological substrate. They are sustained by endogeneous morphogenetical mechanisms developing independently of other levels and of environment. In the subsystem of lover levels of organization the involved morphogenetical mechanisms may sustain not only compensation of the lost structures but also their overproduction. As a rule the program of reparative processes may be realized on higher (e. g. organic) level but partly. Among available criteria of regeneration at the present time the calculation of mitoses should be considered the most adequate one. The systemic approach may prove to be a perspective method both for estimation of regeneratory effect and for deeper analysis of reparative phenomena in general.


[Simple method for the removal of the gelatin coating and the re-covering of histoautoradiographic preparations with an emulsion]. This simple method is used for removing emulsion from unsuccessful histoautoradiographic preparations for putting a new layer of emulsion. For this purpose the old emulsion is solved in warm water, the silver residue is removed from the preparation surface with a 10% solution of potassium ferricyanide.


A suture-reinforced scleral sling. Technique for suspension of the ptotic upper lid. A frontalis sling procedure for ptosis repair, employing preserved human bank sclera and polyfilament, cable-type, ophthalmic (Supramid Extra) suture in combination has been devised and tried. Results indicate that these two readily available materials that are now used separately may be combined for lid suspension. They are easy to work with and produce lasting results.


Bone formation in the normal human otic capsule. Postmoretem examination of undecaicified temporal bones from five patients treated with tetracycline during adult life for unrelated disease showed the uptake of tetracycline label within the endochondral bone the otic capsule. Adult endochondral bone is histologically woven (nonlamellar) in character, and has been assumed to be metabolically inert in the healthy state. The strong perlvascular labelling seen suggests that new bone is normally deposited in the otic capsule and that this new bone is lamellar in character. Continuous new bone formation in the presence of a constant net volume of bone implies that  resorption must also occur normally within the otic capsule.


The brow-lift operation.

The brow-lift operation. We describe a useful technique for local brow-lift operation. We discuss the results and outline procedural modifications that minimize postoperative scarring. The operation may be performed in conjunction with blepharoplasty or other cosmetic surgery.


Evaluation of a single-layer intestinal anastomosis: an experimental study. Fifteen single-layer and 15 double-layer inverting intestinal anastomoses were made in the small intestines of 15 healthy mongrel dogs and the results were compared. The single-layer anastomosis was found to be superior to the double-layer procedure in many respects.


Algorithm for the multi-parameter analysis of nystagmus using a digital computer. A computer program for analyzing nystagmus has been developed and can be used on a small laboratory digital computer. The algorithm accepts digitized data and looks for the minimum and maximum (minmax) points of the nystagmus waveform. These points in turn are used to define seven descriptive parameters of nystagmus, including the amplitude, duration, and velocity of the slow and fast phases, and the frequency. The algorithm uses three user-adjusted criteria for accepting or rejecting minmax points. The treatment of noisy or irregular data can be improved by adjusting the values of these criteria.